Home Remedies for Hyperglycemia

Blood Sugar Miracle

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Hyperglycemia and the Glycemic Index

In contrast to the numerous processes that protect against blood glucose falling too low, there is only one that protects the body from hyperglycemia the release of insulin into the blood in response to the ingestion of food. Plasma insulin concentration, although neither its rate of increase nor its effectiveness (which depend on intrinsic physiology of the B cells and peripheral insulin sensitivity, respectively), is in large part determined by the increase in arterial blood glucose concentration that follows ingestion of a carbohydrate-containing meal. People who develop type 2 diabetes often have a delayed B cell response to intravenous glucose before showing overt evidence of impaired glucose tolerance in response to a meal. This is because their B cells, although relatively insensitive to hyperglycemia alone, remain sensitive to the hormones GIP and GLP-1, collectively known as incretins and that are released into the circulation from endocrine cells in the intestine in response...

Clinical Significance of Postprandial and Fasting Hyperglycemia in Diabetic and Nondiabetic Populations

As with fasting blood glucose levels, postprandial hyperglycemia in nondiabetic populations is a predictor of insulin resistance and cardiovascular disease (CVD). The combined 20-year mortality data on men from the Whitehall, Paris prospective, and Helsinki policemen studies showed that the highest quintile compared with the lowest for the 2-h postplasma glucose load was associated with a 2.7 increased risk of CVD mortality. The fasting glucose values were less predictive for CVD, with only the top 2.5 conferring a 1.8-fold increased mortality risk. During a 7-year period, elderly women with isolated postprandial hyperglycemia and a 2-h value more than 11.1mmol l and fasting value less than 7.0 mmol l on a 75-g oral glucose tolerance test had an approximately threefold increased risk of heart disease compared with women whose 2-h values were less than 11.1 mmol l.


Hyperglycemia Hyperglycemia results in fluid movement from the extravascular to the intra-vascular space and a decrease in the serum sodium concentration. This decrease can be calculated as a 1.6 mEq L decrease in sodium concentration for every 100 mg dL increase in serum glucose more than 100 mg dL 62 . Hyperlipidemia caused by lipolysis also may affect serum sodium measurements and result in a decrease in measured serum sodium concentrations 63 .

Diego Ize Ludlow MD Mark A Sperling MD

Classification, the systematic grouping of disease entities by etiology or other categories, is useful because it guides the thinking of physicians, informs their actions, and provides value to their patients. A classical example is anemia, in which hemoglobin of approximately 6 g dL or less is associated with typical symptoms, such as pallor, fatigue, and shortness of breath irrespective of the cause. Although initial treatment may include transfusion, subsequent management is guided by the cause essential factors for hemoglobin synthesis (iron, vitamin B12, folic acid) correction of factors that promote excessive peripheral destruction of red blood cells (splenectomy, steroids for immune hemolysis, avoidance of drugs, such a sulfonamides in those with G6PD deficiency) and congenital or acquired defects in hemoglobin synthesis (hemoglobinopathy, bone marrow infiltration). Knowledge of the etiology of diabetes mellitus (DM) is not as advanced as that of anemia, but it has become...

Deficiency Signs And Symptoms

Low serum beta-carotene levels have been associated with male gender, younger age, lower non-HDL-cholesterol, greater ethanol consumption and higher BMI (Brady et al 1996), increased lipoprotein density and the presence of inflammation (Kritchevsky 1999), high C-reactive protein (Erlinger et al 2001), high blood glucose (Abahusain et al 1999), hypertension (Coudray et al 1997), exposure to environmental tobacco smoke (Farchi et al 2001), as well as all measures of obesity (Wallstrom et al 2001), including obesity in children (Strauss 1999).

Individuals with chronic disease

Diabetes leads to susceptibility to infection in later stages of the disease because of persistent hyperglycemia (Umpierrez and Kitabchi, 2003 Maldonado et al., 2004) or loss of microcirculation efficiency (Dinh and Veves, 2005). Salmonella (Acheson and Hohmann, 2001), Listeria monocytogenes (Nolla-Salas et al., 2002 Chougle and Narayanaswamy, 2004) and Toxoplasma gondii (Yamamoto et al., 2003) have been isolated from infected tissues of patients with advanced diabetes. Elderly who are diabetic are especially prone to infections in general (Rajagopalan, 2005), which may include foodborne infections.

Immunoassay Of Endogenous Plasma Insulin In Man

Centrations observed in diabetic subjects during the glucose tolerance test are not inconsistent with the less extensive data of Bornstein and Lawrence (1) and Baird and Bornstein (39). Very recently Seltzer and Smith (41), employing the rat diaphragm assay of Vallance-Owen and Hurlock (33), have reported insulin concentrations one hour after glucose, in tolbutamide-sensitive adult diabetics, almost in the normal range, but significantly lower values were observed in juvenile diabetics and adult tolbutamide-insensitive diabetics. To resolve the present finding of a higher than normal integrated insulin output in diabetics during the glucose tolerance test with sustained hyperglycemia in these patients, it must be concluded that the tissues of the maturity-onset diabetic do not respond to his insulin as well as the tissues of the nondiabetic subject respond to his insulin. However, from these observations it cannot be concluded that the early diabetic has the same maximal potential...

General Dietary Influences

Folk beliefs and remedies have also been passed down through generations, and they can still be observed today. The majority of African-American beliefs surrounding food concern the medicinal uses of various foods. For example, yellow root tea is believed to cure illness and lower blood sugar. The bitter yellow root contains the antihist-amine berberine and may cause mild low blood pressure. One of the most popular folk beliefs is that excess blood will travel to the head when one eats large amounts of pork, thereby causing hypertension. However, it is not the fresh pork that should be blamed for this rise in blood pressure, but the salt-cured pork products that are commonly eaten. Today, folk beliefs and remedies are most often held in high regard and practiced by the elder and more traditional members of the population.

Why and how did I get diabetes

Diabetes occurs for a number of reasons, but the ultimate cause of the high blood sugar that characterizes the disorder is either deficiency of the hormone insulin or a combination of insulin deficiency and resistance of the body tissues to its actions. In response to food intake, insulin is released by specialized cells in the pancreas and is necessary for adequate amounts of glucose and other nutrients from food to be absorbed into certain tissues of the body. When insulin is lacking or the body resists its actions, the level of glucose in the blood becomes excessively high and diabetes is diagnosed. The difference in the balance between the two characterizes the two major forms of diabetes type 1 and type 2 (see Question 2). Whatever the form of diabetes, its basis is to some extent hereditary and to some extent environmental. The hereditary contribution is more or less constant throughout recent human evolution. It is the environmental component that has changed markedly over the...

Physiological factors influencing food intake

Chemoreceptors in the gastrointestinal tract detect the chemical presence of nutrients, and provide information on the composition of the foods consumed. Factors such as cholecystokinine (CCK) and glucagon-like peptide 1 (GLP-1) are released in response to the chemical presence of food in the gastrointestinal tract. CCK is a hormone released in the duodenum in response to consumption of fat (i.e. long-chain fatty acids) or protein (i.e. amino acids). GLP-1 is a hormone released in the blood by mucosal cells of the gut in response to the presence of carbohydrates and fat (Macintosh et al., 2001). CCK and GLP-1 suppress appetite by decreasing gastric emptying - by affecting the pyloric pressure, stomach motility and stomach muscle relaxation. By decreasing stomach emptying, the stomach distension increases, leading to sensations of fullness (Geliebter et al., 1988 Rolls et al., 1998). GLP-1 stimulates the islet B-cells in the pancreas to secrete insulin, thereby lowering blood glucose...

Applications To Health Promotion And Disease Prevention

Acute almond consumption favorably influences metabolic factors implicated in the progression of type 2 diabetes. Reductions in glycemia and insulinemia are observed after healthy subjects have consumed meals including 60 g of almonds (e.g., 46 almonds) (Jenkins et al., 2006). In one trial, consumption of almond oil with defatted almond flour, intended to mimic bioaccessible almond composition, significantly decreased the 3-hour blood glucose incremental area under the curve (iAUC) compared to when small almond particles were consumed. However, there was no difference in insulin iAUC (Berry et al., 2008). In contrast, other work revealed that both whole almonds and almond oil decreased postprandial blood glucose iAUC compared to a high glycemic index vehicle (Mori, 2009). The discrepant blood glucose findings between consumption of whole almonds and large almond particles may be due to differences in almond particle size distribution (e.g., naturally masticated versus predefined),...

The risk factors paradigm

By attributing known risk factors, including behavioural, physiological, occupational and environmental ones, to the total number of deaths, or the burden of diseases (measured in DALYs - years of life lost due to premature mortality and disability), it is possible to estimate of how much the burden of diseases is attributable to these selected risk factors (Venkat et al. 2010 WHO, 2009). Based on such analysis, it was realised that more than one third of the world's deaths can be attributed to a small number of risk factors. The five top-ranked risks include high blood pressure, tobacco use, high blood glucose, physical inactivity and overweight obesity. They affect countries of all income groups high, middle and low (Figure 1) (WHO, 2009). When taking into account the fact that two leading world's causes of death include cardiovascular diseases and cancers, this is likely to suggest that avoiding tobacco and obesity, and using regular physical activity, can provide the greatest...

