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单词 brittle diabetes mellitus
释义 DictionarySeediabetes mellitusEncyclopediaSeeDiabetes MellitusMedicalSeeWELL-CONTROLLED DIABETES MELLITUS: Daily blood sugar abstracted from the records of a patient whose DM is well controlled (hemoglobin A1c=6.4). The average capillary blood glucose level is 104 mg/dL, and the standard deviation is 19. Sixty-five percent of the readings are between 90 and 140 mg/dL; the lowest blood sugar is 67 mg/dL (on April 15) and the highest is about 190 (on March 21).

diabetes mellitus

Abbreviation: DM
A chronic metabolic disorder marked by hyperglycemia. DM results either from failure of the pancreas to produce insulin (type 1 DM) or from insulin resistance, with inadequate insulin secretion to sustain normal metabolism (type 2 DM). Either type of DM may damage blood vessels, nerves, kidneys, the retina, and the developing fetus and the placenta during pregnancy. Type 1 or insulin-dependent DM has a prevalence of just 0.3 to 0.4%. Type 2 DM (formerly called adult-onset DM) has a prevalence in the general population of 6.6%. In some populations (such as older persons, Native Americans, African Americans, Pacific Islanders, Mexican Americans), it is present in nearly 20% of adults. Type 2 DM primarily affects obese middle-aged people with sedentary lifestyles, whereas type 1 DM usually occurs in children, most of whom are active and thin, although extremely obese children are now being diagnosed with type 2 diabetes as well. See: table; dawn phenomenon; insulin; insulin pump; insulin resistance; diabetic polyneuropathy; Somogyi phenomenon

Type 1 DM usually presents as an acute illness with dehydration and often diabetic ketoacidosis. Type 2 DM is often asymptomatic in its early years. The American Diabetes Association (1-800-DIABETES) estimates that more than 5 million Americans have type 2 DM without knowing it.

Etiology

Type 1 DM is caused by autoimmune destruction of the insulin-secreting beta cells of the pancreas. The loss of these cells results in nearly complete insulin deficiency; without exogenous insulin, type 1 DM is rapidly fatal. Type 2 DM results partly from a decreased sensitivity of muscle cells to insulin-mediated glucose uptake and partly from a relative decrease in pancreatic insulin secretion.

Symptoms

Classic symptoms of DM are polyuria, polydipsia, and weight loss. In addition, patients with hyperglycemia often have blurred vision, increased food consumption (polyphagia), and generalized weakness. When a patient with type 1 DM loses metabolic control (such as during infections or periods of noncompliance with therapy), symptoms of diabetic ketoacidosis occur. These may include nausea, vomiting, dizziness on arising, intoxication, delirium, coma, or death. Chronic complications of hyperglycemia include retinopathy and blindness, peripheral and autonomic neuropathies, glomerulosclerosis of the kidneys (with proteinuria, nephrotic syndrome, or end-stage renal failure), coronary and peripheral vascular disease, and reduced resistance to infections. Patients with DM often also sustain infected ulcerations of the feet, which may result in osteomyelitis and the need for amputation.

Diagnosis

Several tests are helpful in identifying DM. These include tests of fasting plasma glucose levels, casual (randomly assessed) glucose levels, or glycosylated hemoglobin levels. Diabetes is currently established if patients have classic diabetic symptoms and if on two occasions fasting glucose levels exceed 126 mg/dL (> 7 mmol/L), random glucose levels exceed 200 mg/dL (11.1 mmol/L), or a 2-hr oral glucose tolerance test is 200 mg/dL or more. A hemoglobin A1c test that is more than two standard deviations above normal (6.5% or greater) is also diagnostic of the disease.

Treatment

DM types 1 and 2 are both treated with specialized diets, regular exercise, intensive foot and eye care, and medications.

Patients with type 1 DM, unless they have had a pancreatic transplant, require insulin to live; intensive therapy with insulin to limit hyperglycemia (“tight control”) is more effective than conventional therapy in preventing the progression of serious microvascular complications such as kidney and retinal diseases. Intensive therapy consists of three or more doses of insulin injected or administered by infusion pump daily, with frequent self-monitoring of blood glucose levels as well as frequent changes in therapy as a result of contacts with health care professionals. Some negative aspects of intensive therapy include a three times more frequent occurrence of severe hypoglycemia, weight gain, and an adverse effect on serum lipid levels, i.e., a rise in total cholesterol, LDL cholesterol, and triglycerides and a fall in HDL cholesterol. Participation in an intensive therapy program requires a motivated patient, but it can dramatically reduce eye, nerve, and renal complications compared to conventional therapy. See: insulin pump for illus.

