The World Diabetes Day is an important vehicle for all countries to ensure that people know the true magnitude of the problem of diabetes, a disease that currently affects approximately 220 million people, according to official figures published on the site WHO web.

How could it be otherwise, the secretary general of the United Nations, Ban Ki-moon issued a message in the context of World Diabetes Day, which was published in full in the official website of the international organization.

The chief said that this disease, characterized by having your blood sugar levels high, killing more than a million people a year, mostly in developing nations, as published by the UN Web.

According to this website, Ki-moon said the United Nations its full support to countries that are facing the challenges of diabetes and asked that the international community and international agencies also give support to countries development.

To end this note, it would be good to answer the following question: why this celebration takes place on the 14th of November? Well, in that same date, but the year 1891, was born Canadian physician Frederick Grant Banting, one of the researchers who discovered the hormone insulin, which years later won the Nobel Prize in Medicine for this discovery.

Her daughter, then 18-months old, was rushed and spent several days in the hospital tested until doctors were able to determine the dose of insulin needed to balance your blood sugar level. “I do not understand anything, it was blank,” said Alice to voanoticias.com, who until now had no close relative with Type I diabetes

Hospital Alice and her husband came up with an idea of how the metabolism of Emilia, what dose of insulin would need daily, what kind of diet should continue and at what times I had to eat. In practice, this meant a total rethinking of their lives. Alice had to leave her job of 10 years as a clerk in a blood bank to provide care for her daughter. And over the years, she and her family learned to overcome their fears and prepare for future obstacles.

“Diabetes in itself is not the problem. Is how one is prepared to receive it, “said Alice. In his case, as a mother, assumed that diabetes requires everything to be planned in advance: dining out, family holidays, daily meals, going to the school, children’s birthday, her daughter’s education in the management of their disease. ..

What the human body usually regulates the concentration of glucose-blood-is a function that Emilia’s mother to meet. His daughter received seven daily injections of insulin are two types: one is NPH insulin, intermediate acting, and the other is the ultra-fast, which acts within minutes of being injected. But that is not enough. After each meal, Alice must make a count of Emilia ingested carbohydrates and measure blood glucose value to determine the dose of insulin should administer.

There are other factors to be taken into account. Although physical exercise is highly recommended for diabetics, if the activity is very intense and you do not eat in the hours after the blood glucose level may drop too low. This downturn may also be given if the person receives an excessive dose of insulin. And abnormally low blood sugar can cause hypoglycaemia, the fear of all parents with children with diabetes who do not know yet regulated.

Emilia suffered only two episodes of hypoglycemia, a short time ago. “The person comes into a kind of seizure, start shaking, talked to and does not respond,” said Alice. Sometimes, hypoglycemia can occur at night, when the person is asleep. “For me, sleeping on your run does not exist. Every now and then I wake up to see how Emilia. ”

Other parents invent their own techniques. “One mother said her son had an episode of hypoglycemia, and for a time gave the evening a Milanese huge for your blood sugar level remains high,” he said. “Another mother put a nylon on the mattress of the bed of her son. If the sound of nylon felt, I knew that everything was fine because the child moved. But if the noise was too much, check that they were not seizures. ”

Emilio can live normally? When asked, his mother reflected: “No such thing as normal life. What are the parameters of comparison? We live well because we are accustomed, as we assimilate. Other families, not so much. ”

And if you have assimilated. Every year, parents of Emilia are doctors and diabetes to school to give a talk to teachers about their disease. They also send a newsletter for fellow students and their parents. Emilia carries a kit with all necessary equipment to meet an emergency.

The children’s birthday was an issue. Alice said they hoped the time take the cake for Emilia, and not tempted. Then they learned that she can eat a small piece of cake, with sugar, if then regulates blood sugar. And at first, when Emilia had a birthday, I cooked a cake diet. “The first we was horrible,” recalled Alice. Now found places where they can buy a cake for diabetics or give a small piece of sugary cake.

Educate them in managing their disease is not always easy. “We have to impose limits. She has psychological care. But it is like climbing stairs. When you think you understand everything, down two steps. For example, sometimes we go to the bakery and if there’s something says, ‘No, I can not because I have diabetes. ” And the next day, asking who gave her a gingerbread. ”

There were times when, as a mother, Alice felt guilty. “I wondered whether I would have done something wrong that caused his diabetes.” Once his daughter asked him why he was not born before his brother, Philip. “It was the only question you amazed me.”

Diabetes, like any chronic disease, causes these emotional swings. But Emilia’s family continues, with the autopilot. “One Day at a Time”, is the position of Alice. And Emilia, a beautiful and lively girl of five years, gradually learning about their bodies. Any contention that receives the help, later, to be self-reliant, the greatest desire of his mother.

