TREATING TYPE 1 DIABETES.....

Hi today we are going to discuss about how to manage type 1 diabetes.

Since type one diabetes is caused by autoimmune destruction of the pancreas, that results in an absolute deficiency of insulin, it makes sense that the treatment of type one diabetes is to give insulin. Now, this is true, but unfortunately it's not quite that simple. So let's talk about treating type one diabetes. And before we get into the specifics of the treatment, let's first briefly review some of the metabolic states in the human body. And there are two general states. You have the absorptive state in which the body takes energy and stores it and you have the post-absorptive state, in which the body takes this stored energy from the absorptive state and utilizes it. Now this absorptive state here is driven by the hormone insulin. Whereas the post-absorptive state is driven by the hormone glucagon. Now throughout the day, the human body will typically fluctuate back and forth between this absorptive state and this post-absorptive state. So to get a better understanding of how this looks, let's draw what I'll calla physiologic timeline. And let's just bring in a graph here to help describe this timeline. Now down here on this x-axis we'll have the time of the day. And right here in the middle we'll have noon, six in the morning, six at night, midnight, and then maybe we'll put three AM, nine AM, three PM, and nine PM. Now as I mentioned before, the body will fluctuate back and forth between this absorptive state and post-absorptive state. So let's see that here. And if you look closely, this fluxuation back and forth makes sense here, and around six AM when you go from this post-absorptive state while you're sleeping, and then you eat breakfast, and then you'll go into an absorptive state because you need to absorb the nutrients from the food in breakfast and then as your morning goes you go back into this post-absorptive state and so on and so forth. Now these changes back and forth between these metabolic states are driven by these hormones insulin and glucagon. So on the y-axis here, let's put in these hormone levels. So in purple here we'll put in insulin, and then in green we'll do glucagon. And what you can see from this is that it's really insulin here that's driving these changes between the post-absorptive state and the absorptive state. and glucagon also plays a role, but its level doesn't vary nearly as much as insulin's level throughout the day. Now since in type one diabetes the body doesn't produce enough of this insulin, it makes sense that the goal of treatment when we're treating type one diabetes, is to give insulin that will try and mimic the body's normal production of insulin. However, when we're treating type one diabetes, just giving insulin may be once or twice a day, as is done with most medication, doesn't really work because the levels are changing so frequently. 

So then how exactly do we manage type one diabetes? To get a better understanding of this, let's erase some of our work. Now fortunately, physicians and pharmacologists have created a very elegant method for treating type one diabetes. And this method is known as the Basal-Bolus Strategy. And in order to understand this concept a little bit better, let's first talk briefly about insulin. Now, insulin is a peptide hormone. And as such, that means when we give it as a medication, it can't be taken in a pill form, because the stomach and digestive system would break down the peptides or the protein of insulin into its component parts before it could be absorbed. And there for insulin must be given as an injection. And there are many different types of insulin that are available for use in the treatment of diabetes and they are classified based on how quickly they take effect, which is know as the onset of action and how long they work for, which is known as the duration of action. So to get a better understanding of this, let's create another graph similar to this one that we'll call the pharmacologic timeline. And on the x-axis here we'll put that duration of action. And this will be an hour, so we'll have maybe three, six, nine, 12, 15, 18 hours here. So one of the three main groups of insulins that can be given when treating type one diabetes are known as the rapid-acting insulins. And their pharmacologic time looks something like this. And these rapid-acting insulins usually take somewhere about 15 minutes to 30 minutes before the start working and their duration of action will last, you can see here, somewhere around four to six hours. 

Now the next major group of insulins are known as intermediate-acting insulins. And these intermediate-acting insulins, you can see by the graph, take a little bit longer before they have an onset of action, about 30 minutes to an hour, and then they last a little bit longer than the rapid-acting insulins, for somewhere between maybe eight to 12 hours, as you can see on the graph here. Now the last major category of insulin are known as the long-acting insulins. And as you can see on this graph, the long-acting insulins take even longer to take action, somewhere in the order of maybe one to four hours, and their peek action is not quite as intense as this rapid or intermediate-acting insulins, and their duration of action is much longer. Depending on the type of long-acting insulin, it can be somewhere between 12 and 24 hours. So now that we have a little bit better understanding of the different types of insulin and why it needs to be injected instead of taken as a pill, let's go back to this physiologic timeline here. And let's specifically look at this insulin level 

