Diabetes is a chronic disease and is medically defined by having abnormally high blood glucose (sugar) levels in the body. This may be due to lack of insulin (in Type 1 diabetes, usually in younger patients), or due to a combination of lack of insulin production and increased resistance to insulin in the rest of the body’s tissues (in Type 2 diabetes, usually older patients). Insulin is an important hormone produced by the pancreas that allows glucose to enter our cells from the bloodstream. Our cells use glucose as a source of energy.


Early, intensive, multifactorial (blood pressure, cholesterol) management in patients with type 2 diabetes mellitus was associated with a small, nonsignificant reduction in the incidence of cardiovascular disease events and death in a multinational European study. [73] The 3057 patients in this study had diabetes detected by screening and were randomized to receive either standard diabetes care or intensive management of hyperglycemia (target HbA1c < 7.0%), blood pressure, and cholesterol levels.

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 is a chronic disease and is medically defined by having abnormally high blood glucose (sugar) levels in the body. This may be due to lack of insulin (in Type 1 diabetes, usually in younger patients), or due to a combination of lack of insulin production and increased resistance to insulin in the rest of the body’s tissues (in Type 2 diabetes, usually older patients). Insulin is an important hormone produced by the pancreas that allows glucose to enter our cells from the bloodstream. Our cells use glucose as a source of energy.

Gestational diabetes can be a scary diagnosis, but like other forms of diabetes, it’s one that you can manage. It doesn’t mean that you had diabetes before you conceived or that you will have diabetes after you give birth. It means that, by working with your doctor, you can have a healthy pregnancy and a healthy baby. No matter what, know that you have all the support you need for both you and your baby to be at your best.


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%.

As of 2017, an estimated 425 million people had diabetes worldwide,[9] with type 2 diabetes making up about 90% of the cases.[17][18] This represents 8.8% of the adult population,[9] with equal rates in both women and men.[19] Trend suggests that rates will continue to rise.[9] Diabetes at least doubles a person's risk of early death.[2] In 2017, diabetes resulted in approximately 3.2 to 5.0 million deaths.[9] The global economic cost of diabetes related health expenditure in 2017 was estimated at US$727 billion.[9] In the United States, diabetes cost nearly US$245 billion in 2012.[20] Average medical expenditures among people with diabetes are about 2.3 times higher.[21]
The top 10 countries in number of people with diabetes are currently India, China, the United States, Indonesia, Japan, Pakistan, Russia, Brazil, Italy, and Bangladesh. The greatest percentage increase in rates of diabetes will occur in Africa over the next 20 years. Unfortunately, at least 80% of people in Africa with diabetes are undiagnosed, and many in their 30s to 60s will die from diabetes there.

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.
Inhalable insulin has been developed.[128] The original products were withdrawn due to side effects.[128] Afrezza, under development by the pharmaceuticals company MannKind Corporation, was approved by the United States Food and Drug Administration (FDA) for general sale in June 2014.[129] An advantage to inhaled insulin is that it may be more convenient and easy to use.[130]
Prevention and treatment involve maintaining a healthy diet, regular physical exercise, a normal body weight, and avoiding use of tobacco.[2] Control of blood pressure and maintaining proper foot care are important for people with the disease.[2] Type 1 diabetes must be managed with insulin injections.[2] Type 2 diabetes may be treated with medications with or without insulin.[13] Insulin and some oral medications can cause low blood sugar.[14] Weight loss surgery in those with obesity is sometimes an effective measure in those with type 2 diabetes.[15] Gestational diabetes usually resolves after the birth of the baby.[16]

Prevention and treatment involve maintaining a healthy diet, regular physical exercise, a normal body weight, and avoiding use of tobacco.[2] Control of blood pressure and maintaining proper foot care are important for people with the disease.[2] Type 1 diabetes must be managed with insulin injections.[2] Type 2 diabetes may be treated with medications with or without insulin.[13] Insulin and some oral medications can cause low blood sugar.[14] Weight loss surgery in those with obesity is sometimes an effective measure in those with type 2 diabetes.[15] Gestational diabetes usually resolves after the birth of the baby.[16]


Type 2 diabetes is characterized by a combination of peripheral insulin resistance and inadequate insulin secretion by pancreatic beta cells. Insulin resistance, which has been attributed to elevated levels of free fatty acids and proinflammatory cytokines in plasma, leads to decreased glucose transport into muscle cells, elevated hepatic glucose production, and increased breakdown of fat.
People with diabetes are at greater risk for kidney disease over time. A nephrologist is a doctor that specializes in the treatment of kidney disease. Your primary care doctor can do the yearly test recommended to identify kidney disease as soon as possible, but they may refer you to a nephrologist as needed. The nephrologist can help you manage kidney disease. They can also administer dialysis, treatment that is required when your kidneys aren’t functioning properly.

