What is diabetes foot? complications and care!

What is Diabetes Foot?
The foot is especially affected by diabetes because:
-diabetes damages the nerves (damage can occur to the foot and not be detected) - this is called peripheral neuropathy.
-diabetes also affect the circulation. Poor circulation can affect the ability of the body to heal when damage occurs.
-those with diabetes are more prone to infection - the body's processes that normally fight infection respond slower and often have trouble getting to infections due to the poor circulation.
diabetes can also affect the joints, making them stiffer
-other diabetes complications that can also affect the foot, for example,

-kidney disease (affects proteins that are involved in wound healing) and eye disease (can't see the foot to check for damage).

Complications of Diabetes Foot
-the foot may get damaged and you do not know about (for example, your shoe rubs a sore onto a toe that gets infected - you can not feel it because of the peripheral neuropathy - you can not heal very well due to the infection and poor circulation ).
-foot ulcer are common
-infections can spread
-the ultimate of this process is an amputation. Diabetes is the main cause of amputations.
-Charcot's joints is another complication of diabetes in the foot, especially if peripheral neuropathy is present - the neuropathy cause a numbness (imagine spraining your ankle and not knowing you have done this. You will continue to walk on it - imagine the damage that this would do. This is what happens in a Charcot foot )

Diabetec Foot Care
Diabetes can be dangerous to your feet—even a small cut could have serious consequences. Diabetes may cause nerve damage that takes away the feeling in your feet. Diabetes may also reduce blood flow to the feet, making it harder to heal an injury or resist infection. Because of these problems, you might not notice a pebble in your shoe—so you could develop a blister, then a sore, then a stubborn infection that might cause amputation of your foot or leg.

To avoid serious foot problems that could result in losing a toe, foot, or leg, be sure to follow these guidelines.
Inspect your feet daily. Check for cuts, blisters, redness, swelling, or nail problems. Use a magnifying hand mirror to look at the bottom of your feet. Call your doctor if you notice anything. (If your eyesight is poor, have someone else do it for you.)
Wash your feet in lukewarm (not hot!) water. Keep your feet clean by washing them daily. But only use lukewarm water—the temperature you'd use on a newborn baby.
Be gentle when bathing your feet. Wash them using a soft washcloth or sponge. Dry by blotting or patting—and make sure to carefully dry between the toes.
Moisturize your feet—but not between your toes. Use a moisturizer daily to keep dry skin from itching or cracking. But DON'T moisturize between the toes—this could encourage a fungal infection.
Cut nails carefully—and straight across. Also, file the edges. Don't cut them too short, since this could lead to ingrown toenails.
Never trim corns or calluses . No "bathroom surgery"—let your doctor do the job.
Wear clean, dry socks. Change them daily.
Avoid the wrong type of socks. Avoid tight elastic bands (they reduce circulation). Don't wear thick or bulky socks (they can fit poorly and irritate the skin).
Wear socks to bed. If your feet get cold at night, wear socks. NEVER use a heating pad or hot water bottle.
Shake out your shoes and inspect the inside before wearing. Remember, you may not feel a pebble—so always shake out your shoes before putting them on.
Keep your feet warm and dry. Don't get your feet wet in snow or rain. Wear warm socks and shoes in winter.
Never walk barefoot. Not even at home! You could step on something and get a scratch or cut.
Take care of your diabetes. Keep your blood sugar levels under control.
Don't smoke. Smoking restricts blood flow in your feet.
Get periodic foot exams. See your foot and ankle surgeon on a regular basis for an examination to help prevent the foot complications of diabetes.

Prevent diabetes naturally

Learn how to prevent diabetes naturally without all of the side effects of drugs.The search for information relating to how to prevent diabetes naturally without drugs has become increasingly popular. As a civilization, diabetes has become much more prevalent in our society due to increased obesity. However, you don’t have to be categorized as obese to suffer from diabetes. Learning how to prevent diabetes naturally without drugs is important for decreasing the prevalence of diabetes.

Instructions:

STEP1:If you want to learn how to prevent diabetes naturally, start with your diet.

A high fiber diet and a low sugar diet can be enough for basically healthy individuals who are concerned with a family history of diabetes.

Step2: Weight loss for those who are 20 pounds or more overweight can be a significant help in considering how to prevent diabetes naturally.

Weight gain can restrict the body’s ability to process and utilize the natural insulin, which is the basic cause of diabetes. Obesity and weight gain are cited as the single greatest cause for the increase in diagnosed cases of diabetes.

Step3: Reducing the intake of specific fats is essential in the prevention of this disease. Decreasing dietary fats like saturated fats and trans fats can help ward off diabetic threats.

Step 4: Likewise, increasing the healthy fatty acids can combat the onset of diabetes the natural way. Fish oil supplements or flaxseed oil supplements can help provide the natural Omega 3 fatty acids that the body needs in order to encourage heart health and correct insulin production and use.

Step5: Daily exercise is vital. Simple daily exercise, like walking the family dog or getting a thirty minute Yoga or Tai Chi class can be highly effective in keeping diabetes at bay.

Step6: Smaller meals taken more often are part of how to prevent diabetes naturally. Overeating cause’s insulin overproduction while eating small meals throughout the day can keep insulin production at regular and healthy levels.

Step7: Keeping an eye on your cholesterol and blood pressure levels can be significant indicators as to whether diabetes in waiting in the wings. Many cases of diabetes start with a frighteningly high cholesterol or blood pressure levels. Maintaining healthy levels of both the blood pressure and the cholesterol can help prevent diabetes.

Step8: There is a lot of information regarding how to prevent diabetes naturally on the internet, but the essential ingredient in keeping this potentially deadly disease at bay is common sense eating habits and an eye toward physical exercise. Maintaining a healthier lifestyle is the key to a healthy body.

Step9: While you're here be sure to take a look around for more tips and information for preventing and treating diabetes.

Diabetes and obesity

How to avoid diabetes in obesity:

Diabetes and obesity are at an all time high in America. Many times they're connected because being over weight places you at risk for diabetes. I guess you could say diabetes is like the cousin you wish wasn't in the family at all. Diabetes is a scary disease and can make you wish you would have avoided it when you had the chance.

Instructions:

1:When a person has both diabetes and obesity they're really in trouble. However, there's a possibility of getting rid of both if they lose the weight, keep it off and change their lifestyle. The only thing that could hinder them would be if the diabetes runs in the family this could make it harder.

You can also be thin and get diabetes this usually happens because of genetics. It used to be a disease that occurred later in years, but now that our diets are so bad this isn't true anymore. So, you can be thin and young and get diabetes.

