Diabetes

4 Key excerpts on "Diabetes"

• 

  eBook - ePub

  Metabolic Regulation

  A Human Perspective

  • Keith N. Frayn(Author)
  • 2013(Publication Date)
  • Wiley-Blackwell

    (Publisher)

  11

  Diabetes Mellitus

  Key learning points

  • Diabetes mellitus (commonly called Diabetes) refers to a condition in which blood glucose concentrations are elevated above the normal range.
  • The most common forms are Type 1 Diabetes, in which autoimmune destruction of the pancreatic ß-cells abolishes insulin secretion, and Type 2 Diabetes, which involves a combination of insulin resistance (insulin failing to act normally on its target tissues) and pancreatic ß-cell failure.
  • The metabolic disturbances of Diabetes largely reflect a lack of insulin action. If these are very severe (e.g., in a patient with Type 1 Diabetes who is not treated with insulin), then marked breakdown of stored fuels will occur, and the blood becomes acidic because of the presence of ketone bodies and non-esterified fatty acids: this is the condition known as diabetic ketoacidosis.
  • In Type 2 Diabetes, the metabolic features may not be so severe, but there is often an accompanying disturbance of lipoprotein concentrations similar to the atherogenic lipoprotein phenotype described in Chapter 10. This leads to increased risk of atherosclerosis.
  • Treatment of Type 1 Diabetes always involves replacing insulin. There are many classes of drug available for Type 2 Diabetes, which act on various aspects of metabolic regulation covered elsewhere in this book.
  • Both forms of Diabetes are also characterized by the development of longer-term complications in some people. These complications involve damage to blood vessels and nerves. There is strong evidence that the so-called microvascular complications, affecting capillaries (and hence nerves, retina, and kidney), can be reduced by strict control of the blood glucose concentration. The evidence is less strong for the macrovascular complications (atherosclerosis). Biochemical mechanisms underlying the complications are partly understood and may involve inceased oxidative stress.

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  eBook - ePub

  Global Health Perspectives In Prediabetes And Diabetes Prevention

  • Michael Bergman(Author)
  • 2014(Publication Date)
  • WSPC

    (Publisher)

  Chapter 1: Diagnosis and Definition

  Martin Buysschaert * , Vanessa Preumont ,† Jose Luis Medina ‡ and Michael Bergman §

     

  Diabetes mellitus is a metabolic disorder of multiple etiologies. Specifically, type 2 Diabetes is characterized by chronic hyperglycemia together with disturbances of carbohydrate, fat, and protein metabolism. This condition results from defects of insulin secretion, insulin action, or both, as a consequence of a combination of genetic predisposition, unhealthy diet, physical inactivity, and increased weight.

  1 ,2

  Type 2 Diabetes is a growing public health challenge globally with an estimated prevalence of the disease in 285 million people (corresponding to 6.4% of the world’s adult population), which is expected to reach more than 550 million (7.8% of the population) by 2030, according to recent projections of the International Diabetes Federation (IDF). Of the total, 70% of these cases occur currently in low- and middle-income countries.

  3 ,4

  Long-term hyperglycemia in type 2 Diabetes is associated with progressive damage of various organs, including eyes, kidneys, nerves, heart, and blood vessels, with premature mortality and has considerable economic impact.2

  Prior to the development of type 2 Diabetes, glucose levels can increase in a prediabetic state that may exist for many years before type 2 Diabetes comes to be diagnosed.

  5 ,6

  Dysglycemia is characterized by higher glucose levels than normal but lower than defined by conventionally established thresholds for Diabetes. Globally, preDiabetes should not be viewed as a clinical entity but rather a risk factor for Diabetes development as well as for cardiovascular disease. This high-risk prediabetic state includes isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT), or combined IFG/IGT.7 The prevalence of IFG/IGT increases with age as indicated in the DECODE Study (IGT increased from 3.9% in 30 to 39-year-old men to 15.1% in the 70- to 79-year-old age group and from 4.5 in 30- to 39-year-old women to 16.9% in the 70- to 79-year-old age group).8 It has been predicted that globally there will be 470 million people in 2030 with preDiabetes.4

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  eBook - ePub

  Practical Endocrinology and Diabetes in Children

  • Malcolm D. C. Donaldson, John W. Gregory, Guy Van-Vliet, Joseph I. Wolfsdorf(Authors)
  • 2019(Publication Date)
  • Wiley-Blackwell