Now you notice that the insulin level never goes all the way down to zero. There's always this baseline level here. And we'll call this the basal level. And then intermediately there are these peaks, which we'll call boluses. And these boluses occur after we eat and they're what drive the transition from that post-absorptive state to the absorptive state, about three times a day, depending on how often you eat. Now hopefully what you can see by this is that if we transpose a couple of these graphs from the pharmacologic timeline onto the physiologic timeline, we can use injectable insulin to mimic this physiologic timeline in order to treat type one diabetes. So for these boluses, these kind of rapid peaks, you'll notice that they look somewhat like the rapid-acting insulin here. So let's put that on there. And then this basal level here, this constant level, you can create with a long-acting insulin. So we'll put that on the graph. Now hopefully what you can see by this, and it's starting to geta little crowded here so I'll highlight it, is that by using this Basal-Bolus Strategy someone with type one diabetes can kind of mimic the natural levels of insulin that the pancreas should be producing. And this is why this Basal-Bolus Strategy of treating type one diabetes is very efficient. Because it mimics what the body would do if the pancreas was working properly. So an overview of the Basal-Bolus Strategy is that usually once or twice a day, depending on the type of long-acting insulin, say in the morning and then again at night, someone with type one diabetes will take a dose of insulin, of this long acting insulin that will serve as this basal rate. And then at meal time they'll take an additional dose of the rapid-acting insulin to cover these boluses to help the body transition from the post-absorptive hereto the absorptive state, to absorb the energy in the meal they just ate. Now it's important to know that this graph demonstrates the principle of the Basal-Bolus Strategy, but it is somewhat of an oversimplification and that proper insulin management requires one to be very diligent with their insulin dosing and administration. 

This is especially important in regards to the bolus doses here. And this is because the amount of insulin that someone's gonna need to take with each bolus dose will vary depending on what their blood sugar is at that time as well as on how many carbohydrates they're planning on eating. So in order to properly manage their insulin regiment, individuals with type one diabetes must regularly check their blood sugar levels and adjust their insulin dosing accordingly. Now type one diabetes can be a very serious and potentially even lethal disease. 

However, with diligent adherence to the Basal-Bolus Strategy and regular appointments with one's physician in order to adjust the insulin dosing as well as monitor for complications, someone diagnosed with type one diabetes can still live a very healthy and long life.

If left with any query you can comment in comment section below.

INSULIN AND GLUCAGON

Hi today we are going to discuss about the relationship between insulin and glucagon.

Metabolism is just the flow of energy throughout the body. Energy enters our body when we eat food, and that food is then absorbed in three different forms. It can be absorbed as amino acids, so, things that make up proteins, so, you'd imagine meat would have a lot of amino acids. Or they can be absorbed as fats, so these are lipids, or fatty acids and so your greasy, fried food is pretty rich in fats. Or they can be absorbed in carbohydrates, or I'll just write "carbs" here, which you have a lot of in ice cream or other sweet things.

Each of these things deliver energy into your GI tract. Your stomach, and your intestines, which can then be absorbed and sent elsewhere for use. Now carbohydrates are one of the main currencies for energy, so let's focus on that, and we'll do so by starting with glucose, which is the most basic form of carbohydrates. In fact, it's considered a simple sugar. Now, there are two main hormones that control the availability of glucose throughout the body. And they're at a constant tug of war with each other. One of them, which you've heard of probably is called "insulin."

Insulin regulates that storage of glucose, as we'll talk more about in a minute, and the other guy on the end of the rope, is a hormone called "glucagon." Glucagon regulates the release of glucose from storage. And it's pretty important that we have enough glucose available in the blood. Because, for example, the brain uses about 120 grams of glucose per day. And that's a lot, because it comes out to be about 60 to 70% of all the glucose that we eat in a day. So you can see why it's really important to have enough glucose available for your essential organs to use. And thankfully, we have these two hormones to help regulate the amount of glucose in our blood. So now let's take a look at how these hormones regulate the amount of glucose in our blood. And let's do that on this graph. So let's say this axis represents time, so over time, we'll see some changes, and this axis over here, the Y axis, will represent the concentration of glucose in our blood. So that's the concentration of glucose. And most commonly, that will be represented in milligrams per deciliter. Milligrams per deciliter. Now, the body likes to keep the amount of glucose in the blood to be no lower than about 70 milligrams per deciliter, and no higher than about 120 milligrams per deciliter. This is sort of the range that I would consider to be the sweet spot. Because if we go any higher than 120, then we end up having a condition that's called "hyper," hyper meaning "a lot of," "glycemia." "Hyperglycemia," which just means "a lot of glucose "in the blood." If we have hyperglycemiafor a long period of time, that can lead to what's referred to as "eye, nerve, and kidney disease." Eye, nerve, and kidney disease. And we can go into a lot more detail about how this happens, but, just understand that having a lot of glucose in your blood can cause changes to these structures to make them not work as well. And unfortunately this is a fairly common problem. Because another term for eye, nerve and kidney disease is "diabetes."