2:There are ways to avoid diabetes and obesity, so why not do what you can while you can? Why take the chance? After all, diabetes can get so bad you can lose a limb! As you can see it's not to be taken lightly, especially if it runs in the family. First of all, since diabetes and obesity are so closely related if you make these lifestyle changes it will help you to avoid both of them. It's up to you and nobody else to do what you need to do before you get diabetes, become obese or both

3:Let's start with desserts it's time to get rid of the refined sugar and replace it with fruit. While you're at it eat smaller portions and eat on smaller plates.

Prepare healthy snacks and bring take them with you everywhere you go. Plan your meals, keep a schedule and eat several small meals a day, never eat large meals or eat watching TV.

Don't skip meals, especially breakfast, hungry people overeat and eat things they shouldn't. Eat only lean meat/fish and not much of it and begin to eat a semi-vegetarian diet. Also, watch your calories and keep track of all you eat and drink. Eat 200-500 less calories a day until you reach 1500, no less than 1200.

4:As you adjust your diet it's also important to cut back on sodas, coffee, tea etc. and a little at time replace them with water. Drink plenty of water to flush toxins out of your system, at least 8 glasses a day. These are not habits that you change all at once, but one at a time.Changing your lifestyle to avoid diabetes and obesity can't be a rush job or you will overwhelm yourself and give up. Instead it's done by tackling one small goal at a time until you're where you want to be. This doesn't mean you can put it off that would be a mistake. In fact, you should begin as soon as possible.

5:While diet is a big part of what needs to be done it's not the only part. You also need to keep active and begin an exercise program. It's best to choose something you enjoy, so that you will do it regularly. This means at least 3-5 days a week for 30-60 minutes. It's terrible what diabetes and obesity will do in a person's life if they don't do something to prevent it. Preventive health care is the key and you are only one who can use it to unlock the door and live a life of good health and happiness.

Emergency Treatment In diabetes

Glucagon is a fast-acting hormone used to raise blood glucose levels quickly. It is administered by injection in cases where a person with diabetes has symptoms of hypoglycemia -- such as confusion, seizures, or unconsciousness -- that have not responded to treatment with glucose (sugar).
Reviewed last on: 9/16/2008
Harvey Simon, MD, Editor-in-Chief; Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital.

(The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions.)

Foot Care in Diabetes

Foot Care
Measures to Prevent Foot Ulcers.
Preventive foot care can significantly reduce the risk of ulcers and amputation. Some tips for preventing problems include:
-Patients should inspect their feet daily and watch for changes in color or texture, odor, and firm or hardened areas, which may indicate infection and potential ulcers.
-When washing the feet, the water should be warm (not hot) and the feet and areas between the toes should be thoroughly dried afterward. Check water temperature with the hand or a thermometer before stepping in.
-Apply moisturizers, but NOT between the toes.
-Gently use pumice to remove corns and calluses (patients should not use medicated pads or try to shave the corns or calluses themselves.)
-Trim toenials short and file the edges to avoid cutting adjacent toes.
-Well-fitting footwear is very important. People should be sure the shoe is wide enough. Patients should also avoid high heels, sandals, thongs, and going barefoot. Shoes with a rocker sole reduce pressure under the heel and front of the foot and may be particularly helpful. Custom-molded boots increase the surface area over which foot pressure is distributed. This reduces stress on the ulcers and allows them to heal.
-Changes shoes often during the day.
-Wear socks, particularly with extra padding (which can be specially purchased).
-Patients should avoid tight stockings or any clothing that constricts the legs and feet.
-Consult a specialist in foot care for any problems.

Home management of Diabetes

Home Management of Diabetes:

Monitoring Glucose (Blood Sugar) Levels

Both low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia) are of concern, especially for patients who take insulin. Blood glucose levels are generally more stable in type 2 diabetes than in type 1, so experts usually recommend measuring blood levels only once or twice a day. For patients who have become insulin-dependent, more intensive monitoring is necessary.

Patients should aim for the following measurements:
-Pre-meal glucose levels of between 90 - 130 mg/dL
-Bedtime levels of between 110 - 150 mg/dL

Different goals may be required for specific individuals, including pregnant women, very old and very young people, and those with accompanying serious medical conditions.

Finger-Prick Test.

A typical blood sugar test includes the following:
-A drop of blood is obtained by pricking the finger.
-The blood is then applied to a chemically treated strip.
-Monitors read and provide results.

Home monitors are about 10 - 15% less accurate than laboratory monitors, and many do not meet the standards of the American Diabetes Association. Most doctors believe, however, that they are accurate enough to indicate when blood sugar is too low.

Some simple procedures may improve accuracy:
-Testing the meter once a month.
-Recalibrating it whenever a new packet of strips is used.
-Using fresh strips; outdated strips may not provide accurate results.
-Keeping the meter clean.
-Periodically comparing the meter results with the results from a laboratory.

For patients who have trouble controlling hypoglycemia (low blood sugar) or fluctuating blood sugar levels, continuous glucose sensor monitors are also available. In 2007, the FDA approved the STS-7 System, which continuously measures glucose levels for up to 7 days through a sensor inserted beneath the skin of the abdomen. Continuous glucose sensor monitors do not replace fingerstick glucose meters and test strips, but are used in combination with them.

To monitor the amount of glucose within the blood a person with diabetes should test their blood regularly. The procedure is quite simple and can often be done at home regularly. The procedure is quite simple and can often be done at home.

Glycosylated Hemoglobin
Hemoglobin A1c (also called HbA1c , HA1c, or A1C) is measured periodically every 2 - 3 months to determine the average blood-sugar level over the lifespan of the red blood cell. Normal HbA1c levels should be below 7%. Home tests are also available for measuring A1C.

Preventing Hypoglycemia
The following tips may help avoid hypoglycemia or prepare for attacks:
1-Patients are at highest risk for hypoglycemia at night. Bedtime snacks are advisable if blood glucose levels are below 180 mg/dL (10 mmol/L). Protein snacks may be best
2-Patients who intensively control their blood sugar should monitor blood levels as often as possible, four times or more per day. This is particularly important for patients with hypoglycemia unawareness.
3-In adults, it is also particularly critical to monitor blood glucose levels before driving, when hypoglycemia can be very hazardous.
4-Patients who use medications that put them at risk for hypoglycemia should always carry hard candy, juice, sugar packets, or commercially available glucose substitutes designed for individuals with diabetes.

Family and friends should be aware of the symptoms and be prepared:
-If the patient is helpless (but not unconscious), family or friends should administer three to five pieces of hard candy, two to three packets of sugar, half a cup (four ounces) of fruit juice, or a commercially available glucose solution.
-If there is inadequate response within 15 minutes, the patient should receive additional sugar by mouth and may need emergency medical treatment, possibly including an intravenous glucose solution.
-Family members and friends can learn to inject glucagon, a hormone, which, in contrast to insulin, raises blood glucose.

