To compare the role of glibenclamide and pioglitazone drugs in type 11 non- insulin dependent diabetes mellitus patients.

Authors:Raj kumar chohan,Mashori Ghulam Rasool,Bhurgri Ghulam Rasool,Shamim-u-Rehman,DahriGhulam mustafa,Anis-u-rehman.

Introduction:-

Diabetes comes from the greek word for ‘SIPHON” which one is the first term and implies for a lot of urine is made .The trm “mellitus” comes from a laton word, “met” which means “honey” and was used because the urine was sweet (Wheeler,2004)

Diabetic ketaocidosis is one of life threatening condition requiring some data hospitalization and treatment. Recognition of this condition is of almost importance, because even small delays can have an impact on survival (Nattrass, 2006). Hypoglycaemia are involved in insulin induced episodes in individuals with diabetes. Probably the major factor prescribing, insulin treated patient from achieving the glucose targets needed to prevent diabetic complications. The incidence of hypoglycaemia reflects the inadequancy of current mathods of insulin delievery which lead ot inappropriately high insulin concentration, particularly some persons after eating more foods at night onset of blindness and also a major risk factor heart disease and stroke

(Heller, 2003).

TYPES OF DIABETE MELLITUS

TYPE 1 DIABETES MELLITUS (IDDM):

Type I diabetes affect children of all ages, both sexes and all athenic groups. type 1 diabetes usually occurs by mechanisms. It is most common metabolic condition in children and adolescents (Bui, 2004). Type1diabetes is characterized by immune mediated destruction of pancreatic b -cells resulting in insulin deficiency. This results in a common biochemical end point of hyperglycaemia and risk of ketoacidosis, but the clinical presentaion varies, widely depending on the rate and degree of b -cells failure (Lambert & Bingley. 2005).

Type II diabetes mellitus (NIDDM):

Type II diabetes is a complex metabolic disorder associated with, b -cells dysfunction and with varying degree of insulin resistance primary pathogenic factors leading insulin resistance leading to type 2 diabetes and decreased insulin, secretion which arise from abnormalities with in liver, skeletal muscle and pancreatic b -cells (charles & clark, 1996).

GESTATIONAL DIABETUS MELLITUS

:

Women who develop glucose intolerance in late pregnancy and womens who with previously undiagnosed diabetes.

SECONDARY DIABETUS MELLITUS:

Secondary diabetes is due to disease of the pancreatic and endocrime system, genetic disorders, or exposure to chemical agents.

Type – I diabetes formerly known as insluin dependent diabetes mellitus (IDDM), is characterized by the destruction of the pancreatic beta cells that produces inslulin

Type – I diabetes formerly known as insulin dependent diabetes(IDDM),is characterized by the destruction of pancreatic beta cells that produces insulin.Type-1 diabetes occures most often in children and young adults but it can occures at any age.(Anderson et al 2007).

Type-11 diabetes is not straight uprward. A pancreas that does not produce enough insulin. Liver that release too much glucose,muscle cells that do not readily take in glucose.(Carren 2008)

Many genetic factors are involved in the development of diabetes.Because of new genetic methodology researchers are closers to identifying all of the cadidate gene for both non –insulin dependent and insulin dependent diabetes(Bernhard,1995).

Woman who had gestation diabetes are more likely to develop Type-11diabetes themselves.Pergnant women with diabetes are another disadvantaged group.They need much more intensive antenatal care and close monitoring of blood sugar,blood pressure and weight.(jawed2006)

Over weight children the progression of child obesity into adulthood is associated with early develop of complications, including IgpG2 diabetes and cardiovascular disease.Type diabetes is the most common clinical form of diabetes accountingforabout 90% of all cases,it is currently undergoing world wide epidemic. Type 11diabetes mellitus is caused by body’s infective use of insulin, it is often results from excess body weight and physical inactivity(WHO 2007).

PREVALACES& IINCIDENCE

:

Diabetes mellitus increases with aging, in 200 the prevalance of diabetes,it was estimated to be 0.19% people<20 years old and 8.6% in people>20 years old.There is considered geographic variation in the incidence of both type-1 and type-11 diabetes mellitus.Scavandinvian has the highest incidence of type-1 diabetes mellitus e.g in Finland, the incidence is 35/100,000 per year the pacific rim has a much lower rate in japan and china the incidence is 1 to 3/100,00 per year of type-1 diabetes mellitus, Northern Europe and the United States share an intermediate rate (8to17/100,000 per year).The prevalence of type 11 diabeties mellitus is highest in certain pacific island, intermediate in countries such as India and the United States, and relatively low in Russia and China.This variability is likely due to genetic, beharioral and enviromental factors(Power 2005).Diabettes mellitus prevalance also arises among different ethic population within a given countries it is common inall ethnic groups its prevalance increased with age and more than 5% of individuals of more than 65 years of age have diabetes mellitus (David Owerback 1988).The World wide prevalence of diabetes mellitus has risen dramatically over past two decades.The prevalence of type11 diabettes mellitus is expected, type 11 diabetes mellitus is more prevalent among Hispanies Native Americas,African,American,and Asians, pacific Islanders than in non- Hispanic whites,the incidence is essentially equal in woman and men in all populations. Type 11 diabetes is becoming increasingly common because people are living longer,and the prevalence of diabetes increases with age it is also seen more frequently now than before in young people, in association with the rising prevalenceof childhood obesity although type11 diabetes still countries with the estimated nubers of cases of diabetes in 2000and 2030.