The interaction of insulin resistance and Bcell function

About 5 to 10 of patients with cystic fibrosis have diabetes based on fasting glucose levels, but the prevalence of glucose homeostasis abnormalities has been described in up to 34 62,63 . The clinical course of these patients is characterized by a slow progression from normal glucose tolerance to impaired glucose tolerance and ultimately fasting hyperglycemia 62,63 , with no tendency to ketosis. Patients frequently become glucose intolerant at times of illness. This is presumably caused by limited insulin secretion, which cannot compensate for the stress-induced resistance to insulin action. One such ''stress'' is the use of glucocorticoid bursts to dampen pulmonary inflammation. Poor ( -cell function seems to be the major contributor to cystic fibrosis-related diabetes. In comparison with controls, normal glucose-tolerant cystic fibrosis patients have higher glucose levels at 30, 60, and 90 minutes associated with a delayed rise in insulin levels 64-67 and a decreased first-phase...

Can diabetes be cured

In general, we do not consider that diabetes can be cured once it has been diagnosed. People with type 2 diabetes can reverse the detectable abnormalities of diabetes by lifestyle adjustment without the use of medications (discussed in Question 28). However, the tendency to manifest high blood sugar again is always present if the patient is under significant metabolic stress, such as that caused by medications, severe illness, injury, regaining lost weight, cessation of exercise, aging, etc. Therefore we consider that diabetes can be under excellent control or in remission, but we do not usually use the word cured. Even people with type 1 diabetes who have undergone successful pancreas or islet transplantation and no longer require insulin therapy cannot be considered cured. There is a significant possibility that their diabetes will one day come back for a variety of reasons, including rejection of the transplant or a renewed attack on the transplanted islet tissue by the patient's...

Essentiality and Metabolic Functions of Chromium

Symptoms of a patient on total parenteral nutrition (TPN) were reversed by supplemental Cr. Diabetic symptoms, including elevated blood glucose, weight loss, impaired nerve conduction, brain disorders, and abnormal respiratory quotient, that were refractory to exogenous insulin were reversed following increased intake of the essential nutrient Cr. Upon daily addition of supplemental Cr to the patient's TPN solution for 2 weeks, diabetic symptoms were alleviated and exogenous insulin requirement declined from 45 units per day to zero. These findings have been repeated and documented in the scientific literature on several occasions. The hallmark sign of marginal Cr deficiency is impaired glucose tolerance. The effects of Cr on people with high, low, and normal glucose tolerance as well as diabetes are illustrated in Figure 1. Chromium leads to a decrease in blood glucose in people with elevated blood sugar and an increase in those with low blood sugar due to its role in normalizing...

Michael J Haller MDa Mark A Atkinson PhDb Desmond Schatz MDc

Type 1 diabetes mellitus (T1D) is a heterogeneous disorder characterized by autoimmune-mediated destruction of pancreatic beta cells that culminates in absolute insulin deficiency. T1D is most commonly diagnosed in children and adolescents, usually presents with symptomatic hyperglycemia, and imparts the immediate need for exogenous insulin replacement. Approximately one fourth of patients with T1D are diagnosed as adults and often are labeled as having latent autoimmune disease of adults, however. Approximately 5 to 10 of adults diagnosed with type 2 diabetes actually may have T1D. Terms such as ''juvenile diabetes'' and ''insulin-dependent diabetes'' have been replaced because they no longer adequately reflect our understanding of the natural history and patho-physiology of T1D. This article provides an in-depth review regarding our current understanding of the epidemiology, etiology, presentation, and management of T1D as it relates to childhood and adolescence.

Environmental Factors

The best way to lower the risk of diabetes is to lead a healthy life style by eating a healthy balanced diet, engaging in regular physical activity, and balancing the energy intake with energy expenditure. Indeed, recent evidence would suggest that the adoption of a healthy life style in high-risk subjects can decrease the risk of developing T2D by 60 . There is a close relationship between diabetes and obesity, especially when the latter has central distribution. Apart from obesity, several other nutritional factors affect glucose metabolism and the risk of T2D. Current evidence suggests an association between different types of fats and carbohydrates and insulin resistance and T2D. Diets rich in saturated fats are associated with insulin resistance a multicentre study in a group of healthy individuals showed that a diet high in saturated fat decreased insulin sensitivity compared with a diet high in monounsaturated fat with the same total fat content. Prospective and...

Fibrocalculous Pancreatic Diabetes

Given the underlying problem of malnutrition they benefit from high calorie intake, especially the protein content. There is a need for further investigation into the roles of nutritional, environmental, and genetic factors to establish the etiopathogenesis of this illness.

Oral Glucose Tolerance Test

The World Health Organization proposes that the test and criteria for gestational diabetes should be the same as for nonpregnant adults, with the exception that individuals fitting the category of impaired glucose tolerance be treated the same as diabetics because of the potentially harmful effects of hyper-glycemia on the fetus.

Gestational Diabetes Mellitus

This disorder, which is defined as hyperglycemia first detected during pregnancy, occurs in 2-5 of pregnant women. Often, one cannot determine whether glucose intolerance antedated the pregnancy or whether hyperglycemia was provoked by the hormonal milieu associated with pregnancy. Hyperglycemia remits postpartum in 90 of women with gestational diabetes, but these women are at increased risk for subsequent development of diabetes, which is usually type 2. Although most cases of this form of diabetes are detected by blood glucose screening performed as a routine procedure early in the third trimester, the current recommendation is that universal screening is probably unwarranted. A woman younger than age 25 years, of normal body weight, without a family history of diabetes or a personal history of poor pregnancy outcome, and from an ethnic group with low rates of diabetes is at sufficiently low risk of gestational diabetes that glucose testing can be omitted. In contrast, women with...

Other Abnormalities of Glucose Tolerance

Stress hyperglycemia This denotes an individual who is frankly hyperglycemic (> 7.8mmol l) under conditions of intercurrent illness or during treatment with medications that provoke diabetes. Such people may revert to normal glucose tolerance following removal of the stress. Although not an official category of diabetes, such abnormal glucose values in hospitalized patients cannot be ignored since there is strong evidence that treatment to normoglycemia significantly lowers mortality, at least for patients with acute myocardial infarction or with critical illness in an intensive care unit. Precipitants of stress hyperglycemia are listed in Table 4. Table 4 Risk factors for the development of stress hyperglycemia in critical illness Table 4 Risk factors for the development of stress hyperglycemia in critical illness

Control of Blood Glucose Level

A first and very basic goal of diabetes care is to eliminate the symptoms of hyperglycemia. Treatment is inadequate if the person remains polyuric, thirsty, or continues to lose weight from hypergly-cemia. To cause symptoms, however, hyperglycemia usually must average more than 11 mM (200mg dl). Since blood glucose in the 7-11 mM (125-200 mg dl) range is distinctly abnormal and does cause long-term diabetic complications, freedom from symptoms is only the beginning of adequate therapy.

Prevention or Control of Comorbidities

Morbidity and mortality among people with diabetes are rarely due to acute hyperglycemia or diabetic ketoacidosis. Rather, the long-term complications are either specific to diabetes (e.g., diabetic retinopathy or nephropathy) or accelerated by diabetes (e.g., atherosclerosis). Diabetes significantly increases the risk of coronary artery, cerebro-vascular, and peripheral vascular disease, with these cardiovascular complications accounting for approximately 80 of deaths in diabetes. Prudent dietary management of diabetes therefore requires consideration of what can be done to prevent or control the various comorbidities of this disease. For example, all people with diabetes should be on a diet that minimizes the risk of atherosclerosis. At the first clinical sign of hypertension, dietary methods should be implemented to lower blood pressure.

Nonnutritive Sweeteners

Many 'diet' sweeteners, such as sorbitol or fructose-based snacks, do cause at least some degree of hyperglycemia. Sugar alcohols (polyols) such as sorbitol, mannitol, and xylitol are classified as hydrogenated monosaccharides, hydrogenated disaccharides, and oligosaccharides. They do contain calories, but because they are only partially absorbed in the small intestine, they have a reduced energy value per gram. Excessive use of sugar alcohols has laxative effects and can cause diarrhea.

Accelerated Atherosclerosis

Essentially the same nutritional approaches to the prevention of atherosclerosis apply whether or not a person has diabetes. However, they are even more important for the patient with diabetes since hyperglycemia is a risk factor, and most people with diabetes die of atherosclerotic cardiovascular disease. Therefore, anyone with diabetes should follow a 'heart healthy' diet that focuses on lowering low-density lipoprotein (LDL) cholesterol level, which is a major contributor to the progression of atherosclerosis. Total fat intake can be held to 25-35 of total calories, less than 7 saturated fat and the remainder divided between monounsaturated fat and polyunsaturated fats. The recommendation allows for increased intake of unsaturated fats in place of carbohydrates in people with diabetes. In addition to the antiatherosclerotic diet, there should be routine screening for other specific risk factors, notably hypertension and dyslipidemia. If found, these risk factors, which are even...

