Though not routinely used any longer, the oral glucose tolerance test (OGTT) is a gold standard for making the diagnosis of type 2 diabetes. It is still commonly used for diagnosing gestational diabetes and in conditions of pre-diabetes, such as polycystic ovary syndrome. With an oral glucose tolerance test, the person fasts overnight (at least eight but not more than 16 hours). Then first, the fasting plasma glucose is tested. After this test, the person receives an oral dose (75 grams) of glucose. There are several methods employed by obstetricians to do this test, but the one described here is standard. Usually, the glucose is in a sweet-tasting liquid that the person drinks. Blood samples are taken at specific intervals to measure the blood glucose.


From a dental perspective, pregnancy leads to hormonal changes that increase the mother’s risk of developing gingivitis and gingival lesions called pregnancy tumors (see Right). Not surprisingly, poor glycemic control further adds to this risk. Therefore, it is imperative that if you become pregnant, you should promptly see your dentist. He or she will work with you to ensure that your dental self-care regimen is maximized to prevent or control your dental disease. Additional Resources on Diabetes and Oral Health National Institute of Dental and Craniofacial Research www.nidcr.nih.gov American Diabetes Association www.diabetes.org American Dental Association www.dental.org American Academy of Periodontology www.perio.org The Diabetes Monitor www.diabetesmonitor.com David Mendosa www.mendosa.com Diatribe www.diatribe.us The information contained in this monograph is for educational purposes only. This information is not a substitute for professional medical advice, diagnosis, or treatment. If you have or suspect you may have a health concern, consult your professional health care provider. Reliance on any information provided in this monograph is solely at your own risk.

From a dental perspective, pregnancy leads to hormonal changes that increase the mother’s risk of developing gingivitis and gingival lesions called pregnancy tumors (see Right). Not surprisingly, poor glycemic control further adds to this risk. Therefore, it is imperative that if you become pregnant, you should promptly see your dentist. He or she will work with you to ensure that your dental self-care regimen is maximized to prevent or control your dental disease. Additional Resources on Diabetes and Oral Health National Institute of Dental and Craniofacial Research www.nidcr.nih.gov American Diabetes Association www.diabetes.org American Dental Association www.dental.org American Academy of Periodontology www.perio.org The Diabetes Monitor www.diabetesmonitor.com David Mendosa www.mendosa.com Diatribe www.diatribe.us The information contained in this monograph is for educational purposes only. This information is not a substitute for professional medical advice, diagnosis, or treatment. If you have or suspect you may have a health concern, consult your professional health care provider. Reliance on any information provided in this monograph is solely at your own risk.
The earliest surviving work with a detailed reference to diabetes is that of Aretaeus of Cappadocia (2nd or early 3rd century CE). He described the symptoms and the course of the disease, which he attributed to the moisture and coldness, reflecting the beliefs of the "Pneumatic School". He hypothesized a correlation of diabetes with other diseases, and he discussed differential diagnosis from the snakebite which also provokes excessive thirst. His work remained unknown in the West until 1552, when the first Latin edition was published in Venice.[110]
Education: People with diabetes should learn as much as possible about this condition and how to manage it. The more you know about your condition, the better prepared you are to manage it on a daily basis. Many hospitals offer diabetes education programs and many nurses and pharmacists have been certified to provide diabetes education. Contact a local hospital, doctor, or pharmacist to find out about programs and diabetes educators in your area.
Type 2 diabetes, a form of diabetes mellitus, is likely one of the better-known chronic diseases in the world — and that's no surprise. Data from the Centers for Disease Control and Prevention suggest in the United States alone, 30.3 million people, or 9.4 percent of the U.S. population, has diabetes, and the majority of these people have type 2. (1)
Schedule a yearly physical exam and regular eye exams. Your regular diabetes checkups aren't meant to replace regular physicals or routine eye exams. During the physical, your doctor will look for any diabetes-related complications, as well as screen for other medical problems. Your eye care specialist will check for signs of retinal damage, cataracts and glaucoma.

