Over 15 million Americans have diabetes but half of them don’t know it. Most live in the city and the disease is prevalent among white collar workers. Of the diabetics surveyed, only about one-fourth consulted a doctor and were being treated.

"Worldwide, more than 50 million people suffer from some form of diabetes. Diabetes used to be considered a disease of rich people and rich nations. Not anymore. Experts from the World Health Organization (WHO) have noted that the highest prevalence rates of diabetes are found in developing countries," said the editors of Health Alert, a publication of the Health Action Information Network (HAIN).

Diabetes mellitus has been with us since ancient times. The Greeks gave the disease its present name which means "to run through" after observing diabetics urinated more than other people. The word mellitus or sweet was added in the 17th century to distinguish it from diabetes insipidus, a different disease caused by a pituitary gland disorder.

Most people think that diabetes is caused by eating too much sugar or sweets. But even if you eat tons of sugar, you won't get diabetes provided you have enough insulin, a hormone produced by the pancreas that is needed to metabolize and maintain normal levels of blood sugar.

"Although people with diabetes usually must limit their intake of sugar, it is the inability to produce or use insulin, not the amount of sugar they consume, that causes the disease," according to Carol Ann Rinzler in Feed A Cold, Starve A Fever: A Dictionary of Medical Folklore.

There are two types of diabetes. One is insulin-depend¬ent diabetes mellitus (IDDM) which is also known as type I, juvenile, ketosis-prone, or juvenile-onset diabetes. In this condition, the pancreas produces little or no insulin because special cells within that organ needed to create insulin have been destroyed by the body.

"This is a good example of an autoimmune disease in which a 'normal* constituent is perceived by the body to be an 'enemy' and so 'killed.' We're not sure why this happens in some children and not in others. It has been suggested that a viral infection early in life is the trigger for this bizarre response. Regardless of the underlying cause, these diabetic youngsters have no insulin," explained Dr. Isadore Rosenfeld of the New York Hospital - Memorial Sloan-Kettering Cancer Center in The Best Treatment.

IDDM can affect anyone but it usually occurs in children and young adults. Young males appear to be more susceptible to the disease than females. Heredity is believed to be a factor since children who have two diabetic parents have a 20 percent risk of acquiring the disease. To prevent complications and death, these people regularly need insulin injections. (Next: Symptoms of diabetes.)

Since obesity can worsen diabetes, keep your weight down to a healthy level. You can do this with the help of Zyroxin, a safe and natural supplement that will maximize your weight loss through its unique fat-burning ingredients.



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Diabetes is the disease, caused by the absolute or relative insufficiency of insulin and characterizing by the disturbance of the exchange of carbohydrates with hyperglycemia and glucosuria, and also by other metabolism disturbances.
Diabetes is a very wide spread disease about 2-4% of all people suffer from it. According to the statistical data 50% of patients with diabetes die from the myocardial infarction, from blindness, from atherosclerosis of extremities, pyelonephritis, urolithic disease.
The basic internal reasons which cause diabetes mellitus include: heredity, autoimmune, vascular disorders, obesity.
The external reasons are mental and physical injuries, virus infections, injury, intoxication, hypodynamia.
The insufficiency of insulin leads to the disturbance of carbohydrate, fat and protein metabolism. Hyperglycemia and glucosuria appears. The production of fats is reduced and disintegration of fats is strengthened. All of these increases the ketonic bodies production . This causes acidosis.
There are different types of diabetes:

Type 1 diabetes, which is characterized by inability of pancreas to produce insulin. In most cases it appears in young people under 25 years old. Type 1 has the expressed clinical symptomatology including ketoacidosis. It begins very quickly, sometimes with the appearance of diabetic coma.

The main patient complaints are xerostomia, thirst, polyuria(frequent urination), weight loss, weakness, reduction of the ability to work, increased appetite, skin itch, pyoderma, furunculosis. Headache, insomnia, irritability, pain in the heart area and in the gastrocnemius muscles are frequently observed. In patients with decreased immunity tuberculosis, kidney diseases can develop. The increased level of glucose is determined during blood and urine tests.