Patients are encouraged to wear at all times a medical alert ID bracelet or necklace that states they have diabetes. If patients take insulin, that information should be included as well.

Foot Care
Measures to Prevent Foot Ulcers.

Preventive foot care can significantly reduce the risk of ulcers and amputation. Some tips for preventing problems include:
-Patients should inspect their feet daily and watch for changes in color or texture, odor, and firm or hardened areas, which may indicate infection and potential ulcers.
-When washing the feet, the water should be warm (not hot) and the feet and areas between the toes should be thoroughly dried afterward. Check water temperature with the hand or a thermometer before stepping in.
-Apply moisturizers, but NOT between the toes.
-Gently use pumice to remove corns and calluses (patients should not use medicated pads or try to shave the corns or calluses themselves.)
-Trim toenials short and file the edges to avoid cutting adjacent toes.
-Well-fitting footwear is very important. People should be sure the shoe is wide enough. Patients should also avoid high heels, sandals, thongs, and going barefoot. Shoes with a rocker sole reduce pressure under the heel and front of the foot and may be particularly helpful. Custom-molded boots increase the surface area over which foot pressure is distributed. This reduces stress on the ulcers and allows them to heal.
-Changes shoes often during the day.
-Wear socks, particularly with extra padding (which can be specially purchased).
-Patients should avoid tight stockings or any clothing that constricts the legs and feet.
-Consult a specialist in foot care for any problems.

Causes Of diabetes

Causes:
Type 2 diabetes is caused by a complicated interplay of genes, environment, insulin abnormalities, increased glucose production in the liver, increased fat breakdown, and possibly defective hormonal secretions in the intestine. The recent dramatic increase indicates that lifestyle factors (obesity and sedentary lifestyle) may be particularly important in triggering the genetic elements that cause this type of diabetes.

Insulin Abnormalities
The characteristic features of most patients with type 2 diabetes are:
-Insulin resistance in muscle cells
-Normal or even excessive levels of insulin (to compensate for this resistance), eventually followed by a drop in insulin production
In addition, researchers are trying to determine the factors that might promote insulin resistance:
-Both obesity and insulin resistance at different phases are marked by elevated levels of free fatty acids and the hormones resistin and leptin. It is not known yet if elevated levels are simply a product of obesity or play some causal role in diabetes.
-Insulin resistance is associated with a chronic low inflammatory response, which involves a number of immune factors, such as TGH-beta 1 and C-reactive protein. Such factors can cause damage over time and may be responsible for the association between insulin resistance and heart disease.

Genetic Factors
Type 2 diabetes has a genetic component. As one specific syndrome, maturity-onset diabetes of the young (MODY), seems related to one specific gene.
Generally, diabetes type 2 is thought to result from a combination of the presence of specific genes along with predisposing environmental factors.
Specific mutations may affect parts of the insulin gene and various other physiologic components involved in the regulation of blood sugar.

Most of these genes play a role in regulating insulin action, including the processes that occur in the pancreas’ insulin-producing beta cells. The FTO gene increases the risk for obesity, which itself is a risk factor for type 2 diabetes. These genes appear to cluster around three genetic regions that include a number of chromosomes. Scientists hope that future research will help uncover how genes influence the progression from pre-diabetes to diabetes, and how lifestyle and medical intervention may help delay or prevent this process.

Diagnosis and Screening Tests:

Diagnosis and Screening Tests:
There are no clear-cut guidelines for when to screen for diabetes. Some experts recommend that everyone over age 45 be tested regularly for diabetes, although others do not feel this is necessary in people with no symptoms or risk factors. In fact, early screening may identify some people with impaired glucose levels that would eventually normalize. Such people might be treated unnecessarily with medications that pose a risk for high blood sugar (hyperglycemia).


Still, given the risk for serious complications with diabetes and the potential value of early treatments, most experts recommend that all adults over 45 be screened and that younger adults be screened if they have one or more of the following conditions:
-A weight that is 20% more than ideal body weight
-Risk factors for heart disease, such as high blood pressure or unhealthy cholesterol levels -- especially for patients with low HDL ("good") cholesterol and high triglyceride levels
-History or presence of heart disease, stroke, or peripheral artery disease
-A close relative with diabetes
-A high-risk ethnic group background
-In women, having delivered a baby weighing over 9 pounds or having a history of gestational diabetes
-In women, polycystic ovary disease


Some experts recommend that children over age 10 should be tested for type 2 diabetes (even if they have no symptoms) if they are overweight and have at least two risk factors.




Testing for Diabetes
Fasting Plasma Glucose. The fasting plasma glucose (FPG) test is the standard test for diabetes. It is a simple blood test taken after 8 hours of fasting. Results indicate:
-FPG levels are considered normal up to 100 mg/dL (or 5.5 mmol/L).
-Levels between 100 - 125 mg/dL (5.5 - 7.0 mmol/L) are referred to as impaired fasting glucose or pre-diabetes. These levels are considered to be risk factors for type 2 diabetes and its complications.
-Diabetes is diagnosed when FPG levels are 126 mg/dL (7.0 mmol/L) or higher.


The FPG test is not always reliable, so a repeat test is recommended if the initial test suggests the presence of diabetes, or if the test is normal in people who have symptoms or risk factors for diabetes. For example, people who take the test in the afternoon and show normal results may actually have abnormal levels that would be revealed if they were tested in the morning.


People with FPG levels in the high end of the normal range (high 90s) may have increased risk for developing type 2 diabetes. Obesity further increases this risk. Patients with FPG levels in the upper 90s should exercise and lose weight to help lower their FPG levels.


Glucose Tolerance Test. The oral glucose tolerance test (OGTT) is more complex than the FPG and may overdiagnose diabetes in people who do not have it. Some experts recommend it as a follow-up after FPG, if the latter test results are normal but the patient has symptoms or risk factors of diabetes. The test uses the following procedures:
-The patient first has an FPG test.
-The patient has a blood test 2 hours later, after drinking a special glucose solution.


The following results suggest different conditions:
-OGTT levels are considered normal up to 140 mg/dL.
-Levels between 140 - 199 mg/dL are referred to as impaired glucose tolerance or pre-diabetes. -Diabetes is diagnosed when OGTT levels are 200 mg/dL or higher.


The patient cannot eat for at least 8 hours prior to the FPG and OGTT tests.


Test for Glycosylated Hemoglobin.

Tests for blood levels of glycosylated hemoglobin, also known as hemoglobin A1c (HbA1c), are not used for an initial diagnosis, but they are useful for determining the severity of diabetes. Some experts think this test can help predict complications in people who have FPG levels of 110 - 139, which are above normal but do not indicate full-blown diabetes.


