The earliest surviving work with a detailed reference to diabetes is that of Aretaeus of Cappadocia (2nd or early 3rd century CE). He described the symptoms and the course of the disease, which he attributed to the moisture and coldness, reflecting the beliefs of the "Pneumatic School". He hypothesized a correlation between diabetes and other diseases, and he discussed differential diagnosis from the snakebite, which also provokes excessive thirst. His work remained unknown in the West until 1552, when the first Latin edition was published in Venice.[113]
In those with impaired glucose tolerance, diet and exercise either alone or in combination with metformin or acarbose may decrease the risk of developing diabetes.[24][72] Lifestyle interventions are more effective than metformin.[24] A 2017 review found that, long term, lifestyle changes decreased the risk by 28%, while medication does not reduce risk after withdrawal.[73] While low vitamin D levels are associated with an increased risk of diabetes, correcting the levels by supplementing vitamin D3 does not improve that risk.[74]

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Treatment plans that include both very long-acting insulin and very short-acting insulin are frequently the most successful for controlling blood sugar. Very short-acting insulin is used with meals, to help control the spike in blood sugar levels that occur with a meal. If a person does not eat on a regular schedule, very short-acting insulin can be particularly helpful.
^ Jump up to: a b Cheng J, Zhang W, Zhang X, Han F, Li X, He X, Li Q, Chen J (May 2014). "Effect of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on all-cause mortality, cardiovascular deaths, and cardiovascular events in patients with diabetes mellitus: a meta-analysis". JAMA Internal Medicine. 174 (5): 773–85. doi:10.1001/jamainternmed.2014.348. PMID 24687000.

Unlike people with type 1 diabetes, people with type 2 diabetes produce insulin; however, the insulin their pancreas secretes is either not enough or the body is unable to recognize the insulin and use it properly. This is called insulin resistance. When there isn't enough insulin or the insulin is not used as it should be, sugar (glucose) can't get into the body's cells to be used for fuel. When sugar builds up in the blood instead of going into cells, the body's cells are not able to function properly. Other problems associated with the build up of sugar in the blood include:
Diabetes was one of the first diseases described,[110] with an Egyptian manuscript from c. 1500 BCE mentioning "too great emptying of the urine."[111] The Ebers papyrus includes a recommendation for a drink to take in such cases.[112] The first described cases are believed to have been type 1 diabetes.[111] Indian physicians around the same time identified the disease and classified it as madhumeha or "honey urine", noting the urine would attract ants.[111][112]
This includes both difficulty in urination, as well as an increased urge and frequency of urination. The bladder may become overly active, or the muscles of the bladder may become too weak to completely empty the bladder. This is caused by damage to the nerves due to high blood sugar levels in diabetes. This can significantly affect your quality of life, and can also predispose you to urinary tract infections which will require treatment with a course of antibiotics.
The prevalence of type 2 diabetes mellitus varies widely among various racial and ethnic groups. The image below shows data for various populations. Type 2 diabetes mellitus is more prevalent among Hispanics, Native Americans, African Americans, and Asians/Pacific Islanders than in non-Hispanic whites. Indeed, the disease is becoming virtually pandemic in some groups of Native Americans and Hispanic people. The risk of retinopathy and nephropathy appears to be greater in blacks, Native Americans, and Hispanics.
Diabetes is a metabolic disorder that occurs when your blood sugar (glucose), is too high (hyperglycemia). Glucose is what the body uses for energy, and the pancreas produces a hormone called insulin that helps convert the glucose from the food you eat into energy. When the body either does not produce enough insulin, does not produce any at all, or your body becomes resistant to the insulin, the glucose does not reach your cells to be used for energy. This results in the health condition termed diabetes.
Type 1 and type 2 diabetes were identified as separate conditions for the first time by the Indian physicians Sushruta and Charaka in 400–500 AD with type 1 associated with youth and type 2 with being overweight.[114] The term "mellitus" or "from honey" was added by the Briton John Rolle in the late 1700s to separate the condition from diabetes insipidus which is also associated with frequent urination.[114] Effective treatment was not developed until the early part of the 20th century when the Canadians Frederick Banting and Charles Best discovered insulin in 1921 and 1922.[114] This was followed by the development of the long acting NPH insulin in the 1940s.[114]
Despite advanced age, multiparity, obesity, and social disadvantage, patients with type 2 diabetes were found to have better glycemic control, fewer large-for-gestational-age infants, fewer preterm deliveries, and fewer neonatal care admissions compared with patients with type 1 diabetes. This suggests that better tools are needed to improve glycemic control in patients with type 1 diabetes. [95] (For more information, see Diabetes Mellitus and Pregnancy.)

