Health and LifeStyle

Archive for May, 2009

Before we start discussion about type of diabetes we must know what exactly is diabetes?

Diabetes is a disorder of metabolism—the digestion system of our body for growth and energy. Almost every food we eat broken down to glucose, the form or sugar which is the fuel for our body.

After digestion, glucose passes into the bloodstream, where it is used by cells for growth and energy. For glucose to get into cells, insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach.

When we eat, the pancreas automatically produces the right amount of insulin to move glucose from blood into our cells. For the people having diabetes this is the place of disorder, there pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced.

Types of diabetes: The three main types of diabetes are
Type 1 diabetes
Type 2 diabetes
Gestational diabetes

Type 1 Diabetes (previously known as insulin-dependent diabetes)

Type 1 diabetes is an autoimmune disease. An autoimmune disease results when the body’s system for fighting infection stops in a part of body. In diabetes, the immune system attacks the insulin-producing beta cells in the pancreas and destroys them. The pancreas then produces little or no insulin. A person who has type 1 diabetes must take insulin daily to live.

Type 2 Diabetes (previously known as non-insulin dependent diabetes)

The most common form of diabetes is type 2 diabetes. Nearly 90 to 95 percent of people with diabetes have type 2. This form of diabetes is strongly genetic. About 80 percent of people with type 2 diabetes are overweight.

Type 2 diabetes is increasingly being diagnosed in children and adolescents. However, type 2 diabetes in youth are not in common.

When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin, but for unknown reasons, the body cannot use the insulin effectively, a condition called insulin resistance. After several years, insulin production decreases. The result is the same as for type 1 diabetes—glucose builds up in the blood and the body cannot make efficient use of its main source of fuel.

Gestational Diabetes: (Gdm)

Gestational diabetes develops only during pregnancy. Like type 2 diabetes, it occurs more often in African Americans, American Indians, Hispanic Americans, and among women with a family history of diabetes. Women who have had gestational diabetes have a 20 to 50 percent chance of developing type 2 diabetes within 5 to 10 years.

Heredity: Heredity is a major factor. That diabetes can be inherited has been known for centuries. However, the pattern of inheritance is not fully understood. Statistic indicates that those with a family history of the disease have a higher risk of developing diabetes than those without such a background. The risk factor is 25 to 33 percent more.

One reason why diabetes, especially type-2 diabetes runs in the family is because of the diabetes gene. But even it is caused by genetic factors beyond your control; there is no reason to suffer from it. Diabetes cannot be cured in full sense of the term, but it can be effectively controlled so that you would not know the difference.

Diet: Diabetes has been described by most medical scientists as a prosperity’ disease, primarily caused by systematic overeating. Not only is eating too much sugar and refined carbohydrates harmful, but proteins and fats, which are transformed into sugar, may also result in diabetes if taken in excess.

It is interesting to note that diabetes is almost unknown in countries where people are poor and cannot afford to overeat. The incidence of diabetes is directly linked with the consumption of processed foods rich in refined carbohydrates, like biscuits, bread, cakes chocolates, pudding and ice creams.

Obesity: Obesity is one of the main causes of diabetes. Studies show that 60 to 85 % of diabetics tend to be overweight. In the United States of America, about 80 percent of type 2 non-insulin dependent diabetics are reported to be overweight.

Excess fat prevents insulin from working properly. The more fatty tissue in the body, the more resistant the muscle and tissue cells become to body insulin. Insulin allows the sugar in the blood to enter the cells by acting on the receptor sites on the surface of the cells.

Older people often tend to gain weight, and the same time, many of them develop and mild form of diabetes because who are over weight can often improve their blood sugar simply by losing weight.

Stress and Tension: There is a known connection between stress and diabetes, those who are under stress and/or lead an irregular lifestyle, need to take adequate precautions and make necessary lifestyle adjustments.

Grief, worry and anxiety resulting from examinations, death of a close relative, loss of a joy, business failure and strained marital relationship, all a deep influence on the metabolism and may cause sugar to appear in the urine.

Smoking: Smoking is another important risk factor. Among men who smoke, the risk of developing diabetes is doubled. In women who smoke 25 or more cigarettes a day, the risk of developing diabetes is increased by 40 percent.

Lifestyle Risk: People who are less active have greater risk of developing diabetes. Modern conveniences have made work easier. Physical activity and exercise helps control weight, uses up a lot of glucose (sugar) present in the blood as energy and makes cells more sensitive to insulin. Consequently, the workload on the pancreas is reduced.

Diabetes is a disorder of metabolism the way our bodies use digested food for growth and energy. Most of the food we eat is broken down into glucose, the form of sugar in the blood.

Glucose is the main source of fuel for the body. Diabetes causes glucose to back up in the bloodstream. As more and more glucose remains in the bloodstream blood glucose or blood sugar levels can rise too high.

There are two major types of diabetes. Consider the following information as it relates to both type 1 diabetes and type 2 diabetes.