The basis for this test as a diagnostic measurement in diabetes includes:
-Hemoglobin is a protein molecule found in red blood cells. When glucose binds to it, the hemoglobin becomes modified, a process called glycosylation.
-Glycosylation affects a number of proteins, and elevated levels of glycosylated hemoglobin are strongly associated with complications of diabetes.
-A glycosylated hemoglobin level of 1% above normal range identifies diabetes in 98% of patients. Normal HbA1c levels do not necessarily rule out diabetes, but if diabetes is present and levels are normal, the risk for complications is low.


Food intake does not affect the test, so it can be taken at any time. A home test has been developed that might make it easier to measure HbA1c. In general, measurements suggest the following:
-Normal HbA1c levels should be below 7%.
-Levels of 11 - 12% glycosylated hemoglobin indicate poor control of carbohydrates. High levels are also markers for kidney trouble.


Screening Tests for Complications
Screening for Heart Disease. All patients with diabetes should be tested for hypertension and unhealthy cholesterol and lipid levels and given an electrocardiogram. For cholesterol, people with diabetes should aim for LDL levels below 100 mg/dL, HDL levels over 50 mg/dL, and triglyceride levels below 150 mg/dL. Blood pressure goals should be 130/80 mm Hg or lower. Other tests may be needed in patients with signs of heart disease.


The electrocardiogram (ECG or EKG) is used extensively in the diagnosis of heart disease, from congenital heart disease in infants to myocardial infarction and myocarditis in adults. Several different types of electrocardiogram exist.


Screening for Kidney Damage. The earliest manifestation of kidney damage is microalbuminuria, in which tiny amounts (30 - 300 mg per day) of protein called albumin are found in the urine. About 20% of type 2 patients show evidence of microalbuminuria upon diagnosis of diabetes. (However, not all people with type 2 diabetes eventually develop kidney disease.) Microalbuminuria typically shows up in patients with type 2 diabetes who have high blood pressure.

The American Diabetes Association recommends that people with diabetes receive an annual microalbuminuria urine test. Patients should also have their blood creatinine tested at least once a year. Creatinine is a waste product that is removed from the blood by the kidneys. High levels of creatinine may indicate kidney damage. A doctor uses the results from a creatinine blood test to calculate the glomerular filtration rate (GFR). The GFR is an indicator of kidney function; it estimates how well the kidneys are cleansing the blood.

Screening for Retinopathy. The American Diabetes Association recommends that patients with type 2 diabetes get an initial comprehensive eye exam by an ophthalmologist or optometrist shortly after they are diagnosed with diabetes, and once a year thereafter. (People at low risk may need follow-up exams only every 2 - 3 years.) The eye exam should include dilation to check for signs of retinal disease (retinopathy).

Screening for Neuropathy. All patients should be screened for nerve damage (neuropathy), including a comprehensive foot exam. Patients who lose sensation in their feet should have a foot exam every 3 - 6 months to check for ulcers or infections.
Screening for Thyroid Abnormalities.
Thyroid function tests should be administered.
Resources

Prescribed medicines with brand names

Commonly Prescribed Oral Diabetic Medications
There is a special blood test that your doctor does to determine if your diabetes is in control. This test measures a chemical in your blood called " A1C".
The higher your sugar is, the higher your A1C will be. The American Diabetic Association recommends that diabetics must maintain a A1C of less than 7.0% in order to reduce the complications associated with diabetes. (The American Association of Clinical Endocrinologists recommend 6.5% or less).
The higher your A1C, the more likely it is that you will suffer complications of diabetes such as kidney disease, blindness or amputation.Every point decrease in A1C reduces your risk of diabetic complications and/or dying from a diabetes induced stroke or heart attack. Please take your HBA1C level seriously - your life is in your hands.The best way to control diabetes is with diet and exercise. If this doesn't work, there are many drugs available.
Diabetics must not smoke -- diabetics who smoke are at very high risk of having a heart attack or stroke.
Actos (pioglitizone, Takeda)
- once a day insulin sensitizer
Actos is a drug that increases your body's sensitivity to insulin. Another way to look at it is that when you take Actos, your body's insulin becomes stronger & more effective. Actos can take up to six weeks to kick in to maximum effect.Actos is available in 3 doses - 15mg, 30mg and 45mg. Most people take the 30mg or the 45 mg. Actos is very expensive.

Amaryl (glimepiride, Aventis)
-once-a-day sulfonylurea
The way Amaryl works on the pancreas increase insulin production in response to a meal so that your body can use glucose more efficiently.Amaryl is usually taken once per day. The tablets are very easy to split in case you have to adjust your dose. Amaryl is relatively inexpensive. You must never take Amaryl on an empty stomach - Amaryl should be taken with your first main meal of the day. Amaryl works fast - usually within 24 hours.

Avandia (rosiglitazone; Smithkline Beacham)
- once a day or twice a day insulin sensitizer.
Avandia is a drug that increases your body's sensitivity to insulin. Another way to look at it is that when you takeAvandia, your body's insulin becomes stronger & more effective. Avandia is available in 3 doses - 2mg, 4mg and 8mg. Most people takethe 8mg per day. They either take a 4mg tablet twice per day or an 8mgtablet once per day. Avandia is very expensive.

Avandamet (rosiglitazone maleate and metformin hydrochloride; GlaxoSmithKline)
Avandamet is taken twice a day with meals.
It starts to work within one or two weeks but it can take 2-3 months before the full effects kick in. Avandamet contains metformin so it is normally not taken by people who have sick kidneys.Avandamet is available in four tablet strengths of rosiglitazone/metformin,respectively: 2 mg/500 mg, 4 mg/500 mg, 2mg/1000mg, and 4mg/1000mg.

Byetta (Exantide; injectable given twice per day)
Byetta is very expensive.
Byetta has an interesting background. Scientists noticed that certain reptiles could go for months without eating. They discovered that there was a naturally occurring chemical in the lizards saliva that was able to turn the lizard's pancreas on and off. This discovery lead to Byetta.
Byetta is a synthetic hormone that stimulates insulin secretion in response to blood glucose levels.Byetta is also known to slow down the exit of food from the digestive track so you feel full longer.
Byetta is given twice per day as an injection. It must be taken within one hour BEFORE meals.It comes in a prefilled disposable pen-like injector system. Byetta comes in two strengths - 5 micrograms per dose (5mcg) and 10 micrograms (10mcg) per dose.
The use of Byetta is associated with a modest weight loss. A common side effect of Byetta is nausea and vomiting. They are working on a version of Byetta that you will only have to take once every week instead of twice per day but this is a long way off.Byetta is very expensive.

