Indigenous nuclear reactor set to touch a milestone
Chennai: Armed with the Atomic Energy Regulatory Board's (AERB) clearance for erection of major nuclear reactor components, officials of Bharatiya Nabhikiya Vidyut Nigam (Bhavini) building the Rs.5,600 crore fast reactor near here are gearing up for lowering the huge main vessel.
Argon buffer tank being erected at Kalpakkam nuclear enclave in Tamil Nadu.
India's first indigenously designed breeder reactor - which breeds more material for a nuclear fission reaction than it consumes - is being built by Bhavini at the Kalpakkam nuclear enclave, 80 km from here.
Lowering of the huge stainless steel main vessel -- 12.9 metres in diameter and 12.94 metres in height, weighing 206 tonnes -- is considered a major step in completing the 500 MW power project by the September 2011 deadline.
"We are in the process of creating 100 percent clean environment around the reactor vault so that the main vessel can be lowered inside the already erected safety vessel. The nuclear vault chamber has been air-conditioned," project director Prabhat Kumar told IANS.
As civil works are on in the building housing the reactor vault, officials do not want to risk even a speck of dust inside the main vessel that would hold the coolant liquid sodium, reactor fuel, grid plates and others.
The sodium-cooled fast reactor designed by the Indira Gandhi Centre for Atomic Research (IGCAR) has three vessels - a safety vessel, a main vessel and an inner vessel.
Outermost is the stainless steel safety vessel, which was lowered into the reactor vault last June - the first milestone.
The third and smallest of the three vessels is the inner vessel -- 11 metres tall. It houses pumps, heat exchangers and other equipment. Together, they all go inside the main vessel.
Activities connected with the erection of the main vessel - drawing up the scheme for lifting the vessel, other mock up activities, load testing - have commenced at the project site despite the threat of rain. The officials have kept a two-day window for the operation which should not take over three hours.
Diabetes Information - Symptoms, Causes and Prevention of Diabetes
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Special magazine issue on Che Guevara released
Thu, Oct 29 03:58 PM
Thiruvananthapuram, Oct 29 (IANS) A special magazine edition tracing the life and times of Cuban revolutionary leader Che Guevara was released Thursday in this Kerala capital city.
The special issue of the quarterly Kaumudi magazine, in English, has been published by the Kaumudi Public Relations and is edited by Hashim Rajan.
'I wish to thank Aleida March, Che's wife, Che Guevara Studies Centre Havana and Ocean Press for permitting to publish the writings, speeches and select pictures of Che,' Rajan told IANS.
The contents include speeches, political writings and letters written by Che. The 108-page magazine is priced at Rs.125.
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The precise Etiology of most cases of diabetes is uncertain, although certain contributing factors are as follows:
Type 1 diabetes
Type 1 Diabetes is autoimmune disease that affects 0.3% on average. It is result of destruction of beta cells due to aggressive nature of cells present in the body. Researchers believe that some of the Etiology and Risk factors which may trigger type 1 diabetes may be genetic, poor diet (malnutrition) and environment (virus affecting pancreas). Secondly, in most of the cases, diabetes occurs because there is abnormal secretion of some hormones in blood which act as antagonists to insulin. Example- Adrenocortical hormone, Adrenaline hormone and Thyroid hormone.
Type 2 diabetes
Type 2 Diabetes is also called non insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. It occurs when the body produces enough insulin but cannot utilize it effectively. This type of diabetes usually develops in middle age. A general observation says that about 90-95 % of people suffering with diabetes are type 2; about 80 percent are overweight. It is more common among people who are older; obese; have a family history of diabetes; have had gestational diabetes. There are number of risk factors found to be responsible for type 2 diabetes like, the more the Etiology and Risk factors carried by an individual, the higher the risk for developing diabetes.
Following are the Causes of Diabetes
- Hereditary or Inherited Traits : It is strongly believed that due to some genes which passes from one generation to another, a person can inherit diabetes. It depends upon closeness of blood relationship as mother is diabetic, the risk is 2 to 3%, father is diabetic, the risk is more than the previous case and if both the parents are diabetic, the child has much greater risk for diabetes.
- Age : Increased age is a factor which gives more possibility than in younger age. This disease may occur at any age, but 80% of cases occur after 50 year, incidences increase with the age factor.
- Poor Diet (Malnutrition Related Diabetes) : Improper nutrition, low protein and fiber intake, high intake of refined products are the expected reasons for developing diabetes.
- Obesity and Fat Distribution : Being overweight means increased insulin resistance, that is if body fat is more than 30%, BMI 25+, waist grith 35 inches in women or 40 inches in males.
- Sedentary Lifestyle : People with sedentary lifestyle are more prone to diabetes, when compared to those who exercise thrice a week, are at low risk of falling prey to diabetes.
- Stress : Either physical injury or emotional disturbance is frequently blamed as the initial cause of the disease. Any disturbance in Cortiosteroid or ACTH therapy may lead to clinical signs of the disease.
- Drug Induced: Clozapine (Clozaril), olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel) and ziprasidone (Geodon) are known to induce this lethal disease.
- Infection : Some of the strephylococci is suppose to be responsible factor for infection in pancreas.
- Sex : Diabetes is commonly seen in elderly especially males but, strongly in women and those females with multiple pregnancy or suffering from (PCOS) Polycystic Ovarian Syndrome.
- Hypertension : It had been reported in many studies that there is direct relation between high systolic pressure and diabetes.
- Serum lipids and lipoproteins : High triglyceride and cholesterol level in the blood is related to high blood sugars, in some cases it has been studied that risk is involved even with low HDL levels in circulating blood.
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Pakistan needs to end terror to talk to India: PM
Thu, Oct 29 12:52 PM
Srinagar, Oct 29 (IANS) A day after extending a hand of friendship to Pakistan, Prime Minister Manmohan Singh said Thursday that no peace dialogue will succeed unless Islamabad cracks down on terrorists active against India.
'If negotiations to deal with all outstanding issues are to make any headway, it is essential that the terrorist elements should be brought under control,' the prime minister told reporters here, referring to Pakistan and the many Islamist groups based there.
'We are a democracy. If day in and day out terrorist attacks continue to take precious lives, we cannot create the requisite 'mahol' (atmosphere) for meaningful negotiations. It is not a pre-condition (for talks). It is a practical way of looking at things,' he added.
Manmohan Singh emphasised that Pakistan needed to bring 'under effective control these terrorist groups'.
Women prisoners keen to wed Rahul Mahajan
Wed, Oct 28 03:37 PM
Bhopal, Oct 28 (PTI) Rahul Mahajan, son of the late BJP leader, Pramod Mahajan has a new fan following - women inmates of the Central Jail here - with nine of them wanting to participate in the TV show "Rahul Dulhania Le Jaayega". The show where 33-year-old Mahajan, will choose a life partner has already received 16,755 entries.
The nine aspirants, from a 18-year-old undertrial to a 32-year-old convicted in a drug case, have already started preparing for the event and their inspiration is none other than their erstwhile jail-mate, actress Monica Bedi. Mahajan who had grabbed headlines with his arrest for drug possession as well as a messy divorce, had turned to reality TV with the show ''Big Boss 2''.
"These nine prisoners, including convicts and undertrials, have moved applications, seeking permission to participate in the TV ''Swayamvar'' of Rahul, son of BJP leader Pramod Mahajan," Bhopal Central Jail Superintendent P D Somkunwar told PTI today. He has sent the applications to the Jail Headquarters, adding that the pleas of undertrials will be decided by the court while that of convicts will be looked into by the Headquarters, Somkunwar said.
"These women are very much interested to take part in the TV show and after moving applications they have started wearing lipsticks and dressing up, much to the surprise of other inmates," Somkunwar said
Food subsidy bill could shoot well past Rs 60K cr mark
"In the mid term , this could mean imports of atleast one million tonnes," trade analysts maintain. In fact, the food subsidy bill is expected to remain on a northward trajectory for some years now, primarily thanks to higher grain support price for key commodities such as rice, wheat, oilseeds and pulses to incentivise foodgrain farmers make up for sustained domestic shortfall and high priced imports. .
Upto September 9, the government has released Rs 29,604.21 crore towards food subsidy and government officials hold that the subsidy has crossed Rs 30,000 crore already. Sustained hikes in support boosted the food subsidy by over 30% annually between 2000-01 and 2002-03. After a short lull , the trend resurfaced in 2007-08, showing a 31.2% annual growth, leading on to a 40% growth in 2008-09 (provisional) subsidy tab at Rs 4,3668 crore. The bill touched a record Rs 50,000 crore in 2008-09l, nearly Rs 18,454 crore (or 51%) higher than Rs 31,546 crore in 2007-08. It also exceeded the budgetary provision for the year by Rs 17,333 crore.
A similar fate awaits this year's food budget after indications that the government could annuonce a paddy bonus in order to incentivise farmers from UP, the biggest paddy producer state, to stop holding back their produce and boost sagging State procurment. In end August, the government announced support prices of Rs 980 and Rs 950 per qtl for Grade A and common varieties of paddy against Rs 880 and Rs 850/qtl last year, on the smug assumption that heavy stocks with it and a record production of 99 m tonnes to boost open market supplies would keep paddy/rices price depressed.
A bonus would mean that the economic cost (procurement, storage and transportation) of rice would go up significantly. A key reason why stocks went up to 50 million tonnes by June 2009 is the sustained hike in grain support to boost State buys and prevent a repeat of 2006-07 and 07-08, when highly-priced wheat (7.3 million tonnes) was imported. The unfactored-in drought, though, spoilt the well laid plans. The massive jump in food subsidy in 2008-09 came on account of subsidy levels between 58 to 86 per cent for wheat and 51 to 82 per cent for rice for various categories of households.The MSP for coarse cereals also went up.
Analysts suggest that the governmetn may have little option to cover this year's rice shortfall but to one, announce a bonus and hope to optimise State buys for welfare programmes and two, to enter into less transparent (and therefore less politically sensitive and less impacted by global rice market rates) government-to-government (g-tog) rice import deals with relatively less high profile exporter Myanmar. Or even Viet Nam. Importing from Thailand from the open global market is seen as both poltiically and economically unviable for the government since at the current $414/tonne for its 25% broken white rice, the landed cost per kg is estimated at around Rs 24/kg.. India's signals of import of rice have already driven up the price of this and other varities by aroudn $40 so far and this is expected to go up higher, which could mean a higher landed cost per kg. In comaprision, the government's cost per kg for rice procured from Punjab works out to
around Rs 14/kg currnetly. With a bonus, that could work out to Rs 17-18/kg, far lower than the price of Thai rice.