Some patients with type 2 DM can control their disease with a calorically restricted diet (for instance 1600 to 1800 cal/day), regular aerobic exercise, and weight loss. Most patients, however, require the addition of some form of oral hypoglycemic drug or insulin. Oral agents to control DM include sulfonylurea drugs (such as glipizide), which increase pancreatic secretion of insulin; biguanides or thiazolidinediones (such as metformin or pioglitazone), which increase cellular sensitivity to insulin; or a-glucosidase inhibitors (such as acarbose), which decrease the absorption of carbohydrates from the gastrointestinal tract. Both types of diabetics also may be prescribed pramlintide (Symlin), a synthetic analog of human amylin, a hormone manufactured in the pancreatic beta cells. It enhances postprandial glucose control by slowing gastric emptying, decreasing postprandial glucagon concentrations, and regulating appetite and food intake; thus pramlintide is helpful for patients who do not achieve optimal glucose control with insulin and/or oral antidiabetic agents. When combinations of these agents fail to normalize blood glucose levels, insulin injections are added. Tight glucose control can reduce the patient’s risk of many of the complications of the disease. See: illustration

Prevention of Complications

Patients with DM should avoid tobacco, actively manage their serum lipid levels, and keep hypertension under optimal control. Failure to do so may result in a risk of atherosclerosis much higher than that of the general public. Other elements in care include receiving regular vaccinations, e.g., to prevent influenza and pneumococcal pneumonia).

Prognosis

Diabetes is a chronic disease whose symptoms can be ameliorated and life prolonged by proper therapy. The isolation and eventual production of insulin in 1922 by Canadian physicians F. G. Banting and C. H. Best made it possible to allow people with the disease to lead normal lives.

Patient care

The diabetic patient should learn to recognize symptoms of low blood sugar (such as confusion, sweats, and palpitations) and high blood sugar (such as, polyuria and polydipsia). When either condition results in hospitalization, vital signs, weight, fluid intake, urine output, and caloric intake are accurately documented. Serum glucose and urine ketone levels are evaluated. Chronic management of DM is also based on periodic measurement of glycosylated hemoglobin levels (HbA1c). Elevated levels of HbA1c suggest poor long-term glucose control. The effects of diabetes on other body systems (such as cerebrovascular, coronary artery, and peripheral vascular) should be regularly assessed. Patients should be evaluated regularly for retinal disease and visual impairment and peripheral and autonomic nervous system abnormalities, e.g., loss of sensation in the feet. The patient is observed for signs and symptoms of diabetic neuropathy, e.g., numbness or pain in the hands and feet, decreased vibratory sense, footdrop, and neurogenic bladder. The urine is checked for microalbumin or overt protein losses, an early indication of nephropathy. The combination of peripheral neuropathy and peripheral arterial disease results in changes in the skin and microvasculature that lead to ulcer formation on the feet and lower legs with poor healing. Approx. 45,000 lower-extremity diabetic amputations are performed in the U.S. each year. Many amputees have a second amputation within five years. Most of these amputations are preventable with regular foot care and examinations. Diabetic patients and their providers should look for changes in sensation to touch and vibration, the integrity of pulses, capillary refill, and the skin. All injuries, cuts, and blisters should be treated promptly. The patient should avoid constricting hose, slippers, shoes, and bed linens or walking barefoot. The patient with ulcerated or insensitive feet is referred to a podiatrist for continuing foot care and is warned that decreased sensation can mask injuries.

Home blood glucose self-monitoring is indispensable in helping patients to adjust daily insulin doses according to test results and to achieve optimal long-term control of diabetes. Insulin or other hypoglycemic agents are administered as prescribed, and their action and use explained to the patient. With help from a dietitian, a diet is planned based on the recommended amount of calories, protein, carbohydrates, and fats. The amount of carbohydrates consumed is a dietary key to managing glycemic control in diabetes. For most men, 60 to 75 carbohydrate g per meal are a reasonable intake; for most women, 45 to 60 g are appropriate. Saturated fats should be limited to less than 7% of total caloric intake, and trans-fatty acids (unsaturated fats with hydrogen added) minimized. A steady, consistent level of daily exercise is prescribed, and participation in a supervised exercise program is recommended.

Hypoglycemic reactions are promptly treated by giving carbohydrates (orange juice, hard candy, honey, or any sugary food); if necessary, subcutaneous or intramuscular glucagon or intravenous dextrose (if the patient is not conscious) is administered. Hyperglycemic crises are treated initially with prescribed intravenous fluids and insulin and later with potassium replacement based on laboratory values.