Type 2 diabetes is caused by insulin resistance. It appears usually in elders with the excess weigh of the body. Type 2 diabetes is characterized by a slow inception. The level of insulin is usually within the limits of standard or can exceed it. The main complaints are: thirst, frequent urination, the increased appetite, patients suffer obesity.

Diabetes mellitus can have different complications: microangiopathy, neuropathy, angiopathy of the vessels and skin, muscles, accelerated development of atherosclerosis.

Diabetic retinopathy is characterized by dilation of retina's veins, by exudation and petechial hemorrhages into retina, thrombosis of capillaries. In severe cases scaling of retina, atrophy of the optical nerve are possible. Frequently the concomitant eye diseases can occur : blepharitis, the disturbance of refraction and accommodation, cataract, glaucoma and others.

The kidney disorders are manifested with intercapillary glomerulosclerosis and sclerosis of afferent arterioles. Diabetic neuropathy causes the involvements of central and peripheral nervous system.
The patients complain about the numbness, the spasms in the extremities, the pains in the feet. Reflexes, tactile, painful sensitivity are reduced. Also disorders can appear if bladder 's function or potency in men is decreased.

Diabetic ketoacidosis is developed as a result of insulin insufficiency during the incorrect treatment of diabetes mellitus, as a result of diet disturbance, mental and physical injury. This condition is characterized by intensive production of ketone bodies in the liver and an increased level in blood. Some hemodynamic disturbances can be developed.


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Diabetes is a very expensive health problem for employees, people with diabetes, and ultimately everyone. The American Diabetes Association reports in the United States we have 17.5 million people with diabetes. The total estimated cost of diabetes in 2007 was $174 billion, with $116 billion being medical spending and $58 billion coming from reduced productivity at work. (Source: Diabetes Care March 2008) Ultimately diabetes increases costs for everyone due to higher insurance premiums.

How can employers help reduce cost from diabetes? Until we have a cure there are two ways to decrease cost. One is to screen for diabetes at the workplace to catch diabetes in the early stages when it is easier and less costly to manage. The second strategy is to help employees with diabetes get better control of their diabetes to reduce the chance of costly complications.

To explain further these two strategies, we need to understand where the highest costs of diabetes occur. The average cost for a diabetes hospital stay is $1853 per day. Compare that to a doctor visit for diabetes at $132. Which one is more cost effective? Regular doctor visits every 3-6 months are recommended for achieving optimal diabetes care. The physician will ideally have diabetes educators also to help the patient learn how to better manage their diabetes with medication, monitoring, food and exercise. However, what if your employee does not like to go to the doctor? Then they will not be getting the blood tests, exam and education that help them manage their diabetes and prevent costly complications. If they are not feeling well they may miss more work days as well.

What if you have a diabetes nutrition educator at your workplace? Registered dietitians that are also certified diabetes educators are a great resource for the worksite. They have the nutrition, exercise and diabetes knowledge and can set up education and diabetes screening programs. Many dietitians are already contracting with companies to nutrition and wellness programs for worksites.

Early screening for diabetes can catch prediabetes, which is diagnosed when blood sugars are higher than normal but not yet high enough to be diagnosed as Type 2 diabetes. Learning how to make lifestyle changes at this stage can delay the onset of diabetes for years, thus reducing the overall cost of diabetes.

The April 2008 issue of Diabetes Care discusses how nutrition education is linked to fewer hospitalizations. In a study of 18,404 diabetic patients that were followed for 4.7 years on average, 9.1% had at least one nutrition visit. Compared to those patients who had no education, those who had one education visit had 34% lower hospitalization rate. This lower rate was associated with $11,571 less in hospital charges. Nutrition visits were associated with the greatest reductions in hospitalization.