Ordering up a round of lab tests

The doctor will also often order a complete blood count (CBC), which is a count of your red and white blood cells. It's also a check on whether you may have a blood disease that can cause a person to feel weak and achy, such as anemia or another blood disease. If the CBC comes back normal, in most cases, you don't have such a disease. The doctor will also usually order a test of your blood glucose to rule out diabetes (characterized by hyperglycemia, or high levels of blood glucose) or, at the other end of the scale, hypoglycemia, a condition of unusually low blood sugar.

Indications Purple Star Thistle

Amenorrhea (f BOU) Anorexia (f BOU VAD) Bacteria (1 MPG) Brucella (1 MPG) Cancer (f BIB JLH) Cold (f VAD) Corns (f JLH) Diabetes (f1 MPG VAD) Dyskinesia (f VAD) Fever (f BIB EFS) Fistula (f BIB WO2) Flu (f VAD) Gallstone (f HJP) Gravel (f BIB WO2) Headache (f BOU) High Blood Pressure (1 MPG) Hyperglycemia (f VAD) Infection (1 MPG) Jaundice (f BIB) Kidney stone (f HJP) Malaria (f BOU) Mycobacterium (1 MPG) Nephrosis (f BOU HJP) Ophthalmia (f BOU) Pain (f BOU) Pseudomonas (1 MPG) Salmonella (1 MPG) Staphylococcus (1 MPG) Stone (f BIB BOU WO2) Wound (f BOU) Worm (f BOU).

Impaired Glucose Tolerance and Diabetes

Forty-nine articles of RCTs were reviewed to evaluate the effect of weight loss on fasting blood glucose and fasting insulin. Studies were conducted in individuals with normal blood glucose levels (fasting plasma glucose < 115 mg dL < 6.4 mmol L ), in individuals with impaired glucose tolerance (fasting plasma glucose of < 140 mg dL 7.8 mmol L or 2 hours postprandial plasma glucose of > 140 to < 200 mg dL 7.8-11.1 mmol L ), or in individuals with diabetes (fasting plasma glucose of > 140 mg dL or 2 hours postprandial plasma blood glucose > 200 mg dL).* Evidence Statement Weight loss produced by lifestyle modifications, reduces blood glucose levels in overweight and obese persons without type 2 diabetes, and reduces blood glucose levels and HbAic in some patients with type 2 diabetes. Evidence Category A.

Definition and Impact of Glucose Tolerance

A most important factor underlying the morbidity in diabetes, its complications and concurrent cardiovascular diseases, is hyperglycemia. Importantly, even at such a low degree as not to reach the limit criteria for diabetes, hyperglycemia is related to morbidity. Lifestyle changes and pharmacological interventions to reduce or even normalize the hyper-glycemia exist, and consistent adherence to such regimen will reduce the morbidity. However, hyper-glycemia is initially without symptoms and therefore usually remains undetected for a long period of time. Therefore, it is important to have reliable methods for the detection of hyperglycemia in its initial stages for proper actions to be taken. Such detection relies on analysis of the circulating glucose in the fasting state or after a challenge. Thus, it is important to recognize that hyperglycemia is subdivided into two different entities. The first entity is fasting hyperglycemia. This is mainly due to inappropriately high release of...

Interpretation of Growth Curves

More recent growth curves have been developed from serial ultrasound measurements of fetal growth in normal pregnancies, providing continuous rather than cross-sectional growth patterns. The growth of a preterm infant is better correlated with serially determined fetal growth rates than with cross-sectional neonatal growth curves. Serial ultrasound measurements of fetal growth also more accurately determine how environmental factors can inhibit (for example, maternal undernutrition globally, or hypoglycemia specifically) or enhance (for example, maternal overnutrition globally or hyperglycemia specifically) growth.

What are the most common symptoms of diabetes

The common and early symptoms of diabetes result from the effect of the high blood sugar entering the urine and drawing fluid from the body's tissues along with it. This leads to excess urine production with frequent urination. The loss of body fluid leads to thirst, in order to replace the fluid loss. As long as the person with diabetes is able to keep pace with his or her thirst by regular fluid intake, he or she will remain relatively well. However, without free access to fluid, which can occur for a variety of reasons, one will become dehydrated, which leads to dizziness upon standing upright drowsiness, confusion, and ultimately fainting and unconsciousness. Due to the wasting of calories as glucose in the urine, patients will complain of hunger and will usually lose weight if high blood sugar is very marked. However, it is important to note that only a minority of people with diabetes will experience these symptoms. Frequently, the degree of high blood sugar is more moderate,...

Diabetes Complications

People with diabetes are at increased risk for serious long-term complications. Hyperglycemia, as measured by fasting plasma glucose concentration or glycosylated hemoglobin (HbA1c), causes structural and functional changes in the retina, nerves, kidneys, and blood vessels. This damage can lead to blindness, numbness, reduced circulation, amputations, kidney disease, and cardiovascular disease. Type 1 diabetes is more likely to lead to kidney failure. About 40 percent of people with type 1 diabetes develop severe kidney disease and kidney failure by the age of fifty. Nevertheless, between 1993 and 1997, more than 100,000 people in the United States were treated for kidney failure caused by type 2 diabetes. Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemia state (HHS) are serious diabetic emergencies and the most frequent cause of mortality. Both DKA and HHS result from an insulin deficiency and an increase in counter-regulatory hormones (a.k.a. hyperglycemia). Hyperglycemia...

Hepatic Glucose Metabolism

During infection, the liver increases glucose production to defend against hypoglycemia. In fact, the increase in hepatic glucose production is the major reason why patients with infection have an elevated blood glucose concentration. For example, patients with active malaria can have an increase in fasting glucose concentration due to an increase in gluconeo-genesis and overall glucose production. Approximately 75 of cancer patients, like patients with infection, also have an elevated rate of glucose production. Cancer patients also have a mild form of injury approximately 75 have an elevated rate of hepatic glucose production. In 18 studies, hepatic glucose production for normals ranges between 1.6 and 3.0mg kg min, with an average of 2.1 mg kg min. Glucose production for cancer patients without weight loss ranges from 1.7 to 5.1 mg kg min, with a mean of 2.75 mg kg min. This is a 30 increase in the fasting rate of hepatic glucose production. For cancer patients with weight loss,...

Structural Property Of Ginseng

The other major bioactive ingredient of ginseng is polysaccharide. Acidic polysaccharides found in ginseng such as ginsan (17,18), ginsenan S-IA, and ginsenan S-IIA (19) have been reported to have potential immunological activities. Ginseng's immunomodulatory effects may be one of its antitumor mechanisms. Ginseng polysaccharide GH1 reduces blood glucose and liver glycogen of mice (20). A high-output inducible nitric oxide synthase (iNOS) was shown in female BALB c mice administered intraperitoneally (i.p.) with acidic polysaccharide from ginseng (21). Rhamnogalacturonan II from the leaves of P. ginseng C. A. Meyer acts as a macrophage Fc receptor expression-enhancing polysaccharide (22).

Could I have had diabetes for a long time and not known it

Yes, indeed, you could have had diabetes for a considerable period of time, months or even years, and been unaware of it. However, it is unlikely that you could have had severe diabetes with very high blood sugars for a long time without having to seek medical attention,

Components of Parenteral Nutrition

Difficulties with glucose metabolism are a common problem in preterm infants. This may be due to decreased energy stores, increased gluconeogenesis secondary to stress, decreased insulin secretion, or insulin resistance. When hyperglycemia occurs the glucose infusion rate should be decreased, however the rate should not be decreased below 4-6 mg kg-1 min-1 (0.022-0.33 mmol kg-1 min-1) as this is the minimum supply rate necessary to provide adequate energy to the brain. Usually, the infusion of amino acids improves glucose tolerance by decreasing glucose production, stimulating insulin secretion, and enhancing insulin action. The use of continuous insulin infusions to treat hyperglycemia is controversial. If used, the insulin infusion should be initiated at a rate of 0.05 U kg-1 h-1 and titrated to achieve and maintain a plasma glucose concentration between 80 and 120mgdl-1 (4.44-6.66 mmol l-1).

Adverse Effects And Reactions Allergies And Toxicity

Most work related to the hypoglycemic effects of lupine has been conducted in animals. Recent work on streptozoticin-induced diabetic rats has shown that extracts of the seed can lower blood glucose levels in these rats to normal levels, and can blunt the glucose spike following a meal. The mechanism by which white lupine has this effect is unknown, but the effect is seen both in the wild-type white lupines (with alkaloids present) and in the sweet lupines that are being cultivated in Egypt and Australia. The alkaloids are not the component responsible for the antihyperglycemic effect. The alkaloid 2-thionosparteine, but not lupanine, has also been reported as lowering blood glucose in diabetic animals in a manner comparable to that of the conventional antidiabetic

Lipid complexation with starch

Apart from lipid-starch complexation that could modify the glycemic response, several studies have shown that co-intake of fat along with carbohydrates in a mixed meal could affect postprandial glucose response. It is believed that fat may reduce postprandial glucose by decreasing the rate of gastric emptying, at least in part related to increased stimulation of the gastrointestinal hormones such as glucose-dependent insulin-releasing polypeptide (GIP) and glucagon-like polypeptide-1 (GLP-1) (Morgan, 1998). Several issues, including dosage levels of fat affecting glucose response, have been described by Owen and Wolever (2003). The authors showed that fat intake along with carbohydrates in normal healthy subjects, in a dose-dependent relationship, could decrease the glycemic response however fat consumption in a normal range (17-44 energy) does not significantly affect glycemic response. As pointed out by Owen and Wolever (2003), it is important to note that individuals with diabetes...