This happens because constantly high levels of sugar in the blood stream can damage the blood vessels of the penis, or the blood vessels supplying the nerves to the penis. When the blood vessels and nerves are damaged, the blood flow to the penis is significantly reduced, resulting in erectile dysfunction. Other causes of erectile dysfunction include smoking, heart disease, high blood pressure and high cholesterol levels.
Despite advanced age, multiparity, obesity, and social disadvantage, patients with type 2 diabetes were found to have better glycemic control, fewer large-for-gestational-age infants, fewer preterm deliveries, and fewer neonatal care admissions compared with patients with type 1 diabetes. This suggests that better tools are needed to improve glycemic control in patients with type 1 diabetes. [95] (For more information, see Diabetes Mellitus and Pregnancy.)
A positive result, in the absence of unequivocal high blood sugar, should be confirmed by a repeat of any of the above methods on a different day. It is preferable to measure a fasting glucose level because of the ease of measurement and the considerable time commitment of formal glucose tolerance testing, which takes two hours to complete and offers no prognostic advantage over the fasting test.[69] According to the current definition, two fasting glucose measurements above 7.0 mmol/l (126 mg/dl) is considered diagnostic for diabetes mellitus.
Type 2 diabetes used to be known as adult-onset diabetes, but today more children are being diagnosed with the disorder, probably due to the rise in childhood obesity. There's no cure for type 2 diabetes, but losing weight, eating well and exercising can help manage the disease. If diet and exercise aren't enough to manage your blood sugar well, you may also need diabetes medications or insulin therapy.
Diabetes is a disease of the pancreas gland, which is part of the endocrine system. An endocrinologist is a specialist who diagnoses, treats, and manages pancreatic diseases. People with type 1 diabetes are often under the care of an endocrinologist to help them manage their treatment plan. Sometimes, people with type 2 diabetes may also need an endocrinologist if they have trouble getting their blood glucose levels under control.
Diabetes is a chronic disease, for which there is no known cure except in very specific situations.[78] Management concentrates on keeping blood sugar levels as close to normal, without causing low blood sugar. This can usually be accomplished with a healthy diet, exercise, weight loss, and use of appropriate medications (insulin in the case of type 1 diabetes; oral medications, as well as possibly insulin, in type 2 diabetes).
Diabetes is a serious disease that you cannot treat on your own. Your doctor will help you make a diabetes treatment plan that is right for you -- and that you can understand. You may also need other health care professionals on your diabetes treatment team, including a foot doctor, nutritionist, eye doctor, and a diabetes specialist (called an endocrinologist).
If you have type 1 diabetes, your pancreas no longer makes the insulin your body needs to use blood sugar for energy. You will need insulin in the form of injections or through use of a continuous pump. Learning to give injections to yourself or to your infant or child may at first seem the most daunting part of managing diabetes, but it is much easier that you think.
There are a number of medications and other health problems that can predispose to diabetes.[41] Some of the medications include: glucocorticoids, thiazides, beta blockers, atypical antipsychotics,[42] and statins.[43] Those who have previously had gestational diabetes are at a higher risk of developing type 2 diabetes.[23] Other health problems that are associated include: acromegaly, Cushing's syndrome, hyperthyroidism, pheochromocytoma, and certain cancers such as glucagonomas.[41] Testosterone deficiency is also associated with type 2 diabetes.[44][45]
Vascular diseases that prevent blood flow to the small blood vessels are common if you have diabetes. Nerve damage may also occur with longstanding diabetes. Since restricted blood flow and nerve damage can affect the feet in particular, you should make regular visits to a podiatrist. With diabetes, you may also have a reduced ability to heal blisters and cuts, even minor ones. A podiatrist can monitor your feet for any serious infections that could lead to gangrene and amputation. These visits do not take the place of daily foot checks you do yourself.