Rank Country

2000 Individuals country with diabetes (milloins)

Country

2030 Individuals with diabtes (Million)

India

31.7

India

79.47

China

20.8

China

42.3

USA

17.7

USA

30.3

Indonesia

8.4

Indonesia

21.3

Japan

6.8

Pakistan

13.9

Pakistan

5.2

Brazil

11.3

Russian federation

4.6

Bangladesh

11.1

Brazil

4.6

Japan

8.9

Italy

4.3

Philippines

7.8

Bangladesh

3.2

Egypt

6.7

(Wareham& FOROUHI 2OO6)

DRUG TREATMENT OF DIABETIES MELLITUS

:

Biguanides lower blood glucose, they increase glucose uptake and utilize in skeletal muscle there by reducing insulin resistance, and reduce hepatic glucose production (gluconeogenesis).Lower blood glucose, addionally reduces low denisity and very low denisity lipoproteins (LDL and VLDL) respectively. Metformin has a half life of about 3 hours and is excreted unchanged in the urine.Clinically metformin used in type 2 diabetic who are obese and who fail treatment with diet alone.Adverse effects are produced dose related gastrointestinal disturbances e.g anorexia,diarrhoea,nausea,lactic acidosis rare but potentially fatal toxic effect.(Dale,2003).

]]>

Improving insulin sensitivity by activating certain genes involved in fat synthesis and carbohydrate metabolism Rosigilitazone and Piogiltazone are currently approved.Thiazolidinediones. Thiazolidinediones do not cause hypoglycemia when used alone,although they are usually taken in combination with sulfonylurease.

In some incouraging studies, thaiazolidiniones have produced very favorable effects on the heart, including reducing blood pressure and improving triglycerides and cholestrol levels including increasing HDL level,the good cholestrol. They may also block a molecule called 11 Best HSK that may play a significant role in metabolic syndrome,as well as diabetes type11. One study also sugessted that Rosiglitazone may even improve beta cells functions and so help prevent progression of diabetes.Anemia, weight gain, increased risk of fluid buildup, may worson heart failure.Troglitazone,was withdrawn after a few reports of heart failure.Liver failure abd death.Current Thiazoldinediones don not appear to pose the same effects on the liver although there have been a few reports of liver injury.

In patients with dietry failur the choice of a sulfonylurea agent or insulin therapy has been controversial and empric in favour of insulin therapy are the studies, who reported marked improvement post receptor diagnostic after intensive short term therapy in untreated type 2 diabetes mellitus (Scarlett et al,1984) Sulfonylureas further classified into two groups or generations based on their potency,duration,drug interaction,side effects profiles. Sulfonylureas enhance insulin action in cells in culture and stimulate the synthesis of glucose transporters (Jacobes et al 1998).A sulfonylurea drug should normally be the insulin secretagogue of choice, NICE (National Institute for Clinical Excellence) also recommends that a generic ,drug should be perscribed (Scsade et al1998).

RESEARCH DESIGN AND MATERIAL AND METHODS:

This study was conducted in the deprtment of Pharmacololgy and Therapeutics,Basic Medical Science Institute,Jinnah,Postgraduate Medical Centre,karachi under kind supervision od DRr:GhulamRsool Mashori,Associate Professoer and Head OF Department Of Pharmacology and Therapeutics in colloboration with Medical Outpatient Department Unit111 and Filter Clinic, Medical Department, JPMC,Karachi.

Seventy NIDDM (type-II)diabetic patients were initially enrolled in the study from the filter clinic/ out patient department Medical Unit III ,and diabetic clinic.Out of this 60 diabetic patients were associated in whole period of study, remaining 10 patients were dropped due to poor comlpiance or change in residential place.All the patients were divided in two main groups,groupI and in group II these patients were selected in this study according of inclusion and exclusion criteria.

INCLUSION CRITERIA

:

Newly diagnose patients of non Insulin Dependent Diabtes Mellitus.

Diagnsed patients of diabetes also including having no any history medication.

Having either sex of age between 30 to 60 years.

Diagnosed patients who were Non Insulin Depedent Diabetes Mellitus who were treated with Pioglitazone.

Diagnosed patients who were Non Imsulin Depedent Mellitus, who were treated with drug Glibenclamide.

EXCLUSION CRIRERIA

:

Patients suffering from blood pressure.

Patients suffering from liver disease.

Patients suffering from cardiac disease.

Pregnancies and lactating women.

Patient suffering from renal disorders.

Patients having serious complications.

MATERIAL:

Lacets.

Lancet Hlder(Abbots easy touch TM2 lot 03 Asee).

Glucometer(Medisense) optilim one touch(Abbotts).

Blood glucose nest trpis (IVD for Invitro diagnostic use (Abbott Labortries,Medisense UK Ltd,Abigngdon,Ox14ITR,Masde in UK). Stored between minimum 30?, (4°-30° C) and Maximum 40°C (39°-86°F).

Weight Machine Model No 1101 Lot No.312. TANTIATA.

DRUGS

Tab:Daonil 5 mg (Aventis Pharma)

Drug category:Sulphonylurea.

Generic Name: Glibenclamide.

MFGLIC:No.000007 RegistrationNO.000220

MFG Date:0-06

EXP Date:7-10

Lot NO:B230

Tab:piozer (Hilton Pharm) PvtLTd.

Tab:Poizer 15mg

Drug category:Thaiazolinedione.

Generic Name:Pioglitazone Hydrochloride.

MFG LIC: O.000136 Registration No.03270

MFG Date:3-06

EXP Date:3-o9

Lot No:6287

Tab: Poizer (Hilton Pharma)pvt ltd.

PARAMETERS:

Fasting Blood Sugar (FBS).

Random Blood Sugar (RBS).

Weight.

Key words:Diabetes mellitus,Non-insulin diabetes mellitus,Insulin depedent diabetes mellitus, Daonil,poizer,Insulin.

RESULTS:

Table 1

Weight and Blood Sugar level observed on baseline day 0

In group1 and group11

 

Group 1

Group 11

 

Pioglitazone n=27

Glibenclamide n=33

Weight

63.37

+ 2.25

¯

62.7

+ 15.56

¯

Fasting Blood Sugar

172.7

+ 13.32

¯

188.42

+ 12.o5

¯

Random Blood Sugar

285.11

+ 15 .532

¯

284.18

+ 17.07

¯

All Values are expressed in Means± SEM.