In type 1 diabetes (also called juvenile-onset diabetes or insulin-dependent diabetes), the body completely stops producing any insulin. Insulin is a hormone that enables the body to use glucose to produce energy. Sufferers of type 1 diabetes must take daily insulin injections in order to survive.

Type 1 diabetes usually develops in children or young adults; however, it can occur at any age.

Type 2 diabetes (also called adult-onset diabetes or non insulin-dependent diabetes) results when the body doesn’t produce enough insulin and/or is unable to use insulin properly .

Type 2 diabetes happens when your body either cannot produce enough insulin or does not use the insulin it makes properly.

Insulin is a hormone produced by the pancreas. Many of the foods we eat such as bread, potatoes, rice, pasta and fruit are converted into sugar and give us the energy we need to maintain life. Insulin gets the sugar into the cells.

Diabetes is a life-long condition. High blood glucose levels over a long period of time can cause blindness, heart disease, kidney problems, and amputations.

Good diabetes care and management can prevent or delay the onset of these complications.

To manage your diabetes well, it is very important that you:

- Don’t smoke
- Keep your blood glucose levels in your target range
- Keep your cholesterol and other blood fats in your target range
- Keep your weight in a healthy range
- Keep your blood pressure close to target level
- Take your medication as prescribed

Treatment of infertility depends on the cause, how long you’ve been infertile, the age of the partners and many personal preferences. Some causes of infertility can’t be corrected. However, a woman can still become pregnant with assisted reproductive technology or other procedures to restore fertility.

Restoring fertility
These approaches can involve steps related to the male or to the female, or both.

Increase frequency of intercourse. Having intercourse two to three times a week may improve fertility. However, too-frequent ejaculation can lessen sperm quality. Sperm survive in the female reproductive tract for up to 72 hours, and an egg can be fertilized for up to 24 hours after ovulation.

Treatment for men
Other approaches that involve the male include treatment for:

• General sexual problems. Addressing impotence or premature ejaculation can improve fertility. Treatment for these problems often is with medication or behavioral approaches.
• Lack of sperm. If a lack of sperm is suspected as the cause of a man’s infertility, surgery or hormones to correct the problem or use of assisted reproductive technology is sometimes possible. For example, varicocele can often be surgically corrected. For blockage of the ejaculatory duct or in the case of retrograde ejaculation, sperm can be taken directly from the testicles or recovered from the bladder and injected into an egg in the laboratory setting.

Treatment for women

Stimulating ovulation with fertility drugs
Fertility drugs are the main treatment for women who are infertile due to ovulation disorders. These medications regulate or induce ovulation. In general, they work like natural hormones — such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — to trigger ovulation. Commonly used fertility drugs include:

• Clomiphene citrate (Clomid, Serophene). This drug is taken orally and stimulates ovulation in women who have PCOS or other ovulatory disorders. It causes the pituitary gland to release more FSH and LH, which stimulate the growth of an ovarian follicle containing an egg.
• Human menopausal gonadotropin, or hMG (Repronex). This injected medication is for women who don’t ovulate on their own due to the failure of the pituitary gland to stimulate ovulation. Unlike clomiphene, which stimulates the pituitary gland, hMG and other gonadotropins directly stimulate the ovaries. This drug contains both FSH and LH.
• Follicle-stimulating hormone, or FSH (Gonal-F, Follistim, Bravelle). FSH works by stimulating the ovaries to mature egg follicles.
• Human chorionic gonadotropin, or HCG (Ovidrel, Pregnyl). Used in combination with clomiphene, hMG and FSH, this drug stimulates the follicle to release its egg (ovulate).
• Gonadotropin-releasing hormone (Gn-RH) analogs. This treatment is for women with irregular ovulatory cycles or who ovulate prematurely — before the lead follicle is mature enough — during hMG treatment. Gn-RH analogs deliver constant Gn-RH to the pituitary gland, which alters hormone production, so that a doctor can induce follicle growth with FSH.
• Letrozole (Femara). This drug is in a class of medications called aromatase inhibitors, which are approved for treatment of advanced breast cancer. Doctors sometimes prescribe letrozole for women who don’t ovulate on their own and who haven’t responded to treatment with clomiphene citrate. Letrozole is not approved by the Food and Drug Administration for inducing ovulation. The drug’s manufacturer has warned doctors not to use the drug for fertility purposes because of possible adverse health effects. These adverse effects may include birth defects and miscarriage.
• Metformin (Glucophage). This oral drug is taken to boost ovulation. It’s used when insulin resistance is a known or suspected cause of infertility. Insulin resistance may play a role in the development of PCOS.
• Bromocriptine. This medication is for women whose ovulation cycles are irregular due to elevated levels of prolactin, the hormone that stimulates milk production in new mothers. Bromocriptine inhibits prolactin production.

