Type 2 Diabetes Guide
When your doctor tells you that you have prediabetes, you might think there's no reason to take action just yet. Or you might assume that you're definitely going to get diabetes. Not so! You do need to take prediabetes seriously, but there's still time to turn things around -- if you start now. The goal is to get your blood sugar level out of the prediabetes range, and keep it that way. What you do every day makes a big difference. Making lifestyle changes may be even more powerful than just taking medication. That's what happened in a large study called the Diabetes Prevention Program: People with prediabetes who lost a small amount of weight through diet and exercise cut their odds of getting type 2 diabetes by 58%, compared to 31% for people who only took the prescription drug metformin. Start by making these three changes. If you're overweight, slimming down is the key to turning the odds in your favor. Research shows that shedding just 5% to 10% of your body weight is often enough to get blood sugar levels back into the normal range and avoid diabetes or at least delay its onset. To reach your goal, limit portion sizes; cut calories; and eat fewer foods that are high in fat (especially saturated fat), sugar, and carbohydrates. You should also eat a wide variety of fruits, vegetables, lean protein, and whole grains. Leading an active life is a must. Aim for 30 minutes of aerobic activity (something that raises your heart rate, like walking, biking, or swimming) 5 days a week (150 minutes per week). Plus, do some strength-training exercise, like lifting weights or using resistance bands, at least twice a week. Strength work builds muscle, which helps lower your blood sugar level, helps your body respond better to insulin (which controls blood sugar), and burns calori Continue reading >>
Islet Cell Dysfunction In Progression To Diabetes Mellitus
The epidemic of type 2 diabetes mellitus is increasing in most nations. This illness is a major cause of cardiovascular disease, stroke, blindness, renal failure, and amputations. Because available interventions have failed to show durability, new modes of therapy need to be directed at the underlying causes of abnormal glucose metabolism. The development of such modes of therapy will require an improved understanding of how the β-cell mass compensates for changes in insulin resistance and why β cells lose the capacity to secrete insulin. In addition, new therapeutic modalities need to address α-cell dysregulation, because the inability to suppress glucagon production results in ongoing elevated levels of hepatic glucose. Diabetes mellitus is a worldwide epidemic. Global projections suggest that most nations will have a doubling of the incidence of diabetes mellitus within 20 years.1 Wild et al1 estimated, based on data from the World Health Organization and United Nations, that there were approximately 171 million people with type 2 diabetes mellitus (T2DM) in 2000, and that this number would grow to 366 million by 2030. This epidemic involves all parts of the globe—with India, China, and the Middle East impacted more than Europe, Africa, and North and South America.1 Despite these statistics, obesity is not the ultimate cause of T2DM, because most obese or overweight people do not have T2DM. Investigations into the factors that determine if T2DM will develop are a major thrust of current research. No single etiologic factor has been defined as the cause of T2DM. Thus, we cannot predict with certainty in whom T2DM will develop. Besides obesity, other important risk factors for T2DM include age, ethnicity, and family history.2,3 Although T2DM has a strong genetic c Continue reading >>
The Causes And Progression Of Type 2 Diabetes
Many people are born with a genetic predisposition to developing diabetes at some point in life – though this does not necessarily mean that they are destined to develop diabetes. We explore why and how type 2 diabetes develops in some people, and not others. First comes love…then comes marriage…then comes a baby - wait. That's not the progression we are talking about. We're talking about the progression of a disease. A very deadly disease at that, with type 2 diabetes being the 7th leading cause of death, according to the Centers for Disease Control and Prevention. How does Type 2 Diabetes Develop? Many people are born with a genetic predisposition to developing diabetes at some point in life - though this does not necessarily mean that they are destined to develop diabetes. It does, however mean that you they are more likely to develop diabetes than someone who is not genetically predisposed. Even if you don't have diabetes running in your family - you can certainly still develop it. After conception, your genes are all planned out and locked in for life, you might say. After this point, lifestyle takes over and plays the biggest role in whether you will develop type 2 diabetes in your lifetime. It's the classic nature vs. nurture argument, and we must consider both genetics and environment to explain how you get type 2 diabetes. As you grow and develop as toddler, how you eat can begin to influence the progression of type 2 diabetes. If you consume lots of sugary drinks and fruit juices, candy, and simple carbohydrates like crackers, cookies, and chips, then you are already increasing your risk, as a child, for type 2 diabetes. These kinds of foods cause your pancreas to begin working overtime to produce insulin in order to process all that sugar. So when you c Continue reading >>