FIGURE-1 weight and blood sugar levels observed on baseline (day-o)

In table No shpwing the weight (KG’S) and blood sugar (msg/dl0 levels which is observed on baseline (day-0) in both groups 9group: 1 & group11)

Group: 1 Weight in (Kg’s) mean + SEM) IS 63.37±2.25 Fasting blood sugar 172.7±13.32,and Random

blood sugar 285.11±15.32

Group:11

Weight (KG’s0 (mean +SEM)62.7±1.56 Fasting blood sugar (mg/dl0 188.42±12.05, Random blood sugar is 284.18±17.03.

Figure 2: showing the weight and blood sugar levels observed in base line (day-0) in group: 1 and group 11 weight in 9kg’s) its mean values are 63.37,62.7, Fasting blood sugar in (mg/dl) is 172.71, 188.42 Random blood sugar (mg/dl) is 285.11 &284.18.

TABLE: 2

Peroidic Observation In All Parameters Group1

Goup1(Pioglitazon) n=27

 

P-value

 

Day-0

Day-45

Day-90

Day-0to45

Day-45-90

Weight

63.37

±2.25

63.63

±2.26

63.63

±2.23

>0.05

(NS)

>0.05

(NS)

Fasting blood sugar

172.7

±13.32

165.04

±8.98

153.37

±7.59

>0.05

(NS)

0.05

(NS)

Randomblood sugar

285.11

±15.32

279.78

±13.63

255.56

±12.65

>0.05

(NS)

>0.05

(NS)

All values are expressed in Mean±SEM .(NS) Non significant.

TABLE NO:2

Showing the periodic observations in all parameters in group 1 (piogiltazone) (n+27) weight P.value (day 0 to day 45)>0.05 (NS). Fasting blood sugar >0.05 (NS) Random blood sugar >0.05 (NS) P.values day 90 weight >0.05 (N.S), FBS>0.05 (N.S) 7RBS >0.05(N.S) NON SIGNIFICANT

FIGURE:2 Showing the periodic observation in all parameters in group 1 on day0 day 45& day-90.Mean values in weight (Kg) is 63.37,63.26,63.63, fbs (mg/dl) 172.7,165.04,153.37,RBS(mg/dl) 285.11,279.78,255.56.

TABLE NO3

Peroidic Observation in All Parameters Group11

 

Group 11 (Glibenclamide)

N=33

P-value

 

Day-0

Day-45

Day-90

Day-0 to 45

Day-45 to 90

Weight

62.7

±1.56

65.64

±2.10

64.55

±1.92

>0.05(NS)

0.05(NS0

Fasting blood sugar

188.42

±12.05

168.45

±10.99

140.06

±5.68

>0.05(NS)

>0.05(S)

Random blood sugar

284.18

±17.03

220.12

±13.39

170.94

±5.80

<0.005 (MS)

0.002(MS0

(s) significant, (MS) moderate significant

All values are expressed in Mean±SEM.

Table No3:

Showing the periodic observation in all parameter in goup:11, Group:11 containing drug (Glibenclamide),no of patients (n=33).It’s P-value on day 0 to day 45 on weight >0.05(NS),FBS>0.05(N.S) RBS<0.005 (MS) <0.01- AND DAY 45 TO DAY 90 WEIGHT >0.05 (NS) FBS (0.05) RBS <0.002(M.S0 moderately significant.

Figure 3:Shwing the periodic observations in all parameters in Group 11 weight 62.7,65.64,64.55,FBS (MG/DL) 188.42,168.45 140.06,RBS(mg/dl) 284.18 220.12, 170.94 (on day-0-day 45 to 90).

DISCUSSION:

In Denmark Beck-Nielsenet al,skillman TG (1981) published studies demonstation that glyburide increased he number of receptors on the monocytes of patients with type 11 diabetes mellitus. Some patients were treated with diet and in cobination of second generation sulfonyureas agents Wie. The numbers of insulin receptors all patients were measured before and after the treatment.Intrvenous glucose test shows the persistent impairent of insulin secretion afterthe starting of drug therapy.However those patient who were on drug Pioglitazone some results were obtained of insulin secretion in the impairment in early drug drug therapy.Clinical observations have suggested that the second generation sulfonylureas may exert their effects by potentiating insulin released by other primary stimulators Insulin secreting drug.

According to the study of WilliamC Dukworth et al(1972), aftr the chronic treatment with sulfonylureas it is well documented that plasma insulin levels were decreased in response to oral glucose load. This apparently occures even though glucose tolerance is improved over pre-treatment, levels,present study clearly support that study.

The result og group 11 correlates with the research conducted by Bonnie &Kimmel (2005) produces the same results as FBS reduces from baseline, and at the end of study,with an overall 23.44%,reduction,while with the results showed at the end of study peroid p-value were (p<0,001).

Similarly Michael Alvarsson et al (2003) conducted a similar type of study and the found and overall changes of change of 22.11% in Fbs and 40.88% in Rbs at the end of trial p-value were (p<0.001).

However a study conducted by (Stone &Brown in (2003) didnot match to our results in the parameter of FBS and observer a reduction of 26.22%.

CONCLUSION:

In the light of study discussion it is obiovus the glibenclamide was more effective,tolerable and safer than pioglitzone in a short duration.Diabetes Mellitus is chronic prolong disease for whole life.Poor community can afford it easily,on base of marketing of this drug in pakistan diabetes patients easily go and purchase economically,in fact ,mostly people buy it from pharmacy without dr’s perscription,because pharmacist and patient both of know about this disease.Just like dispirin as analgesic,it is famous anti-diabetic drug in our states as compared of other anti-diabetic drugs.

REFERNCES:

Anderson J,Kendall,Perryman.S etal,”Diet and Diabettes” Diabetes 2006,16(3):17-19-

Bui H- Type 1 diabetes in childhood-Medicine 2006,3 ,1-3

Bernhard –Diabetes-type 11 diabetes mellitus Diabetes care 1995,19(100:12-17-

Clark CM-Oral therapyin type11 diabetes-pharmacological properties and clinical use of current use of currently available agents-Diabetes spectrum 1998,11(4):211-221.

