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Diabetes: Difference between revisions
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===Type 1 diabetes=== | ===Type 1 diabetes=== | ||
Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets of Langerhans in the pancreas, leading to insulin deficiency. This type can be further classified as immune-mediated or idiopathic. The majority of type 1 diabetes is of the immune-mediated nature, in which beta cell loss is a T-cell-mediated | Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets of Langerhans in the pancreas, leading to insulin deficiency. This type can be further classified as immune-mediated or idiopathic. The majority of type 1 diabetes is of the immune-mediated nature, in which beta cell loss is a T-cell-mediated autoimmune attack.<cite>6</cite>There is no known preventive measure against Type 1 diabetes, which causes approximately 10% of diabetes mellitus cases in North America and Europe. Most affected people are otherwise healthy and of a healthy weight when onset occurs. Sensitivity and responsiveness to insulin are usually normal, especially in the early stages. Type 1 diabetes can affect children or adults, but was traditionally termed ''juvenile diabetes'' because a majority of these diabetes cases were in children. | ||
''Brittle'' diabetes, also known as unstable diabetes or labile diabetes, is a term that was traditionally used to describe to dramatic and recurrent swings in glucose levels, often occurring for no apparent reason in insulin-dependent diabetes. This term, however, has no biologic basis and should not be used.<cite>7</cite> There are many reasons for Type 1 diabetes to be accompanied by irregular and unpredictable hyperglycemias, frequently with ketosis, and sometimes serious hypoglycemias, including an impaired counterregulatory response to hypoglycemia, occult infection, gastroparesis (which leads to erratic absorption of dietary carbohydrates), and endocrinopathies (e.g., Addison's disease).<cite>7</cite> These phenomena are believed to occur no more frequently than in 1% to 2% of persons with Type 1 diabetes.<cite>8</cite> | ''Brittle'' diabetes, also known as unstable diabetes or labile diabetes, is a term that was traditionally used to describe to dramatic and recurrent swings in glucose levels, often occurring for no apparent reason in insulin-dependent diabetes. This term, however, has no biologic basis and should not be used.<cite>7</cite> There are many reasons for Type 1 diabetes to be accompanied by irregular and unpredictable hyperglycemias, frequently with ketosis, and sometimes serious hypoglycemias, including an impaired counterregulatory response to hypoglycemia, occult infection, gastroparesis (which leads to erratic absorption of dietary carbohydrates), and endocrinopathies (e.g., Addison's disease).<cite>7</cite> These phenomena are believed to occur no more frequently than in 1% to 2% of persons with Type 1 diabetes.<cite>8</cite> | ||
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===Gestational diabetes=== | ===Gestational diabetes=== | ||
Gestational diabetes mellitus (GDM) resembles Type 2 diabetes in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 2%–5% of all | Gestational diabetes mellitus (GDM) resembles Type 2 diabetes in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 2%–5% of all pregnancies and may improve or disappear after delivery. Gestational diabetes is fully treatable, but requires careful medical supervision throughout the pregnancy. About 20%–50% of affected women develop Type 2 diabetes later in life. | ||
Though it may be transient, untreated gestational diabetes can damage the health of the fetus or mother. Risks to the baby include macrosomia (high birth weight), congenital cardiac and central nervous system anomalies, and skeletal muscle malformations. Increased fetal insulin may inhibit fetal surfactant production and cause | Though it may be transient, untreated gestational diabetes can damage the health of the fetus or mother. Risks to the baby include macrosomia (high birth weight), congenital cardiac and central nervous system anomalies, and skeletal muscle malformations. Increased fetal insulin may inhibit fetal surfactant production and cause respiratory distress syndrome. Hyperbilirubinemia may result from red blood cell destruction. In severe cases, perinatal death may occur, most commonly as a result of poor placental perfusion due to vascular impairment. Labor induction may be indicated with decreased placental function. A Caesarean section may be performed if there is marked fetal distress or an increased risk of injury associated with macrosomia, such as shoulder dystocia. | ||
