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DIABETES

A disorder of metabolism in which the pancreas either produces little or no insulin (a hormone responsible for getting glucose into cells), or the cells do not respond appropriately to the insulin that is produced. Glucose builds up in the blood, overflows into the urine, and passes out of the body. As such, the body loses its main source of fuel even though the blood contains large amounts of sugar.

Main types of diabetes are:

Type 1 diabetes

  • An autoimmune disease in which the immune system attacks the insulin-producing beta cells in the pancreas and destroys them. The pancreas then produces little or no insulin. A person who has type 1 diabetes must take insulin daily to live.
  • Accounts for about 5 to 10 percent of diagnosed diabetes in the United States. It develops most often in children and young adults, but can appear at any age.
  • Symptoms include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue. If not diagnosed and treated with insulin, a person with type 1 diabetes can lapse into a life-threatening diabetic coma, also known as diabetic ketoacidosis.

Type 2 diabetes

  • Most common form of diabetes, comprising about 90 to 95 percent of people with diabetes. It is associated with older age, obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and ethnicity. About 80 percent of people with type 2 diabetes are overweight.
  • The body cannot use the insulin effectively, a condition called insulin resistance. After several years, insulin production decreases. The result is the same as for type 1 diabetes — glucose builds up in the blood and the body cannot make efficient use of its main source of fuel.
  • The symptoms of type 2 diabetes develop gradually and may include fatigue or nausea, frequent urination, unusual thirst, weight loss, blurred vision, frequent infections, and slow healing of wounds or sores. Some people have no symptoms.

Gestational diabetes

  • Develops only during pregnancy. It occurs more often in African Americans, American Indians, Hispanic Americans, and among women with a family history of diabetes. Women who have had gestational diabetes have a 20 to 50 percent chance of developing type 2 diabetes within 5 to 10 years.

DIAGNOSIS

Physician may do/request:

  • History & Physical Exam
  • Fasting plasma glucose
    • Preferred test for diagnosing type 1 or type 2 diabetes and is most reliable when done in the morning. However, a diagnosis of diabetes can be made after positive results on any one of three tests, with confirmation from a second positive test on a different day:
      • A random (taken any time of day) plasma glucose value of 200 mg/dL or more, along with the presence of diabetes symptoms.
      • A plasma glucose value of 126 mg/dL or more after a person has fasted for 8 hours.
      • An oral glucose tolerance test (OGTT) plasma glucose value of 200 mg/dL or more in a blood sample taken 2 hours after a person has consumed a drink containing 75 grams of glucose dissolved in water. This test, taken in a laboratory or the doctor’s office, measures plasma glucose at timed intervals over a 3-hour period.
      • Gestational diabetes is diagnosed based on plasma glucose values measured during the OGTT. Glucose levels are normally lower during pregnancy, so the threshold values for diagnosis of diabetes in pregnancy are lower. If a woman has two plasma glucose values meeting or exceeding any of the following numbers, she has gestational diabetes: a fasting plasma glucose level of 95 mg/dL, a 1-hour level of 180 mg/dL, a 2-hour level of 155 mg/dL, or a 3-hour level of 140 mg/dL.

 

RECOMMENDED MEDICATIONS

For type 1 diabetes, your pancreas no longer makes the insulin your body needs to use blood sugar for energy. You will need insulin in the form of injections or through use of a continuous pump.

Insulin comes in four types:

  • Rapid-acting (taking effect within a few minutes and lasting 2-4 hours)
  • Regular or short-acting (taking effect within 30 minutes and lasting 3-6 hours)
  • Intermediate-acting (taking effect in 2-4 hours and lasting up to 18 hours)
  • Long-acting (taking effect in 6-10 hours and lasting up to 24 hours)

A rapid-acting inhaled insulin (Afrezza) is also FDA-approved for use before meals. It must be used in combination with long-acting insulin in patients with type 1 diabetes and should not be used by those who smoke or have chronic lung disease. It comes as a single dose cartridge.

Premixed insulin is also available for people who need to use more than one type of insulin.

Each treatment plan is tailored for the person and can be adjusted based on what you eat and how much you exercise, as well as for times of stress and illness.

Self-monitoring of blood glucose levels is key in the managment. A glucometer measures glucose levels in a sample of your blood dabbed on a strip of treated paper. Also, there are now devices, called continuous glucose monitoring systems (CGMS), that can be attached to your body to measure your blood sugars every few minutes for up to a week at a time.

For some people with type 2 diabetes, diet and exercise are enough to keep the disease under control. Other people need medication, which may include insulin and an oral drug.

Drugs for type 2 diabetes work in different ways to bring blood sugar levels back to normal. They include:

  • Drugs that increases insulin production by the pancreas, including chlorpropamide (Diabinese), glimepiride, (Amaryl), glipizide (Glucotrol), glyburide (Diabeta, Micronase), nateglinide (Starlix), and repaglinide (Prandin)
  • Drugs that decrease sugar absorption by the intestines, such as acarbose (Precose) and miglitol (Glyset)
  • Drugs that improve how the body uses insulin, such as pioglitazone (Actos) and rosiglitazone (Avandia)
  • Drugs that decrease sugar production by the liver and improve insulin resistance, like metformin (Glucophage)
  • Drugs that increases insulin production by the pancreas or its blood levels and/or reduce sugar production from the liver, including albiglutide (Tanzeum), alogliptin (Nesina), dulaglutide (Trulicity), linagliptin (Tradjenta), exenatide (Byetta, Bydureon), liraglutide (Victoza), saxagliptin (Onglyza), and sitagliptin (Januvia)
  • Drugs that block the reabsorption of glucose by the kidney and increase glucose excretions in urine, called sodium-glucose co-transporter 2 (SGLT2) inhibitors. They are canaglifozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance).
  • Pramlinitide (Symlin) is an injectable synthetic hormone. It helps lower blood sugar after meals in people with diabetes who use insulin.

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