Regular ophthalmological examinations are recommended for early detection of diabetic retinopathy. The patient is educated about diabetes, its possible complications and their management, and the importance of adherence to the prescribed therapy. The patient is taught the importance of maintaining normal blood pressure levels (120/80 mm Hg or lower). Control of even mild-to-moderate hypertension results in fewer diabetic complications, esp. nephropathy, cerebrovascular disease, and cardiovascular disease. Limiting alcohol intake to approximately one drink daily and avoiding tobacco are also important for self-management. Emotional support and a realistic assessment of the patient's condition are offered; this assessment should stress that, with proper treatment, the patient can have a near-normal lifestyle and life expectancy. Long-term goals for a patient with diabetes should include achieving and maintaining optimal metabolic outcomes to prevent complications; modifying diet and lifestyle to prevent and treat obesity, dyslipidemia, cardiovascular disease, hypertension, and nephropathy; improving physical activity; and allowing for the patient’s nutritional and psychosocial needs and preferences. Assistance is offered to help the patient develop positive coping strategies. It is estimated that 23 million Americans will be diabetic by the year 2030. The increasing prevalence of obesity coincides with the increasing incidence of diabetes; approx. 45% of those diagnosed receive optimal care according to established guidelines. According to the CDC, the NIH, and the ADA, about 40% of Americans between ages 40 and 74 have prediabetes, putting them at increased risk for type 2 diabetes and cardiovascular disease. Lifestyle changes with a focus on decreasing obesity can prevent or delay the onset of diabetes in 58% of this population. The patient and family should be referred to local and national support and information groups and may require psychological counseling.

Diabetic KetoacidosisHypoglycemia
OnsetGradualOften sudden
HistoryOften acute infection in a diabetic or insufficient insulin intakeRecent insulin injection, inadequate meal, or excessive exercise after insulin
Previous history of diabetes may be absent
MusculoskeletalMuscle wasting or weight lossWeakness
Tremor
Muscle twitching
GastrointestinalAbdominal pains or cramps, sometimes acuteNausea and vomiting
Nausea and vomiting
Central nervous systemHeadacheConfusion, delirium, or seizures
Double or blurred vision
Irritability
CardiovascularTachycardiaVariable
Orthostatic hypotension
SkinFlushed, dryDiaphoretic, pale
RespiratoryAir hungerVariable
Acetone odor of breathIncreased respiratory rate
Dyspnea
Laboratory valuesElevated blood glucose (> 200 mg/dL)Subnormal blood glucose (0–50 mg/dL)
Glucose and ketones in blood and urineAbsence of glucose and ketones in urine unless bladder is full

non–insulin-dependent diabetes mellitus

Abbreviation: NIDDM
Type 2 diabetes. See: type 1 diabetes for table

pancreatic diabetes

Diabetes associated with destruction of the exocrine and endocrine functions of the pancreas, such as occurs in chronic or recurrent pancreatitis.

phlorhizin diabetes

Glycosuria caused by administration of phlorhizin.

renal diabetes

Renal glycosuria, marked by a low renal threshold for glucose. Glucose tolerance is normal and diabetic symptoms are lacking.

secondary diabetes mellitus

DM that results from damage to the pancreas (e.g., after frequent episodes of pancreatitis) or from drugs such as corticosteroids (which increase resistance to the effects of insulin).

steroid diabetes

Hyperglycemia caused by the use of exogenously administered corticosteroids, e.g., prednisone, methylprednisolone, or dexamethasone.

strict control of diabetes

Regulation of blood glucose to normal or nearly normal levels, both before and after meals. Tight control of blood sugar has been shown to improve the survival of patients in intensive-care units and to prevent long-term complications of DM, e.g., blindness, nerve damage, and kidney failure.

Patients with meticulously controlled DM typically have a hemoglobin A1c level of 6.5 to 7.0 or lower, fasting blood sugars that are less than 110 mg/dL, and after-meal blood sugar readings that are 140 mg/dL or less.

Synonym: tight control of diabetes

tight control of diabetes

Strict control of diabetes.

true diabetes

Diabetes mellitus.

type 1 diabetes

DM that usually has its onset before the age of 25 years, in which the essential abnormality is related to absolute insulin deficiency. It was formerly known as juvenile diabetes. See: table
Type 1Type 2
Age at onsetUsually under 30Usually over 40
Symptom onsetAbruptGradual
Body weightNormalObese—80%
HLA associationPositiveNegative
Family historyCommonNearly universal
Insulin in bloodLittle to noneSome usually present
Islet cell antibodiesPresent at onsetAbsent
Prevalence0.2–0.3%6%
SymptomsPolyuria, polydipsia, polyphagia, weight loss, ketoacidosisPolyuria, polydipsia, peripheral neuropathy
ControlInsulin, diet, and exerciseDiet, exercise, and often oral hypoglycemic drugs or insulin
Vascular and neural changesEventually developWill usually develop
Stability of conditionFluctuates, may be difficult to controlMay be difficult to control in poorly motivated patients

type 1a diabetes mellitus

The most common form of type 1 DM. It is caused by autoimmune destruction of the beta cells of the pancreas and inadequate insulin production. In type 1a DM, antibodies against insulin, islet cells of the pancreas, or glutamic acid decarboxylase is often present in the blood. The patient is prone to develop diabetic ketoacidosis if he or she is not treated with insulin.

