Chapter 1

Diabetes
Diabetes mellitus is one of the most common non-communicable chronic diseases and the most common endocrine disease. It is characterized by disorders of the entire metabolism, carbohydrate metabolism and in particular the complications affecting the eyes, kidneys, nerves and blood vessels. In essence, diabetes is a disease in which the body does not produce enough insulin or not using it effectively. Spreading Through its frequency, diabetes fall into the category of so-called chronic diseases of civilization. Today seems as simple as determining the level of blood glucose is still so difficult to determine the prevalence of diabetes mellitus in a population. It is estimated that 2-6% of the population of Western Europe and North America suffer from this disease. Even more alarming is that nearly one third of these people are not aware of the disease. According to statistics from 1981, over 3% of Romania's population at that time was suffering from diabetes. The disease is more common in people of those cities than in villages. Centralized statistics show that the World Health Organization, 2000,in Romania there were more than a million diabetics and is estimated by 2030 their number will double.
Classification:

Most cases of diabetes mellitus fall into three broad categories: type 1, type 2, and gestational diabetes. Causes - Cases of diabetes are only partially understood. On the one hand, it is known that the appearance of both types of diabetes is related to a certain extent hereditary factors, genetic. On the other hand, environmental factors are believed to play an important role. - One of the environmental factors that are thought to cause many cases of type 1 diabetes mellitus had a virus that infects beta cells, producing insulin in the pancreas. This hypothesis is supported by clinical and experimental evidence. Or viral infection may induce diabetes by destroying insulin-producing cells or by triggering an immunereaction. - Another factor that seems to predispose to autoimmune diabetes (type 1) would be eating cow's milk or infant milk products low. Research suggests that albumin from cow's milk could lead to the appearance of antibodies by cross reactivity, eventually affecting the pancreatic beta cells and thus contributes to diabetes mellitus.
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- In type 2 diabetes, the most important modifiable factors are excess weight and lack of exercise, that is sedentary. - Another notable factor might be excessive mental stress. Immediately after the earthquake of 1977, the diabetes in Bucharest have seen a high incidence of diabetes mellitus. Thus, some authors mentioned as a possible factor diabetogenic stress, especially stress the crowd. - And misuse factors are incriminated food products that excess sugar. All these factors could explain why diabetes is more common in urban areas. Depending on the causes, diabetes, diabetes is divided into primary and secondary diabetes. When there was no other associated disease, primary diabetes alone. When identifiable disorders or pathological conditions that cause or favor the development of diabetes, secondary diabetes alone. Among the causes that may lead to secondary diabetes are: diseases affecting the pancreas (eg pancreatitis chronic alcoholics), hormonal disorders (eg, acromegaly, pheochromocytoma, Cushing's disease), diabetes induced by drugs and chemicals, various genetic diseases, etc. . Depending on the mechanism of occurrence, no diabetes mellitus type 1 and type 2 diabetes. Type 1 diabetes occurs mostly in children and young people and always requires treatment with insulin because the pancreas can not produce. For this reason also called insulin-dependent diabetes. Type 2 diabetes usually occurs in middle-aged adults (40 years) or later, most of all overweight persons. In this case, the body continues to produce insulin, but it can not fulfill the role normally. This second type of diabetes do not usually require treatment with insulin, for which diabetes was also called non-insulin-dependent. But be noted that insulin dependence is not necessarily in the patient after therapy with insulin, also, the term non-insulin-dependent is not always overlap with the absence of insulin treatment. Experts consider it the notion of "insulin dependent" draws attention to the fact that in the absence of insulin administration, the patient at risk for diabetic ketoacidosis. In other words, the terms "insulin" and "noninsulin dependent" actually describe the physiological state ( predisposition, namely resistance to ketoacidosis), while the terms "type 1" and "type 2" refers to the pathogenic mechanism, autoimmune (in type 1) and nonautoimun (in type 2). Symptoms Symptoms of diabetes vary from case to case. In general, diabetes is characterized by increasing the concentration above normal blood sugar (hyperglycemia), with or without removal of sugar in the urine (glycosuria). Other symptoms that may occur are: excessive thirst with increased intake of water, removing large amounts of urine with increased hunger and food intake in large quantities. These three symptoms, known in medical terminology as polydipsia, polyuria and polyphagia that are generally caused by hyperglycemia. In patients who are sick, but ignored the signs for a long time, not so diagnosed, it can happen to be noticed that the first manifestation of diabetic coma. Type 1 diabetes usually makes its presence felt before 40 years, but there are patients who have type 1 diabetes occurs in an atypical way, late in life at age 50 years or even later, in rare cases. Usually, patients with type 1 diabetes occurred at an older age that those who are not obese type 2 diabetes. Type 1 diabetes can occur suddenly, with thirst, excessive urination, increased appetite and weight loss. People with type 1 diabetes may be underweight or normal weight, depending on the time interval between onset of symptoms and early treatment. Usually, in type 1

diabetes, once symptoms have developed, it is necessary to administer insulin. Type 2 diabetes usually begins in midlife or later. Usually, patients with type 2 diabetes are obese or overweight. Also, in these diabetic symptoms appear and manifest themselves gradually. If the patient fails to control their weight by dietary measures, namely by taking antidiabetic drugs administered orally, is not taking insulin. There are quite many people with type 2 diabetes, insulin therapy is applied. Acute and late complications The most serious complications, possibly fatal, are most acute. They appear by marked decrease or increase in blood sugar levels (hypoglycemia with hypoglycemic coma, diabetic ketoacidosis and insulin-dependent diabetes and hyperosmolar coma noncetonica usually non-insulin-dependent diabetes). In a large number of patients, while disease leads to the so called diabetic late complications. While some never make such diabetic complications, others develop them early. On average, late complications occur at interval of 15-20 years after the appearance of overt hyperglycaemia. Some patients may experience more complications simultaneously. Diabetes affects the whole metabolism and, in the absence of adequate treatment, while leading to the occurrence of serious complications due to damage blood vessels to the heart, brain or kidneys. Untreated diabetes can lead to blindness, nerve pains, leg ulcers, etc.. In diabetics, atherosclerosis is more extensive and earlier than the general population. Cardiovascular diseases ischemic cardiomyopathy,asymptomatic myocardial infarction, stroke have a high frequency. Diabetic retinopathy occurs in approximately 85% of patients and is a leading cause of blindness. Diabetic nephropathy is a disease that causes damage to the kidney blood vessels and affects about 35% of patients with type 1 diabetes. This complication often leads to disability and even death. Diabetic neuropathy can affect every portion of the nervous system, brain less. Neuropathy can affect one or more nerve, in which case it diabetic polyneuropathy. This is manifested by numbness, paresthesia (tingling), severe hyperesthesia (increased sensitivity of nerve receptors) and pain. Pain can be intense and often gets worse at night. A unique complication of diabetes is the ulcers in the legs. This is due to abnormal pressure distribution caused by diabetic neuropathy. Evolution of infections in diabetics is generally less serious. Are common skin infections, urinary tract, respiratory, fungal infections (thrush), etc.. Experts warn in particular on four particular gravity infections characteristic of patients with diabetes: malignant external otitis, mucormicoza rinocerebrala (a fungal infection), cholecystitis and pyelonephritis emfizematoasa. Diabetes mellitus type 1 (insulin-dependent) General Diabetes mellitus is an endocrine disorder characterized by metabolic abnormalities, especially of carbohydrate metabolism. Diabetes occurs when the pancreas secretes insufficient amounts of insulin or when the way the body uses insulin is deficient. Insulin is the hormone that provides cellular energy needs by using sugar (glucose) by cells. If the secretion of insulin is deficient or if there is resistance to its action in target tissues, blood sugar (glucose) is too high and tissues can not use glucose for energy production. If blood sugar is persistently increased complications arise in the eye, heart, blood vessels, nerves and kidneys. If you reach very high blood sugar produces
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a metabolic imbalance that characterizes severe diabetic ketoacidosis (CAD). Type 1 diabetes occurs at any age, but prevalent in children and young adults, so it is called juvenile diabetes by some authors. Also, an often used synonym for type 1 diabetes is insulin-dependent diabetes mellitus (diabetes zaharatid). A form of type 1 diabetes latent autoimmune diabetes of adult onset in adulthood, often confused with type 2 diabetes mellitus. Type 1 diabetes accounts for 5% -10% of all diabetes cases. The most common form of diabetes is type 2 diabetes mellitus (insulin-independent diabetes), other forms of diabetes include gestational diabetes and secondary diabetes. Planning for pregnancy Women with type 1 diabetes who become pregnant and have to go to the doctor to be sure they keep blood sugar under control. Hyperglycemia in the first trimester of pregnancy result in increased risk of fetal defects. A careful monitoring of blood glucose during pregnancy reduces the risk of fetal defects. The level of glycohemoglobin (hemoglobin A1c) should grow by more than 1% than normal. Women with diabetes who do not want children can use contraceptive methods that reduce the risk of unwanted pregnancy due to fetal defects. Causes Type 1 diabetes occurs as a result of autoimmune destruction of pancreatic beta cells that secrete insulin. Heredity plays an important role in the pathogenesis of type 1 diabetes mellitus. However, many patients with type 1 diabetes have no family history of insulin-dependent diabetes. Therefore, experts believe that an important role in the etiology of diabetes they have, in addition to genetic predisposition, certain environmental factors. One of the environmental factors involved in producing diabetes, is usually an infectious agent such as virus coxackie b. The relationship between onset of diabetes and vaccinerea against haemophilus influenzae type b infection has not been demonstrated although this hypothesis has been made. Symptoms Symptoms of Type 1 diabetes occurs rapidly, within days or weeks and are caused by elevated blood glucose level. Early symptoms may go ignored by the patient, especially if the person had the flu recently. These early symptoms are: -Frequent urination, especially overnight. Some young children who have learned to begin toilet folosesca have enuresis (bed to urinate at night) Extreme thirst and dry mouthWeight-loss Sometimes blood sugar levels can reach very high values without the person to notice that he suffers from something. Because insulin is nonexistent, cells can not use glucose for energy production. Due to the absolute deficiency of insulin the body uses for energy production and lipid catabolism protides. Burning so much fat and protein are increased in the producing excess ketones that come into the bloodstream. It produces one of the most severe complications of type 1 diabetes mellitus: diabetic ketoacidosis (CAD) whose symptoms are: -Dry skin, red hot -Loss of appetite, abdominal pain, vomiting

-Characteristic odor of acetone on the breath -Rapid breathing, deep Agitation, drowsiness, confusion, coma. Young children lose interest in daily activities. Mechanism fiziopatogenetic Type 1 diabetes mellitus is caused by autoimmune destruction of pancreatic beta cells. The rate of destruction of these insulin-secreting cells is variable, as in children, Sudden onset of disease because beta cells are rapidly destroyed, while in adults, the onset is slow because cell destruction occurs gradually.Sometimes, symptoms of diabetes follows a viral infection (influenza virus). If the doctor is delayed presentation due to massive destruction of beta cells, absolute insulin deficiency produces marked hyperglycemia, body uses protein and fat burning for energy production. Corpus ketones and fatty acids appear in excess and to install one of the most severe complications of type 1 diabetes mellitus CAD, requiring emergency surgery. In some situations, it is observed that for a short time - weeks or months - the pancreas is able to secrete insulin, this time called the "honeymoon" and is not taking insulin or manage only a small amount of insulin depending on the secretory capacity of the pancreas. After the "honeymoon" is mandatory, chronic administration of insulin. Those who have type 1 diabetes follow an individualized treatment that includes: Insulin-taking -Adequate diet Physical-exercise program -Monitoring of blood glucose daily. Blood sugar of people with insulin-dependent diabetes are often outside the normal limits due to insulin injections that can quickly determine, within minutes, a marked decrease in blood sugar (hypoglycemia), which is a redoubtable medical emergency. On the other hand, hyperglycemia, develops slowly, within hours or days. If hyperglycemia persists CAD appears. Over time, tissue and organ damage occur due to persistent hyperglycemia is producing a diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, heart disease (myocardial infarction) and vascular (stroke and vascular obstruction, particularly in the legs). If blood sugar is maintained within safe limits can prevent at least the appearance of such serious complications. Although, some develop complications even with good control of blood glucose. Increased patient compliance (patient collaboration with the specialist and religiously follow the prescribed treatment) is prompting the patient a sense of security, feeling that she controls the disease and gives a good feeling. Risk Factors Risk factors for type 1 diabetes are: - Family history of type 1 diabetes mellitus increases the risk of island cell antibodies but not the risk that the person to do that type 1 diabetes. Only 10-15% of patients with type 1 diabetes have a family history: -Risk is 6% if the father has insulin-dependent diabetes

, Where siblings have type 1 diabetes risk of disease is 5% Parent with type 1 diabetes, the risk of diabetes is to make the descendants of 2% -In case of twins the risk is 30-50% univitelini , Where a parent and a brother / sister insulin-dependent diabetes risk is 30%. Whites increased risk for type 1 diabetes compared with African-Americans, Hispanics, Asians. This anti-beta cells in the blood - so familiar to history and this action anti-beta cells predispose to the development of type 1 diabetes mellitus. Viral infections during childhood - an enterovirus infection, especially infection coxackieB 6-fold increase risk of type 1 diabetes. However, one child had an infection coxackieB will not necessarily develop the disease. Consumption of cow's milk - Infants weaned before the age of 3 months or fed cow's milk before the age of 4 months were significantly greater risk of making type 1 diabetes when associated with this genetic predisposition or other risk factors . Children who have siblings with diabetes who drink more than 236.6 ml of milk per day shows a four times greater risk of having antibodies to beta cells and is given as insulin-dependent diabetes. Experts do not know the role of cow's milk in the pathogenesis of type 1 diabetes mellitus. Call a Doctor It is a medical emergency: - A person who loses consciousness and is breathing the smell of green apples (acetone) - diabetic ketoacidosis. Consult specialist: Symptoms-this intense thirst, excessive urination, weight loss, increased appetite medical need for laboratory investigations The person who has a family history of insulin dependent diabetes and wants to be tested for diabetes. Specialists recommend It is a medical emergency: - A person who loses consciousness and is breathing the smell of green apples (acetone) - diabetic ketoacidosis. Consult specialist: Symptoms-this intense thirst, excessive urination, weight loss, increased appetite medical need for laboratory investigations .The person who has a family history of insulin dependent diabetes and wants to be tested for diabetes. Doctors recommend are: -Endocrinologist -GP -GP -Internist -Pediatrician.