In both diabetic and nondiabetic patients, coronary vasodilator dysfunction is a strong independent predictor of cardiac mortality. In diabetic patients without coronary artery disease, those with impaired coronary flow reserve have event rates similar to those with prior coronary artery disease, while patients with preserved coronary flow reserve have event rates similar to nondiabetic patients. [82]
Rates of type 2 diabetes have increased markedly since 1960 in parallel with obesity.[17] As of 2015 there were approximately 392 million people diagnosed with the disease compared to around 30 million in 1985.[11][18] Typically it begins in middle or older age,[6] although rates of type 2 diabetes are increasing in young people.[19][20] Type 2 diabetes is associated with a ten-year-shorter life expectancy.[10] Diabetes was one of the first diseases described.[21] The importance of insulin in the disease was determined in the 1920s.[22]
^ Jump up to: a b c d Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. (GBD 2015 Disease and Injury Incidence and Prevalence Collaborators) (October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
A British study indicated that the HbA1c level achieved 3 months after the initial diagnosis of type 2 diabetes mellitus predicts subsequent mortality. In other words, according to the report, aggressive lowering of glucose after diagnosis bodes well for long-term survival. (Intensified diabetes control must be introduced gradually in newly diagnosed patients.) [75]

A population-based, retrospective cohort study of 1,010,068 pregnant women examined the association between preeclampsia and gestational hypertension during pregnancy and the risk of developing diabetes post partum. Results showed the incidence rate of diabetes per 1000 person-years was 6.47 for women with preeclampsia and 5.26 for those with gestational hypertension, compared with 2.81 in women with neither condition. Risk was further elevated in women with preeclampsia or gesntational hypertension comorbid with gestational diabetes. [59]


Increased cardiovascular risk appears to begin prior to the development of frank hyperglycemia, presumably because of the effects of insulin resistance. Stern in 1996 [29] and Haffner and D'Agostino in 1999 [30] developed the "ticking clock" hypothesis of complications, asserting that the clock starts ticking for microvascular risk at the onset of hyperglycemia, while the clock starts ticking for macrovascular risk at some antecedent point, presumably with the onset of insulin resistance.
Diabetes occurs throughout the world but is more common (especially type 2) in more developed countries. The greatest increase in rates has however been seen in low- and middle-income countries,[104] where more than 80% of diabetic deaths occur.[108] The fastest prevalence increase is expected to occur in Asia and Africa, where most people with diabetes will probably live in 2030.[109] The increase in rates in developing countries follows the trend of urbanization and lifestyle changes, including increasingly sedentary lifestyles, less physically demanding work and the global nutrition transition, marked by increased intake of foods that are high energy-dense but nutrient-poor (often high in sugar and saturated fats, sometimes referred to as the "Western-style" diet).[104][109] The global number of diabetes cases might increase by 48% between 2017 and 2045.[9]
Vascular diseases that prevent blood flow to the small blood vessels are common if you have diabetes. Nerve damage may also occur with longstanding diabetes. Since restricted blood flow and nerve damage can affect the feet in particular, you should make regular visits to a podiatrist. With diabetes, you may also have a reduced ability to heal blisters and cuts, even minor ones. A podiatrist can monitor your feet for any serious infections that could lead to gangrene and amputation. These visits do not take the place of daily foot checks you do yourself.
One prospective study with a long follow-up challenges the concept of coronary disease risk equivalency between nondiabetic patients with a first myocardial infarction and patients with type 2 diabetes but without any cardiovascular disease. The study found that patients with type 2 diabetes had lower long-term cardiovascular risk compared with patients with first myocardial infarction. Other studies have similarly questioned this risk equivalency. [79]
Regensteiner, J. G., Golden, S., Huebschmann, A. G., Barrett-Connor, E., Chang, A. Y., Chyun, D., … and Anton, B. (2015, December 7). Sex differences in the cardiovascular consequences of diabetes mellitus: A scientific statement from the American Heart Association. Circulation, 132, 2424-2447. Retrieved from https://www.ahajournals.org/doi/pdf/10.1161/cir.0000000000000343
Diabetes can also be a finding in more severe mitochondrial disorders such as Kearns-Sayre syndrome and mitochondrial encephalomyopathy, lactic acidosis, and strokelike episode (MELAS). Mitochondrial forms of diabetes mellitus should be considered when diabetes occurs in conjunction with hearing loss, myopathy, seizure disorder, strokelike episodes, retinitis pigmentosa, external ophthalmoplegia, or cataracts. These findings are of particular significance if there is evidence of maternal inheritance.