Insulin Analogues in Children and Teens with Type 1 Diabetes Advantages and Caveats

Type 1 diabetes mellitus (T1D) is a chronic, metabolic disorder that most commonly presents during childhood and is characterized by absolute insulin deficiency. T1D is caused by selective immune-mediated autoreactive T-cell destruction of beta cells in the pancreatic islets of Langerhans 1 . Insulin deficiency leads to chronic hyperglycemia and other disturbances of intermediary metabolism. As a result, individuals who have diabetes are at risk of developing progressive long-term microvascular (eg, retinopathy, nephropathy, and neuropathy) and macrovascular (eg, cerebral, coronary, and peripheral vascular disease) complications 2 . The seminal trial in T1D, the Diabetes Control and Complications Trial, proved in adults and adolescents that the onset and progression of the microvascular complications can be prevented or delayed by tight control of blood glucose levels 2-4 .

Education And Prepregnancy Planning

The risk of congenital abnormalities among the babies of diabetic women is locked into a close correlation with blood sugar control at the time of conception. An A1c less than 7 percent carries no increased risk of abnormalities. With an A1c between 7.2 and 8.1 percent, the risk of abnormalities jumps to 14 percent. For A1c's between 8.2 and 11.1 percent, the risk is an appalling 23 percent, and for greater than 11.2 percent, the risk rises to greater than 25 percent. That's more than a one in four chance of a tragedy that could have been avoided. In The Diabetic Woman, All Your Questions Answered, Dr. Lois Jovanovic says, It's so much easier to plan to have a baby by first getting your blood sugars as close to normal as possible, rather than having to play catch-up by manipulating insulin, diet, and exercise to quickly normalize blood sugars so your baby does not experience high blood sugars. She recommends that women who are planning on becoming pregnant should pretend they are...

Does diabetes put me at risk of any other diseases or illnesses

Aside from the direct consequences of high blood sugar itself, which are discussed in Question 29, people with diabetes are at risk of suffering from other associated diseases. In the case of type 1 diabetes, the diseases either result from the high blood sugar or from the root cause of the diabetes, which is a predisposition to destroy the hormone-producing tissues (called autoimmunity). Thus, a person with type 1 diabetes is more likely to suffer from adrenal gland damage (Addison's disease), thyroid gland damage (Graves' or, much more commonly, Hashimoto's disease), and several other disorders. Fortunately, except in the case of

Evidence of the Benefits of Enteral Nutrition

EN has not been compared to standard care (SC) in the same systematic way as PN. Systematic reviews of EN compared to PN have consistently shown increased infectious complications with PN. However, all showed significantly elevated blood glucose in the PN group. It is likely that hyperglycemia was more frequent with PN because patients randomized to PN received more energy than those on EN, despite the intent to make both groups isocaloric. Data from a large controlled trial in intensive care unit (ICU) patients showed that keeping blood glucose below 7mmol l irrespective of the route of feeding significantly reduced mortality and multisystem organ failure arising from sepsis. This study indicated that hyperglycemia in the PN arm of the study would have significantly increased the risk of sepsis. None of these studies prove that EN is better than standard therapy they show that it is less likely to cause infection than PN given without regard to the rigid control of blood glucose....

Nutritional Support of Bone Marrow Transplant Patients

A review found that although EN is the current standard for nutritional support, it has not found favor for patients undergoing bone marrow transplant because these patients have severe mucositis, often vomit the tube, and do not tolerate nasogas-tric tubes because of discomfort and ulceration. Veno-occlusive disease with encephalopathy may occur in bone marrow patients, which is another indication for TPN with branched-chain amino acids rather than EN. A controlled trial of EN versus TPN in bone marrow transplant patients showed that outcome was no different but body composition and magnesium levels were better maintained on TPN. In contrast, TPN patients had more fluid overload and hyperglycemia. It should be noted that 'enteral nutrition' in this trial was not tube feeding but a combination of snacks, diet counseling, and tube feeding. The authors concluded that TPN should be reserved for patients with severe mucositis. Review of the Cochrane

Pancreatitis and Enteral Nutrition

The authors concluded that hypocaloric enteral feeding is better than TPN. This study is similar to many others, showing that EN providing less than estimated energy intake is associated with reduced hyperglycemia and sepsis. The conventional interpretation is that the EN route reduces sepsis. The trial by van den Berghe et al. showed that irrespective of the route of nutritional support, control of hyperglycemia reduced mortality in the ICU. Their findings support the alternative explanation that the EN route protects the patient because it results in hypocaloric feeding, which prevents hyper-glycemia. The study shows that EN can be given as a cheaper source of nutrition, but since EN was needed only for 6.7 days with less than adequate energy intake, it raises the question as to whether any nutritional support was required. Another important question is whether TPN should be hypo-caloric rather than meet target energy intake in patients who are unable to take oral...

Perioperative Support in Severe Malnutrition

Increased morbidity and mortality risks are associated with malnourished surgical patients. The Veteran's Affairs Parenteral Nutrition Cooperative Trial evaluated the benefits of preoperative PN in patients with varying degrees of malnutrition. Significant benefit was demonstrated only among those patients who were severely malnourished (albumin < 3.0g dl). Interestingly, an increased rate of infectious complications was observed in mildly and moderately malnourished patients receiving PN compared to the control group. If enteral access is available and feeds are tolerated, preoperative en-teral nutrition support has been found to be equally effective when utilized for 7-14 days or longer in malnourished surgical patients. Early studies that suggested increased adverse outcomes with paren-teral compared to enteral support were often based on management techniques that are no longer consistent with standard of practice, which included the overfeeding of macronutrients, rapid infusion...

Dextrose Prescription

Dextrose in PN solutions generally provides 40-60 of total energy requirements. Hyperglycemia is a common complication of PN due to diabetes, medications, or stress response, so the dextrose load is often initiated below goal until tolerance is demonstrated. The maximum glucose utilization rate is 5-7mg kg minute. Doses that exceed this may result in glucose intolerance or hepatic steatosis. Studies have demonstrated that aggressive blood glucose management is associated with fewer septic complications in critically ill patients.

Historical Cultivation And Usage

All parts of neem have been in use since ancient times, to treat several human ailments, and also as a household pesticide. The commercial use of neem was known to exist in the Vedic period in India (over 4000 years BC), and domestic uses were mentioned by Kautilya in his Arthasastra (4 BC). Under natural conditions, neem seeds ordinarily fall onto the ground and the viable seeds germinate within a week or two, in the presence of rain water. The seedlings that grow in the shade of the tree are transplanted and propagated in empty fields, since neem is renowned for good growth on dry, infertile sites. Neem seed oil, bark, and leaf extracts have been therapeutically used as folk medicine to control diseases such as leprosy, intestinal helminthiasis, respiratory disorders, constipation, and skin infections (Biswas et al., 2002). Neem's excellent antibacterial and anti-allergic properties make it effective in fighting most epidermal dysfunctions, such as acne, psoriasis, and eczema....

Monitoring and Management

Blood glucose levels should be carefully monitored throughout the course of PN infusion in order to detect and prevent hyperglycemia or hypoglycemia. Capillary blood glucose monitoring devices provide a convenient means of determining blood sugars. Blood capillary glucose levels should be obtained more frequently during the initial days of PN therapy and subsequently as needed for 'spot checks' or to verify glucose levels obtained by serum blood sampling. Insulin management may warrant a separate intravenous insulin infusion, subcutaneous coverage with sliding-scale insulin, or the addition of insulin as a component of PN. Because insulin needs are often acutely elevated in infection or stress, sliding-scale subcutaneous insulin or a separate insulin infusion may be used in combination with the addition of insulin to the PN.

What is diabetic retinopathy

Diabetic retinopathy is damage to the eye that results from chronically untreated or inadequately treated high blood sugar. In its more advanced form, it can result in severe visual loss or blindness if untreated, and this can occur suddenly without warning. It is the leading cause of blindness in working age adults in the United States and more than 20,000 people become blind as a result of diabetes each year. In order to prevent this, all people with diabetes should periodically be screened with an eye exam or photography of the

Health Risks due to Overweight Obesity

Increasing body fatness is accompanied by profound changes in physiological function. These changes are, to a certain extent, dependent on the regional distribution of adipose tissue. Generalized obesity results in alterations in total blood volume and cardiac function while the distribution of fat around the thoracic cage and abdomen restricts respiratory excursion and alters respiratory function. The intra-abdominal visceral deposition of adipose tissue, which characterizes upper body obesity, is a major contributor to the development of hypertension, elevated plasma insulin concentrations and insulin resistance, hyperglycemia, and hyperlipidemia. The alterations in metabolic and physiological function that follow an increase in adipose tissue mass are predictable when considered in the context of normal homeostasis.