Stages Of T1d
Type 1 diabetes can now be most accurately understood as a disease that progresses in three distinct stages. TrialNet screening looks for five diabetes-related autoantibodies that signal an increased risk of T1D. The JDRF, ADA and Endocrine Society now classify having two or more of these autoantibodies as early stage T1D. Finding T1D in its earliest stage allows for prompt intervention aiming to change the course of the disease. T1D starts with a genetic predisposition—gene(s) that put you at higher risk. Risk for people in the general population is about 1 in 300. If you have a family member with T1D, your risk is 1 in 20. There are three distinct stages of T1D. The first two stages can be identified by TrialNet screening prior to symptoms. Our goal is to identify the disease in its earliest stage and stop disease progression by preserving beta cell production. Stages of T1D Continue reading >>
How Type 2 Diabetes Can Change Over Time
You probably already know that type 2 diabetes can cause long-term damage if you don’t control it, but it’s also important to understand that even well-controlled diabetes progresses over time — meaning you may have to adjust your treatment plan more than once. The key to learning about the progression of diabetes is to understand the role of your pancreas, which produces insulin. For people with type 1 diabetes, the pancreas does not make any insulin, so they must take it through injections. With type 2, the pancreas doesn’t make enough insulin or the cells don’t respond to it adequately, according to the American Academy of Family Physicians. This means that the body has trouble moving sugar from the blood into cells to be used for energy. Diet, exercise, and medication, if prescribed, can all help those with type 2 diabetes lower their blood sugar levels and help their bodies use insulin made by the pancreas, according to the American Diabetes Association (ADA). If blood sugar levels remain high, the ADA says, you may be at risk for such diabetes complications as vision loss, heart disease, nerve damage, foot or leg amputation, and kidney disease. However, proper diabetes management can help prevent or delay the onset of these complications. How Your Diabetes Treatment Plan Might Change Over time, your medications, diet, and exercise goals may need to be adjusted. “Initially the pancreas produces extra insulin to make up for insulin resistance, but in most people, the pancreas eventually is unable to make the extra insulin to keep blood sugar levels normal,” says Marc Jaffe, MD, a San Francisco endocrinologist in practice with Kaiser Permanente in Northern California. After a type 2 diabetes diagnosis, your doctor will set blood sugar goals for you, rec Continue reading >>
Diabetic Nephropathy
Definition and Causes Diabetic nephropathy (DN) is typically defined by macroalbuminuria—that is, a urinary albumin excretion of more than 300 mg in a 24-hour collection—or macroalbuminuria and abnormal renal function as represented by an abnormality in serum creatinine, calculated creatinine clearance, or glomerular filtration rate (GFR). Clinically, diabetic nephropathy is characterized by a progressive increase in proteinuria and decline in GFR, hypertension, and a high risk of cardiovascular morbidity and mortality. Prevalence and Risk Factors Diabetes has become the primary cause of end-stage renal disease (ESRD) in the United States, and the incidence of type 2 diabetes mellitus continues to grow in the United States and worldwide. Approximately 44% of new patients entering dialysis in the United States are diabetics. Early diagnosis of diabetes and early intervention are critical in preventing the normal progression to renal failure seen in many type 1 and a significant percentage of type 2 diabetics. In the United States, approximately 20.8 million people, or 7.0% of the population, are estimated to have diabetes, with a growing incidence. Roughly one third of this population, 6.2 million, is estimated to be undiagnosed with type 2 diabetes. The prevalence of diabetes is higher in certain racial and ethnic groups, affecting approximately 13% of African Americans, 9.5% of Hispanics, and 15% of Native Americans, primarily with type 2 diabetes.1, 2 Approximately 20% to 30% of all diabetics will develop evidence of nephropathy, although a higher percentage of type 1 patients progress to ESRD. Pathophysiology and Natural History The common progression from microalbuminuria to overt nephropathy has led many to consider microalbuminuria to define early or incipient Continue reading >>
New Insights Into The Progression Of Type 1 Diabetes
