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Translated version of http://bvs.sld.cu/revistas/end/vol11_1_00/end08100.htm

Translated version of http://bvs.sld.cu/revistas/end/vol11_1_00/end08100.htm

New criteria to classify diebetes mellitus

Lic. Eduardo Rode Goatherd, ¹ Dr Leonel Suárez Fonseca, ² Lic. Oscar Diaz ^Horta3 and Dr. Oscar Diaz ^Díaz4

The diabetes mellitus is a heterogenous syndrome that it has, like chronic common element, one hiperglucemia by an insulin deficiency or an insufficient effectiveness of their action.

The glucorregulación is a complex physiological process in which faults at different levels lead finally to one hiperglucemia. At the moment new knowledge are had accumulated where defects at level of cells, weaves have been identified or functions that are related to the expression of the disease. This has given rise to the appearance of new proposals to classify the diabetes mellitus. Recently, the Committee of Experts of the American Association of Diabetes (IT ACCEPTS) ¹ and of the World-wide Organization of Health (the WHO) ² has proposed a new classification that contemplates 4 groups:

• Diabetes mellitus type 1.
• Diabetes mellitus type 2.
• Other specific types of diabetes.
• Gestacional diabetes mellitus.

In the diabetes type 1 the forms of diabetes by destruction of the cell ß caused by immunological alterations or of unknown cause are included (idiopática). They describe as to diabetes type 2 those forms with predominant insulínica resistance and, possibly, insulin a relative secretion deficiency, in which it includes the cases whose cause is essentially desconocida.3

A third group is created, call “Other specific types of diabetes” where the cases are included whose basic defect is known and can be identified. Paradoxicalally, in this group are diabetics type 1 and type 2 of well-known causes. For example types of diabetes that have insulin deficit by destruction of the cells ß, although not of cause are included autoinmune, or cases of diabetes type 2 by resistance to the insulin, by known genetic defects.

The gestacional diabetes simply defines it by the fact to appear during the pregnancy; and it does not establish a etiológica entailment, nevertheless, in the present time knows his heterogeneity, as we see next. ^4-8

Frequency of different causes from hiperglucemia in cases grouped like “gestacional diabetes”

Genetic defects of the function of the cells ß

Frequencies

MODY1 (HNF4 to chromosome 20q) 2.0%

MODY 2 (glucoquinasa chromosome 7p) 3.0%

MODY3 (HNF1 to chromosome 12q) 15.0%

MODY 4 (IPF1 chromosome 13q) 0.0%

MODY 5 (HNF 1ß chromosome 17p) 2.0%

Mutations in mitocondrial DNA (3243) 8.3%

Diabetes type 1 1,7- 3.7%

Diabetes type 2 30.0%

The gestacional diabetes is in fact the waiting room of different types from diabetes, despite we preferred to maintain the one of independent form by its importance in the morbidity and infantile and maternal mortality.

The initial proposal of classification published by nosotros3 has been modified as we suggested next, and where it considers, not only the state of the secretion or insulínica action, but also the causes that originates it, including the existence or not of autoimmunity.

Nuevos criterios para clasificar la diebetes mellitus

Nuevos criterios para clasificar la diebetes mellitus

Lic. Eduardo Cabrera Rode,¹ Dr. Leonel Suárez Fonseca,² Lic. Oscar Díaz Horta³ y Dr. Oscar Díaz Díaz⁴

La diabetes mellitus es un síndrome heterogéneo que tiene, como elemento común, una hiperglucemia crónica por una deficiencia de insulina o una insuficiente efectividad de su acción.

La glucorregulación es un complejo proceso fisiológico en el que fallas a diferentes niveles conducen finalmente a una hiperglucemia. Actualmente se han acumulado nuevos conocimientos donde se han identificado defectos a nivel de células, tejidos o funciones que están relacionados con la expresión de la enfermedad. Esto ha dado lugar a la aparición de nuevas propuestas para clasificar la diabetes mellitus. Recientemente, el Comité de Expertos de la Asociación Americana de Diabetes (ADA)¹ y de la Organización Mundial de la Salud (OMS)² han propuesto una nueva clasificación que contempla 4 grupos:

• Diabetes mellitus tipo 1.
• Diabetes mellitus tipo 2.
• Otros tipos específicos de diabetes.
• Diabetes mellitus gestacional.