Elka Jacobson Dickman MDa b Lynne Levitsky MDab

Most cases of diabetes in childhood are immunologically mediated and eventually lead to complete insulin deficiency. Oral therapies for children with type 1 autoimmune diabetes mellitus (T1DM) are experimental and of unproven efficacy. Eight percent to 45 of children with newly diagnosed diabetes have non-immune-mediated diabetes 1 . Oral medication is often a feasible option for this group of children. The phenotype of type 2 diabetes mellitus (T2DM) is similar in adults and children and includes hyperglycemia, obesity, dyslipidemia, and insulin resistance. Patients who have T2DM are at risk for the same cluster of long-term complications as persons with T1DM, including nephropathy, retinopathy, and neuropathy 2 . Children and young people who have T2DM have a greater risk of early retinopathy and nephropathy than youth with T1DM and have a greater risk of macrovascular disease 3 . The United Kingdom Prospective Diabetes Study (UKPDS) showed that aggressive treatment of hyperglycemia...

What is diabetic nephropathy

Diabetic nephropathy is the term used to describe kidney damage that occurs in diabetes, usually of longstanding. The damage to the kidney in diabetes can result from the high blood sugar itself, which leads to an expansion of certain types of material in the filtering mechanism of the kidney. This expansion damages the delicate cells responsible for filtering waste materials through the kidney. Eventually, there are abnormal pressures and changes in the important electrical balance in this complex structure. These changes lead to leakage of proteins that are usually either retained or reabsorbed by the kidney. The blood pressure can rise due to overload of fluid and constriction of small blood vessels. The rise in blood pressure further damages the kidney if not treated. If there is an excessive leak of protein, the body becomes protein deficient, which can lead to generalized puffiness and swelling. Eventually, the kidneys can fail and their functions must be replaced by the...

Side Effects of Corticosteroids

The side effects of corticosteroids are numerous and very common. They include Cushing's syndrome, fluid retention, increased appetite and weight gain, truncal obesity (skinny arms and legs but increased fat on back and stomach), moon face (fat cheeks), stretch marks, acne, growth retardation, bone-weakening calcium loss, avascular necrosis, muscle weakness, poor blood sugar control (diabetes), cataracts, increased intraocular pressure, increased infections, oral and vaginal thrush, atherosclerosis, extra hair growth, and mood changes. In addition to these common side effects, corticosteroids also may cause high blood pressure, inflammation of the pancreas, and pseudotumor cerebrae (increased pressure in the brain, associated with severe headaches and visual problems).

Why is the risk of blood vessel diseases increased so much in diabetes

There are several reasons why the risk of vascular diseases, such as heart attack, stroke, and diseases of the vessels in the limbs (peripheral vascular disease), is increased in both types of diabetes. The weight gain and lack of exercise common in people with type 2 diabetes lead to other conditions such as abnormal cholesterol levels and high blood pressure, which are potent causes of vascular disease. If all of these risk factors are not treated effectively, the probability of vascular disease remains high. High blood sugar over months and years leads to a chemical reaction of the sugar in the blood vessels, damaging them structurally. Perhaps most importantly, we now know that diabetes and obesity can be described as irritants to the body tissues, meaning that the body becomes generally inflamed. We know that this is so because we can measure high levels of compounds that indicate inflammation in the blood of many people with diabetes. It turns out that this inflammation, when...

Metabolic Consequences of Biotin Deficiency

Rather than the expected hypoglycemia, biotin deficiency may sometimes be associated with hyperglycemia, because of reduced activity of glucokinase. As discussed in Section 11.2.4, this results in both decreased clearance of glucose by the liver and also decreased secretion of insulin in response to hy-perglycemia. In streptozotocin diabetic animals, the administration of biotin improves glucose tolerance as a result of the induction of glucokinase (Zhang etal., 1997).

PMS and Dietary Factors

Several mechanisms proposed for the development of PMS symptoms have been claimed to be promoted by magnesium deficiency. Low magnesium status may also be responsible not only for exacerbating gonadal hormone imbalance in women, but may promote an increase in the aldosterone-to-oestrogen ratio. Enhanced aldosterone levels promote potassium and magnesium excretion and sodium retention, thus inducing fluid retention as found in PMS-H. In addition, deficient levels of magnesium decrease blood glucose control in two ways by decreasing the ability of the liver to metabolize glucose and by increasing insulin secretion in response to glucose. Hence, changes in appetite and craving, both common PMS symptoms, may be closely linked to magnesium deficiency through loosening of blood glucose control. A low blood glucose supply to the brain may cause craving as a signal for increased energy intake. Even the decreased brain dopamine levels postulated to be responsible for anxiety and irritability...

Tissue Uptake of Vitamin C

The relative importance of uptake of dehydroascorbate and dehydroascor-bate by tissues is unclear. It has been suggested that normal physiological concentrations of glucose will inhibit uptake of dehydroascorbate (Liang et al., 2001). Functional signs of deficiency may develop in poorly controlled diabetes mellitus, despite an adequate intake and adequate plasma concentrations, suggesting that hyperglycemia and insulin insensitivity - and thus uptake of dehydroascorbate in competition with glucose - are important. Some of the adverse effects of poor glycemic control in diabetes mellitus (especially the development of cataract) may be related to this impairment of vitamin C

Biologically targeted therapies

MTOR is an intracellular protein kinase which regulates cellular response to nutrients and energy in addition to mediating signaling through downstream growth factors such as insulin-like growth factor (IGF-1).Sporadic neuroendocrine tumors are known to co-express both IGF-1 and its receptor. There is in vitro evidence suggesting stimulation of mTOR pathway and inhibition of this pathway has demonstrated tumor regression in preclinical models (von Wichert et al., 2000 Yao, 2007). Temsirolimus and everolimus are rapamycin derivatives that have been tested in PNET. Temsirolimus was evaluated in a phase II clinical trial in advanced neuroendocrine tumors which included 15 patients with PNET. Partial response rate of 6.7 was observed in the PNET patient population (Duran et al., 2006). In an initial phase 2 study the combination of everolimus and octerotide was evaluated, reporting a partial response of 27 in patients with PNET (Yao et al., 2008b). The activity of everoliumus was...

Role of Insulin in Enhancing Growth with Parenteral Nutrition

Exogenous insulin is most commonly used to control early hyperglycemia in very preterm infants. However, informal surveys suggest that there are a number of centers that use insulin in preterm neonates receiving parenteral nutrition for the purpose of enhancing growth. Insulin has been shown to successfully lower glucose levels and to increase weight gain without undue risk of hypoglycemia 23-25 . It is presumed that improved weight gain is secondary to both increased glucose utilization and improved protein balance in infants receiving parenteral nutrition. However, little is known about the effects of intravenous insulin infusions and relative hyperinsulinemia on the quality of weight gain and on counterregulatory hormone concentrations and the possible effects of these concentrations. Administration of intravenous amino acids has been shown to decrease glucose concentrations in ELBW infants, presumably by enhancing endogenous insulin secretion. In the above study by Thureen et al....

Lipid Soluble Thiamin Derivatives

In recent years, several lipid-soluble derivatives of thiamin have been introduced, of which the best known is benfotiamine. Advantages of these compounds appear to be increased absorption, but by the diffusion mechanism only, and greatly increased transketolase activity. Transketolase is the rate-limiting enzyme of the nonoxidative branch of the pentose phosphate pathway. Benfotiamine has been shown to be useful for the management of rare genetic disorders in thiamin transport and may also prove useful to prevent damage from diabetic hyper-glycemia. One study demonstrated that benfotia-mine prevented experimental retinopathy. Diabetic hyperglycemia is accompanied by an increase in the potentially pathogenic glycolytic metabolites glyceraldehyde-3-phosphate and fructose-6-phosphate. Benfotiamine, by increasing transketolase activity, stimulates the pentose phosphate pathway to metabolise these glycolytic intermediates into pentose-5-phosphates and prevent the intracellular increase of...

The Low Glycemic Index Diet

A high-GI diet elicits a sequence of hormonal events that challenge glucose homeostasis. Soon after a high-GI meal, blood insulin level rises higher than that after a low-GI meal with similar nutrients. Conversely, a high-GI meal inhibits glucagon secretion. The strikingly increased insulin glucagon ratio constitutes a powerful anabolic stimulus, promoting uptake of nutrients in liver, muscle, and fat and suppressing hepatic glucose output. Within 60 min after a high-GI meal, blood glucose begins to fall, often reaching levels below fasting, and release of fatty acids from adipose tissue is suppressed. The body's attempt to restore the metabolic fuel concentrations to normal stimulates hunger and overeating during this metabolic occurrence of rapidly declining blood glucose with low nonesterified fatty acid concentration. In addition, the early postprandial hyperglycemia and hyperinsulinemia and the late postprandial hypo-glycemia and counterregulatory hormone response could adversely...