Investigations A large proportion of patients with insulin-dependent diabetes are diagnosed as suffering from this disease after being hospitalized for diabetic ketoacidosis Emergency (CAD). This medical emergency occurs when glucose can not be used as a source of energy for the body as fat and protein catabolism in turn, is producing excess ketones and fatty acids. CAD occurs in all patients with type 1 diabetes (and in some cases of type 2 diabetes) when blood glucose levels are extremely high. Patients hospitalized with CAD should be closely monitored in terms of electrolyte and glucose levels. If the person is not in CAD, according to the American Diabetes Association (ADA) for the diagnosis of diabetes are taken into account family history (family history), clinical examination and tests that emphasize high levels of blood glucose: The measurement of glucose, usually on an empty stomach, but blood can be harvested at any time if the individual has not eaten -Oral glucose tolerance test (TTOG) - drink a glucose solution and blood glucose measured 2 hours after ingestion. Other tests that help in making a diagnosis of diabetes mellitus Measuring the level of hemoglobin A1c, glycated hemoglobin (glucohemoglobina) is a common practice in diabetes, however, the ADA does not recommend that method of diagnosis. This test is recommended for proper monitoring of treatment in patients who do not often cause blood sugar levels at home. Hemoglibina-A1c is determined at 2-3 months of starting treatment, are assessed as blood glucose after initiation of therapy. Both ambulatory determination of glucose and urine glucose screening is not recommended for screening or diagnosis of diabetes. Early Diagnosis Screening is recommended for children or adults whose parents, brothers and sisters have been diagnosed with type 1 diabetes. Although determination of anti-insular beta cells is a marker for type 1 diabetes is not recommended as a screening method. People have discovered that these antibodies have to give consent to enter into a research program and be available to participate in this study. Medical treatment Adult Treatment All patients with type 1 diabetes should be treated chronic (lifetime) with insulin to maintain glucose levels as close to the target value. Insulin therapy requires: -Daily insulin injections or use an insulin pump -Ambulatory monitoring of blood sugar testing -Maintaining a healthy diet in which carbohydrates to be distributed throughout the day so as to avoid sudden increases in blood sugar after meals -Regular program of exercise, because physical activity increases insulin effectiveness -Periodic medical examination which monitors and adjusts treatment. Regular screening tests and examination are mandatory and are conducted in order to prevent onset of chronic complications of diabetes: retinopathy, nephropathy, neuropathy, cardiovascular disease -Smoking cessation

-Limiting the intake of alcohol, alcohol consumption increases the risk of hypoglycaemic coma. Many patients are diagnosed with diabetes after emergency hospitalization for diabetic ketoacidosis (CAD). If symptoms are severe, should be transferred to an intensive care ward. CAD treatment requires administration of infusion fluids to control dehydration and electrolyte balance, and intravenous insulin for hyperglycemia marked decrease and stop excess ketone body production. Treatment in children Treatment of type 1 diabetes in children as in adults include the same measures in order to keep blood sugar normal. In addition, measures are needed to allow normal growth and development parameters. Prophylaxis Currently, there is a prophylactic treatment of type 1 diabetes, however, studies attempting to find ways of prevention in patients with genetic predisposition to the disease. Those with a family history (brothers, sisters, parents) of insulin-dependent diabetes and who wish to participate in clinical trials will address the specialist doctor, demanding to be tested for anti-beta cells, because their presence increases the risk of serum developing the disease. Animal studies and clinical trials in humans have shown that insulin in small doses, administered orally or by injection may prevent the development of type 1 diabetes mellitus. However, a study on a larger lot, has shown that it is not prevented or delayed insulin-dependent diabetes. In another study, in which insulin was administered orally is observed only as late onset. In a study of children who received vitamin D supplements was observed as reduced risk of diabetes. However, excess vitamin D can be harmful, because not recommend taking vitamin D deficiency than in Vaccination is not correlated with increased risk of diabetes, so children with risk factors for type 1 diabetes may be subject to compulsory vaccination. Prevention of diabetes complications People with type 1 diabetes can prevent or delay the chronic complications of it: - Diabetic nephropathy, retinopathy, neuropathy or cardiovascular disease by keeping blood sugar normal. They will undergo regular medical checks to be detected early signs and symptoms of these complications. If they are detected and treated early, organ damage can be stopped, their evolution can be slowed or even this may be reversible - Chronic diseases like hypertension or hypercholesterolemia should be treated with medication. Stopping smoking reduces the risk of these complications - Superimposed health problems can increase the risk of developing chronic complications. Prophylaxis of influenza and pneumococcal infection People with insulin-dependent diabetes will be subject to annual influenza and pneumococcal vaccination every five years. Pneumococcal vaccination prevents disease caused by pneumococcus, common in diabetics with heart disease and renal complications increasing the risk of installation, hospitalizations and mortality of influenza and pneumococcal infections. Home Treatment In insulin-dependent diabetes specialist doctor will set up a balanced diet, will prescribe an individualized treatment with insulin and a

regular exercise to keep blood sugar at a safe level. Especially in children, these three important ways of regulating blood glucose will be adequate depending on their activity. Daily treatment of diabetes include: Repeated injections of insulin, or use of insulin pumps Distribution-balanced diet with carbohydrates during the day Physical-activity -Glucose to be checked several times a day and night if necessary. The steps to be Diabetic patient must: -Wear a medical identification bracelet that emergency physicians to quickly find a diagnosis of diabetes -To know how to intervene quickly in case of both hyper and hypoglycaemia to prevent onset of acute life-threatening complications Know-how to adjust insulin doses if they become ill or if pregnancy occurs -To submit to regular medical examination for disease monitoring and treatment. Medications In type 1 diabetes, insulin-dependent due to absolute insulin deficiency, drug therapy is the administration of insulin daily. It will be administered by subcutaneous injections of insulin pumps. Usually associated with long-acting insulin administered once or two times a day with rapid-acting insulin before each meal. Administered insulin doses are individualized. Also, the type of insulin dose is adjusted over time according to age, hormonal constellation (as in periods of rapid growth or pregnancy) or the type of physical activity performed. During periods of high emotional stress or during a disease superimposed insulin dosage should be increased. If there are complications of diabetes (eg diabetic nephropathy), you need to add medications to address that complication. Treatment of hypertension or cholesterol lowering medicines help prevent diabetes complications installation. After 30 years of age are recommended to take low-dose aspirin useful for preventing myocardial infarction, cerebrovascular accident or large blood vessel diseases. Surgery Surgery is indicated only in exceptional circumstances: Pancreas transplantation can be performed simultaneously with kidney transplantation ,Pancreatic transplantation of islets is a method which is still in research,Pancreas transplantation is a therapeutic way too expensive. After surgery is recommended for chronic administration (for life) of immunosuppressive drugs to prevent rejection of transplanted organ response. Other treatments There is no cure for type 1 diabetes! Other therapeutic approaches are not recommended for patients with insulin-dependent diabetes. Some people are tempted to try products or pills that promise miraculous healing, but these remedies can be very expensive and harmful. These alternative treatments may delay or replace those healing methods proven to be effective in insulin-dependent diabetes

Chronic complications of insulin-dependent diabetes General A patient with type I diabetes can develop one or more chronic complications. Diabetic Macrovasculopatia Hyperglycemia can cause heart and brain vessels irrigating. It may also be affected lower limb peripheral vessels, blood flow is blocked at this level or fall, causing peripheral artery disease. In terms of irrigation deficient patient with diabetes may suffer stroke or heart attack. Microvascular Complications - Lowers diabetic retinopathy to vision loss - Diabetic nephropathy. Progression of renal vascular lesion leading to renal failure, being necessary to the establishment of dialysis or kidney transplanted - Diabetic neuropathy leads to decreased tactile sensitivity, thermal and painful especially in the legs (feet and legs). Neuropathy can be installed at some nerves involved in controlling body functions leading to changes in digestion and sexual function. Causes Chronic complications of diabetes are due to one or both of the pathophysiological changes described below: - Atherosclerosis - the deposit of atherosclerotic plaques in the walls of blood vessels can become rigid and obstruction - Nerve damage (neuropathy) that reduces or abolishes the transmission of nerve impulses to the internal organs, feet and legs or other body parts. These changes are caused by high blood sugar that cause alterations in the hormonal and cellular functionality. Symptoms Clinical manifestations of diabetes complications depend on the location of lesions caused these complications. Diabetic macrovascular disease (heart and large vessels) Patient has chest pain (angina) or leg pain triggered by exercise (intermittent claudication). However, the first symptom of the disease can be represented by a myocardial infarction, stroke or peripheral arterial disease. Because myocardial infarction neuropathy may occur in the absence of pain (silent infarction). Diabetic retinopathy Symptoms of retinal damage are: - Distorted or blurred vision, difficulty reading. Macular edema or other physiological changes in the eye are responsible for the symptoms of retinopathy. Temporary loss of vision can occur when blood glucose levels rise sharply, disappearing once the blood sugar return to normal - Dark or bright dots that float in the visual field. Retinal detachment or vitreous hemorrhage (in the eye) underlying the occurrence of these symptoms

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- Partial or total loss of vision or a feeling of view through a wave, these symptoms are also caused by retinal detachment or vitreous hemorrhage - Pain in the eye, neovascular glaucoma (increased intraocular pressure) is responsible for this symptom. Diabetic Nephropathy The only symptom of early diabetic nephropathy is the microalbuminuria (urine loss of small amounts of protein). A urine test for microalbuminuria can detect tiny amounts of protein in urine. The appearance of cloudy urine, opalescent, with floaters can be a sign of the proteinuria. As nephropathy is worsening occur: - Swelling in the legs which then generalizes - Hypertension - Increase blood levels of triglycerides and cholesterol. Deterioration of renal function affects the body's ability to remove excess insulin, hypoglycemia ensues. Your doctor may recommend adjusting the insulin dose to avoid the hypoglycemia. Over time, progressive renal damage leading to kidney failure and causing symptoms such as fatigue, loss of appetite, weight loss. Diabetic neuropathy Symptoms of peripheral neuropathy are: - Tingling, numbness, spontaneous pain as burning, crushing, stinging, stabbing pain in the feet, hands or other body parts. There may be joint or bone deformity (Charcot foot) - Reducing sensibilitatatii or numbness in the legs most often - Reducing sweat especially in the legs - Anesthesia (no pain) or hyperesthesia (increased sensation painful) to touch or temperature changes - Weakness and loss of balance and coordination. Symptoms of autonomic neuropathy (affecting the functionality of internal organs) are: - Digestive disorders like bloating frequent belching (ragaituri), constipation, nausea, vomiting, diarrhea and abdominal pain are symptoms that characterize diabetic gastroparesis (delayed and incomplete emptying of the stomach contents) - Disturbances of thermoregulation, profuse sweating on the chest, face, neck occurring at night or after eating certain foods like cheese or spicy foods - Reducing bladder filling sensation and difficulty emptying the bladder filled - Sexual disorders like erectile dysfunction (lack of erection) in men and insufficient lubrication (vaginal dryness) in women -Orthostatic hypotension (dizziness, weakness and fainting) in standing up - Hypoglycemia ignored (difficulties of adjustment in case of hypoglycaemia, no warning signals or decrease when blood glucose control).

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Symptoms of focal neuropathy (affecting a single nerve) usually occur suddenly, are: - Pain, weakness or functional impotence in a single region of the body, most frequently at the wrist, thigh or foot. If the nerve is compressed (as in carpal tunnel syndrome), pain and suffering of the median nerve will gradually develop over a period of weeks or months - Intra-and periocular pain, difficulty moving the eyes and double vision (diplopia) occurs when the focal neuropathy affects the nerves that control muscles hold the eye. Charts If diabetes diagnosis is made early and treatment is instituted early, the evolution of these complications can be slowed, some changes can be reversible incipente. Left untreated, however, the progression of severe complications lead to defeat or death: - Diabetic retinopathy can cause blindness. In the presence of diabetic retinopathy increases your risk of eye diseases causing blindness glaucoma and cataracts - Diabetic nephropathy leading to chronic renal failure - Damage to major vessels leading to myocardial infarction, stroke or peripheral arterial obstruction - Diabetic neuropathy can cause various problems. Peripheral sensory neuropathy associated with arteriopathy cause problems in the foot, including Charcot foot (Charcot osteoartropatia). Any damage, even minor, can become infected and can develop ulcers leading to amputation. Autonomic neuropathy cause gastroparesis, hypoglycemia ignored and impotence. Addressing complications If they are detected early, most minor change in lifestyle can prevent diabetes complications unfavorable. For example, the evolution of early diabetic nephropathy can be halted or delayed the establishment of medication. Diabetes metabolic control (maintaining blood glucose within normal limits) and early treatment of complications are the way to prevent the emergence of new complications. American Diabetes Association recommends maintaining glycated hemoglobin values mean A1c (HbA1c) below 7%. Some patients fail to maintain the value of Hb A1c below 6%. As Hg A1c value is dezvoltariii lower your risk of complications is lower. Hg A1c measurement is made at intervals of 2-3 months. Other ways to stop or delay the evolution of complications are: - For regular medical screening tests - Treatment of hypertension and high cholesterol value - Quitting smoking - Attentive care and foot hygiene, treatment of cuts or corns which can become infected. Good foot care exam consists of legs at each medical examination performed regularly to assess diabetes. Wear comfortable shoes and socks. Risk Factors

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The risk of complications depends largely on the following factors: - The presence of complications increases the risk of new complications - Persistent high blood pressure. In general, people with diabetes and hypertension have a higher risk of developing new complications - Time of onset of diabetes. The longer time of onset of diabetes is even greater in terms of glucose control, the greater the chance of complications. Aproximav 60% of patients with type I diabetes have signs of retinopathy 10 years after the onset of diabetes and almost all have retinopathy at 20 years. Approximately 53% develop proliferative retinopathy after 20 years. Diabetic nephropathy occurs in 20-40% of diabetics with diabetes type I or type II diabetes. Adults with type I diabetes will develop signs of nephropathy at 5 to 10 years after the diagnosis. Nephropathy in children who are detecting the first symptoms is done immediately after the onset of puberty. Most people with diabetes will develop neuropathy but only 13-15% of symptomatic cases is remarkable. Up to 73% of adults with diabetes have high blood pressure and death from cardiovascular disease is 2-4 times more frequently than the general population. Other risk factors: - Smoking - High cholesterol - Family history of cardiovascular disease or peripheral artery disease. Specialist medical advice Emergency medical advice is recommended if a patient with diabetes: - Sudden loss of vision or emerging. Sudden loss of vision, or partial, can be a symptom of many diseases of the eye, including retinal detachment or bleeding in the eye. Sudden loss of vision is always a medical emergency - Chest discomfort or pain in the form of crushing, crushing or heavy feeling. The pain of myocardial infarction usually lasts more than 10 minutes and is accompanied by symptoms such as heavy breathing, sweating, nausea or vomiting, chest pain that radiates to the neck, jaw, one or both shoulders or arms, dizziness, rapid heartbeat or cardiac disorders itm
Each year, diabetic retinopathy

- Eye examination (ophthalmoscopic) -Visual tests (visual acuity exam) -Test for glaucoma more frequently -Fundus photography to track the evolution and treatment efficacy monotorizarea - Fluorescein angiogram to identify the level of retinal hemorrhages Diabetic Nephropathy Every year, one of the following: -Proteinuria (micro-and macroalbuminuria) assess the extent of renal lesions

