Be a part of 2nd World congress on Diabetes & Metabolism

The metabolism of people with diabetes differs to the metabolism of people without it. In type 2 diabetes, the effectiveness of insulin is reduced and in type 1 diabetes, insulin levels in the body are very low. For this reason, type 1 diabetics require insulin delivery from other methods. Insulin resistance, most common in pre-diabetes. metabolic syndrome and type 2 diabetes, impairs the body’s ability to metabolise glucose. Consequently blood sugars become elevated, weight gain is more likely and the resistance to insulin becomes greater. Metabolism refers to the chemical reactions that take place inside the cells of living organisms which are essential for life. For the purposes of this guide, metabolism refers to the processes that occur in the body once food is eaten.

The body’s immune system is responsible for fighting off foreign invaders, like harmful viruses and bacteria. In people with type 1 diabetes, the immune system mistakes the body’s own healthy cells for foreign invaders. The immune system attacks and destroys the insulin-producing beta cells in the pancreas. After these beta cells are destroyed, the body is unable to produce insulin. People with type 2 diabetes have insulin resistance. The body still produces insulin, but it’s unable to use it effectively. Researchers aren’t sure why some people become insulin resistant and others don’t, but several lifestyle factors may contribute, including excess weight and inactivity. Other genetic and environmental factors may also contribute. When you develop type 2 diabetes, your pancreas will try to compensate by producing more insulin. Because your body is unable to effectively use insulin, glucose will accumulate in your bloodstream.

Endocrine disorders involve the body’s over- or under-production of certain hormones, while metabolic disorders affect the body’s ability to process certain nutrients and vitamins. Endocrine disorders include hypothyroidism, congenital adrenal hyperplasia, diseases of the parathyroid gland, diabetes mellitus, diseases of the adrenal glands (including Cushing’s syndrome and Addison’s disease), and ovarian dysfunction (including polycystic ovary syndrome), among others. Behavioural endocrinology is the study of hormonal processes and neuroendocrine systems that influence or regulate behaviour. Endocrinology includes the wide area that not only affects our endocrine system, but also has effects on skin which shows indirectly involvement of dermatology.

Obesity is increasing at unprecedented levels globally, and the overall impact of obesity on the various organ systems of the body is only beginning to be fully appreciated. Because of the myriad of direct and indirect effects of obesity causing dysfunction of multiple tissues and organs, it is likely that there will be heterogeneity in the presentation of obesity effects in any given population. Taken together, these realities make it increasingly difficult to understand the complex interplay between obesity effects on different organs, including the brain. The focus of this review is to provide a comprehensive view of metabolic disturbances present in obesity, their direct and indirect effects on the different organ systems of the body, and to discuss the interaction of these effects in the context of brain aging and the development of neurodegenerative diseases.

Approximately 90% of diabetes cases in pregnant women are considered gestational diabetes mellitus (GDM). It is well known that uncontrolled glucose results in poor pregnancy outcomes in both the mother and fetus. Worldwide there are many guidelines with recommendations for appropriate management strategies for GDM once lifestyle modifications have been instituted and failed to achieve control. The efficacy and particularly the safety of other treatment modalities for GDM has been the source of much debate in recent years. Studies that have demonstrated the safety and efficacy of both glyburide and metformin in the management of patients with GDM will be reviewed. There is a lack of evidence with other oral and injectable non-insulin agents to control blood glucose in GDM. The role of insulin will be discussed, with emphasis on insulin analogs. Ideal patient characteristics for each treatment modality will be reviewed. In addition, recommendations for postpartum screening of patients will be described as well as recommendations for use of agents to manage subsequent type 2 diabetes in patients who are breastfeeding.