Neural invasion as part of pancreatic neuropathy in PCa

While the mechanisms of these neuroplastic alterations are not completely understood, there is increasing evidence that these neuropathic alterations in PCa can in part be attributed to the neurotrophic character of the tumor microenvironment in PCa (Demir et al., 2010). In a novel in vitro neuroplasticity assay, we could demonstrate that tissue extracts of PCa, PCa cell supernatants and supernatants of human pancreatic stellate cells as main generators of desmoplasia can all induce axonal sprouting, increased neurite density and perikaryonal hypertrophy of neurons isolated from dorsal root ganglia or myenteric plecus under in vitro conditions (Demir et al., 2010). In a very recent study, Li et al. added a novel dimension to our understanding of neural alterations in PCa In accordance with their former hypothesis (Li& Ma, 2008), patients with hyperglycemia demonstrate more pronounced neural hypertrophy and increased neural density than normoglycemic patients (Li et al., 2011)....

Impact Of Wheat Sprouts On Glucose And Insulin Metabolism

Interestingly, Kim et al. (2006) showed that the naphthalenemethyl ester derivative of the phenolic compound dihydroxyhydrocinnamic acid was able to decrease blood glucose levels in streptozotocin-induced diabetic C57BL 6 mice and spontaneously diabetic ob ob mice to near normoglycemia. In addition, this phenolic compound increased glucose uptake and enhanced phosphorylation of the insulin receptor-b subunit and insulin receptor substrate 1 in adipocytes in vitro and in vivo, which led to an increase in insulin receptor signaling. The hydroxycinnamic acid caffeic acid enhanced the glucose uptake into isolated adipocytes in a concentration-dependent manner (Hsu et al, 2000). This may in turn lead to an enhanced glucose utilization. Ferulic acid effectively suppressed blood glucose levels in streptozotocin-induced diabetic mice and in KK-Ay mice (Ohnishi et al., 2004).

Structure Of Streptozotocin

Glucose-6-phosphatase catalyzes the final step in glucose production by the liver and kidney. STZ has been reported to increase the expression ofglucose-6-phosphatase mRNA, which contributes to the increased glucose-6-phos-phatase activity in diabetes mellitus (21). Overproduction of glucose by the liver is the major cause of fasting hyperglycemia in both insulin-dependent and non-insulin-dependent diabetes mellitus. Ninety percent of partially pancreatectomized diabetic rats have a > 5-fold increase in the messenger RNA and a 3-4 fold increase in the protein level of the catalytic subunit of hepatic glucose-6-phosphatase. Prolonged hyperglycemia may thus result in overproduction of glucose via increased expression of this protein (22). Normalization of the plasma glucose concentration in diabetic rats with either insulin or the glycosuric agent phlorizin normalized the hepatic glucose-6-phosphatase messenger RNA and protein within approximately 8 hr. However, phlorizin failed to...

Sarah J Glastras MBBS Hons BSc Psychol Honsa Fauzia Mohsin Mbbs Fcpsa Kim C Donaghue MBBS PhD FRACPab

Hyperglycemia is the primary pathogenic factor in the development of complications 1 . Several biochemical pathways may be activated in the presence of hyperglycemia, including polyol accumulation, formation of advanced glycation end products, oxidative stress, and activation of protein kinase C 2,3 . The combined effect of these mechanisms results in further cellular, functional, and structural changes. Vascular changes of diabetes result in hyperperfusion of or-

Early Parenteral Nutrition Studies in ELBW Neonates

The first comprehensive, prospective, randomized, controlled trial of 'aggressive' versus 'conservative' nutrition in 125 relatively sick neonates weighing < 1,500 g at birth was conducted in the 1990s by Wilson et al. 18 . Infants in the aggressive intake group were sicker, were started on earlier enteral nutrition (day 2 vs. day 5 in the control group), parenteral amino acids (day 1 vs. 3), and parenteral lipid (day 2 vs. 5). Nutrients were advanced more quickly and to higher maximal intakes in the aggressive nutrition group, and insulin was used if hyperglycemia developed. In terms of outcomes, there were no differences between groups in survival, hospital stay, days to full enteral feeding, and incidence of necrotizing enterocolitis (NEC), bronchopulmonary dysplasia, sepsis, cholestasis, and osteopenia. There was a significant improvement in weight gain at discharge from hospital in the aggressive intake group, though both groups demonstrated significant postnatal growth failure...

Neurological Degeneration in Vitamin B2 Deficiency

Although the accumulation of methylmalonic acid can lead to increased synthesis of odd-carbon andbranched-chainfatty acids (Section 10.8.2), which might become incorporated into myelin lipids, this does not seem to be responsible for neuropathy. Methylmalonic aciduria can also occur without any evidence of vitamin B12 deficiency, as a result of a genetic defect of either methylmalonyl CoA mutase or the synthesis of adenosylcobalamin. In some cases, the condition is a vitamin dependency syndrome and responds to very high intakes of vitamin B12. Although patients show mental retardation, failure to thrive, intermittent hypo- or hyperglycemia, and protein intolerance, they do not developeither megaloblastic anemia or neurological degeneration. Similarly, in the rare condition of combined methylmalonic aciduria with ho-mocystinuria, caused by a failure of the synthesis of both adenosylmethionine and methylcobalamin, although there is megaloblastic anemia with failure to thrive and mental...

Meranda Nakhla MD Constantin Polychronakos MD

The latest version of the American Diabetes Association practice guidelines 1 distinguishes no fewer than 59 causes of diabetes mellitus. This array of etiologies can be dazzling even to the specialist but can be made manageable by putting it in statistical perspective and reducing it to the two basic physiologic disruptions responsible for hyperglycemia insulin deficiency and insulin resistance. First, it is important to know that most (more than 95 ) patients can be classified into either type 1 or type 2 diabetes. Second, the clinical management of the rare patient with unusual forms of diabetes does not require a profound understanding of the underlying disorder, just the ability to estimate the relative contributions of insulin resistance versus deficiency. A specific diagnosis is helpful in this regard. This is facilitated by the fact that many of these rare etiologies of diabetes are associated with specific (and often pre-existing) clinical syndromes or characteristic age of...

Enzyme Induction by Biotin

Glucokinase is the high-_RTm isoenzyme of hexokinase found in liver and pancreatic f-islet cells. In the liver, its function is to permit rapid uptake and metabolism of glucose when the concentration of glucose in the portal blood is high after a meal. In the pancreas, the increased uptake and metabolism of glucose caused by glucokinase acts as the signal for insulin release. Children with a genetic lack of glucokinase suffer from what has been termed maturity-onset diabetes of the young (MODY) although they can synthesize and secrete normal basal amounts of insulin, they are unable to secrete additional insulin in response to glucose (Froguel et al., 1993). Presumably as a result of increased activity of glucokinase, high doses of biotin have a hypoglycemic effect in insulin-dependent diabetic patients. In non-insulin-dependent spontaneously diabetic mice, the administration of 2 mg of biotin per kg of body weight (considerably in excess of vitamin requirements) lowers blood glucose...

Irans Rich Foods In Vegetables

Reduction of high sugar or a low glycemic diet is something to consider. Many holistic practitioners believe a diet that avoids high levels of blood sugar is critical to reduce inflammation and balance the endocrine system for optimal health and disease prevention. Foods rich in carbohydrates can be evaluated by their glycemic index. A low glycemic index is preferred as it is less likely to cause a high blood sugar level. White rice, pasta and breads, desserts, and candy are some foods known to have high glycemic indexes. Eating carbohydrates in combination with equal amounts of fiber and good fat is also recommended.

What can happen if my diabetes is not properly treated and controlled

Uncontrolled diabetes, which generally refers to glucose levels that are higher rather than lower than the target range, can lead to immediate short-term and longer-term consequences. The short-term consequences result from the very high blood glucose itself, which is described in Question 4. If severe enough or untreated for long enough, markedly high blood glucose levels can result in coma and ultimately death, due to the severe abnormalities of blood chemistry that occur. It is important to note that only a very small minority of patients with either form of diabetes will die in this way. Therefore, although immediate decompensation of diabetes is a serious and life-threatening condition, with a high death rate if detected and treated too late, the majority of people with diabetes should be more concerned about the damaging effects of diabetes that are not well controlled, yet not sufficiently poorly controlled to focus their attention.

Leukotriene Modifiers Safety Considerations

Standard asthma treatments may be complicated by several adverse effects. For instance, p-agonists may cause tachycardia, palpitations, and headaches. Theophylline has a very narrow toxic-therapeutic window, interacts with many medications, and may cause tremors, nausea, and several other ill effects. While systemic corticosteroids have a myriad of adverse effects, including hyperglycemia, growth retardation, hypertension, insomnia, and edema, even inhaled corticosteroids pose risks, including cataracts, thrush, adrenal suppression, and bone loss (162,163). In contrast, the leu-kotriene modifiers continue to have an excellent safety profile and offer the

Lactic Acid and Insulin

Some natural compounds have also been reported to inhibit the cancer-promoting effects of insulin. For example, genistein inhibited insulin-induced proliferation of human breast cancer cells in vitro.132 This likely occurred via inhibition of PTK activity. In addition, some natural compounds may be able to reduce insulin production by reducing insulin resistance. Insulin resistance occurs when cells are no longer sensitive to insulin and thus more is produced in an effort to reduce blood glucose levels. Insulin resistance has been implicated as a risk factor for breast cancer.133,134 135 Diets high in omega-6 fatty acids promote insulin resistance, possibly via chronic activation of PKC.136,137138 Natural compounds that can reduce insulin resistance include omega-3 fatty acids and other PKC inhibitors.139142

Healthy Properties Of Sourdough Bread

The production of organic acids is also quite important in reducing the postprandial glycemic response in human blood. Starch bread is usually rapidly digested and absorbed, leading to hyperglycemia in people suffering from insulin-resistance syndrome. Organic acids produced in sourdough are responsible for a reduction of the glycemic index this seems to be associated with a delay in gastric empting in the case of acetic acid, whereas lactic acid induces interactions between starch and gluten during dough baking and reduces starch availability (Bjorck and Liljeberg Elmstahl, 2003).