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Urinary or serum creatinine, evaluate kidney function treatment -Ratio albumin / creatinine urinary screening protocol includes: 24-hour total proteinuria (Value less than 300 mg/24 hours means macroalbuminuria) Creatinine and blood urea-values evaluate renal treatment capacity Electrolytes, blood, electrolytes evaluate filtering. If renal insufficiency and other tests are necessary. Macrovascular disease in the periodic medical examination: The measurement of blood pressure (less than 130/80 mmHg) -Blood cholesterol and triglycerides LDL below 100 mg / dL (2.60mmol / L) TG less than 150mg/dl (1.7 mmol / L) HDL above 40 mg / dL (1.1 mmol / L) Exercise-ECG-electrocardiogram (ECG) Exercise-ECG Recurrent diabetic neuropathy Neurological examination of sensitivity, thermal, tactile, painful and bilateral vibratory -Examination of muscle strength and reflexes (rotulian and ahilean) -Thorough inspection of infections, injuries, osteo-articular problems, at least once a year The measurement of pulse and blood pressure lying down, sitting and standing. - Electromyogram (EMG) Prophylaxis Prevention of progression or appearance of new complications of diabetes is made by good metabolic control (maintaining blood glucose within normal limits). Tight metabolic control: - Microangiapatice prevents the progression of lesions and lesions of peripheral nerve - Decreases the risk of cardiovascular disease. Home Treatment The most important step forward in preventing complications of diabetes is tight blood glucose control (keeping as close to the target value): - American Diabetes Association recommends maintaining an average glycated hemoglobin A1c (HbA1c) below 7% HbA1c measurement will be made quarterly - Balanced diet - Exercise program

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- Administration of insulin according to the schedule prescribed by specialist - Stop smoking. 1. Heart and large vessels A person with diabetes even if no risk of cardiovascular problems has made these diseases. It is important: - To quit smoking. Tobacco increases the risk of myocardial infarction and stroke and worsens many other problematic health - To follow antihypertensive treatment - To take daily aspirin - To reduce consumption of alcohol (one drink per day for women and two for men). 2. Retinopathy In the event of any vision problems will be quickly contacted an ophthalmologist, because these changes can mean a worsening of the vision of diabetic retinopathy. Detection and early treatment prevents blindness. If your vision is seriously affected will resort to non-governmental organizations can assist in procuring funds to aid vision (visual acuity devices that can maintain the maximum possible capacity). 3. Nephropathy - It is important that hypertension be treated with medication so that it is kept to below 130/80 mmHg. The doctor will ask if there is a need to monitor blood pressure every day at home - Foods containing protein will provide more than 10% of calories, if there is kidney damage with microalbuminuria - Will reduce consumption of salt that favors retention of fluid in the body and lead to high blood pressure. 4. Diabetic foot Diabetic foot care is very important. Any damage, even minor can lead to serious complications. Because peripheral nerve damage (diabetic neuropathy) and damage blood vessels, small injuries occurring at this level can be easily overlooked and can become infected. The patient feels no pain of various injuries, in some cases even the discomfort caused by inappropriate footwear. These injuries can cause deformation of the foot. 5. Diabetic neuropathy If peripheral sensory neuropariei: - Will use a bath thermometer to check if water is not hot - Diabetic patient will not go barefoot, to wear shoes even in the house - Not recommended to use electric blankets. Patients with autonomic neuropathy: - Will be small and frequent meals low in fat and fiber - Proper hydration is important if the patient has sweating and kidney problems

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- Will use the vacuum device for erectile problems and lubricant gel in case of vaginal dryness. The doctor will ask for such use medicamentelelor Sildenafil, Tadalafil, or Verdenafil - Will check your blood sugar several times a day and even at night to detect hypoglycemia installation neglected. Focal neuropathy: - Will wear an elastic bandage / cuff when it was recommended by a doctor - During activities that require repetitive motions will be frequent pauses - Will become an industry in which the work performed will require the affected joint. Medications These drugs are prescribed to treat insulin-dependent diabetes: - Insulin lowers blood sugar by stimulating the uptake of glucose in peripheral cells - Angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers lower blood pressure and microalbuminuria and slow or prevent kidney damage even in the absence of hypertension - Aspirin is recommended to those who have suffered a heart attack or stroke. After 30 years of age, patients with risk factors be taken daily low dose aspirin - Sildenafil, Tadalafil, or Verdenafil are indicated for the treatment of erectile dysfunction in patients who have no contraindications. These drugs can worsen heart disease patients who receive such treatment with nitrates nitroglycerin. Before taking these drugs the patient will seek medical advice. It can also be used a vacuum before they go to drug treatment - Medications for digestive problems. Depending on your digestive pain can be administered metoclopramide, domperidone, or erythromycin (for treatment of gastroparesis) - Analgesics, creams and other injectable drugs are useful in treating pain caused by diabetic neuropathy - Statins (such as Lovastatin and Simvastatin) helps lower cholesterol "bad" (LDL). Medication Choices For the treatment of diabetes: Insulin For the treatment of complications: - ACE-inhibitors or angiotensin II receptor blockers - Aspirin - Sildenafil, Tadalafil, or Verdenafil erectile dysfunction. Note! Cholesterol-lowering medication will be prescribed to patients who have elevated triglycerides and LDL-cholesterol (LDL will remain below 100 mg / dL (2.6 mmol / L), TG below 150 mg / dL (1.7 mmol / L) and HDL-cholesterol more than 40 mg / dL (1.15 mmol / L) in men and more than 50 mg / dL (1.40 mmol / L) in women).

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The blood glucose insulin maintained at a value closer to the target value, although episodes of severe hypoglycemia is the price paid for a good metabolic control. Surgery Some complications of type I diabetes require surgery. Vitrectomy (surgery to remove the vitreous body) improves vision in patients with diabetic retinopathy. If renal failure induced by diabetic nephropathy, renal transplantation should be considered especially if the same is done for pancreas transplantation and. Transplantation of islets pancreatic beta is a surgical method which is still The experimental phase. Note! Transplantation of islets pancreatic beta is a therapeutic way too expensive. After carrying out the surgery necessary to treat immunosuppression prevented graft-versus-host reaction. The success rate of pancreatic transplantation increased lately due to improved surgical techniques and the latest medications. In future, pancreas transplantation will be replaced with a transplant of islets pancreatic complications but patients are not eligible for such treatment. Other treatments Even if some products promise to cure type I diabetes, it should be noted that there is no cure for diabetes type! Also, avoid products will be recommended by the so-called customers "happy." These miracle cures are expensive and harmful, they may delay or replace those healing methods proven to be effective in insulin-dependent diabetes. If patients wish to address these products using non-conventional diabetes therapy is recommended to request clarification about these treatments or medical specialist treating the problems of diabetes educator. Other types of diets Some patients may be tempted to abandon established specialist diet and adopt another type of diet followed by other patients with diabetes to consume foods with low GI (glycemic index raise blood glucose levels over a period of one hour). Before the diet change is recommended to seek advice from a nutritionist.
Complementary Therapies

Complemetare therapies are those treatment modalities which are used in parallel with traditional treatment and include: - Acupuncture - Biofeedback - Chiropraxia / chiroterapia (therapy using hands) - Phytotherapy, antioxidants, vanadium, manganese or chromium. Soluble fiber can help keep blood sugar within normal limits - Osteopathy (branch of alternative medicine that relies on manipulation therapy musculoskeletal). Acupuncture and biofeedback therapy are examples of ways to relieve stress or muscle tension, they improve patients' quality of life but not cure the disease. It is not recommended using complementary therapies with medication unaccompanied by insulin. Choosing a complenentare or alternative therapeutic approaches will be made after a preliminary discussion with your doctor. Measurement of carbohydrates in people with insulin-dependent diabetes mellitus (T1DM)
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General Measurement of carbohydrates in patients who are treated with insulin is the skill of patients with Type I diabetes to plan their diet and controlling blood glucose (blood sugar). Measuring the consumption of carbohydrates in food provide the flexibility those of selfconfidence and diabetes. Measuring carbohydrate meal planning method is recommended for a person with diabetes. This involves the adjustment of insulin based on carbohydrates consumed at each meal or snack to keep blood sugar normal.Carbohydrates (the body's main energy source) more influence than any other nutrient glucose level. All types of carbohydrates increases blood sugar.
Note!

Measurement of carbohydrates in diabetic diet helps maintain proper blood glucose level, which prevents complications. Measurement of carbohydrates allows adjustment of insulin based on the number of grams of carbohydrates consumed at each meal or snack. The formula which determines the amount of insulin needed is called "insulin adjusted to the amount of carbohydrates. Insulin adapted to the amount of carbohydrates varies from person to person. Patients with diabetes who are being treated with insulin with your doctor and nutrition specialist in metabolic diseases will calculate the optimal amount of insulin, depending on the amount of carbohydrates and blood sugar levels after eating them. Foods rich in carbohydrates Foods rich in carbohydrates are: - Fruits and vegetables - Milk and yogurt - Pasta (such as bread, cereals and vegetables such as potatoes and corn) - Sweets (like candy or cookies) Foods that contain sugar are usually an amount of carbs per serving more than foods that contain starch (pasta). Contrary to information circulated, people with diabetes can eat foods containing sugar. However, if the person with diabetes diet dominated by higher concentration of carbohydrate foods, that person may not eat enough other foods best in terms of nutrition. To measure carbohydrate Measurement of carbohydrates help prevent hypoglycaemia or hyperglycaemia, which sometimes can become medical emergencies. Over time, high glucose levels can affect many tissues and organs. Measurement of carbohydrate gram allows proper adjustment of insulin dose food consumed every day to keep blood sugar levels as close to normal limits. This method is efficient because carbohydrates are the main nutrient that causes high blood sugar after a meal, and thus increasing the need for insulin. Less than 2 hours after eating carbohydrates turn into glucose. If the person with diabetes using an insulin pump or multiple insulin injection technique, it must know how many grams of carbohydrates are in each meal to know how much fast-acting insulin to administer before meals . Once we know the amount of carbs to be consumed, insulin pump can be programmed to deliver a sufficient amount of insulin or carbohydrates consumed multiple injections technical person can administer a number of units of insulin needed to consume carbohydrate metabolism . Doses of insulin required the

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same amount of carbohydrate metabolism are different from one person to another and the same person at a time of day to another and depend on their own formula for "insulin adjusted to the amount of carbohydrates." Diabetic patient who treatment with insulin was in her doctor and nutrition specialist in metabolic diseases will calculate the optimal amount of insulin according to carbohydrate intake and glucose levels after eating them. Measurement of carbohydrates in the diet To calculate how many grams of carbs are in a meal, have known the amount of carbohydrates in each food, whether it's a piece of bread, a bowl of lettuce or a tablespoon of salad dressing. Fortunately, almost all packaged foods have labels printed on the amount of carbohydrates per 100 grams of the product or a portion. Also available are lists of the amount of carbohydrates contained in each food, the doctor or the various associations that deal with patients with diabetes. To calculate the carbohydrates in packaged foods, it is necessary to know the food has carbohydrate unit. Each serving or unit glucose (UG) contains about 15 grams of carbohydrates. After knowing the number of grams of carbs to be consumed, diabetic can appreciate the number of units of insulin needed for the metabolism of carbohydrates to be consumed, adapting the number of units of insulin in the number of grams of carbohydrates. For example: diabetes doctor usually recommends for the metabolism of carbohydrates consumed 10 grams of preprandial administration of (a) units of rapidacting insulin. So if a meal is consumed 50 grams of carbohydrates (carbohydrates) for their metabolism requires 5 units of rapid-acting insulin, postprandial blood sugar so you do not skyrocket, exceeding normal values. The ratio of insulin to glucose unit may change over time. In some people, this may be different from one table to another. For example, lunch is usually required (1) unit of rapid-acting insulin for 10 grams of carbohydrate metabolism, but dinner is required (1) unit of insulin for 15 grams of carbohydrate metabolism . Note! To measure gram of carbohydrates can be taken into account the following: - Control of each gate is important: if packaged food label indicated that the number of grams of carbohydrates a serving, and the package contains two servings, when they eat the whole packet must be doubled the number of grams of carbohydrates indicated on - Proteins, fats and vegetable fibers do not grow so fast that your blood sugar and carbohydrates: when they consume large amounts of these nutrients, carbohydrates turn to glucose more slowly than when they consume a small amount of protein, fat and dietary fiber - Exercise affects blood sugar, allowing the patient to use a much smaller amount of insulin, but if you do not exercise. It should be noted that the timing of exercise is extremely important meals. If exercise is performed with less than one hour before meals, the body will need less insulin than if exercise is performed at 3:00 afternoon. Other useful tips Other suggestions are useful for measuring carbohydrates: - Reading labels on food to meet their carbohydrate content: Be sure to read food labels carefully to determine how much of food containing carbohydrate unit (UG) of carbohydrate - Check blood glucose levels: determination of blood glucose before meals and at 1 hour after a meal, help that person understand how

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food affects blood glucose levels. - More rigorous control of blood glucose self-control should be a book reading that at meals and snacks, the amount of carbohydrates in each meal and snack and blood sugar: Periodical visits to the nutritionist or diabetic person ever consider adjustment needs to be consulted diet self-tender. For additional information be made available to interested books and brochures that help to measure carbohydrate, weighing and measuring food and interpret labels on food. However, it is necessary to establish a nutritionist consultation diet tailored to each person. After informing the books, brochures, internet and other educational materials, the person is ready to establish the number of meals and snacks per day, their schedule and total amount of carbohydrate per day. For they have consulted a specialist doctor of nutrition and metabolic diseases. If after informing the patient has some questions about diet, consult a doctor. If problems arise in measuring carbohydrate meal planning or specialist advice should be sought. Monitoring the consumption of carbohydrates to diabetic children General Monitoring carbohydrate consumption is a useful tool that can help the child and his entourage to compose a proper diet, range and which at the same time, to keep blood sugar in normal limits in children suffering from type 2 diabetes mellitus (not requiring insulin). This will enable the child is eating a variety of foods like other children to gain confidence in terms of disease control and become responsible and directly involved in this process. By educating children suffering and their entourage as regards the amount of carbohydrates they contain different foods will allow them to think independently and a diet balanced portion can, over a day, making it possible to maintain blood glucose normal. Hipeglicemia (more sugar in the blood) can cause ill feelings of fatigue and thirst, and while this can lead to damage of many organs and tissues. Key Elements Carbohydrates are some nutrients that cause the most significant increases in blood sugar. Children will receive consistent and thus only carbohydrates will keep blood sugar normal. It will should see a dietitian and diabetes child and his entourage to explain how best to eat carbohydrates. Monitoring carbohydrate consumption This is the recommended method for planning meals in diabetics. The method be adding carbohydrate grams contained in each food ingested. Because the primary role in raising blood sugar carbs I hold, divide them in a balanced manner throughout the day will help keep blood sugar normal. In 2 hours after eating, most carbohydrates are converted into glucose (blood sugar). Foods rich in carbohydrates are: - Fruits and vegetables - Milk and yogurt - Bakery products (breads, cereals, etc..), Potatoes and corn

