DASG - Diabetes in Asia Study Group

At present there are at least 246 million people with diabetes world wide. Diabetes is Fast Becoming a world pandemic. There are at least ………. million people with diabetes in the world day. This figure is expected to be 333 million in the year 2025.

People with diabetes are two to four times more likely to develop cardiovascular disease than people without diabetes unless preventive action is taken NOW!

What is Diabetes?
Diabetes essentially means that your blood glucose/ blood sugar is too high!!!! Insulin (a hormone secreted by the pancreas) helps the cells absorb blood.

Types of Diabetes.
Type 1 diabetes, or juvenile-onset diabetes or insulin-dependent diabetes, IDDM In this form of disease, the pancreas is not able to produce insulin.

Type 2 diabetes, adult-onset diabetes or non insulin-dependent diabetes NIDDM. The fat, muscle and liver cells are not able to use insulin properly. The pancreas secretes additional insulin but later cannot meet the demand. Being overweight and inactive increasing the chance of developing type 2 diabetes.

Gestational diabetes. Some women develop diabetes during the last stage of pregnancy due to hormonal imbalances.

Musculoskeletal Rheumatism

Soft tissue rheumatism is very common in diabetics. It could affect the muscles, tendons, capsule of joints, etc. So those having high blood sugar levels are more likely to have more body and joint pain. Some of the common aches and pains associated with a diabetic are pain in the shoulder with stiffness, pain on bending fingers with difficulty in straightening them, tingling in the hand and fingers due to pressure on the nerve at the wrist puffiness of the hand. Sometimes there is thickening of the skin over the upper back or stiffness of the neck and back due to calcification of spinal ligaments.

These are only some of the common musculoskeletal complications noted in diabetic patients.

What is Diabetes Mellitus?

Diabetes mellitus is a metabolic disorder characterized by a congenital (similar to juvenile-onset or Type I diabetes mellitus in people) or acquired (similar to adult-onset or Type II diabetes mellitus in people) inability to transport sugar from the bloodstream into cells. Once inside cells, sugar (glucose) is used to generate the energy that is essential for normal cellular function. Diabetes in animals is most commonly the acquired form and typically occurs in middle-aged to older pets. The disease results when glucose transport channels on cell membranes are insensitive to the effects of insulin (or when there are too few channels) or when the quantity of insulin produced by the pancreas is inadequate to activate the number of glucose channels needed to maintain normal cellular metabolism. In other words, insulin is the "key" that allows special "gates" for sugar transport across cell membranes to be opened. A diabetic, therefore, has too much glucose in the bloodstream where most of it cannot be utilized, and not enough glucose within the cells themselves, where it is most needed for energy. As a result, cells attempt to derive energy from alternate metabolic pathways, such as fat breakdown. Excessive use of these alternate energy pathways culminates in production of harmful by-products called ketones. The accumulation of ketones causes the body's pH to become acidic (ketoacidosis) which makes the cellular environment inhospitable for normal metabolic functions. This condition can ultimately become life-threatening and requires aggressive medical therapy. Fortunately, most diabetics give some indication of their underlying condition, such as drinking and urinating excessively, before they develop ketoacidosis. Treating diabetics before they become ketotic is considerably more straightforward, safer, and of course less expensive than taking a "wait-and-see" approach to changes in drinking behavior. Equally important, diagnostic testing may reveal other serious conditions which can cause excessive urination and drinking, such as kidney or liver disease, adrenal hormone or electrolyte imbalances and uterus infections.

Type 1 Diabetes Mellitus

Alternative names

Insulin-dependent diabetes mellitus; Juvenile onset diabetes; Diabetes - Type 1

Definition

Type 1 diabetes is a chronic (lifelong) disease that occurs when the pancreas produces too little insulin to regulate blood sugar levels appropriately.

Causes, incidence, and risk factors

Diabetes is a life-long disease for which there is not yet a cure. There are several forms of diabetes, including:

Type 1 diabetes, often called juvenile or insulin-dependent diabetes
Type 2 diabetes, often called adult or non-insulin-dependent diabetes
Gestational diabetes, which occurs during pregnancy.

For all types of diabetes, the metabolism of carbohydrates (including sugars such as glucose), proteins, and fats is altered.

In type 1 diabetes, the beta cells of the pancreas produce little or no insulin, the hormone that allows glucose to enter body cells. Once glucose enters a cell, it is used as fuel.

