Diabetes management

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This article is about the management of diabetes mellitus. For more on the disease itself see diabetes mellitus.
Main article: Diabetes mellitus
See also: Prediabetes, Diabetes mellitus type 1, Diabetes mellitus type 2, Diabetes and pregnancy, Diabetic coma, Blood sugar, Impaired glucose tolerance, Diabetic diet, Antihypertensive agents, Diabetic hypoglycemia, Diabetic ketoacidosis, Diabetic nephropathy, Diabetic retinopathy, and Diabetes UK

Diabetes is a chronic disease with no cure as of 2009. It is associated with an impaired glucose cycle, altering metabolism. Management of this disease may include lifestyle modifications such as achieving and maintaining proper weight, diet, exercise and foot care.

Diabetes mellitus
Related articles
Types of diabetes
Diabetes mellitus type 1
Diabetes mellitus type 2
Gestational diabetes
Prediabetes:
   • Impaired fasting glycaemia
   • Impaired glucose tolerance
Blood tests
Blood sugar
Glycosylated hemoglobin
Glucose tolerance test
Fructosamine
Disease management
Diabetes management:
   • Anti-diabetic drugs
   • Conventional insulinotherapy
   • Diabetic diet
   • Intensive insulinotherapy
Glossary of diabetes
Complications
Cardiovascular disease
Diabetic comas:
   • Diabetic hypoglycemia
   • Diabetic ketoacidosis
   • Nonketotic hyperosmolar
Diabetic myonecrosis
Diabetic nephropathy
Diabetic neuropathy
Diabetic retinopathy
Diabetes and pregnancy

Contents

[edit] Overview of management

[edit] Issues requiring management

This section requires expansion.

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

[edit] Complexities relating to management

The main complexities stem from the nature of the feedback loop itself, which is sought to be regulated:

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

As diabetes is a prime risk factor for cardiovascular disease, controlling other risk factors which may give rise to secondary conditions, as well as the diabetes itself, is one of the facets of diabetes management. Checking cholesterol, LDL, HDL and triglyceride levels may indicate hyperlipoproteinemia, which may warrant treatment with hypolipidemic drugs. Checking the blood pressure and keeping it within strict limits (using diet and antihypertensive treatment) protects against the retinal, renal and cardiovascular complications of diabetes. Regular follow-up by a podiatrist or other foot health specialists is encouraged to prevent the development of diabetic foot. Annual eye exams are suggested to monitor for progression of diabetic retinopathy.

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

[edit] Early advancements

Late in the nineteenth century, sugar in the urine (glycosuria) was associated with diabetes. Various doctors studied the connection. Frederick Madison Allen studied diabetes in 1909-12, then published a large volume, Studies Concerning Glycosuria and Diabetes, (Boston, 1913). He invented a fasting treatment for diabetes called the Allen treatment for diabetes. His diet was an early attempt at managing diabetes.

[edit] Modern approaches

This section requires expansion.

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

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

Other approaches include exercise and other lifestyle changes which impact the glucose cycle.

In addition, a strong partnership between the patient and the primary healthcare provider – general practitioner or internist – is an essential tool in the successful management of diabetes. Often the primary care doctor makes the initial diagnosis of diabetes and provides the basic tools to get the patient started on a management program. Regular appointments with the primary care physician and a certified diabetes educator are some of the best things a patient can do in the early weeks after a diagnosis of diabetes. Upon the diagnosis of diabetes, the primary care physician, specialist, or endocrinologist will conduct a full physical and medical examination. A thorough assessment covers topics such as:

  • Height and weight measurements
  • Blood pressure measurements
  • Thyroid examination
  • Examination of hands, fingers, feet, and toes for circulatory abnormalities
  • Blood tests for fasting blood sugar, A1c, and cholesterol
  • Family history of diabetes, cardiovascular disease, and stroke
  • Prior infections and medical conditions
  • A list of current medications, including:
  • Smoking history, including encouragement to stop smoking (if applicable)
  • Signs of complications with pregnancy or trying to get pregnant for women patients
  • Eating and exercise habits
  • Vision abnormalities, to check for eye health issues
  • Urination abnormalities, which can indicate kidney disease

Diabetes can be very complicated, and the physician needs to have as much information as possible to help the patient establish an effective management plan.

The physician can also make referrals to a wide variety of professionals for additional health care support. In a large city there may be a diabetes center where several specialists, such as diabetes educators and dietitians, work together as a team. In smaller towns, the health care team may come together a little differently depending on the types of practitioners in the area. By working together, doctors and patients can optimize the healthcare team to successfully manage diabetes over the long term.

[edit] Blood sugar level

Blood sugar level is measured by means of a glucose meter, with the result either in mg/dL (milligrams per deciliter in the USA) or mmol/L (millimoles per litre in Canada and Europe) of blood. The average normal person should have a glucose level of around 4.5 to 7.0 mmol/L (80 to 125 mg/dL).