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- Sweets (cakes, candy, etc.). Foods that contain sugar hold a larger amount than the starchy carbohydrates (bread, potatoes, corn, etc.). Contrary to appearances, the child with diabetes and may allow the consumption of sweets and cakes. However, if foods high in sugar are found in significant quantities in your child's diet, then the child will receive an excess of carbohydrates at the expense of other nutrients (fat, protein). Arguments that support the monitoring of the amount of carbohydrates in diabetic diet In this way you can know how many carbohydrates a diabetic child eating at a table and thus can estimate how much it will raise blood sugar after a meal. There is a directly proportional dependence between the amount of carbohydrates consumed and increase blood sugar after a meal. The method is also useful if: - The child is given before meals and insulin dosage as desired depending on the amount of carbohydrates contained in that table, those who do not administer insulin, the method is useful for the reasons outlined above, experts often recommend taking a unit of insulin Quick carbohydrate every 10-15 mg - If your child wants to serve a sugar-rich food (eg a piece of cake at a birthday), then we can reduce the amount of carbohydrates consumed at other meals of that day. Both hyperglycemia and hypoglycemia (blood sugar less) are dangerous and can lead to emergency situations (eg hyperglycemia coma, hypoglycemic coma). Over time, elevated blood sugar can lead to structural and functional damage of many organs and tissues. Other useful tips We recommend carefully reading food labels to find out their content in carbohydrates and calories. Consultation of information materials available to patients and carers by diabetes physicians and nutritionists. Conclusions Following this material, and parents of diabetic children should be familiar with the planning of meals and snacks and method of calculating the amount of carbohydrates in the diet. We will present several methods for monitoring the amount of carbohydrates consumed by children. The highest rates of success in maintaining normal blood sugar levels in their children from families who are directly involved, and its members consume, in turn, a balanced diet. Another advantage of this method is that the family is exposed to a risk of type 2 diabetes dezolva through balanced diet can protect. It will appeal to a diabetes dietitian who will help in planning meals, by compiling a schema. Parents and children will learn what a standard portion of food containing carbohydrates, each containing about 15 grams of carbohydrates. Amounts of carbohydrates must be measured in grams or servings. Parents and children will learn the standard protein portions in a balanced diet is very important consumption of foods containing this nutrient (meat and cheese). Try to limit fat intake, especially in overweight children, and to this end will seek advice dieticianului. Counting carbohydrates It will be used to plan meals for diet portion, indicating that sugar-rich foods should be eaten occasionally and in smaller quantities than starchy foods, fruits and vegetables. It will serve the standard servings, not necessarily food weighed, but this can be useful, especially in the beginning, when parents do not know exactly what a standard portion. It is useful to check blood glucose frequently to the patient and

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one hour before and two hours after meals, because that way we can see how a food affects blood sugar child. It recommends an obvious exact composition of the diet and blood glucose values recorded child, and it may be useful for diabetes doctor can analyze the case more thoroughly. Consultation diabetes If there are concerns about disease and how to calculate the amount of carbohydrates in the diet, it is recommended that they be discussed with experts in the field, without forgetting "log" of all foods consumed by children (Day and hours), together with all blood glucose measurements. Pancreas transplantation islands useful in some patients with type 1 diabetes .Islands pancreas transplantation improve glycemic control, especially in patients with type 1 diabetes and glucose control difficult. A recent study evaluated the efficacy of transplantation of pancreatic islands 36 people with type 1 diabetes. The primary study endpoint was to obtain adequate glycemic control and lack of insulin dependence in a year. This was observed in 16 patients (44%), of which only five (31%) remained insulin 2 years after transplantation. A total of 10 patients (28%) experienced complete graft loss at one year. In total, 21 patients (58%) achieved at some point during the study insulin-independent. Of these, 76% insulin renecesitat 2 years after transplantation.In conclusion, pancreas transplantation islands useful for patients with type 1 diabetes mellitus and unstable control of blood glucose, but insulin independence is usually not sustained. Diabetes mellitus type 2 (non-insulin-dependent) Diabetes mellitus type 2 (insulin independent) is an endocrine disease characterized by metabolic abnormalities, especially of carbohydrate metabolism. Diabetes occurs when the pancreas secretes insufficient amounts of insulin or how the body uses insulin is deficient. Insulin is the hormone that provides cellular energy needs by using glucose (sugar) by cells. Another role of this hormone is to store excess sugar into storage in muscles, liver and adipose tissue. When insulin secretion is deficient or if there is resistance to its action in target tissues, blood sugar (blood glucose, blood glucose) is too large and can not use tissues for energy production. If blood sugar is persistently increased complications arise in the eye, heart, blood vessels, nerves and kidneys. Glucose control is the most effective prevention of complications of type 2 diabetes, particularly of cardiovascular complications. Most patients with type 2 diabetes can carry out normal daily activities when they fail to control blood sugar levels through exercise, proper diet and hypoglycemic drugs. Increasingly more adults and children to develop type 2 diabetes due to unhealthy eating habits and sedentary lifestyle. Causes Diabetes mellitus type 2 is: - When the body's cells do not respond to insulin action, in which cells no longer uses blood glucose for energy production, called peripheral resistance to insulin action; - Pancreas does not produce enough insulin. Obesity, lack of exercise, sedentary lifestyle and family history of insulin-independent diabetes, increased risk of developing type 2 diabetes mellitus.
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Symptoms The first stage of the disease, blood sugar levels rise very slowly, so that the patient is asymptomatic. A third of patients with diabetes do not know suffers from this disease. Symptoms of diabetes include: - Thirst - Polyuria (urinating in greater quantity) - Polyphagia (increased appetite) - Weight loss - Fatigue. Other signs of diabetes: - Many infections or slow healing wounds - View intetosata - Tingling or numbness in the limbs - Numerous skin infections or urinary tract - Vaginitis. Some patients who already have other serious chronic diseases are diagnosed with type 2 diabetes mellitus. Over time, complications can occur kidney, eye, cardiovascular and nervous. Warning signs of these complications are: - Numbness, tingling, pain, burning, swelling of their arms and legs (diabetic neuropathy) - View intetosata, distorted or bright or dark in the visual field, partial or total loss of vision or a feeling of view through a wave "(diabetic retinopathy) - Chest pain or breathing difficulties: they may be signs of heart or vascular problems. Mechanism fiz: Diabetes mellitus is a chronic metabolic disturbances that occur (a process by which the body accumulates energy from food). Diabetes is present when it comes to cellular resistance to insulin action or when the pancreas does not secrete an adequate amount of insulin. Insulin is the hormone that provides cellular energy needs by using glucose (sugar). Hyperglycemia is the main cause for the alterations that occur in other organs: heart, great vessels, eyes, kidneys, nerves. Type 2 diabetes occurs mainly in adults, but more and more cases are diagnosed in children. Often, people with type 2 diabetes are overweight and sedentary. Many people have prediabet (impaired glucose tolerance), which is characterized by elevated blood sugar, but not large enough to be diagnosed with diabetes. Once diagnosed with type 2 diabetes, the medical team should develop an individualized treatment plan. Treatment usually includes, proper diet, exercise program, weight loss, glucose monitoring and medication if needed. Good cooperation with the doctor helps the patient to keep it under control and prevent serious complications. Over time, the secretory capacity of pancreatic endocrine insufficiency becomes increasingly more so that secreted

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insulin can no longer keep blood sugar normal. Controlling blood sugar helps prevent complications: - Hyperosmolar state is an acute complication that occurs in type 2 diabetes is usually caused by infection (flu or another infection), heart failure, dehydration (insufficient intake of fluids), diuretic therapy, especially when fluid loss is replaced by adequate fluid intake. - Late complications caused by hyperglycemia: eye damage (retinopathy), kidney damage (nephropathy), nerve damage (neuropathy), heart abnormalities (including myocardial infarction), vascular atherosclerotic lesions (leading to stroke occurrence, the peripheral arterial possible to amputation). Risk Factors Risk factors that can not be controlled are: - Family history (first degree relatives: father, brother, sister) with type 2 diabetes mellitus; - Race and ethnicity - afroamericanii, Hispanics, Native Americans, Asian Americans and Pacific Island populations are more at risk of type 2 diabetes adezvolta from Caucasian population; - Old age increases the risk of type 2 diabetes, yet the number of children with type 2 diabetes is rising, usually they are obese, sedentary and positive history of diabetes mellitus type 2; - History of gestational diabetes or women who gave birth to a child than birth weight (over 4 kg) were at increased risk of diabetes is type 2 or prediabet; - Polycystic ovary syndrome increases the risk of developing type 2 diabetes mellitus. People who want to prevent the onset of diabetes can make blood glucose testing. Call a Doctor They call a doctor when: - People older than 45 years whose blood sugar was not measured or not never been investigated for diabetes for more than three years; - People younger than 45 years with risk factors for type 2 diabetes who want to be tested; - The presence of one or more symptoms of diabetes mellitus (intense thirst, urination in large quantities, excessive hunger, unexplained weight loss or tiredness); - Presence of other signs of type 2 diabetes and wounds that will not heal or frequent infections; People who have been diagnosed with type 2 diabetes but have found that these symptoms of complications of this disease: - Pain as burning, numbness, tingling in the feet or hands; - Dizziness or weakness asezatul lifting or suddenly; - "Light flashes, spots, spots, stripes in the visual field; - Obese, sedentary, which aims to prevent type 2 diabetes mellitus; - The person who was diagnosed with prediabet who wants to reduce the risk of developing type 2 diabetes mellitus.

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Watchful waiting If symptoms appear for type 2 diabetes is not indicated expectation, as diabetes progresses and serious complications can occur if not diagnosed and no therapeutic intervention was preoce. If there are symptoms of diabetes, especially if risk factors are present is given expert advice. Specialists recommend :People who thinks the existence of insulin-independent diabetes can be diagnosed by: - GP - General practitioners - Physician - Pediatrician - Endocrinology - Doctor of nutrition, metabolic diseases and diabetes. Investigations To confirm the suspicion of type 2 diabetes your doctor will ask a set of tests that measure blood glucose (blood sugar). Usually, the determination of fasting blood glucose in the morning. Sometimes further investigation is needed TTOG (oral glucose tolerance test), but is not recommended because it takes time and has a high cost.To make a diagnosis of type 2 diabetes are taken into account in addition to blood glucose, medical history and physical examination of the patient.If blood sugar is higher than normal but below that value which defines diabetes, this situation characterizes impaired glucose tolerance at high risk of developing type 2 diabetes mellitus.Other laboratory tests such as ambulatory measurement of blood glucose or urine glucose determination are not the best method of diagnosis of type 2 diabetes, but glucose monitoring is essential ambulatory after being diagnosed with diabetes. Also, a complete cardiovascular examination is important for the detection of heart disease. Early Diagnosis After 45 years of age is recommended to determine blood glucose values every three years. There will also be tested for diabetes and hypertensive individuals with elevated cholesterol. The doctor will detect risk factors and determine the frequency at which tests will be performed. American Diabetes Association recommends blood glucose measurements to be done often or to start at an early age in the following situations: - Family history, parent, brother, sister with type 2 diabetes mellitus - Obesity - body mass index (BMI) greater than or equal to 25 - Prediabetul (impaired glucose tolerance) - Hypertension - High cholesterol - History of gestational diabetes or women who gave birth to a child than birth weight (over 4 kg).

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Treatment - General Detection of high risk or making a diagnosis of type 2 diabetes in a person or family member can cause panic. Many are shocked upon hearing the diagnosis, while other patients feel better if you know what is causing their symptoms. It is normal for patients to react with anger or depression if they find that a chronic disease, but it's important that they be informed that they can lead a normal life if they manage to keep your blood sugar normal. Weight loss, proper diet and conducting a regular program of physical exercises are very effective ways to maintain low blood sugar.There is no cure for diabetes, but there are several treatment modalities are indicated in type 2 diabetes mellitus. Even if the patient is asymptomatic is necessary to start treatment for the disease and prevent complications.In some patients, dietary changes or implement a regular exercise program are sufieciente to control blood sugar levels.At others, but it is necessary to introduce drug treatment. Principles of treatment to be followed: - Dietary changes with the distribution of carbohydrates throughout the day so that blood sugar levels remain constant - Exercise program, which improves the body's response to the action of insulin cells - Monitoring of blood glucose levels so as to remain within the normal range established - Adding drugs if diet does not meet or conduct a more intensive program of exercise to keep blood glucose within safe limits. Require one or more types of antidiabetic drugs to stimulate the body's insulin production or to improve its use - Introducing a dose of insulin or chronic therapy, insulin can be given only in injectable form or may be associated with oral antidiabetic drugs - Regular medical examination to assess the effectiveness of treatment or early detection of ocular complications, cardiovascular, renal, nervous. Other important issues - Wearing bracelets made available by a doctor, pharmacist by which to make quick identification of the disease and the person who has diabetes - One with diabetes should quickly recognize and know to treat both hyper and hypoglycemia - Consideration should be given a skin, teeth, feet, gums. Prophylaxis - Maintaining an appropriate body weight. To detect obesity can use the ideal height and weight tables. If it is necessary to lose weight, losing between 4.5 to 9.1 kg can reduce the risk of type 2 diabetes mellitus; - Regular exercise at least 30 minutes per day carrying out some activities should not necessarily exhaustive or subscribe to a gym, any exercise that increases heart rate is useful. For starters, try walking in moderately using pedometrele make that tracks the number of steps. People with risk for type 2 diabetes specialist doctor will address the preparation of an individualized exercise program; - Healthy diet rich in fruits and vegetables, whole grains, nuts may reduce the risk of type 2 diabetes. Excess sweets, red meat, junk food and excess food soft drinks increase risk of developing diabetes.

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Prevention of diabetes complications Reducing the risk of developing diabetes complications can be achieved by: - Blood glucose monitoring and maintaining a value close to the target - Small doses of aspirin to prevent heart attack or stroke or peripheral arterial obstruction - Medical control of blood pressure and high cholesterol levels - Administration of a converting enzyme inhibitor or an angiotensin II receptor blocker, even if the patient is not hypertensive, to prevent the occurrence of diabetic nephropathy - Regular eye exams - Thorough foot care - Stop smoking, smoking hastens diabetes complications. Home Treatment Changing lifestyles in a healthy part of outpatient treatment modalities. Patients need to know more about their disease to be more motivated, more compliant and to feel better and more secure knowing that she can keep the disease under control. Outpatient treatment includes: - Proper diet in which carbohydrates are distributed throughout the day - Performing a physical exercise program - Daily monitoring of blood glucose - Taking oral antidiabetic medication was prescribed if the specialist - Avoid dehydration by increased fluid intake - Low-dose aspirin. Note! - It is recommended that people with diabetes to wear the hand or neck strap with the identification plate to be more easily diagnosed in an emergency - Those who have diabetes must quickly recognize the signs of hypo or hyperglycaemia and know it-and give yourself first aid quickly - Consideration should be given a skin, teeth, gums and feet. Medications Some patients with type 2 diabetes respond well to anti diabetic medications, it stimulates its own insulin production, reduce peripheral resistance to insulin action or slows carbohydrate absorption.Some patients did not need medication, while in others a single agent is sufficient also can join multiple oral agents according to the needs of each and glucose levels.Some patients with type 2 diabetes mellitus or taking antihypertensive treatment decreased serum cholesterol, and low-dose aspirin to prevent heart attack, stroke or peripheral large vessel obstructions.