Without adequate insulin, glucose builds up in the bloodstream instead of going into the cells. The body is unable to use this glucose for energy despite high levels in the bloodstream, leading to increased hunger. In addition, the high levels of glucose in the blood causes the patient to urinate more, which in turn causes excessive thirst. Within 5 to 10 years after diagnosis, the insulin-producing beta cells of the pancreas are completely destroyed, and no more insulin is produced.

Type 1 diabetes can occur at any age, but it usually starts in people younger than 30. Symptoms are usually severe and occur rapidly.

The exact cause of type 1 diabetes is not known. Type 1 diabetes accounts for 3% of all new cases of diabetes each year. There is 1 new case per every 7,000 children per year. New cases are less common among adults older than 20.

Symptoms

increased thirst
increased urination
weight loss despite increased appetite
nausea
vomiting
abdominal pain
fatigue
absence of menstruation

Signs and tests
The following tests can be used to diagnose diabetes:

urinalysis shows glucose and ketone bodies in the urine, but a blood test is required for diagnosis.
fasting blood glucose is 126 mg/dL or higher.
random (nonfasting) blood glucose exceeds 200 mg/dL (this must be confimed with a fasting test).
insulin test (low or undetectable level of insulin).
C-peptide test (low or undetectable level of the protein C-peptide, a by-product of insulin production).

Treatment
At diagnosis, the immediate goals of treatment are to treat diabetic ketoacidosis (also called DKA) and high blood glucose levels. Because of the sudden onset and severity of symptoms in type 1 diabetes, treatment for newly diagnosed people may involve hospitalization.

The long-term goals of treatment are to prolong life, reduce symptoms, and prevent diabetes-related complications such as blindness, kidney failure, and amputation of limbs.

These goals are accomplished through education, insulin use, meal planning and weight control, exercise, foot care, and careful self-testing of blood glucose levels.

INSULIN

Insulin lowers blood sugar by allowing it to leave the blood stream and enter cells. Everyone needs insulin. People with type I diabetes can't make their own insulin, and they must take insulin every day.

Insulin is injected under the skin using a syringe, or in some cases, an infusion pump delivers the insulin continuously. It is not available in an oral form.

Insulin preparations differ in how fast they start to work and how long they last. The health care professional reviews blood glucose levels to determine the appropriate type of insulin the person should use. More than one type of insulin may be mixed together in an injection to achieve the best control of blood glucose.

The injections are needed, in general, from 1 to 4 times a day. People are taught how to give insulin injections by their health care provider or a diabetes nurse educator. Initially, a child's injections may be given by a parent or other adult. By age 14, most children can be expected (but should not be required) to give their own injections.

DIET
Meal planning for type 1 diabetes requires consistency to allow food and insulin to work together to regulate blood glucose levels. If meals and insulin are out of balance, extreme variations in blood glucose can occur.

The American Diabetes Association and the American Dietetic Association has information for planning healthy, balanced meals. Consultation with a registered dietitian or nutrition counselor is an invaluable tool for meal planning and dietary control for diabetics.

PHYSICAL ACTIVITY
Regular exercise is especially important for the person with diabetes, as it helps control the amount of sugar in the blood and helps burn excess calories and fat to achieve optimal weight.

Before people with diabetes begin any exercise program, they should obtain medical approval. Type 1 diabetics must take special precautions before, during and after participation in intense physical activity or exercise.

SELF-TESTING
Blood glucose monitoring is done by checking the glucose content of a small drop of blood. The testing is done on a regular basis and will inform the person with diabetes how well diet, medication, and exercise are working together to control diabetes.

The results can be used to adjust meals, activity, or medications to keep blood-sugar levels within an appropriate range. It will provide valuable information for the health care provider to suggest changes to improve care and treatment. Testing will identify high and low blood-sugar levels before serious problems develop.

FOOT CARE
People with diabetes are prone to foot problems because of complications related to the illness. Diabetes causes damage to the blood vessels and nerves, which can result in a decreased ability to sense trauma or pressure on the foot. A foot injury could go unnoticed until severe infection develops.

Additionally, diabetes alters the bodies immune system, decreasing the body's ability to fight infection. Small infections can rapidly progress to death of the skin and other tissues, necessitating amputation of the affected limb.

To prevent injury to the feet, diabetics should adopt a daily foot care routine.