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

[edit] Hypo and hyperglycemia

Levels which are significantly above or below this range are problematic and can in some cases be dangerous. A level of <3.8 mmol/L (<70 mg/dL) is usually described as a hypoglycemic attack (low blood sugar). Most diabetics know when they're going to "go hypo" and usually are able to eat some food or drink something sweet to raise levels. A patient who is hyperglycemic (high glucose) can also become temporarily hypoglycemic, under certain conditions (e.g. not eating regularly, or after strenuous exercise, followed by fatigue). Intensive efforts to achieve blood sugar levels close to normal have been shown to triple the risk of the most severe form of hypoglycemia, in which the patient requires assistance from by-standers in order to treat the episode.[1] There were annually 48,500 hospitalizations for diabetic hypoglycemia and 13,100 for diabetic hypoglycemia resulting in coma in the period 1989 to 1991, before intensive blood sugar control was as widely recommended as today.[2] One study found that hospital admissions for diabetic hypoglycemia increased by 50% from 1990-1993 to 1997-2000, as strict blood sugar control efforts became more common.[3] Among intensively controlled type 1 diabetics, 55% of episodes of severe hypoglycemia occur during sleep, and 6% of diabetics under age 40 die from nocturnal hypoglycemia in the so-called 'dead-in-bed syndrome,' while National Institute of Health statistics show that 2% to 4% of all diabetics die from hypoglycemia.[4] In children and adolescents following intensive blood sugar control, 21% of hypoglycemic episodes occurred without explanation.[5] In addition to the deaths caused by diabetic hypoglycemia, periods of severe low blood sugar can also cause permanent brain damage.[6]

Levels greater than 13-15 mmol/L (230-270 mg/dL) are considered high, and should be monitored closely to ensure that they reduce rather than continue to remain high. The patient is advised to seek urgent medical attention as soon as possible if blood sugar levels continue to rise after 2-3 tests. High blood sugar levels are known as hyperglycemia, which is not as easy to detect as hypoglycemia and usually happens over a period of days rather than hours or minutes. If left untreated, this can result in diabetic coma and death.

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

Prolonged and elevated levels of glucose in the blood, which is left unchecked and untreated, will, over time, result in serious diabetic complications in those susceptible and sometimes even death. There is currently no way of testing for susceptibility to complications. Diabetics are therefore recommended to check their blood sugar levels either daily or every few days. There is also computer software available from blood testing manufacturers which can display results and trends over time. Type 1 diabetics normally check more often, due to insulin therapy.

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

[edit] Glycemic control

Glycemic control is a medical term referring to the typical levels of blood sugar (glucose) in a person with diabetes mellitus. Much evidence suggests that many of the long-term complications of diabetes, especially the microvascular complications, result from many years of hyperglycemia (elevated levels of glucose in the blood). Good glycemic control, in the sense of a "target" for treatment, has become an important goal of diabetes care, although recent research suggests that the complications of diabetes may be caused by genetic factors[7] or, in type 1 diabetics, by the continuing effects of the autoimmune disease which first caused the pancreas to lose its insulin-producing ability.[8]

Because blood sugar levels fluctuate throughout the day and glucose records are imperfect indicators of these changes, the percentage of hemoglobin which is glycosylated is used as a proxy measure of long-term glycemic control in research trials and clinical care of people with diabetes. This test, the hemoglobin A1c or glycosylated hemoglobin reflects average glucoses over the preceding 2–3 months. In nondiabetic persons with normal glucose metabolism the glycosylated hemoglobin is usually 4-6% by the most common methods (normal ranges may vary by method).

"Perfect glycemic control" would mean that glucose levels were always normal (70-130 mg/dl, or 3.9-7.2 mmol/L) and indistinguishable from a person without diabetes. In reality, because of the imperfections of treatment measures, even "good glycemic control" describes blood glucose levels that average somewhat higher than normal much of the time.

Accepted "target levels" of glucose and glycosylated hemoglobin that are considered good control have been lowered over the last 25 years, because of improvements in the tools of diabetes care, because of increasing evidence of the value of glycemic control in avoiding complications, and by the expectations of both patients and physicians. What is considered "good control" also varies by age and susceptibility of the patient to hypoglycemia.

In the 1990s the American Diabetes Association conducted a publicity campaign to persuade patients and physicians to strive for average glucose and hemoglobin A1c values below 200 mg/dl (11 mmol/l) and 8%. Currently many patients and physicians attempt to do better than that.

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

[edit] Monitoring

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

Relying on their own perceptions of symptoms of hyperglycemia or hypoglycemia is usually unsatisfactory as mild to moderate hyperglycemia causes no obvious symptoms in nearly all patients. Other considerations include the fact that, while food takes several hours to be digested and absorbed, insulin administration can have glucose lowering effects for as little as 2 hours or 24 hours or more (depending on the nature of the insulin preparation used and individual patient reaction). In addition, the onset and duration of the effects of oral hypoglycemic agents vary from type to type and from patient to patient.

