NationMaster - Encyclopedia: Diabetes mellitus

Diabetes mellitus (IPA: /ˌdaɪəˈbiːtiːz/ or /ˌdaɪəˈbiːtəs/, /məˈlaɪtəs/ or /ˈmɛlətəs/), often referred to simply as diabetes (Greek: διαβήτης), is a syndrome characterized by disordered metabolism and abnormally high blood sugar (hyperglycaemia) resulting from insufficient levels of the hormone insulin.^[2] The characteristic symptoms are excessive urine production (polyuria) due to high blood glucose levels, excessive thirst and increased fluid intake (polydipsia) attempting to compensate for increased urination, blurred vision due to high blood glucose effects on the eye's optics, unexplained weight loss, and lethargy. These symptoms are likely to be less apparent if the blood sugar is only mildly elevated. Diabetes insipidus (DI) is a disease characterized by excretion of large amounts of severely diluted urine, which cannot be reduced when fluid intake is reduced. ... Diabetes mellitus strikes 1 in 400 cats and a similar number of dogs, though recent veterinary studies[1] note that it is becoming more common lately. ... Image File history File links Blue_circle_for_diabetes. ... UN redirects here. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // E00-E35 - Endocrine diseases (E00-E07) Disorders of thyroid gland (E00) Congenital iodine-deficiency syndrome (E01) Iodine-deficiency-related thyroid disorders and allied conditions (E02) Subclinical iodine-deficiency hypothyroidism (E03) Other hypothyroidism (E030) Congenital hypothyroidism with diffuse goitre (E031) Congenital hypothyroidism without goitre (E032) Hypothyroidism due to medicaments and other... // E00-E35 - Endocrine diseases (E00-E07) Disorders of thyroid gland (E00) Congenital iodine-deficiency syndrome (E01) Iodine-deficiency-related thyroid disorders and allied conditions (E02) Subclinical iodine-deficiency hypothyroidism (E03) Other hypothyroidism (E030) Congenital hypothyroidism with diffuse goitre (E031) Congenital hypothyroidism without goitre (E032) Hypothyroidism due to medicaments and other... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... In medicine, the term syndrome is the association of several clinically recognizable features, signs, symptoms, phenomena or characteristics which often occur together, so that the presence of one feature alerts the physician to the presence of the others. ... Structure of the coenzyme adenosine triphosphate, a central intermediate in energy metabolism. ... In medicine, blood sugar is a term used to refer to levels of glucose in the blood. ... Hyperglycemia or High Blood Sugar is a condition in which an excessive amount of glucose circulates in the blood plasma. ... For other uses, see Hormone (disambiguation). ... Not to be confused with inulin. ... Polyuria is the passage of a large volume of urine in a given period. ... Polydipsia is a medical condition in which the patient ingests abnormally large amounts of fluids by mouth. ... Fatigue is a feeling of excessive tiredness or lethargy, with a desire to rest, perhaps to sleep. ...

The World Health Organization recognizes three main forms of diabetes mellitus: type 1, type 2, and gestational diabetes (occurring during pregnancy),^[3] which have different causes and population distributions. While, ultimately, all forms are due to the beta cells of the pancreas being unable to produce sufficient insulin to prevent hyperglycemia, the causes are different.^[4] Type 1 diabetes is usually due to autoimmune destruction of the pancreatic beta cells. Type 2 diabetes is characterized by insulin resistance in target tissues. This causes a need for abnormally high amounts of insulin and diabetes develops when the beta cells cannot meet this demand. Gestational diabetes is similar to type 2 diabetes in that it involves insulin resistance; the hormones of pregnancy can cause insulin resistance in women genetically predisposed to developing this condition. WHO redirects here. ... Diabetes mellitus type 1 (Type 1 diabetes, Type I diabetes, T1D, T1DM, IDDM, juvenile diabetes) is a form of diabetes mellitus. ... Diabetes mellitus type 2 or Type 2 Diabetes (formerly called non-insulin-dependent diabetes (NIDDM), obesity-related diabetes, or adult-onset diabetes) is a metabolic disorder that is primarily characterized by insulin resistance, relative insulin deficiency, and hyperglycemia. ... Gestational diabetes is a form of diabetes found in pregnant women. ... This article is about pregnancy in female humans. ... Beta cells are a type of cell in the pancreas in areas called the islets of Langerhans. ... The pancreas is a gland organ in the digestive and endocrine systems of vertebrates. ... Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. ... Insulin resistance is the condition in which normal amounts of insulin are inadequate to produce a normal insulin response from fat, muscle and liver cells. ... This article is about pregnancy in female humans. ...

Gestational diabetes typically resolves with delivery of the child, however types 1 and 2 diabetes are chronic conditions.^[2] All types have been treatable since insulin became medically available in 1921. Type 1 diabetes, in which insulin is not secreted by the pancreas, is directly treatable only with injected insulin, although dietary and other lifestyle adjustments are part of management. Type 2 may be managed with a combination of dietary treatment, tablets and injections and, frequently, insulin supplementation. While insulin was originally produced from natural sources such as porcine pancreas, most insulin used today is produced through genetic engineering, either as a direct copy of human insulin, or human insulin with modified molecules that provide different onset and duration of action. Insulin can also be delivered continuously by a specialized pump which subcutaneously provides insulin through a changeable catheter. Medicine In medicine, a persistent and lasting condition is said to be chronic (from Greek chronos). ... Not to be confused with inulin. ... In nutrition, the diet is the sum of food consumed by a person or other organism. ... An anti-diabetic drug or oral hypoglycemic agent is used to treat diabetes mellitus. ... Insulin pump attached to its user with an infusion set. ...

Diabetes can cause many complications. Acute complications (hypoglycemia, ketoacidosis, or nonketotic hyperosmolar coma) may occur if the disease is not adequately controlled. Serious long-term complications include cardiovascular disease (doubled risk), chronic renal failure, retinal damage (which can lead to blindness), nerve damage (of several kinds), and microvascular damage, which may cause impotence and poor healing. Poor healing of wounds, particularly of the feet, can lead to gangrene, which may require amputation. Adequate treatment of diabetes, as well as increased emphasis on blood pressure control and lifestyle factors (such as not smoking and keeping a healthy body weight), may improve the risk profile of most aforementioned complications. In the developed world, diabetes is the most significant cause of adult blindness in the non-elderly and the leading cause of non-traumatic amputation in adults, and diabetic nephropathy is the main illness requiring renal dialysis in the United States.^[5] In medicine, an acute disease is a disease with either or both of: a rapid onset; a short course (as opposed to a chronic course). ... Hypoglycemia (hypoglycaemia in British English) is a medical term referring to a pathologic state produced by a lower than normal level of glucose (sugar) in the blood. ... It has been suggested that this article or section be merged with Diabetic ketoacidosis. ... Nonketotic hyperosmolar coma is a type of diabetic coma associated with a high mortality seen in diabetes mellitus type 2. ... Cardiovascular disease refers to the class of diseases that involve the heart or blood vessels (arteries and veins). ... Chronic renal failure (CRF, or chronic kidney failure, CKF, or chronic kidney disease, CKD) is a slowly progressive loss of renal function over a period of months or years and defined as an abnormally low glomerular filtration rate, which is usually determined indirectly by the creatinine level in blood serum. ... Diabetic retinopathy is retinopathy (damage to the retina) caused by complications of diabetes mellitus, which could eventually lead to blindness. ... This article is about the visual condition. ... Diabetic neuropathies are neuropathic disorders that are associated with diabetes mellitus. ... Erectile dysfunction (ED) or impotence is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis. ... Gangrene is a complication of necrosis (i. ... Partial hand amputation Amputation is the removal of a body extremity by trauma or surgery. ... A sphygmomanometer, a device used for measuring arterial pressure. ... The cigarette is the most common method of smoking tobacco. ... Weight, in the context of human body weight measurements in the medical sciences and in sports is a measurement of mass, and is thus expressed in units of mass, such as kilograms (kg), or units of force such as pounds (lb). ... Diabetic nephropathy (nephropatia diabetica), also known as Kimmelstiel-Wilson syndrome and intercapillary glomerulonephritis, is a progressive kidney disease caused by angiopathy of capillaries in the kidney glomeruli. ... This article is about clinical dialysis; for the laboratory technique, see Dialysis (biochemistry) In medicine, dialysis is a method for removing waste such as urea from the blood when the kidneys are incapable of this, i. ...

In medicine, blood sugar is a term used to refer to levels of glucose in the blood. ... 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. ...

Classification

The term diabetes, without qualification, usually refers to diabetes mellitus, which is associated with excessive sweet urine (known as "glycosuria") but there are several rarer conditions also named diabetes. The most common of these is diabetes insipidus in which the urine is not sweet (insipidus meaning "without taste" in Latin); it can be caused by either kidney (nephrogenic DI) or pituitary gland (central DI) damage. Diabetes insipidus (DI) is a disease characterized by excretion of large amounts of severely diluted urine, which cannot be reduced when fluid intake is reduced. ... Major function-filter blood. ... | Latin = hypophysis, glandula pituitaria | GraySubject = 275 | GrayPage = 1275 | Image = Gray1180. ...

The principal two idiopathic forms of diabetes mellitus are known as types 1 and 2. The term "type 1 diabetes" has universally replaced several former terms, including childhood-onset diabetes, juvenile diabetes, and insulin-dependent diabetes (IDDM). Likewise, the term "type 2 diabetes" has replaced several former terms, including adult-onset diabetes, obesity-related diabetes, and non-insulin-dependent diabetes (NIDDM). Beyond these two types, there is no agreed-upon standard nomenclature. Various sources have defined "type 3 diabetes" as, among others, gestational diabetes,^[6] insulin-resistant type 1 diabetes (or "double diabetes"), type 2 diabetes which has progressed to require injected insulin, and latent autoimmune diabetes of adults (or LADA or "type 1.5" diabetes.^[7]) There is also maturity onset diabetes of the young (MODY) which is a group of several single gene disorders with strong family histories that present as type 2 diabetes before 30 years of age. Gestational diabetes is a form of diabetes found in pregnant women. ... Latent autoimmune diabetes in adults (LADA) is a genetically-linked, hereditary autoimmune disorder that results in the body mistaking the pancreas as foreign and responding by attacking and destroying the insulin-producing beta islet cells of the pancreas. ... Type 1. ... Maturity onset diabetes of the young (MODY) refers to any of several rare hereditary forms of diabetes mellitus due to dominantly inherited defects of insulin secretion. ...

Type 1 diabetes mellitus

Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets of Langerhans in the pancreas, leading to a deficiency of insulin. The main cause of this beta cell loss is a T-cell mediated autoimmune attack.^[4] There is no known preventive measure which can be taken against type 1 diabetes; it is about 10% of diabetes mellitus cases in North America and Europe (though this varies by geographical location), and is a higher percentage in some other areas. Most affected people are otherwise healthy and of a healthy weight when onset occurs. Sensitivity and responsiveness to insulin are usually normal, especially in the early stages. Type 1 diabetes can affect children or adults but was traditionally termed "juvenile diabetes" because it represents a majority of the diabetes cases in children. Diabetes mellitus type 1 (Type 1 diabetes, Type I diabetes, T1D, T1DM, IDDM, juvenile diabetes) is a form of diabetes mellitus. ... See diabetes mellitus for further general information on diabetes. ... Beta cells are a type of cell in the pancreas in areas called the islets of Langerhans. ... A porcine islet of Langerhans. ... T cells belong to a group of white blood cells known as lymphocytes and play a central role in cell-mediated immunity. ... Autoimmunity is the failure of an organism to recognize its own constituent parts (down to the sub-molecular levels) as self, which results in an immune response against its own cells and tissues. ...