TREATING LOW BLOOD SUGAR
Low blood sugar, known as hypoglycemia, can occur in diabetics when they use too much insulin, exercise too much, or have not eaten enough food. Hypoglycemia can develop quickly in people with diabetes. Symptoms of low blood sugar typically appear when the sugar level falls below 70. Watch for weakness, shaking, sweating, headache, nervousness, and hunger.

If these symptoms occur and you have a blood sugar test kit available, do a blood sugar check. If the level is low, the person with diabetes should eat something with sugar: fruit juice, several teaspoons of sugar, a cup of skim milk, or regular soda. If you don't have a test kit handy, sugar should be eaten anyway - it can't hurt. Symptoms should subside within 15 minutes. If the symptoms don't subside, more sugar should be eaten and the sugar level tested again. AFTER the symptoms subside, more substantial food can be eaten. Eat simple sugar FIRST to get the situation under control. Even if you or your child is hungry, "real" food should not be eaten until the sugar level comes up - real food won't produce enough sugar and takes too long to digest.

If you are a parent, relative, or friend of someone experiencing these symptoms, monitor the person closely. If symptoms become worse -- confusion, seizures, or unconsciousness -- give the person a shot of glucagon. If you don't have glucagon, call 911 immediately.

You should have some glucagon stored for emergencies. Make sure everyone in your home, as well as babysitters and caregivers, knows how to use it. Periodically remind everyone how to use it, and check the expiration date.

Don't panic. Glucagon works very fast -- usually within 15 minutes. While you are waiting for the person to revive, keep him on his side to prevent choking. If the person is not better in 15 minutes, call 911.

TREATING HIGH KETONES
When there is not enough insulin to move glucose into cells, glucose can build up in the blood. The body then looks for other forms of energy and uses fat as a fuel source. As fats are broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous to body tissue. This condition is known as ketoacidosis.

You can check for ketones using a simple urine test available at pharmacies. This test should be performed every 4-6 hours anytime a person with diabetes is registering blood sugar above 240; sick; unusually thirsty or has a dry mouth; urinating frequently; or vomited

The warning signs that ketoacidosis is getting serious might include flushed face, dry skin and mouth, nausea or vomiting, stomach pain, deep, rapid breathing, or fruity breath odor.

If these symptoms occur, call the doctor or go to the emergency room right away. If left untreated, this condition will lead to coma and even death.

MONITORING

Visit your physician and/or diabetes educator at least 4 times a year.
Have your glycosylated hemoglobin (HbA1c) measured 2-4 times a year to evaluate your overall glucose control.
(Ask your doctor how often you should be tested.)
function evaluated yearly.
Visit your ophthalmologist (preferably one that specializes in diabetic retinopathy) at least once a year, more frequently if signs of diabetic retinopathy develop.
Every 6 months have a thorough dental cleaning and examination. Inform your dentist and hygienist that you have diabetes.
Monitor your feet every day for early signs of injury or infection. Make sure your health care provider inspects your feet at each visit.
Stay up-to-date with all of your vaccinations (including pneumococcal), and get a flu shot every year in the fall.

EDUCATION
You are the most important person in managing your diabetes. Diabetes education is a crucial part of the treatment plan. Diabetes education basically involves learning how to live with your diabetes.

Knowledge of disease management is imperative to avoid developing short-term complications such as hypoglycemia and hyperglycemia and to delay or slow the onset of long-term complications of the disease such as diabetic retinopathy (eye disease) or nephropathy (kidney disease).

You should be knowledgeable about the basic principles of diabetes management. Basic "survival skills" include:

how to recognize and treat low blood sugar (hypoglycemia)
how to recognize and treat high blood sugar (hyperglycemia)
diabetes meal planning " how to administer insulin
how to monitor blood glucose and urine ketones
how to adjust insulin and/or food intake during exercise
how to handle sick days
where to buy diabetic supplies and how to store them

Expectations (prognosis)
The outcome for people with diabetes varies. Recent studies show that tight control of blood glucose can prevent or delay the progression of eye disease, kidney disease and nervous system disease that is caused by diabetes. However, complications may occur even when good diabetes control is achieved with insulin and diet.

Complications
EMERGENCY COMPLICATIONS:

DIABETIC KETOACIDOSIS

In a person with type 1 diabetes, the body will use fat as a fuel if insulin is not present. The by-products of fat metabolism are ketones. Ketones build up in the blood and "spill" over into the urine.