In the event, this could become highly politically and economically unviable an option for the governmetn as would tapping Thailand for a governmetn to government (g-to-g)rice import deal with other higher paying customers competing with it. Analysts hold, therefore, that one good option would be for India to enter into a g-to-g rice import deal with relatively less high profile exporter Myanmar. "G-to-g rice import deals are as a matter of course less transparent over prices and with Myanmar, it would be more so for the government. That would make the import issue less politically and economically sensitive. As importantly, rice trade with Myanmar would be insulated to a good extent from price movement in the global rice market although Thai prices could be a benchmark. Plus, smaller quantities in several tranches could be imported," an analyst stressed.
US envoy hails foiling of anti-India plot by FBI
Wed, Oct 28 01:15 PM
New Delhi, Oct 28 (IANS) The US Wednesday hailed the arrest of two men, including an American, by the FBI in connection with a Lashkar-e-Taiba (LeT) plot to launch terror attacks in India and stressed the commitment of the two countries to bring terrorists to justice.
'We congratulate our law enforcement agencies on this important breakthrough in the fight against terrorism that challenges both the United States and India,' US Ambassador to India Timothy J. Roemer said here.
'Radical extremists plotting attacks are a common threat demanding a shared solution, close cooperation, and bold resolve,' he said.
Alluding to enhanced cooperation between the two countries in combating terrorism, the US envoy said: 'We salute the strong and ongoing efforts between our two governments and the peoples of our nations in this global fight.'
'Together, our great democracies stand committed to bringing terrorists to justice and will press forward aggressively until this goal is accomplished,' he stressed.
The US investigating agencies have been cooperating with their Indian counterparts in bringing to justice the perpetrators of the 26/11 Mumbai carnage in which Pakistani nationals were suspected to be involved.
The envoy was referring to a plot by Pakistan-based terror group Lashkar-e-Taiba to use a US national to carry out a major terrorist attack in India.
David Coleman Headley, a 49-year-old US national, was one of two suspects arrested earlier this month by FBI's Joint Terrorism Task Force at Chicago's O'Hare International Airport before he boarded a flight to Philadelphia.
He was allegedly planning to travel to Pakistan from Philadelphia to meet Pakistani terrorists, including the fugitive Ilyas Kashmiri with an intention to target India. Kashmiri is the operational chief of HuJi, a Pakistani-based terrorist organisation with links to al-Qaeda, in Pakistan-controlled Kashmir.
Headley, along with his partner, a Pakistani-Canadian named Tahawwur Hussain Rana, was also hatching a plan to attack the Danish newspaper that published cartoons of Prophet Mohammed in 2005.
FIR in Rajdhani hostage case has no mention of Maoists
Thu, Oct 29 03:55 PM
Kolkata, Oct. 29 (ANI): The First Information Report that was filed against the hijackers of the Rajdhani Express didn't have any mention of any Maoists or the armed wing of the People's Committee Against Police Atrocities (PCPA).
The FIR filed by the Railway authorities in Midnapore's Rajdhani hostage case is being seen as a move to shield the Maoists.
The FIR was lodged with the Jhargram GRP.
The railways on Thursday filed an FIR against "unknown persons" for holding up the train, "heckling passengers" and preventing staff from "discharging their duties for a long time".
The move is being questioned over why Mamata Banerjee's Railways Ministry has not mentioned any names in the FIR when the Maoists and the PCPA had claimed responsibility for the hijack of the train.
According to sources, although famous PCAPA member Santosh Patra was among the crowd, railway officials didn't register any case gainst him, saying, "Who will identify them? We do not know any of them?" (ANI)
diabetes and infections | send to a friend |
Overview
A person with diabetes mellitus is at higher risk for infections than other people.
What is going on in the body?
Diabetes mellitus (abbreviated as DM, but sometimes simply referred to as "diabetes"), is a condition that makes it hard for the body to move glucose, the main form of sugar in the body, from the blood into the cells. The resulting higher than normal level of glucose in the blood, known as hyperglycemia, can cause a number of symptoms and illnesses.
A person with DM is more susceptible to infections generally. These infections may include:
What are the signs and symptoms of the condition?
The signs and symptoms vary depending on the type of infection present. Skin infections may cause hot, red, swollen, or inflamed tissues, especially where the skin is irritated or broken open. Gum infections may produce pain, swelling, and redness in the gum line. Urinary tract infections may cause cloudy or bloody urine or painful urination. Vaginal infections may cause itching, vaginal discharge, or pain.
Other signs of infection that should be reported to a doctor include:
What are the causes and risks of the condition?
What can be done to prevent the condition?
How is the condition diagnosed?
How Not to Die: Surprising Lessons on Living Longer, Safer, and Healthier from America's Favorite Medical Examiner (Hardcover)
Thousands of people make an early exit each year and arrive on medical examiner Jan Garavaglia's table. What is particularly sad about this is that many of these deaths could easily have been prevented. Although Dr. Garavaglia, or Dr. G, as she's known to many, could not tell these individuals how to avoid their fates, we can benefit from her experience and profound insight into the choices we make each day.In How Not to Die, Dr. G acts as a medical detective to identify the often-unintentional ways we harm our bodies, then shows us how to use that information to live better and smarter. She provides startling tips on how to make wise choices so that we don't have to see her, or someone like her, for a good, long time.
- In ''Highway to the Morgue,'' we learn the one commonsense safety tip that can prevent deadly accidents -- and the reason you should never drive with the windows half open
- ''Code Blue'' teaches us how to increase our chances of leaving the hospital alive -- and how to insist that everyone caring for you practice the easiest hygiene method around
- ''Everyday Dangers'' informs us why neat freaks live longer -- and the best ways to stay safe in a car during a lightning storm
Health Tip: Foot Care for People With Diabetes
Pay special attention to your feet
Does Diabetes Slow Alzheimer's?
French study suggesting delayed progression gets guarded response from U.S. experts
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Periodic Dieting May Cut Breast Cancer Risk
In lab studies, intermittent calorie restriction led to dramatic decrease in tumors
Metformin May Lower Diabetics' Odds for Pancreatic Cancer
But another study finding suggests insulin treatment could boost the risk
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Tight Management of Type 1 Diabetes Worth the Effort
Rates of serious complications drop with intensive therapy, study shows
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Exercising them will feel good
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When blood sugar is elevated, but not high enough for full-blown diabetes
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A potential complication of diabetes
Hormone Could Improve Diabetes Treatment
Biomarker might predict how type 2 patients will respond to drugs, study shows
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Doing so can sabotage your health
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Effect of Strict Diabetes Control on Heart Still Unclear
Reviews show it wasn't to blame for excess deaths in one trial, but when therapy starts could be key
New Diabetes Drug Shows Promise in Trial
Liraglutide mimics effects of a natural hormone, researchers say
Antioxidants Blunt Exercise Benefit, Study Shows
Vitamins C, E block creation of free radicals that promote insulin sensitivity, researchers say
Health Tip: Take Care of Your Feet
Suggestions for good foot health
Severe Low Blood Sugar Ups Older Diabetics' Dementia Risk
Study finds being hospitalized for hypoglycemia linked to mental decline
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Help prevent painful problems
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Mamata hand-in-glove with Maoists, allege comrades
NEW DELHI: The Trinamool Congress' "links" with the People's Committee against Police Atrocities (PCPA) — the outfit that staged the Rajdhani
CPM, which unleashed a frontal attack on the railway minister, said a probe should be conducted into her "links with Maoists" as it has been been coming in the way of effecting handling of the Naxalite menace in West Bengal. "The matter calls for a probe.
The finger of suspicion for the incident points to Ms Banerjee. One of the ministers from her very own party went on record saying that he had prior information about the attack. Even the Maoist leader the attackers wanted freed is a former TMC member," said CPM polit bureau member Sitaram Yechury. The CPM leader said that it was strange that attacks had been occurring on the railway property in Maoist areas since the Trinamool Congress chief assumed ministership.
Armed Maoist-backed tribal activists on Tuesday had seized the Bhubaneswar-Delhi Rajdhani Express in West Midnapore district and the train was freed by the central security forces after a five-hour drama. They had demanded the release of their jailed leader Chhatradhar Mahato.
Congress, however, came to the defence of the railway minister. "The allegations are absurd, mindless and outlandish. Such allegations should not be dignified with a response, especially as not an iota of evidence has been furnished," Congress spokesman Abhishek Manu Singhvi said. He also said political parties should act responsibly so that national focus is not diverted from the issue.
But the government on its part was not in agreement with the railway minister's demand to deploy Army for bringing situation under control in West Bengal. "The Army can be deployed for law and order duties only as a last resort. No such proposal is under the consideration of the government," said defence minister A K Antony.
The Trinamool Congress chief had on Tuesday demanded that the Centre should use Army to recover arms allegedly taken away by "CPM goons" from the state armoury in West Bengal.
Gandhi did not have answer to environment problem: Amartya Sen
"Mahatma raised a different set of issues," he said while replying to a question asked at a conference on environment in Beijing about whether Gandhian thoughts hold the key to solving problems concerning environment degradation and climate change.
"Gandhi was even against railways," he said while pointing out that the transportation industry was a crucial aspect of the development and progress the world has seen.
Sen said he had high respect for the Mahatma and Gautam Buddha. But it is not possible to find answers to all problems from any one of the great people one admired.
He was a great admirer of Buddha but did not accept some of his views on the status of man and woman. Buddha's views on women were brought to light by his disciple, Ananda, he said.