The principal treatment of type 1 diabetes, even from its earliest stages, is replacement of insulin combined with careful monitoring of blood glucose levels using blood testing monitors. Without insulin, diabetic ketoacidosis often develops which may result in coma or death. Treatment emphasis is now also placed on lifestyle adjustments (diet and exercise) though these cannot reverse the progress of the disease. Apart from the common subcutaneous injections, it is also possible to deliver insulin by a pump, which allows continuous infusion of insulin 24 hours a day at preset levels, and the ability to program doses (a bolus) of insulin as needed at meal times. An inhaled form of insulin, Exubera, was approved by the FDA in January 2006, although Pfizer discontinued the product for business reasons in October 2007. ^[8] Diabetic ketoacidosis(DKA) is a life-threatening complication in patients with untreated diabetes mellitus (chronic high blood sugar or hyperglycemia). ... The subcutis is the layer of tissue directly underlying the cutis. ... Insulin pump attached to its user with an infusion set. ... In medicine, a bolus (from Latin bolus, ball) is the administration of a medication, drug or other compound that is given to raise blood concentration to an effective level. ... Exubera is the first inhalable insulin to receive US FDA approval. ...

Type 1 treatment must be continued indefinitely in essentially all cases. Treatment need not significantly impair normal activities, if sufficient patient training, awareness, appropriate care, discipline in testing and dosing of insulin is taken. However, treatment is burdensome for patients, insulin is replaced in a non-physiological manner, and this approach is therefore far from ideal. The average glucose level for the type 1 patient should be as close to normal (80–120 mg/dl, 4–6 mmol/l) as is safely possible. Some physicians suggest up to 140–150 mg/dl (7-7.5 mmol/l) for those having trouble with lower values, such as frequent hypoglycemic events. Values above 200 mg/dl (10 mmol/l) is sometimes accompanied by discomfort and frequent urination leading to dehydration. Values above 300 mg/dl (15 mmol/l) usually require medical treatment and may lead to ketoacidosis, although they are not immediately life-threatening. However, low levels of blood glucose, called hypoglycemia, may lead to seizures or episodes of unconsciousness and absolutely must be treated immediately. Dehydration (hypohydration) is the removal of water (hydro in ancient Greek) from an object. ... It has been suggested that this article or section be merged with Diabetic ketoacidosis. ... Hypoglycemia (hypoglycaemia in British English) is a medical term referring to a pathologic state produced by a lower than normal level of glucose (sugar) in the blood. ...

Type 2 diabetes mellitus

Type 2 diabetes mellitus is characterized differently due to insulin resistance or reduced insulin sensitivity, combined with reduced insulin secretion. The defective responsiveness of body tissues to insulin almost certainly involves the insulin receptor in cell membranes. In the early stage the predominant abnormality is reduced insulin sensitivity, characterized by elevated levels of insulin in the blood. At this stage hyperglycemia can be reversed by a variety of measures and medications that improve insulin sensitivity or reduce glucose production by the liver. As the disease progresses the impairment of insulin secretion worsens, and therapeutic replacement of insulin often becomes necessary. Diabetes mellitus type 2 or Type 2 Diabetes (formerly called non-insulin-dependent diabetes (NIDDM), obesity-related diabetes, or adult-onset diabetes) is a metabolic disorder that is primarily characterized by insulin resistance, relative insulin deficiency, and hyperglycemia. ... In molecular biology, the insulin receptor is a transmembrane receptor that is activated by insulin. ... An anti-diabetic drug or oral hypoglycemic agent is used to treat diabetes mellitus. ... The liver is the largest internal organ in the human body, and is an organ present in vertebrates and some other animals. ...

There are numerous theories as to the exact cause and mechanism in type 2 diabetes. Central obesity (fat concentrated around the waist in relation to abdominal organs, but not subcutaneous fat) is known to predispose individuals for insulin resistance. Abdominal fat is especially active hormonally, secreting a group of hormones called adipokines that may possibly impair glucose tolerance. Obesity is found in approximately 55% of patients diagnosed with type 2 diabetes.^[9] Other factors include aging (about 20% of elderly patients in North America have diabetes) and family history (type 2 is much more common in those with close relatives who have had it). In the last decade, type 2 diabetes has increasingly begun to affect children and adolescents, likely in connection with the increased prevalence of childhood obesity seen in recent decades in some places.^[10] Central obesity (or apple-shaped or masculine obesity) occurs when the main deposits of body fat are localised around the abdomen and the upper body. ... The adipokines or adipocytokines are a group of cytokines (cell-to-cell signalling proteins) secreted by adipose tissue. ...

Type 2 diabetes may go unnoticed for years because visible symptoms are typically mild, non-existent or sporadic, and usually there are no ketoacidotic episodes. However, severe long-term complications can result from unnoticed type 2 diabetes, including renal failure due to diabetic nephropathy, vascular disease (including coronary artery disease), vision damage due to diabetic retinopathy, loss of sensation or pain due to diabetic neuropathy, and liver damage from non-alcoholic steatohepatitis. Diabetic ketoacidosis(DKA) is a life-threatening complication in patients with untreated diabetes mellitus (chronic high blood sugar or hyperglycemia). ... Renal failure or kidney failure is a situation in which the kidneys fail to function adequately. ... Diabetic nephropathy (nephropatia diabetica), also known as Kimmelstiel-Wilson syndrome and intercapillary glomerulonephritis, is a progressive kidney disease caused by angiopathy of capillaries in the kidney glomeruli. ... Coronary heart disease (CHD), also called coronary artery disease (CAD) and atherosclerotic heart disease, is the end result of the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium (the muscle of the heart). ... Diabetic retinopathy is retinopathy (damage to the retina) caused by complications of diabetes mellitus, which could eventually lead to blindness. ... Diabetic neuropathies are neuropathic disorders that are associated with diabetes mellitus. ... As its name signifies, Non-alcoholic steatohepatitis (NASH) or Nonalcoholic Fatty Liver Disease (NAFLD) is fatty inflammation of the liver when this is not due to excessive alcohol use. ...

Type 2 diabetes is usually first treated by increasing physical activity, decreasing carbohydrate intake, and losing weight. These can restore insulin sensitivity even when the weight loss is modest, for example around 5 kg (10 to 15 lb), most especially when it is in abdominal fat deposits. It is sometimes possible to achieve long-term, satisfactory glucose control with these measures alone. However, the underlying tendency to insulin resistance is not lost, and so attention to diet, exercise, and weight loss must continue. The usual next step, if necessary, is treatment with oral antidiabetic drugs. Insulin production is initially only moderately impaired in type 2 diabetes, so oral medication (often used in various combinations) can be used to improve insulin production (e.g., sulfonylureas), to regulate inappropriate release of glucose by the liver and attenuate insulin resistance to some extent (e.g., metformin), and to substantially attenuate insulin resistance (e.g., thiazolidinediones). According to one study, overweight patients treated with metformin compared with diet alone, had relative risk reductions of 32% for any diabetes endpoint, 42% for diabetes related death and 36% for all cause mortality and stroke.^[11] Oral medication may eventually fail due to further impairment of beta cell insulin secretion. At this point, insulin therapy is necessary to maintain normal or near normal glucose levels. Lactose is a disaccharide found in milk. ... Weight loss, in the context of medicine or health or physical fitness, is a reduction of the total body weight, 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. ... An anti-diabetic drug is used to treat diabetes mellitus. ... Sulfonylurea derivatives are a class of antidiabetic drugs that are used in the management of diabetes mellitus type 2 (adult-onset). They act by increasing insulin release from the beta cells in the pancreas. ... Metformin (INN; trade names Glucophage, Diabex, Diaformin, Fortamet, Riomet, Glumetza and others) is an anti-diabetic drug from the biguanide class of oral hypoglycemic agents. ... The medication class of thiazolidinedione was introduced in the late 1990s as an adjunctive therapy for diabetes mellitus (type II) and related diseases. ... The relative risk reduction is a measure used in epidemiology. ...

Gestational diabetes

Gestational diabetes mellitus (GDM) resembles type 2 diabetes in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 2%–5% of all pregnancies and may improve or disappear after delivery. Gestational diabetes is fully treatable but requires careful medical supervision throughout the pregnancy. About 20%–50% of affected women develop type 2 diabetes later in life. Gestational diabetes is a form of diabetes found in pregnant women. ... This article is about pregnancy in female humans. ...

Even though it may be transient, untreated gestational diabetes can damage the health of the fetus or mother. Risks to the baby include macrosomia (high birth weight), congenital cardiac and central nervous system anomalies, and skeletal muscle malformations. Increased fetal insulin may inhibit fetal surfactant production and cause respiratory distress syndrome. Hyperbilirubinemia may result from red blood cell destruction. In severe cases, perinatal death may occur, most commonly as a result of poor placental profusion due to vascular impairment. Induction may be indicated with decreased placental function. A cesarean section may be performed if there is marked fetal distress or an increased risk of injury associated with macrosomia, such as shoulder dystocia. Macrosomia, sometimes also called big baby syndrome, is a potential complication during childbirth and the latter stages of pregnancy. ... Surfactants, also known as tensides, are wetting agents that lower the surface tension of a liquid, allowing easier spreading, and lower the interfacial tension between two liquids. ... Infant respiratory distress syndrome (RDS, also called Respiratory distress syndrome of newborn, previously called hyaline membrane disease), is a syndrome caused by developmental lack of surfactant and structural immaturity in the lungs of premature infants. ... Jaundice, technically known as icterus, is yellowing of the skin, sclera (eyes) and mucous membranes caused by increased levels of bilirubin in the system. ... Induction is a way of artificially bringing on labour in a woman. ... A caesarean section (AE cesarean section), or c-section, is a form of childbirth in which a surgical incision is made through a mothers abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies. ... Dystocia (antonym eutocia) is an abnormal or difficult childbirth or labour. ...

A 2008 study completed in the U.S. found that more American women are entering pregnancy with preexisting diabetes. In fact the rate of diabetes in expectant mothers has more than doubled in the past 6 years. ^[12] This is particularly problematic as diabetes raises the risk of complications during pregnancy, as well as increasing the potential that the children of diabetic mothers will also become diabetic in the future.

Other types

There are several rare causes of diabetes mellitus that do not fit into type 1, type 2, or gestational diabetes; attempts to classify them remain controversial. Some cases of diabetes are caused by the body's tissue receptors not responding to insulin (even when insulin levels are normal, which is what separates it from type 2 diabetes); this form is very uncommon. Genetic mutations (autosomal or mitochondrial) can lead to defects in beta cell function. Abnormal insulin action may also have been genetically determined in some cases. Any disease that causes extensive damage to the pancreas may lead to diabetes (for example, chronic pancreatitis and cystic fibrosis). Diseases associated with excessive secretion of insulin-antagonistic hormones can cause diabetes (which is typically resolved once the hormone excess is removed). Many drugs impair insulin secretion and some toxins damage pancreatic beta cells. The ICD-10 (1992) diagnostic entity, malnutrition-related diabetes mellitus (MRDM or MMDM, ICD-10 code E12), was deprecated by the World Health Organization when the current taxonomy was introduced in 1999.^[3] It has been suggested that this article or section be merged into Dominance relationship. ... ... Chronic pancreatitis can present as episodes of acute inflammation in a previously injured pancreas, or as chronic damage with persistent pain or malabsorption. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... WHO redirects here. ...

Signs and symptoms

The classical triad of diabetes symptoms is polyuria, polydipsia and polyphagia, which are, respectively, frequent urination; increased thirst and consequent increased fluid intake; and increased appetite. Symptoms may develop quite rapidly (weeks or months) in type 1 diabetes, particularly in children. However, in type 2 diabetes the symptoms develop much more slowly and may be subtle or completely absent. Type 1 diabetes may also cause a rapid yet significant weight loss (despite normal or even increased eating) and irreducible fatigue. All of these symptoms except weight loss can also manifest in type 2 diabetes in patients whose diabetes is poorly controlled. Polyuria is the passage of a large volume of urine in a given period. ... Polydipsia is a medical condition in which the patient ingests abnormally large amounts of fluids by mouth. ... Phagy or phagia is an ecological term that is used to identify particular nutritional systems. ...