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Surgery Surgery is not indicated for type 2 diabetes. However, overweight patients are considered candidates for surgery, gastrointestinal (gastric ring), which helps in weight loss spectacular. However, there are many risks of this operation and that many experts do not recommend. Other treatments Some people are tempted to try products or pills that promise a cure, but these remedies can be very expensive and harmful. But the choice of alternative medicines or plants will not be until after a preliminary discussion with your doctor will prescribe these remedies. Measurement of carbohydrate in individuals with non-insulin diabetes dependent (type 2 DM) Measurement of carbohydrates is the skill of patients with type II diabetes to plan their diet and blood sugar control. This method helps people to determine the amount of sugar and carbohydrates (glucose) in foods consumed, so that carbohydrates should be distributed throughout the day to prevent high blood sugar after meals. Measuring the consumption of carbohydrates in food provide the flexibility those of self-confidence and diabetes. Foods rich in carbohydrates are: - Fruits and vegetables - Milk and yogurt - Flour (like bread, cereals and vegetables such as potatoes and corn) - Sweets (such as candy or cookies). Foods that contain sugar usually have a quantity of carbs per serving more than foods that contain starch (pasta). Contrary to information circulated, people with diabetes can eat foods containing sugar. However, if the person with diabetes diet dominated by higher concentration of carbohydrate foods, that person may not eat enough other foods best in terms of nutrition. You can use artificial sweeteners (Sucrazit) which contain no sugar. Also, you can consume alcoholic beverages containing sugar, different types of sweeteners do not have the sugar composition, called "sugar free" candies, cake and refreshments. Alcoholic drinks containing sugar are also a type of carbohydrate. Methods for measuring carbohydrate Below are listed the methods that help to measure the carbohydrates in foods consumed and their distribution throughout the day: - Meals at regular intervals - At least three meals a day that contain a high amount of carbohydrates, these tables must be planned at the same time every day. - Preparation of larger amounts of food left on tables and the following conservation - Revaluation menu. Measurement of carbohydrates Measuring compliance with carbohydrates and a balanced diet is achieved by: - Counseling with a nutritionist: dietitian can help people with diabetes to establish the total amount of carbohydrate per day, and number

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of carbohydrates consumed at each meal or snack. - Eating carbohydrate units (UG) of carbohydrates in food: carbohydrates per serving or unit (UG) contains about 15 grams of carbohydrates, foods that contain carbohydrates not be weighed or measured each time, but in the early weighing or measuring foods that contain carbohydrates help the person learning the quantity of each food that is a carbohydrate unit (UG) of carbohydrate - Calculating each gram or portion of carbohydrates: nutritionist to help that person establish how much carbohydrate is needed for each meal or snack, including sweets - Eating standard portions of foods that contain protein: protein foods (meat and cheese) is an important component of a balanced diet - Restriction of fat intake: A balanced diet contains a small amount of fat, it is necessary to consult with a nutritionist to determine the amount of fat that can be consumed. Useful Tips Other suggestions are useful for measuring carbohydrates: - Reading labels on food to meet their carbohydrate content: Be sure to read food labels carefully to determine how much of food containing carbohydrate unit (UG) of carbohydrate - Check blood glucose levels: determination of blood glucose before meals and at 1 hour after a meal, help that person understand how food affects blood glucose levels - More rigorous control of blood glucose self-control should be a book reading that at meals and snacks, the amount of carbohydrates in each meal and snack and blood sugar, made regular visits to the nutritionist, or whenever the person with diabetes believe that needs an adjustment in diet, consult a book of self. For additional information be made available to interested books and brochures that help to measure carbohydrate, weighing and measuring and interpreting food labels on foods. However, it is necessary consultation or a teacher, a nutritionist to determine the diet of each individual's needs. After informing the books, brochures, internet and other educational materials that the person is ready to establish the number of meals and snacks per day, their schedule and total amount of carbohydrate per day. For these, consult a doctor of nutrition and metabolic diseases. If after informing the patient has some questions about diet, consult a doctor. These questions must be marked and even outlined the information material. If problems arise in measuring carbohydrate meal planning or specialist advice should be sought. If self-tender are noted additional information and quantity of food consumed at each meal, we recommend submitting it to the doctor. Chronic complications of diabetes mellitus non-insulin-dependent General Non-insulin-dependent diabetes (type II diabetes) occurs when the pancreas secretes insufficient amounts of insulin or body cells resistance to insulin action is increased. Insulin provide cellular energy needs, facilitating the use of glucose by cells. When insulin secretion is insufficient or if there is resistance to its action in target tissues, blood glucose level is too high and can not use tissues for energy production. If blood glucose is persistently raised serious chronic complications arise.

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Complications Cause hyperglycemia and hormonal alterations of cellular functionality leading to abnormalities in blood vessels and / or peripheral nerves. Chronic complications of diabetes are due to one or both of the following physiological changes: - Atherosclerosis (deposition of the boards aterosclotice blood vessel walls) throughout the body; - Nerve damage (neuropathy) that reduces or abolishes the transmission of nerve impulses message to the internal organs, limbs or other body parts. Diabetes also interfere with the functionality of the immune system so your body is more prone infections than healthy individuals. Atherosclerotic lesions of blood vessels are more common in diabetic patients represents one of the risk factors of coronary disease, myocardial infarction and stroke. Lesions of small blood vessels (diabetic microangiopathy) leads to retinopathy, nephropathy and diabetic neuropathy. Large vessel lesions (diabetic macrovascular disease) causes hypertension, peripheral arterialor diseases, cerebral and myocardial infarctions. Symptoms Symptoms of diabetes complications depend on the location of lesions: 1. Diabetic retinopathy In the early stages of retinopathy are not significant changes of visual signals. As progressive retinal lesions appear: - Blurred vision, distorted or reading difficulties caused by macular edema or other physiological changes in the retina. High levels of blood sugar can cause temporary loss of vision that resolved after a few hours after returning to normal glucose. If these alterations in vision persica more than 12 to 24 hours contact your eye doctor; - Dark or bright dots that float in the visual field caused by retinal detachment or vitreous hemorrhage (inside ochiunlui) - Partial or total loss of vision or a feeling of view through a wave, are also caused by retinal detachment or vitreous hemorrhage; - Pain in the eye, neovascular glaucoma (increased intraocular pressure) is responsible for this symptom. 2. Diabetic Nephropathy In the early stages of incipient diabetic nephropathy is the only symptom of microalbuminuria (urine loss of small amounts of protein). A urine test for microalbuminuria can detect tiny amounts of protein in urine. As nephropathy worsens appear: - Swelling in the legs which will later be extended to the whole body; - Hypertension; - Macroalbuminuria (urinary albumin losses), foamy urine, cloudy, opalescent is a sign of proteinuria; - Increase blood levels of triglycerides and cholesterol.

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Deterioration of renal function affects the body's ability to remove excess insulin, which detrmina occurrence of hypoglycaemia. Consult your doctor to adjust insulin doses to avoid hypoglycemia. There will also be low doses and other drugs. Metformin should not be administered to patients with renal failure. 3. Diabetic neuropathy Siptomele peripheral neuropathy (which are affected nerves that control the sensitivity of tactile, thermal and pain or movement) are the following: - Tingling, numbness, spontaneous pain as burning, crushing, stinging, stabbing pain in the feet, hands or arms. These symptoms occur initially at the toes of the foot and are more pronounced in the evening. There may be foot ulceration and infection, also joint or bone deformities (Charcot osteoartopatia) - Reduction or increased heat and excessive sensitivity to light touch sensation of pain; - Weakness and loss of balance and coordination. Symptoms of autonomic neuropathy (affecting the functionality of internal organs) are the following: - Digestive disorders like bloating frequent belching, constipation, nausea, vomiting, diarrhea and abdominal pain, symptoms that characterize diabetic gastroparesis (delayed and incomplete emptying of the stomach contents); - Disturbances of thermoregulation, sweating on the chest, face and neck at night or after eating certain foods like cheese or spicy foods; - Reducing bladder filling sensation and difficulty emptying the bladder filled; - Sexual disorders like erectile dysfunction (lack of erection) in men and insufficient lubrication (vaginal dryness) in women; - Dizziness, weakness and fainting (hypotension orostatica) on standing; - If the patient suffers from coronary heart disease is increased risk of myocardial infarction painless; - Hypoglycemia ignored (difficulties of adjustment in case of hypoglycaemia, no warning signals or decrease when blood glucose control). Symptoms of focal neuropathy (affecting a single nerve) usually occur suddenly, are: - Pain, weakness or functional impotence in a single region of the body, most frequently at the wrist, thigh or foot. If the nerve is compressed (like carpal tunnel syndrome), pain and suffering of the median nerve will gradually develop over a period of weeks or months; - Intra-and periocular pain, difficulty moving the eyes and double vision (diplopia) when focal neuropathy affecting cranial nerves control the muscles that hold the eye. 4. Diabetic macrovascular disease (affecting the heart and great vessels) The patient shows symptoms of myocardial infarction, stroke or cerbrala peripheral artery disease. Symptoms of coronary artery disease are:Chest pain :- Dyspnoea of effort; - Tachycardia (rapid heartbeat); - Abdominal pain;

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- Irradiated pain in the shoulder; - Nausea; - Dizziness; - Fatigue. If transient ischemic accidents (TIA), a transient interruption of signal flow cerebral symptoms of an ischemic stroke include: - Weakness, paralysis of the face, arm or leg, especially if it is limited to one side; - Numbness, weakness or feeling of heaviness; - Difficulty speaking or understanding words; - Loss or changes in vision as blurred vision or diplopia (double vision). 5. Symptoms of intermittent claudication - Cramps or pain crushing form in the calf, thigh or buttocks caused by motion (occurring during waking); - Reduction of muscle strength and balance while standing; - Toes or entire feet cold and numb; - Reducing pilozitatii the affected limb; - Foot skin color change. 6. Sexual Disorders Dynamics of sexual disorders (eg erectile dysfunction) may be an early sign for alarm and indicate an increased risk of diabetic vasculopatiei production of a heart attack. Charts A patient with non-insulin-dependent diabetes may develop one or more complications even before being diagnosed with diabetes. This action meets stitautie if there is diabetes but was not diagnosed for several years. Left untreated, severe defeat progression of complications or death: - Diabetic retinopathy can lead to blindness. In this increases the risk of diabetic retinopathy and other eye diseases causing blindness glaucoma and cataracts; - Diabetic nephropathy leading to chronic renal failure; - Macrovasculopatia aparitaia lead to myocardial infarction, cerebrovascular accident or peripheral arterial obstruction; - Diabetic neuropathy can cause various problems. Peripheral sensory neuropathy associated with arteriopathy cause problems in the foot, including Charcot foot (Charcot osteoartropatia, severe infection took the form of amputation foot bones). Any damage, even minor, can become infected and can develop ulcers leading to amputation. Autonomic neuropathy cause gastroparesis, hypoglycemia and ignored erectile dysfunction. Risk Factors The following factors increase the risk of developing complications of non-insulin-dependent diabetes:

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- Persistent high blood pressure: people with diabetes and hypertension were more likely to develop new complications; - Time of onset of diabetes: as time of onset of diabetes is even greater in terms of glucose control, the greater the chance of complications; - The presence of complications increases the risk of new complications. Diabetic nephropathy occurs in 20-40% of diabetic patients with type II diabetes. 60% of patients with type II diabetes have signs of retinopathy 10 years after the onset of diabetes and almost all have retinopathy at 20 years. Most people with diabetes will develop neuropathy but only 13-15% of symptomatic cases is remarkable. Other risk factors: - Smoking; - Psychiatric disorders; - Elevated cholesterol; - Family history of diabetic complications. Diabetes mellitus non-insulin-dependent (type II diabetes) in children Type II diabetes (non-insulin-dependent diabetes) is a chronic disease that occurs when the pancreas secretes insufficient amounts of insulin or how the body uses insulin is deficient. In most patients with type II diabetes, peripheral resistance to insulin action is the primary mechanism, while installing the deficit of insulin secretion. Insulin is the hormone that provides cellular energy needs by use of glucose by cells. The role of this hormone is to promote storage of excess glucose into storage in muscles, liver and adipose tissue. When insulin secretion is deficient or if there is resistance to its action in target tissues, blood sugar reaches high levels and not tissue may be used for energy production. Hyperglycemia is an extreme medical emergency resulting in unconsciousness, coma and eventually death of the patient. If blood sugar is persistently increased, whereas, there are complications to the eyes, heart, blood vessels, peripheral nerves and kidneys.Long type II diabetes was considered a disease of adult and type I diabetes, a disease specific child and young adult. But the number of cases of children with type II diabetes is growing. Since detip II diabetes treatment does not require insulin is the term used synonymously with non-insulin-dependent diabetes (NIDDM). Risk factors that lead to the production of diabetes are overweight, sedentary lifestyle and family history of diabetes Non-insulindependent.Din increasingly many adults and children to develop diabetes mellitus non-insulin-dependent, due to unhealthy eating habits and sedentary lifestyle. Causes Causes of non-insulin-dependent diabetes are not fully understood. However, experts believe the disease occurs in both children and adults because the pancreas does not secrete enough insulin or increased peripheral resistance to insulin action is increased, both physiological changes leading to increased blood sugar. Insulin resistance - resistance peripheral insulin action lead to a decrease in peripheral glucose consumption. To overcome peripheral resistance initially increases the secretion of insulin. If insulin production is poor blood sugar rises and diabetes is installed. Factors that determine peripheral resistance to insulin action during childhood are:

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- The increase in insulin resistance during puberty is a 30 CREC%, probably due to growth hormone action; - Female, girls shows a peripheral resistance to insulin action more than boys; - Black race, insulin-resistant African Americans are 30% higher than in adolescents in whites; - Obesity, especially abdominal obesity (android type) is associated with increased insulin sensitivity. Low production of insulin - normally during puberty pancreas secretes a higher amount of insulin. Diabetes occurs in conditions in which deficiency of insulin secretion is increasingly more pronounced and persistent hyperglycemia coincides with the appearance. Do not know the exact mechanisms of adverse evolution of diabetes, because until recently, NIDDM cases were rare in children. Experts believe that the progression of diabetes type II lesions in children is similar to that in adults: persistent hyperglycemia is the main cause for the alterations that occur in other organs: heart, great vessels, eyes, kidneys, peripheral nerves. The main risk factors for progression of injury complication specific period of time from onset of illness and poor metabolic control. A child with type II diabetes will have a higher risk of developing complications because of chronic illness started when life is very long. Chronic complications is unfavorable prognosis, they can be debilitating, leading to vision loss and patient death. Metabolic control late diagnosis and failure of early complications favors installation. Long time a child has type II diabetes increases the likelihood of developing complications in adulthood: - Children and adolescents are frequently diabetic retinopathy and diabetic nephropathy; - Children and teenagers rarely develop symptoms of diabetic neuropathy; - Children who have hypertension and hypercholesterolemia are at risk of developing cardiovascular complications. Persistent Hyperglycemia in children leads to imbalance rate of growth and development: initial growth rate is pronounced compared with healthy children, after development is slowed. Hyperglycemia during puberty is due to delays in the development of secondary sexual characteristics, and installation of menarche (first menstruation) in girls is late. Symptoms Typically, non-insulin-dependent diabetes in children are asymptomatic, due to the gradual installation of hyperglycemia, because of this can take several years before they would be detected. When diabetes becomes clinically manifest symptoms include: - Thirst - Polyuria (urinating in greater quantity). Other symptoms of type II diabetes: - Marked fatigue; - Nausea; - Many infections or slow healing of wounds; - View intetosata;