[edit] Personal (home) glucose monitoring

Control and outcomes of both types 1 and 2 diabetes may be improved by patients using home glucose meters to regularly measure their glucose levels.[9] Glucose monitoring is both expensive (largely due to the cost of the consumable test strips) and requires significant commitment on the part of the patient. The effort and expense may be worthwhile for patients when they use the values to sensibly adjust food, exercise, and oral medications or insulin. These adjustments are generally made by the patients themselves following training by a clinician.

Regular blood testing, especially in type 1 diabetics, is helpful to keep adequate control of glucose levels and to reduce the chance of long term side effects of the disease. There are many (at least 20+) different types of blood monitoring devices available on the market today; not every meter suits all patients and it is a specific matter of choice for the patient, in consultation with a physician or other experienced professional, to find a meter that they personally find comfortable to use. The principle of the devices is virtually the same: a small blood sample is collected and measured. In one type of meter, the electrochemical, a small blood sample is produced by the patient using a lancet (a sterile pointed needle). The blood droplet is usually collected at the bottom of a test strip, while the other end is inserted in the glucose meter. This test strip contains various chemicals so that when the blood is applied, a small electrical charge is created between two contacts. This charge will vary depending on the glucose levels within the blood. In older glucose meters, the drop of blood is placed on top of a strip. A chemical reaction occurs and the strip changes color. The meter then measures the color of the strip optically.

Self-testing is clearly important in type I diabetes where the use of insulin therapy risks episodes of hypoglycaemia and home-testing allows for adjustment of dosage on each administration.[10] However its benefit in type 2 diabetes is more controversial as there is much more variation in severity of type 2 cases.[11] It has been suggested that some type 2 patients might do as well with home urine-testing alone.[12] The best use of home blood-sugar monitoring is being researched.[13]

Benefits of control and reduced hospital admission have been reported.[14] However, patients on oral medication who do not self-adjust their drug dosage will miss many of the benefits of self-testing, and so it is questionable in this group. This is particularly so for patients taking monotherapy with metformin who are not at risk of hypoglycaemia. Regular 6 monthly laboratory testing of HbA1c (glycated haemoglobin) provides some assurance of longterm effective control and allows the adjustment of the patient's routine medication dosages in such cases. High frequency of self-testing in type 2 diabetes has not been shown to be associated with improved control.[15] The argument is made, though, that type 2 patients with poor long term control despite home blood glucose monitoring, either have not had this integrated into their overall management, or are long overdue for tighter control by a switch from oral medication to injected insulin.[16]

[edit] HbA1c test

A useful test that has usually been done in a laboratory is the measurement of blood HbA1c levels. This is the ratio of glycosylated hemoglobin in relation to the total hemoglobin. Persistent raised plasma glucose levels cause the proportion of these molecules to go up. This is a test that measures the average amount of diabetic control over a period originally thought to be about 3 months (the average red blood cell lifetime), but more recently thought to be more strongly weighted to the most recent 2 to 4 weeks. In the non-diabetic, the HbA1C level ranges from 4.0-6.0%; patients with diabetes mellitus who manage to keep their HbA1C level below 6.5% are considered to have good glycemic control. The HbA1c test is not appropriate if there has been changes to diet or treatment within shorter time periods than 6 weeks or there is disturbance of red cell aging (e.g. recent bleeding or hemolytic anemia) or a hemoglobinopathy (e.g. sickle cell disease). In such cases the alternative Fructosamine test is used to indicate average control in the preceding 2 to 3 weeks.

[edit] Ongoing monitoring

Main article: Blood glucose monitoring

Recently, devices have been manufactured which provide ongoing monitoring of glucose levels on an automated basis during the day, for example:

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

[edit] Approaches to management

[edit] Insulin and other drug based approaches

Main article: Anti-diabetic drug

Currently, one goal for diabetics is to avoid or minimize chronic diabetic complications, as well as to avoid acute problems of hyperglycemia or hypoglycemia. Adequate control of diabetes leads to lower risk of complications associated with unmonitored diabetes including kidney failure (requiring dialysis or transplant), blindness, heart disease and limb amputation. The most prevalent form of medication is hypoglycemic treatment through either oral hypoglycemics and/or insulin therapy. There is emerging evidence that full-blown diabetes mellitus type 2 can be evaded in those with only mildly impaired glucose tolerance.[17]

Patients with type 1 diabetes mellitus require direct injection of insulin as their bodies cannot produce enough (or even any) insulin. As of 2005, there is no other clinically available form of insulin administration other than injection for patients with type 1: injection can be done by insulin pump, by jet injector, or any of several forms of hypodermic needle. Non-injective methods of insulin administration have been unattainable as the insulin protein breaks down in the digestive track. There are several insulin application mechanisms under experimental development as of 2004, including a capsule that passes to the liver and delivers insulin into the bloodstream[18]. There have also been proposed vaccines for type I using glutamic acid decarboxylase (GAD), but these are currently not being tested by the pharmaceutical companies that have sublicensed the patents to them.