And in fact, if you have a person who's been fasting overnight to come in for a blood test, and you notice that they have more than 126 milligrams per deciliter of glucose on two different occasions, that's grounds for diagnosis of diabetes. On the other hand, if we have very little glucose on our blood, or not enough, that condition is referred to as "hypoglycemia." "Hypo" meaning, "less or low," and then "glycemia" of course meaning "glucose." And some of the things that you can start to notice, if you're hypoglycemic, is that you're tired, maybe you're lethargic, but if this persists, you can even go into a type of coma, or even die from having too little glucose in your blood. And in most people, we start to notice that we're feeling hypoglycemic when we get below 40 milligrams per deciliter. Now usually, our body's pretty good about making sure that the level of glucose in our blood stays within the sweet spot, or within this sweet range. And the way we accomplish this, is through the hormones I just mentioned. So let's imagine that you eat at this point of time right here. And naturally, the levelof glucose in your blood will rise, because you've introduced more glucose into your system by eating it. Eventually, your body will notice that your glucose levels are rising, and will counter that by releasing insulin to drive the amount of glucose in your blood down. And that's an important point, because insulin decreases the blood-glucose concentration by storing the glucose in another form. And we'll get into more detail about that in a second.

The other thing that could happen is that, you may have a decreasing amount of glucose in your blood. Which, as I mentioned here, is not a good thing to have happen either. What your body does to counter that, is release glucagon to increase the amount of glucose in your blood. And so it's important to remember here as well, that glucagon will increase the serum or the blood concentration of glucose by releasing it from storage. So glucagon does the opposite, it releases glucose from storage. So now that we know how the release of glucagon and insulin can affect blood-glucose levels, let's focus in and see how that happens. So let's start with insulin, and that does a number of things to glucose. But remember, that at the end of the day, all we're doing is storing it. Just remember, insulin causes storage. So, the first thing that insulin does to glucose, is cause it to undergo a process known as "glycolysis."  Glycolysis, which you may have heard of before. It's an irreversible process. It's irreversible, alright, irreversible down here. Because it converts glucose into ATP, which is the most basic unit of energy that we use in the body. And that's an important distinction. ATP is energy to be used anywhere in the body. Okay, instead of storing the energy of glucose in ATP, insulin can cause glucose to undergo what's called "glycogenesis." Glycogenesis, which just means" the formation of glycogen." So, glycogen. And glycogen is just a heavily-branched polymer, or molecule that has a whole bunch of glucose molecules stacked on top of it. And this is just energy to be stored in the short-term in mainly the liver, or muscle tissue. So mainly, liver or muscle. And this is a reversible process, because once we make glycogen, we can break it down and release glucose as well. Finally, the last thing insulin can cause glucose to do, is undergo "lipogenesis." Lipogenesis, which I think you can use the suffix to infer here that we are producing lipids, or fatty acids, so lipids or fatty acids, and this is an irreversible process. So this is irreversible, where we store glucose as lipid, and the key here is that we are taking the energy of glucose, and we are storing it long term. Long term, in what's called "adipose tissue." Adipose tissue, or just, the fatty layers within our body. So adipose tissue.

Now what about glucagon? What are the processes it uses to release energy or glucose into the blood stream? Let's put it this way. If we're releasing glucose into the blood stream, my question is, what are we releasing it from? Well, the first thing we can release it from, is glycogen. And we just talked about this. We can form glycogen using insulin. Or, if there's a lot of glucagon around, we can have what's called "glycogenolysis." Which just means "the breaking down "or the cutting down of glycogen." Now, this is a reversible process, cause we can always go and take glucose to make glycogen again. The other thing we can release glucose energy from, is, or rather I should say, are, amino acids. Amino acids can undergo a process known as "gluconeogenesis." So "gluco" meaning "glucose", "neo" meaning "a new," and then "genesis," meaning "to create," or "the creation of." This is also a reversible process that will take amino acids, bunch them together with other things to convert them into glucose. Now finally, the last thing glucagon can do, is to take fatty acid, so fatty acid or your lipid, and instead of converting it to glucose, glucagon will take the fatty acid, and turn it into these things that are called "ketone bodies." Ketone bodies. And it does so through a process known as "keto," short for "ketone," "genesis," meaning "to generate ketone bodies." Now this is an irreversible process. And it's kind of a funky thing that happens within the body, because it's what we do when we're in our starvation mode.