    (Publisher)

  1 Diabetes Mellitus

  • Definition
  • Incidence
  • Biochemistry
  • Clinical presentation
  • Investigations
  • Initial management of newly diagnosed type 1 Diabetes
  • Insulin therapy in type 1 Diabetes
  • Dietary management
  • Management of the child presenting with ketoacidosis
  • The Diabetes clinic
  • Monitoring and assessment of Diabetes control
  • Exercise
  • Diabetes in preschool‐aged children
  • Diabetes in adolescence
  • Hypoglycaemia in youth with Diabetes
  • Recurrent DKA and its prevention
  • Management of Diabetes during intercurrent illness (‘Sick Day Rules’)
  • Management of Diabetes when travelling
  • Management of Diabetes during surgery
  • Long‐term complications of Diabetes
  • Type 2 Diabetes in children and adolescents
  • Miscellaneous practical matters
  • Endocrine and other disorders associated with Diabetes
  • Unusual causes of Diabetes in childhood
  • Audit and benchmarking
  • Future developments
  • Controversial points
  • Potential pitfalls
  • Case histories
  • Significant Guidelines/Consensus Statements
  • References
  • Useful Information for Patients and Parents
  • Advice on transition from paediatric to adult care

  Definition

  Diabetes mellitus is a heterogeneous disorder characterized by abnormal metabolism of carbohydrate, fat and protein with persistent fasting or postprandial hyperglycaemia resulting from defects in insulin secretion or insulin action (Skyler et al. 2017 ). It is diagnosed in one of four ways (see Table 1.1 ) (American Diabetes 2018 ). A fasting plasma glucose (PG ) of 5.6–6.9 mmol/L (100–125 mg/dL) is considered preDiabetes, whereas <5.6 mmol/L (<100 mg/dL) is normal. The oral glucose tolerance test (OGTT ) is not recommended for routine clinical use. When classic symptoms are present, the diagnosis is usually straightforward and an OGTT is seldom needed; however, an OGTT may be indicated when mild hyperglycaemia is discovered without symptoms (e.g. in the sibling of a child with Diabetes or in children with disorders such as cystic fibrosis (CF

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  eBook - ePub

  Vitamin D

  Two-Volume Set

  • David Feldman, J. Wesley Pike, John S. Adams, David Feldman, J. Wesley Pike, John S. Adams(Authors)
  • 2011(Publication Date)
  • Academic Press

    (Publisher)

  Chapter 94 Vitamin D and Diabetes

  Conny Gysemans, Hannelie Korf and Chantal Mathieu, Katholieke Universiteit Leuven, Leuven, Belgium

  Introduction

  Diabetes mellitus is a common disease in the Western world, with an estimated prevalence of 4 to 5%. The majority (95%) of diabetic patients suffer from type 2 Diabetes or non-insulin-dependent Diabetes, a metabolic syndrome characterized by insulin resistance and relatively inadequate insulin production by the beta cell in the pancreatic islets of Langerhans [1] . In this metabolic syndrome it is still unclear whether the primary dysfunction is situated in the peripheral insulin target organs (being mainly liver, fat, and skeletal muscle) [2] or in the beta cell itself [3 ,4] . Insulin resistance is induced by obesity and sedentary lifestyle and is also involved in the pathogenesis of cardiovascular disease. This insulin resistance is probably the major determinant of the disease, but beta cell dysfunction is always present and will determine the severity of the clinical presentation. Type 1 Diabetes, also known as juvenile or insulin-dependent Diabetes mellitus, is a totally different disease in etiology. It has become clear in recent years that this disease is an autoimmune disorder, characterized by a destruction of the insulin-producing beta cells in the pancreas by the body’s own immune system [5] . Whereas type 2 Diabetes is a typical disease of the obese and aging patient, type 1 Diabetes mainly occurs in children and adolescents.

  Since expression of the vitamin D receptor (VDR) has been described in the majority of immune and metabolic cell types involved in the pathogenesis of both types of Diabetes [6 ,7] , scientists and clinicians have been intrigued by a possible role for these molecules in the disease process, but even more so, their therapeutic potential in the prevention of disease progression [7 –9] . In this chapter, the main effects of vitamin D, and its activated form, on the beta cell, with direct implications for the pathogenesis and prevention of mainly type 2, but also type 1 Diabetes, will be described and discussed. Furthermore, the role of vitamin D and 1,25(OH)2 D3

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