Duetact (pioglitazone HCl and glimepiride)
Duetact is what we pharmacists call a "fixed combination" product.Duetact is a combination of Actos and glimepiride (formerly known asAmaryl).
Fixed combination products are useful to patients because they give youtwo drugs in one pill, making for better convenience.
Another consideration of fixed combination products is that you get 2 different medicines but you only have to pay one copay.
The downside of fixed combination products is that if you get a side effect, it's hard be sure what component of the pill gave you the problem. Since Duetact contains glimepiride, it is important not to take it on an empty stomach. If you take it on an empty stomach, you may get a serious side effect known as "hypoglycemia" or low blood sugar.

Galvus (Vildagliptin)
Galvus is an experimental diabetes drug developed by Novartis.
It is expected to be approved for use in the United Stated some time during early winter of 2006.
Galvus is known as a DPP-4 inhibitor. DDP-4 inhibitors are part of a broader class of medicines known as incretin mimetics, such as Byetta (exenatide). However, unlike Byetta (which must be injected twice per day) Galvus is a pill Galvus is known as a DPP-4 inhibitor. DPP-4 inhibitors work in the pancreas to increase insulin protection. They also work in the liver toregulate the over-production of glucose. Supposedly, Galvus is not expected to cause weight gain such as is seen in other diabetespills such as Actos, Avandia, and sulfonylureas such as glimepiride andglipizide.
When approved, Galvus will be taken once per day. Galvus is similar in action to another experimental DPP-4 pill, Januvia which will be marketed by Merck.Since Galvus is not yet approved by the FDA, the Galvus prescribing information is not available. We will post the Galvus package insert on this page when it is made available to the public.

Glipizide Sulfonlyurea;
Generic; Brand Name = Glucotrol, Pfizer.

Glucophage (metformin, Bristol Meyers Squibb) - biguanide ;
also available in sustained release form; Glucophage XR. Glucophage is a brand name version of a drug called metformin. Metformin is the most popular diabetes drug in the United States. Metformin's main job is to get your liver to stop producing too much glucose. In many diabetics, the liver acts like a sugar factory on overtime; it goes haywire and produces way too much sugar all throughout the day.
What metformin does is to send a signal to the liver to reduce the production of sugar.One drawback of metformin is that it can cause terrible stomach crampsand diarrhea if you take too high a dose too soon. You have to give your body a chance to get used to the metformin. If you build up the dose slowly, day by day, these side effects can be dramatically reduced.If you have poor kidney function you should not take metformin.

Glimepiride
(Generic; formerly known as Amaryl)

Glyburide (Micronase; Upjohn, Glynase; Upjohn, Diabeta; Aventis) sulfonylurea
Glyburide works on the pancreas to increase insulin production in response to a food so that your body can use glucose more efficiently.Glyburide is relatively inexpensive.
You must never take glyburide on an empty stomach . If you take glyburide on an empty stomach your blood sugar may drop too low.
The scientific name for low blood sugar is hypoglycemia. Glyburide is usually taken once or twice per day. Glyburide is an inexpensive drug.

Januvia (sitagliptin phosphate)
Januvia diabetes drug developed by Merck.
It was approved for use in the United Stated October 19th, 2006.
Januvia is indicated to be used alone or in combination with metformin, Actos and Avandia.Januvia is available as tablets containing 25mg, 50mg or 100mg.
The recommended dose of Januvia is 100mg per day to be taken with or without meals. Patients with kidney disease or weakened kidneys shouldtake a smaller dose.
Januvia is known as a DPP-4 inhibitor.
DDP-4 inhibitors are part of abroader class of medicines known as incretin mimetics, such as Byetta (exenatide). However, unlike Byetta (which must be injected twice per day) Januvia is a pill.
DPP-4 inhibitors work in the pancreas to increase insulin protection. They also work in the liver to regulate the over-production of glucose. Supposedly, Januvia is not expected to cause weight gain such as is seen in other diabetes pills such as Actos, Avandia, and sulfonylureas such as glimepiride and glipizide. In trials, Januvia was be taken once per day in doses of 100mg or 200mg.
Januvia is similar in action to another experimental DPP-4 pill, Galvuswhich will be marketed by Novartis.

Janumet
Janumet is a combination of Januvia and metformin in the same pill. This way you get added convenience of one pill rather than two pills and you only have to pay one copay but you are getting two drugs.Janumet is available in two strengths. The low dose pill contains 50mg Januvia + 500mg of metformin.
The 50/500mg pill is light pink and stamped with the number "575".The second strength of Janumet contains 50 mg of Januvia + 1000mg of metformin. The 50/1000mg pill is red and stamped with the number "577".

Glipizide+Metformin ; fixed combination tablet; formerly known as Meta-Glip)
Available in 3 Strengths:
2.5 mg glipizide/250 mg metformin
2.5 mg glipizide/500 mg metformin
5.0 mg glipizide/500 mg

Metformin - biguanide ; also available in sustained release form
Metformin is the most popular diabetes drug in the United States.
Metformin's main job is to get your liver to stop producing too much glucose.
In many diabetics, the liver acts like a sugar factory on overtime; it goes haywire and produces way too much sugar all throughout the day.
What metformin does is to send a signal to the liver to reduce the production of sugar.One drawback of metformin is that it can cause terrible stomach crampsand diarrhea if you take too high a dose too soon.
You have to give your body a chance to get used to the metformin. If you build up the dose slowly, day by day, these side effects are dramatically reduced.If you have poor kidney function you should not take metformin.

Prandi-Met (combination tablet of repaglinide and metformin; Sciele)
Available in 2 strengths:
1 mg Prandin./500 mg metformin.
and 2 mg Prandin./500 mg metformin.

Prandin (repaglinide, NOVO)
Short Acting Insulin secretagogue

Precose (acarbose, Bayer)
glucosidase inhibitor

Rezulin (troglitazone, Parke Davis)
Not available in USA - Voluntarily withdrawn from market due to safety concerns:
side effects, warnings, dose.

Starlix (nateglinide, Novartis)
Short Acting Insulin secretagogue;

Medicines/drugs used in diabetes

Description
An in-depth report on the causes, diagnosis, treatment, and prevention of type 2 diabetes.
Alternative Names
Type 2 diabetes; Maturity onset diabetes; Noninsulin-dependent diabetes

Medications:
Many anti-hyperglycemic drugs are available to help patients with type 2 diabetes control their blood sugar levels. Most of these drugs are aimed at using or increasing sensitivity to the patient's own natural stores of insulin. Metformin is the only drug to date that achieves lower mortality rates.
For the most part older oral hypoglycemic drugs -- such as metformin and sulfonylureas -- are less expensive than, and work as well as, newer diabetes drugs. They are generally recommended as first-line drugs to use. Metformin is a safe and effective drug because it does not cause weight gain or too-low blood sugar. Metformin can also help lower LDL (“bad”) cholesterol.
In general, these drugs will reduce hemoglobin A1c levels by 1 - 2%. Adding a second oral hypoglycemic is generally recommended if inadequate control is not achieved with the first medication. For the most part, doctors should add a second drug rather than trying to push the first drug dosage to the highest levels.