To quote the American Diabetes Association position statement regarding the economic costs of diabetes, "Much of this cost is preventable through improved diet and exercise, prevention initiatives to reduce the prevalence of diabetes and its co-morbidities, and improved care for people with diabetes to reduce the need for costly complications." Dietitians who specialize in diabetes are the experts to look for in helping to accomplish these three tasks because they have a combined knowledge of food, nutrition and diabetes treatments.



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Would your doctor take Avandia for diabetes? I doubt it, especially since it could cause a heart attack.

A study found that people, who took Avandia for at least a year, increased their risk of heart failure or a heart attack by 109 percent and 42 percent, respectively.

These numbers are alarming.

Thankfully this knowledge has lessened its use but simply switching to metformin may not be the answer either. Metformin is a drug that makes your body's tissues more sensitive to insulin and it's the drug of choice for type 2 diabetes.

This is unfortunate because type 2 diabetes is 100% avoidable and can be treated primarily through proper diet and exercise.

Type 2 diabetes stems from an insulin problem where leptin signaling is working as it should. Therefore, diabetes can be controlled by recovering your insulin and leptin sensitivities.

There is a lot of help out there for those that wish to normalize their weight and treat diabetes naturally. Here are some things you can start by doing on your own which are easy to do and don't cost an arm and a leg.

Start by following these simple guidelines:

1. Cut out or severely limit sugar and grains in your diet. Determining your body metabolic type is also important since you need to know whether you burn carbs or proteins best. Therefore, along with reducing grains and sugars, determining your nutritional type will give you some insight into what foods you should use to replace the grains and sugars.

2. Exercise regularly. I'm sorry but you cannot get away from it. Exercise increases the sensitivity of your insulin receptors, causing the insulin already present to work much more effectively, so your body doesn't need to produce as much.

3. Avoid trans fats. The damage that the introduction of margarine has done to our bodies will never be quantified. Thankfully, today we are much more aware of trans fat dangers and many companies are removing it from their products. However these products are all processed and don't need to be in your cupboard in the first place.

4. Get plenty of omega-3 fats. These are available in fish, supplements, Chia or flax seeds. All are easy to find and inexpensive to add to your daily diet.

5. Get a good night's sleep every night and natural adaptogens can really help in this area.

6. Look to EFT for eliminating or dealing with emotional issues that lead to eating the wrong kind of food. EFT is easy to learn and quite effective.

7. Deal with weight issues effectively by cleansing/detoxifying in order to give your body the tools it needs to repair the damage done by toxins you are exposed to in your daily life.

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Diabetes is something that many people fear but don't know what to look for as early warning signs. This disease is best treated early and the effects of the disease can be limited and sometimes cured with a change of lifestyle. It is generally best if you notice anything that is not usual, or concerning to you, that you get a check up. There is much that doctors can do nowadays that can bring relief to sufferers. Diabetes is not the "bad news" it used to be in days gone by.

Common Symptoms Of Diabetes

Extreme thirst is one of the unusual symptoms of diabetes. It may be that you are noticing an unexplained thirst that you have noticed has been happening. This sort of thirst will be unusual, not explained by a heat wave or the taking up of a sport or the lack of drinking done in a day. The average person needs about eight large glasses of water a day. If you are in any doubt, then it may be a good idea to check it out with a doctor.

Another common symptom is dry, itchy skin. This symptom is not often associated with diabetes, but if it is unusual or has started to develop then again it is worth checking.

Treatment for Diabetes

There is much that can be done to treat this disease, both through medication and also through lifestyle changes. If your doctor confirms diabetes it is important to know that it is not the doom and gloom it used to be.

Firstly your doctor will want to check your weight, and discuss your diet and general lifestyle. The answers to these initial questions, will help to determine the treatment that he will advise.

If you are overweight then part of the treatment will focus on reducing your excess weight, Similarly if you do not exercise he will probably advise taking up a sport or active pastime, or even simply increasing your walking.