Amitabh's Barabanki land in fresh trouble
| DAULATPUR (Barabanki): Daulatpur ghost has risen to haunt Amitabh Bachchan. The superstar finds himself in a spot with the gram pradhan of Daulatpur launching a sequel to part one. On Tuesday night Rajkumari Singh, the sixty plus woman pradhan, moved an application in the Mohammadpur Khala police station for lodging of FIR against Bachchan. Her allegation — the actor had regifted the land donated to the Daulatpur gram sabha to Nishtha foundation last week. Rajkumari, the de jure village head, it seems, has little or no role in the drama, her contribution limited to signing on the dotted line. The proxy fight is apparently being carried out by her son Avanendra Singh who approached the station officer Mohammadpur Khala at 9 pm on Tuesday, "the mother being too old and of frail health" . Bachchan, he told TOI, "is trying to cheat the gram sabha of the land after a waiver in its favour made a year and-ahalf ago during the trial of the land allotment case in the high court. Filing of the affidavit in the High Court giving up the claim was simply a ploy to turn off the heat" . The sudden turn of event has pushed the local officials on back foot. The memories of high profile trial which finally ended in a clean chit to the star fresh on his mind, station officer Prem Narayan Tiwari has lost no time in throwing the ball in the SP's court. Rajkumari, he told TOI, had in the application alleged that "Bachchan sought my consent for transfer of 2.50 bighas of land to the gram sabha and I had then consented to the proposal. Now he has given away a piece of same land — gata number 702 — to Nishtha Foundation. This amounts to defrauding the Daulatpur gram sabha and hence calls for action" . The application has been forwarded to the Barabanki SP Alok Kumar Singh, for necessary action , he said. Since the issue pertains to civil matter and the said transfer of land does not amount to a criminal offence, it must be dealt with by revenue officials, Singh pointed out. He has already sent a letter asking the district magistrate to set up a committee and have the matter probed. Further action will be taken after the conclusion of the inquiry, he said. However, if he is indeed caught on the wrong foot the transfer could spell trouble for Bachchan, government sources claimed. In December 2007, the Allahabad High Court while disposing of his writ petition in the land allotment case against the order of additional commissioner Faizabad, had specifically directed Bachchan not to lay any claims to the disputed property. Ruling out "any further action in any civil, criminal or revenue court" against the actor the court had maintained that "his right, title or interest, if any in the same, shall stand extinguished" . Meanwhile, the new twist in Bachchans saga has confused the locals. Kamlesh Tiwari, a farmer tilling the land next to the forlorn patch of nine bighas purchased by Bachchan for setting up a state-of-art girls' college , admitted being sickened by the development. Rajdhani hostage saga: Motive still a mystery 29 Oct 2009, 0816 hrs IST, Ajanta Chakraborty & Sukumar Mahato, TNN blockade. It was rather a pre-planned move by Maoists using the People's Committee Against Police Atrocities (PCPA) at the front. The move has laid bare that PCPA's links with Maoists, which is why Maoist squads took position amid the neighbouring Panisole forests to protect the agitators on the railway tracks. Villagers smelt a rat when an elephant herd came out of the forests some days ago and entered the Jhargram town. The local belief is that these huge mammals can't stay inside the forests in the event of any movement of alien creatures. They could be right given the date and timing of the siege. Maoist leader Kishanji had scripted the strike in a bid to demoralise the security forces who were conducting raids in the villages of West Midnapore, soon after they had to give a safe passage to Kishanji and his armed squad during the release of Sankrail police officer Atindranath Datta held hostage by Maoists. Mark the timing. The "blockade" was planned on a day when a sizeable section of the district police had fanned out along the 7km stretch from Panskura in East Midnapore to Chowringhee, the gateway to Midnapore town, to oversee the route by which chief secretary Asok Mohan Chakrabarti, director general of police Bhupinder Singh, and five other senior IAS officers were coming to Midnapore from Kolkata. A huge police force was also deployed to escort the convoy from Chowringhee to Midnapore town. PCPA supporters gathered at the railway tracks minutes before the Rajdhani Express was about to arrive. Strangely, no one in the district administration had an inkling of this impromptu blockade. And more the high-profile train chugged in without any RPF inside compartments. The Maoist script was perfect till then. They got the mileage they wanted. Confusion began after the agitators were at bay over their future course. PCPA leader Santosh Patra went on air making incoherent claims. On one occasion, he said that agitators would release the train by the next day, and then made amends to the release plan saying they would release the driver by 5pm, and finally claimed that no one was taken hostage. Later, Patra said that they wanted railway minister Mamata Banerjee to come to the spot.
Taliban's war against women in Peshawar 29 Oct 2009, 0659 hrs IST, PTI ISLAMABAD: A car bomb packed with 150 kg of explosives ripped through a bustling commercial hub, including a market meant exclusively for women, in Pakistan's Peshawar city on Wednesday, killing at least 95 people and injuring 213 others, hours after US secretary of state Hillary Clinton arrived here to discuss fight against terror. The toll could be higher as many people are still believed to be trapped in the rubble of six buildings that collapsed due to the powerful blast. Many of the dead and injured in the explosion were women and children. The blast, heard across Peshawar, occurred in the congested 'Peepal Mandi' area of NWFP capital Peshawar shortly after 1 pm local time. Meena Bazar, a market exclusively for women, bore the brunt of the blast. Many bodies were charred and missing limbs, witnesses said. The blast sparked a major fire and white smoke billowed over the city. Footage on television showed two rows of shops on either side of a narrow road going up in flames and collapsing. Dozens of shops and several cars were gutted by the fire while the blast damaged a mosque. The fire spread rapidly as most buildings in the area were made of wood. Mr Shafqat Malik, chief of the city's bomb disposal squad, said the blast, the 13th terror attack in Peshawar in recent weeks, was caused by a car bomb packed with 150 kg of explosives. No group claimed responsibility for the attack that destroyed shops selling bangles, dresses and toys. However, Pakistani authorities have blamed the Taliban, against whom a major military operation is on in the militant stronghold of Waziristan, for the recent terror attacks in the country. Rescue workers scoured the debris for survivors and the injured were still being taken to hospitals over three hours after the blast. Doctors said 50 of the injured were in a serious condition. NWFP information minister Mian Iftikhar Hussain told reporters that many of the dead and injured were women and children. "We will not lose our courage and we will continue our 'jihad' to eliminate these terrorists. We will not forgive these killers. We may lose our lives but we will continue this 'jihad'," Mr Hussain said. Ms Clinton, who arrived in Islamabad on her maiden official visit a few hours before the blast, said Pakistan had "endured a barrage of attacks" for its role in the war on terror. She pledged that the US would stand should-to-shoulder with the Pakistani people in their campaign against extremists.
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NPS: benefits to get better with time An analysis of cost structure of New Pension System dispels impression about high administrative charges. New tax code: A mixed bag for banks Minimum alternate tax would be levied even if banks have suffered losses in a financial year, a clear departure from established theory of taxing only net income. http://economictimes.indiatimes.com/Opinion/opinionshome/897228639.cms Realty back in reckoning as FIIs cut blue-chip stake 29 Oct 2009, 0655 hrs IST, Vijay Gurav, ET Bureau MUMBAI: DLF, Unitech and HDIL are the latest darlings of foreign funds expecting a quick buck, even as they slash holdings in companies such as The sudden fancy for real estate among those overseas funds were probably due to the surge in fund raisings by those debt-ridden companies in the recent bull run when most of them sold shares at less than a third of their peak 2007-08 valuations which overseas investors found attractive. "With interest rates expected to remain benign and stable, some dedicated funds might have bought on hopes of a significant upswing in high-beta sectors like realty," said Tata Asset Management CEO Ved Prakash Chaturvedi. High beta stocks are those which rise or fall more than the benchmark indexes. As of September 30, 2009, FIIs owned 25% of the aggregate equity capital of 36 realty companies, including industry leaders like DLF, Unitech, Indiabulls Real Estate and HDIL. That is higher than the previous year's 9.6% and the year before 10.3%. Indian companies, including Unitech and DLF, have so far raised $12.3 billion through share sale this year and another $17.4 billion may be raised by fiscal year-end exploiting a record stock market rally which saw the benchmark indices more than double from their troughs earlier this year. It was not just one sector that foreign funds who have invested $14.4 billion in the current calendar year so far have favoured, but also raised stakes in sectors such as agrochemical, a key beneficiary in an agrarian economy like India, breweries which benefit from rising incomes in urban centres, and mining. Last year they pulled out $12 billion. Overseas funds own 25.6%, 18.6% and 17.9%, respectively, in agrochemical, breweries and mining sectors. Companies such as United Phosphorus, United Spirits, Gujarat NRE Coke and Sesa Goa have large foreign holdings. But the ones that were favoured in the last bull rally — technology, capital goods, cement and retail aren't lucky this time. Combined FII holdings in all the listed IT companies fell to 12.1% as on September 30, 2009, compared to 15.6% as on September 30, 2008. Their exposure in capital good sector fell to 9.9% from 12.1% and to 15.1% from 18.5% in retail space. "FIIs have been underweight on IT companies due to outsourcing concerns," said Centrum Broking MD Devesh Kumar. "Cement companies are adding new capacities and investors would wait for demand to pick up, which would also depend on the pace of infrastructure development in the country." International companies stung by the economic slowdown have been cutting their spending on technology which the Indian companies depend upon. SAP, Europe's biggest business software producer, on Wednesday cut revenue forecast for the year as companies held on to purse strings. Indian infrastructure companies are also showing delays in executing orders and their valuations at more than 25 times in some cases such as Larsen & Toubro, seem to have run ahead of themselves. India Land's flagship IT project seeks to alter Ambattur facade 27 Oct 2009, 1928 hrs IST, Hemamalini Venkatraman & V Balasubramanian, ET Bureau | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CHENNAI: India Land properties (ILP), part of the Madrid-based Americorp group, is betting big on its flagship technology park at Ambattur to give a fresh impetus to the fast changing industrial landscape of the suburb in north Chennai. By September, the 2.6 million sq ft ILP tech park on 10-acre would be commissioned with marquee clients like the Royal Bank of Scotland (RBS), Kone and Etilsalat. Total office area will be two million sq ft — Tower A (4.2 lakh sq ft) and Tower B (6.3 lakh sq ft) are completed and ready. Tower C (9.5 lakh sq ft) is coming up.The 100% FDI-backed project of the global realty player is in the last