About 84 million adults in the US (more than 1 out of 3) have prediabetes, and about 90% do not know they have it until a routine blood test is ordered, or symptoms of type 2 diabetes develop. For example, excessive thirst, frequent urination, and unexplained weight loss. If you have prediabetes also it puts you at risk for heart attack, stroke, and type 2 diabetes.

The earliest surviving work with a detailed reference to diabetes is that of Aretaeus of Cappadocia (2nd or early 3rd century CE). He described the symptoms and the course of the disease, which he attributed to the moisture and coldness, reflecting the beliefs of the "Pneumatic School". He hypothesized a correlation of diabetes with other diseases, and he discussed differential diagnosis from the snakebite which also provokes excessive thirst. His work remained unknown in the West until 1552, when the first Latin edition was published in Venice.[110]
How does type 2 diabetes progress over time? Type 2 diabetes is a progressive disease, meaning that the body’s ability to regulate blood sugar gets worse over time, despite careful management. Over time, the body’s cells become increasingly less responsive to insulin (increased insulin resistance) and beta cells in the pancreas produce less and less insulin (called beta-cell burnout). In fact, when people are diagnosed with type 2 diabetes, they usually have already lost up to 50% or more of their beta cell function. As type 2 diabetes progresses, people typically need to add one or more different types of medications. The good news is that there are many more choices available for treatments, and a number of these medications don’t cause as much hypoglycemia, hunger and/or weight gain (e.g., metformin, pioglitazone, DPP-4 inhibitors, GLP-1 agonists, SGLT-2 inhibitors, and better insulin). Diligent management early on can help preserve remaining beta cell function and sometimes slow progression of the disease, although the need to use more and different types of medications does not mean that you have failed.
One particular type of sugar that has attracted a lot of negative attention is high-fructose corn syrup (HFCS) — and for good reason, as multiple studies suggest HFCS can influence diabetes risk. Some research in people who are overweight and obese, for example, suggests regularly consuming drinks sweetened with either fructose, a byproduct of HFCS, or glucose can lead to weight gain, and drinks with fructose in particular may reduce insulin sensitivity and spike blood sugar levels.
Insulin, a hormone released from the pancreas (an organ behind the stomach that also produces digestive enzymes), controls the amount of glucose in the blood. Glucose in the bloodstream stimulates the pancreas to produce insulin. Insulin helps glucose to move from the blood into the cells. Once inside the cells, glucose is converted to energy, which is used immediately, or the glucose is stored as fat or glycogen until it is needed.
There are many complications of diabetes. Knowing and understanding the signs of these complications is important. If caught early, some of these complications can be treated and prevented from getting worse. The best way to prevent complications of diabetes is to keep your blood sugars in good control. High glucose levels produce changes in the blood vessels themselves, as well as in blood cells (primarily erythrocytes) that impair blood flow to various organs.
Constant advances are being made in development of new oral medications for persons with diabetes. In 2003, a drug called Metaglip combining glipizide and metformin was approved in a dingle tablet. Along with diet and exercise, the drug was used as initial therapy for Type 2 diabetes. Another drug approved by the U.S. Food and Drug Administration (FDA) combines metformin and rosiglitazone (Avandia), a medication that increases muscle cells' sensitivity to insulin. It is marketed under the name Avandamet. So many new drugs are under development that it is best to stay in touch with a physician for the latest information; physicians can find the best drug, diet and exercise program to fit an individual patient's need.
Diabetes that's triggered by pregnancy is called gestational diabetes (pregnancy, to some degree, leads to insulin resistance). It is often diagnosed in middle or late pregnancy. Because high blood sugar levels in a mother are circulated through the placenta to the baby, gestational diabetes must be controlled to protect the baby's growth and development.
To diagnose diabetes, doctors will  take a medical history (ask you about symptoms) and ask for blood and urine samples. Finding protein and sugar in the urine are signs of type 2 diabetes. Increased glucose and triglyceride (a type of lipid or fat) levels in the blood are also common findings. In most cases, blood glucose levels are checked after a person has been fasting for 8 hours.
Insulin is essential to process carbohydrates, fat, and protein. Insulin reduces blood glucose levels by allowing glucose to enter muscle cells and by stimulating the conversion of glucose to glycogen (glycogenesis) as a carbohydrate store. Insulin also inhibits the release of stored glucose from liver glycogen (glycogenolysis) and slows the breakdown of fat to triglycerides, free fatty acids, and ketones. It also stimulates fat storage. Additionally, insulin inhibits the breakdown of protein and fat for glucose production (gluconeogenesis) in the liver and kidneys.