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- Weight loss. Risk Factors Major risk factors for type II diabetes are: - Obesity, 85% of children with non-insulin diadet body mass index (BMI) is situated on the 85th percentile to age and sex. Feeding these children is high in fat and low in fiber contributes substantially to the production of excess weight; - Physical inactivity (sedentary); - Family history (first degree relatives: father, brother, sister) with type II diabetes. Other risk factors are: - Race - afroamericanii, Hispanics, Native Americans, Asian Americans and Pacific Island populations are more at risk of developing type II diabetes compared to Caucasian populations; - Female; - Mother who developed diabetes during pregnancy. Medical disorders that increase the risk of developing NIDDM: - Hypertension; - Elevated cholesterol and triglycerides; - Fatty liver; - Sleep apnea. Call a Doctor It will be appealed to the emergency room if your child is sleepy or lethargic, diabetes and blood glucose value is less than 60 mg / dl. Will be followed strictly therapeutic indications of hypoglycemia. Consultation is specialized in the following situations: - If the blood glucose level is persistently increased after application of prescribed methods of lowering hyperglycemia; - If blood sugar is low after administration of fresh food (fruit juice, honey, candy); - Child has frequent episodes of hypo-or hyperglycemia is necessary readjustments dose oral antidiabetic medication or insulin; - Blood sugar is persistently high after missing a dose of insulin or oral hypoglycemic agents or insulin after an overdose of prescribed by a doctor; - If problems arise in following the exercise plan or diet. Watchful waiting is the time when parent and child specialist doctor watch symptoms without medical intervention. Not recommended if: - The child shows symptoms, blood glucose measurements will be performed to confirm the diagnosis; - The child is obese and not physically being at risk to make diabetes. Early complications prevents or slows its progression;

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- The child is prediabet; prediabetul may progress to non-insulin-dependent diabetes. Diet and exercise prevent this unfavorable evolution. Specialists recommend Diabetes diagnosis can be made by any healthcare profesinisti. After making the diagnosis, health experts will form a treatment plan tailored to the needs of children with diabetes. The following health professionals will assess the child regularly with non-insulin dependent diabetes: - Pediatrician, family doctor or GP - Nurse - Endocrinology - Specializes in problems of diabetes educator (this may be a doctor, nurse, nurse, nutritionist, pharmacist or other healthcare worker who has been trained and has experience in working with people with diabetes) - Nutritionist - Psychologist. Investigations Most children with type II diabetes have no symptoms and are diagnosed on the occasion of urine or blood tests performed routinely. Your doctor must consider the existence of diabetes when a child is obese, BMI exceeding the 85th percentile or weight to age and sex is 120% higher than the ideal value, especially if associated and other risk factors: - Family history of non-insulin dependent diabetes; - Black race; - Signs of insulin resistance such as acanthosis nigricans skin diseases, hypertension, hypercholesterolemia, elevated liver enzymes as a sign of fatty liver, polycystic ovary syndrome. Some shows high levels of glucose in the time of diagnosis and clinical point of view shows the confusion, drowsiness, loss of consciousness and may develop diabetic ketoacidosis (CAD) one of the complications of diabetes. If diabetes is suspected, the diagnosis will be made on the basis of the American Diabetes Association, is made after a careful history, which reveal a positive family history, a thorough clinical examination and after the realization of specific laboratory investigations. If the patient is asymptomatic will be needed to confirm the diagnosis tests highlight the high levels of blood glucose: - Measurement of blood glucose, fasting usually, but blood can be harvested at any time if the individual has not eaten; - Glucose tolerance test (OGTT) - to measure glucose levels at 2 hours after ingestion of a glucose solution. Other tests To make the diagnosis of type II diabetes with type I diabetes will require further investigations such as measuring insulinemiei (plasma insulin levels), tests for determining the self-antibodies (anti-Ac-insular beta cells) or peptide C. To be made a definite diagnosis can be several months or even years. Sometimes, health professionals may use the rapid tests ambulatory blood and urine tests to highlight the

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high levels of blood glucose or blood sugar, but for sure the diagnosis will be additional testing. Screening Tests Since there is a risk of late complications (ocular, cardiovascular, neurological, kidney) is recommended to perform regular checks of specialty. Early Diagnosis Since the age of 10 years or at onset of puberty a child whose body mass index is located on the 85th percentile to age and sex or weight exceeds the ideal value of 120% and if two of the following associated risk factors, will be tested for diabetes every two years: - Family history of type II diabetes; - Black race; - Signs of insulin resistance such as acanthosis nigricans skin diseases, hypertension, high cholesterol, elevated enzymes hapatice as a sign of fatty liver, polycystic ovary syndrome. If results show high blood sugar but not high enough to define diabetes (prediabet) will carry out repeated tests every three months. If you comply with diet and exercise program is balanced prediabetului evolution can be stopped for non-insulin-dependent diabetes. Treatment - General The main goal of treatment is to maintain blood glucose as close to the target value. Glicemiel level in children with type II diabetes should be maintained at a value greater than adults because their body is growing and, especially, as in children, the risk of installation does not recognize symptoms of hypoglycemia is higher than in adults . Means allowing maintenance treatment biochemical parameters are closer to normal balanced diet, daily physical activity and oral medications for diabetes. 1. Diet A proper nutrition (normo-or calorie) with an appropriate calorie needs allows a good metabolic control of diabetes and contribute to weight loss. The diet should be made so that carbohydrates (sugars and derivatives) to be distributed balanced throughout the day. Such sudden increases in blood glucose are prevented postprandial (after meal) and maintaining an optimal body weight. Individualized diet will be made by a specialist in nutrition taking into account the child's caloric needs. 2. Physical activity Like diet, exercise daily is an extremely important therapeutic factor. Exercise eases peripheral insulin and help control weight. The child does not have to follow a rigorous daily exercise, but to be more active: for example to play with same age children in special places, to do brisk walks along with other family members, to participate in individual or team sports. Experts recommend at least 30 minutes of exercise daily. Parents will limit long watching television or playing computer games their children by encouraging physical activity. Outpatient treatment 1. Diet Feeding the child with diabetes must be healthy, balanced, to ensure adequate caloric needs increase and prevent overweight. The diet will

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be prepared to be assigned so that carbohydrates throughout the day avoiding the appearance of postprandial hyperglycemia. 2. Physical activity It is advisable to follow an exercise program of 30 minutes per day. Promoting a healthy child and adolescent by encouraging participation in sports, daily trips on foot or by bike and reduce hours spent watching television or computer. People around the child with diabetes, including teachers will be trained to handle the special needs of children: blood glucose monitoring, recognition and rapid intervention in case of hypoglycemia installation (taking a snack / sweet food). If a diabetic child participate in group sports activities: - The coach will be informed about the child's illness. Although there is no risk of hypoglycemia is recommended that its education (coach will be given a list of signs of hypoglycaemia); - Administration of snacks containing sugar if hypoglycemia occurs during the game or sports activity. Ambulatory monitoring of blood glucose Parents and children with diabetes should monitor blood sugar more often to get good control of diabetes. The child with diabetes is acceptable glucose value greater than the recommended adult to ensure nutrients needed for growth and development needs of the child and to be avoided extreme episodes of hypoglycemia, more frequent in children. As children get older, blood glucose will be maintained as close to the target value.Children with diabetes have blood glucose levels measured regular outpatient, the best to do testing before breakfast and 2 hours after lunch. If cholesterol and triglyceride levels are high they will be treated with medication. Hypertension should be treated with ACE inhibitors because they have a protective role against damage produced by hyperglycemia and renal circulatory level. The weight loss and the metabolic control of diabetes will be reduced and lower serum cholesterol. If the lifestyle changes you can not maintain normal cholesterol your doctor will recommend drug treatment of hypercholesterolemia.When the diagnosis of type II diabetes, 5-25% of children had very high blood sugar. Hyperglycemia of diabetic ketoacidosis may cause a medical emergency that requires treatment with insulin in hospital. Treatment with insulin is necessary after the metabolic.Tratamentul control diabetes with insulin or oral medications (or both) increases the risk of hypoglycemia episodes. Your doctor will adjust the dosage required to maintain blood glucose within safe limits so as to avoid the appearance of lesions caused by diabetes and installation of episodes of hypoglycemia.Lifestyle changes necessary metabolic control can be onerous for the child or young person with diabetes. Therefore, the whole family will try to change their eating habits, switching to a healthy diet and doing exercise, so that all family members will be rollerblading or bike rides. Adolescents with depressive disorders or food pulse will have trouble achieving metabolic control of diabetes. In addition, teens who drink alcohol or smoke will have difficulty maintaining normal blood glucose levels. Attendance teen support groups help to overcome problems of diabetes management. Insulin treatment Treatment with insulin injection is needed in cases in which diet, exercise and anti diabetic oral medications are not effective in achieving metabolic control. Insulin therapy is mandatory in children with type II diabetes whose secretory activity pancretatica irreversibly

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deteriorated. Other advice needed to avoid problems arising in the management of diabetes: - Recognize the signs of hypoglycemia and the measures needed for this emergency; - Recognition and treatment of hyperglycemia; - Wearing of identification bracelets that will be useful for rapid identification and appropriate treatment in cases of emergency; - Participation in support groups for children with diabetes and their parents; - Diabetic foot care: the child must always wear comfortable shoes (not to walk barefoot around the house), we recommend a daily inspection of feet and a medical checkup whenever injury or infection is observed in the legs; - Recommendations in case of illness: blood glucose monitoring every 4 hours, adequate hydration, avoiding certain medications without a prescription because they can influence blood glucose levels. Diagnosis of diabetes in children and adolescents is difficult to make. Growth and development can interfere with treatment. Often, adolescents with diabetes have a negative attitude toward the disease and its treatment: deny the existence of disease, treatment will not have engaged in risky behavior such as consumption of alcohol or drugs. Parents play an important role in developing the skills necessary for a child with diabetes self treatment. Autoingrijirii be encouraged but under close supervision of the parent: - School-age children (primary school) are able to cooperate in all diabetes care activities, after age 8 can monitor their own blood sugar under adult supervision; - Secondary school students monitor their own but need help in controlling blood sugar episodes of hypoglycemia; after age 10 can manage their own insulin under adult supervision; - Teens make their own disease management under close supervision, if the treatment they require administration of insulin may choose to use an insulin pump, after a prior instruction manual. Medications If after a period of three months blood sugar is controlled through balanced diet and daily exercise are turning to oral antidiabetic: - Oral medications stimulate insulin secretion while increasing sensitivity of peripheral cells (in particular the muscle) to insulin action or slow absorption of carbohydrates in the gut. Sometimes, several doses are needed during the day or combination of several types of drugs; - In some children with type II diabetes is associated with taking insulin alone or oral medication to achieve good metabolic control. Even if your doctor has prescribed daily administration of insulin is needed temporarily during surgical interventions or when superimposed type certain infectious diseases. If it fails to maintain normal blood glucose levels in diabetes and chronic progressive establishment is required insulin therapy. Adults and children with type II diabetes receive the same medication. Antidiabetics own insulin secretion increases, decreases peripheral resistance to insulin action or slow intestinal absorption of sugars. In some cases, good diabetes control is necessary combination of two or more drugs and more effective than monotherapy. Also cover, the "Association" of several drugs is reduced risk of side effects because lower doses than are used alone. However, in certain circumstances

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the risk of hypoglycemia is higher in the combination drug. In some patients, in case of illness or surgery, it is necessary to manage their insulin alone or in combination with oral medications. Over time, daily insulin administration is required, as the pancreas exhausts its secretory capacity and insulin deficiency is absolute. Also during pregnancy or breastfeeding need insulin treatment. Antihypertensive and cholesterol-lowering treatment is necessary in children with hypertension and high cholesterol. Medication Choices : Drugs that decrease insulin resistance: - Biguanides such as metformin or the combination of metformin and glyburide - Thiazolidinediones Pioglitazone or Rosiglitazone as - Sulfonylurea as glipizide, glyburide, Glimperid, or the combination of metformin and glyburide, metformin or Glipizirid - Meglitinine type repaglinide and nateglinide. Drugs that slow the intestinal absorption of sugars: - Alpha inhibitors Acarbose or Miglitolului gucozidaza type. Hypertension and cholesterol-lowering medicines: - ACE inhibitors angiotensinii (IEC) or angiotensin-II receptor blockers - Statins. Metformin is the only oral anti-diabetic and given to children tested and approved for pediatric use by the Food and Drug Administration. Other agents are administered to adults and some experts and use them to treat type II diabetes in children. Metformin is the drug of first intention to treat non-insulin-dependent diabetes in children metformin is achieved by maintaining normal blood sugar without increasing the likelihood of weight gain. If after 3-6 months of their treatment with Metformin does not keep blood sugar within safe limits is necessary combination of another drug. Insulin can be given a single dose at night or a few small doses administered throughout the day or both. Insulin doses administered to children with diabetes type II are usually large to overcome peripheral resistance to insulin action increased and can cause obesity. Although alpha-glucosidase inhibitors in the management of pediatric no risks they can cause flatulence, the side effects makes them less tolerated by teenagers than other oral agents. Surgery Surgery is not indicated for type II diabetes. However, overweight adolescents are considered candidates for surgery, gastrointestinal (gastric ring) or intestinal bypass procedures that help in weight loss. Due to the risks posed by these interventions, many experts recommend them as compassionate intention. Other treatments In children with diabetes are not recommended for ages diets quick weight loss. Experts believe that a healthy diet, calorie balance is sufficient to prevent overweight. Weight loss is recommended when excessive obesity (BMI exceeds 95%) and similar weight reaches adult child. It is suggested that eviatate unconventional products. Additional treatments will be applied in parallel with traditional medical treatment. They may seem attractive but remember that they are not effective in treating diabetes or its complications. Choosing a

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complenentare or alternative therapeutic approaches will be made after a preliminary discussion with your doctor: Alternative methods of treatment include: - Acupuncture; - Biofeedback; - Chiropraxia (therapy using hands); - Phytotherapy, antioxidants (vitamin C), vanadium, manganese, chromium, soluble fiber can help keep blood sugar within normal limits; - Osteopathy (branch of alternative medicine that relies on manipulation therapy musculoskeletal). Prophylaxis Children with BMI located on the 85th percentile to age and gender or body weight exceeds the ideal value were 120% risk for noninsulin-dependent diabetes. Diet and exercise will reduce the chance of excess poder and type II diabetes is reduced. A nutrition specialist will prepare a healthy diet, and specialists in the field of physical therapy or diabetes educator who specializes in problems will help establish a regular exercise plan. Diabetes children (whose blood sugar is higher than the upper limit allowed but not high enough to define diabetes) are at risk of making non-insulin-dependent diabetes. Studies have shown that 25% of children aged between 4 and 10 years and 21% of those 11-18 years who are overweight shows prediabet (impaired glucose tolerance). Balanced diet and daily exercise program helps maintain normal blood sugar and prevent installation in type II diabetes. The child will be assessed periodically prediabet by doctors that will detect early signs of diabetes installation.Studies have found that lifestyle changes in adults with prediabet delay or prevent installation of non-insulin dependent diabetes. However, in children with prediabet, lifestyle change is not the same effects as in adults, studies on Prevention of type II diabetes in adolescents is ongoing. Healthy Eating for Type 2 diabetes A gratifying aspect for patients with diabetes mellitus type 2 (non-insulinonecesitant) is that a healthy diet can reduce the intensity of symptoms and may slow disease progression. But what precisely is not established how to define healthy eating for diabetes patients: to be about candy-free regime, the low-fat or carb? Or ... to be the key to eating meals right? In the following you will find answers to all these questions. Gestational diabetes (pregnancy) Gestational diabetes mellitus (DZG) is defined as glucose intolerance (carbohydrates) of variable severity with onset or first recognition during pregnancy. This definition applies whether insulin is used to treat glucose intolerance or if this condition continues after birth. Because loose definition is that some patients may present undetected diabetes or Type I (insulin dependent) or type II (insulinoindependent), which preceded the pregnancy. Maternal sequelae of DZG Further evolution in the life of gestational diabetes for type II diabetes has been well documented, although the risk varies between studies, in some degree due to different diagnostic criteria used in the diagnosis of diabetes. Because of documented risk, women who had DZG