Biguanides (Metformin)
Metformin (Glucophage) is a biguanide, which works by reducing glucose production in the liver and by making tissues more sensitive to insulin. Many experts recommend it as a first choice for most patients with type 2 diabetes who are insulin resistant, particularly if they are overweight. Metformin achieves lower mortality rates from diabetes and all causes than other drugs. In one comparison study, it achieved the lowest mortality rates (8%) compared to insulin (28%), a sulfonylurea (16%), and a thiazolidinedione (14%). Combinations with insulin-secreting drugs, other insulin-sensitizing drugs, or insulin itself are particularly effective.
Metformin does not cause hypoglycemia or add weight, so it is particularly well-suited for obese patients with type 2 diabetes. (In some studies, in fact, patients lost weight.) Metformin also appears to have beneficial effects on cholesterol and lipid levels and may help protect the heart. Some research has suggested that it significantly reduces the risk for heart attack. It is also the first choice for children who need oral drugs and is proving to be very effective for women with polycystic ovary syndrome and insulin resistance.
Side Effects.
Side effects include:
A metallic taste
Gastrointestinal problems, including nausea, and diarrhea
Interference with absorption of vitamin B12 and folic acid
Rare reports of lactic acidosis, a potentially life-threatening condition, particularly in people with risk factors for it. Major studies, however, found no greater risk with metformin than with any of the other drugs used for type 2 diabetes.
Certain people should not use this drug, including anyone with heart failure or kidney or liver disease. It is rarely suitable for adults over age 80.

Sulfonylureas
Sulfonylureas are oral drugs that stimulate the pancreas to release insulin. They are also first-line oral drugs. For adequate control of blood glucose levels, the drugs should be taken only 20 - 30 minutes before a meal. A number of brands are available, including chlorpropamide (Diabinese), tolazamide (Tolinase), acetohexamide (Dymelor), glipizide (Glucotrol), tolbutamide (Orinase), glyburide (Micronase), glimepiride (Amaryl), and repaglinide (Prandin).
Most patients can take sulfonylureas for 7 - 10 years before they lose effectiveness. Combinations with small amounts of insulin or other oral anti-hyperglycemic drugs (such as metformin or a thiazolidinedione) may extend their benefits. A combination of glyburide and metformin in one pill (Glucovance) is available. Glucovance may be particularly beneficial for patients with unhealthy cholesterol levels and poor control of their blood sugar levels. Some doctors recommend the combination as first-line treatment.
Side Effects and Complications.
In general, women who are pregnant or nursing or by individuals who are allergic to sulfa drugs should not use sulfonylureas.
Side effects may include:
-Weight gain (some sulfonylureas, such as glimepiride, may produce less weight gain than others)
-Water retention
-Although sulfonylureas pose a lower risk for hypoglycemia than insulin does, the hypoglycemia produced by sulfonylureas may be especially prolonged and dangerous. The newer sulfonylureas, such as glimipiride, have much less risk of hypoglycemia than older sulfonylureas.
-Some sulfonylureas may pose a slight risk for cardiac events.
Sulfonylureas interact with many other drugs, and patients must inform their doctor of any medications they are taking, including alternative or over-the-counter drugs.

Meglitinides
Meglitinides stimulate beta cells to produce insulin. They include repaglinide (Prandin), nateglinide (Starlix), and mitiglinide. These drugs are rapidly metabolized and short-acting. If taken before every meal, they actually mimic the normal effects of insulin after eating. Patients, then, can vary their meal times with this drug. (Nateglinide appears to work more quickly and is shorter-acting than repaglinide). These drugs may be particularly helpful in combination with metformin or other drugs. They may also be a good choice for people with potential kidney problems.
Side Effects.
Side effects include:
- diarrhea and headache. As with the sulfonylureas, repaglinide poses a slightly increased risk for cardiac events. (Newer drugs, such as nateglinide, may pose less of a risk.)
-People with heart failure or liver disease should use them with caution and be monitored.

Thiazolidinedione
Thiazolidinediones, also known as peroxisome proliferator-activated receptor (PPAR) agonists, include rosiglitazone (Avandia) and pioglitazone (Actos). They improve insulin sensitivity by activating certain genes involved in fat synthesis and carbohydrate metabolism. These drugs are usually taken once or twice per day; however, it may take several days before the patient notices any results from them and several weeks before they take full effect. Thiazolidinediones are usually taken in combination with other oral drugs or insulin. Thiazolidinediones available as 2-in-1 pills include rosiglitazone and metformin (Avandamet), rosiglitazone and glimepiride (Avandaryl), and pioglitazone and glimepiride (Duetact).
Side Effects.
Thiazolidinediones can have serious side effects.
- They can increase fluid build-up, which can cause or worsen heart failure in some patients. Combinations with insulin increase the risk. They should not be used by patients with heart failure and should be used cautiously in those with risk factors for heart failure.
-Rosiglitazone may also increase the risk for heart attack. Patients who take rosiglitazone, especially those who have heart disease or who are at high risk for heart attack, should discuss their treatment options with their doctors.
Thiazolidinediones may cause more weight gain than other diabetes medications or insulin. Any patient who has sudden weight gain, water retention, or shortness of breath should immediately call their doctor. These drugs have also been linked to increased risks for bone fracture.
There have been rare reports of rosiglitazone causing or worsening diabetic macular edema. This is an eye condition associated with diabetic retinopathy that causes swelling in the macular area of the retina. Symptoms include blurred vision and decreased color sensitivity. Most patients who had this side effect also had swelling in the feet and legs (peripheral edema). The condition resolved or improved when patients stopped taking the drug.
Thiazolidinediones can also cause liver damage. Patients who take these drugs should have their liver enzymes checked regularly.