When the glucose concentration in the blood is raised beyond the renal threshold, reabsorption of glucose in the proximal renal tubuli is incomplete, and part of the glucose remains in the urine (glycosuria). This increases the osmotic pressure of the urine and inhibits the reabsorption of water by the kidney, resulting in increased urine production (polyuria) and increased fluid loss. Lost blood volume will be replaced osmotically from water held in body cells, causing dehydration and increased thirst. In physiology, the renal threshold is that concentration of a blood substance above which the kidneys begin to pass it through into the urine. ... In physiology, reabsorption or tubular reabsorption is the flow of glomerular filtrate from the proximal tubule of the nephron into the peritubular capillaries. ... In the biology of the kidney, the proximal convoluted tubule is the segment of the renal tubule that drains Bowmans capsule. ... This article is about the urine of animals generally. ... This article or section does not adequately cite its references or sources. ... Polyuria is the passage of a large volume of urine in a given period. ... Dehydration (hypohydration) is the removal of water (hydro in ancient Greek) from an object. ...

Prolonged high blood glucose causes glucose absorption, which leads to changes in the shape of the lenses of the eyes, resulting in vision changes. Blurred vision is a common complaint leading to a diabetes diagnosis; type 1 should always be suspected in cases of rapid vision change whereas type 2 is generally more gradual, but should still be suspected.

Patients (usually with type 1 diabetes) may also present with diabetic ketoacidosis (DKA), an extreme state of metabolic dysregulation characterized by the smell of acetone on the patient's breath; a rapid, deep breathing known as Kussmaul breathing; polyuria; nausea; vomiting and abdominal pain; and any of many altered states of consciousness or arousal (such as hostility and mania or, equally, confusion and lethargy). In severe DKA, coma may follow, progressing to death. Diabetic ketoacidosis is a medical emergency and requires hospital admission. For other uses, see Acetone (disambiguation). ... Kussmaul breathing is the rapid, deep, and labored breathing of people who have acidosis. ... Polyuria is the passage of a large volume of urine in a given period. ... Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. ... For other uses, see Coma (disambiguation). ...

A rarer but equally severe possibility is hyperosmolar nonketotic state, which is more common in type 2 diabetes and is mainly the result of dehydration due to loss of body water. Often, the patient has been drinking extreme amounts of sugar-containing drinks, leading to a vicious circle in regard to the water loss. Nonketotic hyperosmolar coma is a type of diabetic coma associated with a high mortality seen in diabetes mellitus type 2. ... Positive feedback is a mechanism by which an output is enhanced. ...

Genetics

Both type 1 and type 2 diabetes are at least partly inherited. Type 1 diabetes appears to be triggered by some (mainly viral) infections, or in a less common group, by stress or environmental exposure (such as exposure to certain chemicals or drugs). There is a genetic element in individual susceptibility to some of these triggers which has been traced to particular HLA genotypes (i.e., the genetic "self" identifiers relied upon by the immune system). However, even in those who have inherited the susceptibility, type 1 diabetes mellitus seems to require an environmental trigger. A small proportion of people with type 1 diabetes carry a mutated gene that causes maturity onset diabetes of the young (MODY). HLA region of Chromosome 6 The human leukocyte antigen system (HLA) is the name of the human major histocompatibility complex (MHC). ... This article does not cite any references or sources. ... For linguistic mutation, see Apophony. ... Maturity onset diabetes of the young (MODY) refers to any of several rare hereditary forms of diabetes mellitus due to dominantly inherited defects of insulin secretion. ...

There is a stronger inheritance pattern for type 2 diabetes. Those with first-degree relatives with type 2 have a much higher risk of developing type 2, increasing with the number of those relatives. Concordance among monozygotic twins is close to 100%, and about 25% of those with the disease have a family history of diabetes. Candidate genes include KCNJ11 (potassium inwardly rectifying channel, subfamily J, member 11), which encodes the islet ATP-sensitive potassium channel Kir6.2, and TCF7L2 (transcription factor 7–like 2), which regulates proglucagon gene expression and thus the production of glucagon-like peptide-1.^[4] Moreover, obesity (which is an independent risk factor for type 2 diabetes) is strongly inherited.^[13] Concordance as used in genetics means the presence of the same trait in both members of a pair of twins, or in sets of individuals. ... For other uses, see Twin (disambiguation). ... Inwardly rectifing potassium channels (Kir or IRK) are potassium selective ion channels. ... Proglucagon is a precursor of glucagon, and several other components. ... GLP-1 and DPP-4 inhibitors Glucagon-like peptide-1 (GLP-1) is derived from the transcription product of the proglucagon gene. ...

Various hereditary conditions may feature diabetes, for example myotonic dystrophy and Friedreich's ataxia. Wolfram's syndrome is an autosomal recessive neurodegenerative disorder that first becomes evident in childhood. It consists of diabetes insipidus, diabetes mellitus, optic atrophy, and deafness, hence the acronym DIDMOAD.^[14] Myotonic dystrophy (DM) is a chronic, slowly progressing, highly variable inherited multisystemic disease that can manifest at any age from birth to old age. ... Friedreichs ataxia is a rare autosomal recessive disorder caused by a mutation in Gene X25 that codes for frataxin, located on chromosome 9. ... Wolfram syndrome, also called DIDMOAD (Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy, and Deafness), is a rare genetic disorder, causing diabetes mellitus, optic atrophy, and deafness. ... In genetics, the term recessive gene refers to an allele that causes a phenotype (visible or detectable characteristic) that is only seen in a homozygous genotype (an organism that has two copies of the same allele). ... Neurodegenerative disease is a condition which affects the brain function. ...

Pathophysiology

Insulin is the principal hormone that regulates uptake of glucose from the blood into most cells (primarily muscle and fat cells, but not central nervous system cells). Therefore deficiency of insulin or the insensitivity of its receptors plays a central role in all forms of diabetes mellitus. Image File history File links Size of this preview: 800 Ã— 517 pixel Image in higher resolution (903 Ã— 584 pixel, file size: 87 KB, MIME type: image/png) Mechanism of glucose dependent insulin release CORRECTION: I think that the potassium channel allows potassium out of rather than into the cell as... Image File history File links Size of this preview: 800 Ã— 517 pixel Image in higher resolution (903 Ã— 584 pixel, file size: 87 KB, MIME type: image/png) Mechanism of glucose dependent insulin release CORRECTION: I think that the potassium channel allows potassium out of rather than into the cell as... Glucose (Glc), a monosaccharide (or simple sugar), is an important carbohydrate in biology. ... In biochemistry, a receptor is a protein on the cell membrane or within the cytoplasm or cell nucleus that binds to a specific molecule (a ligand), such as a neurotransmitter, hormone, or other substance, and initiates the cellular response to the ligand. ...

Much of the carbohydrate in food is converted within a few hours to the monosaccharide glucose, the principal carbohydrate found in blood and used by the body as fuel. Insulin is released into the blood by beta cells (β-cells), found in the Islets of Langerhans in the pancreas, in response to rising levels of blood glucose after eating. Insulin is used by about two-thirds of the body's cells to absorb glucose from the blood for use as fuel, for conversion to other needed molecules, or for storage. Insulin is also the principal control signal for conversion of glucose to glycogen for internal storage in liver and muscle cells. Lowered glucose levels result both in the reduced release of insulin from the beta cells and in the reverse conversion of glycogen to glucose when glucose levels fall. This is mainly controlled by the hormone glucagon which acts in an opposite manner to insulin. Glucose thus recovered by the liver re-enters the bloodstream; muscle cells lack the necessary export mechanism. Monosaccharides are the simplest form of carbohydrates. ... Glycogen Structure Segment Glycogen is a polysaccharide of glucose (Glc) which functions as the primary short term energy storage in animal cells. ... Glucagon ball and stick model A microscopic image stained for glucagon. ...

Higher insulin levels increase some anabolic ("building up") processes such as cell growth and duplication, protein synthesis, and fat storage. Insulin (or its lack) is the principal signal in converting many of the bidirectional processes of metabolism from a catabolic to an anabolic direction, and vice versa. In particular, a low insulin level is the trigger for entering or leaving ketosis (the fat burning metabolic phase). Anabolism is the metabolic process that builds larger molecules from smaller ones. ... Protein biosynthesis (synthesis) is the process in which cells build proteins. ... Some common lipids. ... Anabolism is the aspect of metabolism that contributes to growth. ...

If the amount of insulin available is insufficient, if cells respond poorly to the effects of insulin (insulin insensitivity or resistance), or if the insulin itself is defective, then glucose will not be absorbed properly by those body cells that require it nor will it be stored appropriately in the liver and muscles. The net effect is persistent high levels of blood glucose, poor protein synthesis, and other metabolic derangements, such as acidosis. Insulin resistance is the condition in which normal amounts of insulin are inadequate to produce a normal insulin response from fat, muscle and liver cells. ... For acidosis referring to acidity of the urine, see renal tubular acidosis. ...

Diagnosis

The diagnosis of type 1 diabetes, and many cases of type 2, is usually prompted by recent-onset symptoms of excessive urination (polyuria) and excessive thirst (polydipsia), often accompanied by weight loss. These symptoms typically worsen over days to weeks; about a quarter of people with new type 1 diabetes have developed some degree of diabetic ketoacidosis by the time the diabetes is recognized. The diagnosis of other types of diabetes is usually made in other ways. These include ordinary health screening; detection of hyperglycemia during other medical investigations; and secondary symptoms such as vision changes or unexplainable fatigue. Diabetes is often detected when a person suffers a problem that is frequently caused by diabetes, such as a heart attack, stroke, neuropathy, poor wound healing or a foot ulcer, certain eye problems, certain fungal infections, or delivering a baby with macrosomia or hypoglycemia. Polyuria is the passage of a large volume of urine in a given period. ... Heart attack redirects here. ... For other uses, see Stroke (disambiguation). ... Neuropathy is usually short for peripheral neuropathy. ... toes infection brown with white markings ... Hypoglycemia (hypoglycaemia in British English) is a medical term referring to a pathologic state produced by a lower than normal level of glucose (sugar) in the blood. ...

Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is diagnosed by demonstrating any one of the following:^[3]

A positive result, in the absence of clinical symptoms of diabetes, should be confirmed by another of the above-listed methods on a different day. Most physicians prefer to measure a fasting glucose level because of the ease of measurement and the considerable time commitment of formal glucose tolerance testing, which takes two hours to complete. According to the current definition, two fasting glucose measurements above 126 mg/dL (7.0 mmol/l) is considered diagnostic for diabetes mellitus. A glucose tolerance test in medical practice is the administration of glucose to determine how quickly it is cleared from the blood. ...

Patients with fasting glucose levels between 110 and 125 mg/dL (6.1 and 7.0 mmol/l) are considered to have impaired fasting glycemia. Patients with plasma glucose at or above 140 mg/dL or 7.8 mmol/l two hours after a 75 g oral glucose load are considered to have impaired glucose tolerance. Of these two pre-diabetic states, the latter in particular is a major risk factor for progression to full-blown diabetes mellitus as well as cardiovascular disease. Impaired fasting glycaemia (IFG) is a pre-diabetic state of dysglycemia, associated with insulin resistance and increased risk cardiovascular pathology, although of lesser risk than Impaired glucose tolerance (IGT). ... Impaired Glucose Tolerance (IGT) is a pre-diabetic state of dysglycemia, that is associated with insulin resistance and increased risk of cardiovascular pathology. ...

While not used for diagnosis, an elevated level of glucose irreversibly bound to hemoglobin (termed glycosylated hemoglobin or HbA1c) of 6.0% or higher (the 2003 revised U.S. standard) is considered abnormal by most labs; HbA1c is primarily used as a treatment-tracking test reflecting average blood glucose levels over the preceding 90 days (approximately). However, some physicians may order this test at the time of diagnosis to track changes over time. The current recommended goal for HbA1c in patients with diabetes is <7.0%, which is considered good glycemic control, although some guidelines are stricter (<6.5%). People with diabetes who have HbA1c levels within this range have a significantly lower incidence of complications from diabetes, including retinopathy and diabetic nephropathy.^[15]^[16] Structure of hemoglobin. ... 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. ... This article is about the management of diabetes mellitus. ... Retinopathy is a general term that refers to some form of non-inflammatory damage to the retina of the eye. ... Diabetic nephropathy (nephropatia diabetica), also known as Kimmelstiel-Wilson syndrome and intercapillary glomerulonephritis, is a progressive kidney disease caused by angiopathy of capillaries in the kidney glomeruli. ...