En la diabetes tipo 1 se incluyen las formas de diabetes por destrucción de la célula ß causada por alteraciones inmunológicas o de causa desconocida (idiopática). Se describen como diabetes tipo 2 aquellas formas con resistencia insulínica predominante y, eventualmente, una deficiencia relativa de secreción de insulina, en las cuales incluye los casos cuya causa es esencialmente desconocida.³

Se crea un tercer grupo, llamado "Otros tipos específicos de diabetes" donde se incluyen los casos cuyo defecto básico es conocido y puede ser identificado. Paradójicamente, en este grupo se encuentran diabéticos tipo 1 y tipo 2 de causas conocidas. Por ejemplo se incluyen tipos de diabetes que tienen déficit de insulina por destrucción de las células ß, aunque no de causa autoinmune, o casos de diabetes tipo 2 por resistencia a la insulina, por defectos genéticos conocidos.

La diabetes gestacional la definen simplemente por el hecho de aparecer du-rante el embarazo; y no establece una vinculación etiológica, sin embargo, en la actualidad se conoce su heterogeneidad, como veremos a continuación.^4-8

Frecuencia de diferentes causas de hiperglucemia en casos agrupados como "diabetes gestacional"

Defectos genéticos de la función de las células ß

Frecuencias

MODY1 (HNF4 a cromosoma 20q) 2,0 %

MODY 2 (glucoquinasa cromosoma 7p) 3,0 %

MODY3 (HNF1 a cromosoma 12q) 15,0 %

MODY 4 (IPF1 cromosoma 13q) 0,0 %

MODY 5 (HNF 1ß cromosoma 17p) 2,0 %

Mutaciones en el DNA mitocondrial (3243) 8,3 %

Diabetes tipo 1 1,7-3,7 %

Diabetes tipo 2 30,0 %

La diabetes gestacional es en realidad la antesala de diferentes tipos de diabetes, no obstante preferimos mantener la de forma independiente por su importancia en la morbilidad y la mortalidad infantil y materna.

La propuesta inicial de clasificación publicada por nosotros³ ha sido

Pranic Healing UK - Miracles by Doctors

Pranic Healing UK - Miracles by Doctors: "Dr. Benny Atnil (Indonesia)
A Case of Diabetes Mellitus
Patient: Budi S. Age:31 years

His main complaints were physical fatigue and frequent urination.

The doctor's diagnosis indicated that he was suffering from Diebetes Mellitus. The laboratory examinations show his blood glucose was 490 and urin glucos . Apparently, both his parents had the same illness.

At the advice of his doctor, he was treated in the hospital with insulin injection for eight days. When he went home, his blood glucose was 224. Still he had to undergo a daily check-up at the doctor's private practice where he was given continuous medical treatment in addition to a strict diet.

Later on, feeling distressed with unbearable discomfort, he sought the advice of a friend who suggested him to try pranic healing. He was referred to me. After the first treatment, his blood glucos was substantially reduced to 175. During subsequent visits, it dropped further down to 138. His medication was gradually reduced until he gave it up completely.

After intensive treatment with pranic healling 3 times a week, his blood glucos is now 108. His physical and health conditions have increasingly improved. He is now free from Diabetes Mellitus which would otherwise tied him to a life-long medication and strict diet."

CID PITOMBO et al.: Visceral fat removal improves

CID PITOMBO et al.: Visceral fat removal improves blood glucose levels (Journal of Endocrinology): "
Amelioration of diet-induced diabetes mellitus (diebetes mellitus on some websits)by removal of visceral fat
Cid Pitombo1,3, Eliana P. Ara�jo1, Cl�udio T. De Souza1, Jos� C. Pareja2 Bruno Geloneze1 and L�cio A. Velloso1
Departments of 1Internal Medicine and 2Surgery, State University of Campinas, and Department of 3Surgery, Rio de Janeiro Federal University, Brazil

(Requests for offprints should be addressed to Licio A Velloso; Email lavelloso@fcm.unicamp.br)
Abstract

The objective of this study was to evaluate the effect of visceral fat removal upon glucose homeostasis, insulin signal transduction and serum adipokine levels in an animal model of diet induced obesity and diabetes mellitus (DIO).

Swiss mice were initially divided into two groups fed with regular rodent chow or with chow containing 24 g% saturated fat (DIO). DIO mice became obese and overtly diabetic after eight weeks. DIO mice were then divided into three groups: control; sham; and visceral (epididymal and perinephric) fat removal. All groups were submitted to evaluation of basal glucose and insulin levels and intra-peritoneal insulin tolerance test. Insulin signal transduction in muscle was evaluated by immunoprecipitation and immunoblot and serum adipokine levels were determined by ELISA.