leg of completion. The Rs 450 crore project has a potential to generate over 20,000 jobs in the IT, ITES, retail and support services. It is expected to play a major role in transforming Ambattur, which is one of the oldest industrial hubs in Chennai. ILP has emerged as the largest player with its plug-and-play tech park by building IT space which is double the size of Tidel (1.3 million sq ft) and Olympia Tech Park (1.2 million sq ft) in the city. ILP director, S Salai Kumaran told ET Ambattur is witnessing a sea change. From an industrial belt, it is transforming into a catchment area for companies, including MNCs, in diverse fields. It has the potential to become a central business district (CBD) and another OMR given its proximity to leading hospitals, schools and the entire eco-system. It also has the advantage of a strong road and rail connectivity linking centres like Tiruvallur, Perumbur, Anna Nagar and Vadapalani which have a high concentration of workforce from diverse sectors, he added. "Our development work is progressing well. We expect to become fully operational by September," ILP country head C S Ilangovan alias Umesh told ET, noting that office premises would absorb a space of 2 million sq ft, while the balance would be used for parking, retail (multi-cuisine food courts) and landscaping infrastructure. Core sector grows 4%, may pull down IIP 29 Oct 2009, 0442 hrs IST, ET Bureau NEW DELHI: The industrial output growth, as measured by the Index of Industrial Production (IIP), may see a drop in September from the 10.4%  None of the six core industries captured by the index — crude oil, petroleum refinery products, coal, electricity, cement and finished steel (carbon) — showed a month-on-month uptick in production. Crude oil and petroleum refinery products were the only two segments which showed a higher annual growth rate. Analysts are expecting the growth rate in these two segments to gather momentum as the output from Reliance's KG basin and Cairn's oilfield in Rajasthan stabilise. Policymakers pointed that this would have an impact on electricity generation as well. Planning commission member Saumitra Chaudhari told ET: "The gas output from oil fields, which started production recently, will help in keeping the electricity generation high." He added this was one of the reasons why the electricity generation was relatively high inspite of reservoir levels being low on account of truant monsoon. With the late revival of monsoon, the reservoirs are also recharged, especially in south. A recent note by Citi economist Rohini Malkani points out that the strong coal production in first half of the year may be due to higher cement production, as coal is an input and a source of power in cement production. "The delayed monsoon has helped the construction industry and will lead to better year-on-year growth in cement and steel," Mr Chaudhari pointed out. On a cumulative basis, the core sector index was up 4.8% during first six months of the year, outpacing the 3.4% growth seen during the same period last year. Growth in coal and cement in the first six months of the current fiscal outperformed growth in same period last year. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Saarc ministers promise to cut negative list, free services sector 29 Oct 2009, 0435 hrs IST, Amiti Sen, ET Bureau KATHMANDU: Trade Services could be incorporated into the South Asia Free Trade Agreement (SAFTA) soon. Saarc ministers, who met in Kathmandu on Wednesday, also decided to work on reducing the negative list of items that are not covered under Safta to make the free trade agreement more ``meaningful''. Safta, which, so far, is an agreement for elimination of tariffs on goods traded within the Saarc region, was signed in January 2004. Speaking on the occasion, Indian commerce and industry minister Anand Sharma pointed out that India had unilaterally reduced its negative list for LDCs in the Saarc region, from 744 items to below 500 items. "We are also working towards reduction on negative list with reference to non-LDCs of Saarc (which include Pakistan and Sri Lanka)," the minister said. The minister urged the non-LDC members to consider reviewing their respective negative lists in respect of both LDCs and non-LDCs, so that intra-Saarc trade could be further expanded. Interestingly, Pakistan continues to trade with India based on a positive list of items it allows from India. The Safta, however, requires all members to trade with each other on the basis of a negative list, which means that all goods would be allowed to be traded except the ones included in the negative list. In his opening remarks, Saarc secretary general Sheel Kant Sharma pointed out that the expert group that had been constituted to draft the agreement on services had made good progress. "The agreement on trade in services should be finalised before the next Saarc Summit in April 2010," he said. Services accounts for more than half the GDP in the Saarc countries. On the need to prune the negative lists of Saarc countries, Mr Sharma said it should be a fixed percentage of the total regional trade of the countries and the next reduction should happen before the Saarc Summit next year. Intra-Saarc trade in the first six months of 2009 was $377 billion, which is encouraging, as it is more than the traded figure for the entire 2008, Mr Sharma said. Intra-regional trade share in 2008 in the case of South Asia was 4.31% as against 27.06% in case of Asean. The Indian minister stated that for better regional integration, Saarc needs to focus on establishing a framework for cooperation in investments. "The draft agreement on promotion and protection of investment needs to be concluded as early as possible," he said. Saarc countries include Bangladesh, Bhutan, Maldives, India, Pakistan, Nepal and Sri Lanka.  Enlarge Photo Reuters Car bomb kills 91 in PakistanIANS A car bomb ripped through a crowded market in Peshawar city in north-western Pakistan, killing 91 people, as US Secretary of State Hillary Clinton arrived on a visit to the country and assured full support in fight against terrorism. Six UN foreign staff killed in attack in KabulReutersTaliban militants killed 6 UN foreign staff in an attack on an international guest-house in Kabul, deepening concerns about security for the presidential elections. US envoy hails foiling of anti-India plot by FBIIANSThe US hailed the arrest of two men, including an American, by the FBI in connection with a Lashkar-e-Taiba (LeT) plot to launch terror attacks in India and stressed the commitment of the two countries to bring terrorists to justice. NATIONAL Bollywood celebrities says polls tool of change NATIONAL Here's a look at the celebs at India Couture Week WORLD Take a look at the best 50 public companies in Asi... NATIONAL Government to tighten norms for business visas WORLD Eco-friendly cars at Frankfurt Motor Show 2009 WORLD Tortured in Pak, migrants want to stay in India NATIONAL Bollywood celebrities says polls tool of change NATIONAL Here's a look at the celebs at India Couture Week National NewsReuters
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Salary levels to rise in India In India base salary levels are poised to jump nearly 10 per cent Inside NewsEditor's picksNEWS SERVICESWEATHEREnter City or Postal Code:Explore Yahoo! News on Mobile PaginationDiabetes mellitusFrom Wikipedia, the free encyclopedia (Redirected from Diabetes)
Diabetes mellitus (pronounced /ˌdaɪ.əˈbiːtiːz/ or /ˌdaɪ.əˈbiːtɨs/; /mɨˈlaɪtəs/ or /ˈmɛlɨtəs/)—often referred to simply as diabetes—is a condition in which the body either does not produce enough, or does not properly respond to, insulin, a hormone produced in the pancreas. Insulin enables cells to absorb glucose in order to turn it into energy. In diabetes, the body either fails to properly respond to its own insulin, does not make enough insulin, or both. This causes glucose to accumulate in the blood, often leading to various complications.[2][3] Many types of diabetes are recognized:[3] The principal three are:
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. All forms of diabetes have been treatable since insulin became medically available in 1921, but there is no cure for the common types except a pancreas transplant; gestational diabetes usually resolves after delivery. Diabetes and its treatments can cause many complications. Acute complications including hypoglycemia, diabetic ketoacidosis, or nonketotic hyperosmolar coma may occur if the disease is not adequately controlled. Serious long-term complications include cardiovascular disease, chronic renal failure, retinal damage that can lead to blindness, several types of nerve damage, and microvascular damage that may cause erectile dysfunction and poor wound healing. Poor healing of wounds, particularly of the feet, can lead to gangrene, possibly requiring amputation. Adequate treatment of diabetes, as well as increased emphasis on blood pressure control and lifestyle factors such as not smoking and maintaining a healthy body weight, may improve the risk profile of most of the chronic complications. In the developed world, diabetes is the most significant cause of adult blindness in the non-elderly and the leading cause of non-traumatic amputation in adults. Diabetic nephropathy is the main illness requiring renal dialysis in the United States.[6] [edit] Classification
The term diabetes, without qualification, usually refers to diabetes mellitus, which roughly translates to excessive sweet urine (known as "glycosuria"), but there are several rarer conditions also named diabetes. The most common of these is diabetes insipidus in which large amounts of urine are produced (polyuria), which is not sweet (insipidus means "without taste" in Latin); it can be caused either by kidney (nephrogenic DI) or pituitary gland (central DI) damage. It is a noninfectious disease. Among the body systems affected by diabetes mellitus are the nervous, digestive, circulatory, endocrine and urinary systems, but all body systems are in some way affected. The term "type 1 diabetes" has universally 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 non-insulin-dependent diabetes mellitus (NIDDM). Beyond these two types, there is no agreed-upon standard nomenclature. Various sources have defined "type 3 diabetes" as, among others, gestational diabetes,[7] insulin-resistant type 1 diabetes (or "double diabetes"), type 2 diabetes which has progressed to require injected insulin,[citation needed] and latent autoimmune diabetes of adults (or LADA or "type 1.5" diabetes.[8]) [edit] Type 1 diabetesMain article: Diabetes mellitus type 1 Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets of Langerhans in the pancreas leading to a deficiency of insulin. This type of diabetes can be further classified as immune-mediated or idiopathic. The majority of type 1 diabetes is of the immune-mediated nature, where beta cell loss is a T-cell mediated autoimmune attack.[2] There is no known preventive measure which can be taken against type 1 diabetes, which contain approximately 10% of diabetes mellitus cases in North America and Europe (though this varies by geographical location). Most affected people are otherwise healthy and of a healthy weight when onset occurs. Sensitivity and responsiveness to insulin are usually normal, especially in the early stages. Type 1 diabetes can affect children or adults but was traditionally termed "juvenile diabetes" because it represents a majority of the diabetes cases in children. The principal treatment of type 1 diabetes, even in its earliest stages, is the delivery of exogenous insulin (often by injection) combined with careful monitoring of blood glucose levels using glucose meters. Without insulin, diabetic ketoacidosis often develops which may result in coma or death. Apart from the subcutaneous injections, it is also possible to deliver insulin by a pump, which allows continuous, controllable infusion of insulin 24 hours a day and the ability to program doses (boluses) of insulin as needed at meal times or to counter high blood glucose levels. An inhaled form of insulin was approved by the FDA in January 2006. It was discontinued for business reasons in October 2007.