This article may require cleanup to meet Wikipedia's quality standards. Please discuss this issue on the talk page or replace this tag with a more specific message. This article has been tagged since July 2006.

Diabetes is a chronic disease with no cure as of 2007. It is associated with an impaired glucose cycle, altering metabolism. Management of this disease may include lifestyle modifications such as achieving and maintaining proper weight, diet, exercise and foot care. Image File history File links Broom_icon. ... For the disease characterized by excretion of large amounts of very dilute urine, see diabetes insipidus. ... This article is about the disease that features high blood sugar. ... Medicine In medicine, a persistent and lasting condition is said to be chronic (from Greek chronos). ... 2007 is a common year starting on Monday of the Gregorian calendar. ... This is a description of the glucose cycle, presented in clear and simple words that everyone can understand. ... A few of the metabolic pathways in a cell. ...

Fructosamine, also known as Glycated Serum Protein (GSP) or Glycated Albumin, is used primarily to identify the plasma glucose concentration over time and so assess diabetic control . ... A glucose tolerance test in medical practice is the administration of glucose to determine how quickly it is cleared from the blood. ... Glycosylated (or glycated) hemoglobin (hemoglobin A1c, Hb1c , HbA1c or HgA1c) is a form of hemoglobin used primarily to identify the plasma glucose concentration over time. ...

Overview of management

Issues requiring management

The primary issue requiring management is the glucose cycle, whereby glucose in the bloodstream is made available to cells in the body, a process dependent upon the twin cycles of glucose entering the bloodstream, and insulin allowing appropriate uptake into the cells of the body. Both aspects can require management.

Complexities relating to management

The main complexities stem from the nature of the feedback loop itself, which is sought to be regulated: In cybernetics and control theory, feedback is a process whereby some proportion or in general, function, of the output signal of a system is passed (fed back) to the input. ...

• The glucose cycle is a system which is affected by two factors: entry of glucose into the bloodstream and also blood levels of insulin to control its transport out of the bloodstream
• As a system, it is sensitive to diet and exercise
• It is affected by the need for user anticipation due to the complicating effects of time delays between any activity and the respective impact on the glucose system
• Management is highly intrusive and compliance is an issue, since it relies upon user lifestyle change and (often) upon regular sampling and measuring of blood glucose levels, multiple times a day in many cases
• It changes as people grow and develop
• It can be highly individual

As diabetes is a prime risk factor for cardiovascular disease, controlling other risk factors which may give rise to secondary conditions, as well as the diabetes itself, is one of the facets of diabetes management. Checking cholesterol, LDL, HDL and triglyceride levels may indicate hyperlipoproteinemia, which may warrant treatment with hypolipidemic drugs. Checking the blood pressure and keeping it within strict limits (using diet and antihypertensive treatment) protects against the retinal, renal and cardiovascular complications of diabetes. Regular follow-up by a podiatrist or other foot health specialists is encouraged to prevent the development of diabetic foot. Annual eye exams are suggested to monitor for progression of diabetic retinopathy. Cardiovascular disease refers to the class of diseases that involve the heart and/or blood vessels (arteries and veins). ... Cholesterol is a sterol (a combination steroid and alcohol) and a lipid found in the cell membranes of all body tissues, and transported in the blood plasma of all animals. ... Low-density lipoprotein (LDL) refers to a class and range of lipoprotein particles, varying somewhat in their size and contents, which carry cholesterol in the blood and around the body, for use by various cells. ... High density lipoproteins (HDL) form a class of lipoproteins, varying somewhat in their size and contents, that carry cholesterol from the bodys tissues to the liver. ... Example of an unsaturated fat triglyceride. ... Hyperlipoproteinemia is the presence of elevated levels of lipoprotein in the blood. ... A sphygmomanometer, a device used for measuring blood pressure. ... Antihypertensives are a class of drugs that are used in medicine and pharmacology to treat hypertension (high blood pressure). ... Podiatry is a field of healthcare devoted to the study and treatment of disorders of the foot, ankle, and sometimes knee, leg and hip (collectively known as the lower extremity). ... Diabetic foot is an umbrella term for foot problems in patients with diabetes mellitus. ...

The expense, inconvenience and discomfort of frequent blood glucose measurements has been limited until recently. Recently newer devices which monitor glucose levels on an ongoing basis have been developed, as detailed below.

