What is diabetes?

          Type-2 diabetes is the most common form of diabetes, accounting for 90% of cases diabetes. This disease affects nearly 17 million Americans and is the seventh leading cause of death in the United States. Even though 17 million Americans have type-2 diabetes only half of these people are aware that they have diabetes. The death rate in patients with diabetes may be up to 11 times higher than in persons without the disease. The occurrence of diabetes in persons 45 to 64 years of age is 7 percent, but the proportion increases significantly in persons 65 years of age or older. Type-2 diabetes accounts for more than 90% of all diabetes worldwide. Over 100 million people worldwide have type-2 diabetes, and the prevalence is increasing dramatically in both the developed and developing worlds. Type-2 diabetes is a lifelong illness, which generally starts in middle age or later part of life, but can start at any age. It has a different cause than Type-1: patients with type-2 diabetes do not respond properly to insulin, the hormone that normally allows the body to convert blood glucose into energy or store it in cells to be used later. The problem in type-2 diabetes is not lack of insulin production; most of these patients produce variable, even normal or high, amounts of insulin. The first stage in type-2 diabetes is the condition called insulin resistance. Insulin helps glucose to enter cells, where it is used for energy. In patients with insulin resistance, although insulin can attach normally to receptors on liver and muscle cells, certain mechanisms prevent insulin from moving glucose into these cells where it is utilized. As a result body starts making more and more insulin and in the beginning, this amount is usually sufficient to overcome such resistance, but during the later phases of the disease the insulin resistance increases in severity and, blood glucose increases, but at the same time the body is unable to use it properly, and the bodys cells are actually starving for energy. Even with increased amounts of insulin the insulin demands of the body is not met because of the increasing tissue resistance. Because the body does not use insulin properly, blood glucose rises above the safe level. The initial effect at this stage may be an abnormal rise in blood glucose right after a meal (called postprandial hyperglycemia). Type-2 diabetes differs from type-1 diabetes in that type-1 diabetes is always caused by the body's inability to make enough insulin.

          Type-1 diabetes typically arises in early life, and would result in lifelong dependence on insulin therapy. In contrast type-2 diabetes generally starts in the later part of life and is often treated initially with diet modification alone or by oral medications. The exact mechanisms by which people get insulin resistance in type-2 diabetes are not wholly known. Just because in type-2 diabetes daily injections of insulin are not given, doesnt mean that it is a milder form of the disease. The consequences of sustained poor blood glucose control can be severe in all forms of diabetes and include damage to the eyes, kidneys and nerves, as well as increased risk of complications in the larger blood vessels (leading to heart attacks and strokes). Type-2 diabetes tends to run in families. Though there are many available and effective treatments for type-2 diabetes, it may be extremely difficult to achieve the desired ultimate target namely, lifelong restoration of normal glucose control. If blood glucose remains high for years, blood vessels and nerves throughout the body may be damaged, putting you at increased risk for eye, heart, blood vessel, nerve, and kidney illness.

          Blood glucose levels may even before diabetes symptoms occur. Over the long term, high blood glucose can lead to medical complications such as heart illness, kidney failure, nerve damage, infections, and blindness. Not everyone with type-2 diabetes needs medicines or insulin replacement therapy and many can be treated with diet modifications and exercise. Family history is the number-one risk factor for type-2 diabetes and obesity is a strong second risk factor. Doing little or no exercise is another risk factor for this disease

Risk factors for the development of type-2 diabetes

• Close family member like parents or siblings with diabetes
• Obesity
• African American, Hispanic or Native American, Asian American, Pacific Islander
• Age more thant 45
• Hypertension
• History of developing high blood sugar during pregnancy or birth of a baby weighing more than 9 lb

Symptoms of diabetes

These are the classical symptoms of diabetes

• Frequent urination because of large volume of urine (polyuria),
• Excessive thirst (polydipsia),
• Hunger and eating more (polyphagia), and
• Loss of weight despite eating more

Less common symptoms may include:

• Tiredness
• Head aches and pains
• Blurring of vision
• Dry skin
• Dry mouth,
• Impotence (in a male)
• Vaginal yeast infections (in a female)
• Difficulty in healing of cuts and scrapes, or
• Excessive infections or infections with unusual bugs

Treatment of type-2 diabetes

Oral agents used in the treatment of type-2 diabetes

• Sulfonylureas
• Metformin
• Alpha-Glucosidase Inhibitors
• Troglitazone
• Repaglinide

Sulfonylureas

Despite the development of several new classes of drugs, sulfonylureas still play a primary role in the treatment of type-2 diabetes

First generation Sulfonylureas

• Orinase (tolbutamide)
• Tolinase (tolazamide)
• Diabinese (chlorpropamide)

Second generation Sulfonylureas

• Glucotrol (glipizide)
• Micronase, Diabeta (glyburide)
• Glynase (micronized gly)

Third generation Sulfonylureas

• Amaryl (glimepiride)

Metformin

Metformin is used alone or together with sulfonylureas for treatment of type-2 diabetes. When used alone, metformin does not cause low blood sugar. This drug should not be used if the kidney function is abnormal. This drug may be stopped for few days if you are having a procedure like CT scan using intravenous dye.

Alpha-Glucosidase Inhibitors

Acarbose (Precose) and miglitol (Glyset), are the commonly used drugs in this group and can be used alone or in combination with sulphonylureas. These drugs block the breakdown of complex carbohydrates and delay the absorption of glucose from the gastrointestinal tract. The dose should be increased slowly to decrease the side-effects of flatulence and gastrointestinal upset.

Thiazolidinediones

Thiazolidinediones group of drugs are called "insulin sensitizers" that promote uptake of glucose by the muscle.

Troglitazone is the first agent of this drug from this class that was introduced for the treatment of type-2 diabetes. This drug should not be used alone. This drug was withdrawn from the market due to side effects. Rosiglitazone (Avandia) and pioglitazone are the newer drug in this group.

Repaglinide

This drug has a mechanism of action similar to sulfonylureas and the side effects are also resmble sylfonylurea. Repaglinide is a suitable option for patients with severe sulfa allergy who are not candidates for sulfonylurea therapy. The drug is used alone or in combination with metformin.

Insulin

Even though type-2 diabetes patients are generally resistant to the action of insulin, this drug may be a reasonable choice in some situations.

More details on diabetic drugs

Home glucose monitoring

The goal of diabetes treatment is to keep your blood sugar level as close to normal as possible. Home blood glucose monitoring helps people with diabetes to monitor their blood glucose levels throughout the day. For millions of Americans with diabetes, regular home testing of blood glucose levels is critical in controlling their disease. Self-monitoring of blood glucose (SMBG) is an important part of the care and management of people with diabetes. The first step is to eat a healthy diet and exercise regularly. Monitoring allows them to make immediate changes in their treatment plan when needed.

There are a variety of meters available for use in home blood glucose testing. It is important to use SMBG effectively and efficiently since it is a relatively expensive intervention and patients often find it is painful.

Extra monitoring of blood glucose should be done when:

• Low blood sugar is suspected
• More physical activity is done
• Weight loss or gain occurred
• Pregnant, or planning a pregnancy
• One is not sure about symptoms of low blood sugar
• Levels too high or too low
• Intensive insulin therapy

Prevention of type-2 diabetes

Your best chance of prevention of diabetes is avoid obesity and to do regular exercise. You should avoid foods that cause high rises in blood sugar and should eat a healthy diet If you have high risk of developing diabetes you may get benefit by taking metformin (glucophage).