type 1b diabetes mellitus

A relatively less common form of type 1 DM (seen in only about 10% of type 1 diabetics) in which autoimmune antibodies against insulin, pancreatic beta cells, or their protein products are not found in the blood. Beta cells are nonetheless destroyed (by unknown means), and the patient develops hyperglycemia or ketoacidosis unless he or she receives insulin. Synonym: idiopathic diabetes

type 2 diabetes

A type of DM that occurs predominantly in adults. The insulin produced is sufficient to prevent ketoacidosis but insufficient to meet the total needs of the body, and resistance to the effects of insulin on peripheral tissues is often present. This type of diabetes in nonobese patients can usually be controlled by diet and oral hypoglycemic agents (e.g., sulfonylurea drugs or metformin). Eventually, insulin therapy is often required. In some patients the condition can be controlled by careful diet and regular exercise. Synonym: non–insulin-dependent diabetes mellitus See: type 1 diabetes for table

unstable diabetes mellitus

Brittle diabetes.

diabetes

See DIABETES MELLITUS.

diabetes

a metabolic disorder, either where there is an increase in the amount of urine excreted (diabetes insipidus), or where excess sugar appears in the blood and urine, associated with thirst and loss of weight (diabetes mellitus). The former is caused by the failure of the pituitary to secrete ADH, and the latter by the failure of the ISLETS OF LANGERHANS to produce sufficient insulin.

Diabetes

A disease characterized by an inability to process sugars in the diet, due to a decrease in or total absence of insulin production. May require injections of insulin before meals to aid in the metabolism of sugars.Mentioned in: Adrenal Gland Cancer, Pancreatitis, Retinal Hemorrhage

diabetes

A chronic disease that occurs when the pancreas does not produce enough insulin, or alternatively, when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels (definition of the World Health Organization). The most common types of diabetes are: Type 1 diabetes, which is characterized by a lack of insulin production and therefore dependent upon insulin administration and Type 2 diabetes, which is characterized by an ineffective use of insulin. Type 1 diabetes is the most common type in young people whereas type 2 is the most common diabetes and affects primarily but not exclusively adults and it is largely the result of obesity and physical inactivity. The main complications in the eye are retinopathy, cataract, rubeosis iridis, ocular motor nerve palsies, xanthelasma and ptosis. See accommodative insufficiency; anisocoria; neovascular glaucoma; open-angle glaucoma; hypoxia; lenticular myopia; paralysis of the sixth nerve; paralysis of the third nerve; Adie's pupil; tritanopia; vitrectomy; vitreous detachment.

di·a·be·tes

(dī-ă-bē'tēz) Avoid using the simple word diabetes for diabetes mellitus unless the sense is clear from the context. Either diabetes insipidus or diabetes mellitus, diseases having in common the triad of symptoms polyuria, weight loss, and significant glucosuria.[G. diabētēs, a compass, a siphon, diabetes]

Patient discussion about diabetes

Q. My 7yr has Diabetes. She been Diabetic for about 5 weeks and we can't get numbers at a good spot. she aether way to low (30- 60 scary when she gets like this) and to high (300 - 400) We been looking at what she eating calling the physician. he been play with here shots but nothing working. Its when she at school is were the nuber are mostly going up an down. we been trying to work with the school but she the only one in the hole school that has Diabetes. what to do ? A. Try to reduce her stress.
Keep an eye on her, but don't make it sound like such a big deal.

Q. how diabetes is caused A. Diabetes is the inability of the body to ‘produce insulin - type 1 diabetes’ or ‘proper use of insulin - type 2 diabetes, gestational diabetes and pre-diabetes’. Diabetes is often goes undiagnosed because many of the symptoms of diabetes seems harmless. The causes of diabetes continues to be a mystery, pancreas it the organ whose defect causes diabetes.
for further information please visit:
http://healthy-ojas.com/html/diabetes_mellitus.html
Here we can find information on alternative medicines for diabetes.

Q. my grandmother was diabetic ... and i learned that diabetic is genetic ... should i be concern for me or or for one of my family reletives ... she suffered a lot and she died of it .. if a blood tests shows high amount of sugar in my blood , does i mean i am diabetic ?