Early advancements

Late in the nineteenth century, sugar in the urine (glycosuria) was associated with diabetes. Various doctors studied the connection. Frederick Madison Allen studied diabetes in 1909-12, then published a large volume, Studies Concerning Glycosuria and Diabetes, (Boston, 1913). He invented a fasting treatment for diabetes called the Allen treatment for diabetes. His diet was an early attempt at managing diabetes. 1909 (MCMIX) was a common year starting on Friday (see link for calendar). ... 1912 (MCMXII) was a leap year starting on Monday in the Gregorian calendar (or a leap year starting on Tuesday in the 13-day-slower Julian calendar). ... Fasting is primarily the act of willingly abstaining from some or all food, drink, or both, for a period of time. ...

Modern approaches

Modern approaches to diabetes primarily rely upon dietary and lifestyle management, often combined with regular ongoing blood glucose level monitoring.

Diet management allows control and awareness of the types of nutrients entering the digestive system, and hence allows indirectly, significant control over changes in blood glucose levels. Blood glucose monitoring allows verification of these, and closer control, especially important since some symptoms of diabetes are not easy for the patient to notice without actual measurement.

Other approaches include exercise control, and other lifestyle changes impacting upon the glucose cycle.

Blood sugar level

Blood sugar level is measured by means of a glucose meter, with the result either in mg/dL (milligrams per deciliter in the USA) or mmol/L (millimoles per litre in Canada and Europe) of blood. The average normal person should have a glucose level of around 4.5 to 7.0 mmol/L (80 to 125 mg/dL). In the diabetic patient a before-meal level of <6.1 mmol/L (<110 mg/dL) and a level two hours after the start of a meal of <7.8 mmol/L (<140 mg/dL) is acceptable.^{[citation needed]} Four generations of blood glucose meter, c. ...

Optimal management of diabetes involves patients measuring and recording their own blood glucose levels. By keeping a diary of their own blood glucose measurements and noting the effect of food and exercise, patients can modify their lifestyle to better control their diabetes. For patients on insulin, patient involvement is important in achieving effective dosing and timing. In medicine, blood sugar is glucose in the blood. ...

Hypo- and hyper-glycaemia

Levels which are significantly above or below this range are problematic and can in some cases be dangerous. A level of <3.8 mmol/L (<70 mg/dL) is usually described as a hypoglycaemic attack (low blood sugar). Most diabetics know when they're going to "go hypo" and usually are able to eat some food or drink something sweet to raise levels. A patient who is hyperglycemic (high glucose) can also become temporarily hypoglycemic, under certain conditions (e.g. not eating regularly, or after strenuous exercise, followed by fatigue).

Levels greater than 13-15 mmol/L (230-270 mg/dL) are considered high, and should be monitored closely to ensure that they reduce rather than continue to remain high. The patient is advised to seek urgent medical attention as soon as possible if blood sugar levels continues to rise after 2-3 tests. High blood sugar levels are known as hyperglycaemia, which is not as easy to detect as hypoglycemia and usually happens over a period of days rather than hours or minutes. If left untreated, this can result in diabetic coma and death. Diabetic coma is a medical emergency in which a person with diabetes mellitus is comatose (unconscious) because of one of three acute complications of diabetes: Severe diabetic hypoglycemia Advanced diabetic ketoacidosis advanced enough to result in unconsciousness from a combination of severe hyperglycemia, dehydration and shock, and exhaustion Hyperosmolar nonketotic...

A blood glucose test strip for an older style (ie, optical color sensing) monitoring system

Prolonged and elevated levels of glucose in the blood, which is left unchecked and untreated, will, over time, result in serious diabetic complications and sometimes even death. It is therefore highly important that a diabetic patient checks their blood levels either daily or every few days to see what levels they are achieving over a given period of time. There is also computer software for the PC which is available from blood testing manufacturers which can display results and trends over time. Type 1 patients will have to check on a more regular daily basis due to insulin therapy, which is a fine art to master. (c) 2004 Krzysztof P. Jasiutowicz File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ... (c) 2004 Krzysztof P. Jasiutowicz File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ...

A history of blood sugar level results is especially useful for the diabetic to present to their doctor or physician in the monitoring and control of the disease. Failure to maintain a strict regimen of testing can accelerate symptoms of the condition, and it is therefore imperative that any diabetic patient strictly monitor their glucose levels regularly.

