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1 :
Diabetes mellitus is a disease characterized by persistent hyperglycemia (high blood sugar levels). It is a metabolic disease that requires medical diagnosis, treatment and lifestyle changes. The World Health Organization recognizes three main forms of diabetes: type 1, type 2 and gestational diabetes (or type 3, occurring during pregnancy)[1], although these three "types" of diabetes are more accurately considered patterns of pancreatic failure rather than single diseases. Type 1 is due to autoimmune destruction of the insulin-producing cells, while type 2 and gestational diabetes are due to insulin resistance by tissues. Since the first therapeutic use of insulin (1921) diabetes has been a treatable but chronic condition, and the main risks to health are its characteristic long-term complications. These include cardiovascular disease (doubled risk), chronic renal failure (it is the main cause for dialysis in developed world adults), retinal damage which can lead to blindness and is the most significant cause of adult blindness in the non-elderly in the developed world, nerve damage, erectile dysfunction (impotence), to gangrene with risk of amputation of toes, feet, and even legs. Type 1 diabetes mellitus Main article: Diabetes mellitus type 1 Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets of Langerhans of the pancreas. Sensitivity and responsiveness to insulin are usually normal, especially in the early stages. This type comprises up to 10% of total cases in North America and Europe, though this varies by geographical location. This type of diabetes can affect children or adults, but has traditionally been termed "juvenile diabetes" because it represents a majority of cases of diabetes affecting children. The most common cause of beta cell loss leading to type 1 diabetes is autoimmune destruction, accompanied by antibodies directed against insulin and islet cell proteins. The principal treatment of type 1 diabetes, even from the earliest stages, is replacement of insulin. Without insulin, ketosis and diabetic ketoacidosis can develop and coma or death will result. Type 1 diabetes - formerly known as insulin-dependent diabetes (IDDM), childhood diabetes, or juvenile-onset diabetes - is most commonly diagnosed in children and adolescents, but can occur in adults, as well. It is characterized by β-cell destruction, which usually leads to an absolute deficiency of insulin. Most cases of type 1 diabetes are immune-mediated characterized by autoimmune destruction of the body's β-cells in the islets of Langerhans of the pancreas, destroying them or damaging them sufficiently to reduce insulin production. However, some forms of type 1 diabetes are characterized by loss of the body's β-cells without evidence of autoimmunity.[citation needed] Lifestyle does not affect the probability of getting type 1 diabetes. Currently, type 1 diabetes can be treated only with insulin (injected or inhaled), with careful monitoring of blood glucose levels using blood testing monitors. Emphasis is also placed on lifestyle adjustments (diet and exercise). Apart from the common subcutaneous injections, it is also possible to deliver insulin via a pump, which allows infusion of insulin 24 hours a day at preset levels, and the ability to program a push dose (a bolus) of insulin as needed at meal times. This is at the expense of an indwelling subcutaneous catheter. It is also possible to deliver insulin via an inhaled powder. Type 1 treatment must be continued indefinitely at present. Treatment does not impair normal activities, if sufficient awareness, appropriate care, and discipline in testing and medication. The average glucose level for the type 1 patient should be as close to normal (80–120 mg/dl, 4–6 mmol/l) as possible. Some physicians suggest up to 140–150 mg/dl (7-7.5 mmol/l) for those having trouble with lower values, such as frequent hypoglycemic events. Values above 200 mg/dl (10 mmol/l) are often accompanied by discomfort and frequent urination leading to dehydration. Values above 300 mg/dl (15 mmol/l) usually require immediate treatment and may lead to ketoacidosis. Low levels of blood glucose, called hypoglycemia, may lead to seizures or episodes of unconsciousness. [edit] Type 2 diabetes mellitus Main article: Diabetes mellitus type 2 Type 2 diabetes mellitus is due to a combination of defective insulin secretion and defective responsiveness to insulin (often termed reduced insulin sensitivity). In early stages, the predominant abnormality is reduced insulin sensitivity, characterized by elevated levels of insulin in the blood. When insulin secretion is affected, the effect is more subtle than in Type 1, and initially involves only the earliest phase of insulin secretion. [citation needed]In the early stages, hyperglycemia can be reversed by a variety of measures