More discussions about diabetes
">diabetes of a patient whose DM is well controlled (hemoglobin A1c=6.4). The average capillary blood glucose level is 104 mg/dL, and the standard deviation is 19. Sixty-five percent of the readings are between 90 and 140 mg/dL; the lowest blood sugar is 67 mg/dL (on April 15) and the highest is about 190 (on March 21)." href="javascript:eml2('davisTab', 'd16.jpg')">WELL-CONTROLLED DIABETES MELLITUS: Daily blood sugar abstracted from the records of a patient whose DM is well controlled (hemoglobin A1c=6.4). The average capillary blood glucose level is 104 mg/dL, and the standard deviation is 19. Sixty-five percent of the readings are between 90 and 140 mg/dL; the lowest blood sugar is 67 mg/dL (on April 15) and the highest is about 190 (on March 21).

diabetes mellitus

Abbreviation: DM
A chronic metabolic disorder marked by hyperglycemia. DM results either from failure of the pancreas to produce insulin (type 1 DM) or from insulin resistance, with inadequate insulin secretion to sustain normal metabolism (type 2 DM). Either type of DM may damage blood vessels, nerves, kidneys, the retina, and the developing fetus and the placenta during pregnancy. Type 1 or insulin-dependent DM has a prevalence of just 0.3 to 0.4%. Type 2 DM (formerly called adult-onset DM) has a prevalence in the general population of 6.6%. In some populations (such as older persons, Native Americans, African Americans, Pacific Islanders, Mexican Americans), it is present in nearly 20% of adults. Type 2 DM primarily affects obese middle-aged people with sedentary lifestyles, whereas type 1 DM usually occurs in children, most of whom are active and thin, although extremely obese children are now being diagnosed with type 2 diabetes as well. See: table; dawn phenomenon; insulin; insulin pump; insulin resistance; diabetic polyneuropathy; Somogyi phenomenon

Type 1 DM usually presents as an acute illness with dehydration and often diabetic ketoacidosis. Type 2 DM is often asymptomatic in its early years. The American Diabetes Association (1-800-DIABETES) estimates that more than 5 million Americans have type 2 DM without knowing it.

Etiology

Type 1 DM is caused by autoimmune destruction of the insulin-secreting beta cells of the pancreas. The loss of these cells results in nearly complete insulin deficiency; without exogenous insulin, type 1 DM is rapidly fatal. Type 2 DM results partly from a decreased sensitivity of muscle cells to insulin-mediated glucose uptake and partly from a relative decrease in pancreatic insulin secretion.

Symptoms

Classic symptoms of DM are polyuria, polydipsia, and weight loss. In addition, patients with hyperglycemia often have blurred vision, increased food consumption (polyphagia), and generalized weakness. When a patient with type 1 DM loses metabolic control (such as during infections or periods of noncompliance with therapy), symptoms of diabetic ketoacidosis occur. These may include nausea, vomiting, dizziness on arising, intoxication, delirium, coma, or death. Chronic complications of hyperglycemia include retinopathy and blindness, peripheral and autonomic neuropathies, glomerulosclerosis of the kidneys (with proteinuria, nephrotic syndrome, or end-stage renal failure), coronary and peripheral vascular disease, and reduced resistance to infections. Patients with DM often also sustain infected ulcerations of the feet, which may result in osteomyelitis and the need for amputation.

Diagnosis

Several tests are helpful in identifying DM. These include tests of fasting plasma glucose levels, casual (randomly assessed) glucose levels, or glycosylated hemoglobin levels. Diabetes is currently established if patients have classic diabetic symptoms and if on two occasions fasting glucose levels exceed 126 mg/dL (> 7 mmol/L), random glucose levels exceed 200 mg/dL (11.1 mmol/L), or a 2-hr oral glucose tolerance test is 200 mg/dL or more. A hemoglobin A1c test that is more than two standard deviations above normal (6.5% or greater) is also diagnostic of the disease.

Treatment

DM types 1 and 2 are both treated with specialized diets, regular exercise, intensive foot and eye care, and medications.

Patients with type 1 DM, unless they have had a pancreatic transplant, require insulin to live; intensive therapy with insulin to limit hyperglycemia (“tight control”) is more effective than conventional therapy in preventing the progression of serious microvascular complications such as kidney and retinal diseases. Intensive therapy consists of three or more doses of insulin injected or administered by infusion pump daily, with frequent self-monitoring of blood glucose levels as well as frequent changes in therapy as a result of contacts with health care professionals. Some negative aspects of intensive therapy include a three times more frequent occurrence of severe hypoglycemia, weight gain, and an adverse effect on serum lipid levels, i.e., a rise in total cholesterol, LDL cholesterol, and triglycerides and a fall in HDL cholesterol. Participation in an intensive therapy program requires a motivated patient, but it can dramatically reduce eye, nerve, and renal complications compared to conventional therapy. See: insulin pump for illus.