Glycemic control

Glycemic control is a medical term referring to the typical levels of blood sugar (glucose) in a person with diabetes mellitus. Much evidence suggests that many of the long-term complications of diabetes, especially the microvascular complications, result from many years of hyperglycemia (elevated levels of glucose in the blood). Good glycemic control, in the sense of a "target" for treatment, has become an important goal of diabetes care. Glucose (Glc), a monosaccharide (or simple sugar), is the most important carbohydrate in biology. ... For the disease characterized by excretion of large amounts of very dilute urine, see diabetes insipidus. ... Hyperglycemia or High Blood Sugar is a condition in which an excessive amount of glucose circulates in the blood plasma. ...

Because blood sugar levels fluctuate throughout the day and glucose records are imperfect indicators of these changes, the percentage of hemoglobin which is glycosylated is used as a proxy measure of long-term glycemic control in research trials and clinical care of people with diabetes. This test, the hemoglobin A1c or glycosylated hemoglobin reflects average glucoses over the preceding 2-3 months. In nondiabetic persons with normal glucose metabolism the glycosylated hemoglobin is usually 4-6% by the most common methods (normal ranges may vary by method). 3-dimensional structure of hemoglobin. ... Glycosylation is the process or result of addition of saccharides to proteins and lipids. ... HbA1c is shorthand for glycated hemoglobin A1c, a surrogate marker for blood glucose levels. ... Glycosylated (or glycated) hemoglobin (hemoglobin A1c, Hb1c , HbA1c or HgA1c) is a form of hemoglobin used primarily to identify the plasma glucose concentration over time. ...

"Perfect glycemic control" would mean that glucose levels were always normal (70-130 mg/dl, or 3.9-7.2 mMol/L) and indistinguishable from a person without diabetes. In reality, because of the imperfections of our treatment measures for replacing a pancreas, even "good glycemic control" describes blood glucose levels that average somewhat higher than normal much of the time. The pancreas is an organ in the digestive and endocrine system (of vertebrates[2]). It is both exocrine (secreting pancreatic juice containing digestive enzymes) and endocrine (producing several important hormones, including insulin, glucagon, and somatostatin). ...

Accepted "target levels" of glucose and glycosylated hemoglobin that are considered good control have been lowered over the last 25 years, because of improvements in the tools of diabetes care, because of increasing evidence of the value of glycemic control in avoiding complications, and by the expectations of both patients and physicians. What is considered "good control" also varies by age and susceptibility of the patient to hypoglycemia. Hypoglycemia (hypoglycæmia in the UK) is a medical term referring to a pathologic state produced by a lower than normal amount of sugar (glucose) in the blood. ...

In the 1990s the American Diabetes Association conducted a publicity campaign to persuade patients and physicians to strive for average glucose and hemoglobin A1c values below 200 mg/dl and 8%. Currently many patients and physicians attempt to do better than that. The American Diabetes Association, or the ADA, is an American health organization providing diabetes research, information and advocacy. ...

Poor glycemic control refers to persistently elevated blood glucose and glycosylated hemoglobin levels, which may range from 200-500 mg/dl (11-28 mMoles/L) and 9-15% or higher over months and years before severe complications occur.

Monitoring

An older style portable blood glucose meter. A blood sample is applied to an inserted strip (see image above) and color changes caused by reaction with blood glucose are measured by the meter.

Relying on their own perceptions of symptoms of hyperglycemia or hypoglycemia is usually unsatisfactory as mild to moderate hyperglycemia causes no obvious symptoms in nearly all patients. Other considerations include the fact that, while food takes several hours to be digested and absorbed, insulin administration can have glucose lowering effects for as little as 2 hours or 24 hours or more (depending on the nature of the insulin preparation used and individual patient reaction). In addition, the onset and duration of the effects of oral hypoglycemic agents vary from type to type and from patient to patient. (c)2004 Krzysztof P. Jasiutowicz released under the GNU FDL licence File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ... (c)2004 Krzysztof P. Jasiutowicz released under the GNU FDL licence File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ...

Personal (home) glucose monitoring

Control and outcomes of both types 1 and 2 diabetes may be improved by patients using home glucose meters to regularly measure their glucose levels.^[1] Glucose monitoring is both expensive (largely due to the cost of the consumable test strips) and requires significant commitment on the part of the patient. The effort and expense may be worthwhile for patients when they use the values to sensibly adjust food, exercise, and oral medications or insulin. These adjustments are generally made by the patients themselves following training by a clinician. Four generations of blood glucose meter, c. ... Glucose (Glc), a monosaccharide (or simple sugar), is the most important carbohydrate in biology. ...