When we're not getting the right amount of nutrients of some reason or another. And the reason why this is sort of a last resort, is because ketone bodies are very unique, in that they are energy, forms of energy to be used only, only by the heart and brain. Ketone bodies don't really supply energy anywhere else. So that's why it's sort of a last minute starvation mechanism to provide energy where it's most critically needed to help us survive. So you can sort of see here that there's a tug of war game that goes on between insulin and glucagon. In fact, insulin itself, when it's released into the blood, will inhibit the release of glucagon. Which just goes to show you how opposite their end goals really are. And there's a lot more to talk about how insulin is released, or how glucagon is released and where it comes from, this is a great overview of what they end up doing in the body.

DIABETES IN PREGNANCY

Hi today we are joing to discuss about diabetes in pregnancy.

Diabetes, it's certainly not a problem that's unique to pregnancy, but it's something weal ways have to discuss when we're talking about pregnancy because it can really complicate that picture quite a bit.

 

So firstly, diabetes and pregnancy split up into two different categories. There's the category of women who had diabetes before becoming pregnant, and that's called pre-gestational diabetes. So that category is referred to as pre-gestational diabetes. Pre for before, gestational for pregnancy, so before pregnancy diabetes. And then there are the women who become diabetic during their pregnancy, which is called gestational diabetes. So that's the second category,gestational diabetes. And 90% of cases, so that's nine of every 10 cases of diabetes in pregnancy falls into this category of gestational diabetes. And then the other 10% are pre-gestational diabetics. 

So there's something about pregnancy that makes women more susceptibleto developing diabetes and we'll discuss exactlywhat that is in just a bit. But firstly, why do weeven split up diabetes into these two different groups? Well, if a woman haspre-gestational diabetes, that means that her blood sugars may have been poorly controlled at the time that the baby was conceived. Or even during the first eight weeks of the pregnancy, during a period called organogenesis. So the first eight weeks of pregnancy is a period called organogenesis, when the fetus' organs are made. And those high levels of glucose during that really pivotal time can lead to a miscarriage or it can lead to significant anomalies within the fetus. However, with gestational diabetes, that problem with glucose control develops during the pregnancy, in some ways because of the pregnancy. And usually the glucose control isn't impaired until the second trimester, so after the point of conception and after the point of organogenesis. So miscarriage and fetal anomalies don't tend to be a problem with gestational diabetes. 

But that's not to say that gestational diabetes doesn't harm the fetus. Rather, diabetes as a whole, so regardless of the category, can cause preterm labor. It can cause problems with the growth of the fetus. It can even lead to stillbirth. And one of the complications that we tend to think about a lot, that tends to be talked about a lot, is fetal macrosomia. So fetal macrosomia. So let me explain that a little bit. Alright, so if mom has diabetes, the basic gist of it allis that her glucose levels tend to run on the high side. And glucose can cross the placenta, into the bloodstream of the fetus. That's like one of the main purposes of the placenta, to allow glucose to enter the baby's bloodstream as an energy supply. So then when mom has high glucose levels in her blood, then the fetus has high glucose levels in its blood. And that drives the release of insulin in the fetus, because that's the body's primary response to glucose, to release insulin. Insulin is kind of the key that allows cells to open up their doors and take up glucose and use it. And so that insulin that's released in the fetus allows glucose to be taken up. And insulin does a few other things. It also stimulates fat storage in the body, right? And it also binds to receptors on different organs, such as the heart and the liver, and it causes them to grow. It causes the organs to actually grow in size. And so the end result of it all, the end result of the high glucose levels in the mom, leading to high glucose levels in the baby, leading to high insulin levels in the baby, is that the baby grows to a larger size than normal, which is called fetal macrosomia. Macro for large and soma for body. So larger body. Now another thing that I want to mention is that in pre-gestational diabetes, so again, diabetes before the point of pregnancy, the impaired glucose control is more long-standing. 

So these women are more likely to have diabetic complications such as kidney damage or vascular problems, so blood vessel related problems, and damage to the retina. And pregnancy can aggravate these complications, so it can it make worse. So it's really important to monitor these conditions throughout the pregnancy. Now, I want to stop dancing around the issue of why women can become diabetic during pregnancy. A lot of it has to do with the hormones that are released during pregnancy. So hormones such as HPL, that's not one that many people have heard of, right? It stand for human placental, human placental lactogen. Alright, so that's HPL. Another hormone is cortisol. So the body's main stress hormone. Another one that you may have heard of before is growth hormone, that's released in a large quantity during pregnancy. And then finally, progesterone. Progesterone, which is exceptionally important for the maintenance of a healthy pregnancy. So these hormones are released during pregnancy and they have lots of important roles. And among their many, many roles, these hormones increase mom's production of glucose during pregnancy to make sure that the fetus has enough of the glucose, enough of its primary fuel source. And that leads to high glucose levels within the mom's blood. And you might be thinking,"Well, that's no problem, "because the glucose will cause insulin to be released "and that insulin will cause mom's cells "to take up the glucose and problem solved. "You don't have high glucose levels in the blood any more." Well, unfortunately, it doesn't really work that way, because these same hormones make the mom's body resistant to insulin. So that the cells don't respond to insulin and don't take up as much glucose from the blood. And this is done for a purpose. It's actually done so that you can reduce mom's utilization of the glucose so that more of the glucose is available for the fetus. And that's why you can end up with high blood glucose levels and diabetes in pregnancy. Or if you had diabetes before you became pregnant, it can become worse during pregnancy. So, given that diabetes can cause all of these complications for mom and baby during pregnancy, it goes without saying that we do our absolute best to screen for it during pregnancy. So for women who have a normal risk of having diabetes, we do a routine screen. So for all women, all average women, we do a routine screen around 26 to 28 weeks into the pregnancy. And that screening testis usually in the form of a glucose tolerance test.