Treatment for Diabetes

Factors, diabetes requires lifestyle changes and medication adherence in order to control blood glucose levels. Due to the damage caused by hyper-glycemia, diabetic patients also experience a number of complications related to the disease. With good self-management practices, however, individuals with diabetes can live a long and productive life. see also Carbohydrates Exchange System Glycemic Index Hyperglycemia Hypoglycemia Insulin. Yki-Jarvinen, Hannele (1998). Toxicity of Hyperglycemia in Type 2 Diabetes. Diabetes Metabolism Reviews 14 S45-S50.

Can I feel my high and low blood sugars reliably

Although many people with diabetes confidently state that they can reliably detect both their high and low blood sugars without actual measurement, studies have shown that these beliefs are not usually accurate. It is generally easier to be aware of hypoglycemia (low sugars) than high blood sugars. This is because the margin of safety between blood sugars in the lower part of the normal range and dangerously low blood sugars is quite narrow only about 25 mg dl and the body has a vigorous and rapid response system, designed to ensure that a source of energy is rapidly found and consumed. Nevertheless, especially after longstanding diabetes or a period of very tight glucose control, symptoms of low blood sugar are often not detected by patients. If they are detected, they are perceived with insufficient time to take preventive action. Typical early symptoms of hypoglycemia are shakiness, sweatiness, hunger, abdominal discomfort, palpitations (i.e., a fluttering sensation in the chest),...

Major Drug Nutrient Interactions of Clinical Relevance

Can cause hyperglycemia Decreased absorption of calcium and phosphorus increased urinary excretion chronic high dose can cause osteomalacia emptying Hyperglycemia Hyperglycemia and hypoglycemia Changes in serum phosphorus Hyperkalaemia and hypokalemia Increased absorption by delayed gastric

Plate Vi Skin Alterations Related To Vascularization Paleness Hyperemia Telangiectasia

Plates VIC and VID Telangiectasia on the upper concha and pigmentation of the root of the helix in a 65-year-old female affected by diabetes mellitus treated with oral hypoglycemic drugs (C). The worsening of the patient's hyperglycemia 1 year later was accompanied by a darkening of the pigmented area, a higher evidentiation of telangiectasia on the upper concha and by the appearance of a new telangiectasia on the anthelix (D). Plates VIC and VID Telangiectasia on the upper concha and pigmentation of the root of the helix in a 65-year-old female affected by diabetes mellitus treated with oral hypoglycemic drugs (C). The worsening of the patient's hyperglycemia 1 year later was accompanied by a darkening of the pigmented area, a higher evidentiation of telangiectasia on the upper concha and by the appearance of a new telangiectasia on the anthelix (D).

Adipose tissuederived proteins

Resistin was identified in 2001 (Steppan et al. 2001), and rodent studies confirmed its adipose tissue-specific expression. Circulating resistin is increased in obese rodents (Rajala et al. 2004) and it appears to increase insulin resistance (Steppan et al. 2001 Banerjee and Lazar 2003). Mice lacking resistin have similar body weight as wild-type mice, but they exhibit lower blood glucose levels after fasting, due to reduced hepatic glucose production (Banerjee et al. 2004). Recently, Graveleau et al. (2005) demonstrated that resistin directly impaired glucose transport in primary mouse cardiomyocytes. All these findings suggest that resistin contributes to the development of insulin resistance in obese rodents. Nevertheless, whether resistin also plays a role in human obesity and diabetes is still unclear (Banerjee and Lazar 2003).

Fatty Liver and Kidney Syndrome in Biotin Deficient Chicks

Birds fed the high-carbohydrate, low-fat, low-protein diet show more marked hypoglycemia on fasting than do controls, and modest hyperglycemia on refeeding. The cause of death in response to modest stress is believed to be acute hypoglycemia because of the impairment of hepatic gluconeogenesis birds fed the same diet that do not succumb are believed to have a compensatory increase in renal gluconeogenesis, and hence are more resistant to the effects of food deprivation (Bannister, 1976a, 1976b Whitehead et al., 1976).

What is diabetic neuropathy

Diabetic neuropathy is the term used to describe the usually chronic damage to nerves that occurs as a result of untreated, or inadequately treated, high blood sugar. It results from a complex sequence of events that leads to damage and destruction of the minute blood vessels that nourish nerves along their course to the region of the body they serve after leaving the spinal canal. Each such nerve is a single cell. The longest nerves, much like long chains, are the most susceptible to damage. If a peripheral nerve (i.e., a nerve cell not contained in the brain or spinal column) emerging from the spinal column and traveling to the toes were the thickness of a piece of string, it would be 3 miles in length At frequent intervals along its length, each peripheral nerve receives nourishment from tiny blood vessels. If any of these tiny blood vessels are irreversibly damaged, that part of the nerve dies and no signals are conducted in

Hormones and Glucose Homeostasis

Insulin is the only major hormone capable of lowering blood glucose levels (Table 1). It does so by inhibiting glycogen breakdown in the liver and inhibiting gluconeogenesis and by encouraging glucose uptake by peripheral tissues. It achieves this mainly by activating the glucose transporter protein, GLUT-4, an action that is enhanced by exercise and hyperglycemia. Consequently, insulin lowers The release of insulin from the B cells of the pancreatic islets depends on the concentration of glucose in the blood perfusing them. At blood glucose levels less than approximately 3.5-4.0 mmol l-1, insulin secretion is minimal (constitutive). This means that as the arterial blood glucose declines toward its basal level in the postabsorptive state, plasma insulin levels also decline. However, they never decline low enough in the nondiabetic subject to permit uncontrolled liberation of glucose by the liver or fatty acids by adipocytes. This does, of course, happen when the B cells are destroyed,...

Dysregulation of CRF pathways in human disease states

Caused by prolonged activation of the HPA axis or long-term treatment with exogenous glucocorticoids results in Cushing's disease or syndrome (Nelson, 1989). Continued exposure to high levels of glucocorticoids eventually leads to metabolic dysfunction that may include muscle wasting, abnormal fat deposits, brittle bones, thin skin, hair loss, and hyperglycemia.

Insufficient Consumer Education

Recognize the importance of safety issues associated with some herbal products. Use of herbal remedies can thus be less discerning and more indiscriminate as compared to use of conventional medicine. It is important for consumers to appreciate the fact that though herbal medicines have been in use for a long time, they still bring with them risks of side effects. A good example is ma huang (ephedra), commonly marketed as a natural weight loss product. Ma huang is a Chinese healing herb that has been used for thousands of years. The ephedra plant is a short, bushy shrub. Its stems contain the active constituent from which the stimulant ephedrine is now synthesized. The ephedra plant also produces ephedrine's stereoisomer, pseudoephedrine. Pseudoephedrine is the favored active ingredient in nondrowsy cold and sinus decongestants (2,39,40). Ephedrine was used traditionally to treat a variety of conditions, including asthma, hypotension, and depression. More effective medications have...

Delays in Secretory Activation

A number of pathological conditions may delay secretory activation in women, including cesarean section, diabetes, obesity, and stress during parturition. The role of cesarean section is controversial, but if there is one it is likely to have only a modest effect. However, poorly controlled diabetes, stress from delivery, or obesity are associated with significant decreases in early milk production. Because each of these conditions is related to higher blood glucose, hyperglycemia may be an underlying factor in the delay in lactation. However, once it is established, diabetics do not have a problem in maintaining lactation. Thus, compensatory factors may override initiation defects to ensure infant nutrition in these disorders.

What is the difference between diabetes mellitus and diabetes insipidus

Physical properties, when large amounts of glucose are filtered by our kidneys into the urine, it cannot be fully reabsorbed and retains a large amount of water with it, thus creating very large volumes of urine. The second part of the name, mellitus, is derived from the word meaning sweet, as in mellifluous music. Mellitus was added when it was discovered that the urine in a person with diabetes and very high blood sugar is sweet.

Pathophysiology of Uncontrolled Diabetes

Uncontrolled diabetes mellitus occurs when circulating insulin levels are inadequate to lower elevated blood glucose concentrations. This condition includes a spectrum of metabolic abnormalities that range from the effects of mild insulin deficiency (i.e., hyperglycemia) to the effects of marked and prolonged insulinopenia (i.e., ketoacidosis and fluid and electrolyte depletion). Diabetic ketoacidosis, which is the most severe acute manifestation of insulin deficiency, is almost entirely restricted to patients with type 1 diabetes, or those with severe pancreatic disease of other etiologies. In people without absolute insulin deficiency, although the combination of significant insulin resistance and relatively low levels of insulin can result in significant hyperglycemia, ketone body production sufficient to cause ketosis and metabolic acidosis does not occur. Even low levels of insulin, such as are typically present in type 2 diabetes, suffice to restrain lipolysis and limit the...

