Diabetes in Women: Pathophysiology and Therapy (Contemporary Diabetes)
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Failure to maintain a strict regimen of testing can accelerate symptoms of the condition, and it is therefore imperative that any diabetic patient strictly monitor their glucose levels regularly. Glycemic control is a medical term referring to the typical levels of blood sugar glucose in a person with diabetes mellitus. Much evidence suggests that many of the long-term complications of diabetes, especially the microvascular complications, result from many years of hyperglycemia elevated levels of glucose in the blood.
Good glycemic control, in the sense of a "target" for treatment, has become an important goal of diabetes care, although recent research suggests that the complications of diabetes may be caused by genetic factors  or, in type 1 diabetics, by the continuing effects of the autoimmune disease which first caused the pancreas to lose its insulin-producing ability. Because blood sugar levels fluctuate throughout the day and glucose records are imperfect indicators of these changes, the percentage of hemoglobin which is glycosylated is used as a proxy measure of long-term glycemic control in research trials and clinical care of people with diabetes.
Pathogenesis of Type 2 Diabetes Mellitus
This test, the hemoglobin A1c or glycosylated hemoglobin reflects average glucoses over the preceding 2—3 months. In reality, because of the imperfections of treatment measures, even "good glycemic control" describes blood glucose levels that average somewhat higher than normal much of the time. In addition, one survey of type 2 diabetics found that they rated the harm to their quality of life from intensive interventions to control their blood sugar to be just as severe as the harm resulting from intermediate levels of diabetic complications. Currently many patients and physicians attempt to do better than that.
Meta-analysis of large studies done on the effects of tight vs. Additionally, tight glucose control decreased the risk of progression of retinopathy and nephropathy, and decreased the incidence peripheral neuropathy, but increased the risk of hypoglycemia 2.
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Relying on their own perceptions of symptoms of hyperglycemia or hypoglycemia is usually unsatisfactory as mild to moderate hyperglycemia causes no obvious symptoms in nearly all patients. Other considerations include the fact that, while food takes several hours to be digested and absorbed, insulin administration can have glucose lowering effects for as little as 2 hours or 24 hours or more depending on the nature of the insulin preparation used and individual patient reaction.
In addition, the onset and duration of the effects of oral hypoglycemic agents vary from type to type and from patient to patient. Control and outcomes of both types 1 and 2 diabetes may be improved by patients using home glucose meters to regularly measure their glucose levels. Lifestyle adjustments are generally made by the patients themselves following training by a clinician. Regular blood testing, especially in type 1 diabetics, is helpful to keep adequate control of glucose levels and to reduce the chance of long term side effects of the disease.
The principle of the devices is virtually the same: a small blood sample is collected and measured. In one type of meter, the electrochemical, a small blood sample is produced by the patient using a lancet a sterile pointed needle.
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The blood droplet is usually collected at the bottom of a test strip, while the other end is inserted in the glucose meter. This test strip contains various chemicals so that when the blood is applied, a small electrical charge is created between two contacts.
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This charge will vary depending on the glucose levels within the blood. In older glucose meters, the drop of blood is placed on top of a strip. A chemical reaction occurs and the strip changes color.
The meter then measures the color of the strip optically. Self-testing is clearly important in type I diabetes where the use of insulin therapy risks episodes of hypoglycemia and home-testing allows for adjustment of dosage on each administration.
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Benefits of control and reduced hospital admission have been reported. This is particularly so for patients taking monotherapy with metformin who are not at risk of hypoglycaemia. Regular 6 monthly laboratory testing of HbA1c glycated haemoglobin provides some assurance of long-term effective control and allows the adjustment of the patient's routine medication dosages in such cases. High frequency of self-testing in type 2 diabetes has not been shown to be associated with improved control.
Continuous Glucose Monitoring CGM CGM technology has been rapidly developing to give people living with diabetes an idea about the speed and direction of their glucose changes. While it still requires calibration from SMBG and is not indicated for use in correction boluses, the accuracy of these monitors is increasing with every innovation. The results are that certain foods can be identifiesd as causing one's blood sugar levels to rise and other foods as safe foods- that donot make a person's blood sugar levels to rise. Each individual absorbs sugar differently and this is why testing is a necessity.