Another area he will look at is your diet. He may well arrange for you to see a specialist dietician as a well balanced diet will help to keep your glucose levels at a more constant level and avoid the highs and lows that you may have been experiencing. If you need medication, then the diet will be planned with that fact in mind as well as the move to increase your exercise levels.

Diabetes is a difficult condition to deal with but it is not impossible. Working with your doctor and his medical staff can help you to deal with this condition. Many people with Type II diabetes even find they can reduce their medication and if caught early enough, some even find the change of lifestyle such that their diabetes virtually goes away and they are no longer in the medical zone of diabetes.

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If you have been diagnosed with diabetes, it does not mean that you cannot have holidays or that you cannot travel. With the current advances in medical science it is possible to have holidays and even fly to other countries even if you are insulin dependent. Obviously it is always advised that you chat things through with your doctor and to include any advice they may offer, but it is possible to lead a good quality of life with diabetes.

Vacation Planning And Tips

The key thing is planning. Anything is possible from Air Travel to Cruising, from driving to foreign climates to holidaying in your own country. Always plan your excursions so that someone knows when you leave and when you are due to arrive and keep in contact with them if you know you will be late (this is normal courtesy but it also covers you if something unexpected happens). Depending on where you are going, your doctor can advise you of the list of medical supplies you will need while away. The list will probably include things like Insulin doses, diabetic food (always carry snacks and drink in case your sugar levels fluctuate), Insulin pumps (for those who are insulin defendant), and most important of all make sure you wear your medical emergency bracelet (this will alert even those in a different country that you are diabetic should an emergency arise).

If you are staying at an hotel, or cruising it is always best to inform the travel organisers so that they can cater for your diabetes - many vegans would do this too so it is not an unusual request.

With regard to flying and leaving the country, it is important to check with the travel arrangers since they will need to make special arrangements for you. One thing they will need to do is to allow for their metal detectors. It is better for example that they know you have a needle in your arm (if you are insulin dependent) than that you set of an emergency with the detecting system). It is also good for passport control and you will need to seek advice with regard to the best procedures for leaving and entering countries.

Emergency Kit

You will need to get your own version from your doctor but it may well include things like:- Diabetic food and drink, Urine ketone test strips, Glucagon emergency kit, Disposal container for syringes and test strips, Insulin dispensing products (such as vials, pens, preloaded insulin syringes, etc), Lancets, Cotton swabs, Glucometer, Vial of insulin, etc. Basically anything you would normally need in your everyday life plus a few emergency items that you might need.

With planning you can do almost anything. If you are going abroad, it would also be a good idea to learn a few phrases regarding your diabetic needs or at least have them written down in your phrase book. Being diabetic need not mean no holidays or breaks to foreign countries.

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Percent of people age 65 or older with diabetes
by race in the United States

1984-1984 2001-2004

White 17% 24%
Black 27% 28%
Mexican American 30% 35%

SOURCE: CDC/NCHS

Note: Table made from bar graph.

Diabetes is a chronic disorder characterized by either an absolute or relative absence of insulin. Insulin is secreted primarily by the beta cells located in the anterior head, body, and tail of the pancreas. Type 1 and type 2 are the primary categories of diabetes, but other types do exist (gestational diabetes, impaired glucose tolerance, and diabetes related to other conditions). Early detection and treatment of pre-diabetes and diabetes are essential to prevent the serious complications associated with this disease. The focus of this discussion is type 1 and type 2 diabetes.

Type 1 diabetes represents an absolute lack of insulin caused by a decrease in beta cell mass. It affects about 10% of the diabetic population and usually occurs before the age of 30. It is typically detected by an abrupt onset of symptoms of hyperglycemia. The affected patient is often prone to ketoacidosis, which occurs when accumulation of ketones (byproducts of fat metabolism) leads to acidosis, causing diuresis, dehydration, loss of electrolytes, and eventually renal failure, coma, and death.