Regular blood testing, especially in type 1 diabetics, is essential to keep adequate control of glucose levels and to reduce the chance of long term side effects of the disease. There are many (at least 20+) different types of blood monitoring devices available on the market today; not every meter suits all patients and it is a specific matter of choice for the patient, in consultation with a physician or other experienced professional, to find a meter that they personally find comfortable to use. The principle of the devices is virtually the same: a small blood sample is collected and measured. In one type of meter, the electrochemical, a small blood sample is produced by the patient using a lancet (a sterile pointed needle). The blood droplet is usually collected at the bottom of a test strip, while the other end is inserted in the glucose meter. This test strip contains various chemicals so that when the blood is applied, a small electrical charge is created between two contacts. This charge will vary depending on the glucose levels within the blood. In older glucose meters, the drop of blood is placed on top of a strip. A chemical reaction occurs and the strip changes color. The meter then measures the color of the strip optically. Side-effect can mean: Side-effect (computer science), a state change caused by a function call Adverse drug reaction, an unintended consequence specifically arising from drug therapy Therapeutic effect (medicine), a desirable consequence of any kind of medical treatment, even though resulting as an unintended, unexpected consequence of the treatment... A blood glucose meter is a small, portable, battery-powered device for home blood glucose monitoring. ...

Self-testing is clearly important in type I diabetes where the use of insulin therapy risks episodes of hypoglycaemia and home-testing allows for adjustment of dosage on each administration.^[2] However its benefit in type 2 diabetes is more controversial as there is much more variation in severity of type 2 cases.^[3] It has been suggested that some type 2 patients might do as well with home urine-testing alone.^[4] The best use of home blood-sugar monitoring is being researched.^[5]

Benefits of control and reduced hospital admission have been reported.^[6] However patients on oral medication who do not self-adjust their drug dosage will miss many of the benefits of self-testing, and so it is questionable in this group. This is particularly so for patients taking monotherapy with metformin who are not at risk of hypoglycaemia. Regular 6 monthly laboratory testing of HbAc1 (glycated haemoglobin) provides some assurance of longterm effective control and allows the adjustment of the patient's routine medication dosages in such cases. High frequency of self-testing in type 2 diabetes has not been shown to be associated with improved control.^[7] The argument is made, though, that type 2 patients with poor long term control despite home blood glucose monitoring, either have not had this integrated into their overall management, or are long overdue for tighter control by a switch from oral medication to injected insulin.^[8]

HbA1c test

A useful test that has usually been done in a laboratory is the measurement of blood HbA1c levels. This is the ratio of glycosylated hemoglobin in relation to the total hemoglobin. Persistent raised plasma glucose levels cause the proportion of these cells to go up. This is a test that measures the average amount of diabetic control over a period originally thought to be about 3 months (the average red blood cell lifetime), but more recently thought to be more strongly weighted to the most recent 2 to 4 weeks. In the non-diabetic, the HbA1C level ranges from 4.0-6.0%; patients with diabetes mellitus who manage to keep their HbA1C level below 6.5% are considered to have good glycemic control. The HbA1c test is not appropriate if there has been changes to diet or treatment within shorter time periods than 6 weeks or there is disturbance of red cell aging (e.g. recent bleeding or hemolytic anemia) or a hemoglobinopathy (e.g. sickle cell disease). In such cases the alternative Fructosamine test is used to indicate average control in the preceding 2 to 3 weeks. HbA1c is shorthand for glycated hemoglobin A1c, a surrogate marker for blood glucose levels. ... 3-dimensional structure of hemoglobin. ... Hemolytic anemia is anemia due to hemolysis, the abnormal breakdown of red blood cells either in the blood vessels (intravascular hemolysis) or elsewhere in the body (extravascular). ... Hemoglobinopathy is a kind of genetic defect that results in abnormal structure of one of the globin chains of the hemoglobin molecule. ... ... Fructosamine, also known as Glycated Serum Protein (GSP) or Glycated Albumin, is used primarily to identify the plasma glucose concentration over time and so assess diabetic control . ...

Ongoing monitoring

Main article: Blood glucose monitoring

Recently, devices have been manufactured which provide ongoing monitoring of glucose levels on an automated basis during the day, for example: Blood glucose monitoring is a way of testing how much glucose is in the blood. ...