[9][10] Non-insulin treatments, such as monoclonal antibodies and stem-cell based therapies, are effective in animal models but have not yet completed clinical trials in humans.[11] Type 1 treatment must be continued indefinitely in essentially all cases. The longest surviving Type I diabetes patient is Gladys Dull, who has lived with the condition for over 83 years. Treatment need not significantly impair normal activities, if sufficient patient training, awareness, appropriate care, discipline in testing and dosing of insulin is taken. However, treatment is burdensome for some patients; insulin is replaced in a non-physiological manner, and this approach is therefore far from ideal. The average glucose level for the type 1 patient should be as close to normal (80–120 mg/dl, 4–6 mmol/L) as is "safely" possible. Some physicians suggest up to 140–150 mg/dl (7-7.5 mmol/L) for those having trouble with lower values, such as frequent hypoglycemic events. Values above 400 mg/dl (20 mmol/L) are sometimes accompanied by discomfort and frequent urination leading to dehydration. Values above 600 mg/dl (30 mmol/L) usually require medical treatment and may lead to ketoacidosis, although they are not immediately life-threatening. However, low levels of blood glucose, called hypoglycemia, may lead to seizures or episodes of unconsciousness and absolutely must be treated immediately, by emergency high-glucose gel placed in the patient's mouth, intravenous administration of dextrose, or an injection of glucagon. [edit] Type 2 diabetesMain article: Diabetes mellitus type 2 [edit] PathophysiologyType 2 diabetes mellitus is characterized differently and is due to insulin resistance or reduced insulin sensitivity, combined with relatively reduced insulin secretion which in some cases becomes absolute. The defective responsiveness of body tissues to insulin almost certainly involves the insulin receptor in cell membranes. However, the specific defects are not known. Diabetes mellitus due to a known specific defect are classified separately. Type 2 diabetes is the most common type. In the early stage of type 2 diabetes, the predominant abnormality is reduced insulin sensitivity, characterized by elevated levels of insulin in the blood. At this stage hyperglycemia can be reversed by a variety of measures and medications that improve insulin sensitivity or reduce glucose production by the liver. As the disease progresses, the impairment of insulin secretion worsens, and therapeutic replacement of insulin often becomes necessary. There are numerous theories as to the exact cause and mechanism in type 2 diabetes. Central obesity (fat concentrated around the waist in relation to abdominal organs, but not subcutaneous fat) is known to predispose individuals to insulin resistance. Abdominal fat is especially active hormonally, secreting a group of hormones called adipokines that may possibly impair glucose tolerance. Obesity is found in approximately 55% of patients diagnosed with type 2 diabetes.[12] Other factors include aging (about 20% of elderly patients in North America have diabetes) and family history (type 2 is much more common in those with close relatives who have had it). In the last decade, type 2 diabetes has increasingly begun to affect children and adolescents, probably in connection with the increased prevalence of childhood obesity seen in recent decades in some places.[13] Environmental exposures may contribute to recent increases in the rate of type 2 diabetes. A positive correlation has been found between the concentration in the urine of bisphenol A, a constituent of polycarbonate plastic from some producers, and the incidence of type 2 diabetes.[14] Type 2 diabetes may go unnoticed for years because visible symptoms are typically mild, non-existent or sporadic, and usually there are no ketoacidotic episodes. However, severe long-term complications can result from unnoticed type 2 diabetes, including renal failure due to diabetic nephropathy, vascular disease (including coronary artery disease), vision damage due to diabetic retinopathy, loss of sensation or pain due to diabetic neuropathy, liver damage from non-alcoholic steatohepatitis and heart failure from diabetic cardiomyopathy. Many studies show that hormones like cortisol and testosterone play a crucial role in the sugar absorption and in the insulin resistance[citation needed]. It has been suggested that subclinical Cushing's syndrome (cortisol exces) is associated with diabetes mellitus type 2 [15]. The percentage of sublinical Cushing's syndrome on diabetic population seems to be about 9%, but it also seems that the real percentage is higher than previously believed [16]. The diabetic patients with a pituitary microadenoma, can significantly improve insulin sensitivity and glucose tolerance by transsphenoidal surgery, because the remotion of microadenomas can decrease ACTH and cortisol levels [15]. Hypogonadism is often associated with cortisol excess, and testosterone deficiency is also associated with diabetes mellitus type 2 [17][18], even if the exact mechanism by which testosterone improve insulin resistance is still not know (probably it reduces corticol diabetogenic effects), it is probable that testosterone plays a crucial role in the sugar absorption. [edit] TreatmentType 2 diabetes is usually first treated by increasing physical activity, decreasing saturated fat and carbohydrate intake, and losing weight. These can restore insulin sensitivity even when the weight loss is modest, for example around 5 kg (10 to 15 lb), most especially when it is in abdominal fat deposits. It is sometimes possible to achieve long-term, satisfactory glucose control with these measures alone. However, the underlying tendency to insulin resistance is not lost, and so attention to diet, exercise, and weight loss must continue. The usual next step, if necessary, is treatment with oral antidiabetic drugs. Insulin production is initially only moderately impaired in type 2 diabetes, so oral medication (often used in various combinations) can be used to improve insulin production (e.g., sulfonylureas), to regulate inappropriate release of glucose by the liver and attenuate insulin resistance to some extent (e.g., metformin), and to substantially attenuate insulin resistance (e.g., thiazolidinediones). According to one study, overweight patients treated with metformin compared with diet alone, had relative risk reductions of 32% for any diabetes endpoint, 42% for diabetes related death and 36% for all cause mortality and stroke.[19] Oral medication may eventually fail due to further impairment of beta cell insulin secretion. At this point, insulin therapy is necessary to maintain normal or near normal glucose levels. [edit] Gestational diabetesMain article: Gestational diabetes 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%–5% of all pregnancies and may improve or disappear after delivery. Gestational diabetes is fully treatable but requires careful medical supervision throughout the pregnancy. About 20%–50% of affected women develop type 2 diabetes later in life. Even though it may be transient, untreated gestational diabetes can damage the health of the fetus or mother. Risks to the baby include macrosomia (high birth weight), congenital cardiac and central nervous system anomalies, and skeletal muscle malformations. Increased fetal insulin may inhibit fetal surfactant production and cause respiratory distress syndrome. Hyperbilirubinemia may result from red blood cell destruction. In severe cases, perinatal death may occur, most commonly as a result of poor placental perfusion due to vascular impairment. Induction may be indicated with decreased placental function. A cesarean section may be performed if there is marked fetal distress or an increased risk of injury associated with macrosomia, such as shoulder dystocia. A 2008 study completed in the U.S. found that more American women are entering pregnancy with preexisting diabetes. In fact, the rate of diabetes in expectant mothers has more than doubled in the past 6 years.[20] This is particularly problematic as diabetes raises the risk of complications during pregnancy, as well as increasing the potential that the children of diabetic mothers will also become diabetic in the future. [edit] Other typesMost cases of diabetes mellitus fall into the two broad etiologic categories of type 1 or type 2 diabetes. However, many types of diabetes mellitus have more specific known causes, and thus fall into more specific categories. As more research is done into diabetes, many patients who were previously diagnosed as type 1 or type 2 diabetes will have their condition reclassified. Some cases of diabetes are caused by the body's tissue receptors not responding to insulin (even when insulin levels are normal, which is what separates it from type 2 diabetes); this form is very uncommon. Genetic mutations (autosomal or mitochondrial) can lead to defects in beta cell function. Abnormal insulin action may also have been genetically determined in some cases. Any disease that causes extensive damage to the pancreas may lead to diabetes (for example, chronic pancreatitis and cystic fibrosis). Diseases associated with excessive secretion of insulin-antagonistic hormones can cause diabetes (which is typically resolved once the hormone excess is removed). Many drugs impair insulin secretion and some toxins damage pancreatic beta cells. The ICD-10 (1992) diagnostic entity, malnutrition-related diabetes mellitus (MRDM or MMDM, ICD-10 code E12), was deprecated by the World Health Organization when the current taxonomy was introduced in 1999.[21] [edit] Signs and symptomsThe classical symptoms are polyuria and polydipsia which are, respectively, frequent urination and increased thirst and consequent increased fluid intake. Symptoms may develop quite rapidly (weeks or months) in type 1 diabetes, particularly in children. However, in type 2 diabetes symptoms usually develop much more slowly and may be subtle or completely absent. Type 1 diabetes may also cause a rapid yet significant weight loss (despite normal or even increased eating) and irreducible mental fatigue. All of these symptoms except weight loss can also manifest in type 2 diabetes in patients whose diabetes is poorly controlled, although unexplained weight loss may be experienced at the onset of the disease. Final diagnosis is made by measuring the blood glucose concentration. When the glucose concentration in the blood is raised beyond its renal threshold (about 10 mmol/L, although this may be altered in certain conditions, such as pregnancy), reabsorption of glucose in the proximal renal tubuli is incomplete, and part of the glucose remains in the urine (glycosuria). 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 will be replaced osmotically from water held in body cells and other body compartments, causing dehydration and increased thirst. Prolonged high blood glucose causes glucose absorption, which leads to changes in the shape of the lenses of the eyes, resulting in vision changes; sustained sensible glucose control usually returns the lens to its original shape. Blurred vision is a common complaint leading to a diabetes diagnosis; type 1 should always be suspected in cases of rapid vision change, whereas with type 2 change is generally more gradual, but should still be suspected. Patients (usually with type 1 diabetes) may also initially present with diabetic ketoacidosis (DKA), an extreme state of metabolic dysregulation characterized by the smell of acetone on the patient's breath; a rapid, deep breathing known as Kussmaul breathing; polyuria; nausea; vomiting and abdominal pain; and any of many altered states of consciousness or arousal (such as hostility and mania or, equally, confusion and lethargy). In severe DKA, coma may follow, progressing to death. Diabetic ketoacidosis is a medical emergency and requires immediate hospitalization. A rarer but equally severe possibility is hyperosmolar nonketotic state, which is more common in type 2 diabetes and is mainly the result of dehydration due to loss of body water. Often, the patient has been drinking extreme amounts of sugar-containing drinks, leading to a vicious circle in regard to the water loss. [edit] GeneticsBoth type 1 and type 2 diabetes are at least partly inherited. Type 1 diabetes appears to be triggered by some (mainly viral) infections, with some evidence pointing at Coxsackie B4 virus. There is a genetic element in individual susceptibility to some of these triggers which has been traced to particular HLA genotypes (i.e., the genetic "self" identifiers relied upon by the immune system). However, even in those who have inherited the susceptibility, type 1 diabetes mellitus seems to require an environmental trigger. There is a stronger inheritance pattern for type 2 diabetes. Those with first-degree relatives with type 2 have a much higher risk of developing type 2, increasing with the number of those relatives. Concordance among monozygotic twins is close to 100%, and about 25% of those with the disease have a family history of diabetes. Genes significantly associated with developing type 2 diabetes, include TCF7L2, PPARG, FTO, KCNJ11, NOTCH2, WFS1, CDKAL1, IGF2BP2, SLC30A8, JAZF1, and HHEX.