Carren M.Types of Diabetes mellitus-Diabettes 2006 10 (3),07-

David Owerback NJ-Prevalence in diabetes population-Diabetes 1988,02(6):31-32

Dale MM,-Treatment of Diabetes mellitus –pharmacology 20035th edition:287-391.

Heller SR –Hypoglycemic in diabetes Ketoacidosis and hypoglycemic-Medicine 2006:34(03):102-110.

Jawad F Untraveling the mystry of Diabetes’Diabetes 2006;15(3):13-15.

Jacobes D-Insulin-Diabetes 1998;6(3);1160126.

Lambert and Bingliy-basic facts-medicine 2006,34(6):3-7.

Natters M-Ketoacdosis and hyperglycemia-Medicine 2006;34(3):104-106.

Power AC-Epidemiology of type11 diabetes Basic facts of diabetes –Diabetes 2005;1(1)7-9

Scarlet Oral therapy in type 11 diabetes sulfonylureas 1984;16(10);3-9.

Schade DS et al A placebo controlled randomized study of glimepiride in patients of Diabetes mellitus- Diabetes 19998, 38(7);636-641.

Warchman and Forouhi-Epidimology of Diabetes- Diabetes basic facts- Medicine 2006 ;34(2);57-60

Wheeler Gd- Aaccident dicovery led to the noble prize for canadian reseachers,2005,01-02.

WHO Report-Health-Diabetes Mellitus-Defiition and types of Diabetes 2007;1:1-4.

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What is type 1 diabetes?

Type 1 diabetes may also be known by a variety of other names, including the following:

insulin-dependent diabetes mellitus (IDDM)
juvenile diabetes
brittle diabetes
sugar diabetes

There are two forms of type 1 diabetes:

idiopathic type 1 diabetes – refers to rare forms of the disease with no known cause.
immune-mediated diabetes – an autoimmune disorder in which the body’s immune system destroys, or attempts to destroy, the cells in the pancreas that produce insulin.

Immune-mediated diabetes is the most common form of type 1 diabetes, and the one generally referred to as type 1 diabetes. The information on this page refers to this form of type 1 diabetes.

Type 1 diabetes accounts for 5 to 10 percent of all diagnosed cases of diabetes in the US. Type 1 diabetes usually develops in children or young adults, but can start at any age.

What causes type 1 diabetes?

The cause of type 1 diabetes is unknown, but it is believed that genetic and environmental factors (possibly viruses) may be involved. The body’s immune system attacks and destroys the insulin producing cells in the pancreas. Insulin allows glucose to enter the cells of the body to provide energy.

When glucose cannot enter the cells, it builds up in the blood and the body’s cells literally starve to death. People with type 1 diabetes must take daily insulin injections and regularly monitor their blood sugar levels.

What are the symptoms of type 1 diabetes?

Type 1 diabetes often appears suddenly. The following are the most common symptoms of type 1 diabetes. However, each individual may experience symptoms differently. Symptoms may include:

high levels of sugar in the blood when tested
high levels of sugar in the urine when tested
unusual thirst
frequent urination
extreme hunger but loss of weight
blurred vision
nausea and vomiting
extreme weakness and fatigue
irritability and mood changes

In children, symptoms may be similar to those of having the flu.

The symptoms of type 1 diabetes may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

What complications may be associated with type 1 diabetes?

Type 1 diabetes can cause many different problems. However, the three key complications of diabetes include the following:

hypoglycemia – low blood sugar; sometimes called an insulin reaction; occurs when blood sugar drops too low.
hyperglycemia – high blood sugar; occurs when blood sugar is too high, and can be a sign that diabetes is not well controlled.
ketoacidosis – diabetic coma; loss of consciousness due to untreated or under-treated diabetes.
Treatment for type 1 diabetes:

Specific treatment for type 1 diabetes will be determined by your physician based on:

your age, overall health, and medical history
extent of the disease
your tolerance for specific medications, procedures, or therapies
expectations for the course of the disease
your opinion or preference

People with type 1 diabetes must have daily injections of insulin to keep their blood sugar level within normal ranges. Other parts of the treatment protocol may include:

appropriate diet (to manage blood sugar levels)
exercise (to lower and help the body use blood sugar)
careful self-monitoring of blood sugar levels several times a day, as directed by your physician
careful self-monitoring of ketone levels in the urine several times a day, as directed by your physician
regular monitoring of the hemoglobin A1c levels
The hemoglobin A1c test (also called HbA1c test) shows the average amount of sugar in the blood over the last three months. The result will indicate if the blood sugar level is under control. The frequency of HbA1c testing will be determined by your physician. It is recommended that testing occur at least twice a year if the blood sugar level is in the target range and stable, and more frequently if the blood sugar level is unstable.

Advances in diabetes research have led to improved methods of managing diabetes and treating its complications. However, scientists continue to explore the causes of diabetes and ways to prevent and treat the disorder. Other methods of administering insulin through inhalers and pills are currently being studied. Scientists are investigating gene involvement in type 1 and type 2 diabetes, and some genetic markers for type 1 diabetes have been identified. Pancreas transplants are also being performed.

What is type 2 diabetes?

Type 2 diabetes is a metabolic disorder resulting from the body’s inability to make enough, or to properly use, insulin. It used to be called non-insulin-dependent diabetes mellitus (NIDDM).

Without adequate production or utilization of insulin, the body cannot move blood sugar into the cells. It is a chronic disease that has no known cure. It is the most common type of diabetes, accounting for 90 to 95 percent of diabetes cases.

What is prediabetes?

In prediabetes, blood glucose levels are higher than normal but not high enough to be defined as diabetes. However, many people with prediabetes develop type 2 diabetes within 10 years, states the National Institute of Diabetes and Digestive and Kidney Diseases. Prediabetes also increases the risk of heart disease and stroke. With modest weight loss and moderate physical activity, people with prediabetes can delay or prevent type 2 diabetes.