and medications that improve insulin sensitivity or reduce glucose production by the liver, but as the disease progresses the impairment of insulin secretion worsens, and therapeutic replacement of insulin often becomes necessary. Type 2 diabetes is quite common, comprising 90% or more of cases of diabetes, especially in the developed world. There is a strong, but not exclusive, association with obesity, with aging, and with family history, although in the last decade it has increasingly begun to affect children and adolescents. In the past, this type of diabetes was often termed adult-onset diabetes, maturity-onset diabetes, or non-insulin dependent diabetes mellitus (NIDDM); each of these terms have been abandoned. . In type 2 diabetes insulin levels are initially normal or even elevated, but peripheral tissues lose responsiveness to insulin (known as "insulin resistance"), almost certainly involving the insulin receptor in cell membranes. There are numerous theories as to the exact cause and mechanism for this resistance, but central obesity (fat concentrated around the waist in relation to abdominal organs, not it seems, subcutaneous fat) is known to predispose for insulin resistance, possibly due to its secretion of adipokines ( a group of hormones) that impair glucose tolerance. Abdominal fat is especially active hormonally. Obesity is found in approximately 85% of North American patients diagnosed with type 2 diabetes. Type 2 diabetes may go unnoticed for years in a patient before diagnosis, since the symptoms are typically milder (eg, lack of ketoacidotic episodes) and can be sporadic. However, severe complications can result from unnoticed type 2 diabetes, including renal failure, vascular disease (including coronary artery disease), vision damage, etc. Type 2 diabetes is usually first treated by changes in physical activity (usually increase), diet (generally decrease carbohydrate intake, especially glucose generating carbohydrates), and through weight loss. These can restore insulin sensitivity, even when the weight loss is modest, for example, around 5 kg (10 to 15 lb), most especially when it is in abdominal fat deposits. The next step, if necessary, is treatment with oral antidiabetic drugs. As insulin production is initially unimpaired, oral medication (often used in combination) can still be used that improves insulin production (eg, sulfonylureas) and regulate inappropriate release of glucose by the liver (and attenuate insulin resistance to some extent (eg, metformin), and substantially attenuate insulin resistance (eg, thiazolidinediones). If these fail, insulin therapy will be necessary to maintain normal or near normal glucose levels. A disciplined regimen of blood glucose checks is recommended in most cases, most particularly and necessarily when taking most of these medications. Diabetes insipidus (DI) is a disease characterized by excretion of large amounts of severely diluted urine, which cannot be reduced when fluid intake is reduced. It denotes inability of the kidney to concentrate urine. DI is caused by a deficiency of antidiuretic hormone, or by an insensitivity of the kidneys to that hormone.
2 :
Diabetes Insipidus: Despite the similar names, diabetes insipidus is not related to diabetes mellitus (which is sometimes called sugar diabetes). Some people with diabetes insipidus have kidneys that don't concentrate urine very well (meaning their urine is more diluted). They have to urinate very often. They might wake up 2 or 3 times in the night to urinate. People with diabetes insipidus are thirsty all the time. They often want to drink liquids every hour. Two things cause diabetes insipidus. In some people, a part of the brain (called the hypothalamus) doesn't make enough antidiuretic hormone (called ADH), which your body needs to work right. In other people, the kidneys don't work with this hormone the way they should. Most people with diabetes insipidus get it after an injury to the head or after brain surgery. Some people with diabetes insipidus have a brain tumor. Sometimes it runs in families. Some medicines, like lithium, can also cause it. About 25% of the time, doctors can't find any reason for it. Usually your doctor will check a sample of your urine to see if it is very dilute (weak). He or she will also check a sample of your blood to see if it is concentrated (strong) or diluted. Your doctor may then give you a "water deprivation" test. During the time of this test, you aren't allowed to drink any liquids. The staff will weigh you, check your urine and draw your blood every hour for several hours. If the results of the test show that you have diabetes insipidus, you will probably also have pictures taken of your brain. You might have a CT (computed tomographic) scan or an MRI (magnetic resonance image). These scans are a little like x-rays. The scans would show if you have a