What is diabetes?

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1. What is diabetes?


Global epidemic
(source: American, and Canadian diabetes Association)
An estimated 285 million people worldwide are affected by diabetes. With a further 7 million people developing diabetes each year, this number is expected to hit 438 million by 2030.

Based on a U.S. study, a North American child born in 2000 stands a one in three chance of being diagnosed with diabetes in his or her lifetime. In Canada, more than 3 million Canadians have diabetes and this number is expected to reach 3.7 million by 2020.

According to the Centers for Disease Control :

  • Diabetes is an epidemic.
  • 17 million Americans have diabetes.. with 5.9 million completely unaware that they even have the disease.
  • Diabetes is the 5th leading cause of death in the United States.. with over 200,000 deaths each year from diabetes-related complications.
  • Among U.S. adults, diagnosed diabetes increased 49% from 1990 to 2000.
    Similar increases are expected in the next decade and beyond

Diabetes is a serious problem that costs our entire planet. Most people do not realize that it is not only the world’s 4th leading cause of death, diabetes is increasing daily and now affects an estimated 246 million people globally.


Who is at Greater Risk for Type 2 Diabetes?
(Source: American diabetes Association)

  • People with impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG)
  • People over age 45
  • People with a family history of diabetes
  • People who are overweight
  • People who do not exercise regularly
  • People with low HDL cholesterol or high triglycerides, high blood pressure
  • Certain racial and ethnic groups (e.g., Non-Hispanic Blacks, Hispanic/Latino Americans, Asian Americans and Pacific Islanders, and American Indians and Alaska Natives)
  • Women who had gestational diabetes, or who have had a baby weighing 9 pounds or more at birth
    http://www.diabetes.org/diabetes-basics/prevention/risk-factors/

What are the symptoms?
(Source: American Diabetes Association)
Diabetes often goes undiagnosed because many of its symptoms seem so harmless. Recent studies indicate that the early detection of diabetes symptoms and treatment can decrease the chance of developing the complications of diabetes.


Type 1 Diabetes

  • Main Symptoms of Diabetes Frequent urination
  • Unusual thirst
  • Extreme hunger
  • Unusual weight loss
  • Extreme fatigue and Irritability
Type 2 Diabetes*
  • Any of the type 1 symptoms
  • Frequent infections
  • Blurred vision
  • Cuts/bruises that are slow to heal
  • Tingling/numbness in the hands/feet
  • Recurring skin, gum, or bladder infections
    *Often people with type 2 diabetes have no symptoms
    If you have one or more of these diabetes symptoms, see your doctor right away. You can also take our Online Diabetes Risk Test to find out if you are at risk for diabetes.
    http://www.diabetes.org/diabetes-basics/symptoms/
    (Source: From Wikipedia, the free encyclopedia)

What are the risk factors for diabetes?
If you are aged 40 or older, you are at risk for type 2 diabetes and should be tested at least every three years. If any of the following risks factors apply, you should be tested earlier and/or more often.


Being:

  • A member of a high-risk group (Aboriginal, Hispanic, Asian, South Asian or African descent)
  • Overweight (especially if you carry most of your weight around your middle)

Having:

  • A parent, brother or sister with diabetes
  • Health complications that are associated with diabetes
  • Given birth to a baby that weighed more than 4 kg (9 lb)
  • Had gestational diabetes (diabetes during pregnancy)
  • Impaired glucose tolerance or impaired fasting glucose
  • High blood pressure
  • High cholesterol or other fats in the blood
  • Been diagnosed with polycystic ovary syndrome, acanthosis nigricans (darkened patches of skin), or schizophrenia
    http://www.diabetes.ca/about-diabetes/what/facts/
Cost of Diabetes
(Source: Canadian Diabetes Association)
The personal costs of diabetes may include a reduced quality of life and the increased likelihood of complications such as heart disease, stroke, kidney disease, blindness, amputation and erectile dysfunction.
  • Approximately 80% of people with diabetes will die as a result of heart disease or stroke.
  • Diabetes is a contributing factor in the deaths of approximately 41,500 Canadians each year.
  • Canadian adults with diabetes are twice as likely to die prematurely, compared to people without diabetes.
  • Life expectancy for people with type 1 diabetes may be shortened by as much as 15 years. Life expectancy for people with type 2 diabetes may be shortened by 5 to 10 years.
The financial burden of diabetes and its complications is enormous.
  • People with diabetes incur medical costs that are two to three times higher than those without diabetes. A person with diabetes can face direct costs for medication and supplies ranging from $1,000 to $15,000 a year.
  • By 2020, it's estimated that diabetes will cost the Canadian healthcare system $16.9 billion a year.
What is diabetes? : definition
(Source: From Wikipedia, the free encyclopaedia)
Diabetes mellitus often simply referred to as diabetes's a condition in which a person has a high blood sugar (glucose) level as a result of the body either not producing enough insulin, or because body cells do not properly respond to the insulin that is produced. Insulin is a hormone produced in the pancreas which enables body cells to absorb glucose, to turn into energy. If the body cells do not absorb the glucose, the glucose accumulates in the blood (hyperglycemia), leading to various potential medical complications.[2][3]


There are three major types of diabetes:
Type 1(Insulin dependent)
(Source: American diabetes association)
Type1 diabetes is usually diagnosed in children and young adults, and was previously known as juvenile diabetes. In type 1 diabetes, the body does not produce insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. Only 5-10% of people with diabetes have this form of the disease. With the help of insulin therapy and other treatments, even young children with type 1 diabetes can learn to manage their condition and live long, healthy, happy lives
http://www.diabetes.org/diabetes-basics/type-1/

Type 2(Non-insulin-dependent)
(Source: American diabetes association)
Glucose Insulin Day Type 2 diabetes is the most common form of diabetes. Millions of Americans have been diagnosed with type 2 diabetes, and many more are unaware they are at high risk. Some groups have a higher risk for developing type 2 diabetes than others. Type 2 diabetes is more common in African Americans, Latinos, Native Americans, and Asian Americans, Native Hawaiians and other Pacific Islanders, as well as the aged population.

In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin. Insulin is necessary for the body to be able to use glucose for energy. When you eat food, the body breaks down all of the sugars and starches into glucose, which is the basic fuel for the cells in the body. Insulin takes the sugar from the blood into the cells. When glucose builds up in the blood instead of going into cells, it can lead to diabetes complications
http://www.diabetes.org/diabetes-basics/type-2/

Gestational diabetes
(Source:American Diabetes Association)
During pregnancy -- usually at around 28 weeks or later -- many women are diagnosed with gestational diabetes. A diagnosis of gestational diabetes doesn't mean that you had diabetes before you conceived, or that you will have diabetes after giving birth. But it's important to follow your doctor's advice regarding blood glucose (blood sugar) levels while you're planning your pregnancy, so you and your baby both remain healthy

Pre-diabetes
(Source: Canadian Diabetes Association)

Prediabetes refers to blood glucose levels that are higher than normal, but not yet high enough to be diagnosed as type 2 diabetes (i.e. a fasting plasma glucose level of 7.0 mmol/L or higher). Although not everyone with prediabetes will develop type 2 diabetes, many people will.

It is important to know if you have prediabetes, because research has shown that some long-term complications associated with diabetes such as heart disease and nerve damage may begin during prediabetes.
http://www.diabetes.ca/about-diabetes/what/prediabetes/


Complications of Diabetes
(Source: American Diabetes Association)
Long-term complications are mostly related to arteries and nerves. Diabetes causes serious damage to both large and small arteries.

Heart disease and stroke

  • In 2004, heart disease was noted on 68% of diabetes-related death certificates among people aged 65 years or older.
  • In 2004, stroke was noted on 16% of diabetes-related death certificates among people aged 65 years or older.
  • Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes.
  • The risk for stroke is 2 to 4 times higher among people with diabetes.

High blood pressure

  • In 2003, 2004, 75% of adults with self-reported diabetes had blood pressure greater than or equal to 130/80 mmHg, or used prescription medications for hypertension.