What causes type 2 diabetes?

The exact cause of type 2 diabetes is unknown. However, there does appear to be a genetic factor which causes it to run in families. And, although a person can inherit a tendency to develop type 2 diabetes, it usually takes another factor, such as obesity, to bring on the disease.

Prevention or delay of onset of type 2 diabetes:

Type 2 diabetes may be prevented or delayed by following a program to eliminate or reduce risk factors – particularly losing weight and increasing exercise. Information gathered by the Diabetes Prevention Program, sponsored by the National Institutes of Health and the American Diabetes Association, continues to study this possibility.

What are the symptoms of type 2 diabetes?

The following are the most common symptoms of type 2 diabetes. However, each individual may experience symptoms differently. Symptoms may include:

frequent infections that are not easily healed
high levels of sugar in the blood when tested
high levels of sugar in the urine when tested
unusual thirst
frequent urination
extreme hunger but loss of weight
blurred vision
nausea and vomiting
extreme weakness and fatigue
irritability and mood changes
dry, itchy skin
tingling or loss of feeling in the hands or feet

Some people who have type 2 diabetes exhibit no symptoms. Symptoms may be mild and almost unnoticeable, or easy to confuse with signs of aging. Half of all Americans who have diabetes do not know it.

The symptoms of type 2 diabetes may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

What are the risk factors for type 2 diabetes?

Risk factors for type 2 diabetes include the following:

age
People over the age of 45 are at higher risk for diabetes.
family history of diabetes
being overweight
not exercising regularly
race and ethnicity
Being a member of certain racial and ethnic groups, such as African-Americans, Hispanic Americans, and Native Americans increases the risk for type 2 diabetes.
history of gestational diabetes, or giving birth to a baby that weighed more than 9 pounds
a low level HDL (high-density lipoprotein – the “good cholesterol”)
a high triglyceride level
Treatment for type 2 diabetes:

Specific treatment for type 2 diabetes will be determined by your physician based on:

your age, overall health, and medical history
extent of the disease
your tolerance for specific medications, procedures, or therapies
expectations for the course of the disease
your opinion or preference

The goal of treatment is to keep blood sugar levels as close to normal as possible. Emphasis is on control of blood sugar (glucose) by monitoring the levels, regular physical activity, meal planning, and routine healthcare. Treatment of diabetes is an ongoing process of management and education that includes not only the person with diabetes, but also healthcare professionals and family members.

Often, type 2 diabetes can be controlled through losing weight, improved nutrition, and exercise alone. However, in some cases, these measures are not enough and either oral medications and/or insulin must be used. Treatment often includes:

proper diet
weight control
an appropriate exercise program
regular foot inspections
oral medications, other medications, and/or insulin replacement therapy, as directed by your physician
There are various types of medications that may be used to treat type 2 diabetes when lifestyle changes such as diet, exercise, and weight loss are not effective. Oral medications of several different types are available, with each type working in a different manner to lower blood sugar. One medication may be combined with another one to improve blood sugar control. When oral medications are no longer effective, insulin may be required.

New medications for treating diabetes are in development. GLP-1 agonists are one of the new types of medications. GLP-1 agonists work by stimulating insulin production by the pancreas, slowing the emptying of food from the stomach, and inhibiting the production of glucagon in the pancreas (glucagon is a hormone produced by the pancreas that stimulates release of glucose by the liver). Byetta®, a GLP-1 agonist approved by the FDA in 2005, is given by injection.
regular monitoring of the hemoglobin A1c levels
The hemoglobin A1c test (also called HbA1c test) shows the average amount of sugar in the blood over the last three months. The result will indicate if the blood sugar level is under control. The frequency of HbA1c testing will be determined by your physician. It is recommended that testing occur at least twice a year if the blood sugar level is in the target range and stable, and more frequently if the blood sugar level is unstable.

Untreated or inappropriately-treated diabetes can cause problems with the kidneys, legs, feet, eyes, heart, nerves, and blood flow, which could lead to kidney failure, gangrene, amputation, blindness, or stroke. For these reasons, it is important to follow a strict treatment plan.

What is gestational diabetes?

Gestational diabetes is a condition in which the glucose level is elevated and other diabetic symptoms appear during pregnancy in a woman who has not previously been diagnosed with diabetes. All diabetic symptoms disappear following delivery.

Unlike type 1 diabetes, gestational diabetes is not caused by a lack of insulin, but by blocking effects of other hormones on the insulin that is produced, a condition referred to as insulin resistance.

Approximately 7 percent of all pregnant women in the United States are diagnosed with gestational diabetes.

What causes gestational diabetes?

Although the cause of gestational diabetes is not known, there are some theories as to why the condition occurs.

The placenta supplies a growing fetus with nutrients and water, as well as produces a variety of hormones to maintain the pregnancy. Some of these hormones (estrogen, cortisol, and human placental lactogen) can have a blocking effect on insulin. This is called contra-insulineffect, which usually begins about 20 to 24 weeks into the pregnancy.

As the placenta grows, more of these hormones are produced, and insulin resistance becomes greater. Normally, the pancreas is able to make additional insulin to overcome insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results.

What are the risks factors associated with gestational diabetes?

Although any woman can develop gestational diabetes during pregnancy, some of the factors that may increase the risk include the following:

obesity
family history of diabetes
having given birth previously to a very large infant, a still birth, or a child with a birth defect
having too much amniotic fluid (polyhydramnios)
age
Women who are older than 25 are at a greater risk for developing gestational diabetes than younger women.

Although increased glucose in the urine is often included in the list of risk factors, it is not believed to be a reliable indicator for gestational diabetes.

How is gestational diabetes diagnosed?

Gestational diabetes maybe diagnosed with a 50 gram glucose screening test, which involves drinking a glucose drink followed by measurement of blood sugar levels after one hour.