A 2008 study completed in the U.S. found the number of American women entering pregnancy with pre-existing diabetes is increasing. In fact, the rate of diabetes in expectant mothers has more than doubled in the past six years.<cite>9</cite> This is particularly problematic as diabetes raises the risk of complications during pregnancy, as well as increasing the potential for the children of diabetic mothers to become diabetic in the future. | A 2008 study completed in the U.S. found the number of American women entering pregnancy with pre-existing diabetes is increasing. In fact, the rate of diabetes in expectant mothers has more than doubled in the past six years.<cite>9</cite> This is particularly problematic as diabetes raises the risk of complications during pregnancy, as well as increasing the potential for the children of diabetic mothers to become diabetic in the future. | ||
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All forms of diabetes increase the risk of long-term complications. These typically develop after many years (10–20), but may be the first symptom in those who have otherwise not received a diagnosis before that time. The major long-term complications relate to damage to blood vessels. Diabetes doubles the risk of cardiovascular disease.<cite>13</cite> The main ''macrovascular'' diseases (related to atherosclerosis of larger arteries) are ischemic heart disease (angina and myocardial infarction), stroke and peripheral vascular disease. | All forms of diabetes increase the risk of long-term complications. These typically develop after many years (10–20), but may be the first symptom in those who have otherwise not received a diagnosis before that time. The major long-term complications relate to damage to blood vessels. Diabetes doubles the risk of cardiovascular disease.<cite>13</cite> The main ''macrovascular'' diseases (related to atherosclerosis of larger arteries) are ischemic heart disease (angina and myocardial infarction), stroke and peripheral vascular disease. | ||
Diabetes also damages the capillaries (causes microangiopathy).<cite>14</cite> Diabetic retinopathy, which affects blood vessel formation in the retina of the eye, can lead to visual symptoms, reduced vision, and potentially blindness. Diabetic nephropathy, the impact of diabetes on the kidneys, can lead to scarring changes in the kidney tissue, loss of small or progressively larger amounts of protein in the urine, and eventually chronic kidney disease requiring dialysis. Diabetic neuropathy is the impact of diabetes on the | Diabetes also damages the capillaries (causes microangiopathy).<cite>14</cite> Diabetic retinopathy, which affects blood vessel formation in the retina of the eye, can lead to visual symptoms, reduced vision, and potentially blindness. Diabetic nephropathy, the impact of diabetes on the kidneys, can lead to scarring changes in the kidney tissue, loss of small or progressively larger amounts of protein in the urine, and eventually chronic kidney disease requiring dialysis. Diabetic neuropathy is the impact of diabetes on the nervous system, most commonly causing numbness, tingling and pain in the feet and also increasing the risk of skin damage due to altered sensation. Together with vascular disease in the legs, neuropathy contributes to the risk of diabetes-related foot problems (such as diabetic foot ulcers) that can be difficult to treat and occasionally require amputation. | ||
==Causes== | ==Causes== | ||
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===United States=== | ===United States=== | ||
[[Image:Diabetes County level estimates 2004-2009.gif|thumb|Diabetes rates at county levels 2004 - 2009.]] | |||
For at least 20 years, diabetes rates in North America have been increasing substantially. In 2010, nearly 26 | |||
For at least 20 years, diabetes rates in North America have been increasing substantially. In 2010, nearly 26 million people have diabetes in the United States, of whom 7 million people remain undiagnosed. Another 57 million people are estimated to have prediabetes.<ref>{{cite press release|url=http://www.cdc.gov/media/releases/2011/p0126_diabetes.html |title=Number of Americans with Diabetes Rises to Nearly 26 Million |publisher=Centers for Disease Control and Prevention |date=2011-01-26 |accessdate=2012-05-27}}</ref><ref>{{cite web | |||