DIO mice became diabetic (228 mg/dl vs. 115 mg/dl), hyperinulinemic (7.59 ng/ml vs. 3.15 ng/ml) and insulin resistant (Kitt 2.88 %/min vs. 4.97 %/min) as compared to control. Visceral fat removal partially reverted all parameters (147 mg/dl glucose; 3.82 ng/ml insulin; and 4.20 %/min Kitt). In addition, visceral fat removal completely reversed the impairment of insulin signal transduction through insulin receptor, IRS-1, IRS-2 and Akt in muscle. Finally, serum levels of pro-inflammatory cytokines TNF-a, IL-1b and IL-6 were significantly increased while adiponectin levels were significantly reduced in DIO mice. After visceral fat removal the levels of adipokines returned to near-control levels.

The present study shows that removal of visceral fat improves insulin signal transduction and glucose homeostasis in an animal model of diet-induced obesity and diabetes mellitus and these metabolic and molecular outcomes are accompanied by the restoration of adipokine levels.

Journal of Endocrinology

Return to the list of Advance Abstracts
"

Long Term Care and Long Term Care Insurance? Your Chances and Your

Clearly, you don't want to dwell on an image of you or your
spouse in a wheel chair or nursing home, but if you don't
plan ahead now for such eventualities, you could end up
with a crippling financial burden that can strip a family
of it's entire nest egg.

Funding for eventual long term care must be planned for far
in advance, and long term care insurance seems to be the
tool of choice. The alternatives really suck by
comparison, so it's time to get going to put your plan in
place while you still can.

Fact is, there is nearly a 50% chance that during
retirement, due to medical conditions or extended
longevity, a person will eventually end up requiring
24-hour skilled nursing care in a long term care facility.

Another astounding fact is that more than 40% of nursing
home residents are under age 65. In truth, at age 57, due
to advanced Multiple Sclerosis, I myself would be in a care
home if my wife would let me out of her sight.

And now let's look at the average length of facility care
plus the projected costs for that care…

Long Term Care - It's Leading Causes & Average Lengths of
Nursing Home Stays ( from Financial Planning News ):

Alzheimer's: 96 months
Diabetes this includes Diebetes Mellitus: 48 months
Pulmonary: 36 months
Cancer: 36 months
Stroke: 21 months
Cardiac:16 months

What happens if you don't have long term care insurance,
but you do need this long term care?

Well, at room rates of $300.00 per day, if care costs
inflate at least 5% annually, then 10 years from now, the
average, Alzheimer's, long term care stay in a private room
could cost a family over $1,400,000.00+

Do you want your family to pay THAT out of savings? I
don't think so, and long term care insurance is clearly the
only sensible answer, but is long term care insurance too
expensive?

Long term care insurance can cost from under $100/mo. to
over $1000/month, so sure, at first insurance can seem
expensive, yet consider this:

At 5% annual compounded inflation, in 10 years, actual
real-life care costs could mount to well over anything you
might ever put into long term care insurance. Just do the
math.

The annual long term care insurance premium investment is
often less than the actual cost of just ONE MONTH in a care
situation.

One important factor to take into account is whether particular
illnesses are covered in the costs,
e.g. Alzheimer's,diebetes mellitus:heart problems,Cancer

NOTE: Recent industry articles indicate that long term care
insurance is such a valuable planning tool that financial
advisors may face legal action if they neglect to at least
recommend consideration of coverage. (Trusts & Estates
Magazine)

Long term care insurance may make good financial sense for
you and yours, and the early bird gets the worm, because
the lowest long term care insurance prices are locked in at
the younger ages and are designed to remain level
thereafter.

In any case, each policy is designed to custom fit your
circumstances, so you have to work with a trained long term
care insurance specialist in order to create the optimal
coverage plan. You'll want a multi-company broker who can
compare companies and policies to find the best long term
care insurance plan for your unique situation.
Copyright (c) 2006 Clay Cotton

This article has been amended and changed by the editor

----------------------------------------------------
Long term care insurance activist, Clay Cotton, writes for
http://www.PrepSmart.com - The Online Baby Boomers Decision
Assistance Center, where you get Free Long Term Care
Insurance advice, comparative rate quotes and personal
guidance, all at home while in your favorite pajamas and
bunny slippers. So cool!