If this test shows a blood sugar level of greater than 140 mg/dL, a three-hour glucose tolerance test may be performed after a few days of following a special diet. If results of the second test are in the abnormal range, gestational diabetes is diagnosed.

Treatment for gestational diabetes:

Specific treatment for gestational diabetes will be determined by your physician based on:

your age, overall health, and medical history
extent of the disease
your tolerance for specific medications, procedures, or therapies
expectations for the course of the disease
your opinion or preference

Treatment for gestational diabetes focuses on keeping blood glucose levels in the normal range. Treatment may include:

special diet
exercise
daily blood glucose monitoring
insulin injections
Possible complications for the baby:

Unlike type 1 diabetes, gestational diabetes generally does not cause birth defects. Birth defects usually originate sometime during the first trimester (before the 13th week) of pregnancy. But, the insulin resistance from the contra-insulin hormones produced by the placenta does not usually occur until approximately the 24th week. Women with gestational diabetes generally have normal blood sugar levels during the critical first trimester.

The complications of gestational diabetes are usually manageable and preventable. The key to prevention is careful control of blood sugar levels just as soon as the diagnosis of gestational diabetes is made.

Infants of mothers with gestational diabetes are vulnerable to several chemical imbalances, such as low serum calcium and low serum magnesium levels, but, in general, there are two major problems of gestational diabetes: macrosomia and hypoglycemia.

macrosomia
Macrosomia refers to a baby that is considerably larger than normal. All of the nutrients the fetus receives come directly from the mother’s blood. If the maternal blood has too much glucose, the pancreas of the fetus senses the high glucose levels and produces more insulin in an attempt to use this glucose. The fetus converts the extra glucose to fat. Even when the mother has gestational diabetes, the fetus is able to produce all the insulin it needs. The combination of high blood glucose levels from the mother and high insulin levels in the fetus results in large deposits of fat which causes the fetus to grow excessively large.
hypoglycemia
Hypoglycemia refers to low blood sugar in the baby immediately after delivery. This problem occurs if the mother’s blood sugar levels have been consistently high, causing the fetus to have a high level of insulin in its circulation. After delivery, the baby continues to have a high insulin level, but it no longer has the high level of sugar from its mother, resulting in the newborn’s blood sugar level becoming very low. The baby’s blood sugar level is checked after birth, and if the level is too low, it may be necessary to give the baby glucose intravenously.

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Vitamins and minerals are substances that are found in foods we eat.

Your body needs them to work correctly, so you grow and expand just like you should.

When it comes to vitamins, each one has a special role to play. For example:

1.    Vitamin D in milk helps your bones.
2.    Vitamin A in carrots helps you see at night.
3.    Vitamin C in oranges helps your body heal if you get a cut.
4.    B vitamins in leafy green vegetables help your body make protein and energy.

Benefit of Vitamin A

Vitamin A, also called retinol, helps your eyes adjust to light changes when you come in from outside and also helps keep your eyes, skin and mucous membranes moist.

Vitamin A mostly comes from creature foods, but some plant-based foods provide beta-carotene, which your body then converts into Vitamin A.

It also has antioxidant properties that neutralize free radicals in the body that cause tissue and cellular damage.

1.    Act as anti-oxidant, helping to protect our cells against cancer and other disease

2. Vitamin A improves our vision and prevents night blindness

3. This vitamin promotes formation of strong bones

4. Vitamin A guards us against bacterial, viral, parasitic infections

5. Guards us against heart disease, stroke and lowers blood cholesterol level

6. It can improve skin condition like acne or psoriasis

7. A well-known wrinkle eliminator, vitamin A reduces fine lines in the skin and helps fade age spots.

8. Vitamin A supplements may help kids who have respiratory problem

9. The supplement is also believed to help people suffering from

Benefit of Vitamin C

Vitamin C is the most popular single vitamin. Besides captivating it to treat colds, people pop vitamin C capsules eager that it will cure numerous ailments.

There is now scientific evidence to support some of that hope.

Scientifically proscribed studies using vitamin C for colds show that it can reduce the harshness of cold symptoms, acting as a natural antihistamine.

The vitamin may be useful for allergy control for the same reason: It may reduce histamine levels.

By giving the immune system one of the imperative nutrients it needs, extra vitamin C can often shorten the period of the cold as well.

However, studies have been unable to prove that mega doses of the vitamin can actually prevent the common cold.

Vitamin C is an antioxidant

And can protect your body from free radicals, which may cause heart disease and cancer.

Vitamin C is responsible for producing collagen. Collagen is present in your muscles and bones. It is responsible for holding the cells together.

Vitamin C helps your immune system. It helps you heal from scrapes and bruises.

Vitamin C also keeps your gums healthy. People with lack of Vitamin C often develop black, swollen gums otherwise known as scurvy.

Vitamin E

Vitamin E acts as a authoritative antioxidant by neutralize free radicals in the body that cause tissue and cellular damage.

Vitamin E also contribute to a healthy circulatory system and aids in proper blood clotting and improve wound healing.

Some studies have bare that vitamin E decreases symptoms of premenstrual syndrome and certain types of breast illness.

Some public take mega-doses of fat-soluble vitamins, which can lead to toxicity.

Eating a regular diet of foods rich in these vitamins won’t cause a trouble. Remember, you only want small amount of any vitamin.

Summer is in full-swing, which means that the lazy days of summer are officially upon us! Whether you’re summer plans involve relaxing by the pool with a good book and cold beverage, snacks of diabetes, getting some sunshine at the beach, or driving the kids from one summertime event to another, here are some tips to help you make the most of these lazy days while staying healthy and energetic!

Get in the Water: The summer is filled with activities that are centered around water. From water sports like sailing to simply jumping into the crystal clear pool waters you’ve been dying to test out, it’s time to take advantage of water rather than sunbathe near it!

Swimming and water aerobics provide some of the best outlets for toning your entire body using water for resistance (rather than those clunky weights at the gym). Or spend some time in the water with your kids next time they jump in the pool…you’ll be surprised by how toned your arms can get from tossing them into back flips!