Fertility drugs and the risk of multiple pregnancies
Injectable fertility drugs increase the chance of multiple births. Oral fertility drugs (Clomid) increase the chance of multiple births but at a much lower rate. The use of these drugs requires careful monitoring using blood tests, hormone tests and ultrasound measurement of ovarian follicle size. Generally, the greater the number of fetuses, the higher the risk of premature labor. Babies born prematurely are at increased risk of health and developmental problems. These risks are greater for triplets than for twins or single pregnancies.

The risk of multiple pregnancies can be reduced. If a woman requires an HCG injection to trigger ovulation, and ultrasound exams show that too many follicles have developed, she and her doctor can decide to withhold the HCG injection. For many couples, however, the desire to become pregnant overrides concerns about conceiving multiple babies.

When too many babies are conceived, removal of one or more fetuses (multifetal pregnancy reduction) can offer improved survival odds for the surviving fetuses. This presents serious emotional and ethical challenges for many people. If you and your partner are considering fertility drug treatment, discuss this possibility with your doctor before starting treatment.

Surgery
Depending on the cause, surgery may be a treatment option for infertility. Blockages or other problems in the fallopian tubes can often be surgically repaired. Laparoscopic techniques allow delicate operations on the fallopian tubes.

Infertility due to endometriosis often is difficult to treat. Although hormones such as those found in birth control pills are effective for treating endometriosis and relieving pain, they haven’t been useful in treating infertility. If you have endometriosis, your doctor may treat you with ovulation therapy, in which medication is used to stimulate or regulate ovulation, or in vitro fertilization, in which the egg and sperm are joined in the laboratory and transferred to the uterus.

Assisted reproductive technology (ART)
ART has revolutionized the treatment of infertility. Each year thousands of babies are born in the United States as a result of ART. Medical advances have enabled many couples to have their own biological child. An ART health team includes physicians, psychologists, embryologists, laboratory technicians, nurses and allied health professionals who work together to help infertile couples achieve pregnancy.

The most common forms of ART include:

• In vitro fertilization (IVF). This is the most effective ART technique. IVF involves retrieving mature eggs from a woman, fertilizing them with a man’s sperm in a dish in a laboratory and implanting the embryos in the uterus three to five days after fertilization. IVF often is recommended when both fallopian tubes are blocked. It’s also widely used for a number of other conditions, such as endometriosis, unexplained infertility, cervical factor infertility, male factor infertility and ovulation disorders. IVF increases your chances of having more than one baby at a time because often multiple fertilized eggs are often implanted back into your uterus so that there is a greater chance one will develop into a baby. IVF also requires frequent blood tests and daily hormone injections.
• Electrical or vibratory stimulation to achieve ejaculation. Electric or vibratory stimulus brings about ejaculation to obtain semen. This procedure can be used in men with a spinal cord injury who can’t otherwise achieve ejaculation.
• Surgical sperm aspiration. This technique involves removing sperm from part of the male reproductive tract such as the epididymis, vas deferens or testicle. This allows retrieval of sperm if the ejaculatory duct is blocked.
• Intracytoplasmic sperm injection (ICSI). This technique consists of a microscopic technique (micromanipulation) in which a single sperm is injected directly into an egg to achieve fertilization in conjunction with the standard IVF procedure. ICSI has been especially helpful in couples who have previously failed to achieve conception with standard techniques. For men with low sperm concentrations, ICSI dramatically improves the likelihood of fertilization.
• Assisted hatching. This technique attempts to assist the implantation of the embryo into the lining of the uterus.

ART works best when the woman has a healthy uterus, responds well to fertility drugs, and ovulates naturally or uses donor eggs. The man should have healthy sperm, or donor sperm should be available. The success rate of ART gradually diminishes after age 32.

Complications of treatment
Certain complications exist with the treatment of infertility. These include:

• Multiple pregnancy. The most common complication of ART is multiple pregnancy. The number of quality embryos kept and matured to fetuses and birth ultimately is a decision made by the couple. If too many babies are conceived, the removal of one or more fetuses (multifetal pregnancy reduction) is possible to improve survival odds for the other fetuses.
• Ovarian hyperstimulation syndrome (OHSS). If overstimulated, a woman’s ovaries may enlarge and cause pain and bloating. Mild to moderate symptoms often resolve without treatment, although pregnancy may delay recovery. Rarely, fluid accumulates in the abdominal cavity and chest, causing abdominal swelling and shortness of breath. This accumulation of fluid can deplete blood volume and lower blood pressure. Severe cases require emergency treatment. Younger women and those who have polycystic ovary syndrome have a higher risk of developing OHSS than do other women.
• Bleeding or infection. As with any invasive procedure, there is a risk of bleeding or infection with assisted reproductive technology.
• Low birth weight. The greatest risk factor for low birth weight is a multiple pregnancy. In single live births, there may be a greater chance of low birth weight associated with ART.
• Birth defects. There is some concern about the possible relationship between ART and birth defects. More research is necessary to confirm this possible connection. Weigh this factor if you’re considering whether to take advantage of this treatment. ART is the most successful fertility-enhancing therapy to date.