Some patients with type 2 DM can control their disease with a calorically restricted diet (for instance 1600 to 1800 cal/day), regular aerobic exercise, and weight loss. Most patients, however, require the addition of some form of oral hypoglycemic drug or insulin. Oral agents to control DM include sulfonylurea drugs (such as glipizide), which increase pancreatic secretion of insulin; biguanides or thiazolidinediones (such as metformin or pioglitazone), which increase cellular sensitivity to insulin; or a-glucosidase inhibitors (such as acarbose), which decrease the absorption of carbohydrates from the gastrointestinal tract. Both types of diabetics also may be prescribed pramlintide (Symlin), a synthetic analog of human amylin, a hormone manufactured in the pancreatic beta cells. It enhances postprandial glucose control by slowing gastric emptying, decreasing postprandial glucagon concentrations, and regulating appetite and food intake; thus pramlintide is helpful for patients who do not achieve optimal glucose control with insulin and/or oral antidiabetic agents. When combinations of these agents fail to normalize blood glucose levels, insulin injections are added. Tight glucose control can reduce the patient’s risk of many of the complications of the disease. See: illustration

Prevention of Complications

Patients with DM should avoid tobacco, actively manage their serum lipid levels, and keep hypertension under optimal control. Failure to do so may result in a risk of atherosclerosis much higher than that of the general public. Other elements in care include receiving regular vaccinations, e.g., to prevent influenza and pneumococcal pneumonia).

Prognosis

Diabetes is a chronic disease whose symptoms can be ameliorated and life prolonged by proper therapy. The isolation and eventual production of insulin in 1922 by Canadian physicians F. G. Banting and C. H. Best made it possible to allow people with the disease to lead normal lives.

Patient care

The diabetic patient should learn to recognize symptoms of low blood sugar (such as confusion, sweats, and palpitations) and high blood sugar (such as, polyuria and polydipsia). When either condition results in hospitalization, vital signs, weight, fluid intake, urine output, and caloric intake are accurately documented. Serum glucose and urine ketone levels are evaluated. Chronic management of DM is also based on periodic measurement of glycosylated hemoglobin levels (HbA1c). Elevated levels of HbA1c suggest poor long-term glucose control. The effects of diabetes on other body systems (such as cerebrovascular, coronary artery, and peripheral vascular) should be regularly assessed. Patients should be evaluated regularly for retinal disease and visual impairment and peripheral and autonomic nervous system abnormalities, e.g., loss of sensation in the feet. The patient is observed for signs and symptoms of diabetic neuropathy, e.g., numbness or pain in the hands and feet, decreased vibratory sense, footdrop, and neurogenic bladder. The urine is checked for microalbumin or overt protein losses, an early indication of nephropathy. The combination of peripheral neuropathy and peripheral arterial disease results in changes in the skin and microvasculature that lead to ulcer formation on the feet and lower legs with poor healing. Approx. 45,000 lower-extremity diabetic amputations are performed in the U.S. each year. Many amputees have a second amputation within five years. Most of these amputations are preventable with regular foot care and examinations. Diabetic patients and their providers should look for changes in sensation to touch and vibration, the integrity of pulses, capillary refill, and the skin. All injuries, cuts, and blisters should be treated promptly. The patient should avoid constricting hose, slippers, shoes, and bed linens or walking barefoot. The patient with ulcerated or insensitive feet is referred to a podiatrist for continuing foot care and is warned that decreased sensation can mask injuries.

Home blood glucose self-monitoring is indispensable in helping patients to adjust daily insulin doses according to test results and to achieve optimal long-term control of diabetes. Insulin or other hypoglycemic agents are administered as prescribed, and their action and use explained to the patient. With help from a dietitian, a diet is planned based on the recommended amount of calories, protein, carbohydrates, and fats. The amount of carbohydrates consumed is a dietary key to managing glycemic control in diabetes. For most men, 60 to 75 carbohydrate g per meal are a reasonable intake; for most women, 45 to 60 g are appropriate. Saturated fats should be limited to less than 7% of total caloric intake, and trans-fatty acids (unsaturated fats with hydrogen added) minimized. A steady, consistent level of daily exercise is prescribed, and participation in a supervised exercise program is recommended.

Hypoglycemic reactions are promptly treated by giving carbohydrates (orange juice, hard candy, honey, or any sugary food); if necessary, subcutaneous or intramuscular glucagon or intravenous dextrose (if the patient is not conscious) is administered. Hyperglycemic crises are treated initially with prescribed intravenous fluids and insulin and later with potassium replacement based on laboratory values.