Walk that Beach: Just about everyone takes a few days to get down to the beach each summer. Next time you’re at the beach, don’t just watch the sand crabs; get out and enjoy the sand yourself! Walking or running with diabetic footwear in sand not only helps to tone your leg muscles (the softer the sand, the harder it is to walk and the more calories you’ll burn), but it will ensure that you get at least a little bit of cardio in between bouts of wave watching and book reading. Be sure to apply sunscreen before you head out for a walk; just 30 minutes in the bright summer sun is enough to burn your skin and scalp.

Don’t Just Wait in the Car
If you’re like many parents and you think that the summer has come down to a series of waiting periods while your children complete their summer activities, you’re not alone. But next time your child has a soccer practice, dance lesson, or art class, don’t just wait in the car; get out and exercise!

Dress for the occasion in workout clothes, or simply keep some sneakers in the car if you don’t have time for a full-on workout. While your child practices soccer, walk or jog around the field. If your child is taking a dance lesson, take time for yourself to run around the neighborhood where the dance studio is.

With the high prices of gas these days, it’s more cost effective to stay in the vicinity of the lesson rather than going home and coming back after your child’s activity anyway. You’ll usually have about an hour to yourself to get active and keep your weight down, or pull in other parents to work out together while you wait.

Always Have a Snack On-Hand Like Sugarfree Desserts
Almond Snack It’s easy to gain weight in the summer with the level of physical activity decreasing in the hot sun while the number of ice cream stands generally goes through the roof. In order to put cravings at bay, make sure to always have a healthy snack on hand for you and your family. Almonds and dried fruit are excellent, healthy choices and they last in even the hottest of cars.

Click Here For : Snacks For Diabetics

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Weight loss, in the context of medicine, health or physical fitness, is reductions of the total body mass, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue. It can occur unintentionally due to an underlying disease or can arise from a conscious effort to improve an actual or perceived overweight or obese state.

Diabetes and weight loss is generally one of the most troubling aspects of your diabetes prevention program. Another is how you manage day to day living with diabetes. Diabetes weight loss, natural weight loss supplements and specifically how to lose body fat are detailed in the article below. Read on!

High Body Fat is directly correlated to the onset and risk of complications associated with Diabetes. Studies indicate that obese people are more likely to become Diabetic than people of normal weight. Studies also indicate that the complications associated with Diabetes are made worse by obesity or excess body fat.

* Excess body fat is linked to many of the following conditions:

* High cholesterol

* Fatty deposits in the arteries

* Clogged or hardened arteries

* High blood pressure

* Poorly functioning kidneys

* A sedentary lifestyle

* Poor blood circulation

* Depression

* Increased risk of getting a stroke

* Damage to blood vessels

* High blood sugar levels

* Infections caused by high blood sugar levels

Weight loss can help to not only delay the onset of Type 2 Diabetes but it can also off-set the severity of associated complications. In fact, studies show that losing just 10% of your body weight can reduce your risk of developing Diabetes and its complications by as much as 50%. For many people, that means losing just five to ten pounds of body fat.

Losing weight should be done in a variety of ways in order to ensure that the weight loss is sustainable and effective. Many Diabetics rely upon medications and diabetes supplements in order to get the insulin in their bodies to convert fat and sugar to usable forms of energy. Exercise and nutrition are also essential elements that are necessary to losing weight.

In order to effectively lose weight and body fat, many people find that they need to develop a diet plan or enlist the help of a support network, such as a weight loss program or a friend. Losing weight becomes less of a task and more of a social occasion when you can associate the undertaking with friends and shared goals.

Learn more about Sugars and Starches and How Your Digestion Works by taking Weight Control Supplements.

Walking is an excellent way to get a cardiovascular workout no matter what shape you are in. When you walk, you will not only improve blood circulation throughout your body, but you will also burn those fat-producing calories. As you know, less fat is healthier for your heart and metabolism and will help you maintain control of your Diabetes.

For more information about the best weight loss plans and weight loss dietary supplement for your body and lifestyle, consult your physician.

Know more about Glucose supplements and Weight loss supplements

Type 2 diabetes is a syndrome affecting many different body organ systems, and we recognize today that a few of these areas are also associated in the weight gain that people with type 2 diabetes experience. The thyroid gland, the liver, the adrenals, the pancreas, as well as the gastrointestinal system all play a role in diabetes type 2. In addition to these bodily organs, individuals with type 2 diabetes are experiencing insulin resistance. Let’s discuss some of the causative factors of excess weight and diabetes.

1. The Thyroid gland
The thyroid is a gland responsible for the regulation of our metabolic rate. When the thyroid gland is manufacturing too much thyroid hormone, it can speed the entire body up too much. On the other hand, if the thyroid gland is under producing thyroid hormone, it can slow your rate of metabolism down too much. When your metabolic rate is slow you can experience weight gain. Also, if your thyroid hormonal levels are decreased your energy levels are going to be reduced which makes it quite challenging to want to exercise. The thyroid is a essential body organ in the area of weight gain for diabetes patients and it is commonly overlooked.

2. The Liver
The liver is among the main bodily organs in your body accountable for internal cleansing. It is quite common to find increased liver enzymes on the blood exams of individuals with type 2 diabetes. Significant levels of medication together with excessive toxins in the environment can cause the liver to become overwhelmed with toxic agents. As the liver backs up it may be affected bringing about increased liver enzymes. As soon as the body loses its ability to rid itself of poisons adequately it’s also common to observe increased cholesterol levels and weight gain.

3. Insulin Resistance
If you have type 2 diabetes, you also have insulin resistance. Insulin resistance means that you are having problems getting glucose from your blood stream into your cells. Because you cannot get this glucose into your cells, the level of glucose in your bloodstream rises. This extra blood glucose leads to a good deal of inflammation and also often leads to weight gain. If your system is unable to get this extra glucose into your cells to generate energy, it routes the glucose away and off to the liver so that it may be converted into triglycerides and body fat.