A condition called ketoacidosis develops when the blood is made acidic by the ketones.

HYPOGLYCEMIA

Hypoglycemia (low blood glucose) occurs when the balance between insulin, food intake, and exercise is disturbed. Symptoms of mild hypoglycemia include hunger, nervousness, and fast heart rate. More serious hypoglycemia can lead to confusion and even loss of consciousness. Loss of consciousness due to low blood sugar is called hypoglycemic coma.

LONG-TERM COMPLICATIONS:

People who have had diabetes for several years are likely to develop long-term complications, which can be minimized but not entirely eliminated by proper diabetic management:

VASCULAR DISEASE

By age 55, about 35% of men and women with type 1 diabetes have died from a heart attack compared to 8% of nondiabetic men and 4% of nondiabetic women.

People with type 1 diabetes are also at higher risk to develop blockages in the major arteries of the legs than nondiabetics. Lower the risk of vascular disease by aggressively treating cholesterol and blood pressure, exercising regularly, and avoiding or quitting tobacco products.

MICROVASCULAR DISEASE

Microvascular (small vessel) changes occur in capillaries of every organ of the body. There is a thickening of the wall of the small blood vessels. These changes are responsible for many of the diabetes complications.

EYE COMPLICATIONS

Changes in the small blood vessels of the retina (also known as diabetic retinopathy) predispose the diabetic to several eye disorders. After 15 years of diabetes, 80% of diabetics will have some diabetic retinopathy. If bleeding and scarring has developed, a retinal detachment may occur, causing blindness. Vascular changes in the iris may cause obstruction of the flow of ocular fluid and cause glaucoma. Diabetics are also more likely than nondiabetics to develop cataracts.

DIABETIC NEPHROPATHY (kidney disease)

Kidney abnormalities may be noted early in the disease. Poorly controlled diabetes may accelerate the development of kidney failure. Urinary tract infections in diabetics tend to be more severe and may result in kidney damage.

Diabetics are more vulnerable to kidney damage from high blood pressure than nondiabetics.

DIABETIC NEUROPATHY(nerve damage)

People with diabetes may develop temporary or permanent damage to nerve tissue. Diabetic neuropathy is more likely to develop if blood glucose is poorly controlled. Some diabetics will not develop neuropathy, while others may develop this condition relatively early.

On average, symptoms such as numbness and tingling occur 10 to 20 years after diabetes has been diagnosed.

DIABETIC FOOT PROBLEMS

The feet of people with diabetes are very susceptible to infection and injury. Many diabetes-related hospital admissions are for foot problems, and a significant number of non-accident-related leg amputations are performed on diabetics.

Several foot problems are common in people with diabetes, including skin changes (loss of hair; loss of ability to sweat; and dry, cracked skin), arterial insufficiency (impaired blood supply to feet), neuropathy, and specific foot deformities (hallux valgus, bunion, hammertoe, and calluses).

SKIN AND MUCUS MEMBRANE PROBLEMS

People with diabetes are more likely than nondiabetics to develop infections. Hyperglycemia (high blood sugar) predisposes diabetics to fungal infections of the skin, nails, and female genital tract and to urinary tract infection.

Calling your health care provider

Medical follow-up for a person newly diagnosed with type 1 diabetes should probably occur weekly until good control of blood glucose is achieved. The health care provider will want to review results of home glucose monitoring and urine testing, and a diary of meals, snacks, and insulin injections. As the disease becomes more stable, follow-up visits will be less frequent. Periodic evaluation is very important for the evaluation of long-term complications associated with diabetes.

Call your health care provider or go to the emergency room if symptoms of ketoacidosis are present:

increased thirst and urination
nausea
deep and rapid breathing
abdominal pain
sweet-smelling breath
loss of consciousness (This may occur in insulin dependent diabetics when a dose of insulin is missed, or if illness or infection is present.)

Go to the emergency room or call the local emergency number (such as 911) if symptoms of severe hypoglycemia or insulin reaction are present:

trembling
weakness
drowsiness
headache
confusion
dizziness
double vision
lack of coordination
convulsions or unconsciousness

Early signs of hypoglycemia may be treated at home by eating sugar or candy or injecting glucagon. If the signs of hypoglycemia are not relieved by the above action or if blood glucose levels remain below 60 mg/dL go to the emergency room.