For type 2 diabetics, diabetic management consists of a combination of diet, exercise, and weight loss, in any achievable combination depending on the patient. Obesity is very common in type 2 diabetes and contributes greatly to insulin resistance. Weight reduction and exercise improve tissue sensitivity to insulin and allow its proper use by target tissues.[19] Patients who have poor diabetic control after lifestyle modifications are typically placed on oral hypoglycemics. Some Type 2 diabetics eventually fail to respond to these and must proceed to insulin therapy.

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

Insulin therapy requires close monitoring and a great deal of patient education, as improper administration is quite dangerous. For example, when food intake is reduced, less insulin is required. A previously satisfactory dosing may be too much if less food is consumed causing a hypoglycemic reaction if not intelligently adjusted. In addition, exercise decreases insulin requirements as exercise increases glucose uptake by body cells whose glucose uptake is controlled by insulin, and vice versa. In addition, there are available several types of insulin with varying times of onset and duration of action.

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


The U.S. Food and Drug Administration (FDA) has approved a treatment called Exenatide, based on the saliva of a Gila monster, to control blood sugar in patients with type 2 diabetes.

[edit] Diet and supplements

Main article: Diabetic diet

For most Type 1 diabetics there will always be a need for insulin injections throughout their life. However, both Type 1 and Type 2 diabetics can see dramatic normalization of their blood sugars through controlling their diet, and some Type 2 diabetics can fully control the disease by dietary modification. As diabetes can lead to many other complications it is critical to maintain blood sugars as close to normal as possible and diet is the leading factor in this level of control.

The American Diabetes Association in 1994 recommended that 60-70% of caloric intake should be in the form of carbohydrates. This is somewhat controversial, with some researchers claiming that 40% is better,[20] while others claim benefits for a high-fiber, 75% carbohydrate diet.[21].

An article summarizing the view of the American Diabetes Association[22] gives many recommendations and references to the research. One of the conclusions is that caloric intake must be limited to that which is necessary for maintaining a healthy weight. The methodology of the dietary therapy has attracted lots of attentions from many scientific researchers and the protocols are ranging from nutritional balancing to ambulatory diet-care [23], [24], [25].

Specific diets

G.I. Diet - lowering the glycemic index of one's diet can improve the control of diabetes.[26][27] This includes avoidance of such foods as potatoes cooked in certain ways, and white bread, and instead favoring multi-grain and sourdough breads, legumes and whole grains -- foods that are converted more slowly to glucose in the bloodstream.

Low Carb Diet - It has been suggested that the gradual removal of carbohydrates from the diet and replacement with fatty foods such as nuts, seeds, meats, fish, oils, eggs, avocados, olives, and vegetables may help reverse diabetes. Fats would become the primary calorie source for the body, and complications due to insulin resistance would be minimized.[28] However, it's vitally important that such a diet is low in saturated fats. The American Diabetes Association explains: "saturated fat raises blood cholesterol. High blood cholesterol is a risk factor for heart disease. People with diabetes have more frequent heart disease."[29]

High fiber diet - It has been shown that a high fiber diet works better than the diet recommended by the American Diabetes Association in controlling diabetes, and may control blood sugar levels with the same efficacy as oral diabetes drugs.[30][31][32]

Cinnamon

Though not yet evaluated by the Food and Drug Administration, at least two studies have shown that cinnamon can act significantly reducing some effects of diabetes. One study on people used fine ground cinnamon (Cinnamomum cassia) for oral consumption. Another study used an extract (MHCP) on laboratory rats.

The study on people published in 2003 conducted in the Department of Human Nutrition, NWFP Agricultural University, Peshawar, Pakistan concluded:

The results of this study demonstrate that intake of 1, 3, or 6 g of cinnamon per day reduces serum glucose, triglyceride, LDL cholesterol, and total cholesterol in people with type 2 diabetes and suggest that the inclusion of cinnamon in the diet of people with type 2 diabetes will reduce risk factors associated with diabetes and cardiovascular diseases.[33]

The study on laboratory rats at Department of Biochemistry, Biophysics and Molecular Biology, Iowa State University published in 2001 used purified hydroxychalcone from cinnamon. The extract was named "MHCP". Part of the study's conclusion stated that "the MHCP is fully capable of mimicking insulin" and recommended further studies.[34][35]