problem in your brain. You might not be bothered by your symptoms. Some people aren't. If you aren't bothered, you might not have to do anything. However, your doctor will want to check on you more often. Also, you should make sure you always have something to drink, so your body doesn't get dehydrated (dried out). If you have to get up often at night to urinate, you might be bothered by this. A medicine called DDAVP can help. This medicine is very much like your body's natural ADH. The medicine comes in a nasal spray. You just spray it in each nostril before going to bed. If you have to get up many times in the night, you may need to use the spray at night and in the morning. If you are taking DDAVP, you must make sure you don't drink too much, or your body will get overloaded with fluids. If you get too much fluid in your body, you might feel weak or dizzy, or you might just feel bad all over. If your diabetes insipidus is caused by kidneys that don't work well with ADH, DDAVP won't help you. Other medicines, like hydrochlorothiazide (a "water" pill), may help. Water pills help your body balance salt and water. Talk to your doctor about which option is right for you. Diabetes Mellitus: For the disease characterized by excretion of large amounts of severely diluted urine, see diabetes insipidus. For diabetes mellitus in pets, see diabetes in cats and dogs. Diabetes mellitus is a disease characterized by persistent hyperglycemia (high blood sugar levels). It is a metabolic disease that requires medical diagnosis, treatment and lifestyle changes. The World Health Organization recognizes three main forms of diabetes: type 1, type 2 and gestational diabetes (or type 3, occurring during pregnancy)[1], although these three "types" of diabetes are more accurately considered patterns of pancreatic failure rather than single diseases. Type 1 is due to autoimmune destruction of the insulin-producing cells, while type 2 and gestational diabetes are due to insulin resistance by tissues. Since the first therapeutic use of insulin (1921) diabetes has been a treatable but chronic condition, and the main risks to health are its characteristic long-term complications. These include cardiovascular disease (doubled risk), chronic renal failure (it is the main cause for dialysis in developed world adults), retinal damage which can lead to blindness and is the most significant cause of adult blindness in the non-elderly in the developed world, nerve damage, erectile dysfunction (impotence), to gangrene with risk of amputation of toes, feet, and even legs.
3 :
Diabetes Insipidus is a rare disease caused by deficiency of vasopressin, one of the hormones of the posterior pituitary gland, which controls the amount of urine secreted by the kidneys. The symptoms of diabetes insipidus are marked thirst and the excretion of large quantities of urine, as much as 4 to 10 liters a day. This urine has a low specific gravity and contains no excess sugar. In many cases, injection or nasal inhalation of vasopressin controls the symptoms of the disease. =-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=- Diabetes Mellitus is a disease in which the pancreas produces little or no insulin, a hormone that helps the body’s tissues absorb glucose (sugar) so it can be used as a source of energy. The condition may also develop if muscle, fat, and liver cells respond poorly to insulin. In people with diabetes, glucose levels build up in the blood and urine, causing excessive urination, thirst, hunger, and problems with fat and protein metabolism. Diabetes mellitus differs from the less common diabetes insipidus, which is caused by lack of the hormone vasopressin that controls the amount of urine secreted. In the United States, about 17 million people (6 percent of the population) suffer from diabetes mellitus. Every year, about 1 million people learn they have the disease. Diabetes mellitus kills over 400,000 U.S. residents each year, and it is the sixth leading cause of all deaths caused by disease. In Canada, more than 2.2 million residents (7 percent of the population) have diabetes mellitus, and the disease contributes to more than 25,000 deaths a year. Diabetes is most common in adults over 45 years of age; in people who are overweight or physically inactive; in individuals who have an immediate family member with diabetes; and in people of African, Hispanic, and Native American descent. The highest rate of diabetes in the world occurs in Native Americans. More women than men have been diagnosed with the disease. In diabetes mellitus low insulin levels prevent cells from absorbing glucose. As a result, glucose builds up in the blood. When glucose-laden blood passes through the kidneys, the organs that remove blood impurities, the kidneys cannot absorb all of the excess glucose. This excess glucose spills into the urine, accompanied by water and