Screening

Diabetes screening is recommended for many people at various stages of life, and for those with any of several risk factors. The screening test varies according to circumstances and local policy, and may be a random blood glucose test, a fasting blood glucose test, a blood glucose test two hours after 75 g of glucose, or an even more formal glucose tolerance test. Many healthcare providers recommend universal screening for adults at age 40 or 50, and often periodically thereafter. Earlier screening is typically recommended for those with risk factors such as obesity, family history of diabetes, high-risk ethnicity (Hispanic, Native American, Afro-Caribbean, Pacific Island, and South Asian ancestry).^[17]^[18] A risk factor is a concept in finance theory such as the CAPM, APT and other theories that use pricing kernels. ... A glucose tolerance test in medical practice is the administration of glucose to determine how quickly it is cleared from the blood. ... In medicine, a family history consists of information about disorders that a patients direct blood relatives have suffered from. ... This article or section should be merged with ethnic group Ethnicity is the cultural characteristics that connect a particular group or groups of people to each other. ... Hispanic (Spanish: ; Portuguese: ; Latin: , adjective from HispÄnia, the Roman name for the Iberian Peninsula) is a term that historically denoted relation to the ancient Hispania and its peoples. ... For other uses, see Native Americans (disambiguation). ... The African diaspora was the movement of Africans and their descendants to places throughout the world - predominantly to the Americas, then later to Europe, the Middle East and other corners of the globe. ... The Pacific Ocean has an estimated 20,000 to 30,000 islands; the exact number is unknown. ... Map of South Asia (see note on Kashmir). ...

Many medical conditions are associated with diabetes and warrant screening. A partial list includes: high blood pressure, elevated cholesterol levels, coronary artery disease, past gestational diabetes, polycystic ovary syndrome, chronic pancreatitis, fatty liver, hemochromatosis, cystic fibrosis, several mitochondrial neuropathies and myopathies, myotonic dystrophy, Friedreich's ataxia, some of the inherited forms of neonatal hyperinsulinism. The risk of diabetes is higher with chronic use of several medications, including high-dose glucocorticoids, some chemotherapy agents (especially L-asparaginase), as well as some of the antipsychotics and mood stabilizers (especially phenothiazines and some atypical antipsychotics). Dyslipidemia is a disruption in the amount of lipids in the blood. ... Polycystic Ovary Syndrome (abbreviated PCOS or POS), also known clinically as Stein-Leventhal syndrome, is an endocrine disorder that affects approximately 10% of all women . ... Different stages of liver damage Fatty liver (also known as steatorrhoeic hepatosis or steatosis hepatis) is a reversible condition where large vacuoles of triglyceride fat accumulate in liver cells via the process of steatosis. ... Haemochromatosis, also spelled hemochromatosis, is a hereditary disease characterized by improper processing by the body of dietary iron which causes iron to accumulate in a number of body tissues, eventually causing organ dysfunction. ... Myotonic dystrophy (DM) is a chronic, slowly progressing, highly variable inherited multisystemic disease that can manifest at any age from birth to old age. ... Friedreichs ataxia is a rare autosomal recessive disorder caused by a mutation in Gene X25 that codes for frataxin, located on chromosome 9. ... Glucocorticoids are a class of steroid hormones characterised by an ability to bind with the cortisol receptor and trigger similar effects. ... Chemotherapy, in its most general sense, refers to treatment of disease by chemicals that kill cells, specifically those of micro-organisms or cancer. ... Asparaginase (EC 3. ... Phenothiazines are the largest of the 5 main classes of antipsychotic drugs. ... The atypical antipsychotics (also known as second generation antipsychotics) are a class of prescription medications used to treat psychiatric conditions. ...

People with a confirmed diagnosis of diabetes are screened routinely for complications. This includes yearly urine testing for microalbuminuria and examination of the retina (retinal photography) for retinopathy. In the UK, screening for diabetic retinopathy has helped reduce the incidence of legal blindness since its implementation.^{[citation needed]} Microalbuminuria - the measurement of small amounts of albumin in the urine that cannot be detected by urine dipstick methods. ... Human eye cross-sectional view. ...

Prevention

Type 1 diabetes risk is known to depend upon a genetic predisposition based on HLA types (particularly types DR3 and DR4), an unknown environmental trigger (suspected to be an infection, although none has proven definitive in all cases), and an uncontrolled autoimmune response that attacks the insulin producing beta cells.^[19] Some research has suggested that breastfeeding decreased the risk in later life; ^[20]^[21] various other nutritional risk factors are being studied, but no firm evidence has been found. ^[22] Giving children 2000 IU of Vitamin D during their first year of life is associated with reduced risk of type 1 diabetes, though the causal relationship is obscure.^[23] HLA region of Chromosome 6 The human leukocyte antigen system (HLA) is the name of the human major histocompatibility complex (MHC). ... Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. ... Beta cells are a type of cell in the pancreas in areas called the islets of Langerhans. ... Suckling redirects here. ...

Children with antibodies to beta cell proteins (ie, at early stages of an immune reaction to them) but no overt diabetes, and treated with vitamin B-3 (niacin), had less than half the diabetes onset incidence in a 7-year time span as did the general population, and an even lower incidence relative to those with antibodies as above, but who received no vitamin B3.^[24] Niacin, also known as nicotinic acid or vitamin B3, is a water-soluble vitamin whose derivatives such as NADH, NAD, NAD+, and NADP play essential roles in energy metabolism in the living cell and DNA repair. ...

Type 2 diabetes risk can be reduced in many cases by making changes in diet and increasing physical activity.^[25]^[26] The American Diabetes Association (ADA) recommends maintaining a healthy weight, getting at least 2½ hours of exercise per week (several brisk sustained walks appears sufficient), having a modest fat intake, and eating a good amount of fiber and whole grains. The ADA does not recommend alcohol consumption as a preventive, but it is interesting to note that moderate alcohol intake may reduce the risk (though heavy consumption absolutely clearly increases damage to body systems significantly). There is inadequate evidence that eating foods of low glycemic index is clinically helpful despite recommendations and suggested diets in favor.^[27] The American Diabetes Association, or the ADA, is an American health organization providing diabetes research, information and advocacy. ... The relationship between alcohol consumption and health has been the subject of formal scientific research since at least 1926, when Dr. Raymond Pearl published his book, Alcohol and Longevity, in which he reported his finding that drinking alcohol in moderation was associated with greater longevity than either abstaining or drinking... Glycemic index (also glycaemic index, GI) is a ranking system for carbohydrates based on their effect on blood glucose levels. ...

There are numerous studies which suggest connections with some aspect of Type II diabetes with ingestion of certain foods or with some drugs. Some studies have shown delayed progression to diabetes in predisposed patients through prophylactic use of metformin,^[26] rosiglitazone,^[28] or valsartan.^[29] In patients on hydroxychloroquine for rheumatoid arthritis, incidence of diabetes was reduced by 77% though causal mechanisms are unclear.^[30] Breastfeeding may also be associated with the prevention of type 2 of the disease in mothers.^[31] Rosiglitazone is an anti-diabetic drug from the thiazolidinedione class. ... Valsartan (trade name DiovanÂ®) is an angiotensin II receptor antagonist, acting on the AT1 subtype. ... Hydroxychloroquine is an antimalarial drug, sold under the trade name PlaquenilÂ®, also used to reduce inflammation in the treatment of Rheumatoid arthritis (see Disease-modifying antirheumatic drugs) and lupus. ... Rheumatoid arthritis (RA) is traditionally considered a chronic, inflammatory autoimmune disorder that causes the immune system to attack the joints. ...

Treatment and management

Diabetes mellitus is currently a chronic disease, without a cure, and medical emphasis must necessarily be on managing/avoiding possible short-term as well as long-term diabetes-related problems. There is an exceptionally important role for patient education, dietetic support, sensible exercise, self glucose monitoring, with the goal of keeping both short-term blood glucose levels, and long term levels as well, within acceptable bounds. Careful control is needed to reduce the risk of long term complications. This is theoretically achievable with combinations of diet, exercise and weight loss (type 2), various oral diabetic drugs (type 2 only), and insulin use (type 1 and increasingly for type 2 not responding to oral medications). In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications should be undertaken to control blood pressure^[32] and cholesterol by exercising more, smoking cessation, consuming an appropriate diet, wearing diabetic socks, and if necessary, taking any of several drugs to reduce pressure. Many Type 1 treatments include the combination use of regular or NPH insulin, and/or synthetic insulin analogs such as Humalog, Novolog or Apidra; the combination of Lantus/Levemir and Humalog, Novolog or Apidra. Another Type 1 treatment option is the use of the insulin pump with some of the most popular pump brands being: Cozmo, Animas, Medtronic Minimed, and Omnipod. This article is about the management of diabetes mellitus. ... Medicine In medicine, a persistent and lasting condition is said to be chronic (from Greek chronos). ... This article is about the management of diabetes mellitus. ... 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. ... A diabetic sock is a sock which is specially designed for those with diabetes. ...

In countries using a general practitioner system, such as the United Kingdom, care may take place mainly outside hospitals, with hospital-based specialist care used only in case of complications, difficult blood sugar control, or research projects. In other circumstances, general practitioners and specialists share care of a patient in a team approach. Optometrists, podiatrists/chiropodists, dietitians, physiotherapists, clinical nurse specialists (eg, Certified Diabetes Educators and DSNs (Diabetic Specialist Nurse)), or nurse practitioners may jointly provide multidisciplinary expertise. In countries where patients must provide their own health care (i.e., the United States in the developed world), the impact of out-of-pocket costs of diabetic care can be high. In addition to the medications and supplies needed, patients are often advised to receive regular consultation from a physician (e.g., at least every three to six months). A general practitioner (GP), family physician or family practitioner (FP) is a medical doctor who provides primary care. ... Optometry is a doctoral-degree health care profession concerned with eyes and related structures, as well as vision, visual systems, and vision information processing in humans. ... Podiatry, more appropriately podiatric medicine is a field of healthcare devoted to the study and treatment of disorders of the foot, ankle, and the knee, leg and hip (collectively known as the lower extremity). ... A dietitian (sometimes spelled dietician) is an expert in food and nutrition. ... Physical therapy (or physiotherapy[1]) is the provision of services to people and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan. ... A Certified diabetes educator (CDE) is a health care professional who is qualified by the American Association of Diabetes Educators to teach people with diabetes how to manage their condition. ... A nurse practitioner is a registered nurse who has completed specific advanced nursing education (generally a masters degree) and training in the diagnosis and management of common medical conditions. ...

Cure

Cures for type 1 diabetes

There is no practical cure now for type 1 diabetes. The fact that type 1 diabetes is due to the failure of one of the cell types of a single organ with a relatively simple function (i.e. the failure of the islets of Langerhans) has led to the study of several possible schemes to cure this form of diabetes mostly by replacing the pancreas or just the beta cells.^[33] Only those type 1 diabetics who have received either a pancreas or a kidney-pancreas transplant (often when they have developed diabetic kidney disease (ie, nephropathy) and become insulin-independent may now be considered "cured" from their diabetes. A simultaneous pancreas-kidney transplant is a promising solution, showing similar or improved survival rates over a kidney transplant alone.^[34] Still, they generally remain on long-term immunosuppressive drugs and there is a possibility that the immune system will mount a host versus graft response against the transplanted organ.^[33] Diabetes mellitus type 1 (Type 1 diabetes, Type I diabetes, T1D, IDDM) is a form of diabetes mellitus. ... For a list of immunosuppressive drugs, see the transplant rejection page. ... Transplant rejection occurs when the immune system of the recipient of a transplant attacks the transplanted organ or tissue. ...