Type 1 diabetes occurs because the insulin-producing cells of the pancreas (beta cells) are damaged. In type 1 diabetes, the pancreas makes little or no insulin, so sugar cannot get into the body's cells for use as energy. People with type 1 diabetes must use insulin injections to control their blood glucose. Type 1 is the most common form of diabetes in people who are under age 30, but it can occur at any age. Ten percent of people with diabetes are diagnosed with type 1.
Although this newfound knowledge on sugar, and specifically added sugar, may prompt you to ditch the soda, juice, and processed foods, be mindful of the other factors that can similarly influence your risk for type 2 diabetes. Obesity, a family history of diabetes, a personal history of heart disease, and depression, for instance, are other predictors for the disease, according to the NIH.
Can you “exercise your way” out of this problem? Sometimes you can; however, the key is exercising properly. For younger patients, it is best to exercise briefly and intensely. Within the first 20 minutes of intense exercise, your body burns its sugar stores, which are hanging out in liver and muscle again. After that, you start burning fat. Although this sounds good; and to some extent it is, if you spend hours running or exercising excessively, you train your body to burn fat efficiently, which subsequently lead to also training your body to store fat efficiently.
ORAL GLUCOSE TOLERANCE TEST. Blood samples are taken from a vein before and after a patient drinks a thick, sweet syrup of glucose and other sugars. In a non-diabetic, the level of glucose in the blood goes up immediately after the drink and then decreases gradually as insulin is used by the body to metabolize, or absorb, the sugar. In a diabetic, the glucose in the blood goes up and stays high after drinking the sweetened liquid. A plasma glucose level of 11.1 mmol/L (200 mg/dL) or higher at two hours after drinking the syrup and at one other point during the two-hour test period confirms the diagnosis of diabetes.
Often people don't experience symptoms of diabetes until their blood sugars are very high. Symptoms of diabetes include: increased thirst, increased urination, increased hunger, extreme fatigues, numbness and tingling in the extremities (hands and feet), cuts and wounds that are slow to heal, and blurred vision. Some people also experience other less common symptoms including weight loss, dry itchy skin, increased yeast infections, erectile dysfunction, and acanthosis nigricans (thick, "velvety" patches found in the folds or creases of skin, such as the neck, that is indicative of insulin resistance).
^ Jump up to: a b Cheng, J; Zhang, W; Zhang, X; Han, F; Li, X; He, X; Li, Q; Chen, J (May 2014). "Effect of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on all-cause mortality, cardiovascular deaths, and cardiovascular events in patients with diabetes mellitus: a meta-analysis". JAMA Internal Medicine. 174 (5): 773–85. doi:10.1001/jamainternmed.2014.348. PMID 24687000.
Type 2 diabetes, the most common type of diabetes, is a disease that occurs when your blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes mainly from the food you eat. Insulin, a hormone made by the pancreas, helps glucose get into your cells to be used for energy. In type 2 diabetes, your body doesn’t make enough insulin or doesn’t use insulin well. Too much glucose then stays in your blood, and not enough reaches your cells.
A chronic metabolic disorder marked by hyperglycemia. DM results either from failure of the pancreas to produce insulin (type 1 DM) or from insulin resistance, with inadequate insulin secretion to sustain normal metabolism (type 2 DM). Either type of DM may damage blood vessels, nerves, kidneys, the retina, and the developing fetus and the placenta during pregnancy. Type 1 or insulin-dependent DM has a prevalence of just 0.3 to 0.4%. Type 2 DM (formerly called adult-onset DM) has a prevalence in the general population of 6.6%. In some populations (such as older persons, Native Americans, African Americans, Pacific Islanders, Mexican Americans), it is present in nearly 20% of adults. Type 2 DM primarily affects obese middle-aged people with sedentary lifestyles, whereas type 1 DM usually occurs in children, most of whom are active and thin, although extremely obese children are now being diagnosed with type 2 diabetes as well. See: table; dawn phenomenon; insulin; insulin pump; insulin resistance; diabetic polyneuropathy; Somogyi phenomenon