electrolytes—ions required by cells to regulate the electric charge and flow of water molecules across the cell membrane. This causes frequent urination to get rid of the additional water drawn into the urine; excessive thirst to trigger replacement of lost water; and hunger to replace the glucose lost in urination. Additional symptoms may include blurred vision, dramatic weight loss, irritability, weakness and fatigue, and nausea and vomiting. TYPE 1 DIABETES Diabetes is classified into two types. In Type 1 diabetes, formerly called insulin-dependent diabetes mellitus (IDDM) and juvenile-onset diabetes, the body does not produce insulin or produces it only in very small quantities. Symptoms usually appear suddenly, typically in individuals under 20 years of age. Most cases occur around puberty—around age 10 to 12 in girls and age 12 to 14 in boys. In the United States Type 1 diabetes accounts for 5 to 10 percent of all diabetes cases. In Canada, Type 1 diabetes accounts for about 10 percent of all diabetes cases. Type 1 diabetes is considered an autoimmune disease because the immune system (system of organs, tissues, and cells that rid the body of disease-causing organisms or substances) attacks and destroys insulin-producing cells, known as beta cells, in the pancreas. Scientists believe that a combination of genetic and environmental factors may somehow trigger the immune system to destroy these cells. Scientists have so far identified 20 genes that play a role in Type 1 diabetes, although the exact function of these genes is still under investigation. Environmental factors, such as certain viruses, may also contribute to the development of the disease, particularly in people who already have a genetic predisposition for the disease. Untreated Type 1 diabetes affects the metabolism of fat. Because the body cannot convert glucose into energy, it begins to break down stored fat for fuel. This produces increasing amounts of acidic compounds in the blood called ketone bodies, which interfere with cellular respiration, the energy-producing process in cells. TYPE 2 DIABETES In Type 2 diabetes, formerly known as non-insulin-dependent diabetes mellitus (NIDDM) and adult-onset diabetes, the body’s delicate balance between insulin production and the ability of cells to use insulin goes awry. Symptoms characteristic of Type 2 diabetes include those found in Type 1 diabetes, as well as repeated infections or skin sores that heal slowly or not at all, generalized tiredness, and tingling or numbness in the hands or feet. Of the nearly 16 million people in the United States with diabetes, 90 to 95 percent (about 15 million people) have Type 2 diabetes. About 90 percent of all diabetes cases in Canada are Type 2. The onset of Type 2 diabetes usually occurs after the age of 45, although the incidence of the disease in younger people is growing rapidly. Because symptoms develop slowly, individuals with the disease may not immediately recognize that they are sick. A number of genes work together to cause Type 2 diabetes. In addition, scientists believe that there is a strong relationship between obesity and Type 2 diabetes. About 80 percent of diabetics with this form of the disease are significantly overweight. COMPLICATIONS If left untreated, diabetes mellitus may cause life-threatening complications. Type 1 diabetes can result in diabetic coma (a state of unconsciousness caused by extremely high levels of glucose in the blood) or death. In both Type 1 and Type 2 diabetes, complications may include blindness, kidney failure, and heart disease. Diabetes can cause tiny blood vessels to become blocked; when this occurs in blood vessels of the eye, it can result in retinopathy (the breakdown of the lining at the back of the eye), causing blindness. Diabetes mellitus is the leading cause of new cases of blindness in people aged 20 to 74. When diabetes affects the kidney it is called nephropathy (the inability of the kidney to properly filter body toxins). About 40 percent of new cases of end-stage renal disease (kidney failure) are caused by diabetes mellitus. Blockages of large blood vessels in diabetics can lead to many cardiovascular problems, including high blood pressure, heart attack, and stroke. Although these conditions also occur in nondiabetic individuals, people with diabetes are two to four times more likely to develop cardiovascular disorders. Diabetes mellitus may also cause loss of feeling, particularly in the lower legs. This numbness may prevent a person from feeling the pain or irritation of a break in the skin or of foot infection until after complications have developed, possibly necessitating amputation of the foot or leg. Burning pain, sensitivity to touch, and coldness of the foot, conditions collectively known as neuropathy, can also occur. Other complications include higher-risk pregnancies in diabetic women and a