Regular ophthalmological examinations are recommended for early detection of diabetic retinopathy. The patient is educated about diabetes, its possible complications and their management, and the importance of adherence to the prescribed therapy. The patient is taught the importance of maintaining normal blood pressure levels (120/80 mm Hg or lower). Control of even mild-to-moderate hypertension results in fewer diabetic complications, esp. nephropathy, cerebrovascular disease, and cardiovascular disease. Limiting alcohol intake to approximately one drink daily and avoiding tobacco are also important for self-management. Emotional support and a realistic assessment of the patient's condition are offered; this assessment should stress that, with proper treatment, the patient can have a near-normal lifestyle and life expectancy. Long-term goals for a patient with diabetes should include achieving and maintaining optimal metabolic outcomes to prevent complications; modifying diet and lifestyle to prevent and treat obesity, dyslipidemia, cardiovascular disease, hypertension, and nephropathy; improving physical activity; and allowing for the patient’s nutritional and psychosocial needs and preferences. Assistance is offered to help the patient develop positive coping strategies. It is estimated that 23 million Americans will be diabetic by the year 2030. The increasing prevalence of obesity coincides with the increasing incidence of diabetes; approx. 45% of those diagnosed receive optimal care according to established guidelines. According to the CDC, the NIH, and the ADA, about 40% of Americans between ages 40 and 74 have prediabetes, putting them at increased risk for type 2 diabetes and cardiovascular disease. Lifestyle changes with a focus on decreasing obesity can prevent or delay the onset of diabetes in 58% of this population. The patient and family should be referred to local and national support and information groups and may require psychological counseling.

Diabetic KetoacidosisHypoglycemia
OnsetGradualOften sudden
HistoryOften acute infection in a diabetic or insufficient insulin intakeRecent insulin injection, inadequate meal, or excessive exercise after insulin
Previous history of diabetes may be absent
MusculoskeletalMuscle wasting or weight lossWeakness
Tremor
Muscle twitching
GastrointestinalAbdominal pains or cramps, sometimes acuteNausea and vomiting
Nausea and vomiting
Central nervous systemHeadacheConfusion, delirium, or seizures
Double or blurred vision
Irritability
CardiovascularTachycardiaVariable
Orthostatic hypotension
SkinFlushed, dryDiaphoretic, pale
RespiratoryAir hungerVariable
Acetone odor of breathIncreased respiratory rate
Dyspnea
Laboratory valuesElevated blood glucose (> 200 mg/dL)Subnormal blood glucose (0–50 mg/dL)
Glucose and ketones in blood and urineAbsence of glucose and ketones in urine unless bladder is full

non–insulin-dependent diabetes mellitus

Abbreviation: NIDDM
Type 2 diabetes. See: type 1 diabetes for table

pancreatic diabetes

Diabetes associated with destruction of the exocrine and endocrine functions of the pancreas, such as occurs in chronic or recurrent pancreatitis.

phlorhizin diabetes

Glycosuria caused by administration of phlorhizin.

renal diabetes

Renal glycosuria, marked by a low renal threshold for glucose. Glucose tolerance is normal and diabetic symptoms are lacking.

secondary diabetes mellitus

DM that results from damage to the pancreas (e.g., after frequent episodes of pancreatitis) or from drugs such as corticosteroids (which increase resistance to the effects of insulin).

steroid diabetes

Hyperglycemia caused by the use of exogenously administered corticosteroids, e.g., prednisone, methylprednisolone, or dexamethasone.

strict control of diabetes

Regulation of blood glucose to normal or nearly normal levels, both before and after meals. Tight control of blood sugar has been shown to improve the survival of patients in intensive-care units and to prevent long-term complications of DM, e.g., blindness, nerve damage, and kidney failure.

Patients with meticulously controlled DM typically have a hemoglobin A1c level of 6.5 to 7.0 or lower, fasting blood sugars that are less than 110 mg/dL, and after-meal blood sugar readings that are 140 mg/dL or less.

Synonym: tight control of diabetes

tight control of diabetes

Strict control of diabetes.

true diabetes

Diabetes mellitus.

type 1 diabetes

DM that usually has its onset before the age of 25 years, in which the essential abnormality is related to absolute insulin deficiency. It was formerly known as juvenile diabetes. See: table
Type 1Type 2
Age at onsetUsually under 30Usually over 40
Symptom onsetAbruptGradual
Body weightNormalObese—80%
HLA associationPositiveNegative
Family historyCommonNearly universal
Insulin in bloodLittle to noneSome usually present
Islet cell antibodiesPresent at onsetAbsent
Prevalence0.2–0.3%6%
SymptomsPolyuria, polydipsia, polyphagia, weight loss, ketoacidosisPolyuria, polydipsia, peripheral neuropathy
ControlInsulin, diet, and exerciseDiet, exercise, and often oral hypoglycemic drugs or insulin
Vascular and neural changesEventually developWill usually develop
Stability of conditionFluctuates, may be difficult to controlMay be difficult to control in poorly motivated patients

type 1a diabetes mellitus

The most common form of type 1 DM. It is caused by autoimmune destruction of the beta cells of the pancreas and inadequate insulin production. In type 1a DM, antibodies against insulin, islet cells of the pancreas, or glutamic acid decarboxylase is often present in the blood. The patient is prone to develop diabetic ketoacidosis if he or she is not treated with insulin.