Inhalable insulin has been developed.[128] The original products were withdrawn due to side effects.[128] Afrezza, under development by the pharmaceuticals company MannKind Corporation, was approved by the United States Food and Drug Administration (FDA) for general sale in June 2014.[129] An advantage to inhaled insulin is that it may be more convenient and easy to use.[130]
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.
What is endocrinology? An endocrinologist specializes in all things relating to our hormones. Conditions affected by hormones range from thyroid problems to diabetes and insomnia. Here, we look at the endocrine system, the organs that make more than 50 hormones, why they often go wrong, and why you might want to consult an endocrinologist. Read now
The term "type 1 diabetes" has replaced several former terms, including childhood-onset diabetes, juvenile diabetes, and insulin-dependent diabetes mellitus (IDDM). Likewise, the term "type 2 diabetes" has replaced several former terms, including adult-onset diabetes, obesity-related diabetes, and noninsulin-dependent diabetes mellitus (NIDDM). Beyond these two types, there is no agreed-upon standard nomenclature.[citation needed]
Gestational diabetes mellitus (GDM) resembles type 2 diabetes in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 2–10% of all pregnancies and may improve or disappear after delivery.[52] However, after pregnancy approximately 5–10% of women with GDM are found to have DM, most commonly type 2.[52] GDM is fully treatable, but requires careful medical supervision throughout the pregnancy. Management may include dietary changes, blood glucose monitoring, and in some cases, insulin may be required[53]
It would be advisable to see a doctor for further evaluation, if you experience one of these diabetes symptoms in men. Generally, retrograde ejaculation doesn’t need formal treatment unless fertility is a problem. Treatment options may include medications that help keep the bladder neck muscle closed during ejaculation – however these only work if the problem is caused by nerve damage, such as in diabetes.