[22] KCNJ11 (potassium inwardly rectifying channel, subfamily J, member 11), encodes the islet ATP-sensitive potassium channel Kir6.2, and TCF7L2 (transcription factor 7–like 2) regulates proglucagon gene expression and thus the production of glucagon-like peptide-1.[2] Moreover, obesity (which is an independent risk factor for type 2 diabetes) is strongly inherited.[23] Monogenic forms, e.g., MODY, constitute 1-5 % of all cases.[24] Various hereditary conditions may feature diabetes, for example myotonic dystrophy and Friedreich's ataxia. Wolfram's syndrome is an autosomal recessive neurodegenerative disorder that first becomes evident in childhood. It consists of diabetes insipidus, diabetes mellitus, optic atrophy, and deafness, hence the acronym DIDMOAD.[25] Gene expression promoted by a diet of fat and glucose as well as high levels of inflammation related cytokines found in the obese results in cells that "produce fewer and smaller mitochondria than is normal," and are thus prone to insulin resistance.[26] [edit] Pathophysiology Mechanism of insulin release in normal pancreatic beta cells. Insulin production is more or less constant within the beta cells, irrespective of blood glucose levels. It is stored within vacuoles pending release, via exocytosis, which is primarily triggered by food, chiefly food containing absorbable glucose. The chief trigger is a rise in blood glucose levels after eating Insulin is the principal hormone that regulates uptake of glucose from the blood into most cells (primarily muscle and fat cells, but not central nervous system cells). Therefore deficiency of insulin or the insensitivity of its receptors plays a central role in all forms of diabetes mellitus. The effectiveness of insulin (i.e. the concentration of its receptor) is also regulated by many hormones (i.e. cortisol, testosterone, GH, adrenaline, androsterone, estrogens, insulin growth factor type I...). For example cortisol highly decreases insulin sensitivity, while testosterone increases sugar absorption. Cushing's syndrome and hypogonadism are strongly suspected of being linked with diabetes mellitus[citation needed]. Most of the carbohydrates in food are converted within a few hours to the monosaccharide glucose, the principal carbohydrate found in blood and used by the body as fuel. The most significant exceptions are fructose, most disaccharides (except sucrose and in some people lactose), and all more complex polysaccharides, with the outstanding exception of starch. Insulin is released into the blood by beta cells (β-cells), found in the Islets of Langerhans in the pancreas, in response to rising levels of blood glucose, typically after eating. Insulin is used by about two-thirds of the body's cells to absorb glucose from the blood for use as fuel, for conversion to other needed molecules, or for storage. Insulin is also the principal control signal for conversion of glucose to glycogen for internal storage in liver and muscle cells. Lowered glucose levels result both in the reduced release of insulin from the beta cells and in the reverse conversion of glycogen to glucose when glucose levels fall. This is mainly controlled by the hormone glucagon which acts in an opposite manner to insulin. Glucose thus recovered by the liver re-enters the bloodstream; muscle cells lack the necessary export mechanism. Higher insulin levels increase some anabolic ("building up") processes such as cell growth and duplication, protein synthesis, and fat storage. Insulin (or its lack) is the principal signal in converting many of the bidirectional processes of metabolism from a catabolic to an anabolic direction, and vice versa. In particular, a low insulin level is the trigger for entering or leaving ketosis (the fat burning metabolic phase). If the amount of insulin available is insufficient, if cells respond poorly to the effects of insulin (insulin insensitivity or resistance), or if the insulin itself is defective, then glucose will not be absorbed properly by those body cells that require it nor will it be stored appropriately in the liver and muscles. The net effect is persistent high levels of blood glucose, poor protein synthesis, and other metabolic derangements, such as acidosis. [edit] Diagnosis
The diagnosis of type 1 diabetes, and many cases of type 2, is usually prompted by recent-onset symptoms of excessive urination (polyuria) and excessive thirst (polydipsia), often accompanied by weight loss. These symptoms typically worsen over days to weeks; about a quarter of people with new type 1 diabetes have developed some degree of diabetic ketoacidosis(Ketoacidosis is a type of metabolic acidosis which is caused by high concentrations of ketone bodies, formed by the breakdown of fatty acids and the deamination of amino acids.) by the time the diabetes is recognized. The diagnosis of other types of diabetes is usually made in other ways. These include ordinary health screening; detection of hyperglycemia during other medical investigations; and secondary symptoms such as vision changes or unexplainable fatigue. Diabetes is often detected when a person suffers a problem that is frequently caused by diabetes, such as a heart attack, stroke, neuropathy, poor wound healing or a foot ulcer, certain eye problems, certain fungal infections, or delivering a baby with macrosomia or hypoglycemia. Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is diagnosed by demonstrating any one of the following:[21]
A positive result, in the absence of unequivocal hyperglycemia, should be confirmed by a repeat of any of the above-listed methods on a different day. Most physicians prefer 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.[27] According to the current definition, two fasting glucose measurements above 126 mg/dL (7.0 mmol/L) is considered diagnostic for diabetes mellitus. Patients with fasting glucose levels from 100 to 125 mg/dL (6.1 and 7.0 mmol/L) are considered to have impaired fasting glucose. Patients with plasma glucose at or above 140 mg/dL or 7.8 mmol/L, but not over 200, two hours after a 75 g oral glucose load are considered to have impaired glucose tolerance. Of these two pre-diabetic states, the latter in particular is a major risk factor for progression to full-blown diabetes mellitus as well as cardiovascular disease.[28] While not used for diagnosis, an elevated level of glucose irreversibly bound to hemoglobin (termed glycated hemoglobin or HbA1c) of 6.0% or higher (the 2003 revised U.S. standard) is considered abnormal by most labs; HbA1c is primarily used as a treatment-tracking test reflecting average blood glucose levels over the preceding 90 days (approximately) which is the average lifetime of red blood cells which contain hemoglobin in most patients. However, some physicians may order this test at the time of diagnosis to track changes over time. The current recommended goal for HbA1c in patients with diabetes is 6.5%.[29][30] [edit] ScreeningDiabetes screening is recommended for many people at various stages of life, and for those with any of several risk factors. The screening test varies according to circumstances and local policy, and may be a random blood glucose test, a fasting blood glucose test, a blood glucose test two hours after 75 g of glucose, or an even more formal glucose tolerance test. Many healthcare providers recommend universal screening for adults at age 40 or 50, and often periodically thereafter. Earlier screening is typically recommended for those with risk factors such as obesity, family history of diabetes, high-risk ethnicity (Hispanic, Native American, Afro-Caribbean, Pacific Islander, or Maori).[31][32] Many medical conditions are associated with diabetes and warrant screening. A partial list includes: high blood pressure, elevated cholesterol levels, coronary artery disease, past gestational diabetes, polycystic ovary syndrome, chronic pancreatitis, fatty liver, hemochromatosis, cystic fibrosis, several mitochondrial neuropathies and myopathies, myotonic dystrophy, Friedreich's ataxia, some of the inherited forms of neonatal hyperinsulinism. The risk of diabetes is higher with chronic use of several medications, including high-dose glucocorticoids, some chemotherapy agents (especially L-asparaginase), as well as some of the antipsychotics and mood stabilizers (especially phenothiazines and some atypical antipsychotics). People with a confirmed diagnosis of diabetes are tested routinely for complications. This includes yearly urine testing for microalbuminuria and examination of the retina of the eye for retinopathy. [edit] PreventionType 1 diabetes risk is known to depend upon a genetic predisposition based on HLA types (particularly types DR3 and DR4), an unknown environmental trigger (suspected to be an infection, although none has proven definitive in all cases), and an uncontrolled autoimmune response that attacks the insulin producing beta cells.[33] Some research has suggested that breastfeeding decreased the risk in later life;[34][35] various other nutritional risk factors are being studied, but no firm evidence has been found.[36] Giving children 2000 IU of Vitamin D during their first year of life is associated with reduced risk of type 1 diabetes, though the causal relationship is obscure.[37] Children with antibodies to beta cell proteins (ie at early stages of an immune reaction to them) but no overt diabetes, and treated with vitamin B-3 (niacin), had less than half the diabetes onset incidence in a 7-year time span as did the general population, and an even lower incidence relative to those with antibodies as above, but who received no vitamin B3.[38] Type 2 diabetes risk can be reduced in many cases by making changes in diet and increasing physical activity.[39][40] The American Diabetes Association (ADA) recommends maintaining a healthy weight, getting at least 2½ hours of exercise per week (several brisk sustained walks appear sufficient), having a modest fat intake, and eating sufficient fiber (e.g., from whole grains). The ADA does not recommend alcohol consumption as a preventive, but it is interesting to note that moderate alcohol intake may reduce the risk (though heavy consumption absolutely and clearly increases damage to bodily systems significantly); a similarly confused connection between low dose alcohol consumption and heart disease is termed the French Paradox. There is inadequate evidence that eating foods of low glycemic index is clinically helpful despite recommendations and suggested diets emphasizing this approach.[41] Diets that are very low in saturated fats reduce the risk of becoming insulin resistant and diabetic.[42][43] Study group participants whose "physical activity level and dietary, smoking, and alcohol habits were all in the low-risk group had an 82% lower incidence of diabetes.".[44] In another study of dietary practice and incidence of diabetes, "foods rich in vegetable oils, including non-hydrogenated margarines, nuts, and seeds, should replace foods rich in saturated fats from meats and fat-rich dairy products. Consumption of partially hydrogenated fats should be minimized."