Myroslava Romach Karen Parker

Fact Treatment is not unsuccessful because further treatments are needed. Suppose a diabetic is brought to the Emergency Room unconscious from extremely high blood-sugar, is treated with insulin, regains consciousness, and reduces the blood-sugar level to normal. The patient will probably need insulin every day for the rest of his or her life, but this emergency treatment was certainly successful. With addiction, as with diabetes, we must see treatment as an ongoing process, successful if at the time it reduces the severity of the disorder. It unfortunately does not have a permanent fix, like setting a broken bone or surgically removing all of a cancer. The goal is improvement, not cure.

Presentations classic silent and diabetic ketoacidosis

Children who have classic new-onset T1D typically present with polydipsia, polyuria, polyphagia, weight loss, and lethargy. Classic-onset T1D is differentiated from DKA because children who have classic onset have enough preserved beta cell function to avoid metabolic decompensation with resultant acidosis. The symptoms of classic diabetes are caused by prolonged hyperglycemia. Once blood glucose concentrations exceed the renal threshold for reabsorption (approximately 180mg dL), glycosuria ensues with the resultant osmotic diuresis, dehydration, and thirst. Over time, increasingly poor glucose uptake by tissues, resultant chronic glycosuria, and breakdown of amino acids for gluconeogenic substrate with fat breakdown to supply fatty acids for ketogenesis all contribute to weight loss. Classic T1D is usually diagnosed in the outpatient setting when a slightly ill-appearing child presents to the pediatrician for evaluation of weight loss and other nonspecific symptoms. A high index of...

Feel as if my memory has gotten worse since I developed diabetes Could I be right

Studies have shown that memory, and other higher brain functions, can be negatively affected by diabetes. This pertains to both type 1 and type 2 diabetes and to both adults and children. A large part of this effect is related to blood sugar control. Children with repeated episodes of low blood sugar have been shown to have poor long-term memory performance. However, both high and low blood sugar levels are associated with poor memory performance. This affects recall of things previously remembered and memorization of new information. The effect of low blood sugar on memory appears to be the same whether a person is aware of the blood sugar or unaware of it. When memory problems are associated with high blood sugars, the good news is that they are often reversible with improved control of the diabetes, even in older people. Therefore, if you feel that your memory has deteriorated, a first step would be to ensure that your diabetes is under the best possible...

Rationale for and against Early Aggressive Nutrition

Replicating body composition of the fetus of the same gestational age as the preterm infant may be a more desirable nutritional goal. However, this necessitates an appreciation of the differences between normal fetal nutrition and commonly used postnatal nutritional practices in very preterm neonates. Amino acid uptake by the fetus is far in excess of that needed to meet accretion requirements the excess amino acids are oxidized, contributing significantly to fetal energy production. However, amino acids are delivered to the preterm neonate in the first several weeks of life at low rates that are significantly less than required to provide for normal rates of fetal protein accretion. Glucose delivery to the fetus is determined by the maternal glucose concentration and occurs at a rate that reflects fetal glucose utilization for energy production. Fetal glucose utilization also occurs at relatively low plasma insulin concentrations. In the preterm newborn glucose usually is...


Three systemic reviews of herbal medicines for glycaemic control in diabetes found that Aloe vera can lower blood glucose levels in diabetic patients (Grover et al 2002, Vogler & Ernst 1999, Yeh et al 2003). In one trial aloe juice consisting of 80 gel or placebo was given in a trial of 40 patients who were recently diagnosed with type 1 diabetes at the dose of 1 tablespoon twice daily. From day 14 the blood sugar levels in the aloe group began to fall significantly compared with the control group and Aloe vera 27

Blood Glucose

Weight loss produced by lifestyle modification reduces blood glucose levels in overweight and obese persons without diabetes, and weight loss reduces blood glucose levels and HbAlc in some patients with type 2 diabetes. There is suggestive evidence that decreases in abdominal fat will improve glucose tolerance in overweight individuals with impaired glucose tolerance, although not independent of weight loss and there is limited evidence that increased cardiorespiratory fitness improves glucose tolerance in overweight individuals with impaired glucose tolerance or diabetes, although not independent of weight loss. In addition, there is suggestive evidence from randomized trials that weight loss induced by weight loss medications does not appear to improve blood glucose levels any better than weight loss through lifestyle therapy in overweight persons both with and without type 2 diabetes. Based on a full review of the data in these 17 RCT articles, the panel makes the following...

Future trends

Currently, several different food ingredients are being screened that inhibit DNL, or more precisely FAS, such as protein concentrates from Amaranthus cruentus seeds (Escudero et al. 2006) and whey protein (Morifuji et al. 2005). However, only animal studies are available so far, and whether these substances are useful supplements for humans is not clear yet. In general, it has to be considered that inhibition of FAS entails an increase in cytosolic malonyl-CoA levels, causing inhibition of CPT 1 and consequently of mitochondrial fatty acid oxidation. Short-term inhibition of fatty acid oxidation improves hyperglycemia (Deems et al. 1998), but long-term inhibition causes accumulation of TAG in liver and muscle and reduces insulin sensitivity (Dobbins et al. 2001).


Adults A high carbohydrate fat ratio is associated with better maintenance of body weight. However, this may reflect increased fat accumulation rather than an increase in protein synthesis. Hyperglycemia alone can increase alanine efflux from skeletal muscle, without stimulating protein synthesis. Euglycemia, using exogenous insulin with high glucose delivery, can inhibit amino acid oxidation and favor amino acid synthesis. This may reflect an effect of IGF-1, which is released in response to insulin. In addition, hyper-glycemia stimulates hepatic lipogenesis and increased CO2 production, which may prevent weaning from ventilatory support. Hyperglycemia must therefore be prevented.


Type 2 diabetes is a multifactorial disease with genetic and environmental factors playing a key role in its pathogenesis. Central to the etiology is a defect in insulin action, hepatic glucose output, and insulin secretion. Although insulin resistance is frequently the first detectable abnormality in the progression of T2D, insulin resistance by itself does not cause the disease, which is only manifested when there is a coexisting insulin secretory defect. T2D typically occurs in middle-aged and elderly people but there is an increasing trend of T2D occurring in young individuals. The main question yet to be answered is whether T2D is one disorder or a group of disorders with hyperglycemia as the end point in disease pathogenesis. Insulin resistance is common to several other disorders, including ischemic heart disease, hypertension, dyslipidemia, central obesity, and coagulation defects the clustering of these disorders is known as the metabolic syndrome or the insulin resistance...

Gestational Diabetes

The maternal risk due to GDM include increased risks in pregnancy, accelerated fetal growth leading to macrosomia and increased rates of caesarian section. The fetal risks include stillbirth, congenital malformations, shoulder dystocia, birth trauma and the risk of neonatal hypoglycemia and calcium and bilirubin disturbances in the neonatal period. There is also an increased risk of the child subsequently becoming obese and developing diabetes in adult life as a result of in utero hyperglycemia.


Diabetes mellitus is a chronic disorder that results from a deficiency of the hormone insulin. This occurs either because of an absolute decrease in the amount of insulin produced by the 0 cells of the islets of Langerhans in the pancreas or because of a relative deficiency of insulin in patients whose tissues are resistant to the hormone. The hallmark of untreated diabetes mellitus is elevated blood glucose concentrations. Frequently, there are associated disturbances of fat and protein metabolism. In addition to reversible acute metabolic abnormalities resulting from inadequate effects of insulin, long-term diabetes is often characterized by the development of irreversible complications that include damage to the kidney, retina, nervous system, and both large and small blood vessels. The diagnosis of diabetes mellitus is based on the existence of hyperglycemia alone and does not require the presence of any of the associated metabolic or systemic complications. Although patients with...


Glycosuria may indicate the presence of diabetes, but it is not diagnostic, nor does the absence of glycosuria exclude diabetes. In individuals with a low renal threshold, glucose may be present in the urine in the absence of hyperglycemia. Such ''renal glycosuria'' is particularly common during the later stages of pregnancy and in some renal tubular disorders. The excretion of other sugars, such as lactose (more common during pregnancy) or fructose, galactose, or xylose (people with inborn errors of metabolism), can yield false-positive results through cross-reactivity in the testing method unless glucose-specific test strips are used. In patients with compromised renal perfusion or function, glycosuria may be absent despite significant hyperglycemia.


Based on the metabolic functions of insulin discussed above, the ingestion of carbohydrate produces an immediate increase in plasma insulin concentrations. This immediate rise in plasma insulin concentration minimizes the extent of hyperglycemia after a meal. The effects of insulin deficiency (elevated blood glucose concentration) are exemplified by type 1 diabetes. Individuals who have type 2 diabetes may or may not produce insulin and insulin-dependent muscle and adipose tissue cells may or may not respond to increased insulin concentrations (insulin resistant) therefore, circulating glucose is not effectively taken up by these tissues and metabolized.

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