Chromium and vanadium

Chromium - Cholesterol and triglycerides are risk factors in heart disease and diabetes, and studies show that chromium lowers levels of total cholesterol, LDL cholesterol, and triglycerides.[36][37][38][39] Chromium supplements such as chromium picolinate have been shown to improve glucose tolerance in people with type 2 diabetes,[40][41][42] although other studies have not replicated this result.[43] A meta analysis of these trials concluded that chromium supplements had no beneficial effect on healthy people, but that there might be an improvement in glucose metabolism in diabetics, although the authors stated that the evidence for this effect remains weak.[44]

Vanadium - A form of vanadium, vanadyl sulfate, seems to improve glucose control in people with type 2 diabetes.[45][46][47][48][49]

A pilot study has also found evidence that Tai Chi and Qigong reduce the severity of type 2 diabetes.[50] For a helpful presentation that highlights the importance of exercise in the prevention of diabetes, click here: [1]

Benfotiamine, a pro-vitamin of vitamin B1 which has been in use in Europe as an over-the-counter medicine for alcoholic neuropathy for the past half century with no significant side-effects or toxicity, has recently been found to block the major metabolic pathways by which excess blood glucose in the body is transformed into the advanced glycation endproducts (AGEs) which cause diabetic complications.[51] Studies have shown that taking oral benfotiamine can prevent diabetic retinopathy,[52] diabetic neuropathy,[53] and diabetic nephropathy[54] independently of any affect on the blood sugar levels of the patient. In theory, taking benfotiamine might allow patients to be less scrupulous in trying to normalize blood sugar levels and thus free them from the danger of hypoglycemia and the stress of stringent blood sugar monitoring, while still protecting them against the negative effects of hyperglycemia. Research is ongoing to establish the full significance of benfotiamine in the treatment of diabetes.

[edit] Academic resources

  • British Journal of Diabetes & Vascular Disease, ISSN: 1474-6514 [55]
  • Clinical Diabetes, ISSN: 0891-8929 [56]
  • Diabetes & Vascular Disease Research [57]
  • Diabetic Medicine [58]
  • Diabetes
  • Diabetes Care
  • Diabetes Spectrum, ISSN: 1040-9165 [59]
  • Diabetes Research and Clinical Practice [60]
  • Experimental Diabetes Research [61]
  • International Journal of Diabetes and Metabolism, ISSN: 1606-7754 [62]
  • International Journal of Diabetes in Developing Countries [63]
  • Journal of Diabetes and its Complication [64]
  • Journal of Diabetes Science and Technology, ISSN: ISSN:1932-2968 [65]
  • Journal of Endocrinology, Metabolism and Diabetes of South Africa, ISSN: 1608-9677 [66]
  • Pediatric Diabetes [67]
  • Primary Care Diabetes [68]
  • South African Journal of Diabetes and Vascular Disease, ISSN: 1811-6515 [69]

[edit] Industrial resources

  • Canadian Journal of Diabetes [70]
  • Journal of Diabetes Nursing [71]