[45] There are numerous studies which suggest connections between some aspects of Type II diabetes with ingestion of certain foods or with some drugs. Some studies have shown delayed progression to diabetes in predisposed patients through prophylactic use of metformin,[40] rosiglitazone,[46] or valsartan.[47] In patients on hydroxychloroquine for rheumatoid arthritis, incidence of diabetes was reduced by 77% though causal mechanisms are unclear.[48] Breastfeeding may also be associated with the prevention of type 2 of the disease in mothers.[49] Clear evidence for these and any of many other connections between foods and supplements and diabetes is sparse to date; none, despite secondary claims for (or against), is sufficiently well established to justify as a standard clinical approach. It is necessary to avoid highly diabetogenic drugs as corticosteroids, this kind of compounds can lead to diabetes mellitus even with topical use [50]. [edit] Treatment and managementMain article: Diabetes management 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[51] 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 for their own health care (e.g in 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) although research is underway to develop artificial intelligence systems which may reduce the frequency of such visits.[52] 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.[53] 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. [edit] Cure[edit] Cures for type 1 diabetesMain 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.[54] 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.[55] 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.[54] 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.[56] 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.[54] This new method autologous nonmyeloablative hematopoietic stem cell transplantation was developed by a research team composed by Brazilian and American scientists (Dr. Julio Voltarelli, Dr. Carlos Eduardo Couri, Dr Richard Burt, and colleagues) and it was the first study to use stem cell therapy in human diabetes mellitus. This was initially tested in mice and in 2007 there was the first publication of stem cell therapy to treat this form of diabetes. Until 2009, there was 23 patients included and followed for a mean period of 29.8 months (ranging from 7 to 58 months). In the trial, severe immunosuppresion with high doses of cyclophosphamide and anti-thymocyte globulin is used with the aim of "turning off" the immunologic system", and then autologous hematopoietic stem cells are reinfused to regenerate a new one. In summary it is a kind of "immunologic reset" that blocks the autoimmune attack against residual pancreatic insulin-producing cells. Until December 2009, 12 patients remained continuously insulin-free for periods raging from 14 to 52 months and 8 patients became transiently insulin-free for periods ranging from 6 to 47 months. Of these last 8 patients, 2 became insulin-free again after the use of sitagliptin, a DPP-4 inhibitor approved only to treat type 2 diabetic patients and this is also the first study to document the use and complete insulin-independendce in humans with type 1 diabetes with this medication. In parallel with insulin suspension, indirect measures of endogenous insulin secretion revealed thate it significantly increased in the whole group of patients, regardless the need of daily exogenous insulin use.[57] 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. [edit] Cures for type 2 diabetesType 2 diabetes is usually first treated by increasing physical activity, and eliminating saturated fat and reducing sugar and carbohydrate intake with a goal of losing weight. These can restore insulin sensitivity even when the weight loss is modest, for example around 5 kg (10 to 15 lb), most especially when it is in abdominal fat deposits. Diets that are very low in saturated fats can reverse insulin resistance.[42][43]. Testosterone replacement therapy can significantly improve glucose tolerance and insulin sensitivity in diabetic hypogonadal men, and its use as anti-diabetic drug is increasing. The scientists are making researchs to learn the mechanisms by which testosterone decreases insulin resistance in order to optimize testosterone replacement therapy against diabetes mellitus type 2 [15]. 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.[58] This surgery has the additional benefit of reducing the death rate from all causes by up to 40% in severely obese people.[59] A small number of normal to moderately obese patients with type 2 diabetes have successfully undergone similar operations.[60][61] [edit] Complications and prognosisPatient education, understanding, and participation is vital since the complications of diabetes are far less common and less severe in people who have well-controlled blood sugar levels.[62][63] Wider health problems accelerate the deleterious effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise. According to one study, women with high blood pressure (hypertension) were three times more likely to develop type 2 diabetes as compared with women with optimal BP after adjusting for various factors such as age, ethnicity, smoking, alcohol intake, body mass index (BMI), exercise, family history of diabetes, etc.[64] The study was conducted by researchers from the Brigham and Women's Hospital, Harvard Medical School and the Harvard School of Public Health, USA, who followed over 38,000 female health professionals for ten years. Anecdotal evidence suggests that some of those with type 2 diabetes who exercise regularly, lose weight, and eat healthy diets may be able to keep some of the disease or some of the effects of the disease in 'remission.' Certainly these tips can help prevent people predisposed to type 2 diabetes and those at pre-diabetic stages from actually developing the disorder as it helps restore insulin sensitivity. However patients should talk to their doctors about this for real expectations before undertaking it (esp. to avoid hypoglycemia or other complications); few people actually seem to go into total 'remission,' but some may find they need less of their insulin medications since the body tends to have lower insulin requirements during and shortly following exercise. Regardless of whether it works that way or not for an individual, there are certainly other benefits to this healthy lifestyle for both diabetics and nondiabetics. The way diabetes is managed changes with age. Insulin production decreases because of age-related impairment of pancreatic beta cells. Additionally, insulin resistance increases because of the loss of lean tissue and the accumulation of fat, particularly intra-abdominal fat, and the decreased tissue sensitivity to insulin. Glucose tolerance progressively declines with age, leading to a high prevalence of type 2 diabetes and postchallenge hyperglycemia in the older population.[65] Age-related glucose intolerance in humans is often accompanied by insulin resistance, but circulating insulin levels are similar to those of younger people.[66] Treatment goals for older patients with diabetes vary with the individual, and take into account health status, as well as life expectancy, level of dependence, and willingness to adhere to a treatment regimen.[67] [edit] Acute complications
Diabetic ketoacidosis (DKA) is an acute and dangerous complication that is always a medical emergency. Low insulin levels cause the liver to turn to fat for fuel (ie, ketosis); ketone bodies are intermediate substrates in that metabolic sequence. This is normal when periodic, but can become a serious problem if sustained. Elevated levels of ketone bodies in the blood decrease the blood's pH, leading to DKA. On presentation at hospital, the patient in DKA is typically dehydrated, and breathing rapidly and deeply. Abdominal pain is common and may be severe. The level of consciousness is typically normal until late in the process, when lethargy may progress to coma. Ketoacidosis can easily become severe enough to cause hypotension, shock, and death. Urine analysis will reveal significant levels of ketone bodies (which have exceeded their renal threshold blood levels to appear in the urine, often before other overt symptoms). Prompt, proper treatment usually results in full recovery, though death can result from inadequate or delayed treatment, or from complications (e.g., brain edema). DKA is always a medical emergency and requires medical attention. Ketoacidosis is much more common in type 1 diabetes than type 2.
Hyperosmolar nonketotic state (HNS) is an acute complication sharing many symptoms with DKA, but an entirely different origin and different treatment. A person with very high (usually considered to be above 300 mg/dl (16 mmol/L)) blood glucose levels, water is osmotically drawn out of cells into the blood and the kidneys eventually begin to dump glucose into the urine. This results in loss of water and an increase in blood osmolarity. If fluid is not replaced (by mouth or intravenously), the osmotic effect of high glucose levels, combined with the loss of water, will eventually lead to dehydration. The body's cells become progressively dehydrated as water is taken from them and excreted. Electrolyte imbalances are also common and are always dangerous. As with DKA, urgent medical treatment is necessary, commonly beginning with fluid volume replacement. Lethargy may ultimately progress to a coma, though this is more common in type 2 diabetes than type 1.
Hypoglycemia, or abnormally low blood glucose, is an acute complication of several diabetes treatments. It is rare otherwise, either in diabetic or non-diabetic patients. The patient may become agitated, sweaty, weak, and have many symptoms of sympathetic activation of the autonomic nervous system resulting in feelings akin to dread and immobilized panic. Consciousness can be altered or even lost in extreme cases, leading to coma, seizures, or even brain damage and death. In patients with diabetes, this may be caused by several factors, such as too much or incorrectly timed insulin, too much or incorrectly timed exercise (exercise decreases insulin requirements) or not enough food (specifically glucose containing carbohydrates). The variety of interactions makes cause identification difficult in many instances. It is more accurate to note that iatrogenic hypoglycemia is typically the result of the interplay of absolute (or relative) insulin excess and compromised glucose counterregulation in type 1 and advanced type 2 diabetes. Decrements in insulin, increments in glucagon, and, absent the latter, increments in epinephrine are the primary glucose counterregulatory factors that normally prevent or (more or less rapidly) correct hypoglycemia. In insulin-deficient diabetes (exogenous) insulin levels do not decrease as glucose levels fall, and the combination of deficient glucagon and epinephrine responses causes defective glucose counterregulation. Furthermore, reduced sympathoadrenal responses can cause hypoglycemia unawareness. The concept of hypoglycemia-associated autonomic failure (HAAF) in diabetes posits that recent incidents of hypoglycemia causes both defective glucose counterregulation and hypoglycemia unawareness. By shifting glycemic thresholds for the sympathoadrenal (including epinephrine) and the resulting neurogenic responses to lower plasma glucose concentrations, antecedent hypoglycemia leads to a vicious cycle of recurrent hypoglycemia and further impairment of glucose counterregulation. In many cases (but not all), short-term avoidance of hypoglycemia reverses hypoglycemia unawareness in affected patients, although this is easier in theory than in clinical experience. In most cases, hypoglycemia is treated with sugary drinks or food. In severe cases, an injection of glucagon (a hormone with effects largely opposite to those of insulin) or an intravenous infusion of dextrose is used for treatment, but usually only if the person is unconscious. In any given incident, glucagon will only work once as it uses stored liver glycogen as a glucose source; in the absence of such stores, glucagon is largely ineffective. In hospitals, intravenous dextrose is often used.