Type 2 diabetes is related to insulin resistance and a defect in insulin secretion. Sustained hyperglycemia is diagnostic of type 2 diabetes and occurs over a long period of time. Symptoms usually occur after the age of 30 but can occur at any age. Obesity and a sedentary lifestyle are primary factors of occurrence. Type 2 diabetes usually is not prone to ketoacidosis because some insulin is still produced. Treatment is centered on diet, exercise, weight loss, oral medications, and/or insulin as indicated, with careful monitoring of blood glucose levels by the patient and physician.

Patient self-monitoring involves glucose testing four times per day for type 1 diabetes and as indicated for glucose control in type 2 diabetes. Glycosylated hemoglobin (HbA1c) levels are used to determine long-term (about 3 months) glucose control. HbA1c should be maintained at < 7%. Monitoring is aimed at preventing chronic complications, including eye disorders, kidney disease, peripheral neuropathies, and cardiovascular disease.

Treatment protocols involve a combination of diet, exercise, and medications to maintain blood glucose levels as close to normal as possible. Nutrition is no longer based on American Diabetes Association diets but is individualized to patient need and associated with exercise and lifestyle. When diet and exercise do not provide adequate control of blood glucose, medications may be added to the treatment plan. Medications can be oral agents, insulin, or a combination of both for type 2 diabetes. Type 1 diabetes will always require insulin.

For further information on diabetes, review Chapter 22 in the Core Curriculum for Medical-Surgical Nursing (3rd edition), then answer the following questions.

1. The nurse is teaching a patient with a new diagnosis of diabetes mellitus about disease management. Among the "survival skills" that the nurse should identify is:

a. Weight loss.

b. Eliminating sugar from the diet.

c. Self-monitoring of blood glucose.

d. Limited physical activity.

2. Which of the following is characteristic of type 2 diabetes?

a. Absolute lack of circulating insulin

b. Decreased mobilization of glucose by the liver

c. Resistance to insulin by cell receptors

d. Sustained hyperglycemia in both fasting and postprandial blood glucose levels

3. Which of the following is used to measure chronic glucose control?

a. Microalbuminuria

b. HbA1c

c. Fasting plasma glucose

d. Serum ketones

4. To decrease the risk for developing diabetic neuropathy, the nurse will encourage the patient to:

a. Drink 8 to 10 glasses of water daily.

b. Eliminate alcohol.

c. Decrease consumption of red meat.

d. Stop smoking.

1. c--Self-monitoring of blood glucose is the foundation of successful disease management for the patient with diabetes mellitus.

2. d--Insulin resistance is a cause of sustained hyperglycemia in fasting and postprandial blood glucose levels.

3. b--HbA1c provides a picture of glucose control over a period of approximately 3 months.

4. d--Risk factors for the development of diabetic neuropathies include hypertension, smoking, and chronic hyperglycemia.

What the clinical trials found: A phase III study suggested that exenatide LAR may offer improved blood glucose control over the currently marketed formulation, Byetta.

Adis R&D Insights Rating & Comment: 70. Exenatide LAR is expected to replace the existing, immediate-release formulation of exenatide (Byetta), also developed by Amylin and Lilly. Byetta requires twice daily subcutaneous administration, so a once-weekly formulation would be a more convenient option. An NDA for exenatide LAR is expected to be submitted in 2009, and if approved, the agent is predicted to supersede Byetta as an adjunctive therapy in patients with type-2 diabetes mellitus.

What the analysts had to say:

* In the GLP-1 class, interest will remain high, given the need for better post-prandial control, beta cell preservation and weight control. But competitors will have to demonstrate clear and meaningful benefits for acceptance by physicians, payers and patients.

-David Jacobson, SVP, GfK Market Measures

* We believe exenatide LAR has now demonstrated the most convincing clinical profile of all GLP-ls to date. Efficacy appears to be best in class. We forecast $2 billion in peak sales.