If you have Type 1 diabetes or know someone who does, you’re likely aware that this type of diabetes is an autoimmune disorder that results in the destruction of the beta cells (the cells that make insulin) in the pancreas. Having Type 1 diabetes means having to take lifelong insulin injections, and people who are diagnosed with this condition must start on insulin right away. Type 1 diabetes progresses Type 2 diabetes, the “other” type of diabetes, is a whole different ball of wax. This type of diabetes partly stems from insulin resistance, meaning that the pancreas produces insulin but the body has a hard time using it. Type 2 diabetes is often described as being “progressive”: caught in the early stages, for example, it’s possible to manage it through healthy eating, weight loss (if necessary), and physical activity. But over time, many people require the help of medication, often in the form of diabetes pills, and then, perhaps, noninsulin injectable meds. Eventually, insulin injections may be needed. In the case of Type 1 diabetes, researchers now believe that this disease also progresses at predictable rates and stages before a person develops signs and symptoms. The discovery of these stages is a big deal, as it will enable researchers to find ways to intervene to delay and hopefully prevent progression to the onset of symptoms and lifelong insulin dependence. Stages of Type 1 diabetes The discovery of the various stages leading up to symptomatic Type 1 diabetes are outlined in the October 2015 issue of the journal Diabetes Care. The paper is entitled “Staging Presymptomatic Type 1 Diabetes: A Scientific Statement of JDRF, the Endocrine Society, and the American Diabetes Association.” Here’s a closer look at the crux of this paper. Stage 1: Auto Continue reading >>
Retinopathy Progression And Sudden Lowering Of Hba1c , Etc
Generally retinopathy progresses according to the parameters below. There are very few exceptions. Once background retinopathy develops, unless diabetic control is improved as below, the retinopathy will deteriorate, laser will be needed, and even with laser sight may be affected. glucose level/HbA1c, linear relationship with retinopathy progression blood pressure, linear relationship lipid level, probably a near linear relationship smoking, probable linear relationship (some work suggests 20 cigarettes a day triples/quadruples retinopathy, others less so) pregnancy may cause a rapid deterioration sudden improvement (lowering to normal) of glucose levels in a person whose diabetes has been poorly controlled for sometime see and here . Certain clinical situations are recognised: Some people never seem to develop retinopathy: a suggestion has been made that these patients have ultra-low blood pressures, and this is what protects them. There are genes controlling retinopathy progression, and these may act through blood pressure effects. Retinopathy may run in families; there is certainly a genetic contribution All of a sudden a patient's retinopathy may start to get much worse: this may be because of a relatively sudden rise in blood pressure, which is quite common. Sometimes this seems to occur as renal function decreases. Some people's retinopathy never seems to get worse. I am not convinced this situation exists, but if it does it could be explained: a person whose diabetes was reasonably, but not well, controlled, perhaps an HbA1c of 8% with a low blood pressure, develops retinopathy, but then starts to control their diabetes and blood pressure really well, achieving an HbA1c of 7%, then the retinopathy does not progress. When a patient with poorly controlled type 2 di Continue reading >>
Prediabetes
Prediabetes is the precursor stage before diabetes mellitus in which not all of the symptoms required to diagnose diabetes are present, but blood sugar is abnormally high. This stage is often referred to as the "grey area."[1] It is not a disease; the American Diabetes Association says,[2] "Prediabetes should not be viewed as a clinical entity in its own right but rather as an increased risk for diabetes and cardiovascular disease (CVD). Prediabetes is associated with obesity (especially abdominal or visceral obesity), dyslipidemia with high triglycerides and/or low HDL cholesterol, and hypertension."[2] It is thus a metabolic diathesis or syndrome, and it usually involves no symptoms and only high blood sugar as the sole sign. Impaired fasting blood sugar and impaired glucose tolerance are two forms of prediabetes that are similar in clinical definition (glucose levels too high for their context) but are physiologically distinct.[3] Insulin resistance, the insulin resistance syndrome (metabolic syndrome or syndrome X), and prediabetes are closely related to one another and have overlapping aspects. Classification[edit] Impaired fasting glucose[edit] Main article: Impaired fasting glycaemia Impaired fasting glycaemia or impaired fasting glucose (IFG) refers to a condition in which the fasting blood glucose or the 3-month average blood glucose (A1C) is elevated above what is considered normal levels but is not high enough to be classified as diabetes mellitus. It is considered a pre-diabetic state, associated with insulin resistance and increased risk of cardiovascular pathology, although of lesser risk than impaired glucose tolerance (IGT). IFG sometimes progresses to type 2 diabetes mellitus. There is a 50% risk over 10 years of progressing to overt diabetes. Many newl Continue reading >>
Symptoms At Diagnosis May Predict Progression Of Type 2 Diabetes