Blindness

  • Diabetes is the leading cause of new cases of blindness among adults aged 20 ~ 74 years.
  • Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year.

Kidney disease

  • Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2005.
  • In 2005, 46,739 people with diabetes began treatment for end-stage kidney disease in the United States and Puerto Rico.
  • In 2005, a total of 178,689 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States and Puerto Rico.

Nervous system disease (Neuropathy)

  • About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage.

Amputation

  • More than 60% of nontraumatic lower-limb amputations occur in people with diabetes.
  • In 2004, about 71,000 nontraumatic lower-limb amputations were performed in people with diabetes. 

2. Diagnosis and Treatment of Diabetes

Diagnosis of Diabetes (1)
(Source: Canadian diabetes association)
The amount of glucose (sugar) in your blood is measured in mmol/L.

  1. Glucose Insulin Release Fasting Blood Glucose (FPG)
    You must not eat or drink anything except water for at least eight hours before this test. A test result of 7.0 mmol/L or greater indicates diabetes.
  2. Casual Blood Glucose
    This test may be done at any time, regardless of when you last ate. A test result of 11.0 mmol/L or greater, plus symptoms of diabetes, indicates diabetes.
  3. Oral Glucose Tolerance Test
    You will be given a special sweetened drink prior to this blood test. A test result of 11.1 mmol/L or greater taken two hours after having the sweet drink indicates diabetes.
    A second test must be done in all cases (except if you have acute signs and symptoms). Once diabetes has been diagnosed, ask your doctor to refer you for diabetes education.

Diagnosis of Diabetes(2)
(Source: Wikipedia, the free encyclopedia)
Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is diagnosed by demonstrating any one of the following : [10]

  • Fasting plasma glucose level at or above 7.0 mmol/L (126 mg/dL).
  • Plasma glucose at or above 11.1 mmol/L (200 mg/dL) two hours after a 75 g oral glucose load as in a glucose tolerance test.
  • Symptoms of hyperglycemia and casual plasma glucose at or above 11.1 mmol/L (200 mg/dL).
  • Glycated hemoglobin (hemoglobin A1C) at or above 6.5. (This criterion was recommended by the American Diabetes Association in 2010 ; it has yet to be adopted by the WHO.)[28]

    About a quarter of people with new type 1 diabetes have developed some degree of diabetic ketoacidosis (a type of metabolic acidosis which is caused by high concentrations of ketone bodies, formed by the breakdown of fatty acids and the deamination of amino acids) by the time the diabetes is recognized. The diagnosis of other types of diabetes is usually made in other ways. These include ordinary health screening; detection of hyperglycemia during other medical investigations; and secondary symptoms such as vision changes or unexplainable fatigue. Diabetes is often detected when a person suffers a problem that is frequently caused by diabetes, such as a heart attack, stroke, neuropathy, poor wound healing or a foot ulcer, certain eye problems, certain fungal infections, or delivering a baby with macrosomia or hypoglycemia.

    A positive result, in the absence of unequivocal hyperglycemia, should be confirmed by a repeat of any of the above-listed methods on a different day. Most physicians prefer to measure a fasting glucose level because of the ease of measurement and the considerable time commitment of formal glucose tolerance testing, which takes two hours to complete and offers no prognostic advantage over the fasting test.[29] According to the current definition, two fasting glucose measurements above 126 mg/dL (7.0 mmol/L) is considered diagnostic for diabetes mellitus.

    Patients with fasting glucose levels from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) are considered to have impaired fasting glucose. Patients with plasma glucose at or above 140 mg/dL (7.8 mmol/L), but not over 200 mg/dL (11.1 mmol/L), two hours after a 75 g oral glucose load are considered to have impaired glucose tolerance. Of these two pre-diabetic states, the latter in particular is a major risk factor for progression to full-blown diabetes mellitus as well as cardiovascular disease.[30]


1999 WHO Diabetes criteria[27]

Condition

2 hour glucose

Fasting glucose

mmol/l(mg/dl)

mmol/l(mg/dl)

Normal

<7.8 (<140)

<6.1 (<110)

Impaired fasting glycaemia

<7.8 (<140)

≥ 6.1(≥110) & <7.0(<126)

Impaired glucose tolerance

≥7.8 (≥140)

<7.0 (<126)

Diabetes mellitus

≥11.1 (≥200)

≥7.0 (≥126)

 

 

3.Metabolic syndrome 

(Source: Canadian Diabetes Association)

Metabolic syndrome is a term used to describe a group of conditions that puts people at higher risk of developing type 2 diabetes, heart disease and other heart-related problems (according to the United States Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults).

