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Diabetes Mellitus And Pregnancy

Diabetes Mellitus And Pregnancy

This article is about the effects of pre-existing diabetes upon pregnancy. For temporary diabetic symptoms as a complication of pregnancy, see Gestational diabetes. For pregnant women with diabetes mellitus some particular challenges for both mother and child. If the woman has diabetes as an intercurrent disease in pregnancy, it can cause early labor, birth defects, and very large babies. Planning in advance is emphasized if one wants to have a baby and has type 1 diabetes mellitus or type 2 diabetes mellitus. Pregnancy management for diabetics needs stringent blood glucose control even in advance of having pregnancy. Physiology[edit] During a normal pregnancy, many physiological changes occur such as increased hormonal secretions that regulate blood glucose levels, such as a glucose-'drain' to the fetus, slowed emptying of the stomach, increased excretion of glucose by the kidneys and resistance of cells to insulin. Risks for the child[edit] The risks of maternal diabetes to the developing fetus include miscarriage, growth restriction, growth acceleration, fetal obesity (macrosomia), mild neurological deficits,[1] polyhydramnios and birth defects.[citation needed] A hyperglycemic maternal environment has also been associated with neonates that are at greater risk for development of negative health outcomes such as future obesity, insulin resistance, type 2 diabetes mellitus, and metabolic syndrome.[2] Mild neurological and cognitive deficits in offspring — including increased symptoms of ADHD, impaired fine and gross motor skills, and impaired explicit memory performance — have been linked to pregestational type 1 diabetes and gestational diabetes.[3][4][5] Prenatal iron deficiency has been suggested as a possible mechanism for these problems.[6] Birth defects are Continue reading >>

Diabetic Angiopathy - Wikipedia

Diabetic Angiopathy - Wikipedia

Diabetic angiopathy is a form of angiopathy associated with diabetic complications [1] . While not exclusive, the two most common forms are Diabetic retinopathy and Diabetic nephropathy , whose pathophysiologies are largely identical. Diabetes mellitus is the most common cause of adult kidney failure worldwide. It also the most common cause of amputation in the US, usually toes and feet, often as a result of gangrene , and almost always as a result of peripheral vascular disease. Retinal damage (from microangiopathy ) makes it the most common cause of blindness among non-elderly adults in the US. As insulin is required for glucose uptake, hyperglycemia in diabetes mellitus does not result in a net increase in intracellular glucose in most cells. However, chronic dysregulated blood glucose in diabetes is toxic to cells of the vascular endothelium which passively assimilate glucose. That is, cells in which insulin is not required for intercellular transport of glucose, most-notably the pericytes of the microvasculature . In addition to direct glucose-induced damage by (e.g.) glycation , pericytes express enzymes which convert glucose into osmologically-active metabolites such as sorbitol leading to hypertonic cell lysis. Over time, pericyte death may result in reduced capillary integrity; subsequently, there is leaking of albumin and other proteins into fluid compartments. The glomeruli of the kidneys are especially sensitive see diabetic nephropathy where protein leakage caused by late-stage angiopathy results in diagnostic proteinuria and eventually renal failure . In diabetic retinopathy the end-result is often blindness due to irreversible retinal damage. Continue reading >>

Glossary Of Diabetes

Glossary Of Diabetes

The following is a glossary of diabetes which explains terms connected with diabetes . A brown to black, poorly defined, velvety hyperpigmentation of the skin , usually present in the posterior and lateral folds of the neck , the axilla , groin , umbilicus , and other areas. This occurs due to insulin spillover (from excessive production due to obesity or insulin resistance ) into the skin which results in abnormal growth being observed. The most common cause would be insulin resistance , usually from type 2 diabetes mellitus . A byproduct of fat metabolism. One of three ketone body substances. Produced in high levels during periods of stress, infection, etc possibly leading to diabetic ketoacidosis , a very serious condition. It can sometimes be smelled on the breath of those in, or about to enter diabetic ketoacidosis as a fruity (nail polish remover, or lacquer thinner) sort of smell. It is very rapidly released into via the lungs into the breath, unlike the other ketone bodies. It is chemically a ketone . An acidic condition in body fluids, chiefly blood. If prolonged, or severe, it can cause coma and death regardless of cause. For a person with diabetes, this can be caused by insufficient glucose absorption (e.g. from inadequate insulin) combined with metabolic ketosis. It can lead to diabetic ketoacidosis , a medical emergency. a weak acid carbon compound containing carbon, hydrogen, oxygen, and nitrogen. The nitrogenous amine group is characteristic of each. Amino acids are the building blocks of protein and there are about 20 used in the human body, of which about half can be constructed internally. The rest must come in the dietthey are the essential amino acids . Chemicals produced by the immune system which are very carefully tuned to attach only to particul Continue reading >>