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diabetes should be examined using current international recommendations. Women who had DZG also shows a higher prevalence of obesity, lipid management, vascular atherosclerosis, hypertension and mortality. In addition to raising long-term maternal morbidity, shortterm morbidity during pregnancy (hidramnios, hypertension and Caesarean delivery) was reported in several studies. Sequelae of perinatal DZG It is unclear whether DZG is associated with increased perinatal mortality in modern obstetrics. Earlier studies that showed an increase in perinatal mortality, often had defects in study design. There was no reported increase in perinatal mortality in women DZG in recently published studies. This is due to be examined and increased prosecution DZG complicated tasks, or the general improvement of obstetric care. DZG association between neonatal mortality and is well established. Perinatal mortality normally associated with an increased risk DZG: - babies overweight- Birth trauma - Neonatal hypoglycemia - Hyperbilirubinemia - Hypocalcemia - Polycythemia (increase in blood figurative elements). Moreover, recent data indicate that the effects on children DZG extend far beyond the perinatal period. Children born to mothers with DZG have an increased risk of childhood obesity and diabetes and all the morbidity associated with this disease. Tests for detecting DZG Accepted screening consists of administration per os dose of 50 grams of glucose between 24 and 28 weeks of pregnancy. The patient should not be hungry. Studies have shown that assay of 50 g glucose challenge is more sensitive and specific predictor DZG than other methods. There is a dispute regarding the proper amount of provocation test in time to be used as a starting point for diagnostic testing of oral glucose tolerance at 3:00 (OGTT). If used a limit of 140 mg / dL, approximately 14% of the population will require an OGTT and diagnosis of DZG not confirm about 10% of the population affected. If used a limit of 130 mg / dl, will be detected DZG virtually all cases, but 23% of pregnant women will require an OGTT. Screening test, as indicated above, using a limit value of blood glucose above 140 mg / dl, was approved by the Fourth International Conference on Gestational Diabetes Mellitus with some clarification: a randomized plasma glucose measurement of greater value 200 mg / dL in non-glucose challenge test or a fasting morning plasma glucose more than 126 mg / dL suggests diabetes status and justifies thorough investigation. The recommendation for examination by GCT at 24-28 weeks gestation should not eliminate the early testing, depending on circumstances. Indications for testing Fourth International Conference on Gestational Diabetes Mellitus recommended screening women of ethnic groups with relatively high rates of carbohydrate intolerance and diabetes during pregnancy appeared later in life. These include women of Hispanic, African, Native American, South or East Asian or Pacific Island indigenous Australian, especially if you live in Western countries or urban settlements. On the contrary, certain features situated women at low risk for DZG and would not be effective in terms of cost screening these patients. The low-risk women include: - Who are not members of ethnic groups with increased risk of developing type II diabetes mellitus - Not have a history of impaired glucose tolerance or complicated tasks associated with DZG - Which shows the age of 25 years, normal body weight and without family history of diabetes mellitus. If a clinic or a surgery has few such patients, it would be preferable for general screening of losing a person at risk for DZG. Our method is

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general screening. Attitude in case of abnormal OGTT results Nutritional counseling is the health care of women with DZG. All women should be counseled nutritional DZG a qualified dietitian when possible. Unfortunately, there is a poverty of information in randomized trials evaluating the optimal number and proportion of carbohydrate calories, fat and protein diet DZG. Now the American Diet Association recommend individualization of carbohydrate content of diet to get normoglicemia.Objectives are getting hypoglycaemic dietary care, defined as fasting morning plasma glucose less than 95 mg / dl, plasma glucose at 1 hour post-meal less than 140 mg / dL and / or 2 hours less than 120 mg / dl also providing a proper diet and pregnancy in terms of nutrition.According to one study, 70% of the women had levels of fasting plasma glucose in the morning less than 95 mg / dl in OGTT test using 100 g of glucose, blood sugar control target obtained in the first two weeks of diet therapy without Further improvement in glycemic control. Therefore, if dietary therapy fails to achieve target glycemic control in the first two weeks, would be associated with other treatment options. In the same study, only 30% of women who had morning plasma glucose values of less than 95 mg / dl were able to achieve target glycemic control with diet only. Monitoring blood glucose levels Once nutritional therapy was initiated, maternal blood glucose concentrations should be monitored frequently. Home blood glucose monitoring using memory glucometers seems superior monitoring strips read visually when checking blood glucose is somewhat questionable. Postprandial Hyperglycemia correlates better with macrosomia than with fasting hyperglycemia in pregnancies complicated by preexisting diabetes. This observation led to recommendations for monitoring both fasting and postprandial glucose in women with DZG, although this practice has not only showed superior monitoring of fasting. Both fasting and postprandial blood glucose levels can provide important medical information. The Fourth International Conference on Practical Application of Gestational Diabetes Mellitus recommends maintaining blood glucose concentrations less than 95 mg / dl before meals and less than 140 and 120 mg / dl at one hour and two hours respectively after meals. A postprandial glucose was defined by the American Association Diet 1 or 2 hours after beginning the meal. Our approach is to check blood sugar after fasting and DZG patients an hour postprandial (four values each day). If all values remain normal testing frequency decreases as the pregnancy progresses. Insulin Additional treatment should be provided to women who often have elevated blood glucose despite diet therapy. Insulin therapy is the most common treatment option. It uses either a combination of human insulin plus NPH or NPH insulin plus regular human insulin analogue (lispro). Lispro does not form aggregates when injected, thus allowing faster installation and shorter duration of action than regular insulin. These properties help to minimize the increase in postprandial blood glucose levels and decreased risk of late hypoglycaemia. Equivalence between regular and lispro insulin is 1:1. Insulin therapy decreases fetal macrosomiei frequency and perinatal morbidity. Unfortunately, optimal insulin regimens have not been determined. Following procedure is recommended for women who have DZG and unresponsive to diet therapy: if the patient has normal fasting glucose levels but elevated postprandial values, is used as the initial dose regimen of NPH insulin 20 units plus 10 units of insulin lispro or regular insulin at breakfast. It is finely tuned properly at home daily glucose,measurements of the patient. If the patient still has high blood sugar morning, when 10 units of insulin Suplimentary NPH plus 10units regular insulin or insulin lispro should be administered either at dinner or at bedtime. If using regular insulin should be administered approximately 30 minutes before lunch, if you use insulin lispro can be administered just before the start of the table. Again, the doses are changed as needed to get normoglicemia. Dosage adjustments made during regular visits to the clinic, often within weeks,

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could not be legally sufficient time to prevent the consequences of hyperglycemia. Therefore, patients should contact two or three times each week, preferably by a doctor or a qualified nurse diabetic education to obtain records of sugar and adjust insulin doses as needed. Oral antidiabetic Recently, safety and efficacy of glyburide's, one of the newest oral sulfonylurea drugs has been documented for women with DZG. Glyburide site, unlike the older sulfonylurea drugs and metformin site, do not cross the placenta. Glyburide-can be used in women diagnosed with mild hyperglycemia DZG showing despite diet therapy. Starting dose is 2.5 mg for oral glyburide in the morning. When indicated, the dose of glyburide to increase next week and then 2.5 mg, 5 mg weekly to a total dose of 20 mg, when necessary, to achieve glycemic control. Monitoring pregnancy in the event of DZG Unfortunately, there are few prospective data to help us. As a rule, women DZG that also presents other complications such as hypertension, a previous stillbirth or birth of complicated tasks, like women are cared for pre-existing diabetes. In addition, if necessary with insulin or glyburide therapy to achieve and maintain glycemic control, the task is taken care of that in women with preexisting diabetes. This evaluation will include a weekly nonstress test (NST) in the third quarter, increasing to two NRC evaluations of the week 36 of gestation until delivery. DZG Most women do not have such complications and care plan can be modified so as to be less intense. Mom, ever since the third quarter, fetal movements can make determinations that are cheap and easy to execute. Testing the health of the fetus is becoming more frequent until week 40 of gestation. With an excellent glycemic control without any complications, the possibility of an abnormal fetal testing positive is low-true. DZG Most women will require insulin during labor. However, it is important to continue to measure blood glucose concentration every two hours, to detect patients who require insulin therapy. Birth in the case of pregnancy complicated by DZG Programming birth in the absence of maternal or fetal hazard should take into account fetal growth characteristics and risks associated with induction of labor and prematurity. If the patient is controlled through diet, shows excellent glycemic control and normal fetal growth, spontaneous labor is probably justified waiting until 41-42 weeks of gestation. If the patient required insulin or glyburide therapy, it is preferable to birth no later than 40 weeks gestation. Rates of cesarean births among women with DZG is more than double that of women nondiabetice. A rate increase would macrosomiei explain this to some extent, however, just knowing that the mother shows DZG was treated with insulin or can, and only, to increase the chances of a cesarean birth. A diagnosis of DZG is not an indication of caesarean birth. To limit the iatrogenic morbidity, the route of delivery of women with well controlled DZG should be based on the same maternal and fetal considerations that apply to pregnant women nondiabetice. Attitude after birth Patients should be instructed on lifestyle changes to reduce weight and increase physical activity. DZG Since all patients with increased risk of developing diabetes, women with previous DZG should attend a family planning program. Preconception evaluation and counseling should achieve appropriate topics such as contraception, the need for early assessment of glucose tolerance in case of future pregnancies and risk of congenital malformations in diabetic pregnancies undiagnosed. All women who are thinking about a future pregnancy should be encouraged to take extra folic acid (less than 400 micrograms / day) to reduce the risk of neural tube defects in children. At 6-12 weeks post-partum, all patients had DZG during pregnancy should be evaluated and reclassified as follows. Morning blood sugar and should be obtained 2 hours post-meal or the patient should perform the test at 75 g glucose tolerance (as a preparation for a test to obtain a glucose OGTT morning, then the patient ingested 75 g glucose, and obtain a

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second blood glucose two hours). Measurement of carbohydrates in women with gestational diabetes Measurement of carbohydrates is the best way to plan meals from a person with gestational diabetes. Measurement of carbohydrates helps to calculate the amount of sugar and other carbohydrates (carbs) in food, which is very important because they affect blood sugar more than other nutrients. Measurement of carbohydrates to help people determine the amount of sugar and carbohydrates (glucose) in foods consumed, so that carbohydrates should be distributed throughout the day to prevent high blood sugar after meals. Blood glucose testing is recommended to be done and after meals to see the influence of different foods containing carbohydrates on blood glucose levels.Measuring carbohydrate meal planning method is recommended for a person with gestational diabetes. Measuring the amount of carbohydrates is adding carbohydrate foods and their distribution corresponding to each meal. Carbohydrates affect your blood sugar more than other nutrients. These nutrients are essential for the body include: - Fresh fruits and vegetables - Milk and milk derivatives - Flour (like bread, cereals and vegetables such as potatoes and corn) - Sweets (such as candy or cookies). All types of carbohydrates increases blood glucose levels. Foods that contain sugar usually have a quantity of carbs per serving more than foods that contain starch (pasta), such as bread. Contrary to information circulated persons with gestational diabetes can eat foods containing sugar. However if in a person with diabetes diet dominated by higher concentration of carbohydrate foods, that person may not eat enough other foods best in terms of nutrition. Indications Measurement of carbohydrates helps knowing the amount of carbohydrates in foods consumed during a meal. As more carbohydrates are consumed in a meal, the more postprandial blood glucose levels will rise. Measurement of carbohydrates is helpful in these situations: - Persons who administer insulin in front on the table, which nutritionist doctor wants to adjust the dose of insulin in the number of grams of carbohydrates consumed during meals - Even in people who are not treated with insulin for diabetes balancing is necessary to measure the carbohydrates needed to know the amount of carbohydrates in each meal and to prevent high levels of postprandial glucose - When your doctor recommends a patient with rapid-acting insulin doses adequate amounts of carbohydrates consumed at each meal. (Often, your doctor recommends pregnant women with diabetes receiving a unit of a rapid-acting insulin for every 10 grams of carbs) - Is recommended to use a set amount of carbs per day by the practitioner and its distribution according to the number of meals a day to keep blood sugar levels within safe limits, preventing hypo-or hyperglycemia, which can cause medical emergencies. The increased level of glucose favors the appearance of complications that can affect both the health of the pregnant woman and fetus. Methods Here are mentioned the methods that help to measure the carbohydrates in foods consumed and their distribution throughout the day: - Meals at regular intervals - At least three meals a day, which contain a high amount of carbohydrates. - These tables should be planned at the same time every day. For more suggestions can be consulted diet cookbook and can thus determine the main meals (eg dinner). You can prepare large quantities of food and left food can be kept in the fridge for the next meal. You can even