Researchers followed patients who were newly diagnosed with type 2 diabetes for 18 months to classify their disease progression based on 20 baseline symptoms. With Caroline A. Brorsson, PhD, and Michael Gonzalez-Campoy, MD, PhD Three major subgroups of newly diagnosed patients with type 2 diabetes (T2D) experienced different rates of disease progression over 18 months,1 according to data presented at the 53rd annual meeting of the European Association for the Study of Diabetes in Lisbon, Portugal. The research was part of the Diabetes Research on Patient Stratification project (DIRECT) within the European Union Framework 7 Innovative Medicines Initiative. Patients with type 2 diabetes are likely to present with varying degrees of insulin resistance and beta cell failure.1 Understanding the heterogeneity of a T2D presentation may lead to more effective treatment strategies for these patients. An underlying difference in pathophysiology may be indicative of a patient’s responsiveness to a prescribed treatment and have an anticipated effect on disease progression.1 Evaluating Differences in Diabetes Progression Caroline Brorsson, PhD, a postdoctoral researcher at the Technical University of Denmark and colleagues used the detailed clinical phenotyping from the Diabetes Remission Clinical Trial (DIRECT) to identify and cluster subgroups of patients who were newly diagnosed with T2D.1,2 In the DIRECT study, detailed metabolic data were collected on patients newly diagnosed with either prediabetes or type 2 diabetes.2 “Using a very detailed clinical phenotyping methodology, we wanted to systematically capture disease heterogeneity in newly diagnosed diabetes patients using a data-driven approach to be able to investigate the effect of different patient subgroups on diseas Continue reading >>
Changing Perspectives On The Progression Of Type 1 Diabetes
Type 1 diabetes remains an enigmatic disease from both a scientific and a clinical viewpoint. The symptoms are widely understood to present when the insulin-secreting beta cells in the islets of Langerhans are destroyed via a process of autoimmunity.1,2 For this reason, the immediate therapeutic approach at diagnosis is to supplement the endogenous insulin deficiency with an exogenous supply. This has been the status quo over many years and, for the majority of patients, it provides an appropriate means to stabilise their condition and allows for effective glucose control over the longer term. However, this is not universally true and despite the best efforts to maintain glucose homeostasis, the disease is still associated with significant morbidity and mortality. Therefore, important questions remain about whether alternative therapeutic approaches which prevent rather than treat the condition might be developed in future. At present, identifying those individuals who are progressing to type 1 diabetes among the background population is a difficult task because presentation of the disease occurs sporadically and is usually unheralded. It develops most frequently in subjects with a specific genetic predisposition and considerable efforts have been invested to identify the genes involved.3 However, this information has not stimulated widespread attempts to screen for such individuals. There are various reasons for this, not least the fact that many members of the general population have the ‘high risk’ genetic profile yet do not develop the disease. Allied to this is a still more basic problem which, in our view, defines the nub of the issue most starkly; namely that we still have only a rudimentary understanding of the processes that cause the disease in the pancrea Continue reading >>
Diabetes Update: The Untold Story Of Disease Progression
CE credit is no longer available for this article. Originally posted March 2001 Pick up the paper. Turn on the radio. Diabetes is rapidly becoming a national epidemic. An estimated 18 million Americans have diabetes—and that number is growing, particularly among children. Certain ethnic groups, such as African-Americans, Hispanics, and Native Americans, have the highest incidence. Among those groups, one in four over the age of 45 will most likely develop diabetes. The Centers for Disease Control and Prevention (CDC) reports that between 1990 and 1998, the incidence of diabetes rose by 70% among people ages 30 - 39; by 40% among those 40 - 49; and by 31% among those 50 - 59. What may be even more disturbing is the percentage of people who don't even know that they have diabetes: About 33% of the population with Type 1 diabetes and up to 55% of people with Type 2 go undiagnosed. Many patients are hyperglycemic for up to six years before finding out they have diabetes. The toll diabetes takes is staggering. It is the leading cause of new cases of adult blindness, end-stage renal disease, and nontraumatic lower extremity amputations. And patients with diabetes have an incidence of cardiovascular morbidity and mortality four times that of non-diabetics. In fact, 65% of patients with Type 2 diabetes will die of a cardiovascular complication. The cost is enormous: $138 billion annually. The average per capita medical expenditure is $10,000 per diabetic patient, vs. $2,700 for the non-diabetic individual. The good news is that complications of diabetes can be limited and its progression slowed with strict control of blood sugar and new treatment protocols. New drugs provide more therapeutic options. Insulin sensitizers, insulin secretagogues, medications that alter the diges Continue reading >>