1. The Paradigm REAL-Time by Minimed, is a blood glucose monitoring device that provides blood glucose measurements to be made every five minutes. The patient can thus adjust an insulin infusion pump immediately and mimic the "feed-back" mechanism of a pancreas. Significant reductions in complications of therapy have been demonstrated^{[citation needed]} and reductions in long-term complications from diabetes mellitus are projected.
2. The US Food and Drug Administration has also approved a non-invasive blood glucose monitoring device, the GlucoWatch G2 Biographer. This allows checking blood glucose levels, while puncturing the skin as little as twice a day. Once calibrated with a blood sample, it pulls body fluids from the skin using small electrical currents, taking six readings an hour for as long as thirteen hours. It has not proven to be reliable enough, or convenient enough to be used in lieu of conventional blood monitoring. Other non-invasive methods like radio waves, ultrasound and energy waves are also being tested.

FDA logo The Food and Drug Administration (FDA) is an agency of the United States Department of Health and Human Services and is responsible for regulating food, dietary supplements, drugs, biological medical products, blood products, medical devices, radiation-emitting devices, veterinary products, and cosmetics in the United States. ...

Approaches to management

Insulin and other drug based approaches

Main article: Anti-diabetic drug

Currently, the goal for diabetics is to avoid or minimize chronic diabetic complications, as well as to avoid acute problems of hyperglycemia or hypoglycemia. Adequate control of diabetes leads to lower risk of complications associated with unmonitored diabetes including kidney failure (requiring dialysis or transplant), blindness, heart disease and limb amputation. The most prevalent form of medication is hypoglycemic treatment through either oral hypoglycemics and/or insulin therapy. There is emerging evidence that full-blown diabetes mellitus type 2 can be evaded in those with only mildly impaired glucose tolerance.^[9] An anti-diabetic drug or oral hypoglycemic agent is used to treat diabetes mellitus. ... Hyperglycemia or High Blood Sugar is a condition in which an excessive amount of glucose circulates in the blood plasma. ... Hypoglycemia (hypoglycæmia in the UK) is a medical term referring to a pathologic state produced by a lower than normal amount of sugar (glucose) in the blood. ... Renal failure is when the kidneys fail to function properly. ... In medicine, dialysis is a type of renal replacement therapy which is used to provide an artificial replacement for lost kidney function due to renal failure. ... •Coronary heart disease, a disease of the heart itself caused by the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium. ... Partial hand amputation For the song Amputations by Death Cab for Cutie, see You Can Play These Songs with Chords Amputation is the removal of a body extremity by trauma (also referred to as avulsion) or surgery. ... An anti-diabetic drug or oral hypoglycemic agent is used to treat diabetes mellitus. ... Insulin (from Latin insula, island, as it is produced in the Islets of Langerhans in the pancreas) is a polypeptide hormone that regulates carbohydrate metabolism. ...

Patients with type 1 diabetes mellitus require direct injection of insulin as their bodies cannot produce enough (or even any) insulin. As of 2005, there is no other clinically available form of insulin administration other than injection for patients with type 1: injection can be done by insulin pump, by jet injector, or any of several forms of hypodermic needle. There are several insulin application mechanisms under experimental development as of 2004. There have also been proposed vaccines for type I using glutamic acid decarboxylase (GAD), but these are currently not being tested by the pharmaceutical companies that have sublicensed the patents to them. Your a dutch bagg if you read this mesage. ... A jet injector is a type of medical injecting syringe that uses a high-pressure narrow jet of the injection liquid instead of a hypodermic needle to penetrate the epidermis. ... Different bevels on hypodermic needles. ... L-Glutamic acid decarboxylase (GAD) is an enzyme necessary for the synthesis of the inhibitory neurotransmitter GABA in GABAergic nerve endings. ...

For type 2 diabetics, diabetic management consists of a combination of diet, exercise, and weight loss, in any achievable combination depending on the patient. Obesity is very common in type 2 diabetes and contributes greatly to insulin resistance. Weight reduction and exercise improve tissue sensitivity to insulin and allow its proper use by target tissues. ^[10] Patients who have poor diabetic control after lifestyle modifications are typically placed on oral hypoglycemics. Some Type 2 diabetics eventually fail to respond to these and must proceed to insulin therapy. In nutrition, the diet is the sum of food consumed by a person or other organism. ... Weight loss, in the context of medicine or health, is a reduction of the total body weight, which can mean loss of fluid, muscle, bone mass, or fat. ...