A diabetes diet simply means eating the healthiest foods in moderate amounts and sticking to regular mealtimes. A diabetes diet is a healthy-eating plan that's naturally rich in nutrients and low in fat and calories. Key elements are fruits, vegetables and whole grains. In fact, a diabetes diet is the best eating plan for most everyone. Along with healthy eating, physical activity is important. Be as active as possible in as many different ways as possible. Aim to do at least 30 minutes of moderate intensity physical activity on most, if not all days of the week. A regular half-hour of physical activity can help to:

• Lower your blood glucose levels
• Lower your cholesterol
• Lower your blood pressure
• Reduce stress and anxiety
• Improve your mood and self-esteem
• Improve the quality of your sleep
• Increase muscle and bone strength.

The incidence rate of diabetes is exceptionally high across the globe, fueled by reducing physical activities and unhealthy diet. According to IMARC’s report, compared to Type-1 diabetes, Type-2 diabetes represents the more prevalent type, accounting for the majority of all diagnosed diabetes cases. Urban areas dominate rural areas in the number of diabetes patients and females presently account for the majority of the total diabetes patients. Despite the general down climate of the economy and healthcare, there has been great progress in the advancement of diabetes knowledge, treatment and prevention in recent years. This progress continues of a daily basis, with scientific advances being announced at an exponential rate. New therapeutic products are being introduced regularly and the pipeline is now full of new diabetes therapeutics in development.

Minor wounds, cuts, and burns are an unfortunate but unavoidable part of life. However, for people with diabetes, these injuries can lead to serious health issues. Many people with diabetes develop wounds that are slow to heal, do not heal well, or never heal. Sometimes, an infection might develop. An infection can spread to tissue and bone near the wound or more distant areas of the body. In some cases, and without emergency care, an infection can be life-threatening or may even be fatal. Even when an infection does not develop in a wound, slow healing can adversely affect a person’s overall health and quality of life. Cuts or injuries on the feet or legs can make walking difficult or exercise painful. It is essential that people who have diabetes keep their blood sugar levels under control to reduce the risk of slow-healing wounds and complications, including foot ulcers. According to some reports, foot ulcers will develop in about 1 in 4 people with diabetes. Foot ulcers are painful sores that can ultimately lead to foot amputation.

Diabetes mellitus involves absence of insulin secretion (type 1) or peripheral insulin resistance (type 2), causing hyperglycemia. Early symptoms are related to hyperglycemia and include polydipsia, polyphagia, polyuria, and weight loss. Diagnosis is by measuring plasma glucose levels. Treatment depends on type but includes drugs that reduce blood glucose levels, diet, and exercise.  The types of diabetes mellitus (diabetes) in children are similar to those in adults, but psychosocial problems are different and can complicate treatment. Type 1 diabetes is the most common type in children, accounting for two thirds of new cases in children of all ethnic groups. It is one of the most common chronic childhood diseases, occurring in 1 in 350 children by age 18; the incidence has recently been increasing, particularly in children < 5 years. Although type 1 can occur at any age, it typically manifests between age 4 years and 6 years or between 10 years and 14 years. Type 2 diabetes, once rare in children, has been increasing in frequency in parallel with the increase in childhood obesity (see obesity in children). It typically manifests after puberty, with the highest rate between age 15 years and 19 years (see obesity in adolescents).

Sepsis develops when an infection surpasses local tissue containment. A series of dysregulated physiological responses are generated, leading to organ dysfunction and a 10% mortality risk. When patients with sepsis demonstrate elevated serum lactates and require vasopressor therapy to maintain adequate blood pressure in the absence of hypovolemia, they are in septic shock with an in-hospital mortality rate >40%. With improvements in intensive care treatment strategies, overall sepsis mortality has diminished to ~20% at 30 days; however, mortality continues to steadily climb after recovery from the acute event. Traditionally, it was thought that the complex interplay between inflammatory and anti-inflammatory responses led to sepsis-induced organ dysfunction and mortality. However, a closer examination of those who die long after sepsis subsides reveals that many initial survivors succumb to recurrent, nosocomial, and secondary infections.