Transplants of exogenous beta cells have been performed experimentally in both mice and humans, but this measure is not yet practical in regular clinical practice partly due to the limited number of beta cell donors. Thus far, like any such transplant, it has provoked an immune reaction and long-term immunosuppressive drugs have been needed to protect the transplanted tissue.^[35] An alternative technique has been proposed to place transplanted beta cells in a semi-permeable container, isolating and protecting them from the immune system. Stem cell research has also been suggested as a potential avenue for a cure since it may permit regrowth of Islet cells which are genetically part of the treated individual, thus perhaps eliminating the need for immuno-suppressants.^[33] This has been done in mice, and a 2007 trial of 15 newly diagnosed patients with type 1 diabetes treated with stem cells raised from their own bone marrow after immune suppression showed that the majority did not require any insulin treatment for prolonged periods of time.^[36] Mouse embryonic stem cells. ... Mouse embryonic stem cells with fluorescent marker. ... For the Dir en grey album, see The Marrow of a Bone. ... Immunosuppression is the medical suppression of the immune system. ...

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

Cures for type 2 diabetes

Type 2 has had no cure. But, very recently, it has been shown that a type of gastric bypass surgery can normalize blood glucose levels in 80-100% of severely obese patients. The effect is not due to weight loss because it usually occurs within days of surgery, which is before significant weight loss happens. The pattern of secretion of gastrointestinal hormones is changed by the bypass and removal of the duodenum and proximal jejunum, which together form the upper (proximal) part of the small intestine. The precise causal mechanisms are being intensively researched. This approach may become a standard treatment for some people with type 2 diabetes in the near future. ^[37] One hypothesis is that the proximal small intestine is dysfunctional in type 2 diabetes; its removal eliminates the source of an unknown hormone that contributes to insulin resistance.^[38] This surgery has been widely performed on morbidly obese patients and has had the additional the benefit of reducing the death rate from all causes by up to 40%.^[39] A small number of normal to moderately obese patients with type 2 diabetes have successfully undergone similar operations.^[40]^[41] Gastric bypass procedures (GBP) are any of a group of similar operations used to treat morbid obesityâ€”the severe accumulation of excess weight as fatty tissueâ€”and the health problems (comorbidities) it causes. ... In anatomy of the digestive system, the duodenum is a hollow jointed tube about 25-30 cm long connecting the stomach to the jejunum. ... Diagram of the Human Intestine In anatomy of the digestive system, the jejunum is the central of the three divisions of the small intestine and lies between the duodenum and the ileum. ... In biology the small intestine is the part of the gastrointestinal tract (gut) between the stomach and the large intestine and comprises the duodenum, jejunum, and ileum. ...

Prognosis

Patient education, understanding, and participation is vital since the complications of diabetes are far less common and less severe in people who have well-controlled blood sugar levels.^[42]^[43] Wider health problems accelerate the deleterious effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise. According to a study, women with high blood pressure have a threefold risk of developing diabetes. This article is about the management of diabetes mellitus. ... The cigarette is the most common method of smoking tobacco. ... Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood [1]. It is not a disease but a metabolic derangement that can be secondary to many diseases and can contribute to many forms of disease, most notably cardiovascular disease. ... For other forms of hypertension, see Hypertension (disambiguation). ... The term Exercise can refer to: Physical exercise such as running or strength training Exercise (options), the financial term for enacting and terminating a contract Category: ... A sphygmomanometer, a device used for measuring arterial pressure. ...

Anecdotal evidence suggests that some of those with type 2 diabetes who exercise regularly, lose weight, and eat healthy diets may be able to keep some of the disease or some of the effects of the disease in 'remission.' Certainly these tips can help prevent people predisposed to type 2 diabetes and those at pre-diabetic stages from actually developing the disorder as it helps restore insulin sensitivity. However patients should talk to their doctors about this for real expectations before undertaking it (esp. to avoid hypoglycemia or other complications); few people actually seem to go into total 'remission,' but some may find they need less of their insulin medications since the body tends to have lower insulin requirements during and shortly following exercise. Regardless of whether it works that way or not for an individual, there are certainly other benefits to this healthy lifestyle for both diabetics and nondiabetics.

The way diabetes is managed changes with age. Insulin production decreases because of age-related impairment of pancreatic beta cells. Additionally, insulin resistance increases because of the loss of lean tissue and the accumulation of fat, particularly intra-abdominal fat, and the decreased tissue sensitivity to insulin. Glucose tolerance progressively declines with age, leading to a high prevalence of type 2 diabetes and postchallenge hyperglycemia in the older population.^[44] Age-related glucose intolerance in humans is often accompanied by insulin resistance, but circulating insulin levels are similar to those of younger people. ^[45] Treatment goals for older patients with diabetes vary with the individual, and take into account health status, as well as life expectancy, level of dependence, and willingness to adhere to a treatment regimen.^[46]

Acute complications

Diabetic ketoacidosis (DKA) is an acute and dangerous complication that is always a medical emergency. Lack of insulin causes the liver to turn fat into ketone bodies for use as fuel. This is normal when periodic, but can become a serious problem if sustained. Elevated levels of ketone bodies in the blood decrease the blood's pH, leading to DKA. On presentation at hospital, the patient in DKA is typically dehydrated, and breathing rapidly and deeply. Abdominal pain is common and may be severe. The level of consciousness is typically normal until late in the process, when lethargy may progress to coma. Ketoacidosis can become severe enough to cause hypotension, shock, and death. Urine analysis reveals significant levels of ketone bodies (which spill over from the blood when the kidneys filter blood) well before overt symptoms. Prompt, proper treatment usually results in full recovery, though death can result from inadequate or delayed treatment, or from complications. Nevertheless, DKA is always a medical emergency and requires medical attention. Ketoacidosis is much more common in type 1 diabetes than type 2. Diabetic ketoacidosis(DKA) is a life-threatening complication in patients with untreated diabetes mellitus (chronic high blood sugar or hyperglycemia). ... Nonketotic hyperosmolar coma is a type of diabetic coma associated with a high mortality seen in diabetes mellitus type 2. ... Hypoglycemia (hypoglycaemia in British English) is a medical term referring to a pathologic state produced by a lower than normal level of glucose (sugar) in the blood. ... 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... Diabetic ketoacidosis(DKA) is a life-threatening complication in patients with untreated diabetes mellitus (chronic high blood sugar or hyperglycemia). ... {{Otheruses4|the medical term|the Australian television series|Medical Emergenc an immediate threat to a persons life or long term health. ... The liver is the largest internal organ in the human body, and is an organ present in vertebrates and some other animals. ... Ketone bodies are three chemicals that are produced as by-products when fatty acids are broken down for energy. ... For other uses, see PH (disambiguation). ... hdhdhdhdhdhdh ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ... This article is about the medical condition. ...

Hyperosmolar nonketotic state (HNS) is an acute complication sharing many symptoms with DKA, but an entirely different cause and different treatment. In a person with very high blood glucose levels (usually considered to be above 300 mg/dl (16 mmol/l)), water is drawn out of cells into the blood by osmosis and the kidneys dump glucose into the urine. This results in loss of water and an increase in blood osmolarity. If fluid is not replaced (by mouth or intravenously), the osmotic effect of high glucose levels combined with the loss of water will eventually lead to dehydration. The body's cells become progressively dehydrated as water is taken from them and excreted. Electrolyte imbalances are also common and dangerous. As with DKA, urgent medical treatment is necessary, especially volume replacement. Lethargy may ultimately progress to a coma, which is more common in type 2 diabetes than type 1. Nonketotic hyperosmolar coma is a type of diabetic coma associated with a high mortality seen in diabetes mellitus type 2. ... Osmosis is the spontaneous net movement of water across a semipermeable membrane from a region of low solute concentration to a solution with a high solute concentration, down a solute concentration gradient. ... Osmolality, in biology and chemistry, is a measure of moles of solute per kg of water. ... Dehydration (hypohydration) is the removal of water (hydro in ancient Greek) from an object. ...

Hypoglycemia, or abnormally low blood glucose, is an acute complication of several diabetes treatments. The patient may become agitated, sweaty, and have many symptoms of sympathetic activation of the autonomic nervous system resulting in feelings similar to dread and immobilized panic. Consciousness can be altered or even lost in extreme cases, leading to coma, seizures, or even brain damage and death. In patients with diabetes, this may be caused by several factors, such as too much or incorrectly timed insulin, too much or incorrectly timed exercise (exercise decreases insulin requirements) or not enough food (specifically glucose-producing carbohydrates), but this is an over-simplification. Hypoglycemia (hypoglycaemia in British English) is a medical term referring to a pathologic state produced by a lower than normal level of glucose (sugar) in the blood. ... This article or section is in need of attention from an expert on the subject. ... This article is about epileptic seizures. ...

It is more accurate to note that iatrogenic hypoglycemia is typically the result of the interplay of absolute (or relative) insulin excess and compromised glucose counterregulation in type 1 and advanced type 2 diabetes. Decrements in insulin, increments in glucagon, and, absent the latter, increments in epinephrine are the primary glucose counterregulatory factors that normally prevent or rapidly correct hypoglycemia. In insulin-deficient diabetes (exogenous) insulin levels do not decrease as glucose levels fall, and the combination of deficient glucagon and epinephrine responses causes defective glucose counterregulation. An iatrogenic (pronounced , IPA) condition is a state of ill health or adverse effect caused by medical treatment, usually due to mistakes made in treatment. ...

Furthermore, reduced sympathoadrenal responses can cause hypoglycemia unawareness. The concept of hypoglycemia-associated autonomic failure (HAAF) in diabetes posits that recent incidents of hypoglycemia causes both defective glucose counterregulation and hypoglycemia unawareness. By shifting glycemic thresholds for the sympathoadrenal (including epinephrine) and the resulting neurogenic responses to lower plasma glucose concentrations, antecedent hypoglycemia leads to a vicious cycle of recurrent hypoglycemia and further impairment of glucose counterregulation. In many cases (but not all), short-term avoidance of hypoglycemia reverses hypoglycemia unawareness in most affected patients, although this is easier in theory than it is in practice.

In most cases, hypoglycemia is treated with sugary drinks or food. In severe cases, an injection of glucagon (a hormone with the opposite effects of insulin) or an intravenous infusion of dextrose is used for treatment, but usually only if the person is unconscious. In hospitals, intravenous dextrose is often used. Glucagon ball and stick model A microscopic image stained for glucagon. ... An intravenous drip in a hospital Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ...

Chronic complications

Chronic elevation of blood glucose level leads to damage of blood vessels (angiopathy). The endothelial cells lining the blood vessels take in more glucose than normal, since they don't depend on insulin. They then form more surface glycoproteins than normal, and cause the basement membrane to grow thicker and weaker. In diabetes, the resulting problems are grouped under "microvascular disease" (due to damage to small blood vessels) and "macrovascular disease" (due to damage to the arteries). f you all The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... Angiopathy is a disease of the blood vessels (arteries, veins, and capillaries) that occurs when someone has diabetes for a long time. ... The endothelium is the layer of thin, flat cells that lines the interior surface of blood vessels, forming an interface between circulating blood in the lumen and the rest of the vessel wall. ... N-linked protein glycosylation (N-glycosylation of N-glycans) at Asn residues (Asn-x-Ser/Thr motifs) in glycoproteins[1]. Glycoproteins are proteins that contain oligosaccharide chains (glycans) covalently attached to their polypeptide backbones. ... ... Microvascular disease is a disease of any small blood vessels in the body. ... Macrovascular disease is a disease of any large (macro) blood vessels in the body. ... For other uses, see Artery (disambiguation). ...

The damage to small blood vessels leads to a microangiopathy, which can cause one or more of the following: Image File history File links Size of this preview: 800 Ã— 510 pixelsFull resolution (975 Ã— 621 pixel, file size: 54 KB, MIME type: image/jpeg) File historyClick on a date/time to view the file as it appeared at that time. ... Image File history File links Size of this preview: 800 Ã— 510 pixelsFull resolution (975 Ã— 621 pixel, file size: 54 KB, MIME type: image/jpeg) File historyClick on a date/time to view the file as it appeared at that time. ... Example of eye fundus image The fundus of the eye is the interior surface of the eye, opposite the lens, and includes the retina, optic disc, macula, and posterior pole. ... A laser scalpel is a scalpel for surgery, cutting tissue by the energy of laser light. ... Diabetic retinopathy is retinopathy (damage to the retina) caused by complications of diabetes mellitus, which could eventually lead to blindness. ... Microangiopathy is a disease process affecting small blood vessels. ...