Diabetes Mellitus

Diabetes Mellitus

"Diabetes" redirects here. For other uses, see Diabetes (disambiguation). Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic disorders in which there are high blood sugar levels over a prolonged period.[7] Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger.[2] If left untreated, diabetes can cause many complications.[2] Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic state, or death.[3] Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, and damage to the eyes.[2] Diabetes is due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced.[8] There are three main types of diabetes mellitus:[2] Type 1 DM results from the pancreas's failure to produce enough insulin.[2] This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes".[2] The cause is unknown.[2] Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to insulin properly.[2] As the disease progresses a lack of insulin may also develop.[9] This form was previously referred to as "non insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes".[2] The most common cause is excessive body weight and insufficient exercise.[2] Gestational diabetes is the third main form, and occurs when pregnant women without a previous history of diabetes develop high blood sugar levels.[2] Prevention and treatment involve maintaining a healthy diet, regular physical exercise, a normal body weight, and avoiding use of tobacco.[2] Control of blood pressure and maintaining proper foot care are important for people with t Continue reading >>

Gestational Diabetes

Gestational Diabetes

Gestational diabetes is a condition in which a woman without diabetes develops high blood sugar levels during pregnancy.[2] Gestational diabetes generally results in few symptoms;[2] however, it does increase the risk of pre-eclampsia, depression, and requiring a Caesarean section.[2] Babies born to mothers with poorly treated gestational diabetes are at increased risk of being too large, having low blood sugar after birth, and jaundice.[2] If untreated, it can also result in a stillbirth.[2] Long term, children are at higher risk of being overweight and developing type 2 diabetes.[2] Gestational diabetes is caused by not enough insulin in the setting of insulin resistance.[2] Risk factors include being overweight, previously having gestational diabetes, a family history of type 2 diabetes, and having polycystic ovarian syndrome.[2] Diagnosis is by blood tests.[2] For those at normal risk screening is recommended between 24 and 28 weeks gestation.[2][3] For those at high risk testing may occur at the first prenatal visit.[2] Prevention is by maintaining a healthy weight and exercising before pregnancy.[2] Gestational diabetes is a treated with a diabetic diet, exercise, and possibly insulin injections.[2] Most women are able to manage their blood sugar with a diet and exercise.[3] Blood sugar testing among those who are affected is often recommended four times a day.[3] Breastfeeding is recommended as soon as possible after birth.[2] Gestational diabetes affects 3–9% of pregnancies, depending on the population studied.[3] It is especially common during the last three months of pregnancy.[2] It affects 1% of those under the age of 20 and 13% of those over the age of 44.[3] A number of ethnic groups including Asians, American Indians, Indigenous Australians, and Pacific Continue reading >>

Diabetes: Definition, Causes And Symptoms

Diabetes: Definition, Causes And Symptoms

Diabetes: Definition, Causes and Symptoms Diabetes: Definition, Causes and Symptoms Diabetes is a disease that affects your bodys ability to produce or use insulin. Insulin is a hormone. When your body turns the food you eat into energy (also called sugar or glucose), insulin is released to help transport this energy to the cells. Insulin acts as a key. Its chemical message tells the cell to open and receive glucose . If you produce little or no insulin, or are insulin resistant, too much sugar remains in your blood. Blood glucose levels are higher than normal for individuals with diabetes. There are two main types of diabetes: Type 1 and Type 2. When you are affected with Type 1 diabetes, your pancreas does not produce insulin. Type 1 diabetes is also called juvenile diabetes, since it is often diagnosed in children or teens. This type accounts for 5-10 percentof people with diabetes. Type 2 diabetes occurs when the body does not produce enough insulin, or when the cells are unable to use insulin properly, which is called insulin resistance. Type 2 diabetes is commonly called adult-onset diabetes since it is diagnosed later in life, generally after the age of 45. 90-95 percentof people with diabetes have this type. In recent years Type 2 diabetes has been diagnosed in younger people, including children, more frequently than in the past. Gestational diabetes occurs during pregnancy and affects about18 percentof all pregnancies, according to the American Diabetes Association . Gestational diabetes usually goes away after pregnancy, but once you've had gestational diabetes, your chances are higher that it will happen in future pregnancies. In some women pregnancy uncovers Type 1 or Type 2 diabetes and these women will need to continue diabetes treatment after pregnancy. Continue reading >>