Blood glucose (blood sugar) monitoring is the main tool you have to check your diabetes control. This check tells you your blood glucose level at any one time. The artificial pancreas bridges the gap between two pieces of diabetes technology that already exist: the insulin pump and the continuous glucose monitor (CGM). Relatively, a large percentage of world population is affected by diabetes mellitus, out of which approximately 5-10% with type 1 diabetes while the remaining 90% with type 2. Insulin administration is essential for type 1 patients while it is required at later stage by the patients of type 2. Current insulin delivery systems are available as transdermal injections which may be considered as invasive. Several non-invasive approaches for insulin delivery are being pursued by pharmaceutical companies to reduce the pain, and hypoglycemic incidences associated with injections in order to improve patient compliance.

• Insulin pumps and insulin infusion systems
• Insulin secretion in vitro and exocytosis
• Insulin Pens and novel Insulin delivery techniques
• Acupuncture for diabetic complications
• Bariatric surgery versus intensive medical and conventional therapy
• Artificial pancreas
• Glucose sensors (invasive and non-invasive)
• Implantable pumps and sensors
• Closed-loop system and algorithm
• Informatics in the service of medicine; telemedicine, software and other technologies
• New insulin delivery systems: Inhaled, transdermal, and implanted devices
• Blood glucose monitoring: Glucose pumps and sensors

Diabetic retinopathy is the most common form of diabetic eye disease. Diabetic retinopathy usually only affects people who have had diabetes (diagnosed or undiagnosed) for a significant number of years. Retinopathy can affect all diabetics and becomes particularly dangerous, increasing the risk of blindness, if it is left untreated. The risk of developing diabetic retinopathy is known to increase with age as well with less well controlled blood sugar and blood pressure level. Diabetic retinopathy occurs when changes in blood glucose levels cause changes in retinal blood vessels. In some cases, these vessels will swell up (macular oedema) and leak fluid into the rear of the eye. In other cases, abnormal blood vessels will grow on the surface of the retina. Unless treated, diabetic retinopathy can gradually become more serious and progress from ‘background retinopathy’ to seriously affecting vision and can lead to blindness.

Diabetic nephropathy is common. One in 4 women and one in 5 men with type 2 diabetes develops diabetic nephropathy. It is even more common in type 1 diabetes. Diabetic nephropathy usually has no symptoms early on. You can’t tell that there is protein in your urine – it’s something that is detected with a urine test. It can take many years for the kidney damage to progress. Symptoms usually only appear when kidney damage has deteriorated significantly. Even then, the symptoms tend to be vague.

If the kidney damage becomes severe, you may notice:

• Weight loss
• A poor appetite or feeling sick
• Swollen ankles and feet (due to retaining fluid)
• Puffiness around the eyes
• Dry, Itchy skin
• Muscle cramps
• Needing to pass urine more often
• Feeling tired
• Having difficulty concentrating

Biomarkers are essential for the identification of high risk children as well as monitoring of prevention outcomes for type 1 diabetes (T1D).  As a prognostic biomarker for progression of diabetic nephropathy, albuminuria fails in terms of sensitivity and specificity. Better urinary or plasma biomarkers are needed that can predict which diabetic patients are at highest risk for progression. Bhensdadia et al. report proteomic investigations that identified urinary haptoglobin as a potential prognostic biomarker for progressive diabetic nephropathy. Although as a single marker urinary haptoglobin adds little to albuminuria, together the two appear to provide better diagnostic accuracy than albuminuria alone. Excess adiposity is the most important risk factor for the development of insulin resistance and type 2 diabetes (1). However, mechanisms whereby body fat induces insulin resistance in distant tissues are not well understood. Recent evidence indicates that obesity may be an inflammatory markers.

• Prognostic biomarkers
• Diabetic nephropathy biomarkers
• Diabetes: Clinical trials and new biomarkers under development
• Pharmacotherapy in treatment of diabetes
• Molecular markers for both metabolic syndrome and hypoglycemia responses
• Inflammatory markers: Type 2 diabetes
• New drug treatments and devices for diabetes: current research