greater occurrence of dental disease. DIAGNOSIS AND TREATMENT Diabetes is detected by measuring the amount of glucose in the blood after an individual has fasted (abstained from food) for about eight hours. In some cases, physicians diagnose diabetes by administering an oral glucose tolerance test, which measures glucose levels before and after a specific amount of sugar has been ingested. Another test being developed for Type 1 diabetes looks for specific antibodies (proteins of the immune system that attack foreign substances) present only in persons with diabetes. This test may detect Type 1 diabetes at an early stage, reducing the risk of complications from the disease. Once diabetes is diagnosed, treatment consists of controlling the amount of glucose in the blood and preventing complications. Depending on the type of diabetes, this can be accomplished through regular physical exercise, a carefully controlled diet, and medication. Individuals with Type 1 diabetes require insulin injections, often two to four times a day, to provide the body with the insulin it does not produce. The amount of insulin needed varies from person to person and may be influenced by factors such as a person’s level of physical activity, diet, and the presence of other health disorders. Typically, individuals with Type 1 diabetes use a meter several times a day to measure the level of glucose in a drop of their blood obtained by pricking a fingertip. They can then adjust the amount of insulin injected, physical exercise, or food intake to maintain the blood sugar at a normal level. People with Type 1 diabetes must carefully control their diets by distributing meals and snacks throughout the day so as not to overwhelm the ability of the insulin supply to help cells absorb glucose. They also need to eat foods that contain complex sugars, which break down slowly and cause a slower rise in blood sugar levels. Although most persons with Type 1 diabetes strive to lower the amount of glucose in their blood, levels that are too low can also cause health problems. For example, if a person with Type 1 diabetes injects too much insulin, it can produce low blood sugar levels. This may result in hypoglycemia, a condition characterized by shakiness, confusion, and anxiety. A person who develops hypoglycemia can combat symptoms by consuming food that contains sugar, such as glucose tablets, fruit juice, or hard candy. In order to control insulin levels, people with Type 1 diabetes must monitor their glucose levels several times a day. In 1983 a group of 1,441 Type 1 diabetics aged 13 to 39 began participating in the Diabetes Control and Complications Trial (DCCT), the largest scientific study of diabetes treatment ever undertaken. The DCCT studied the potential for reducing diabetes-related complications, such as nerve or kidney disease or eye disorders, by having patients closely monitor their blood sugar levels four to six times a day, maintaining the levels as close to normal as possible. The results of the study, reported in 1993, showed a 50 to 75 percent reduction of diabetic complications in people who aggressively monitored and controlled their glucose levels. Although the study was performed on people with Type 1 diabetes, researchers believe that close monitoring of blood sugar levels would also benefit people with Type 2 diabetes. For persons with Type 2 diabetes, treatment begins with diet control, exercise, and weight reduction, although over time this treatment may not be adequate. People with Type 2 diabetes typically work with nutritionists to formulate a diet plan that regulates blood sugar levels so that they do not rise too swiftly after a meal. A recommended meal is usually low in fat (30 percent or less of total calories), provides moderate protein (10 to 20 percent of total calories), and contains a variety of carbohydrates, such as beans, vegetables, and grains. Regular exercise helps body cells absorb glucose—even ten minutes of exercise a day can be effective. Diet control and exercise may also play a role in weight reduction, which appears to partially reverse the body’s inability to use insulin. For some people with Type 2 diabetes, diet, exercise, and weight reduction alone may work initially, but eventually this regimen does not help control high blood sugar levels. In these cases, oral medication may be prescribed. If oral medications are ineffective, a person with Type 2 diabetes may need insulin injections or a combination of oral medication and insulin injections. About 49 percent of individuals with Type 2 diabetes require oral medications, 40 percent require insulin injections or a combination of insulin injections and oral medications, and 10 percent use diet and exercise alone. CURRENT RESEARCH At present no cure exists for diabetes, and scientists are unsure of the exact cause, although researchers are investigating