Macrovascular disease leads to cardiovascular disease, to which accelerated atherosclerosis is a contributor: Diabetic retinopathy is retinopathy (damage to the retina) caused by complications of diabetes mellitus, which could eventually lead to blindness. ... Human eye cross-sectional view. ... Macular edema occurs when fluid and protein deposits collect on or under the macula, causing it to thicken and swell. ... Human eye cross-sectional view. ... Visual loss results in the absence of vision where it existed before, which can happen either acutely (i. ... Diabetic neuropathies are neuropathic disorders that are associated with diabetes mellitus. ... Diabetic foot is an umbrella term for foot problems in patients with diabetes mellitus. ... Autonomic neuropathy is a disease of the non-voluntary, non-sensory nervous system affecting mostly the internal organs such as the bladder muscles, the cardiovascular system, the digestive tract, and the genital organs. ... This article or section is in need of attention from an expert in the field of medicine. ... Diabetic nephropathy (nephropatia diabetica), also known as Kimmelstiel-Wilson syndrome and intercapillary glomerulonephritis, is a progressive kidney disease caused by angiopathy of capillaries in the kidney glomeruli. ... Major function-filter blood. ... 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. ... Of the causes leading to cardiac dysfunction, diabetes is the most prevalent. ... Macrovascular disease is a disease of any large (macro) blood vessels in the body. ...

Diabetic foot, often due to a combination of neuropathy and arterial disease, may cause skin ulcer and infection and, in serious cases, necrosis and gangrene. It is why diabetics are prone to leg and foot infections and why it takes longer for them to heal from leg and foot wounds. It is the most common cause of adult amputation, usually of toes and or feet, in the developed world. Coronary heart disease (CHD), also called coronary artery disease (CAD) and atherosclerotic heart disease, is the end result of the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium (the muscle of the heart). ... angina tonsillaris see tonsillitis. ... Heart attack redirects here. ... For other uses, see Stroke (disambiguation). ... In medicine, peripheral artery occlusive disease (PAOD), also known as peripheral vascular disease (PVD) and peripheral artery disease (PAD) is a collator for all diseases caused by the obstruction of large peripheral arteries, which can result from atherosclerosis, inflammatory processes leading to stenosis, an embolism or thrombus formation. ... Intermittent claudication is a cramping sensation in the legs that is present during exercise or walking and occurs as a result of decreased oxygen supply. ... Please wikify (format) this article or section as suggested in the Guide to layout and the Manual of Style. ... Endoscopic images of a duodenal ulcer. ... An infection is the detrimental colonization of a host organism by a foreign species. ... Necrosis (in Greek ÎÎµÎºÏÏŒÏ‚ = Dead) is the name given to accidental death of cells and living tissue. ...

Carotid artery stenosis does not occur more often in diabetes, and there appears to be a lower prevalence of abdominal aortic aneurysm. However, diabetes does cause higher morbidity, mortality and operative risks with these conditions.^[47] Carotid artery stenosis is obstruction of the carotid artery, usually by atheroma (a fatty lump, the result of atherosclerosis). ... A plate from Grays Anatomy with yellow lines depicting the most common infrarenal location of the AAA. Abdominal aortic aneurysm, also written as AAA and often pronounced triple-A, is a localized dilatation of the abdominal aorta, that exceeds the normal diameter by more than 50%. The normal diameter...

Diabetic encephalopathy is the increased cognitive decline and risk of dementia observed in diabetes. Various mechanisms are proposed, including alterations to the vascular supply of the brain and the interaction of insulin with the brain itself.^[48]. For other uses, see Dementia (disambiguation). ...

Epidemiology

In 2000, according to the World Health Organization, at least 171 million people worldwide suffer from diabetes, or 2.8% of the population.^[49] Its incidence is increasing rapidly, and it is estimated that by the year 2030, this number will almost double.^[49] Diabetes mellitus occurs throughout the world, but is more common (especially type 2) in the more developed countries. The greatest increase in prevalence is, however, expected to occur in Asia and Africa, where most patients will likely be found by 2030.^[49] The increase in incidence of diabetes in developing countries follows the trend of urbanization and lifestyle changes, perhaps most importantly a "Western-style" diet. This has suggested an environmental (i.e., dietary) effect, but there is little understanding of the mechanism(s) at present, though there is much speculation, some of it most compellingly presented.^[49] However, the criteria for diagnosing diabetes in the USA mean that it is more readily diagnosed than in some other countries. The Centers for Disease Control has termed the change an epidemic.^[50] The National Diabetes Information Clearinghouse estimates that diabetes costs $132 billion in the United States alone every year. About 5%–10% of diabetes cases in North America are type 1, with the rest being type 2. The fraction of type 1 in other parts of the world differs; this is likely due to both differences in the rate of type 1 and differences in the rate of other types, most prominently type 2. Most of this difference is not currently understood. The American Diabetes Association point out the 2003 assessment of the National Center for Chronic Disease Prevention and Health Promotion (Centers for Disease Control and Prevention) that 1 in 3 Americans born after 2000 will develop diabetes in their lifetime.^[51]^[52] The Centers for Disease Control and Prevention (CDC) in Atlanta is recognized as the lead United States agency for protecting the public health and safety of people by providing credible information to enhance health decisions, and promoting health through strong partnerships with state health departments and other organizations. ... In epidemiology, an epidemic (from [[Latin language] epi- upon + demos people) is a disease that appears as new cases in a given human population, during a given period, at a rate that substantially exceeds what is expected, based on recent experience (the number of new cases in the population during... The National Diabetes Information Clearinghouse (NDIC) is an information service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). ...

According to the American Diabetes Association, approximately 18.3% (8.6 million) of Americans age 60 and older have diabetes. ^[53] Diabetes mellitus prevalence increases with age, and the numbers of older persons with diabetes are expected to grow as the elderly population increases in number. The National Health and Nutrition Examination Survey (NHANES III) demonstrated that, in the population over 65 years old, 18% to 20% have diabetes, with 40% having either diabetes or its precursor form of impaired glucose tolerance.^[44] Impaired Glucose Tolerance (IGT) is a pre-diabetic state of dysglycemia, that is associated with insulin resistance and increased risk of cardiovascular pathology. ...

Indigenous populations in first world countries have a higher prevalence and increasing incidence of diabetes than their corresponding non-indigenous populations. In Australia the age-standardised prevalence of self-reported diabetes in Indigenous Australians is almost 4 times that of non-indigenous Australians.^[54] Preventative community health programs such as Sugar Man (diabetes education) are showing some success in tackling this problem. Not to be confused with Sugar Man. ...

History

The term diabetes (Greek: διαβήτης, diabētēs) was coined by Aretaeus of Cappadocia. It was derived from the Greek verb διαβαίνειν, diabaínein, itself formed from the prefix dia-, "across, apart," and the verb bainein, "to walk, stand." The verb diabeinein meant "to stride, walk, or stand with legs asunder"; hence, its derivative diabētēs meant "one that straddles," or specifically "a compass, siphon." The sense "siphon" gave rise to the use of diabētēs as the name for a disease involving the discharge of excessive amounts of urine. Diabetes is first recorded in English, in the form diabete, in a medical text written around 1425. In 1675, Thomas Willis added the word mellitus, from the Latin meaning "honey", a reference to the sweet taste of the urine. This sweet taste had been noticed in urine by the ancient Greeks, Chinese, Egyptians, Indians, and Persians. In 1776, Matthew Dobson confirmed that the sweet taste was because of an excess of a kind of sugar in the urine and blood of people with diabetes.^[55] Aretaeus (Î‘ÏÎµÏ„Î±Î¹Î¿Ï‚), one of the most celeÂbrated of the ancient Greek physicians, of whose life, however, no particulars are known. ... Thomas Willis Thomas Willis (1621-1673) was an English physician who played an important part in the history of the science of anatomy and was a co-founder of the Royal Society (1662). ... Latin was the language originally spoken in the region around Rome called Latium. ...

The ancient Indians tested for diabetes by observing whether ants were attracted to a person's urine, and called the ailment "sweet urine disease" (Madhumeha). The Korean, Chinese, and Japanese words for diabetes are based on the same ideographs (糖尿病) which mean "sugar urine disease". For other uses, see Ant (disambiguation). ...

In medieval Persia, Avicenna (980-1037) provided a detailed account on diabetes mellitus in The Canon of Medicine, "describing the abnormal appetite and the collapse of sexual functions and he documented the sweet taste of diabetic urine." Like Aretaeus before him, Avicenna recognized a primary and secondary diabetes. He also described diabetic gangrene, and treated diabetes using a mixture of lupine, trigonella (fenugreek), and zedoary seed, which produces a considerable reduction in the excretion of sugar, a treatment which is still prescribed in modern times. Avicenna also "described diabetes insipidus very precisely for the first time", though it was later Johann Peter Frank (1745-1821) who first differentiated between diabetes mellitus and diabetes insipidus.^[56] edit Geographical extent of Iranian influence in the 1st century BCE. The Parthian Empire (mostly Western Iranian) is shown in red, other areas, dominated by Scythia (mostly Eastern Iranian), in orange. ... For the lunar crater, see Avicenna (crater). ... A Latin copy of the Canon of Medicine, dated 1484, located at the P.I. Nixon Medical Historical Library of The University of Texas Health Science Center at San Antonio. ... Gangrene is a complication of necrosis (i. ... Species 150-200 species, including: Lupinus albus Lupinus angustifolius Lupinus luteus Lupinus albifrons Lupinus arboreus Lupinus arizonicus Lupinus bicolor Lupinus chamissonis Lupinus diffusus Lupinus excubitus Lupinus formosus Lupinus longifolius Lupinus microcarpus Lupinus mutabilis Lupinus nanus Lupinus nootkatensis Lupinus perennis Lupinus polyphyllus Lupinus sparsiflorus Lupinus sulphureus Lupinus texensis Lupinus tidestromii Lupinus... Species See text Trigonella is a large genus from the family Fabaceae. ... Binomial name L. Fenugreek (Trigonella foenum-graecum) or menthya (Kannada)or Venthayam (Tamil) belongs to the family Fabaceae. ... Binomial name Curcuma zedoaria (Christm. ... Johann Peter Frank (1745 - 1821) was a German physician and hygienist who was a native of Rodalben. ...

Although diabetes has been recognized since antiquity, and treatments of various efficacy have been known in various regions since the Middle Ages, and in legend for much longer, pathogenesis of diabetes has only been understood experimentally since about 1900.^[57] The discovery of a role for the pancreas in diabetes is generally ascribed to Joseph von Mering and Oskar Minkowski, who in 1889 found that dogs whose pancreas was removed developed all the signs and symptoms of diabetes and died shortly afterwards.^[58] In 1910, Sir Edward Albert Sharpey-Schafer suggested that people with diabetes were deficient in a single chemical that was normally produced by the pancreas—he proposed calling this substance insulin, from the Latin insula, meaning island, in reference to the insulin-producing islets of Langerhans in the pancreas.^[57] Ancient redirects here. ... The Middle Ages formed the middle period in a traditional schematic division of European history into three ages: the classical civilization of Antiquity, the Middle Ages, and modern times, beginning with the Renaissance. ... This article is about medicinal compounds. ... Joseph, Baron von Mering (born February 28, 1849, in Cologne - died January 5, 1908, at Halle an der Saale, Germany) was a German physician. ... Oskar Minkowski (January 13, 1858, Kaunas, Lithuania - July 18, 1931, Mecklenburg, Germany) was a famous Jewish doctor of Polish origin. ... Sir Edward Albert Sharpey-Schafer (1850-1935) coined the word insulin after theorising that a single substance from the pancreas was responsible for diabetes mellitus. ... A porcine islet of Langerhans. ...