If you have 3 or more of the following conditions, you are considered to have metabolic syndrome: 

·         High fasting blood glucose levels (5.6 mmol/L or higher)

·         High blood pressure (130/85 mm Hg or higher)

·         High level of triglycerides, a type of fat in your blood (1.7 mmol/L or higher)

·         Low levels of HDL, the “good” blood cholesterol (lower than 1.0 mmol/L in men or 1.3 mmol/L in women)

·         Abdominal obesity or too much fat around your waist [a waist circumference of greater than 102 cm (40 inches) in men and greater than 88 cm (35 inches) in women]

The more of these conditions you have, the higher your risks of developing type 2 diabetes and heart disease.

There is still some debate about what causes metabolic syndrome. Some researchers believe the cause may be related to insulin resistance (when the body does not effectively use insulin to turn sugar from food into energy for the body). Genetics, older age and lifestyle - including a high-fat diet and inactivity - also appear to play a role.

4.Blood Glucose Control

(Source: American Diabetes Association)

Blood glucose (blood sugar) is an essential measure of your health. If you're struggling to manage your blood glucose levels, we can help! With the latest tools and strategies, you can take steps today to monitor your condition, prevent serious complications, and feel better while living with diabetes.

http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/

How to prepare blood glucose test

Fasting blood sugar (FBS)

For a fasting blood sugar test, do not eat or drink anything other than water for at least 8 hours before the blood sample is taken.

If you have diabetes, you may be asked to wait until you have had your blood tested before taking your morning dose of insulin or diabetes medication.

2-hours after eating blood sugar

For a 2 hours after eating test, eat a meal exactly 2 hours before the blood sample is taken. A home blood sugar test is the most common way to check 2-hour postprandial blood sugar levels.

Random blood sugar (RBS)

No special preparation is required before having a random blood sugar test.

Talk to your health professional about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results may indicate.

Results

Normal

A blood glucose test measures the amount of a type of sugar, called glucose, in your blood.

Results are often ready in 1 to 2 hours. Glucose levels in a blood sample taken from your vein (called a blood plasma value) may differ a little than glucose levels checked with a finger stick.

 

Recent diabetes criteria

                                                        Blood glucose

Fasting blood glucose

70–99 mg/dL ( less than 5.5 mmol/L)

2 hours after eating(postprandial)

70–145 mg/dL (less than 7.9 mmol/L)

Random (casual):

70–125 mg/dL (less than 7.0 mmol/L)

 

Normal results may vary from lab to lab. Many conditions can change your blood glucose levels. Your health professional will discuss any significant abnormal results with you in relation to your symptoms and medical history.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:

·         Eating or drinking less than 8 hours before a fasting blood test or less than 2 hours before a 2-hour postprandial test.

·         Drinking alcohol.

·         Illness or emotional stress, smoking, and caffeine.

Taking a medicine, such as birth control pills, medicines used to treat high blood pressure, phenytoin (Dilantin), furosemide (Lasix), triamterene (Dyrenium, Dyazide), hydrochlorothiazide (Esidrix, Hydro Par, Oretic), niacin, propranolol (Inderal), or corticosteroids (prednisone), can cause changes in your test results. Make sure that your doctor knows about any medicines you take and how often you take them.

What affects my blood glucose levels?

It is important to understand what can make your blood glucose rise or fall, so that you can take steps to stay on target.