Diabetes Mellitus

Diabetes Mellitus

diabetes mel·li·tus (mə-lī′təs, mĕl′ĭ-) [New Latin diabētēs mellītus, literally, honey-sweet diabetes (so called because excessive glucose is excreted in the urine and the resulting sweet taste of the urine was used in diagnosis) : Medieval Latin diabētēs, diabetes; see diabetes + Latin mellītus, honey-sweet (Latin mel, mell-, honey; see melit- in Indo-European roots + -ītus, adjectival suffix).] American Heritage® Dictionary of the English Language, Fifth Edition. Copyright © 2016 by Houghton Mifflin Harcourt Publishing Company. Published by Houghton Mifflin Harcourt Publishing Company. All rights reserved. diabe′tes mel′li•tus (ˈmɛl ɪ təs) n. either of two chronic forms of diabetes in which insulin does not effectively transport glucose from the bloodstream: a rapidly developing form, affecting children and young adults, in which the body does not produce enough insulin and insulin must therefore be injected (juvenile-onset diabetes) or a slowly developing form in which the body's tissues become unable to use insulin effectively (adult-onset diabetes). [< New Latin: literally, sweet diabetes] diabetes mellitus A condition characterized by frequent thirst and urination, caused by excess sugar in the blood. Results from a lack of insulin. Noun 1. diabetes mellitus - diabetes caused by a relative or absolute deficiency of insulin and characterized by polyuria; "when doctors say `diabetes' they usually mean `diabetes mellitus'"DMdiabetes - a polygenic disease characterized by abnormally high glucose levels in the blood; any of several metabolic disorders marked by excessive urination and persistent thirstautoimmune diabetes, growth-onset diabetes, IDDM, insulin-dependent diabetes mellitus, juvenile diabetes, juvenile-onset diabetes, ketoacido Continue reading >>

Complications Of Diabetes Mellitus

Complications Of Diabetes Mellitus

The complications of diabetes mellitus are far less common and less severe in people who have well-controlled blood sugar levels. Acute complications include hypoglycemia and hyperglycemia, diabetic coma and nonketotic hyperosmolar coma. Chronic complications occur due to a mix of microangiopathy, macrovascular disease and immune dysfunction in the form of autoimmune disease or poor immune response, most of which are difficult to manage. Microangiopathy can affect all vital organs, kidneys, heart and brain, as well as eyes, nerves, lungs and locally gums and feet. Macrovascular problems can lead to cardiovascular disease including erectile dysfunction. Female infertility may be due to endocrine dysfunction with impaired signalling on a molecular level. Other health problems compound the chronic complications of diabetes such as smoking, obesity, high blood pressure, elevated cholesterol levels, and lack of regular exercise which are accessible to management as they are modifiable. Non-modifiable risk factors of diabetic complications are type of diabetes, age of onset, and genetic factors, both protective and predisposing have been found. Overview[edit] Complications of diabetes mellitus are acute and chronic. Risk factors for them can be modifiable or not modifiable. Overall, complications are far less common and less severe in people with well-controlled blood sugar levels.[1][2][3] However, (non-modifiable) risk factors such as age at diabetes onset, type of diabetes, gender and genetics play a role. Some genes appear to provide protection against diabetic complications, as seen in a subset of long-term diabetes type 1 survivors without complications .[4][5] Statistics[edit] As of 2010, there were about 675,000 diabetes-related emergency department (ED) visits in the Continue reading >>

Diabetes Mellitus Type 1

Diabetes Mellitus Type 1

Diabetes mellitus type 1 (also known as type 1 diabetes) is a form of diabetes mellitus in which not enough insulin is produced.[4] This results in high blood sugar levels in the body.[1] The classical symptoms are frequent urination, increased thirst, increased hunger, and weight loss.[4] Additional symptoms may include blurry vision, feeling tired, and poor healing.[2] Symptoms typically develop over a short period of time.[1] The cause of type 1 diabetes is unknown.[4] However, it is believed to involve a combination of genetic and environmental factors.[1] Risk factors include having a family member with the condition.[5] The underlying mechanism involves an autoimmune destruction of the insulin-producing beta cells in the pancreas.[2] Diabetes is diagnosed by testing the level of sugar or A1C in the blood.[5][7] Type 1 diabetes can be distinguished from type 2 by testing for the presence of autoantibodies.[5] There is no known way to prevent type 1 diabetes.[4] Treatment with insulin is required for survival.[1] Insulin therapy is usually given by injection just under the skin but can also be delivered by an insulin pump.[9] A diabetic diet and exercise are an important part of management.[2] Untreated, diabetes can cause many complications.[4] Complications of relatively rapid onset include diabetic ketoacidosis and nonketotic hyperosmolar coma.[5] Long-term complications include heart disease, stroke, kidney failure, foot ulcers and damage to the eyes.[4] Furthermore, complications may arise from low blood sugar caused by excessive dosing of insulin.[5] Type 1 diabetes makes up an estimated 5–10% of all diabetes cases.[8] The number of people affected globally is unknown, although it is estimated that about 80,000 children develop the disease each year.[5] With Continue reading >>