The endocrine role of the pancreas in metabolism, and indeed the existence of insulin, was not further clarified until 1921, when Sir Frederick Grant Banting and Charles Herbert Best repeated the work of Von Mering and Minkowski, and went further to demonstrate they could reverse induced diabetes in dogs by giving them an extract from the pancreatic islets of Langerhans of healthy dogs.^[59] Banting, Best, and colleagues (especially the chemist Collip) went on to purify the hormone insulin from bovine pancreases at the University of Toronto. This led to the availability of an effective treatment—insulin injections—and the first patient was treated in 1922. For this, Banting and laboratory director MacLeod received the Nobel Prize in Physiology or Medicine in 1923; both shared their Prize money with others in the team who were not recognized, in particular Best and Collip. Banting and Best made the patent available without charge and did not attempt to control commercial production. Insulin production and therapy rapidly spread around the world, largely as a result of this decision. Sir Frederick Banting Sir Frederick Grant Banting (November 14, 1891–February 21, 1941) was a Canadian medical scientist and Nobel laureate. ... Charles Herbert Best (February 27, 1899 _ March 31, 1978) was a medical scientist. ... James Collip was part of the Toronto group which helped create insulin. ... The University of Toronto (U of T) is a public research university in the city of Toronto, Ontario, Canada. ... Emil Adolf von Behring was the first person to receive the Nobel Prize in Physiology or Medicine, for his work on the treatment of diphtheria. ... Not to be confused with inulin. ...

The distinction between what is now known as type 1 diabetes and type 2 diabetes was first clearly made by Sir Harold Percival (Harry) Himsworth, and published in January 1936.^[60] Sir Harold Percival (Harry) Himsworth (19 May 1905 - 1 November 1993) was a British scientist, best known for his medical research on diabetes mellitus. ...

Despite the availability of treatment, diabetes has remained a major cause of death. For instance, statistics reveal that the cause-specific mortality rate during 1927 amounted to about 47.7 per 100,000 population in Malta.^[61] This article is about the field of statistics. ... Crude death rate by country Mortality rate is a measure of the number of deaths (in general, or due to a specific cause) in some population, scaled to the size of that population, per unit time. ...

In 1980, U.S. biotech company Genentech developed human insulin. The insulin is isolated from genetically-altered bacteria (the bacteria contain the human gene for synthesizing human insulin), which produce large quantities of insulin. Scientists then purify the insulin and distribute it to pharmacies for use by diabetes patients. Sulfonylurea derivatives are a class of antidiabetic drugs that are used in the management of diabetes mellitus type 2 (adult-onset). They act by increasing insulin release from the beta cells in the pancreas. ... Metformin Buformin. ... Phenformin is an anti-diabetic drug from the biguanide class. ... Metformin (INN; trade names Glucophage, Diabex, Diaformin, Fortamet, Riomet, Glumetza and others) is an anti-diabetic drug from the biguanide class of oral hypoglycemic agents. ... Peptide sequence or amino acid sequence is the order in which amino acid residues, connected by peptide bonds, lie in the chain. ... Frederick Sanger, OM, CH, CBE, FRS (born 13 August 1918) is an English biochemist and a two time Nobel laureate in chemistry. ... Radioimmunoassay is a scientific method used to test hormone levels in the blood without the need to use a bioassay. ... Rosalyn Sussman Yalow (born on July 19, 1921) is an American medical physicist, and a co-winner of the 1977 Nobel Prize in Physiology or Medicine for her development of the radioimmunoassay (RIA) technique. ... Solomon Aaron Berson (New York City 22 April 1918 - Atlantic City 11 April 1972) was an American physician whose discoveries, mostly together with Rosalyn Yalow, caused major advances in clinical biochemistry. ... For the file format that describes the 3D structures of molecules found in the Protein Data Bank, see Protein Data Bank (file format). ... Gerald Reaven is an American endocrinologist and professor emeritus in medicine at the Stanford University School of Medicine in Stanford, California. ... Metabolic syndrome is a combination of medical disorders that increase ones risk for cardiovascular disease and diabetes. ... This article is about the management of diabetes mellitus. ... The medication class of thiazolidinedione was introduced in the late 1990s as an adjunctive therapy for diabetes mellitus (type II) and related diseases. ...

Social issues

The 1989 Declaration of St Vincent was the result of international efforts to improve the care accorded to those with diabetes. Doing so is important both in terms of quality of life and life expectancy but also economically - expenses to diabetes have been shown to be a major drain on health- and productivity-related resources for healthcare systems and governments.

Several countries established more and less successful national diabetes programmes to improve treatment of the disease.^[64]

A study shows that diabetic patients with neuropathic symptoms such as numbness or tingling in feet or hands are twice more likely to be unemployed than those without the symptoms.^[65] Paresthesia or paraesthesia (in British English) is a sensation of tingling, pricking, or numbness of a persons skin with no apparent long-term physical effect, more generally known as the feeling of pins and needles or of a limb being asleep (but not directly related to the phenomenon of... Unemployment rates in the United States. ...

