DIABETES

Diabetes affects millions of people around the world. It is a condition where body is not able to regulate blood glucose level.

Fundamentals and facts

• It is the world’s highest prevailing disease.
• Diabetes can be referred to as a chronic disease characterized by high levels of glucose in the blood.
• Heart disease is a common condition in people who have diabetes.
• Diabetes insipidus is not related with glucose and insulin
• Diabetes insipidus occurs due to Anti‐diuretic hormone related problems
• Diabetes mellitus is related with glucose and insulin

Diabetes may develop due to the following factors

• Overweight
• Family history of diabetes
• High cholesterol
• High Blood Pressure
• Family history of gestational diabetes

Types of Diabetes

There are four types of diabetes

1. Pre‐ diabetes

It is the starting stage for diabetes in which all the symptoms
required to diagnose diabetes are not present.

2. Type I

It is insulin dependent diabetes mellitus (IDDM). It is an autoimmune disorder. It occurs when your pancreas stops producing insulin.

3. Type II

It is the non‐insulin dependent diabetes mellitus (NIDDM). These type of diabetes is lifestyle related. It occurs when your body does not respond properly to the insulin.

4. Gestational Diabetes

It is a condition in which women without diabetes develops high
blood sugar level during pregnancy. This may cause problems for baby too. Controlling blood sugar levels with a healthy lifestyle will minimize the risks.

• Kidney damage
• Foot damage
• Cardiovascular disease
• Nerve damage
• Eye damage
• Hearing impairment
• Skin conditions
• Erectile dysfunction
• Gestroparesis
• Gestroparesis

Psychological effects of diabetes

• Depression
• Stress
• Anxiety
• Social anxiety
• Low self Esteem
• Health related Thoughts

The key to treating diabetes is to keep blood sugar levels controlled. All of the following help to control blood sugar level.

• Eating healthy food
• Being active
• Taking medicine as directed
• Taking care of your body
• Check feet to make sure there is no nerve damage
• Take care of teeth
• Control blood pressure
• No smoking
• Blood sugar checked along with weight, blood pressure
• Check blood sugar levels daily by using home monitoring device

Exercise

Weight Training- Light Weight lifting is a best exercise for diabetic patient. Make sure it should not too heavy to lift according to your age. This exercise builds muscle mass, important for those with type 2 diabetes.

Walking- It is easy for all type of patient. It is most prescribed activities for people with type 2 diabetes.

Yoga - A number of studies proven that yoga can benefit you in several ways. It can help lower body fat, blood sugar, fight insulin resistance, and improve all body functionality.

Swimming - It is an aerobic exercise. Swimming is an ideal exercise with type 2 diabetes.

Pharmacology of Diabetes devided in 3 section

• Oral Hypoglycemic Agents
• Injectables
• Insulin

Oral Hypoglycemic Agents

Medication that increase insulin release: Sulfonylurea

Slow down the liver insulin release : Metformin

Incretin drugs

Amylin receptor agonist : Pramlintide

SGLT‐2 Inhibitors : Dapagliflozin, Canagliflozin

α‐ Glycosidase inhibitors : Acarbose

Dopa‐amine receptor 2 agonist: Bromocryptine

Insulin

It is used for type 1 diabetes, in which body does not produce enough insulin. The person needs to use an insulin pump or inject the hormone. Doctors generally recommend other medications first for type 2 diabetes.

Metformin

In type 2 diabetes, doctors usually prescribe metformin. It helps to control blood sugar levels by reducing the amount of sugar. Metformin is available in tablet and liquid form. Doctor usually start with a low dosage of metformin and gradually increase the dosage depending on blood sugar levels respond to the medication.

Common side effects of Metformin

• headache
• nausea
• vomiting
• runny nose
• diarrhea
• loss of appetite
• a rash
• a metallic taste in the mouth

DPP-4 inhibitors

It is a new class of drug for type 2 diabetes. They increase the production of insulin in the body and help to lower a patient blood sugar levels. It is generally prescribed in combination with metformin. DPP 4 inhibitors mostly prescribed for older patients or patient having chronic kidney disease. These drugs include

• linagliptin
• linagliptin-metformin
• alogliptin
• sitagliptin
• sitagliptin and simvastatin

SGLT-2 inhibitors

It is a new group of oral medications for type 2 diabetes. It helps to lower a person's blood sugar levels. It is generally prescribed in combination with metformin when metformin alone cannot sufficiently. These drugs are not recommended for people with kidney diseases. Drugs include

• dapagliflozin
• dapagliflozin-metformin
• empagliflozin
• empagliflozin-metformin

Thiazolidinediones

These drug increase the body's sensitivity to insulin which regulate blood sugar levels. It's generally prescribed when first-line treatment failed to achieve the desired result. Taking this medication at proper scheduled is very important. These medication increase the risks of heart failure and bladder cancer. Drugs include

• rosiglitazone
• rosiglitazone-metformin
• rosiglitazone-glimepiride
• pioglitazone
• pioglitazone-metformin

Amylinomimetic drug

It’s an injectable drug, reduces glucagon secretion after meals and lowers your blood sugar.

Sulfonylureas

It stimulate the pancreas to produce more insulin. These drugs include

• glipizide
• glipizide-metformin
• glimepiride
• glimepiride-pioglitazone
• glimepiride-rosiglitazone
• gliclazide
• glyburide
• glyburide-metformin

• Unfortunately, there is not yet a cure for diabetes. But there are always new facts and discoveries being made every day.
• Doctors are providing treatment that can lower symptoms of
  diabetes of all types, which can reduce pain.
• By following a good diet and exercise plan, body may be able to use
  insulin minimally, or none at all in cases besides type 1
• There is also research being done on “islet” transplantation.