So the screening test is often called the glucose tolerance test, where the woman is given a very specific amount of glucose and her blood glucose levels are measured at one, two, or three hours after consuming that very specific amount of glucose. And if her blood glucose levels are above the normal range, then she's found to be diabetic. And if a woman is diagnosed with diabetes during her pregnancy, we do our best to control it with diet. And if that doesn't work, then insulin is kind of our second line of treatment. And it's also important to know that gestational diabetes, so again, diabetes that occurs during pregnancy, kind of as a process of pregnancy, increases the risk of a woman having overt diabetes after the pregnancy is over. So it's really important to follow up with all these women after they deliver. Kind of the set point, six weeks after they deliver to test them for diabetes. Okay, so that is gestational diabetes in a nut shell. 

DIABETES MELLITUS AND INSULIN

Hi, today we will be discussing about the relationship between diabetes mellitus and insulin.

We can break down food into many different types of nutrients. One of the most important nutrients our body needs is a sugar called glucose, which is the fuel that powers the cells of our body. Glucose is transported throughout the body by blood and requires careful regulation, since too much glucose in the blood can lead to disastrous consequences, such as diabetes mellitus. Read this article to learn more about the symptoms, cause, and treatment of this disease.

Let’s talk about blood glucose regulation first. The body has many ways to increase or decrease the amount of glucose in the blood. Some ways to increase blood glucose include eating a meal, synthesizing glucose from scratch, or releasing glucose from storage, while some ways to decrease blood glucose are to transport glucose into cells, which either use up glucose for energy or store it. Throughout the day, the body is constantly making slight adjustments to keep blood glucose levels at an optimal range. These slight adjustments are controlled by the hormones insulin and glucagon, but in this article, we’ll focus on insulin. Insulin is released into the bloodstream when blood glucose is high, such as after a meal. It signals to cells to take in glucose for energy or storage. It also prevents more glucose from being synthesized or released from storage. Therefore, the overall effect of insulin is to decrease blood glucose levels. Diabetes mellitus, or simply diabetes, occurs when this insulin signalling pathway is broken. Without proper functioning of insulin, blood glucose levels skyrocket. Despite glucose being a very important source of fuel for the body, too much of it in the blood is extremely damaging. In the short term, high blood glucose leads to the hallmark symptom of diabetes: glucosuria, or glucose in the urine. In fact, the term “mellitus” means “honey” in Latin to reflect this symptom of sweet-tasting urine. How does this occur?

At the kidneys, glucose is filtered out of the blood and into the urine, but is later transported back into the blood since the body does not want to lose this valuable source of fuel. This reabsorption uses proteins which have a maximum rate of transport. When there is too much glucose in the blood, more of it is filtered into the urine. Even at their maximum transport rate, the proteins cannot transport all of the glucose out of the urine, leading to glucosuria. This causes excess urination, since the presence of glucose in the urine draws in more water by osmosis. Excess thirst and dehydration are a consequence of this since more water is lost through urine. In addition, since cells cannot take up glucose for energy without insulin, the body perceives itself to be “starving”, leading to both increased appetite and fatigue. In the long term, high blood glucose damages blood vessels in the eyes and kidneys, which is why diabetes is the leading cause of adult blindness and kidney failure. High blood glucose also damages nerves, leading to loss of sensation in the feet and hands. When those areas get injured, such as from cuts or from blood vessel damage, the person does not notice the injury, leading to infections and necrosis that eventually require amputation. Most importantly, the damage to blood vessels in the heart and brain can lead to high blood pressure, stroke, and heart attacks, which account for most of the deaths in diabetic patients.