The Use Of Animal Models In Diabetes Research

The Use Of Animal Models In Diabetes Research

The use of animal models in diabetes research Diabetes Research Group, King's College London, London, UK Aileen King, Diabetes Research Group, Guy's Campus, King's College London, London SE1 1UL, UK. E-mail: [email protected] Received 2011 Aug 19; Revised 2012 Feb 10; Accepted 2012 Feb 13. Copyright 2012 The Author. British Journal of Pharmacology 2012 The British Pharmacological Society This article has been cited by other articles in PMC. Diabetes is a disease characterized by a relative or absolute lack of insulin, leading to hyperglycaemia. There are two main types of diabetes: type 1 diabetes and type 2 diabetes. Type 1 diabetes is due to an autoimmune destruction of the insulin-producing pancreatic beta cells, and type 2 diabetes is caused by insulin resistance coupled by a failure of the beta cell to compensate. Animal models for type 1 diabetes range from animals with spontaneously developing autoimmune diabetes to chemical ablation of the pancreatic beta cells. Type 2 diabetes is modelled in both obese and non-obese animal models with varying degrees of insulin resistance and beta cell failure. This review outlines some of the models currently used in diabetes research. In addition, the use of transgenic and knock-out mouse models is discussed. Ideally, more than one animal model should be used to represent the diversity seen in human diabetic patients. This paper is the latest in a series of publications on the use of animal models in pharmacology research. Readers might be interested in the previous papers. Robinson V (2009). Less is more: reducing the reliance on animal models for nausea and vomiting research. Holmes AM, Rudd JA, Tattersall FD, Aziz Q, Andrews PLR (2009). Opportunities for the replacement of animals in the study of nausea and vomiting. Continue reading >>

Impaired Fasting Glucose

Impaired Fasting Glucose

Impaired fasting glucose, or Impaired Fasting Glycemia (IFG) is a type of prediabetes, in which a person's blood sugar levels during fasting are consistently above the normal range, but below the diagnostic cut-off for a formal diagnosis of diabetes mellitus.[1] Together with impaired glucose tolerance, it is a sign of insulin resistance. In this manner, it is also one of the conditions associated with Metabolic Syndrome. Those with impaired fasting glucose are at an increased risk of vascular complications of diabetes, though to a lesser extent. The risks are cumulative, with both higher blood glucose levels, and the total amount of time it spends elevated, increasing the overall complication rate. IFG can eventually progress to type 2 diabetes mellitus without intervention, which typically involves lifestyle modification. Those with impaired fasting glucose have a 1.5 fold increased risk of developing clinical diabetes within 10 years, when compared to the general population. Some studies suggest that without lifestyle changes, IFG will progress to clinically diagnosable diabetes in just under 3 years, on average.[2] Impaired fasting glucose is often, though not always, associated with impaired glucose tolerance, though it may occur in isolation, with such persons having a normal response to a glucose tolerance test. Signs and Symptoms[edit] Impaired fasting glucose is often without any signs or symptoms, other than higher than normal glucose levels being detected in an individual's fasting blood sample. There may be signs and symptoms associated with elevated blood glucose, though these are likely to be minor, with significant symptoms suggestive of complete progression to type 2 diabetes. Such symptoms include:[3] Increased thirst Increased urination, especially wak Continue reading >>