Type 1 diabetes is partly inherited, with multiple genes, including certain HLA genotypes, known to influence the risk of diabetes. In genetically susceptible people, the onset of diabetes can be triggered by one or more environmental factors,[42] such as a viral infection or diet. Several viruses have been implicated, but to date there is no stringent evidence to support this hypothesis in humans.[42][43] Among dietary factors, data suggest that gliadin (a protein present in gluten) may play a role in the development of type 1 diabetes, but the mechanism is not fully understood.[44][45]
Yamasaki et al found that abnormal results on single-photon CT myocardial perfusion imaging in asymptomatic patients with type 2 diabetes indicated a higher risk for cardiovascular events (13%), including cardiac death. Smoking and low glomerular filtration rate were significant contributing factors. [80] However, an earlier study questioned the merit of routine screening with adenosine-stress radionuclide myocardial perfusion imaging (MPI) in otherwise asymptomatic type 2 diabetic patients (the Detection of Ischemia in Asymptomatic Diabetics [DIAD] study). [81]
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.
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.
Patients using less frequent insulin injections or noninsulin therapies – Use SMBG results to adjust to food intake, activity, or medications to reach specific treatment goals; clinicians must not only educate these individuals on how to interpret their SMBG data, but they should also reevaluate the ongoing need for and frequency of SMBG at each routine visit.
The amount of glucose in your bloodstream is tightly regulated by the hormone insulin. Insulin is always being released in small amounts by the pancreas. When the amount of glucose in your blood rises to a certain level, the pancreas will release more insulin to push more glucose into the cells. This causes the glucose levels in your blood (blood glucose levels) to drop.
^ Saenz A, Fernandez-Esteban I, Mataix A, Ausejo M, Roque M, Moher D (July 2005). "Metformin monotherapy for type 2 diabetes mellitus". The Cochrane Database of Systematic Reviews (3): CD002966. doi:10.1002/14651858.CD002966.pub3. PMID 16034881. (Retracted, see doi:10.1002/14651858.cd002966.pub4. If this is an intentional citation to a retracted paper, please replace {{Retracted}} with {{Retracted|intentional=yes}}.)
When glucose concentration in the blood remains high over time, the kidneys reach a threshold of reabsorption, and the body excretes glucose in the urine (glycosuria).[64] This increases the osmotic pressure of the urine and inhibits reabsorption of water by the kidney, resulting in increased urine production (polyuria) and increased fluid loss. Lost blood volume is replaced osmotically from water in body cells and other body compartments, causing dehydration and increased thirst (polydipsia).[62] In addition, intracellular glucose deficiency stimulates appetite leading to excessive food intake (polyphagia).[65]
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.
^ Jump up to: a b Petzold A, Solimena M, Knoch KP (October 2015). "Mechanisms of Beta Cell Dysfunction Associated With Viral Infection". Current Diabetes Reports (Review). 15 (10): 73. doi:10.1007/s11892-015-0654-x. PMC 4539350. PMID 26280364. So far, none of the hypotheses accounting for virus-induced beta cell autoimmunity has been supported by stringent evidence in humans, and the involvement of several mechanisms rather than just one is also plausible.
Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes from the food you eat. Insulin, a hormone made by the pancreas, helps glucose from food get into your cells to be used for energy. Sometimes your body doesn’t make enough—or any—insulin or doesn’t use insulin well. Glucose then stays in your blood and doesn’t reach your cells.
Most cases of diabetes involve many genes, with each being a small contributor to an increased probability of becoming a type 2 diabetic.[10] If one identical twin has diabetes, the chance of the other developing diabetes within his lifetime is greater than 90%, while the rate for nonidentical siblings is 25–50%.[13] As of 2011, more than 36 genes had been found that contribute to the risk of type 2 diabetes.[39] All of these genes together still only account for 10% of the total heritable component of the disease.[39] The TCF7L2 allele, for example, increases the risk of developing diabetes by 1.5 times and is the greatest risk of the common genetic variants.[13] Most of the genes linked to diabetes are involved in beta cell functions.[13]

Insulin resistance is associated with increased lipid accumulation in liver and smooth muscle, but not with increased myocardial lipid accumulation. [27] Persistent lipid abnormalities remain in patients with diabetes despite the use of lipid-modifying drugs, although evidence supports the benefits of these drugs. Statin dose up-titration and the addition of other lipid-modifying agents are needed. [28]


Per the WHO, people with fasting glucose levels from 6.1 to 6.9 mmol/l (110 to 125 mg/dl) are considered to have impaired fasting glucose.[70] people with plasma glucose at or above 7.8 mmol/l (140 mg/dl), but not over 11.1 mmol/l (200 mg/dl), two hours after a 75 gram oral glucose load are considered to have impaired glucose tolerance. Of these two prediabetic states, the latter in particular is a major risk factor for progression to full-blown diabetes mellitus, as well as cardiovascular disease.[71] The American Diabetes Association (ADA) since 2003 uses a slightly different range for impaired fasting glucose of 5.6 to 6.9 mmol/l (100 to 125 mg/dl).[72]
"Brittle" diabetes, also known as unstable diabetes or labile diabetes, is a term that was traditionally used to describe the dramatic and recurrent swings in glucose levels, often occurring for no apparent reason in insulin-dependent diabetes. This term, however, has no biologic basis and should not be used.[40] Still, type 1 diabetes can be accompanied by irregular and unpredictable high blood sugar levels, frequently with ketosis, and sometimes with serious low blood sugar levels. Other complications include an impaired counterregulatory response to low blood sugar, infection, gastroparesis (which leads to erratic absorption of dietary carbohydrates), and endocrinopathies (e.g., Addison's disease).[40] These phenomena are believed to occur no more frequently than in 1% to 2% of persons with type 1 diabetes.[41]
Schizophrenia has been linked to the risk for type 2 diabetes. Dysfunctional signaling involving protein kinase B (Akt) is a possible mechanism for schizophrenia; moreover, acquired Akt defects are associated with impaired regulation of blood glucose and diabetes, which is overrepresented in first-episode, medication-naive patients with schizophrenia. [58] In addition, second-generation antipsychotics are associated with greater risk for type-2 diabetes.
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