Saturday 30 May 2015

To diagnose type 1 or Type 2 diabetes

Type 1 Diabetes

In the early 1980s a breakthrough showed that early onset diabetes, now called Type 1 was actually an autoimmune disease in which the body destroyed its own beta cells. Antibodies produced by the immune system signaled a clear cause that distinguished it from adult onset diabetes.

Type 1 or insulin-dependent diabetes mellitus (IDDM) appears primarily in childhood or adolescence with excessive thirst and urination, loss of weight, and extremely high glucose levels. Other than the recent weight loss, a relatively normal weight is typical when Type 1 diabetes starts. Type 1 occurs in 7 to 22% of all people who have diabetes (See Type 1.5 below). Treatment for this type revolves around replacing the missing insulin delivery with an insulin pump or injections t match diet and exercise.

Many interventions are being attempted to stop the progressive loss of beta cells that is seen in Type 1 diabetes. Antibodies can often be detected a couple of years before glucose levels rise sufficiently for a diagnosis, and some children with antibodies do not develop Type 1 diabetes. When antibodies are present, there is a 68% probability of developing Type 1 diabetes, and the presence of multiple autoantibodies has the highest predictive value for Type 1 diabetes.1

Type 2 Diabetes

In contrast to Type 1 where the immune system destroys beta cells, Type 2 diabetes develops from a gradual decline in the beta cells’ ability to over-produce insulin. Type 2 is a progressive disease in which insulin production has been increased for several years as the body attempts to keep up with the insulin resistance associated with abdominal obesity or an apple shape. Insulin production gradually degrades as the beta cells become exhausted.
Type 2 is often part of a metabolic syndrome that includes various signs of insulin resistance: high blood pressure, high total cholesterol (over 200), high triglycerides (also over 200), low levels of HDL or protective cholesterol (under 40 mg/dl), gout, and abdominal obesity.

Treatment for Type 2 diabetes revolves around varied combinations of diet, exercise, medications, and/or insulin injections. Type 2 diabetes can be prevented if a person remains diligent about staying physically active and maintaining normal weight. In the Diabetes Prevention Program conducted by the NIH, the diagnosis of diabetes was reduced by 58% in the group that did these two things.4 Two classes of diabetes medications, GLP-1 agonists and glitizones, have been shown to slow the loss of beta cells in Type 2 diabetes. When started early, these medications appear to preserve insulin production, delay loss of glucose control, and delay the need for insulin for at least several years.
At least 90% of people with diabetes have Type 2 and 30 to 40% of them currently use insulin. About 30% of Americans have insulin resistance and about 30% of these will eventually develop Type 2 diabetes at some time in their lives.

Of all the people with diabetes, roughly 10% will have classic Type 1, 75% will have Type 2 (insulin resistant), and another 15% will have Type 1.5.

Source : www.diabetesnet.com/about-diabetes/types-diabetes/what-type

To diagnose type 1 diabetes, your doctor will ask for a:

    Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It works by measuring the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates you have diabetes.

If the A1C test isn't available, or if you have certain conditions that can make the A1C test inaccurate — such as if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — your doctor may use the following tests to diagnose diabetes:

    Random blood sugar test. A blood sample will be taken at a random time. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst.
    Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.

Source : www.mayoclinic.org/diseases-conditions/type-1-diabetes/basics/tests-diagnosis/con-20019573

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