(from the National Institute of Health)

Type 2 Diabetes Mellitus

Alternative names

Noninsulin-dependent diabetes mellitus; Diabetes - Type 2

Definition

Type 2 diabetes is a chronic, life-long disease that results when the body's insulin does not work effectively. Insulin is a hormone released by the pancreas in response to increased levels of blood sugar (glucose) in the blood.

Causes, incidence, and risk factors

Diabetes is caused by a problem in the way your body makes or uses insulin. Insulin is necessary for glucose to move from the blood to the inside of the cells.

Unless glucose gets into cells, the body cannot use it for energy. Excess glucose remains in the blood, and is then removed by the kidneys. The symptoms inlcude excessive thirst, frequent urination, hunger, and fatigue.

There are several types of diabetes:

Type 1 diabetes, which requires total insulin replacement in order to live because the body does not make adequate amounts
Type 2 diabetes, which is related to insulin resistance (lack of the ability of the body to respond to insulin appropriately) and is often accompanied by obesity and high cholesterol

Gestational diabetes, which occurs during pregnancy

Diabetes affects up to 6% of the population in the U.S. Type 2 diabetes accounts for 90% of all cases.

A main component of type 2 diabetes is "insulin resistance". This means that the insulin produced by your pancreas cannot connect with fat and muscle cells to let glucose inside and produce energy. This causes hyperglycemia (high blood glucose).

To compensate, the pancreas produces more insulin. The cells sense this flood of insulin and become even more resistant, resulting in a vicious cycle of high glucose levels and often high insulin levels.

Type 2 diabetes usually occurs gradually. Most people with type 2 diabetes are overweight at the time of diagnosis. However, the disease can also develop in lean people, especially if elderly.

Genetics play a large role in type 2 diabetes and family history is a risk factor. However, low activity level, poor diet, and excess body weight (especially around the waist) significantly increase your risk for type 2 diabetes. Other risk factors include:

Race/ethnicity; African-Americans, Hispanic-Americans, and Native Americans all have high rates of diabetes
Age greater than 45 years
Previously identified impaired glucose tolerance by your doctor
High blood pressure
HDL cholesterol of less than 35 and/or triglyceride
level of greater than 250
History of gestational diabetes

Symptoms
Often, people with type 2 diabetes have no symptoms at all. If you do have symptoms, they may include:

increased thirst
increased urination
increased appetite
fatigue
blurred vision
frequent and/or slow-healing infections (including bladder,
vaginal, skin)
erectile dysfunction in men

Signs and tests
Type 2 diabetes is diagnosed with the following blood tests:

Fasting blood glucose level -- diabetes is diagnosed if higher than 126 mg/dL on two occasions.
Random (non-fasting) blood glucose level -- diabetes is suspected if higher than 200 mg/dL and accompanied by the classic symptoms of increased thirst, urination, and fatigue. (This test must be confirmed with a fasting blood glucose test.)
Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours.

Treatment

The first goals are to eliminate the symptoms and stabilize your blood glucose levels. The ongoing goals are to prevent long-term complications and prolong your life. The primary treatment for type 2 diabetes is exercise and diet.

LEARN THESE SKILLS
You should learn basic diabetes management skills. They will help prevent complications and the need for medical care. These skills include:

How to test and record your blood glucose (see blood glucose monitoring).
What to eat and when.
How to take medications, if indicated.
How to recognize and treat low and high blood sugar.
How to handle sick days.
Where to buy diabetes supplies and how to store them.

It may take several months to learn the basic skills. Once your condition has stabilized, continue to educate yourself about the disease process, how to control and live with diabetes, and long-term complications of the disease. Over time, stay current on new research and treatment.

SELF-TESTING Blood sugar testing, or self-monitoring of blood glucose, is done by checking the glucose content of a small drop of blood. Regular testing tells you how well diet, exercise, and medication are working together to control diabetes.

The results of the test can be used to adjust meals, activity, or medications to keep blood sugar levels in an appropriate range. Testing provides valuable information for the health care provider and identifies high and low blood sugar levels before serious problems develop.

When testing blood sugars yourself, a glucometer is used. A glucometer is a small device that provides an exact reading of blood glucose. A test strip is used to collect a small drop of blood, obtained by pricking the finger with a small, specially-designed needle (called a lancet).

The strip is then placed in the meter. Results are available within 30 to 45 seconds. A health care provider or diabetes educator will help set up an appropriate testing schedule for you. You will also be taught how to respond to different ranges of glucose values obtained when you self-test.