Subclinical Diabetes

Subclinical Diabetes

It has been suggested that this article be merged into Impaired glucose tolerance . ( Discuss ) Estimate of insulin resistance (IR) and insulin sensitivity (%S) according to the Homeostatic model assessment (HOMA). Patterns were modeled as a function of fasting plasma insulin and varying fasting plasma glucose. Calculated using HOMA Calculator. Adapted from [1] Subclinical diabetes is a stage of hyperinsulinemia due to insulin resistance in normoglycemic individuals and, therefore, not diagnosed for hyperglycemic states characteristic of diabetes mellitus. It anticipates the prediabetes and diabetes stages characterized by hyperglycemia among other glucocentric biomarkers. [1] Insulin resistance can be diagnosed by measures of plasma insulin , both fasting or during a glucose tolerance test as originally reported by the pathologist Dr. Joseph R. Kraft. [2] and Prof. Gerald Reaven . [3] It has been endorsed by the American Diabetes Association in the Consensus Development Conference on Insulin Resistance, [4] where they state that "if the assay for fasting insulin was reliable, it would be useful to detect insulin resistance early (i.e., before or soon after the pubertal period, which itself causes insulin resistance) and before clinical disease appears". Lima, Luis Mauricio TR (2017). "Subclinical Diabetes" (PDF). An Acad Bras Cienc. 89 (1): 591614. doi : 10.1590/0001-3765201720160394 . PMID 28492735 . Kraft, JR (1975). "Detection of Diabetes Mellitus In Situ (Occult Diabetes)" . Laboratory Medicine. 6 (2): 1022. doi : 10.1093/labmed/6.2.10 . Reaven, GM; Lerner, RL; Stern, MP; Farguhar, JW (1967). "Role of insulin in endogenous hypertriglyceridemia" (PDF). The Journal of Clinical Investigation. 46 (11): 175667. doi : 10.1172/JCI105666 . PMID 6061748 . Association, Amer Continue reading >>

Endocrinology

Endocrinology

For the academic journal, see Endocrinology (journal). Endocrinology (from Greek ἔνδον, endon, "within"; κρίνω, krīnō, "to separate"; and -λογία, -logia) is a branch of biology and medicine dealing with the endocrine system, its diseases, and its specific secretions known as hormones. It is also concerned with the integration of developmental events proliferation, growth, and differentiation, and the psychological or behavioral activities of metabolism, growth and development, tissue function, sleep, digestion, respiration, excretion, mood, stress, lactation, movement, reproduction, and sensory perception caused by hormones. Specializations include behavioral endocrinology[1][2][3] and comparative endocrinology. The endocrine system consists of several glands, all in different parts of the body, that secrete hormones directly into the blood rather than into a duct system. Hormones have many different functions and modes of action; one hormone may have several effects on different target organs, and, conversely, one target organ may be affected by more than one hormone. The endocrine system[edit] Norepinephrine Triiodothyronine Examples of amine hormones Main article: Endocrine system Endocrinology is the study of the endocrine system in the human body. This is a system of glands which secrete hormones. Hormones are chemicals which affect the actions of different organ systems in the body. Examples include thyroid hormone, growth hormone, and insulin. The endocrine system involves a number of feedback mechanisms, so that often one hormone (such as thyroid stimulating hormone) will control the action or release of another secondary hormone (such as thyroid hormone). If there is too much of the secondary hormone, it may provide negative feedback to the pr Continue reading >>

Prediabetes

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 >>

Diabetic Nephropathy

Diabetic Nephropathy

Diabetic nephropathy (diabetic kidney disease) (DN)[1] is the chronic loss of kidney function occurring in those with diabetes mellitus. It is a serious complication, affecting around one-quarter of adult diabetics in the United States. It usually is slowly progressive over years. [2] Pathophysiologic abnormalities in DN begin with long-standing poorly controlled blood glucose levels. This is followed by multiple changes in the filtration units of the kidneys, the nephrons. (There are normally about 3/4-1 1/2 million nephrons in each adult kidney).[3] Initially, there is constriction of the efferent arterioles and dilation of afferent arterioles, with resulting glomerular capillary hypertension and hyperfiltration; this gradually changes to hypofiltration over time.[4] Concurrently, there are changes within the glomerulus itself: these include a thickening of the basement membrane, a widening of the slit membranes of the podocytes, an increase in the number of mesangial cells, and an increase in mesangial matrix. This matrix invades the glomerular capillaries and produces deposits called Kimmelstiel-Wilson nodules. The mesangial cells and matrix can progressively expand and consume the entire glomerulus, shutting off filtration.[5] The status of DN may be monitored by measuring two values: the amount of protein in the urine - proteinuria; and a blood test called the serum creatinine. The amount of the proteinuria is a reflection of the degree of damage to any still-functioning glomeruli. The value of the serum creatinine can be used to calculate the estimated glomerular filtration rate (eGFR), which reflects the percentage of glomeruli which are no longer filtering the blood.[citation needed] Treatment with an angiotensin converting enzyme inhibitor (ACEI) or angiotensi Continue reading >>

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