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make a menu list in a day and this will be displayed on the refrigerator. Measurement of carbohydrates Measuring compliance with carbohydrates and a balanced diet by: - Counseling with a nutritionist. Dietitian can help people with diabetes to establish the total amount of carbohydrate per day and the number of carbohydrates consumed at each meal or snack - Use a book that is this list of foods and their carbohydrate content - Eating carbohydrate units (UG) of carbohydrates in food. Each serving or unit glucose (UG) contains about 15 grams of carbohydrates. Foods that contain carbohydrates should not be weighed or measured each time, but in the early weighing or measuring foods that contain carbohydrates help the person learning the quantity of each food that is a carbohydrate unit (UG) of carbohydrates. - Calculating each gram or portion of carbohydrates. If an elevated postprandial blood sugar, the person with diabetes can adjust the amount of carbohydrates, eliminating or lowering some of the grams of carbohydrates consumed during that meal - Eating standard portions of foods that contain protein. Foods that contain protein (meat and cheese), does not contain a significant amount of carbohydrates, so do not need to be measured food carbohydrates protein component, however, it is necessary to consuming adequate amounts of protein. Each patient should consult a physician nutrition specialist to determine the amount of protein that can be consumed - Restriction of fat intake. A balanced diet contains a small amount of fat, especially in people with obesity. It is necessary to consult with a nutritionist to determine the amount of fat that can be consumed. Tips Other suggestions are useful for measuring carbohydrates: - Reading labels on food to meet their carbohydrate content. You must read food labels carefully to determine what amount of foods containing carbohydrate unit (UG) of carbohydrate - Check blood glucose levels and its Tercera in a self-tender. Periodical visits to the nutritionist or educator in determining diet, diabetes, or whenever the person considers that an adjustment needs to consult a book of self-control diet. For additional information be made available to interested books and brochures that help to measure carbohydrate, weighing and measuring and interpreting food labels on foods. However, it is necessary consultation or a teacher, a nutritionist to determine the diet of each individual's needs. Next Step After informing the books, brochures, internet and other educational materials that the person is ready to establish the number of meals and snacks per day, their schedule and total amount of carbohydrate per day. For them, consult your doctor or nutritional and metabolic diseases educator specializing in establishing diet (this is the role of nurse specialist). If after informing the patient has some questions about diet, consult a doctor. If problems arise in measuring carbohydrate meal planning or specialist advice should be sought. If self-tender are noted additional information and quantity of food consumed at each meal, we recommend submitting it to the doctor. About 30% of Romanian health evaluated through the risk of disease with diabetes mellitus.Over eight million Romanians have made tests in July 1, 2007 to March 31, 2008, through the health assessment and 30% of them are at risk of getting sick with diabetes, according to data from the Ministry of Health. Half of Romanians have made the program analyzes the health assessment. Of the patients evaluated, 207 903 persons were found suffering from us, and about 30%, meaning 2.5 million people at risk of disease by diabetes mellitus,

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according to data presented by the Minister of Health. "In Bucharest this was the lowest in the analysis (34.79 percent), while there has been an increased presence in such counties Harghita, Covasna, Dolj, Alba and Satu Mare," said Eugen Nicolaescu. Approximately 11% of those who were presented to the family doctor had no health insurance.From a financial standpoint, in the first nine months of the program have been discounted medical services provided by family physicians and laboratories, worth EUR 100 million. Assessment Program of the Population health began on 1 July 2007 and is funded entirely by the Ministry of Public Health. It is estimated that the amount necessary for developing this program is around 300 million euros. The money will be allocated from the ministry's own funds. Romans benefits for free under this program, a clinical consultation and a free set of tests to help detect possible heart disease, liver, kidney.Lack of medical insurance or poor health care financing of diabetes contribute to the unfavorable evolution of the disease and the development of chronic complications. Specialist medical advice It is suggested that you contact the emergency services: - A patient treated for hypoglycemia maintain their blood glucose less than 60 mg / d and becomes drowsy or lethargic. The recommendations will be followed in case of hypoglycemia treatment; - Sudden loss of vision: sudden loss of vision, or partial, can be a symptom of many diseases of the eye, including retinal detachment or bleeding in the eye. Sudden loss of vision is always a medical emergency; - Chest discomfort or pain in the form of crushing, crushing or heavy feeling, characteristic symptoms infactului attack. Pain may radiate to the neck, jaw or one or both shoulders or arms, usually lasting more than 10 minutes and is accompanied by symptoms such as sweating, shortness of breath (dyspnea), nausea or vomiting, dizziness, fast or irregular heartbeat. Incidence of painless infarctions is increased in diabetic patients. Patients experiencing heart attack symptoms will take 325 mg of aspirin to prevent the installation of a thrombosis; - Any sign of stroke: numbness, weakness, paralysis of the face, arm or leg, especially if it is limited to one side, vision problems at one or both eyes (spots, double vision or loss for vision); confusion, trouble speaking or understanding words, difficulty walking, dizziness, lack of balance or coordination, severe headache with no known cause. Call a professional to do if new symptoms appear or worsen symptoms of complicated background: - Blurred or distorted view, "light flashes, spots, stains, streaks or ocular pain will require an ophthalmologist; - Any injury or infection occurs in the legs; - Pain as burning, numbness or swelling in the limbs; - Frequent bloating, belching (eructation), nausea, vomiting, diarrhea and abdominal pain (symptoms of gastroparesis) - Profuse sweating or no sweating, dizziness or weakness in the feet moving into position, reducing bladder filling sensation and difficulty emptying the bladder filled, the dynamics of sexual disorders (lack of erection, vaginal dryness), hypoglycemia ignored. If glucose levels are persistently elevated person should contact a medical specialist. Specialists recommend Depending on the location of lesions due to chronic hyperglycemia in patients with diabetes need specialist advice to health professionals following: - Cardiologist or specialist in cardiovascular surgery for the treatment of cardiovascular problems; - Nephrologists;

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- Ophthalmology or optometrist for diagnosis of eye damage from diabetes detrminata, for complications of retinal ophthalmologist is recommended; - Neurologist for diagnosis and treatment of neuropathy; - Gastroenterologist to treat digestive disorders caused by gastroparesis; - Urologist to treat uro-genital tract problems; - Podiatrist, cismarul producing special footwear or orthopedic prostheses and proper care of the diabetic foot. Home Treatment Patients with diabetes mellitus-Independence must know that they can lead a normal life. The most important step forward in preventing complications of diabetes is tight glycemic control (maintaining blood glucose as close to the target value). Established early treatment reduces the risk of losing sight of the development of renal failure or amputations. Compliance program is recommended visits to a GP or other medical specialists who will detect the first signs of complications and will monitor the evolution of existing complications. 1. Heart and large vessels A person with diabetes even if it is at risk of cardiovascular problems make these diseases. It is important: - To quit smoking tobacco increases the risk of myocardial infarction and stroke; - After 30 years of age to take low-dose aspirin daily; - To follow antihypertensive treatment prescribed by a specialist. 2. Diabetic retinopathy Ophthalmology optometrist or actresses detection and early treatment prevents blindness. In the event of any vision problems will be quickly contacted an ophthalmologist because vedrii these changes can mean a worsening of diabetic retinopathy. 3. Diabetic Nephropathy - High blood pressure medication will be treated so as to be kept to below 130/80 mmHg; - Restriction of protein: protein foods will provide more than 10% of calories, if there is kidney damage with microalbuminuria; - Will reduce consumption of salt that favors retention of fluid in the body and lead to high blood pressure; - Will be avoided inflammatory drugs such nesteriodiene ibuprofen or naproxen with renal toxicity. 4. Diabetic foot Diabetic foot care is very important. The patient will make a daily inspection of the foot and if it is sighted another inspection will be conducted persoana.Principale diabetic foot care measures are: - Avoid those exercises that can cause foot injuries, walking is recommended but jogging Can be harmful; - Avoid hot baths; - Taratamentul any injuries, even minor (such as corns or scratches) because it can lead to serious complications. 5. Diabetic neuropathy If peripheral sensory neuropariei: - Will use a bath thermometer to check if water is not hot; - The patient will never go barefoot, to wear shoes / slippers, even in the house; - Not recommended to use electric blankets;

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- The house will be arranged so slightly to ease the daily traffic and avoid hitting objects or furniture. Patients with autonomic neuropathy: - Will be small and frequent meals low in fat and fiber when shows gastroparesis or other digestive disorders; - Proper hydration is important if the patient has kidney problems and intense sweating; - Will use the vacuum device for erectile problems and lubricant gel in case of vaginal dryness. The doctor will ask for use for impotence medicamentelelor: - Will check your blood sugar several times a day and night to even detect hypoglycemia installation neglected. If this focal neuropathy: - Wear the cuff if the affected joint was recommended by a physician; - During activities that require repetitive motions will be frequent breaks. Medications Diabetes non-insulin-dependency can not be controlled through diet often respond to oral antidiadetice. Patients in whom oral medication is not enough to control blood sugar will be treated with insulin injections or using subcutanete an insulin pump. - After 30 years of age are recommended to take low-dose aspirin to prevent myocardial infarction, stroke or peripheral arteries; - For digestive problems will be given metoclopramide, domperidone, or erythromycin; - Analgeticele form of ointment or oral medication will be administered for peripheral neuropathic pain; - Erectile dysfunction drugs will administer medical indication numui simply because they can aggravate heart problems, especially in patients who require treatment with nitrates nitroglycerin type. Medication Choices For the treatment of insulin-independent diabetes complications: - Aspirin for prevention of cardiovascular and cerebrovascular accidents, or after; - Type statins atorvastatin, simvastatin or Provastatin; - ACE-inhibitors or angiotensin II receptor inhibitors for the treatment of diabetic nephropathy; - Medicines for erectile dysfunction phosphodiesterase type-2 inhibitors. Prior to resort to these drugs will require specialist advice. Note! Reducing the risk of developing diabetes complications can be achieved by controlling blood sugar medication (oral hypoglycemics and insulin in some cases) and keeping as close to a target value. If cholesterol levels are raised will be given statins to keep LDL-cholesterol level below 100 mg / dL (2.60mmol / L), triglycerides less than 150mg/dl (1.7 mmol / L) and HDL cholesterol of 40 mg over / dL (1.1 mmol / L). Treat high blood pressure so this value should be kept below 130/80 mmHg. If systolic blood pressure values between 130 and 139 are inadreaza mm Hg and the blood pressure of 80-89 mm Hg diastoloce before starting drug therapy will try viatra style changes or behavioral therapy for 3 months. Surgery Some complications of diabetes can be treated surgically. For example Vitrectomy in diabetic retinopathy (vitreous surgery to remove) improves the patient. Diabetic foot problems caused by neuropathy can lead to amputation. Tuburarile crdiovasculare be treated surgically. Other treatments

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It is recommended to be avoided products recommended by the so-called patients "satisfied" with the results. These medicines or remedies can be expensive and harmful. If patients wish to address these products using non-conventional diabetes therapy is recommended to request clarification about the treatment of the Romanian Association of Diabetes and Nutrition, a medical specialist treating the problems of diabetes educator. Types of diet Some patients may be tempted to abandon diets determined by your doctor and take another type of diet followed by other patients with diabetes to consume foods with low GI (glycemic index raise blood glucose levels over a period of one hour). Before the diet change is recommended to seek advice from a dietitian. Complemetare therapies Complemetare therapies are those treatment modalities which are used in parallel with traditional treatment. They may seem attractive but remember that they are not effective in treating diabetes or its complications. Taratament alternative methods include: - Acupuncture; - Biofeedback; - Chiroterapia (therapy using hands); - Phytotherapy, antioxidants, vanadium, manganese or chromium. Soluble fiber can help keep blood sugar within normal limits; - Osteopathy (branch of alternative medicine that relies on manipulation therapy musculoskeletal). Acupuncture and biofeedback therapy are examples of ways to relieve stress or muscle tension, they improve patients' quality of life but not cure the disease. It is not recommended using complementary therapies with medication unaccompanied by insulin. Juvenile Diabetes Diabetes is the endocrine and metabolic disease most common in childhood, characterized by a steady increase of glucose, with or without clinical signs are caused by alterations in insulin secretion or disruption of its action. It affects both sexes equally, with a slight predominance of males. Diabetes mellitus is classified as residual insulin secretion: Type I or juvenile diabetes, or insulin; type II diabetes or non-insulin dependent or adult. The most frequently found in children and adolescents is type I, may meet exceptionally and type II. Schooling Diabetes mellitus and its treatment should influence the life and work as little as a child or adolescent. For the safety of his own health must always have a medallion or a notebook to write the diagnosis on which he has, he is receiving treatment every day, how many units of insulin, and a small amount of sugar, which to use in case of hypoglycemia. Teachers will be aware of their condition, giving them support if needed. Insulin can not do anyone. If a higher dose is given, the student may present a similar state of drunkenness or may lose consciousness, you can not help himself. If it is found in this state will be given sugar water immediately, and if it can not swallow or if 15 minutes is not to be transported to the hospital. Student life-threatening loss of time. It is recommended that education be made in the area of home, family environment that can more easily ensure that dietary needs Exercise child with diabetes should be encouraged to practice physical activities and sports, which will help him physically and psychologically. Exercise therapy is part of the disease environment, as diet and insulin treatment.Exercise can be practiced by students with type I diabetes mellitus without

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cardiovascular complications, respiratory, liver, blood, kidneys. They must be practiced regularly, progressively, in terms of duration and intensity. Exercise will be supervised by a physician. It is recommended that collective sports: volleyball, handball, basketball, football, and those who do not carry the risk of violent strikes and efforts and also can be practiced as a team or group tennis, cycling, gymnastics, jogging and ballet, dancing, walking or cycling. Not recommended for sports involving high risk of hypoglycemia, which once started would have dramatic consequences: swimming, climbing, sailing in solitary water diving, skydiving, jumping on the trampoline alone. In performing a moderate physical activity recommended reducing the dose of insulin and a further increase in carbohydrate ration. Exercise is an essential aid engaged constantly in disease specific diet. A good education and working life are the best means to further social and professional integration. Long-term prognosis is dominated by the emergence of diabetes complications such as kidney damage, damage to the retina, which can be added to neurological disorders (neuropathy) and cardiovascular disease. Kidney involvement by diabetic nephropathy (late complication of diabetes), determines the vital prognosis of the child. The onset is found in urine protein removal (protenurie or albuminuria), plus, over time, edema, hypertension, etc.. In evolution, may reach renal failure for which renal dialysis. Damage of the retina (retinopathy) can progress to blindness (blindness). It can be detected early by fluorescence angiography. In case of unfavorable evolution can be treated by laser photocoagulation. Neuropathy can affect neurovegetative causing bowel disorders manifested by diarrhea, psychomotor instability. The disease is also responsible for disorders of deep sensitivity, the loss of tendon reflexes and decreased muscle strength.Vocational guidance should take proper account of all the elements that make the diagnosis. Thus, because of hypoglycaemic accidents that may occur is forbidden any activity with risk of injury to themselves and for others in traffic safety such as: pilot, sailor, manager of transportation, high weight trucks, firefighter , acar, impiegat, professions at risk of falling (from high on the scaffolding, near the firewood or water, such as carpenter, iglar, occupations that require high visual acuity: watchmaker, mechanical precision, are also recommended. are not allowed in environmental activities with ionizing radiation or chemical pollutants, poor light or glare, visual overload (retinopathy risk), environment-threatening infections, high temperature work, field activities that prevent compliance with a regular schedule the tables, night work (risk of coma), intense noise, permanent nerve strains. It is not recommended youth: a military career, military service or jobs that necessarily require military service: national security, border service, forestry engineer. Featured occupations are instead taking place in an atmosphere of calm, regular pace of work, sitting position (but in alternation with the orthostatic), under the comfortable environment. Are permitted activities as: public and education officials.

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Bibliography:
1. Zhang Y, Proenca R, Maffei M, Barone M, Leopold L, Friedman JM. Positional cloning of the mouse obese gene and its human homologue. 2. Pelleymounter MA, Cullen MJ, Baker MB, et al. Effects of the obese gene product on body weight regulation in ob/ob mice. 3. Moller DE. Potential role of TNF-alpha in the pathogenesis of insulin resistance and type 2 diabetes. Trends Endocrinol Metab. 4. http://www.medicinenet.com/diabetes/focus.htm. 5. http://harvester.fzk.de/harvester/. 6. http://www.webmd.com/. 7. http://en.wikipedia.org/wiki/Bing_Health. 8. http://en.wikipedia.org/wiki/AltaVista

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