Type 2 diabetes is mainly caused by insulin resistance. This means no matter how much or how little insulin is made, the body can't use it as well as it should. As a result, glucose can't be moved from the blood into cells. Over time, the excess sugar in the blood gradually poisons the pancreas causing it to make less insulin and making it even more difficult to keep blood glucose under control.

Insulin is a hormone that is produced by specialized cells (beta cells) of the pancreas. (The pancreas is a deep-seated organ in the abdomen located behind the stomach.) In addition to helping glucose enter the cells, insulin is also important in tightly regulating the level of glucose in the blood. After a meal, the blood glucose level rises. In response to the increased glucose level, the pancreas normally releases more insulin into the bloodstream to help glucose enter the cells and lower blood glucose levels after a meal. When the blood glucose levels are lowered, the insulin release from the pancreas is turned down. It is important to note that even in the fasting state there is a low steady release of insulin than fluctuates a bit and helps to maintain a steady blood sugar level during fasting. In normal individuals, such a regulatory system helps to keep blood glucose levels in a tightly controlled range. As outlined above, in patients with diabetes, the insulin is either absent, relatively insufficient for the body's needs, or not used properly by the body. All of these factors cause elevated levels of blood glucose (hyperglycemia).


^ Jump up to: a b c Maruthur, NM; Tseng, E; Hutfless, S; Wilson, LM; Suarez-Cuervo, C; Berger, Z; Chu, Y; Iyoha, E; Segal, JB; Bolen, S (19 April 2016). "Diabetes Medications as Monotherapy or Metformin-Based Combination Therapy for Type 2 Diabetes: A Systematic Review and Meta-analysis". Annals of Internal Medicine. 164 (11): 740–51. doi:10.7326/M15-2650. PMID 27088241.
To diagnose diabetes, doctors will  take a medical history (ask you about symptoms) and ask for blood and urine samples. Finding protein and sugar in the urine are signs of type 2 diabetes. Increased glucose and triglyceride (a type of lipid or fat) levels in the blood are also common findings. In most cases, blood glucose levels are checked after a person has been fasting for 8 hours.