[edit] References

  1. ^ V. Briscoe and H. Davis, "Hypoglycemia in Type 1 and Type 2 Diabetes," Clinical Diabetes, vol. 24, no. 3, p. 115 (2004)
  2. ^ H. Fishbein and P. Palumbo, "Acute Metabolic Complications in Diabetes," ch. 13 of Diabetes in America (Bethesda: National Diabetes Data Group, 1995) p. 283
  3. ^ M. Asuncion, et al, "Increase in Hypoglycemia Admissions," Ethnicity and Diabetes, vol. 17, no. 3, p. 536 (2007)
  4. ^ L. Perlmutter, et al, "Glycemic Control and Hypoglycemia," Diabetes Care, vol. 31, p. 2072 (2008)
  5. ^ S. Tupok, et al, "Severe Hypoglycemia in Children and Adolescents During Multiple Dose Therapy," Diabetes Medicine, vol. 15, no. 8, p. 695 (1998)
  6. ^ M. Fugioka, et al, "Specific Changes in Human Brain after Hypoglycemic Injury," Stroke, vol. 28, p. 524 (1997)
  7. ^ L. Tarnow, "European Rational Approach for the Genetics of Diabetic Complications," Nephrology, Dialysis, Transplantation, vol. 23, no. 1, p. 161 (2008)
  8. ^ Duncan Adams, "Autoimmune Destruction of Pericytes as the Cause of Diabetic Retinopathy," Clinical Ophthalmology, vol. 2, no. 2, p. 295 (2008)
  9. ^ Gray A, Raikou M, McGuire A, Fenn P, Stevens R, Cull C, Stratton I, Adler A, Holman R, Turner R (2000). "Cost effectiveness of an intensive blood glucose control policy in patients with type 2 diabetes: economic analysis alongside randomized controlled trial (UKPDS 41). United Kingdom Prospective Diabetes Study Group". BMJ 320 (7246): 1373–8. doi:10.1136/bmj.320.7246.1373. PMID 10818026. http://bmj.bmjjournals.com/cgi/content/full/320/7246/1373. 
  10. ^ Evans JM, Newton RW, Ruta DA, MacDonald TM, Stevenson RJ, Morris AD (10 Jul 1999). "Frequency of blood glucose monitoring in relation to glycaemic control: observational study with diabetes database". BMJ 319 (7202): 83–6. PMID 10398627. http://bmj.bmjjournals.com/cgi/content/full/319/7202/83. 
  11. ^ Gallichan M (1997). "Self monitoring of glucose by people with diabetes: evidence based practice". BMJ 314 (7085): 964–7. PMID 9099125. http://bmj.bmjjournals.com/cgi/content/full/314/7085/964. 
  12. ^ Chantelau E, Nowicki S (1997). "Self monitoring of glucose by people with diabetes. Patients with non-insulin dependent diabetes should monitor urine rather than blood glucose". BMJ 315 (7101): 185. PMID 9251556. 
  13. ^ Farmer A, Wade A, French DP, Goyder E, Kinmonth AL, Neil A (2005). "The DiGEM trial protocol—a randomized controlled trial to determine the effect on glycaemic control of different strategies of blood glucose self-monitoring in people with type 2 diabetes [ISRCTN47464659]". BMC Fam Pract 6: 25. doi:10.1186/1471-2296-6-25. PMID 15960852. 
  14. ^ Kibriya MG, Ali L, Banik NG, Khan AK (1999). "Home monitoring of blood glucose (HMBG) in Type-2 diabetes mellitus in a developing country". Diabetes Res Clin Pract 46 (3): 253–7. doi:10.1016/S0168-8227(99)00093-5. PMID 10624792. 
  15. ^ Jaworska J, Dziemidok P, Kulik TB, Rudnicka-Drozak E (2004). "Frequency of self-monitoring and its effect on metabolic control in patients with type 2 diabetes". Ann Univ Mariae Curie Sklodowska [Med] 59 (1): 310–6. PMID 16146003. 
  16. ^ Roach P (2004). "Better systems, not guidelines, for glucose monitoring". BMJ 329 (7479): E332. doi:10.1136/bmj.329.7479.E332. PMID 15591539. http://bmj.bmjjournals.com/cgi/content/full/329/7479/E332. 
  17. ^ Tuomilehto J, Lindström J, Eriksson J, Valle T, Hämäläinen H, Ilanne-Parikka P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M (2001). "Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.". N Engl J Med 344 (18): 1343–50. doi:10.1056/NEJM200105033441801. PMID 11333990. 
  18. ^ "Making insulin delivery in capsule form a reality". http://www.oramed.com/research/. 
  19. ^ "Diabetes Mellitus Management". Diabetes Mellitus and Oral Health. Armenian Medical Network. 2006. http://www.health.am/db/diabetes-management/. Retrieved on 2007-05-10. 
  20. ^ Garg, Abhimanyu; et al. (11 May 1994). "Effects of varying carbohydrate content of diet in patients with non-insulin-dependent diabetes mellitus". JAMA 271 (18): 1421–8. doi:10.1001/jama.271.18.1421. PMID 7848401. http://www.ncbi.nlm.nih.gov.ezp1.harvard.edu/entrez/query.fcgi?holding=hulib&db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=7848401&query_hl=2&itool=pubmed_docsum. 
  21. ^ Kiehm, Tae; et al. (01 August 1976). "Beneficial effects of a high carbohydrate, high fiber diet on hyperglycemic diabetic men" (abstract). Am J Clin Nutr 29 (8): 895–99. PMID 941870. http://www.ajcn.org/cgi/content/abstract/29/8/895. 