Insulin resistance causes you to feel worn out simply because you aren’t able to generate energy or ATP within your cells and you put on weight since the glucose which should have been changed to energy has now been changed into body fat. You feel hungry regularly because your cells are hungry for energy, and you’re gaining extra fat at the same time. It’s additionally incredibly tough to work out because you don’t have the energy reserves to do it.

The solution to beating this never-ending cycle is to have a qualified professional perform adequate tests to determine where your system has broken down. Running the conventional diabetes blood assessments is just not adequate to discover the origin of the issue
You don’t have to be a prisoner to type 2 diabetes and weight gain. Find an experienced professional today that can help you discover the cause of your diabetes.

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Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine”, National Institute of Health. People with diabetes take supplements to manage their diabetes and diabetes complications. We have listed articles that discuss supplements and their believed benefits and harm. We suggest you speak with your health care professionals about whether you should take diabetes nutritional supplements.

Magnesium is a mineral. Foods high in magnesium include green leafy vegetables, nuts, seeds, and some whole grains. Glucose supplements and various supplemental forms of magnesium are marketed as tablets, capsules, or liquids.

Magnesium has many important functions in the body, including in the heart, nerves, muscles, bones, handling glucose, and making proteins. Low levels of magnesium are commonly seen in people with diabetes. Scientists have studied the relationship between magnesium and diabetes for a long time, but it is not yet fully understood.

Summary of the Research Findings

There have been a handful of studies on magnesium and type 2 diabetes, many of them very small in size and/or short in length and primarily looking at blood glucose control. The results have been mixed, with most finding that magnesium did not affect blood glucose control. Some studies have suggested that low magnesium levels may make glucose control worse in type 2 diabetes (interrupting insulin secretion in the pancreas and increasing insulin resistance) and contribute to diabetes complications. There is evidence that magnesium supplementation may be helpful for insulin resistance. Additional controlled studies are needed to establish firmly whether magnesium supplements have any role or benefit as a CAM therapy for type 2 diabetes.

Side Effects and Other Risks

Magnesium supplements and supplements for diabetes appear to be safe for most adults at low doses. High doses can be unsafe and cause such problems as nausea, diarrhea, loss of appetite, muscle weakness, difficulty breathing, extremely low blood pressure, irregular heart rate, and confusion. Magnesium can interact with and affect the action of certain drugs, including some antibiotics, drugs to prevent osteoporosis, certain high blood pressure medicines (calcium channel blockers), muscle relaxants, and diuretics (“water pills”).

Living With Diabetes – Diabetes – A Silent Killer. Care World Channel has ‘Living With Diabetes’, a show dedicated to providing vital information about diabetes, like the symptoms, causes and effects of the dreaded disease, all by expert doctors. This episode of ‘Living With Diabetes’ poses practical questions that are sure to alert victims of diabetes and warn them to take precautions. Dr. Vijay Panekar, a diabetologist gives basic information, symptoms, causes, etc. of diabetes in great detail. Log on to www.rajshri.com to watch more beauty, health & Yoga tips.

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Learn more about diabetes at www.bloodsugarsimplified.com Diabetes is a disease where your body does not produce enough insulin, or else the insulin it produces is not doing what it is supposed to do, which is to lower blood sugar. As a result, your blood sugar levels increase causing hyperglycemia.
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Ayurveda is one of the alternative medical systems originated from India. Ayurveda in India is famous for curing various types of curable diseases including inflammation of the stomach, infections of the gums and teeth, formation of cataract, disorders of the fallopian tubes, acidity, disorders of the brain, tension, neuralgia, severe ulcers, the spinal nerves, disorders of urinary tract and many more. All these diseases are easily get cured by ayurveda massage therapies and exercises. In India you will find number of ayurveda massage centers that offers various types of massage therapy courses at different rates and packages. Not only in Kerala but these ayurveda centers are now able to follow the paths of Delhi, Mumbai, Hyderabad, Noida, Gurgaon, Bangalore and many more states of the nation. Every year numbers of tourist from western side of the globe coming to India for their recovery from different diseases. Here they will find number of world class ayurvedic institutes that offer a number of specialized massage training programs that can make you adept at administering ayurvedic treatment for illness.     

The basic philosophy of Ayurveda medical system is based on the panchamahabhoota theory that believes on human body is made up of five elements earth, air, fire, space and water. Ayurveda massage system is the science of life which is dealing not only with treatment of some curable diseases but also maintains the complete body structure. Ayurveda is one of the renewing and revitalizing your body and mind without any side effect like in case of allopathic medicare system. During ayurveda treatment, these five body elements combine to form controlling forces and biological humours called Dosha. This product is used to recover the body’s energy from protecting body from several diseases. Ayurvedic treatment is one of the ancient medicare systems has its own natural world that uses ayurvedic herbal and oil for curing diseases and massage therapies.  

Ayurveda and massage therapies form an integral part of the cultural heritage of India. Ayurveda in India has been practiced in all parts of India including Kerala since time unknown of this alternate medical system and still regarded as one of the safest alternatives to many other conventional systems of medicine. India houses large number of Ayurvedic resorts offering a wide range of massage therapies and ayurveda exercises. In India as compare to all other states Kerala is one of the states with pristine and refreshing surroundings of beautiful backwaters, exotic beaches and hill stations. Here in India kerala-ayurvedics.com brings you with some of the popular ayurvedic massage resorts in India where one can avail the world class services of Ayurveda massage therapies include the Somatheeram Ayurvedic Beach Resort, Heritage Resort, Keraleeyam Ayurveda Resort, Kairali Ayurvedic Resort, Taj Garden Retreat Kumarakom, Aquaserene Ayurvedic Resort, Susya Ayurvedic Health Resort, Olasha Ayurvedic Center and Kumarakom Lake Resort. Here you will find number of ayurveda resorts that comprises a large team of well qualified Ayurveda massage practitioners and therapists who can examine you and then recommend the required massage therapy.