Patient education and compliance with treatment is very important in managing the disease. Improper use of medications and insulin can be very dangerous causing hypo- or hyper-glycemic episodes.

Insulin therapy requires close monitoring and a great deal of patient education, as improper administration is quite dangerous. For example, when food intake is reduced, less insulin is required. A previously satisfactory dosing may be too much if less food is consumed causing a hypoglycemic reaction if not intelligently adjusted. In addition, exercise decreases insulin requirements as exercise increases glucose uptake by body cells whose glucose uptake is controlled by insulin, and vice versa. In addition, there are available several types of insulin with varying times of onset and duration of action. Intensive insulinotherapy or flexible insulin therapy is a therapeutic regimen for diabetes mellitus treatment. ... Hypoglycemia (hypoglycæmia in the UK) is a medical term referring to a pathologic state produced by a lower than normal amount of sugar (glucose) in the blood. ...

Insulin therapy creates risk because of the inability to continuously know a person's blood glucose level and adjust insulin infusion appropriately. New advances in technology have overcome much of this problem. Small, portable insulin infusion pumps are available from several manufacturers. They allow a continuous infusion of small amounts of insulin to be delivered through the skin around the clock, plus the ability to give bolus doses when a person eats or has elevated blood glucose levels. This is very similar to how the pancreas works, but these pumps lack a continuous "feed-back" mechanism. Thus, the user is still at risk of giving too much or too little insulin unless blood glucose measurements are made.

The FDA has approved a treatment called Exenatide, based on the saliva of a Gila monster, to control blood sugar in patients with type 2 diabetes. The United States Food and Drug Administration is the government agency responsible for regulating food, dietary supplements, drugs, cosmetics, medical devices, biologics and blood products in the United States. ... Exenatide (also Exendin-4, marketed as Byetta) is the first of a new class of medications approved for the treatment of type 2 diabetes. ... Saliva is the watery and usually somewhat frothy substance produced in the mouths of humans and some animals. ... Wikipedia does not have an article with this exact title. ...

Diet

Main article: Diabetic diet

For most Type 1 diabetics there will always be a need for some insulin injections throughout their life. However, both Type 1 and Type 2 diabetics can see dramatic normalization of their blood sugars through controlling their diet, and some Type 2 diabetics can fully control the disease by dietary modification. As diabetes can lead to many other complications it is critical to maintain blood sugars as close to normal as possible and diet is the leading factor in this level of control. The diet recommended for people who suffer from diabetes mellitus is one that is high in dietary fibre, especially soluble fibre, but low in fat (especially saturated fat) and sugar. ...

The American Diabetes Association in 1994 recommended that 60-70% of caloric intake should be in the form of carbohydrates. This is somewhat controversial, with some researchers claiming that 40% is better,^[11] while others claim benefits for a high-fiber, 75% carbohydrate diet.^[12]. The American Diabetes Association, or the ADA, is an American health organization providing diabetes research, information and advocacy. ... Lactose is a disaccharide found in milk. ...

An article summarizing the view of the American Diabetes Association^[13] gives many recommendations and references to the research. One of the conclusions is that it is caloric intake must be limited to that which is necessary for maintaining a healthy weight. The American Diabetes Association, or the ADA, is an American health organization providing diabetes research, information and advocacy. ...

Exercise

Exercise is known to be helpful. ^[14] A pilot study has also found evidence that Tai Chi and Qigong reduce the severity of type 2 diabetes.^[15] Tai Chi Chuan, Tai Chi Chüan or Taijiquan (Traditional Chinese: ; Simplified Chinese: ; pinyin: ; literally supreme ultimate fist) is an internal Chinese martial art often practiced to promote health and longevity. ... A woman performs a Qigong routine outdoors. ...