  22. ^ American Diabetes Association (2006). "Nutrition Recommendations and Interventions for Diabetes–2006". Diabetes Care 29: 2140–57. doi:10.2337/dc06-9914. PMID 16936169. http://care.diabetesjournals.org/cgi/content/full/29/9/2140?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=29&firstpage=2140&resourcetype=HWCIT. 
  23. ^ Ono, Y.. "Diet therapy for diabetes and obesity, considering osteoporosis". http://www.ncbi.nlm.nih.gov/pubmed/18445886. Retrieved on 8 January 2009. 
  24. ^ Sunsaneevithayakul, Prasert et al.. "Result of ambulatory diet therapy in gestational diabetes mellitus". http://cat.inist.fr/?aModele=afficheN&cpsidt=18156352. Retrieved on 8 January 2009. 
  25. ^ Yuzo, Sato. "New timea of the diabetes mellitus treatment. Treatment. Diet therapy and exercise therapy". http://sciencelinks.jp/j-east/article/200604/000020060406A0084331.php. Retrieved on 8 January 2009. 
  26. ^ Brand-Miller, J (1999). "Diets with a low glycemic index: from theory to practice.". Nutr Today 34: 64–72. 
  27. ^ Sheard et al. (2004). "Dietary carbohydrate (amount and type) in the prevention and management of diabetes: a statement by the American Diabetes Association." Diabetes Care;27(9):2266-71
  28. ^ Bernstein, Richard K (2007) (in English). Dr Bernstein's Diabetes Solution. New York, NY: Little, Brown and Company. ISBN 978-0-316-16716-1. http://www.diabetes-book.com/readit.shtml. 
  29. ^ American Diabetes Association, Fat - Diabetes Food Pyramid, American Diabetes Association website, retrieved July 5, 2009
  30. ^ Chandalia, M, et al. (2000). "Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus.". New Engl J Med 342: 1392–8. doi:10.1056/NEJM200005113421903. PMID 10805824. 
  31. ^ Rodríguez-Morán, M (1998). "Lipid- and glucose-lowering efficacy of plantago psyllium in type II diabetes.". Diabetes Its Complications 12: 273–8. doi:10.1016/S1056-8727(98)00003-8. 
  32. ^ Schwartz, SE (1988). "Sustained pectin ingestion: effect on gastric emptying and glucose tolerance in non-insulin-dependent diabetic patients.". Am J Clin Nutr 48: 1413–7. 
  33. ^ Alam Khan, MS, PHD, Mahpara Safdar, MS, Mohammad Muzaffar Ali Khan, MS, PHD, Khan Nawaz Khattak, MS and Richard A. Anderson, PHD, Cinnamon Improves Glucose and Lipids of People With Type 2 Diabetes, DIABETES CARE, Vol. 26, Number 12, December 2003, retrieved August 4, 2008
  34. ^ Karalee J. Jarvill-Taylor, PhD, Richard A. Anderson, PhD and Donald J. Graves, PhD A Hydroxychalcone Derived from Cinnamon Functions as a Mimetic for Insulin in 3T3-L1 Adipocytes Journal of the American College of Nutrition Vol. 20, No. 4, 327-336 (2001), retrieved August 4, 2008
  35. ^ Richard A. Anderson, Ph.D., CNS, Cinnamon, Glucose Tolerance and Diabetes, www.ars.usda.gov, August 23, 2005, retrieved August 4, 2008
  36. ^ Sherman, L (1968). "Failure of trivalent chromium to improve hyperglycemia in diabetes mellitus.". Metabolism 17: 439–42. doi:10.1016/0026-0495(68)90066-8. 
  37. ^ Lee, NA (1994). "Beneficial effect of chromium supplementation on serum triglyceride levels in NIDDM.". Diabetes Care 17: 1449–52. doi:10.2337/diacare.17.12.1449. PMID 7882815. 
  38. ^ Hermann, J (1998). "Effects of chromium or copper supplementation on plasma lipids, plasma glucose and serum insulin in adults over age fifty.". J Nutr Elderly 18: 27–45. doi:10.1300/J052v18n01_03. 
  39. ^ Press, RI (1990 January). "The effect of chromium picolinate on serum cholesterol and apolipoprotein fractions in human subjects.". West J Med. 152: 41–45. 
  40. ^ Evans, GW (1989). "The effect of chromium picolinate on insulin controlled parameters in humans.". Int J Biosocial Med Res 11: 163–80. 
  41. ^ Anderson, RA (1998). "Chromium, glucose intolerance and diabetes.". J Am Coll Nutr 17: 548–55. 
  42. ^ Anderson, RA (2000). "Chromium in the prevention and control of diabetes.". Diabetes Metab 26: 22–7. 
  43. ^ Kleefstra N, Houweling ST, Bakker SJ, et al. (2007). "Chromium treatment has no effect in patients with type 2 diabetes in a Western population: a randomized, double-blind, placebo-controlled trial". Diabetes Care 30 (5): 1092–6. doi:10.2337/dc06-2192. PMID 17303791. 
  44. ^ Balk EM, Tatsioni A, Lichtenstein AH, Lau J, Pittas AG (2007). "Effect of chromium supplementation on glucose metabolism and lipids: a systematic review of randomized controlled trials". Diabetes Care 30 (8): 2154–63. doi:10.2337/dc06-0996. PMID 17519436. http://care.diabetesjournals.org/cgi/pmidlookup?view=long&pmid=17519436. 