Things that can make blood glucose rise:

  • A meal or snack with more food or more carbohydrates than usual
  • Inactivity
  • Side effects of medications
  • Infection or other illness
  • Changes in hormone levels, such as during menstrual periods
  • Stress

Things that can make blood glucose fall:

  • A meal or snack with less food or fewer carbohydrates than usual
  • Extra activity
  • Side effects of other medications
  • Missing a meal or snack
  • Drinking alcoholic beverages (especially on an empty stomach)

 

 

 

 

 

5.HbA1c

(Source: American diabetes association)

 

·         The A1C test measures your average blood glucose control for the past 2 to 3 months.

·         It is determined by measuring the percentage of glycated hemoglobin, or HbA1c, in the blood.

·         Check your A1C twice year at a minimum, or more frequently when necessary.

·         It does not replace daily self-testing of blood glucose.

Checking your blood glucose at home with a meter tells you what your blood sugar level  is at any one time, but suppose you want to know how you're doing overall. The A1C test gives you a picture of your average blood glucose control for the past 2 to 3 months. The results give you a good idea of how well your diabetes treatment plan is working.

In some ways, the A1C test is like a baseball player's season batting average, it tells you about a person's overall success. Neither a single day's blood test results nor a single game's batting record gives the same big picture.(http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/a1c/)

 

Recent HbA1c test criteria

 

Normal                under 5.5 mmol/L

Pre-diabetes                  5.6- 6.4 mmol/L

Diabetes                        6.5 mmol/L or higher       

 

If you have been diagnosed with diabetes, you will asked to  visit  the doctor's office for regular testing. If your diabetes is well controlled, then you will need to have your hemoglobin (HbA1c) tested every six months. If your diabetes is not under control, then you will need to have your hemoglobin tested every three months.

6.Oral medication

(Source: American Diabetes Association)

·         The first treatment for type 2 diabetes blood glucose (sugar) control is often meal planning, weight loss, and exercising. Sometimes these measures are not enough to bring blood glucose levels down near the normal range. The next step is taking a medicine that lowers blood glucose levels.

http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/oral-medications/

7.Insulin

(Source: American Diabetes Association)

Insulin is a naturally occurring hormone secreted by the pancreas. Many people with diabetes are proscribed insulin, either because their bodies do not produce insulin (type 1 diabetes) or do not use insulin properly (type 2 diabetes). There are more than 20 types of insulin sold in the United States. These insulins differ in how they are made, how they work in the body, and how much they cost. Your doctor will help you find the right type of insulin for your health needs and your lifestyle.

http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/insulin/

 

8.Pathophysiology

(Source;Wikipedia, the free encyclopedia)

Insulin is the principal hormone that regulates uptake of glucose from the blood into most cells (primarily muscle and fat cells, but not central nervous system cells). Therefore deficiency of insulin or the insensitivity of its receptors plays a central role in all forms of diabetes mellitus.

Humans are capable of digesting some carbohydrates, in particular those most common in food; starch, and some disaccharides such as sucrose, are converted within a few hours to simpler forms most notably the monosaccharide glucose, the principal carbohydrate energy source used by the body. The most significant exceptions are fructose, most disaccharides (except sucrose and in some people lactose), and all more complex polysaccharides, with the outstanding exception of starch. The rest are passed on for processing by gut flora largely in the colon. Insulin is released into the blood by beta cells (β-cells), found in the Islets of Langerhans in the pancreas, in response to rising levels of blood glucose, typically after eating. Insulin is used by about two-thirds of the body's cells to absorb glucose from the blood for use as fuel, for conversion to other needed molecules, or for storage.

Insulin is also the principal control signal for conversion of glucose to glycogen for internal storage in liver and muscle cells. Lowered glucose levels result both in the reduced release of insulin from the beta cells and in the reverse conversion of glycogen to glucose when glucose levels fall. This is mainly controlled by the hormone glucagon which acts in the opposite manner to insulin. Glucose thus forcibly produced from internal liver cell stores (as glycogen) re-enters the bloodstream; muscle cells lack the necessary export mechanism. Normally liver cells do this when the level of insulin is low (which normally correlates with low levels of blood glucose).