| publisher = Centers for Disease Control and Prevention | | publisher = Centers for Disease Control and Prevention | ||
| title = National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011 | year = 2011 | url = http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf | accessdate = 2012-05-31 }}</ref> | | title = National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011 | year = 2011 | url = http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf | accessdate = 2012-05-31 }}</ref> | ||
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==History== | ==History== | ||
Diabetes was one of the first diseases described,<ref>{{cite book|last=Ripoll|first=Brian C. Leutholtz, Ignacio|title=Exercise and disease management|publisher=CRC Press|location=Boca Raton|isbn=978-1-4398-2759-8|page=25|url=http://books.google.ca/books?id=eAn9-bm_pi8C&pg=PA25|edition=2nd|date=2011-04-25}}</ref> with an Egyptian manuscript from Circa|c. 1500 Common Era|BCE mentioning ''too great emptying of the urine''.<ref name=History2010/> The first described cases are believed to be of Type 1 diabetes.<ref name=History2010>{{cite book|last=editor|first=Leonid Poretsky,|title=Principles of diabetes mellitus|year=2009|publisher=Springer|location=New York|isbn=978-0-387-09840-1|page=3|url=http://books.google.ca/books?id=i0qojvF1SpUC&pg=PA3|edition=2nd}}</ref> Indian physicians around the same time identified the disease and classified it as ''madhumeha'' or ''honey urine'', noting the urine would attract ants.<ref name=History2010/> The term ''diabetes'' or ''to pass through'' was first used in 230 BCE by the Greek Apollonius (physician)|Appollonius of Memphis.<ref name=History2010/> The disease was considered as rare during the time of the Roman empire, with Galen commenting he had only seen two cases during his career.<ref name=History2010/> This is possibly due the diet and life-style of the ancient people, or because the clinical symptoms were observed during the advanced stage of the disease. Galen named the disease ''diarrhea of the urine'' (diarrhea urinosa). The earliest surviving work with a detailed reference to diabetes is that of Aretaeus of Cappadocia (2nd or early 3rd c. CE). He described the symptoms and the course of the disease, which he attributed to the moisture and coldness, reflecting the beliefs of the ''Pneumatic School''. He hypothesized a correlation of diabetes with other diseases and he discussed differential diagnosis from the snakebite which also provokes excessive thirst. His work remained unknown in the West until the middle of the 16th century when, in 1552, the first Latin edition was published in Venice.<ref>{{cite journal | author = Konstantinos Laios ''et al.'' | year = 2012 | title = Aretaeus of Cappadocia and the first description of diabetes | url = | journal = Hormones | volume = 11 | issue = 1| pages = 109–113 }}</ref> | Diabetes was one of the first diseases described,<ref>{{cite book|last=Ripoll|first=Brian C. Leutholtz, Ignacio|title=Exercise and disease management|publisher=CRC Press|location=Boca Raton|isbn=978-1-4398-2759-8|page=25|url=http://books.google.ca/books?id=eAn9-bm_pi8C&pg=PA25|edition=2nd|date=2011-04-25}}</ref> with an Egyptian manuscript from Circa|c. 1500 Common Era|BCE mentioning ''too great emptying of the urine''.<ref name=History2010/> The first described cases are believed to be of Type 1 diabetes.<ref name=History2010>{{cite book|last=editor|first=Leonid Poretsky,|title=Principles of diabetes mellitus|year=2009|publisher=Springer|location=New York|isbn=978-0-387-09840-1|page=3|url=http://books.google.ca/books?id=i0qojvF1SpUC&pg=PA3|edition=2nd}}</ref> Indian physicians around the same time identified the disease and classified it as ''madhumeha'' or ''honey urine'', noting the urine would attract ants.<ref name=History2010/> The term ''diabetes'' or ''to pass through'' was first used in 230 BCE by the Greek Apollonius (physician)|Appollonius of Memphis.<ref name=History2010/> The disease was considered as rare during the time of the Roman empire, with Galen commenting he had only seen two cases during his career.<ref name=History2010/> This is possibly due the diet and life-style of the ancient people, or because the clinical symptoms were observed during the advanced stage of the disease. Galen named the disease ''diarrhea of the urine'' (diarrhea urinosa). The earliest surviving work with a detailed reference to diabetes is that of Aretaeus of Cappadocia (2nd or early 3rd c. CE). He described the symptoms and the course of the disease, which he attributed to the moisture and coldness, reflecting the beliefs of the ''Pneumatic School''. He hypothesized a correlation of diabetes with other diseases and he discussed differential diagnosis from the snakebite which also provokes excessive thirst. His work remained unknown in the West until the middle of the 16th century when, in 1552, the first Latin edition was published in Venice.<ref>{{cite journal | author = Konstantinos Laios ''et al.'' | year = 2012 | title = Aretaeus of Cappadocia and the first description of diabetes | url = | journal = Hormones | volume = 11 | issue = 1| pages = 109–113 }}</ref> | ||