type 1b diabetes mellitus

A relatively less common form of type 1 DM (seen in only about 10% of type 1 diabetics) in which autoimmune antibodies against insulin, pancreatic beta cells, or their protein products are not found in the blood. Beta cells are nonetheless destroyed (by unknown means), and the patient develops hyperglycemia or ketoacidosis unless he or she receives insulin. Synonym: idiopathic diabetes

type 2 diabetes

A type of DM that occurs predominantly in adults. The insulin produced is sufficient to prevent ketoacidosis but insufficient to meet the total needs of the body, and resistance to the effects of insulin on peripheral tissues is often present. This type of diabetes in nonobese patients can usually be controlled by diet and oral hypoglycemic agents (e.g., sulfonylurea drugs or metformin). Eventually, insulin therapy is often required. In some patients the condition can be controlled by careful diet and regular exercise. Synonym: non–insulin-dependent diabetes mellitus See: type 1 diabetes for table

unstable diabetes mellitus

Brittle diabetes.

diabetes

See DIABETES MELLITUS.

diabetes

a metabolic disorder, either where there is an increase in the amount of urine excreted (diabetes insipidus), or where excess sugar appears in the blood and urine, associated with thirst and loss of weight (diabetes mellitus). The former is caused by the failure of the pituitary to secrete ADH, and the latter by the failure of the ISLETS OF LANGERHANS to produce sufficient insulin.

Diabetes

A disease characterized by an inability to process sugars in the diet, due to a decrease in or total absence of insulin production. May require injections of insulin before meals to aid in the metabolism of sugars.Mentioned in: Adrenal Gland Cancer, Pancreatitis, Retinal Hemorrhage

diabetes

A chronic disease that occurs when the pancreas does not produce enough insulin, or alternatively, when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels (definition of the World Health Organization). The most common types of diabetes are: Type 1 diabetes, which is characterized by a lack of insulin production and therefore dependent upon insulin administration and Type 2 diabetes, which is characterized by an ineffective use of insulin. Type 1 diabetes is the most common type in young people whereas type 2 is the most common diabetes and affects primarily but not exclusively adults and it is largely the result of obesity and physical inactivity. The main complications in the eye are retinopathy, cataract, rubeosis iridis, ocular motor nerve palsies, xanthelasma and ptosis. See accommodative insufficiency; anisocoria; neovascular glaucoma; open-angle glaucoma; hypoxia; lenticular myopia; paralysis of the sixth nerve; paralysis of the third nerve; Adie's pupil; tritanopia; vitrectomy; vitreous detachment.

di·a·be·tes

(dī-ă-bē'tēz) Avoid using the simple word diabetes for diabetes mellitus unless the sense is clear from the context. Either diabetes insipidus or diabetes mellitus, diseases having in common the triad of symptoms polyuria, weight loss, and significant glucosuria.[G. diabētēs, a compass, a siphon, diabetes]

Patient discussion about diabetes

Q. My 7yr has Diabetes. She been Diabetic for about 5 weeks and we can't get numbers at a good spot. she aether way to low (30- 60 scary when she gets like this) and to high (300 - 400) We been looking at what she eating calling the physician. he been play with here shots but nothing working. Its when she at school is were the nuber are mostly going up an down. we been trying to work with the school but she the only one in the hole school that has Diabetes. what to do ? A. Try to reduce her stress.
Keep an eye on her, but don't make it sound like such a big deal.

Q. how diabetes is caused A. Diabetes is the inability of the body to ‘produce insulin - type 1 diabetes’ or ‘proper use of insulin - type 2 diabetes, gestational diabetes and pre-diabetes’. Diabetes is often goes undiagnosed because many of the symptoms of diabetes seems harmless. The causes of diabetes continues to be a mystery, pancreas it the organ whose defect causes diabetes.
for further information please visit:
http://healthy-ojas.com/html/diabetes_mellitus.html
Here we can find information on alternative medicines for diabetes.

Q. my grandmother was diabetic ... and i learned that diabetic is genetic ... should i be concern for me or or for one of my family reletives ... she suffered a lot and she died of it .. if a blood tests shows high amount of sugar in my blood , does i mean i am diabetic ?

More discussions about diabetes
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更新时间:2024/12/22 18:44:52