Most diabetes cases can be divided into two types based on how the insulin signalling pathway is malfunctioning. Type 1 diabetes accounts for around 10% of diabetes cases, while Type 2 makes up most of the remainder. The last few percentage points are attributed to rarer forms of diabetes that you can check out in the video description. Type 1 diabetes is caused by a lack of insulin production. In the pancreas, there are special clusters of endocrine cells called the islets of Langerhans. One type of endocrine cell in these islets is the beta cell, which produce and release insulin. In Type 1 diabetes, the beta cells are destroyed by the immune system. Therefore, the body can no longer produce insulin and blood glucose levels rise uncontrollably, leading to the symptoms mentioned earlier. Scientists believe both genetic mutations and environmental factors, such as infections, may play a role in triggering this autoimmune attack. An additional symptom of Type 1 diabetes is rapid weight loss, as fat cells, or adipocytes, begin to break down fats into another type of energy molecule known as ketone bodies. Large amounts of these ketone bodies are released into the blood, which can be taken up by other cells as an alternative source of fuel. However, ketone bodies are slightly acidic molecules, so excessive amounts of these molecules can acidify the blood. This is known as diabetic ketoacidosis, which is a life-threatening condition if untreated. However, when most people think of “diabetes”, they are probably imagining the more common Type 2 diabetes associated with obesity, ahigh sugar and fat diet, and a lack of exercise. These three lifestyle factors, as well as genetic factors, dramatically increase the risk of developing Type 2 diabetes. Unlike Type 1 diabetics, Type 2 diabetics continue to produce insulin. However, their cells have become resistant to insulin, meaning that more insulin is required to achieve the same effect of lowering blood glucose. 

To compensate for insulin’s ineffectiveness, beta cells will produce even more insulin. However, when insulin resistance becomes so severe that the insulin required by the body exceeds the maximum amount of insulin produced by beta cells, symptoms of high blood glucose begin to appear. Weight loss and diabetic ketoacidosis from fat breakdown also occur in some cases of Type 2 diabetes. Furthermore, in some cases the continued overproduction takes a toll on the beta cells, which eventually die and causes a lack of insulin production, further worsening the problem. The cause of insulin resistance is still not well understood; however, factors such as high insulin levels from excessive sugar consumption and fat around the liver and pancreas are being investigated as possible causes of insulin resistance. It is important to note that it is very difficult to “cure” diabetes as of now. Doctors are only able to make living with diabetes tolerable, as long as medications are taken and lifestyle changes occur. Current treatment depends on the type of diabetes. Since the high blood glucose of Type 1 diabetes is caused by a lack of insulin, simply administer insulin during periods of high blood glucose, such as after a meal. However, this is easier said than done. Insulin is a protein and will get degraded in the stomach if taken orally. Therefore, Type 1 diabetics must inject insulin directly into the bloodstream, usually just under the skin of their abdomen. The dose is also extremely important – too little and blood glucose levels remain high, but too much insulin will cause blood glucose levels to plummet, leading to coma or even death. On the other hand, decreasing high blood glucose in Type 2 diabetes is much more complicated. Insulin is only effective in around 30% of patients as cells are already insulin resistant, so other methods of decreasing blood glucose are required. Many diabetic drugs have been developed which target the mechanisms of blood glucose regulation mentioned in the beginning of this video. These drugs can decrease glucose absorption in the intestines after a meal, decrease synthesis of new glucose, or increase insulin sensitivity which leads to more glucose uptake by cells. For example, the drug metformin is the first line treatment to Type 2 diabetes because it can activate certain metabolic pathways to both decrease glucose synthesis and increase glucose uptake by cells by increasing insulin sensitivity. However, despite our best efforts, diabetes is the 6th leading cause of death worldwide, with 3 people dying from diabetes complications every minute. Therefore, the best treatment of diabetes is to prevent diabetes from occurring in the first place. Though no prevention method is known for Type1 diabetes, frequent exercise and a healthy diet drastically reduces the risk of the much more common Type 2 diabetes. Currently, it is estimated that 400 million adults, which is around 10% of the worldwide adult population, is living with diabetes, although this number is expected to increase in the future. If more people become aware of and avoid the lifestyle choices associated with diabetes, we can slow down or even reverse this trend. 

Furthermore, Type 2 diabetes in particular develops slowly and silently over time, leading scientists to suspect that almost half of the worldwide diabetic population is undiagnosed, which is why it is so important to educate the public about the causes and symptoms of this disease. It is also important to note that diabetes is an extremely complex and not fully understood disease that scientists are still finding new information about everyday. So if you want to learn more about diabetes, like new treatments and research, check out the links in the description below.

Thanks for reading.