Alpha-Glucosidase Inhibitors
Alpha-glucosidase inhibitors, including acarbose (Precose, Glucobay) and miglitol (Glyset), reduce glucose levels by interfering with the absorption of starch in the small intestine. Acarbose tends to lower insulin levels after meals, a particular advantage, since higher levels of insulin after meals are associated with an increased risk for heart disease. Some evidence suggests that early use of these drugs may reduce heart risk factors, including high blood pressure. Alpha-glucosidase inhibitors are not as effective alone as other single oral drugs, but combinations, such as with metformin, insulin, or a sulfonylurea, increase their effectiveness.
Side Effects.
These medications need to be taken with meals. Unfortunately, about a third of patients stop taking the drug because of flatulence and diarrhea, particularly after high-carbohydrate meals. The drug may also interfere with iron absorption.
Alpha-glucosidase inhibitors do not cause hypoglycemia when used alone, but combinations with other drugs do. In such cases, it is important that the patient receive a solution that contains glucose or lactose, not table sugar. This is because acarbose inhibits the breakdown of complex sugar and starches, which includes table sugar.

GLP-1 Inhibitors (Exenatide)
Incretin mimetics belong to a new class of drugs that help improve blood sugar control. Incretins include glucagon-like peptide-1 (GLP-1) inhibitors and DDP-4 inhibitors.
In 2005, the FDA approved exenatide (Byetta), the first GLP-1 inhibitor drug. Exenatide is an injectable drug that is a synthetic version of the hormone found in the saliva of the Gila monster, a venomous desert lizard. Exenatide is injected twice a day, 1 hour before morning and evening meals. It is prescribed for patients with type 2 diabetes who have not been able to control their glucose with metformin or a sulfonylurea drug. It can be taken in combination with these drugs or alone.
Side Effects.
Exenatide stimulates insulin secretion only when blood sugar levels are high and so has less risk for causing low blood sugar (hypoglycemia) when it is taken alone. However, the risk for hypoglycemia increases when exenatide is taken along with a sulfonylurea drug. There does not appear to be a risk for hypoglycemia when exenatide is used along with metformin. Other side effects may include nausea, vomiting, and diarrhea.
Exenatide has been associated with cases of acute pancreatitis, which is sudden inflammation of the pancreas. Symptoms of acute pancreatitis include severe abdominal pain that may radiate to the back. The pain may or may not be accompanied by nausea and vomiting. Patients who feel severe stomach pain that does not go away should seek prompt medical attention.

DPP-4 Inhibitors (Gliptins)
Dipeptidyl peptidase-4 (DPP-4) inhibitors, also called gliptins, are the second class of incretin drugs. In October 2006, the FDA approved the first DPP-4 inhibitor -- sitagliptin (Januvia). It can be used alone or in combination with metformin or a thiazolidinedione drug. It may also be used as add-on therapy to a sulfonylurea drug. In 2007, the FDA approved Janumet, which combines sitagliptin with metformin in one pill. Other DPP-4 drugs being studied include vildagliptin (Galvus) and saxagliptin.
DPP-4 inhibitors work in a similar way to GLP-1 inhibitors. However, unlike exenatide, which is given by injection, DPP-4 inhibitor drugs are taken as pills by mouth.
Like exenatide, DPP-4 inhibitors do not cause weight gain, have low risks for hypoglycemia, and have few severe side effects. The most common side effects include upper respiratory tract infection, sore throat, and diarrhea.

Pramlintide (Symlin)
Approved in 2005, pramlintide (Symlin) is a new type of injectable drug that may help patients who take insulin but still need better blood sugar control.
Pramlintide is a synthetic form of amylin, a hormone that is related to insulin.
Pramlintide is used in combination with insulin to lower blood sugar levels in the 3 hours after meals.

Insulin Replacement
Insulin replacement may be necessary when natural insulin reserves are depleted. It is typically started in combination with an oral drug (usually metformin).
Because type 2 diabetes is progressive, many patients eventually need insulin. However, when a single oral drug fails to control blood sugar it is not clear whether it is better to add insulin replacement or a second or third oral drug.
Some experts advocate using insulin as early as possible for optimal control. However, in patients who still have insulin reserves, there is concern that extra natural insulin will have adverse effects. Low blood sugar (hypoglycemia) and weight gain are the main side effects of insulin therapy. It is still not clear if insulin replacement improves survival rates compared to oral drugs, notably metformin.
Fortunately, studies to date have not reported any adverse cardiac effects in patients with type 2 diabetes who take insulin. In fact, insulin has been associated, in some cases, with improvement in heart risk factors. More research is needed to clarify these important issues.
Forms of Insulin.
Doctors are working toward administering insulin so that it closely mimics the daily pattern of insulin, which responds to blood sugar levels by surging after meals and then falling to a steady base level afterward. To achieve this, doctors may use two insulin types:
-Fast-Acting Insulins for Surges. Insulin lispro and aspart are fast-acting insulins. They mimic insulin's response to food intake. They are taken before meals, and their short action reduces the risk for hypoglycemia afterward.
-Slower Insulins for Base Levels. Intermediate forms (including NPH and lente) and long-acting forms (glargine, ultralente) were developed to provide a steady level of insulin throughout the day. To date, glargine (Lantus) seems to be the most successful in achieving this goal in type 2 diabetes.
In general, there is no advantage to dosing insulin more than two times a day for patients with type 2 diabetes.

Investigational Drugs
Sodium Glucose Uptake Transporter 2 (SGLT-2) Inhibitors. SGLT-2 inhibitors are a new class of drug being investigated for treatment of type 2 diabetes. Preliminary trials for two of these drugs, dapagliflozin and sergliflozin, have shown promising results in helping improve blood glucose control. The drugs are being tested in combination with metformin.

Warning on Dietary Supplements
Various fraudulent products are often sold on the Internet as “cures” or treatments for diabetes. These dietary supplements have not been studied or approved. In 2006, the FDA and Federal Trade Commission (FTC) launched a crackdown on these scams. The FDA and FTC warn patients with diabetes not to be duped by bogus and unproven remedies.

Cure

Cures for type 1 diabetes
Main article: Cure for diabetes mellitus type 1
There is no practical cure, at this time, for type 1 diabetes. The fact that type 1 diabetes is due to the failure of one of the cell types of a single organ with a relatively simple function (i.e. the failure of the beta cells in the Islets of Langerhans) has led to the study of several possible schemes to cure this form of diabetes mostly by replacing the pancreas or just the beta cells. Only those type 1 diabetics who have received either a pancreas or a kidney-pancreas transplant (often when they have developed diabetic kidney disease (ie, nephropathy) and become insulin-independent) may now be considered "cured" from their diabetes.
A simultaneous pancreas-kidney transplant is a promising solution, showing similar or improved survival rates over a kidney transplant alone. Still, they generally remain on long-term immunosuppressive drugs and there is a possibility that the immune system will mount a host versus graft response against the transplanted organ.