Tests are usually done before meals and at bedtime. More frequent testing may be indicated during illness or stress. Accurate record keeping of test results will make them more useful for planning how to best control your diabetes.

DIET AND WEIGHT CONTROL
Meal planning includes choosing healthy foods, eating the right amount of food, and eating meals at the right time. You should work closely with your health care provider to learn how much fat, protein, and carbohydrates you need in your diet. Your specific meal plans need to be tailored to your food habits and preferences. A registered dietitian can be helpful in determining your specific, individual dietary needs.

In type 2 diabetes, weight management and a well-balanced diet are important. Some people with type 2 diabetes can stop medications after intentional weight loss, although the diabetes is still present. Consultation with a registered dietitian is an invaluable planning tool.

REGULAR PHYSICAL ACTIVITY
Regular exercise is important for everyone, but especially if you have diabetes. Regular exercise helps control the amount of glucose in the blood. It also helps burn excess calories and fat to achieve optimal weight.

Exercise improves overall health by improving blood flow and blood pressure. It naturally decreases insulin resistance even without weight loss. Exercise also increases the body's energy level, lowers tension, and improves your ability to handle stress. Everyone should obtain medical approval before starting an exercise program, but this is especially important if you have diabetes.

The following should be considered:

Choose an enjoyable physical activity that is appropriate for the current fitness level.
Exercise every day, and at the same time of day, if possible.
Monitor blood glucose levels by home testing before and after exercise.
Carry food that contains a fast-acting carbohydrate in case blood glucose levels get too low during or after exercise.
Wear a diabetes identification bracelet and carry change for a phone call in case of emergency.
Drink extra fluids that do not contain sugar before, during and after exercise.
Changes in exercise intensity or duration may require modification of your diet or medication to keep blood glucose levels in an appropriate range.

MEDICATION
When you cannot achieve normal or near-normal blood glucose levels with diet and exercise, medication is added to the treatment plan. Your doctor will start you on oral (by mouth) medicines, such as:

Oral sulfonylureas (like glimepiride, glyburide, and tolazamide) trigger the pancreas to make more insulin.
Biguanides (Metformin) tell the liver to decrease its production of glucose, which increases glucose levels in the blood stream.
Alpha-glucosidase inhibitors (such as acarbose) decrease the absorption of carbohydrates from the digestive tract, thereby lowering the after-meal glucose levels.
Thiazolidinediones (such as rosiglitazone) help insulin work better at the cell site. In essence, they increase the cell's sensitivity (responsiveness) to insulin.
Meglitinides (including repaglinide and nateglinide) trigger the pancreas to make more insulin in response to how much glucose is in the blood.

If you continue to have poor blood glucose control despite lifestyle changes and using oral medicines, your doctor will prescribe insulin. Insulin may also be prescribed if you have had a bad reaction to oral medicines. Insulin must be injected under the skin using a syringe and cannot be taken by mouth.

Insulin preparations differ in how fast they start to work and how long they work. The health-care professional will determine the appropriate type of insulin to use and will counsel you on what time of day to use it.

More than one type may be mixed together in an injection to achieve the best control of blood glucose. The injections are needed, in general, from one to four times a day. You will be taught how to give yourself injections by your doctor or a diabetes educator referred by your doctor.

FOOT CARE
People with diabetes are prone to foot problems because of complications caused by damage to blood vessels and nerves and decreased ability to fight infection. Blood flow to the feet may become compromised and damage to the nerves may cause an injury to the foot to go unnoticed until infection develops. Death of skin and other tissue can occur. If left untreated, amputation of the affected foot may ultimately be necessary.

To prevent injury to the feet, diabetics should adopt a daily routine of checking and caring for the feet as follows:

Check your feet every day, and report sores or changes and signs of infection.
Wash feet every day with lukewarm water and mild soap, and dry them thoroughly.
Soften dry skin with lotion or petroleum jelly.
Protect feet with comfortable, well-fitting shoes.
Exercise daily to promote good circulation.
See a podiatrist for foot problems, or to have corns or calluses removed.
Remove shoes and socks during a visit to the health care provider to remind them to examine your feet.
Discontinue smoking because it worsens blood flow to the feet.