TRAVELLING WITH DIABETES

I travel domestically and abroad and one thing you learn with that experience is you have to be prepared when you have Type 1 Diabetes. You have to sort of think forward a little bit and decide what would be problems you may have. For example, you might not always get to food when you need to have it or you might not be able to take insulin conveniently when they’re serving food, so you have to think those things through a little bit. There’s a few things you need to prepare if you’re going to travel if you have Type 1 Diabetes.

 First, you need your insulin and you need to have back up for your insulin. You need enough insulin to carry you not only for the trip but in case there’s an unanticipated delay. When I’m traveling I usually figure how many days I’m going to be gone. I figure out how much insulin I’ll need for those days and then I at least double it if not triple it. You never know when something is going to happen -- the plane doesn’t take off right.

 If you have Type 2 Diabetes, the same rule applies to you. You need to take your oral medications to control your diabetes, not only for the time that you’re going to be gone but have back up in case you don’t get home on time.  

Second, you need a way to assess your glucose. You need to check your control and know what your control is; that means you carry a meter and enough strips to carry you.

Third, you need a way to correct a hypoglycemic reaction, a low blood sugar.  That could either be a form of rapid acting you know carbohydrates or something to eat but make sure you have it.

Fourth, you need to have a form of identification. In case you get into trouble where you can't help yourself, you need the help of somebody else and they need to know that you have diabetes. When I’m taking a long plane flight where there’s going to be meal service, there’s three things I want on my person. I don’t want them overhead where I may not be able to get to them because of turbulence or something in the aisle. I don’t want them under the plane. I want my glucose tabs with me in case I get low. I want my insulin with me so I can't take it for the meal. And I want to have a meter with me so I can adjust and determine what dose to take. When you start traveling over large time zones, for example if you’re going over to Europe or Asia or someplace where the time really shifts a lot, you need to think a little bit about your diabetes and how your insulin works in terms of the timing of your insulin.  So if your insulin is good for four to six hours but you change the time zone, you need to account for that. When you’re thinking about traveling for pleasure, taking a vacation, sometimes you can really incorporate a lot of things into that vacation that are really good, sound practices for diabetes. You can take vacations that have physical activity built into them. Go to national parks, take hikes, go out into the wilderness a little bit and use your feet. You know, not a bad idea. Sometimes you can go to places where there’s pools and oceans and--and  the options for swimming or using a bicycle .It’s not a bad idea to  incorporate good diabetes care into having fun and into vacation.

 When you’re driving in your car, a couple of good rules: 

First, don’t put your insulin in the glovebox, leave it there, and forget because if the car gets too hot or gets too cold you ruin your insulin. Now you have nothing to work with and that’s a big problem.

Number two, make sure you have something to help you correct hypoglycemia. If you get low that means you need to have something that’s rapid and will correct it and you shouldn’t drive while you do that. You should pull over, correct it, and that brings us to the third rule: have a meter. You don’t know what’s going on unless you can check. So you need to find out when you’re safe to drive. If you have diabetes and you haven't traveled a lot yet, you can get excellent advice from your healthcare team. They can give you good sound tips about how to travel safely with diabetes.

If you’re living with diabetes, you can get excellent information, great educational support at a really wonderful website https://diabetesexperienceindia.blogspot.com/ I’m pushpender singh and my Type 1 Diabetes does not prevent me from traveling.  

DIABETIC FOOT PROBLEM: SYMPTOMS,CAUSES AND TREATMENT

Hi today we are going to discuss about the different kinds of foot problems can occur in people with diabetes. There are a number of problem that a diabetic may face:

• Two main conditions are  
• Peripheral artery disease (PAD) and Peripheral neuropathy, are responsible for the increased risk of foot problems in people with diabetes.
• Symptoms and signs of diabetic foot problems arise due to the decreased sensation from nerve damage as well as the lack of oxygen delivery to the feet caused by vascular disease.
• People with diabetes have an increased risk of ulcers and damage to the feet.
• Diabetic foot problems also include bunions, corns, calluses, hammertoes, fungal infections, dryness of the skin, and ingrown toenails. These problems are not specific to diabetes, but may occur more commonly due to the nerve and vascular damage caused by diabetes.
• Treatment depends on the exact type of foot problem. Surgery or even amputation may be required for some cases.
• Gangrene (dry gangrene) is tissue death due to absence of blood circulation. It can be life threatening if bacterial infection develops (wet gangrene).
• Many diabetes-related foot problems can be prevented by good control of blood sugar levels combined with appropriate care of the feet.

How can diabetes cause foot problems?

Both type 1 and type 2 diabetes cause damage to blood vessels and peripheral nerves that can result in problems in the legs and feet. Two main conditions, 1) peripheral artery disease (PAD), and 2) peripheral neuropathy are responsible for the increased risk of foot problems in people with diabetes.