Also called diabe·tes mel·li·tus [mel-i-tuh s, muh-lahy-] . a disorder of carbohydrate metabolism, usually occurring in genetically predisposed individuals, characterized by inadequate production or utilization of insulin and resulting in excessive amounts of glucose in the blood and urine, excessive thirst, weight loss, and in some cases progressive destruction of small blood vessels leading to such complications as infections and gangrene of the limbs or blindness.
^ Sattar N, Preiss D, Murray HM, Welsh P, Buckley BM, de Craen AJ, Seshasai SR, McMurray JJ, Freeman DJ, Jukema JW, Macfarlane PW, Packard CJ, Stott DJ, Westendorp RG, Shepherd J, Davis BR, Pressel SL, Marchioli R, Marfisi RM, Maggioni AP, Tavazzi L, Tognoni G, Kjekshus J, Pedersen TR, Cook TJ, Gotto AM, Clearfield MB, Downs JR, Nakamura H, Ohashi Y, Mizuno K, Ray KK, Ford I (February 2010). "Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials". Lancet. 375 (9716): 735–42. doi:10.1016/S0140-6736(09)61965-6. PMID 20167359.

Type 2 diabetes is the most common form of diabetes, affecting almost 18 million Americans. While most of these cases can be prevented, it remains for adults the leading cause of diabetes-related complications such as blindness, non-traumatic amputations, and chronic kidney failure requiring dialysis. Type 2 diabetes usually occurs in people over age 40 who are overweight, but can occur in people who are not overweight. Sometimes referred to as "adult-onset diabetes," type 2 diabetes has started to appear more often in children because of the rise in obesity in young people.
Diabetes occurs throughout the world but is more common (especially type 2) in more developed countries. The greatest increase in rates has however been seen in low- and middle-income countries,[104] where more than 80% of diabetic deaths occur.[108] The fastest prevalence increase is expected to occur in Asia and Africa, where most people with diabetes will probably live in 2030.[109] The increase in rates in developing countries follows the trend of urbanization and lifestyle changes, including increasingly sedentary lifestyles, less physically demanding work and the global nutrition transition, marked by increased intake of foods that are high energy-dense but nutrient-poor (often high in sugar and saturated fats, sometimes referred to as the "Western-style" diet).[104][109] The global number of diabetes cases might increase by 48% between 2017 and 2045.[9]
In the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study, increased mortality was noted among the poorly-controlled patients in the intensive glycemic arm; indeed there was a 66% increase in mortality for each 1% increase in HbA1c; the best outcome occurred among patients who achieved the target of an HbA1c of less than 6%. The excess mortality between the intensive and conventional glycemic arms occurred for A1c above 7%.
Type 2 diabetes is a chronic disease. It is characterized by high levels of sugar in the blood. Type 2 diabetes is also called type 2 diabetes mellitus and adult-onset diabetes. That's because it used to start almost always in middle- and late-adulthood. However, more and more children and teens are developing this condition. Type 2 diabetes is much more common than type 1 diabetes, and is really a different disease. But it shares with type 1 diabetes high blood sugar levels, and the complications of high blood sugar.
Diabetes mellitus, and particularly type 2 diabetes mellitus, is the leading contributor to end-stage renal disease (ESRD) in the United States. [84] According to the CDC, diabetes accounts for 44% of new cases of ESRD. [83] In 2008, 48,374 people with diabetes in the United States and Puerto Rico began renal replacement therapy, and 202,290 people with diabetes were on dialysis or had received a kidney transplant. [84]
People may see a primary care doctor or a family practitioner when they get sick or when having general checkups. A specialist called an endocrinologist has special training in diagnosing and treating diabetes. However, if you cannot find an endocrinologist in your area, you can alternatively look for a primary care doctor, who can either be an internist or a family practitioner. 
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