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==Society and culture== | ==Society and culture== | ||
The 1990 ''St. Vincent Declaration''<ref>{{Cite book|last=Theodore H. Tulchinsky|first=Elena A. Varavikova|title=The New Public Health, Second Edition|publisher=Academic Press|year=2008|page=200|location=New York|isbn=0-12-370890-7}}</ref><ref>{{cite journal | author = Piwernetz K, Home PD, Snorgaard O, Antsiferov M, Staehr-Johansen K, Krans M | title = Monitoring the targets of the St Vincent Declaration and the implementation of quality management in diabetes care: the DIABCARE initiative. The DIABCARE Monitoring Group of the St Vincent Declaration Steering Committee | journal = Diabetic Medicine | volume = 10 | issue = 4 | pages = 371–7 | year = 1993 | month = May | pmid = 8508624 | doi = 10.1111/j.1464-5491.1993.tb00083.x }}</ref> was the result of international efforts to improve the care accorded to those with diabetes. Doing so is important not only in terms of quality of life and life expectancy, but also economically—expenses due to diabetes have been shown to be a major drain on health- and productivity-related resources for healthcare systems and governments. | The 1990 ''St. Vincent Declaration''<ref>{{Cite book|last=Theodore H. Tulchinsky|first=Elena A. Varavikova|title=The New Public Health, Second Edition|publisher=Academic Press|year=2008|page=200|location=New York|isbn=0-12-370890-7}}</ref><ref>{{cite journal | author = Piwernetz K, Home PD, Snorgaard O, Antsiferov M, Staehr-Johansen K, Krans M | title = Monitoring the targets of the St Vincent Declaration and the implementation of quality management in diabetes care: the DIABCARE initiative. The DIABCARE Monitoring Group of the St Vincent Declaration Steering Committee | journal = Diabetic Medicine | volume = 10 | issue = 4 | pages = 371–7 | year = 1993 | month = May | pmid = 8508624 | doi = 10.1111/j.1464-5491.1993.tb00083.x }}</ref> was the result of international efforts to improve the care accorded to those with diabetes. Doing so is important not only in terms of quality of life and life expectancy, but also economically—expenses due to diabetes have been shown to be a major drain on health- and productivity-related resources for healthcare systems and governments. | ||
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==In other animals== | ==In other animals== | ||
In animals, diabetes is most commonly encountered in dogs and cats. Middle-aged animals are most commonly affected. Female dogs are twice as likely to be affected as males, while according to some sources, male cats are also more prone than females. In both species, all breeds may be affected, but some small dog breeds are particularly likely to develop diabetes, such as Miniature Poodles.<cite>61</cite> The symptoms may relate to fluid loss and polyuria, but the course may also be insidious. Diabetic animals are more prone to infections. The long-term complications recognised in humans are much rarer in animals. The principles of treatment (weight loss, oral antidiabetics, subcutaneous insulin) and management of emergencies (e.g. ketoacidosis) are similar to those in humans.<cite>61</cite> | In animals, diabetes is most commonly encountered in dogs and cats. Middle-aged animals are most commonly affected. Female dogs are twice as likely to be affected as males, while according to some sources, male cats are also more prone than females. In both species, all breeds may be affected, but some small dog breeds are particularly likely to develop diabetes, such as Miniature Poodles.<cite>61</cite> The symptoms may relate to fluid loss and polyuria, but the course may also be insidious. Diabetic animals are more prone to infections. The long-term complications recognised in humans are much rarer in animals. The principles of treatment (weight loss, oral antidiabetics, subcutaneous insulin) and management of emergencies (e.g. ketoacidosis) are similar to those in humans.<cite>61</cite> | ||