• Peripheral artery disease (PAD), sometimes referred to as peripheral vascular disease (PVD), means that there is narrowing or occlusion by atherosclerotic plaques of arteries outside of the heart and brain. This is sometimes referred to as "hardening" of the arteries. Diabetes is a known risk factor for developing peripheral artery disease. In addition to pain in the calves during exercise (medically known as intermittent claudication), the signs and symptoms of peripheral artery disease relate to a decreased delivery of oxygen to the lower legs and feet. In severe cases, the lack of oxygen delivery to tissues can result in ulcers and even gangrene (tissue death).
• Peripheral neuropathy refers to damage to the peripheral nerves directly as a result of diabetes. Symptoms of peripheral neuropathy include decreased sensation in the nerves of the legs and feet, making it difficult to perceive injuries due to lack of feeling. Peripheral neuropathy also causes a tingling, pain, or burning in the involved areas. It can also cause the muscles of the feet to work improperly, leading to misalignment of the foot that can put pressure on certain areas of the foot.

Peripheral Artery Disease (PAD or PVD) Symptoms

Peripheral artery disease (or peripheral vascular disease) symptoms include:

·        Intermittent claudication

·        Numbness in the extremities

·        Weakness of the calf muscle

·        Pain at rest

·        Hair loss

·        Coldness in the legs or feet

What are the symptoms of foot problems caused by diabetes?

In the most severe case, as mentioned above, due to a combination of decreased sensation and reduced blood flow to the feet, ulcers may develop. If the tissues continue to receive insufficient oxygen, tissue death (gangrene) occurs. Gangrene is a serious and potentially life-threatening condition. Other potentially serious problems that may develop include cellulitis (infection of the tissues beneath the skin) and osteomyelitis (infection of the bone); sepsis (the infection spreads to the bloodstream) also is possible.

People with diabetes are at increased risk for milder problems with the feet that are not specific to diabetes but may occur more frequently due to problems with the nerves and circulation to the feet.

Some of these conditions are:

Calluses and corns, that may develop due to abnormal alignment of the feet or abnormal gait

• Fungal infections of the nails, which can appear as thickened, discolored, and at times brittle nails
• Tinea pedis, or athlete's foot, a fungal infection of the skin of the feet
• Hammertoes, or bent toes due to muscle weakness.
• Bunions, or the angling of the big toe toward the second toe. The area of the bunion may become reddened and irritated, leading to callus formation.
• Ingrown toenails
• Cracking of the skin of the feet, especially the heels, due to dry skin

How are foot problems caused by diabetes treated?

Treatment depends upon the type of foot problem. For example, some problems such as corns may require wearing corrective shoes, while others such as mild infections may be treated with antibiotics or antifungals. Other problems may need surgical debridement and antibiotics. Gangrene, or tissue death, cannot be reversed, but treatments are available to prevent gangrene (often termed dry gangrene) from spreading or becoming infected (dry gangrene becomes infected and develops into wet gangrene). Surgical removal of the dead tissue is typically required, and antibiotics are given to prevent the development of life-threatening infections in the dead tissue. In severe cases of gangrene, amputation of the affected part may be necessary.

Other types of foot problems can be relieved by proper footwear, sometimes with orthotic devices, and splinting or bracing. For some conditions like hammertoes, bunions, and ingrown toenails; surgery may be necessary to correct severe cases.

Taking proper care of your feet (see Prevention section) can help prevent or relieve many common foot problems in people with diabetes.

Can diabetes-related foot problems be prevented?

Some diabetes foot-related problems can be prevented by taking careful steps to observe and care for your feet. Keeping blood sugar levels under control (in the ranges advised by your doctor), and following your recommended diet and exercise program are the best way to prevent all complications of diabetes, including foot problems. In addition to keeping your diabetes under control, you can take steps to care for your feet, including the following:

• Wear comfortable, closed-toe footwear at all times. Special shoes are available for people with bunions or foot deformities if these are necessary. Be sure no objects are trapped inside the shoes that could cut or injure your feet.
• Don't walk barefoot, even at home. Be sure your feet do not get burned by walking on very hot pavement in summer
• Always wash your feet with warm water and dry them well after washing.
• Check your feet daily for any sores or problems.
• Apply lotion to dry areas, especially heels, but don't use lotion between the toes. Corns and calluses can be lightly smoothed with a pumice stone. Never use scissors or razors to cut away corns or calluses.
• Trim toenails straight across, and do not cut the corners shorter than the rest of the nail.
• Be sure that your doctor checks your feet at every checkup.
• Stop smoking, if you are a smoker. Smoking further increases the risk of arteriosclerosis and poor circulation to the feet.

If left with any doubt or query you can comment in the comment section below.