A useful test that has usually been done in a laboratory is the measurement of blood HbA1c levels. This is the ratio of glycated hemoglobin in relation to the total hemoglobin. Persistent raised plasma glucose levels cause the proportion of these molecules to go up. This is a test that measures the average amount of diabetic control over a period originally thought to be about 3 months the average red blood cell lifetime , but more recently [ when? In the non-diabetic, the HbA1c level ranges from 4. The HbA1c test is not appropriate if there has been changes to diet or treatment within shorter time periods than 6 weeks or there is disturbance of red cell aging e.
In such cases the alternative Fructosamine test is used to indicate average control in the preceding 2 to 3 weeks. This product is no longer sold. It was a retrospective device rather than live. Several live monitoring devices have subsequently been manufactured which provide ongoing monitoring of glucose levels on an automated basis during the day. The British National Health Service launched a programme targeting , people at risk of diabetes to lose weight and take more exercise in In it was announced that the programme was successful.
Because high blood sugar caused by poorly controlled diabetes can lead to a plethora of immediate and long-term complications, it is critical to maintain blood sugars as close to normal as possible, and a diet that produces more controllable glycemic variability is an important factor in producing normal blood sugars.
People with type 1 diabetes who use insulin can eat whatever they want, preferably a healthy diet with some carbohydrate content; in the long term it is helpful to eat a consistent amount of carbohydrate to make blood sugar management easier. There is a lack of evidence of the usefulness of low-carbohydrate dieting for people with type 1 diabetes.
Currently, one goal for diabetics is to avoid or minimize chronic diabetic complications, as well as to avoid acute problems of hyperglycemia or hypoglycemia. Adequate control of diabetes leads to lower risk of complications associated with unmonitored diabetes including kidney failure requiring dialysis or transplant , blindness, heart disease and limb amputation. There is emerging evidence that full-blown diabetes mellitus type 2 can be evaded in those with only mildly impaired glucose tolerance.
Patients with type 1 diabetes mellitus require direct injection of insulin as their bodies cannot produce enough or even any insulin. As of , there is no other clinically available form of insulin administration other than injection for patients with type 1: injection can be done by insulin pump , by jet injector , or any of several forms of hypodermic needle. Non-injective methods of insulin administration have been unattainable as the insulin protein breaks down in the digestive tract.
There are several insulin application mechanisms under experimental development as of , including a capsule that passes to the liver and delivers insulin into the bloodstream. For type 2 diabetics, diabetic management consists of a combination of diet , exercise, and weight loss , in any achievable combination depending on the patient.
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Obesity is very common in type 2 diabetes and contributes greatly to insulin resistance. Weight reduction and exercise improve tissue sensitivity to insulin and allow its proper use by target tissues. Some Type 2 diabetics eventually fail to respond to these and must proceed to insulin therapy. A study conducted in found that increasingly complex and costly diabetes treatments are being applied to an increasing population with type 2 diabetes.
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Data from to was analyzed and it was found that the mean number of diabetes medications per treated patient increased from 1. Patient education and compliance with treatment is very important in managing the disease.
Improper use of medications and insulin can be very dangerous causing hypo- or hyper-glycemic episodes. For type 1 diabetics, there will always be a need for insulin injections throughout their life, as the pancreatic beta cells of a type 1 diabetic are not capable of producing sufficient insulin.
However, both type 1 and type 2 diabetics can see dramatic improvements in blood sugars through modifying their diet, and some type 2 diabetics can fully control the disease by dietary modification. Insulin therapy requires close monitoring and a great deal of patient education, as improper administration is quite dangerous. For example, when food intake is reduced, less insulin is required. A previously satisfactory dosing may be too much if less food is consumed causing a hypoglycemic reaction if not intelligently adjusted. Exercise decreases insulin requirements as exercise increases glucose uptake by body cells whose glucose uptake is controlled by insulin, and vice versa.
In addition, there are several types of insulin with varying times of onset and duration of action. Several companies are currently working to develop a non-invasive version of insulin, so that injections can be avoided. Mannkind has developed an inhalable version, while companies like Novo Nordisk , Oramed and BioLingus have efforts undergoing for an oral product.
Also oral combination products of insulin and a GLP-1 agonist are being developed. Insulin therapy creates risk because of the inability to continuously know a person's blood glucose level and adjust insulin infusion appropriately.