Type 2 Diabetes
Type 2 diabetes is a progressive condition in which the body becomes resistant to the normal effects of insulin and/or gradually loses the capacity to produce enough insulin in the pancreas. We do not know what causes type 2 diabetes. Type 2 diabetes is associated with modifiable lifestyle risk factors. Type 2 diabetes also has strong genetic and family related risk factors. Type 2 diabetes: Is diagnosed when the pancreas does not produce enough insulin (reduced insulin production) and/or the insulin does not work effectively and/or the cells of the body do not respond to insulin effectively (known as insulin resistance) Represents 85–90 per cent of all cases of diabetes Usually develops in adults over the age of 45 years but is increasingly occurring in younger age groups including children, adolescents and young adults Is more likely in people with a family history of type 2 diabetes or from particular ethnic backgrounds For some the first sign may be a complication of diabetes such as a heart attack, vision problems or a foot ulcer Is managed with a combination of regular physical activity, healthy eating and weight reduction. As type 2 diabetes is often progressive, most people will need oral medications and/or insulin injections in addition to lifestyle changes over time. Type 2 diabetes develops over a long period of time (years). During this period of time insulin resistance starts, this is where the insulin is increasingly ineffective at managing the blood glucose levels. As a result of this insulin resistance, the pancreas responds by producing greater and greater amounts of insulin, to try and achieve some degree of management of the blood glucose levels. As insulin overproduction occurs over a very long period of time, the insulin producing cells in the pan Continue reading >>
Defining And Characterizing The Progression Of Type 2 Diabetes
Go to: Progression from pre-diabetes to overt diabetes Because glucose is a continuous variable, the use of thresholds to make a diagnosis is somewhat arbitrary. The term “pre-diabetes” has become well established and implies a risk of progression to overt diabetes. However, although such progression is well studied in prevention trials, little is known about the rate of progression and the characteristics of such progression in the population at large. Table 1 summarizes some of the factors associated with such progression. Nichols et al. (2) studied the progression of pre-diabetes to overt disease and observed that 8.1% of subjects whose initial abnormal fasting glucose was 100–109 mg/dl and 24.3% of subjects whose initial abnormal fasting glucose was 110–125 mg/dl developed diabetes over an average of 29.0 months (1.34 and 5.56% per year, respectively). A steeper rate of increasing fasting glucose; higher BMI, blood pressure, and triglycerides; and lower HDL cholesterol predicted diabetes development. The Baltimore Longitudinal Study of Aging (3) concluded that although phenotypic differences in rates of progression are partly a function of diagnostic thresholds, fasting and postchallenge hyperglycemia may represent phenotypes with distinct natural histories in the evolution of type 2 diabetes. Does hyperglycemia evolve from normoglycemia gradually over time or as a step increase? Ferrannini et al. (4) measured plasma glucose and insulin levels during oral glucose testing at baseline and after 3 and 7 years of follow-up. In subjects with normal glucose tolerance on all three occasions (nonconverters), FPG increased only slightly over 7 years. In contrast, conversion to both impaired glucose tolerance (IGT) and diabetes among normal glucose tolerance subjects Continue reading >>
Variation In Macro And Trace Elements In Progression Of Type 2 Diabetes
The Scientific World Journal Volume 2014 (2014), Article ID 461591, 9 pages 1Strategic Center for Diabetes Research, King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia 2Nutrition Department, University Diabetes Center, King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia Academic Editor: Juei-Tang Cheng Copyright © 2014 Khalid Siddiqui et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Macro elements are the minerals of which the body needs more amounts and are more important than any other elements. Trace elements constitute a minute part of the living tissues and have various metabolic characteristics and functions. Trace elements participate in tissue and cellular and subcellular functions; these include immune regulation by humoral and cellular mechanisms, nerve conduction, muscle contractions, membrane potential regulations, and mitochondrial activity and enzyme reactions. The status of micronutrients such as iron and vanadium is higher in type 2 diabetes. The calcium, magnesium, sodium, chromium, cobalt, iodine, iron, selenium, manganese, and zinc seem to be low in type 2 diabetes while elements such as potassium and copper have no effect. In this review, we emphasized the status of macro and trace elements in type 2 diabetes and its advantages or disadvantages; this helps to understand the mechanism, progression, and prevention of type 2 diabetes due to the lack and deficiency of different macro and trace elements. 1. Introduction Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effective Continue reading >>