Higher insulin levels increase some anabolic ("building up") processes such as cell growth and duplication, protein synthesis, and fat storage. Insulin (or its lack) is the principal signal in converting many of the bidirectional processes of metabolism from a catabolic to an anabolic direction, and vice versa. In particular, a low insulin level is the trigger for entering or leaving ketosis (the fat burning metabolic phase).

If the amount of insulin available is insufficient, if cells respond poorly to the effects of insulin (insulin insensitivity or resistance), or if the insulin itself is defective, then glucose will not have its usual effect so that glucose will not be absorbed properly by those body cells that require it nor will it be stored appropriately in the liver and muscles. The net effect is persistent high levels of blood glucose, poor protein synthesis, and other metabolic derangements, such as acidosis.

 

Mechanism of insulin release in normal pancreatic beta cells. Insulin production is more or less constant within the beta cells, irrespective of blood glucose levels. It is stored within vacuoles pending release, via exocytosis, which is primarily triggered by food, chiefly food containing absorbable glucose. The chief trigger is a rise in blood glucose levels after eating

9.BACKGROUND OF ART in the patent WO2004,067009A1

Diabetes mellitus is a mammalian condition in which the amount of glucose in the blood plasma is abnormally high. Elevated glucose levels in some instances can lead to higher than normal amounts of particular hemoglobin, HbA1c. This condition can be life-threatening and high glucose levels in the blood plasma, hyperglycemia, can lead to a number of chronic diabetes syndromes, for example, atherosclerosis, microangiopathy, kidney disorders or failure, cardiac disease, diabetic retinopathy and other ocular disorders, including blindness.

Diabetes mellitus is known to be existed in two forms of the disease. One of those is known as Type II, non-insulin dependent diabetes (NIDDM) or adult-onset, and another is juvenile diabetes or Type I, of which pancreas often continues to secrete normal amounts of insulin. However, this insulin is ineffective in preventing the symptoms of diabetes which include cardiovascular risk factors such as hyperglycemia, impaired carbohydrate mechanism, particularly glucose metabolism, glycosuria, decreased insulin sensitivity, centralized obesity hypertriglyceridemia, low HDL levels, elevated blood pressure and various cardiovascular effects. Many of these cardiovascular risk factors are known to precede the onset of diabetes by as much as a decade. These symptoms, if left untreated, often lead to severe complications, including premature atherosclerosis, retinopathy, nephropathy, and neuropathy. Insulin resistance is believed to be a precursor to overt NIDDM and strategies directed toward ameliorating insulin resistance may provide unique benefits to patients with NIDDM.

Current drugs used for managing Type II diabetes and its precursor syndromes, such as insulin resistance, fall within five classes of compounds: the biguanides, thiazolidinediones, the sulfonylureas, benzoic acid derivatives and alpha-glucosidase inhibitors. The biguanides, such as metformin, are believed to prevent excessive hepatic gluconeogenesis. The thiazolidinediones are believed to act by increasing the rate of peripheral glucose disposal. The sulfonylureas, such as tolbutamide and glyburide, the benzoic acid derivatives, such as repaglinide, and the alpha-glucosidase inhibitors, such as acarbose, lower plasma glucose primarily by stimulating insulin secretion.

Above sulfonylureas have disadvantages that these drugs cannot be administered to IDDM patient, NIDDM patient having decreased insulin secretion, and fecund female being worried about anomalous child birth, abortion and stillbirth. Additionally, most of the sulfonylureas should be administered carefully to liver dysfunction patient and kidney dysfunction patient because of sulfonylurea metabolism.

The pathway of biguanides such as metformin has not been verified clearly but the biguanides cannot increase the insulin secretion of pancreas. The biguanides have lower glucose-decreasing effect than the sulfonylureas but have low occurrence of hypoglycemia. And the biguanides treatment may happen nausea, vomiting, diarrhea, eruption etc. in early stage and causes lactic acidosis of fatal side effect, so those are used only as experimental agents in U.S.A.

The sulfonylureas or the biguanides have above disadvantages and side effects; therefore it is required to develop a new hypoglycemic drug having fewer side effects and greater safeties for effective treatment than those of current drugs.