CONTINUING CARE
A person with type 2 diabetes should have a visit with a diabetes care provider every three months. A thorough three-month evaluation includes:

Glycosylated hemoglobin (HbA1c) is a weighted three-month average of what your blood glucose has been. This test measures how much glucose has been sticking to the red blood cells. It also indicates how much glucose has been sticking to other cells. A high HbA1c is an indicator of risk for long-term complications. Currently, the ADA recommends an HbA1c of less than 7% to protect oneself from complications. This test should be done every three months.
pressure check.
Foot and skin examination.
Ophthalmoscopy examination.
Neurological examination.

The following evaluations should be done at least annually:

Random microalbumin (urine test for protein).
BUN and serum creatinine.
Serum cholesterol, HDL, and triglycerides.
ECG.
Dilated retinal exam.

Expectations (prognosis)
The risks of long-term complications from diabetes can be reduced. Those with the best control of blood glucose and blood pressure significantly reduce their risk of death, stroke, heart failure, and other complications. Reduction of HbA1c by even one percentage point can decrease your risk for complicatons by 25%.

Complications

Emergency complications include diabetic coma.
Long-term complications include:
diabetic retinopathy (eye disease)
diabetic nephropathy (kidney disease)
diabetic neuropathy (nerve damage)
peripheral vascular disease (damage to blood vessels/circulation)
high cholesterol, high blood pressure, atherosclerosis, and coronary artery disease

Calling your health care provider
Call your health care provider immediately if you have:

trembling
weakness
drowsiness
headache
confusion
dizziness
double vision
lack of coordination

These symptoms can rapidly progress to emergency conditions (such as convulsions, unconsciousness, or hypoglycemic coma).

Prevention
Everyone over 45 should have their blood glucose checked at least every three years. Regular testing of random blood glucose should begin at a younger age and be performed more often if you are at particular risk for diabetes. Maintain a healthy body weight and keep an active lifestyle to help prevent the onset of type 2 diabetes.

What is Diabetes Mellitus?
Diabetes mellitus is a metabolic disorder characterized by a congenital (similar to juvenile-onset or Type I diabetes mellitus in people) or acquired (similar to adult-onset or Type II diabetes mellitus in people) inability to transport sugar from the bloodstream into cells. Once inside cells, sugar (glucose) is used to generate the energy that is essential for normal cellular function. Diabetes in animals is most commonly the acquired form and typically occurs in middle-aged to older pets. The disease results when glucose transport channels on cell membranes are insensitive to the effects of insulin (or when there are too few channels) or when the quantity of insulin produced by the pancreas is inadequate to activate the number of glucose channels needed to maintain normal cellular metabolism. In other words, insulin is the "key" that allows special "gates" for sugar transport across cell membranes to be opened. A diabetic, therefore, has too much glucose in the bloodstream where most of it cannot be utilized, and not enough glucose within the cells themselves, where it is most needed for energy. As a result, cells attempt to derive energy from alternate metabolic pathways, such as fat breakdown. Excessive use of these alternate energy pathways culminates in production of harmful by-products called ketones. The accumulation of ketones causes the body's pH to become acidic (ketoacidosis) which makes the cellular environment inhospitable for normal metabolic functions. This condition can ultimately become life-threatening and requires aggressive medical therapy. Fortunately, most diabetics give some indication of their underlying condition, such as drinking and urinating excessively, before they develop ketoacidosis. Treating diabetics before they become ketotic is considerably more straightforward, safer, and of course less expensive than taking a "wait-and-see" approach to changes in drinking behavior. Equally important, diagnostic testing may reveal other serious conditions which can cause excessive urination and drinking, such as kidney or liver disease, adrenal hormone or electrolyte imbalances and uterus infections.

Type 1 Diabetes Mellitus

Alternative names

Insulin-dependent diabetes mellitus; Juvenile onset diabetes; Diabetes - Type 1

Definition

Type 1 diabetes is a chronic (lifelong) disease that occurs when the pancreas produces too little insulin to regulate blood sugar levels appropriately.

Causes, incidence, and risk factors

Diabetes is a life-long disease for which there is not yet a cure. There are several forms of diabetes, including:

Type 1 diabetes, often called juvenile or insulin-dependent diabetes
Type 2 diabetes, often called adult or non-insulin-dependent diabetes
Gestational diabetes, which occurs during pregnancy.

increased thirst
increased urination
weight loss despite increased appetite
nausea
vomiting
abdominal pain
fatigue
absence of menstruation