  45. ^ Halberstam, M, et al. (1996). "Oral vanadyl sulfate improves insulin sensitivity in NIDDM but not in obese nondiabetic subjects.". Diabetes 45: 659–66. doi:10.2337/diabetes.45.5.659. PMID 8621019. 
  46. ^ Boden, G, et al. (1996;). "Effects of vanadyl sulfate on carbohydrate and lipid metabolism in patients with non-insulin dependent diabetes mellitus.". Metabolism 45: 1130–5. doi:10.1016/S0026-0495(96)90013-X. 
  47. ^ Goldfine, AB, et al. (2000). "Metabolic effects of vanadyl sulfate in humans with non-insulin-dependent diabetes mellitus: in vivo and in vitro studies.". Metabolism 49: 400–10. doi:10.1016/S0026-0495(00)90418-9. 
  48. ^ Badmaev, V, et al. (1999). "Vanadium: a review of its potential role in the fight against diabetes.". Altern Complement Med. 5: 273–291. doi:10.1089/acm.1999.5.273. 
  49. ^ Goldwaser, I, et al. (1999). "L-Glutamic Acid gamma -Monohydroxamate. A POTENTIATOR OF VANADIUM-EVOKED GLUCOSE METABOLISM IN VITRO AND IN VIVO". J Biol Chem 274: 26617–26624. doi:10.1074/jbc.274.37.26617. PMID 10473627. 
  50. ^ Melanie Christiansen (2005-12-20). "Tai Chi a promising remedy for diabetes". Australian Broadcasting Corporation. http://www.abc.net.au/pm/content/2005/s1535304.htm.  - Pilot study of qigong and T'ai Chi in diabetes sufferers.
  51. ^ Du X, et al, "Oral Benfotiamine Plus Alpha Lipoic Acid Normalises Complication-Causing Pathways in Type 1 Diabetes," Diabetologia, vol. 51, no. 10, p. 1930 (2008)
  52. ^ H. Hammes, et al, "Benfotaimine Blocks Three Major Pathways of Hyperglycemic Damage and Prevents Experimental Diabetic Retinopathy," Nature Medicine, vol. 9, no. 3, p. 294 (2003)
  53. ^ H. Stracke, et al, "Benfotiamine in Diabetic Polyneuropathy," Experimental and Clinical Endocrinology and Diabetes, vol. 116, no. 10, p. 600 (2009)
  54. ^ R. Babaei-Jadidi, et al, "Prevention of Incipient Diabetic Nephropathy by High-Dose Thiamine and Benfotiamine," Diabetes, vol. 52, no. 8, p. 2110 (2003)
  55. ^ SAGE Publications. "British Journal of Diabetes & Vascular Disease". http://dvd.sagepub.com/. Retrieved on 8 January 2009. 
  56. ^ American Diabetes Association. "Clinical Diabetes". http://clinical.diabetesjournals.org/. Retrieved on 8 January 2009. 
  57. ^ Sherborne Gibbs. "Diabetes & Vascular Disease Research". http://www.dvdres.com/. Retrieved on 8 January 2009. 
  58. ^ John Wiley & Sons. "Diabetic Medicine". http://www.wiley.com/bw/journal.asp?ref=0742-3071&site=1. Retrieved on 8 January 2009. 
  59. ^ American Diabetes Association. "Diabetes Spectrum". http://spectrum.diabetesjournals.org/. Retrieved on 8 January 2009. 
  60. ^ Elsevier. "Diabetes Research and Clinical Practice". http://www.elsevier.com/wps/find/journaldescription.cws_home/505949/description. Retrieved on 8 January 2009. 
  61. ^ Hindawi Publishing. "Experimental Diabetes Research". http://www.hindawi.com/journals/edr/. Retrieved on 8 January 2009. 
  62. ^ Management Council of the International Journal of Diabetes. "International Journal of Diabetes and Metabolism". http://ijod.uaeu.ac.ae/. Retrieved on 8 January 2009. 
  63. ^ Medknow. "International Journal of Diabetes in Developing Countries". http://www.ijddc.com/. Retrieved on 8 January 2009. 
  64. ^ Elsevier. "Journal of Diabetes and its Complication". http://www.elsevier.com/wps/find/journaldescription.cws_home/505770/description. Retrieved on 8 January 2009. 
  65. ^ Diabetes Technology Society. "Journal of Diabetes Science and Technology". http://www.journalofdst.org/. Retrieved on 8 January 2009. 
  66. ^ Sabinet. "Journal of Endocrinology, Metabolism and Diabetes of South Africa". http://www.journals.co.za/sama/m_jemdsa.html. Retrieved on 9 January 2009. 
  67. ^ John Wiley & Sons. "Pediatric Diabetes". http://www.wiley.com/bw/journal.asp?ref=1399-543X. Retrieved on 8 January 2009. 
  68. ^ Elsevier. "Primary Care Diabetes". http://www.primary-care-diabetes.com/. Retrieved on 8 January 2009. 
  69. ^ Sabinet. "South African Journal of Diabetes and Vascular Disease". http://www.journals.co.za/ej/ejour_sajdvd.html. Retrieved on 8 January 2009. 
  70. ^ Canadian Diabetes Association. "Canadian Journal of Diabetes". http://www.diabetes.ca/for-professionals/resources/publications/canadian-journal/. Retrieved on 8 January 2009. 
  71. ^ SB Communications. "Journal of Diabetes Nursing". http://www.thejournalofdiabetesnursing.co.uk/index.php. Retrieved on 8 January 2009. 

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