Elfvingia applanata KARST employed in the present invention belong to Polyporaceae and is distributed all over the world. Elfvingia applanata KARST, white rot mycelium, grows naturally on a latifoliate tree horizontally in summer and its fruit body is an annual plant in the form of semicircle and is known to have anti-cancer effect.

 

10. What is Aldose reductase (or aldehyde reductase)?

(source: Wikipedia, the free encyclopedia)

Aldose reductase (or aldehyde reductase) is an enzyme in carbohydrate metabolism that converts glucose to sorbitol.

The aldose reductase reaction, in particular the sorbitol produced, is important for the function of various organs in the body. For example, it is generally used as the first step in a synthesis of fructose from glucose; the second step is the oxidation of sorbitol to fructose catalyzed bysorbitol dehydrogenase. The main pathway from glucose to fructose (glycolysis) involves phosphorylation of glucose by hexokinase to formglucose 6-phosphate, followed by isomerization to fructose 6-phosphate and hydrolysis of the phosphate, but the sorbitol pathway is useful because it does not require the input of energy in the form of ATP:

§  Seminal vesicles: Fructose produced from sorbitol is used by the sperm cells.

§  Liver: Fructose produced from sorbitol can be used as an energy source for glycolysis and glyconeogenesis.

Aldose reductase is also present in the lensretinaSchwann  cells of peripheral nerves, placenta and red blood cells.

Glucose concentrations are often elevated in diabetics and aldose reductase has long been believed to be responsible for diabetic complications involving a number of organs. Many aldose reductase inhibitors have been developed as drug candidates but virtually all have failed although some such as epalrestat are commercially available in several countries.

11.Glucose and Inhibition of Aldose reductase in prevention and

   treatments of diabetes and diabetic complications

Glucose is the main energy source of cells in animal tissues including human, however, excess amount of glucose in tissues leads to hyperglycemia. Several metabolic pathways have been implicated in the toxic effects of hyperglycemia, and many experimental data have demonstrated a link between glucose metabolism via the polyol pathway and diabetic complications. Aldose reductase, the first enzyme of this pathway, catalyzes the NADPH-dependent reduction of glucose to sorbitol. The significance of this enzyme has been shown in the pathogenesis of diabetic complications, such as neuropathy, retinopathy and cataract. This enzyme catalyses the reduction of various aldehydes such as glucose and galactose to their corresponding sugar alcohols. Sorbitol can be produced more rapidly by aldose reductase than it is converted to fructose by sorbitol dehydrogenase, resulting in an accumulation of sorbitol. The intracellular accumulation of a polar sugar alcohol can produce a hyperosmotic effect, which has been observed to lead to changes in membrane permeability and the onset of cellular pathology. Therefore, the inhibition of aldose reductase may be effective in preventing diabetic complications.

(source: Planta Medica, 69, 853(2003) 

12.What is Sorbitol?

(Source: Wikipedia, the free encyclopedia)

Sorbitol, also known as glucitol, is a sugar alcohol that the human body metabolises slowly. It is obtained by reduction of glucose changing the aldehyde group to an additional hydroxyl group.

Medical importance

Even in the absence of dietary sorbitol, cells produce sorbitol naturally.

Too much sorbitol trapped in eye and nerve cells can damage these cells, leading to retinopathy and neuropathy. Substances that prevent or slow the action of aldose reductase are being studied as a way to prevent or delay these complications of diabetes. Aldose reductase is the first enzyme in the sorbitol pathway. This pathway is responsible for the conversion of glucose to sorbitol, and of galactose to galactitol. Under conditions of hyperglycemia, sorbitol accumulation occurs. Aldose reductase inhibitors prevent the accumulation of intracellular sorbitol..[6] Sensitivity to the substance may result in severe pain among individuals who are intolerant of it and exhibit adverse symptoms from sorbitol.