See also

References

^ "IDF Chooses Blue Circle to Represent UN Resolution Campaign". Unite for Diabetes (17 March 2006).
^ ^a ^b L M Tierney, S J McPhee, M A Papadakis (2002). Current medical Diagnosis & Treatment. International edition. New York: Lange Medical Books/McGraw-Hill, 1203-1215. ISBN 0-07-137688-7.
^ ^a ^b ^c World Health Organisation Department of Noncommunicable Disease Surveillance (1999). "Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications" (PDF).
^ ^a ^b ^c Rother, KI (2007). "Diabetes Treatment — Bridging the Divide". N Engl J Med 356 (15): 1499–1501. doi:10.1056/NEJMp078030. PMID 17429082.
^ Mailloux, Lionel (2007-02-13). "UpToDate Dialysis in diabetic nephropathy". UpToDate. Retrieved on 2007-12-07.
^ "Other "types" of diabetes". American Diabetes Association (August 25, 2005).
^ "Diseases: Johns Hopkins Autoimmune Disease Research Center". Retrieved on 2007-09-23.
^ "FDA Approves First Ever Inhaled Insulin Combination Product for Treatment of Diabetes". Retrieved on 2007-09-09.
^ Eberhart, MS; Ogden C, Engelgau M, Cadwell B, Hedley AA, Saydah SH (November 19, 2004). "Prevalence of Overweight and Obesity Among Adults with Diagnosed Diabetes --- United States, 1988--1994 and 1999--2002". Morbidity and Mortality Weekly Report 53 (45): 1066–1068. Centers for Disease Control and Prevention. Retrieved on 2007-03-11.
^ Arlan Rosenbloom, Janet H Silverstein (2003). Type 2 Diabetes in Children and Adolescents: A Clinician's Guide to Diagnosis, Epidemiology, Pathogenesis, Prevention, and Treatment. American Diabetes Association,U.S., 1. ISBN 978-1580401555.
^ "Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group" (1998). Lancet 352 (9131): 854–65. doi:10.1016/S0140-6736(98)07037-8. PMID 9742977.
^ Lawrence JM, Contreras R, Chen W, Sacks DA (May 2008). "Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women, 1999-2005". Diabetes Care 31 (5): 899–904. doi:10.2337/dc07-2345. PMID 18223030.
^ Walley AJ, Blakemore AI, Froguel P (2006). "Genetics of obesity and the prediction of risk for health". Hum. Mol. Genet. 15 Spec No 2: R124–30. doi:10.1093/hmg/ddl215. PMID 16987875.
^ Barrett TG (2001). "Mitochondrial diabetes, DIDMOAD and other inherited diabetes syndromes". Best Pract. Res. Clin. Endocrinol. Metab. 15 (3): 325–43. doi:10.1053/beem.2001.0149. PMID 11554774.
^ Sniderman, AD; Bhopal R, Prabhakaran D, Sarrafzadegan N, Tchernof A (2007). "Why might South Asians be so susceptible to central obesity and its atherogenic consequences? The adipose tissue overflow hypothesis". International journal of epidemiology 36 (1): 220–225. doi:10.1093/ije/dyl245. PMID 17510078.
^ Genuth S (Jan-Feb 2006). "Insights from the diabetes control and complications trial/epidemiology of diabetes interventions and complications study on the use of intensive glycemic treatment to reduce the risk of complications of type 1 diabetes.". Endocr Pract 12 (Suppl 1): 34–41. ISSN 1530-891X. PMID 16627378.
^ Lee CM, Huxley RR, Lam TH, et al (2007). "Prevalence of diabetes mellitus and population attributable fractions for coronary heart disease and stroke mortality in the WHO South-East Asia and Western Pacific regions". Asia Pacific journal of clinical nutrition 16 (1): 187–92. PMID 17215197.
^ Seidell JC (2000). "Obesity, insulin resistance and diabetes--a worldwide epidemic". Br. J. Nutr. 83 Suppl 1: S5–8. PMID 10889785.
^ Daneman D (2006). "Type 1 diabetes". Lancet 367 (9513): 847–58. doi:10.1016/S0140-6736(06)68341-4. PMID 16530579.
^ Borch-Johnsen K, Joner G, Mandrup-Poulsen T, Christy M, Zachau-Christiansen B, Kastrup K, Nerup J (1984). "Relation between breast-feeding and incidence rates of insulin-dependent diabetes mellitus. A hypothesis". Lancet 2 (8411): 1083–6. doi:10.1016/S0140-6736(84)91517-4. PMID 6150150.
^ Naim Shehadeh, Raanan Shamir, Moshe Berant, Amos Etzioni (2001). "Insulin in human milk and the prevention of type 1 diabetes". Pediatric Diabetes 2 (4): 175–177. doi:10.1034/j.1399-5448.2001.20406.x.
^ Virtanen S, Knip M (2003). "Nutritional risk predictors of beta cell autoimmunity and type 1 diabetes at a young age". Am J Clin Nutr 78 (6): 1053–67. PMID 14668264.
^ Hyppönen E, Läärä E, Reunanen A, Järvelin MR, Virtanen SM (2001). "Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study". Lancet 358: 1500. doi:10.1016/S0140-6736(01)06580-1. PMID 11705562.
^ Elliott RB, Pilcher CC, Fergusson DM, Stewart AW (Sep-Oct 1996). "A population based strategy to prevent insulin-dependent diabetes using nicotinamide". J. Pediatr. Endocrinol. Metab. 9 (5): 501–9. PMID 8961125.
^ Lindström J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson J, Hemiö K, Hämäläinen H, Härkönen P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Mannelin M, Paturi M, Sundvall J, Valle T, Uusitupa M, Tuomilehto J (2006). "Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study.". Lancet 368 (9548): 1673–9. doi:10.1016/S0140-6736(06)69701-8. PMID 17098085.
^ ^a ^b Knowler W, Barrett-Connor E, Fowler S, Hamman R, Lachin J, Walker E, Nathan D (2002). "Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.". N Engl J Med 346 (6): 393–403. doi:10.1056/NEJMoa012512. PMID 11832527.
^ Bantle JP, Wylie-Rosett J, Albright AL, et al (2006). "Nutrition recommendations and interventions for diabetes--2006: a position statement of the American Diabetes Association". Diabetes Care 29 (9): 2140–57. doi:10.2337/dc06-9914. PMID 16936169.
^ Gerstein H, Yusuf S, Bosch J, Pogue J, Sheridan P, Dinccag N, Hanefeld M, Hoogwerf B, Laakso M, Mohan V, Shaw J, Zinman B, Holman R (2006). "Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomised controlled trial". Lancet 368 (9541): 1096–105. doi:10.1016/S0140-6736(06)69420-8. PMID 16997664.
^ Kjeldsen SE, Julius S, Mancia G, McInnes GT, Hua T, Weber MA, Coca A, Ekman S, Girerd X, Jamerson K, Larochelle P, Macdonald TM, Schmieder RE, Schork MA, Stolt P, Viskoper R, Widimsky J, Zanchetti A; for the VALUE Trial Investigators (2006). "Effects of valsartan compared to amlodipine on preventing type 2 diabetes in high-risk hypertensive patients: the VALUE trial.". J Hypertens 24 (7): 1405–1412. doi:10.1097/01.hjh.0000234122.55895.5b. PMID 16794491.
^ Wasko MC, Hubert HB, Lingala VB, et al (2007). "Hydroxychloroquine and risk of diabetes in patients with rheumatoid arthritis". JAMA 298 (2): 187–93. doi:10.1001/jama.298.2.187. PMID 17622600.
^ Stuebe AM, Rich-Edwards JW, Willett WC, Manson JE, Michels KB (2005). "Duration of lactation and incidence of type 2 diabetes". JAMA 294 (20): 2601–10. doi:10.1001/jama.294.20.2601. PMID 16304074.
^ Adler, A.I.; Stratton, I. M.; Neil, H.A.; et al (2000). "Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study". BMJ 321 (7258): 412–419. doi:10.1136/bmj.321.7258.412. ISSN 0959-8146. PMID 10938049.
^ ^a ^b ^c Vinik AI, Fishwick DT, Pittenger G (2004). "Advances in diabetes for the millennium: toward a cure for diabetes". MedGenMed : Medscape general medicine 6 (3 Suppl): 12. PMID 15647717.
^ Stratta RJ, Alloway RR. (1998). "Pancreas transplantation for diabetes mellitus: a guide to recipient selection and optimum immunosuppression.". BioDrugs. 10 (5): 347–357. PMID 18020607.
^ Shapiro AM, Ricordi C, Hering BJ, et al (2006). "International trial of the Edmonton protocol for islet transplantation". N. Engl. J. Med. 355 (13): 1318–30. doi:10.1056/NEJMoa061267. PMID 17005949.
^ Voltarelli, JC; Couri CE, Stracieri AB, Oliveira MC, Moraes DA, Pieroni F, Coutinho M, Malmegrim KC, Foss-Freitas MC, Simoes BP, Foss MC, Squiers E, Burt RK. (2007). "Autologous nonmyeloablative hematopoietic stem cell transplantation in newly diagnosed type 1 diabetes mellitus.". JAMA 297 (14): 1568–76. doi:10.1001/jama.297.14.1568. PMID 17426276.
^ Rubino, F; Gagner M (2002). "Potential of surgery for curing type 2 diabetes mellitus". Ann. Surg. 236 (5): 554–9. doi:10.1097/00000658-200211000-00003. ISSN 0003-4932. PMID 12409659.
^ Rubino, F; Forgione A, Cummings DE, et al (2006). "The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes". Ann. Surg. 244 (5): 741–9. doi:10.1097/01.sla.0000224726.61448.1b. PMID 17060767.
^ Adams, TD; Gress RE, Smith SC, et al (2007). "Long-term mortality after gastric bypass surgery". N. Engl. J. Med. 357 (8): 753–61. doi:10.1056/NEJMoa066603. PMID 17715409.
^ Cohen, RV; Schiavon CA, Pinheiro JS, Correa JL, Rubino F (2007). "Duodenal-jejunal bypass for the treatment of type 2 diabetes in patients with body mass index of 22-34 kg/m2: a report of 2 cases". Surg Obes Relat Dis. 3 (2): 195–7. doi:10.1016/j.soard.2007.01.009. PMID 17386401.
^ Vasonconcelos, Alberto (2007-09-01). "Could type 2 diabetes be reversed using surgery?". New Scientist (2619): 11–13. Retrieved on 2007-09-26.
^ Nathan, D.M.; Cleary P.A., Backlund J.Y., et al (2005). "Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes". N. Engl. J. Med. 353 (25): 2643–53. doi:10.1056/NEJMoa052187. PMID 16371630.
^ The Diabetes Control and Complications Trial Research Group (1995). "The effect of intensive diabetes therapy on the development and progression of neuropathy". Annals of Internal Medicine 122 (8): 561–568. ISSN 0003-4819. PMID 7887548.
^ ^a ^b Harris MI, Flegal KM, Cowie CC, et al (1998). "Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1988-1994". Diabetes Care 21 (4): 518–24. doi:10.2337/diacare.21.4.518. PMID 9571335.
^ Annette M. Chang and Jeffrey B. Halter (2003). "Aging and insulin secretion". AJP - Endocrinology and Metabolism. Retrieved on 2007-05-14.
^ "Diabetes and Aging". Diabetes Dateline. National Institute of Diabetes and Digestive and Kidney Diseases (2002). Retrieved on 2007-05-14.
^ Weiss J, Sumpio B (2006). "Review of prevalence and outcome of vascular disease in patients with diabetes mellitus.". Eur J Vasc Endovasc Surg 31 (2): 143–50. doi:10.1016/j.ejvs.2005.08.015. PMID 16203161.
^ Gispen WH, Biessels GJ (November 2000). "Cognition and synaptic plasticity in diabetes mellitus". Trends Neurosci. 23 (11): 542–9. doi:10.1016/S0166-2236(00)01656-8. PMID 11074263.
^ ^a ^b ^c ^d Wild S, Roglic G, Green A, Sicree R, King H (May 2004). "Global prevalence of diabetes: estimates for the year 2000 and projections for 2030". Diabetes Care 27 (5): 1047–53. doi:10.2337/diacare.27.5.1047. PMID 15111519.
^ "CDC's Diabetes Program - News and Information - Press Releases - October 26 2000". Retrieved on 2008-06-23.
^ Narayan K, Boyle J, Thompson T, Sorensen S, Williamson D (2003). "Lifetime risk for diabetes mellitus in the United States". JAMA 290 (14): 1884–90. doi:10.1001/jama.290.14.1884. PMID 14532317.
^ American Diabetes Association (2005). "Total Prevalence of Diabetes & Pre-diabetes". Retrieved on 2006-03-17.
^ "Seniors and Diabetes". Elderly And Diabetes - Diabetes and Seniors. LifeMed Media (2006). Retrieved on 2007-05-14.
^ Australian Institute for Health and Welfare. "Diabetes, an overview". Retrieved on 2008-06-23.
^ Dobson, M. (1776). "Nature of the urine in diabetes". Medical Observations and Inquiries 5: 298–310.
^ Nabipour, I. (2003), “Clinical Endocrinology in the Islamic Civilization in Iran”, International Journal of Endocrinology and Metabolism 1: 43–45 [44–5]
^ ^a ^b ^c Patlak M (2002). "New weapons to combat an ancient disease: treating diabetes". FASEB J 16 (14): 1853. PMID 12468446.
^ Von Mehring J, Minkowski O. (1890). "Diabetes mellitus nach pankreasexstirpation.". Arch Exp Pathol Pharmakol 26: 371–387. doi:10.1007/BF01831214.
^ Banting FG, Best CH, Collip JB, Campbell WR, Fletcher AA (1922). "Pancreatic extracts in the treatment of diabetes mellitus". Canad Med Assoc J 12: 141–146. PMID 1933711.
^ Himsworth (1936). "Diabetes mellitus: its differentiation into insulin-sensitive and insulin-insensitive types". Lancet i: 127–130. doi:10.1016/S0140-6736(01)36134-2.
^ Department of Health (Malta), 1897–1972:Annual Reports.
^ Yalow RS, Berson SA (1960). "Immunoassay of endogenous plasma insulin in man". J. Clin. Invest. 39: 1157–75. doi:10.1172/JCI104130. PMID 13846364.
^ The Diabetes Control And Complications Trial Research Group, (1993). "The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group.". N Engl J Med 329 (14): 977–86. doi:10.1056/NEJM199309303291401. PMID 8366922.
^ Dubois, HFW and Bankauskaite, V (2005). "Type 2 diabetes programmes in Europe" (PDF). Euro Observer 7 (2): 5–6.
^ Stewart WF, Ricci JA, Chee E, Hirsch AG, Brandenburg NA (2007). "Lost productive time and costs due to diabetes and diabetic neuropathic pain in the US workforce". J. Occup. Environ. Med. 49 (6): 672–9. doi:10.1097/JOM.0b013e318065b83a. PMID 17563611.

is the 76th day of the year (77th in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... For other meanings of the acronym WHO, see WHO (disambiguation) WHO flag Headquartered in Geneva, Switzerland, the World Health Organization (WHO) is an agency of the United Nations, acting as a coordinating authority on international public health. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 44th day of the year in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 341st day of the year (342nd in leap years) in the Gregorian calendar. ... The American Diabetes Association, or the ADA, is an American health organization providing diabetes research, information and advocacy. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 266th day of the year (267th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 252nd day of the year (253rd in leap years) in the Gregorian calendar. ... is the 323rd day of the year (324th in leap years) in the Gregorian calendar. ... Year 2004 (MMIV) was a leap year starting on Thursday of the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 70th day of the year (71st in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... ISSN, or International Standard Serial Number, is the unique eight-digit number applied to a periodical publication including electronic serials. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... ISSN, or International Standard Serial Number, is the unique eight-digit number applied to a periodical publication including electronic serials. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... ISSN, or International Standard Serial Number, is the unique eight-digit number applied to a periodical publication including electronic serials. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 244th day of the year (245th in leap years) in the Gregorian calendar. ... New Scientist is a weekly international science magazine covering recent developments in science and technology for a general English-speaking audience. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 269th day of the year (270th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... ISSN, or International Standard Serial Number, is the unique eight-digit number applied to a periodical publication including electronic serials. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 134th day of the year (135th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 134th day of the year (135th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Common Era (or Anno Domini), in accordance with the Gregorian calendar. ... is the 174th day of the year (175th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 76th day of the year (77th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 134th day of the year (135th in leap years) in the Gregorian calendar. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Common Era (or Anno Domini), in accordance with the Gregorian calendar. ... is the 174th day of the year (175th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ...

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In medicine, adrenal insufficiency (or hypocortisolism) is the inability of the adrenal gland to produce adequate amounts of cortisol in response to stress. ... Addisons disease(also known as chronic adrenal insufficiency, hypocortisolism or hypocorticism) is a rare endocrine disorder in which the adrenal gland produces insufficient amounts of steroid hormones (glucocorticoids and often mineralocorticoids). ... In medicine (endocrinology), hypoaldosteronism refers to decreased levels of the hormone aldosterone. ... The gonad is the organ that makes gametes. ... Polycystic Ovary Syndrome (abbreviated PCOS or POS), also known clinically as Stein-Leventhal syndrome, is an endocrine disorder that affects approximately 10% of all women . ... Premature Ovarian Failure (POF) is the cessation of menstrual periods and ovulation in women under the age of 40. ... It has been suggested that this article or section be merged with Guevedoche. ... 17-beta-hydroxysteroid dehydrogenase deficiency is a rare disorder of sexual development which can produce impaired virilization (traditionally termed male pseudohermaphroditism) of genetically male infants and children and excessive virilization of female adults. ... -1... Puberty is described as delayed when a boy or girl has passed the usual age of onset of puberty with no physical or hormonal signs that it is beginning. ... Precocious puberty means early puberty. ... Androgen insensitivity syndrome (AIS, or Androgen resistance syndrome) is a set of disorders of sexual differentiation that results from mutations of the gene encoding the androgen receptor. ... In medicine, autoimmune polyendocrine syndromes are a heterogenous group of rare diseases characterised by autoimmune activity against more than one endocrine organs, although non-endocrine organs can be affected. ... Carcinoid syndrome refers to the array of symptoms that occur secondary to carcinoid tumors. ... Anna Haining Bates with her parents Greek gigas, gigantus (giant) is a condition characterized by excessive height growth and bigness. ... People who are shorter have short stature. ... Laron syndrome is a disorder characterized by an insensitivity to growth hormone, caused by a variant of the growth hormone receptor. ... Psychogenic dwarfism, Psychosocial dwarfism or Stress dwarfism is a growth disorder that is observed between the ages of 2 and 15, caused by extreme emotional deprivation or stress. ... Multiple endocrine neoplasia (MEN) (or multiple endocrine adenomas, or multiple endocrine adenomatosis -- MEA) consists of three syndromes featuring tumors of endocrine glands, each with its own characteristic pattern. ... Multiple endocrine neoplasia type 1 is part of a group of disorders that affect the endocrine system. ... Multiple endocrine neoplasia type 2 is part of a group of disorders that affect the endocrine system. ... Progeria (Greek, old age) refers specifically to Hutchinson-Gilford Progeria syndrome. ... Woodhouse-Sakati syndrome is a rare autosomal recessive[1] genetic disorder which causes malformations and deficiencies affecting the endocrine system. ...

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