The immune response is impaired in individuals with diabetes mellitus. Cellular studies have shown that hyperglycemia both reduces the function of immune cells and increases inflammation. The vascular effects of diabetes also tend to alter lung function, all of which leads to an increase in susceptibility to respiratory infections such as pneumonia and influenza among individuals with diabetes. Several studies also show diabetes associated with a worse disease course and slower recovery from respiratory infections.[68] [edit] Chronic complications
Chronic elevation of blood glucose level leads to damage of blood vessels (angiopathy). The endothelial cells lining the blood vessels take in more glucose than normal, since they don't depend on insulin. They then form more surface glycoproteins than normal, and cause the basement membrane to grow thicker and weaker. In diabetes, the resulting problems are grouped under "microvascular disease" (due to damage to small blood vessels) and "macrovascular disease" (due to damage to the arteries). However, some research challenges the theory of hyperglycemia as the cause of diabetic complications. The fact that 40% of diabetics who carefully control their blood sugar nevertheless develop neuropathy,[69] and that some of those with good blood sugar control still develop nephropathy,[70] requires explanation. It has been discovered that the serum of diabetics with neuropathy is toxic to nerves even if its blood sugar content is normal.[71] Recent research suggests that in type 1 diabetics, the continuing autoimmune immune disease which initially destroyed the beta cells of the pancreas may also cause retinopathy,[72] neuropathy,[73] and nephropathy.[74] One researcher has even suggested that retinopathy may be better treated by drugs to suppress the abnormal immune system of diabetics than by blood sugar control.[75] The familial clustering of the degree and type of diabetic complications[76] indicates that genetics may also play a role in causing complications such as diabetic retinopathy.[77] and nephropathy[78] Non-diabetic offspring of type 2 diabetics have been found to have increased arterial stiffness and neuropathy despite normal blood glucose levels,[79] and elevated enzyme levels associated with diabetic renal disease have been found in non-diabetic first-degree relatives of diabetics.[80][81] Even rapid tightening of blood glucose levels has been shown to worsen rather than improve diabetic complications, though it has usually been held that complications would improve over time with more normal blood sugar, provided this could be maintained.[82] However. one study continued for 41 months found that the initial worsening of complications from improved glucose control was not followed by the expected improvement in the complications.[83]  The damage to small blood vessels leads to a microangiopathy, which can cause one or more of the following:
Macrovascular disease leads to cardiovascular disease, to which accelerated atherosclerosis is a contributor:
Diabetic foot, often due to a combination of sensory neuropathy (numbness or insensitivity) and vascular damage, increases rates of skin ulcers and infection and, in serious cases, necrosis and gangrene. It is why diabetics are prone to leg and foot infections and why it takes longer for them to heal from leg and foot wounds. It is the most common cause of non-traumatic adult amputation, usually of toes and or feet, in the developed world. Carotid artery stenosis does not occur more often in diabetes, and there appears to be a lower prevalence of abdominal aortic aneurysm. However, diabetes does cause higher morbidity, mortality and operative risks with these conditions.[84] Diabetic encephalopathy[85] is the increased cognitive decline and risk of dementia observed in diabetes. Various mechanisms are proposed, including alterations to the vascular supply of the brain and the interaction of insulin with the brain itself.[86] [edit] EpidemiologyIn 2000, according to the World Health Organization, at least 171 million people worldwide suffer from diabetes, or 2.8% of the population.[87] Its incidence is increasing rapidly, and it is estimated that by the year 2030, this number will almost double.[87] Diabetes mellitus occurs throughout the world, but is more common (especially type 2) in the more developed countries. The greatest increase in prevalence is, however, expected to occur in Asia and Africa, where most patients will probably be found by 2030.[87] The increase in incidence of diabetes in developing countries follows the trend of urbanization and lifestyle changes, perhaps most importantly a "Western-style" diet. This has suggested an environmental (i.e., dietary) effect, but there is little understanding of the mechanism(s) at present, though there is much speculation, some of it most compellingly presented.[87] For at least 20 years, diabetes rates in North America have been increasing substantially. In 2008 there were about 24 million people with diabetes in the United States alone, from those 5.7 million people remain undiagnosed. Other 57 million people are estimated to have pre-diabetes.[88] The Centers for Disease Control has termed the change an epidemic.[89] The National Diabetes Information Clearinghouse estimates that diabetes costs $132 billion in the United States alone every year. About 5%–10% of diabetes cases in North America are type 1, with the rest being type 2. The fraction of type 1 in other parts of the world differs; this is probably due to both differences in the rate of type 1 and differences in the rate of other types, most prominently type 2. Most of this difference is not currently understood. The American Diabetes Association cite the 2003 assessment of the National Center for Chronic Disease Prevention and Health Promotion (Centers for Disease Control and Prevention) that 1 in 3 Americans born after 2000 will develop diabetes in their lifetime.[90][91] According to the American Diabetes Association, approximately 18.3% (8.6 million) of Americans age 60 and older have diabetes.[92] Diabetes mellitus prevalence increases with age, and the numbers of older persons with diabetes are expected to grow as the elderly population increases in number. The National Health and Nutrition Examination Survey (NHANES III) demonstrated that, in the population over 65 years old, 18% to 20% have diabetes, with 40% having either diabetes or its precursor form of impaired glucose tolerance.[65] Indigenous populations in first world countries have a higher prevalence and increasing incidence of diabetes than their corresponding non-indigenous populations. In Australia the age-standardised prevalence of self-reported diabetes in Indigenous Australians is almost 4 times that of non-indigenous Australians.[93] Preventative community health programs such as Sugar Man (diabetes education) are showing some success in tackling this problem. [edit] HistoryThe term diabetes (Greek: διαβήτης, diabētēs) was coined by Aretaeus of Cappadocia. It was derived from the Greek verb διαβαίνειν, diabaínein, itself formed from the prefix dia-, "across, apart," and the verb bainein, "to walk, stand." The verb diabeinein meant "to stride, walk, or stand with legs asunder"; hence, its derivative diabētēs meant "one that straddles," or specifically "a compass, siphon." The sense "siphon" gave rise to the use of diabētēs as the name for a disease involving the discharge of excessive amounts of urine. Diabetes is first recorded in English, in the form diabete, in a medical text written around 1425. In 1675, Thomas Willis added the word mellitus, from the Latin meaning "honey", a reference to the sweet taste of the urine. This sweet taste had been noticed in urine by the ancient Greeks, Chinese, Egyptians, Indians, and Persians. In 1776, Matthew Dobson confirmed that the sweet taste was because of an excess of a kind of sugar in the urine and blood of people with diabetes.[94] Diabetes mellitus appears to have been a death sentence in the ancient era. Hippocrates makes no mention of it, which may indicate that he felt the disease was incurable. Aretaeus did attempt to treat it but could not give a good prognosis; he commented that "life (with diabetes) is short, disgusting and painful."[95] Sushruta (6th century BCE) identified diabetes and classified it as Medhumeha.[96] He further identified it with obesity and sedentary lifestyle, advising exercises to help "cure" it.[96] The ancient Indians tested for diabetes by observing whether ants were attracted to a person's urine, and called the ailment "sweet urine disease" (Madhumeha). The Korean, Chinese, and Japanese words for diabetes are based on the same ideographs (糖尿病) which mean "sugar urine disease". In medieval Persia, Avicenna (980-1037) provided a detailed account on diabetes mellitus in The Canon of Medicine, "describing the abnormal appetite and the collapse of sexual functions and he documented the sweet taste of diabetic urine." Like Aretaeus before him, Avicenna recognized a primary and secondary diabetes. He also described diabetic gangrene, and treated diabetes using a mixture of lupine, trigonella (fenugreek), and zedoary seed, which produces a considerable reduction in the excretion of sugar, a treatment which is still prescribed in modern times. Avicenna also "described diabetes insipidus very precisely for the first time", though it was later Johann Peter Frank (1745-1821) who first differentiated between diabetes mellitus and diabetes insipidus.[97] Although diabetes has been recognized since antiquity, and treatments of various efficacy have been known in various regions since the Middle Ages, and in legend for much longer, pathogenesis of diabetes has only been understood experimentally since about 1900.[98] The discovery of a role for the pancreas in diabetes is generally ascribed to Joseph von Mering and Oskar Minkowski, who in 1889 found that dogs whose pancreas was removed developed all the signs and symptoms of diabetes and died shortly afterwards.[99] In 1910, Sir Edward Albert Sharpey-Schafer suggested that people with diabetes were deficient in a single chemical that was normally produced by the pancreas—he proposed calling this substance insulin, from the Latin insula, meaning island, in reference to the insulin-producing islets of Langerhans in the pancreas.[98] The endocrine role of the pancreas in metabolism, and indeed the existence of insulin, was not further clarified until 1921, when Sir Frederick Grant Banting and Charles Herbert Best repeated the work of Von Mering and Minkowski, and went further to demonstrate they could reverse induced diabetes in dogs by giving them an extract from the pancreatic islets of Langerhans of healthy dogs.[100] Banting, Best, and colleagues (especially the chemist Collip) went on to purify the hormone insulin from bovine pancreases at the University of Toronto. This led to the availability of an effective treatment—insulin injections—and the first patient was treated in 1922. For this, Banting and laboratory director MacLeod received the Nobel Prize in Physiology or Medicine in 1923; both shared their Prize money with others in the team who were not recognized, in particular Best and Collip. Banting and Best made the patent available without charge and did not attempt to control commercial production. Insulin production and therapy rapidly spread around the world, largely as a result of this decision. Banting is honored by World Diabetes Day which is held on his birthday, November 14. The distinction between what is now known as type 1 diabetes and type 2 diabetes was first clearly made by Sir Harold Percival (Harry) Himsworth, and published in January 1936.[101] Despite the availability of treatment, diabetes has remained a major cause of death. For instance, statistics reveal that the cause-specific mortality rate during 1927 amounted to about 47.7 per 100,000 population in Malta.[102] Other landmark discoveries include:[98]
In 1980, U.S. biotech company Genentech developed human insulin. The insulin is isolated from genetically altered bacteria (the bacteria contain the human gene for synthesizing human insulin), which produce large quantities of insulin. Scientists then purify the insulin and distribute it to pharmacies for use by diabetes patients. [edit] Social issuesThe 1990 "St Vincent Declaration"[105][106] was the result of international efforts to improve the care accorded to those with diabetes. Doing so is important both in terms of quality of life and life expectancy but also economically-expenses due to diabetes have been shown to be a major drain on health-and productivity-related resources for healthcare systems and governments. Several countries established more and less successful national diabetes programmes to improve treatment of the disease.[107] A study shows that diabetic patients with neuropathic symptoms such as numbness or tingling in feet or hands are twice as likely to be unemployed as those without the symptoms.[108] [edit] See also
[edit] References
[edit] External links
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