Diabetic retinopathy and neuropathy may be related to excess sorbitol in the cells of the eyes and nerves. The source of this sorbitol in diabetics is excess glucose, which goes through thesorbitol-aldose reductase pathway.[7]

In some human enzyme deficiencies such as galactosemia, sorbitol excess arises and can cause damage to the body. In diabetes mellitus, enzyme deficiency in the lens of the eye may cause sorbitol accumulation and cataracts[citation needed].

 

 

13. Diabetes statistics in the US- 2007 national diabetes fact sheet in the US

( source: American Diabetes Association)

Data from the 2007 National Diabetes Fact Sheet (the most recent year for which data is available)

Total: 23.6 million children and adults in the United States—7.8% of the population—have diabetes.

Diagnosed: 17.9 million people

Undiagnosed: 5.7 million people

Pre-diabetes: 57 million people

New Cases: 1.6 million new cases of diabetes are diagnosed in people aged 20 years and older each year.

Total prevalence of diabetes

Under 20 years of age

  • 186,300, or 0.22% of all people in this age group have diabetes
  • About one in every 400 to 600 children and adolescents has type 1 diabetes
  • 2 million adolescents (or 1 in 6 overweight adolescents) aged 12-19 have pre-diabetes

Age 20 years or older

  • 23.5 million, or 10.7% of all people in this age group have diabetes

Age 60 years or older

  • 12.2 million, or 23.1% of all people in this age group have diabetes

Men

  • 12.0 million, or 11.2% of all men aged 20 years or older have diabetes

Women

  • 11.5 million, or 10.2% of all women aged 20 years or older have diabetes

Race and ethnic differences in prevalence of diagnosed diabetes

After adjusting for population age differences, 2004-2006 national survey data for people diagnosed with diabetes, aged 20 years or older include the following prevalence by race/ethnicity:

  • 6.6% of non-Hispanic whites
  • 7.5% of Asian Americans
  • 11.8% of non-Hispanic blacks
  • 10.4% of Hispanics

Among Hispanics rates were:

  • 8.2% for Cubans
  • 11.9% for Mexican Americans
  • 12.6% for Puerto Ricans.

Morbidity and Mortality

Deaths

Diabetes was the seventh leading cause of death listed on U.S. death certificates in 2006. This ranking is based on the 72,507 death certificates in 2006 in which diabetes was listed as the underlying cause of death. According to death certificate reports, diabetes contributed to a total of 233,619 deaths in 2005, the latest year for which data on contributing causes of death are available.

Complications

Heart disease and stroke

• In 2004, heart disease was noted on 68% of diabetes-related death certificates among people aged 65 years or older.
• In 2004, stroke was noted on 16% of diabetes-related death certificates among people aged 65 years or older.
• Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes.
• The risk for stroke is 2 to 4 times higher among people with diabetes.

High blood pressure

• In 2003–2004, 75% of adults with self-reported diabetes had blood pressure greater than or equal to 130/80 mmHg, or used prescription medications for hypertension.

Blindness

• Diabetes is the leading cause of new cases of blindness among adults aged 20–74 years.
• Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year.

Kidney disease

• Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2005.
• In 2005, 46,739 people with diabetes began treatment for end-stage kidney disease in the United States and Puerto Rico.
• In 2005, a total of 178,689 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States and Puerto Rico.

Nervous system disease (Neuropathy)

• About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage.

Amputation

• More than 60% of nontraumatic lower-limb amputations occur in people with diabetes.
• In 2004, about 71,000 nontraumatic lower-limb amputations were performed in people with diabetes.

Cost of Diabetes

$174 billion: Total costs of diagnosed diabetes in the United States in 2007

  • $116 billion for direct medical costs
  • $58 billion for indirect costs (disability, work loss, premature mortality)

After adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than what expenditures would be in the absence of diabetes.

Factoring in the additional costs of undiagnosed diabetes, pre-diabetes, and gestational diabetes brings the total cost of diabetes in the United States in 2007 to $218 billion.

• $18 billion for the 6.3 million people with undiagnosed diabetes
• $25 billion for the 57 million American adults with pre-diabetes
• $623 million for the 180,000 pregnancies where gestational diabetes is diagnosed

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