Transplants of exogenous beta cells have been performed experimentally in both mice and humans, but this measure is not yet practical in regular clinical practice partly due to the limited number of beta cell donors. Thus far, like any such transplant, it has provoked an immune reaction and long-term immunosuppressive drugs have been needed to protect the transplanted tissue.
An alternative technique has been proposed to place transplanted beta cells in a semi-permeable container, isolating and protecting them from the immune system. Stem cell research has also been suggested as a potential avenue for a cure since it may permit regrowth of Islet cells which are genetically part of the treated individual, thus perhaps eliminating the need for immuno-suppressants. This new method, autologous nonmyeloablative HSTC, was recently developed by a research team composed of scientists from the US and Brazil. This was originally tested in mice and in 2007 there was the first trial with fifteen patients.
Recently this trial was continued and 8 more patients were added. In the trial, the researchers implanted diabetes type 1 patients with their own stem cells raised from their own bone marrow. The stem cell transplant led to an appreciable repopulation of functioning insulin-producing beta cells in the pancreas so the patients became insulin free. Most of these patients became insulin independent for a mean period of 18.8 months. At the present time, autologous nonmyeloablative HSCT remains the only treatment capable of reversing type 1 DM in humans.

Microscopic or nanotechnological approaches are under investigation as well, in one proposed case with implanted stores of insulin metered out by a rapid response valve sensitive to blood glucose levels. At least two approaches have been demonstrated in vitro. These are, in some sense, closed-loop insulin pumps.

Cures for type 2 diabetes
Type 2 has had no definitive cure, although recently it has been shown that a type of gastric bypass surgery can normalize blood glucose levels in 80-100% of severely obese patients with diabetes.
The precise causal mechanisms are being intensively researched; its results are not simply attributable to weight loss, as the improvement in blood sugars precedes any change in body mass. This approach may become a standard treatment for some people with type 2 diabetes in the relatively near future. This surgery has the additional benefit of reducing the death rate from all causes by up to 40% in severely obese people.
A small number of normal to moderately obese patients with type 2 diabetes have successfully undergone similar operations.

Treatment

Diabetes mellitus is currently a chronic disease with no cure.
Medical emphasis must necessarily be on managing/avoiding possible short-term as well as long-term diabetes-related problems.
There is an exceptionally important role for patient education, dietetic support, sensible exercise, self monitoring of blood glucose, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds.
Careful control is needed to reduce the risk of long term complications. This is theoretically achievable with combinations of diet, exercise and weight loss (type 2), various oral diabetic drugs (type 2 only), and insulin use (type 1 and for type 2 not responding to oral medications, mostly those with extended duration diabetes). In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications should be undertaken to control blood pressure and cholesterol by exercising more, smoking less or ideally not at all, consuming an appropriate diet, wearing diabetic socks, wearing diabetic shoes, and if necessary, taking any of several drugs to reduce blood pressure.

Many type 1 treatments include combination use of regular or NPH insulin, and/or synthetic insulin analogs (e.g., Humalog, Novolog or Apidra) in combinations such as Lantus/Levemir and Humalog, Novolog or Apidra. Another type 1 treatment option is the use of the insulin pump (e.g., from Deltec Cozmo, Animas, Medtronic Minimed, Insulet Omnipod, or ACCU-CHEK). A blood lancet is used to pierce the skin (typically of a finger), in order to draw blood to test it for sugar levels.
In countries using a general practitioner system, such as the United Kingdom, care may take place mainly outside hospitals, with hospital-based specialist care used only in case of complications, difficult blood sugar control, or research projects. In other circumstances, general practitioners and specialists share care of a patient in a team approach. Optometrists, podiatrists/chiropodists, dietitians, physiotherapists, nursing specialists (e.g., DSNs (Diabetic Specialist Nurse)), nurse practitioners, or Certified Diabetes Educators, may jointly provide multidisciplinary expertise. In countries where patients must provide their own health care (i.e., in the developed world, the US, and in much of the undeveloped world), the impact of out-of-pocket costs of adequate diabetic care can be very high. In addition to the medications and supplies needed, patients are often advised to receive regular consultation from a physician (e.g., at least every three to six months).
Oral administration of aloe vera might be a useful adjunct for lowering blood glucose in diabetic patients as well as for reducing blood lipid levels in patients with hyperlipidaemia. Ten controlled clinical trials were found to reach that conclusion in four independent literature searches. However, caveats reported in each study led the researchers to conclude that aloe vera's clinical effectiveness was not yet sufficiently defined in 1999.
Peer support links people living with diabetes. Within peer support, people with a common illness share knowledge and experience that others, including many health workers, do not have. Peer support is frequent, ongoing, accessible and flexible and can take many forms—phone calls, text messaging, group meetings, home visits, and even grocery shopping. It complements and enhances other health care services by creating the emotional, social and practical assistance necessary for managing disease and staying healthy.

Types Of Diabetes.

Many types of diabetes are recognized: The principal three are:
Type 1:
Results from the body's failure to produce insulin. It is estimated that 5-10% of Americans who are diagnosed with diabetes have type 1 diabetes. Presently almost all persons with type 1 diabetes must take insulin injections.
Type 2:
Results from a condition in which the body fails to use insulin properly, combined with relative insulin deficiency. Most Americans who are diagnosed with diabetes have type 2 diabetes. Many people destined to develop type 2 diabetes spend many years in a state of Pre-diabetes: Termed "America's largest healthcare epidemic,10-11, a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. As of 2009 there are 57 million Americans who have pre-diabetes.

Gestational diabetes: Pregnant women who have never had diabetes before but who have high blood sugar (glucose) levels during pregnancy are said to have gestational diabetes. Gestational diabetes affects about 4% of all pregnant women. It may precede development of type 2 (or rarely type 1).
Many other forms of diabetes mellitus are categorized separately from these. Examples include congenital diabetes due to genetic defects of insulin secretion, cystic fibrosis-related diabetes, steroid diabetes induced by high doses of glucocorticoids, and several forms of monogenic diabetes.

What Is diabates?

Diabetes mellitus (pronounced /ˌdaɪ.əˈbiːtiːz/ or /ˌdaɪ.əˈbiːtɨs/; /mɨˈlaɪtəs/ or /ˈmɛlɨtəs/)—often referred to simply as diabetes—is a disease in which the body does not produce enough, or properly respond to, insulin, a hormone produced in the pancreas. Insulin is needed to turn sugar and other food into energy. In diabetes, the body either doesn't make enough insulin or can't use its own insulin as well as it should, or both. This causes sugar to accumulate in the blood, often leading to various complications.
The American Diabetes Association reported in 2009 that there are 23.6 million children and adults in the United States—7.8% of the population, who have diabetes. While an estimated 17.9 million in the US alone have been diagnosed with diabetes, nearly one in four (5.7 million) diabetics are unaware that they have the disease.