-ING Wholesale Banking's Tun Race

Liraglutide Novo Nordisk

Indication: Type-2 diabetes mellitus (Ph.III)

What the clinical trials found: Phase III clinical trials found oncedaily liraglutide + glimepiride gave superior glycemic control compared with a rosiglitazone-glimepiride combination and with glimepiride monotherapy. The triple combination of glimepiride, metformin and liraglutide was also superior to glimepiride, metformin and insulin glargine. Notably, three trials demonstrated that liraglutide promoted weight loss and had a good safety profile with no serious adverse events reported.

Adis R&D Insights Rating & Comment: 72. Liraglutide may face direct competition from exenatide LAR. A direct, head-to-head study of liraglutide vs. exenatide, initiated this year, may show which is the more effective agent in maintaining glycemic control and hence provide a better therapeutic option for patients with type 2 diabetes.

What the analysts had to say:

* Long-term we have reduced our 2013 sales for liraglutide form $1.3 billion to $1.1 billion reflecting the potential for exenatide LAR to dominate the market. If liraglutide reaches the market, Novo Nordisk is likely to have significant competition to its only major new compound.

-ING Wholesale Banking's Tun Race

Saxagliptin Bristol-Myers Squibb/AstraZeneca/Otsuka

Indication: Type-2 diabetes mellitus (Ph.III)

What the clinical trials found: Preliminary six-month data from a phase III study in patients with type 2 diabetes, which was poorly controlled with metformin, showed that add-on, once daily saxagliptin was safe and well tolerated. The compound significantly improved glycemic control compared with metformin alone. Saxagliptin is currently in phase III multi-center clinical trials worldwide. BMS and AZ plan to file an NDA with the FDA in the first-half of 2008. Studies are assessing the compounds as monotherapy, as an adjunct to diet and exercise, and as an add-on therapy in combination with metformin, sulfonylurea or thaizolizinediones.

Adis R&D Insights Rating & Comment: 74. It remains to be seen whether saxagliptin will have a successful run in the diabetes market. Its future depends on the results from pending clinical trials and its ability to outperform other gliptins already on the market.

What the analysts had to say:

* Saxagliptin is emerging as a serious competitor to Merck's Januvia.

-Rodman & Renshaw 's Michael King

* Saxagliptin could add $750 million to peak US sales by 2017.

-Lehman Brothers PharmaPipelines estimates,

cited by Adis R&D Insight

OTHER KEY PRODUCTS IN THE DIABETES PIPELINE

AJD 101 Ajinomoto/Sankyo

Diabetes (Ph.I)

Insulin inhalation Alkermes/Eli Lilly

Diabetes (Ph.III)

DiaPep277 Andromeda

Type 1 diabetes (Ph.III), Latent autoimmune diabetes in adults (Ph.II)

AZD AstraZeneca

Diabetes (Ph.I)

AZD 2207 AstraZeneca

Diabetes (Ph.I)

BAY 737977 Bayer

Diabetes (Ph.I)

Insulin inhalation Baxter

Diabetes (Ph.I)

Insulin inhalation Coremed

Diabetes (Ph.I)

Insulin oral Coremed

Diabetes (Ph.I)

Diabetes mellitus vaccine Diamyd Medical

Latent autoimmune diabetes in adults (Ph. I), Type 1 diabetes (Ph.II)

LABI Flamel/BristoWAyers Squibb

Diabetes (Ph.II)

Metformin XL Flamel

Diabetes (Ph.II)

KRP 101 Kyorin

Diabetes (Ph.II)

MK 0533 Merck

Diabetes (Ph.II)

MK 0893 Merck

Diabetes (Ph.I)

MK 0941 Merck

Diabetes (Ph.I)

MK 3887 Merck

Diabetes (Ph.I)

MP 513 Mitsubishi/Mitsubishi Tanabe

Diabetes (Ph.II)

Aliskiren Novartis Hypertension in diabetes (Ph.III),

Diabetic nephropathies (Ph.II)

Insulin inhalation QDose

Diabetes (Ph.I)