a combination of genetic and environmental factors. So far researchers have identified 20 genes involved in Type 1 diabetes, and they are working to determine each gene’s role in causing the disease. The inheritance patterns of Type 1 diabetes are complicated, with many different genes influencing a person’s risk. For instance, a gene known as DR plays a role in Type 1 diabetes. Two forms of this gene, called DR3 and DR4, are present in 95 percent of people with Type 1 diabetes. People who inherit DR3 alone develop diabetes at an older age and have antibodies that destroy insulin-producing beta cells. Those who inherit DR4 tend to develop diabetes earlier in life and have antibodies that destroy insulin. A person with both DR3 and DR4 typically develops diabetes at a very young age and has the highest level of insulin-destroying antibodies. In 2000 researchers were surprised to find that a variation of a gene called Caplain-10, which is not involved in glucose metabolism, is associated with the development of Type 2 diabetes. One form of this gene produces a small amount of protein, and researchers are studying how this decrease in protein increases a person’s risk for diabetes. Other genetic studies indicate that certain genes cause a variation of Type 2 diabetes called maturity onset diabetes of the young (MODY), which develops in people under the age of 25. Although scientists do not yet understand how these genes cause MODY, the genes are known to be active in the liver, intestine, kidney, and pancreas. Other scientists hope to identify the environmental factors that trigger Type 1 diabetes in people with a genetic predisposition for the disease. If they can determine what causes the immune system to attack the cells that produce insulin, they may discover how to prevent the condition from developing. For instance, studies suggest that certain viruses, such as coxsackie B, rubella, and mumps, may trigger an immune reaction against beta cells or in some cases directly infect and destroy these cells. Researchers attribute most cases of Type 2 diabetes to obesity. Studies show that the risk for developing Type 2 diabetes increases by 4 percent for every pound of excess weight a person carries. Researchers are investigating the exact role that extra weight plays in preventing the proper utilization of insulin and why some overweight people develop the disease while others do not. Research also focuses on transplanting a healthy pancreas or its insulin-producing beta cells into a person with Type 1 diabetes to provide a natural source of insulin. Some patients who have received pancreas transplants have experienced considerable improvements in their health, but positive, long-term results with beta-cell transplants have not yet occurred. In both types of transplants recipients must take drugs that suppress their immune systems so the body will not reject the new pancreas or cells. These drugs can cause life-threatening side effects because the patient’s body can no longer protect itself from other harmful substances. In most people with diabetes, these drugs pose a greater risk to health than living with diabetes. Scientists are also studying the development of an artificial pancreas and ways to genetically manipulate non-insulin-producing cells into making insulin. New methods for accurately measuring blood glucose levels may improve the quality of life for many individuals with diabetes. New techniques include the use of laser beams and infrared technology. For example, a tiny computer using infrared light can be used to measure a person’s blood sugar level. The computer automatically delivers the reading to an insulin pump carried on the diabetic’s body that injects the appropriate amount of insulin. Other advances include new drugs that control blood sugar. In April 2000 the United States Food and Drug Administration (FDA) approved glargine, an insulin drug that needs to be injected only once a day. Sold under the brand name Lantus, this drug can be used by people with Type 1 diabetes, as well as by those with Type 2 diabetes who require insulin injections. A number of drugs have been developed to help people with Type 2 diabetes. Examples include acarbose, (sold under the brand name Precose), which controls blood sugar by slowing the digestion of carbohydrates, and metformin (sold under the brand name Glucophage), which controls liver production of sugar, causes weight loss, and reduces total cholesterol. In 2000 the FDA removed the drug troglitazone (sold under the brand name Rezulin) from the market. Although the drug enhances the ability of cells to use glucose, it was found to produce severe liver toxicity. KKG
4 :
I think diabetes mellitus is caused by Insufficient secretion if Insulin Hormone while diabetes insipidus is caused by over secretion of it.
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