There are a number of medications and other health problems that can predispose to diabetes.[39] Some of the medications include: glucocorticoids, thiazides, beta blockers, atypical antipsychotics,[40] and statins.[41] Those who have previously had gestational diabetes are at a higher risk of developing type 2 diabetes.[23] Other health problems that are associated include: acromegaly, Cushing's syndrome, hyperthyroidism, pheochromocytoma, and certain cancers such as glucagonomas.[39] Testosterone deficiency is also associated with type 2 diabetes.[42][43]
Oral medications are available to lower blood glucose in Type II diabetics. In 1990, 23.4 outpatient prescriptions for oral antidiabetic agents were dispensed. By 2001, the number had increased to 91.8 million prescriptions. Oral antidiabetic agents accounted for more than $5 billion dollars in worldwide retail sales per year in the early twenty-first century and were the fastest-growing segment of diabetes drugs. The drugs first prescribed for Type II diabetes are in a class of compounds called sulfonylureas and include tolbutamide, tolazamide, acetohexamide, and chlorpropamide. Newer drugs in the same class are now available and include glyburide, glimeperide, and glipizide. How these drugs work is not well understood, however, they seem to stimulate cells of the pancreas to produce more insulin. New medications that are available to treat diabetes include metformin, acarbose, and troglitizone. The choice of medication depends in part on the individual patient profile. All drugs have side effects that may make them inappropriate for particular patients. Some for example, may stimulate weight gain or cause stomach irritation, so they may not be the best treatment for someone who is already overweight or who has stomach ulcers. Others, like metformin, have been shown to have positive effects such as reduced cardiovascular mortality, but but increased risk in other situations. While these medications are an important aspect of treatment for Type II diabetes, they are not a substitute for a well planned diet and moderate exercise. Oral medications have not been shown effective for Type I diabetes, in which the patient produces little or no insulin.
The woman’s weight may also play a role. Changing hormone levels and weight gain are part of a healthy pregnancy, but both changes make it more difficult for the body to keep up with its need for insulin. This may lead to gestational diabetes. As pregnancy progresses, the placenta also produces insulin-blocking hormones, which might result in a woman’s blood-glucose levels becoming elevated if there isn’t enough insulin to counter this effect.
Brittle diabetics are a subgroup of Type I where patients have frequent and rapid swings of blood sugar levels between hyperglycemia (a condition where there is too much glucose or sugar in the blood) and hypoglycemia (a condition where there are abnormally low levels of glucose or sugar in the blood). These patients may require several injections of different types of insulin during the day to keep the blood sugar level within a fairly normal range.

Sequelae. The long-term consequences of diabetes mellitus can involve both large and small blood vessels throughout the body. That in large vessels is usually seen in the coronary arteries, cerebral arteries, and arteries of the lower extremities and can eventually lead to myocardial infarction, stroke, or gangrene of the feet and legs. atherosclerosis is far more likely to occur in persons of any age who have diabetes than it is in other people. This predisposition is not clearly understood. Some believe that diabetics inherit the tendency to develop severe atherosclerosis as well as an aberration in glucose metabolism, and that the two are not necessarily related. There is strong evidence to substantiate the claim that optimal control will mitigate the effects of diabetes on the microvasculature, particularly in the young and middle-aged who are at greatest risk for developing complications involving the arterioles. Pathologic changes in the small blood vessels serving the kidney lead to nephrosclerosis, pyelonephritis, and other disorders that eventually result in renal failure. Many of the deaths of persons with type 1 diabetes are caused by renal failure.

Longer-term, the goals of treatment are to prolong life, reduce symptoms, and prevent diabetes-related complications such as blindness, kidney failure, and amputation of limbs. These goals are accomplished through education, insulin use, meal planning and weight control, exercise, foot care, and careful self-testing of blood glucose levels. Self-testing of blood glucose is accomplished through regular use of a blood glucose monitor (pictured, right). This machine can quickly and easily measure the level of blood glucose based by analysing the level from a small drop of blood that is usually obtained from the tip of a finger. You will also require regular tests for glycated haemoglobin (HbA1c). This measures your overall control over several months.
When you have Type 2 diabetes, you may start out with something called insulin resistance. This means your cells do not respond well to the insulin you are making. "Insulin levels may be quite high, especially in the early stages of the disease. Eventually, your pancreas may not be able to keep up, and insulin secretion goes down," Rettinger explains. Insulin resistance becomes more common as you put on more weight, especially weight around your belly.
Kidney disease: According to the Centers for Disease Control and Prevention (CDC), an estimated 33 percent of people with diabetes have chronic kidney disease. Diabetes can also damage blood vessels in the kidneys, impairing function. The kidneys play a vital role in balancing fluid levels and removing waste from the body. Kidney health is therefore vital for preserving overall health.
In general, women live longer than men do because they have a lower risk of heart disease, but when women develop diabetes, their risk for heart disease skyrockets, and death by heart failure is more likely in women than in men. Another study also found that in people with diabetes, heart attacks are more often fatal for women than they are for men. Other examples of how diabetes affects women differently than men are:
×