Tuesday, August 19, 2008

Diabetes Mellitus

Diabetes is the term used for two different endocrine diseases, both of which are characterized by excessive urination and thirst. Diabetes Mellitus is a pancreatic disease affecting carbohydrate, protein, and lipid metabolism. In severe diabetes mellitus, the concentration in the blood of a sugar, glucose, is markedly elevated and large amounts of glucose are excreted in the urine. Diabetes insipidus is a condition associated with the inability of the kidney to conserve water. It is caused by a failure of a hypothalamus to release antidiuretic hormone. The discussion on this article is limited to Diabetes Mellitus which is a far more prevalent and important diseases than Diabetes Insipidus.

Type of Diabetes Mellitus
Diabetes Mellitus is doe to an inability of the Pancreas to secrete sufficient Insulin to maintain a normal blood-glucose concentration. Secondary diabetes results from damage to or removal of the pancreas. Primary diabetes, the most common type is probably caused by both environmental and genetic factors.

The insulin dependent from of primary diabetes generally has its onset on childhood and characteristic by severe insulin deficiency. Without insulin, diabetic will develop ketoacidosis (high level of ketone bodies in blood, causing low blood pH and possible hearth failure) and coma (caused by high level of blood glucose).

The non-insulin dependent form usually occur in obese people of age 40 or older. They have higher than normal level of insulin, although the insulin is less effective in lowering blood glucose than in diabetics and they are rarely develop ketoacidosis. This pattern is also seen in population that have recently adopted Western process-food diets. Some women developed elevated glucose level during pregnancy, called gestational diabetes, which disappear after they give bird but leave them with an increase risk of developing non-insulin dependent diabetes in the future.

Diagnosis and Treatment
A variety of methods may be used to diagnose diabetes mellitus. In the glucose tolerance test, for example, abnormal glucose metabolism is identified by having a patient who has fasted for 1.8 to 24 hours drink a concentrated solution o glucose; glucose concentration is then measured in blood and urine samples taken ½, 1, 2, and 3 hours after ingestion. The most reliable diagnostic methods detect a blood glucose concentration greater than 140 milligrams per deciliter (normal is 70-1900 mg/dl) after an overnight fast. Also, the presence of 64 K antibody has proved a good predictor of insulin dependent diabetes.

After the isolation of insulin by Frederick G. Banting and Charles Best in 1921, death from ketoacidosis and diabetic coma decreased dramatically. The prolonged life span revealed long-term complications, however, including kidney failure, atheroscierotic heart diseases, blindness, and disorders of the nervous system. These complications are believed to be related to elevated blood-glucose concentrations. The objective of diabetes treatment, therefore, is to restore blood glucose to normal. In obese non-insulin-dependent diabetics the treatment of choice is weigh loss. If this method does not suffice, then oral hypoglycemic agents or insulin is required. Oral hypoglycemic agent act primarily by stimulating the patient’s pancreas to secrete additional insulin.

Insulin-dependent diabetics traditionally have been treated with one or two daily injections of slowly absorbable insulin. This made of insulin therapy; however, result in poor control of the blood glucose. The mimic the closely linked changes in blood glucose and insulin concentrations that occurs in healthy non-diabetics, new techniques for insulin is either injected with a syringe or infused using a small pump under the skin prior to each meal. Low insulin concentrations are maintained between meals by injecting a long-acting insulin preparation or by infusing insulin continuously. New forms of therapy, such as islet or pancreas transplantation, are aimed at normalizing glucose levels.
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