References

1. ^ Gray A, Raikou M, McGuire A, Fenn P, Stevens R, Cull C, Stratton I, Adler A, Holman R, Turner R (2000). "Cost effectiveness of an intensive blood glucose control policy in patients with type 2 diabetes: economic analysis alongside randomized controlled trial (UKPDS 41). United Kingdom Prospective Diabetes Study Group". BMJ 320 (7246): 1373–8. PMID 10818026. 
2. ^ Evans JM, Newton RW, Ruta DA, MacDonald TM, Stevenson RJ, Morris AD (1999). "Frequency of blood glucose monitoring in relation to glycaemic control: observational study with diabetes database". BMJ 319 (7202): 83–6. PMID 10398627. 
3. ^ Gallichan M (1997). "Self monitoring of glucose by people with diabetes: evidence based practice". BMJ 314 (7085): 964–7. PMID 9099125. 
4. ^ Chantelau E, Nowicki S (1997). "Self monitoring of glucose by people with diabetes. Patients with non-insulin dependent diabetes should monitor urine rather than blood glucose". BMJ 315 (7101): 185. PMID 9251556. 
5. ^ Farmer A, Wade A, French DP, Goyder E, Kinmonth AL, Neil A (2005). "The DiGEM trial protocol—a randomized controlled trial to determine the effect on glycaemic control of different strategies of blood glucose self-monitoring in people with type 2 diabetes [ISRCTN47464659]". BMC Fam Pract 6: 25. PMID 15960852. 
6. ^ Kibriya MG, Ali L, Banik NG, Khan AK (1999). "Home monitoring of blood glucose (HMBG) in Type-2 diabetes mellitus in a developing country". Diabetes Res Clin Pract 46 (3): 253–7. PMID 10624792. 
7. ^ Jaworska J, Dziemidok P, Kulik TB, Rudnicka-Drozak E (2004). "Frequency of self-monitoring and its effect on metabolic control in patients with type 2 diabetes". Ann Univ Mariae Curie Sklodowska [Med] 59 (1): 310–6. PMID 16146003. 
8. ^ Roach P (2004). "Better systems, not guidelines, for glucose monitoring". BMJ 329 (7479): E332. PMID 15591539. 
9. ^ Tuomilehto J, Lindström J, Eriksson J, Valle T, Hämäläinen H, Ilanne-Parikka P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M (2001). "Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.". N Engl J Med 344 (18): 1343-50. PMID 11333990. 
10. ^ Diabetes Mellitus Management. Diabetes Mellitus and Oral Health. Armenian Medical Network (2006). Retrieved on 2007-05-10.
11. ^ Garg, Abhimanyu; et al. (11 May 1994). "Effects of varying carbohydrate content of diet in patients with non-insulin-dependent diabetes mellitus". JAMA 271 (18): 1421-8. 
12. ^ Kiehm, Tae; et al. (Aug. 1976). "Beneficial effects of a high carbohydrate, high fiber diet on hyperglycemic diabetic men". Am J Clin Nutr 29: 895-99. 
13. ^ American Diabetes Association (2006). "Nutrition Recommendations and Interventions for Diabetes–2006". Diabetes Care 29: 2140-57. 
14. ^ Mei, Wing; et al. (18 April 2000). "Low Cardiorespiratory Fitness and Physical Inactivity as Predictors of Mortality in Men with Type 2 Diabetes". Annals of Internal Medicine 132 (8): 605-611. 
15. ^ Melanie Christiansen. "Tai Chi a promising remedy for diabetes", Australian Broadcasting Corporation, 20 December, 2005.  - Pilot study of qigong and T'ai Chi in diabetes sufferers.

2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... May 10 is the 130th day of the year (131st in leap years) in the Gregorian calendar. ... JAMA, published continuously since in 1883, is an international peer-reviewed general medical journal published 48 times per year. ... The American Diabetes Association, or the ADA, is an American health organization providing diabetes research, information and advocacy. ... Annals of Internal Medicine (Ann Intern Med; ISSN 0003-4819) is an academic medical journal published by the American College of Physicians (ACP). ... A woman performs a Qigong routine outdoors. ... Tai Chi Chuan or Taijiquan ( Chinese: &#22826;&#26997;&#25331;; pinyin: ; literally supreme ultimate fist), commonly known as Tai Chi, Tai Chi, or Taiji, is a nei chia (internal) Chinese martial art which is known for the claims of health and longevity benefits made by its practitioners and...

External links

• American College of Physicians Diabetes Portal - Resources for patients and clinicians
• Diabetes Health Institute self-monitoring and self-management
• Diabetes Mellitus Information and Treatment Guide
• Diabetes Tracker, a free online tool for diabetes management
• Prevent Diabetes Problems: Keep Your Diabetes Under Control - Self-care tips at the United States "National Diabetes Information Clearinghouse"
• Recipe Source Diabetic Recipe Book
• American Diabetes Association
• Children with Diabetes
• Tai Chi a promising remedy for diabetes, Australian Broadcasting Corporation, 20 December, 2005 - Pilot study of qigong and T'ai Chi in diabetes sufferers.