To inform the public about the symptoms of diabetes, to help early detection and thus prevent cases of ketoacidosis, especially in children and adolescents, Diabetes Foundation and the Spanish Society of Pediatric Endocrinology with the collaboration of the General Council of Official Colleges of Pharmacists (CGCOF) have launched the campaign “Know the symptoms of Diabetes.” In this, to be held under the World Diabetes Day, celebrated on 14 November, more than 21,500 participating pharmacies throughout Spain.

In order to present this campaign, and studies have highlighted the need for information in this regard, we organized a press conference next Thursday November 11 at 10.30 am in the General Council of Pharmaceutical officers. The meeting was attended by Dr. Beatriz García Cuartero, Service of Endocrinology, Hospital Severo Ochoa, Andoni Lorenzo, father of a child with diabetes, Ana Aliaga, secretary of CGCOF, and M ª Carmen Marín, executive director of the Foundation for Diabetes.

The type 2 diabetes
Type-2 diabetes have a resistance of body cells to the biological effects of insulin. Once this so-called insulin resistance is too strong, does the injected insulin in a diabetes therapy is not effective enough. Be increased in these cases, the insulin sensitivity by insulin sensitizers. These sensitizers are firstly used for type-2 diabetes with marked insulin resistance, ie, in patients in whom insulin alone is insufficient. On the other hand in diabetic patients who are not the standard combination of insulin and metformin because of contraindications or intolerance can take.

To date, registered in Germany, two insulin sensitizers: Pioglitazone and rosiglitazone. These drugs increase insulin sensitivity of liver cells, muscle, and adipose tissue. The cells absorb more sugar by these substances, the liver, however, limits their glucose production. The result: the blood sugar level falls, both fasting and after meals.

The study
In the current study for three years more than 4000 patients taking part. All will be treated with the combination of insulin and pioglitazone. The first interim analysis of data from 2086 patients from 408 different diabetological study centers appears very positive. The blood glucose levels of the test subjects fell by nearly one percentage point. As an ultimate goal, the leaders recommend a percentage of 6.5%. In addition, the interim results showed that 22% of patients required less insulin. Blood pressure and blood lipid values of study participants also improved.

Possible side effects
The compatibility ratio of this therapy was quite good and was 97.7%, which was tolerated in most patients, the combination without major problems. One in seven patients, there was water retention in the legs. Through a diuretic these unwanted side effects, however, were already resolved during therapy. Encouraging, the researchers expressed the fact that no patient had to discontinue the therapy and already well-known complications with pioglitazone were observed.

Treatment Information
In patients receiving the combination therapy for the first time it is very important that the physician individually reduces the insulin dose to prevent hypoglycaemia. Those in charge of the study suggest, therefore, patients in the first few weeks follow closely, especially with regard to the occurrence of Herzinsuffiziensymptomen. Particularly crucial to a problem-entry into this type of therapy is the continuous adjustment of insulin dose.

In contrast to the insulin-dependent type 1 diabetes produce humans with type 2 diabetes, even a small amount of endogenous insulin. This amount is often small, that they no longer sufficient to adequately regulate the blood sugar. In addition, the metabolism of a type-2 diabetics often speaks to the existing insulin significantly less responsive than in perfectly healthy people would be the case. In this problem, so-called “oral agents” to correct the situation. These tablets increase the effects of the existing residual insulin and stimulate the pancreas to pour out to, for example at meals sufficient endogenous insulin. In the tablets even no insulin is included because it would be destroyed by stomach acid. In Germany, a type-2 diabetes is usually treated with oral antidiabetic agents. Only when the excess of regular long-term blood sugar levels (HbA1c), despite all efforts, the level of 7% are type 2 diabetics treated with insulin.

Texas study examines the advantages and disadvantages of diabetes therapy
A team of endocrinologists in the United States had now for three years, recently published study examined the self-treatment of people with type 2 diabetes. The study involved about 58 people had taken part with a newly diagnosed diabetes who were assigned randomly to one of two groups. One group was treated during the three-year observation period with insulin and the drug metformin, the other group received a combination treatment with the antidiabetic metformin, pioglitazone, and glyburide.

Insulin and combination tablets are equally good
The result: The HbA1c of both groups differed at the end of the study, only 0.1 percent. The insulin group had reached an average of 6.1%, the tablet group had the slightly better value of 6%. Weight gain was observed in both groups. Surprisingly, participants had risen kg in the insulin group, however, only about 4.5, while the tablet group average of 7.2 kg with a lot more put on the scales. Hypoglycemia occurred during the study in both groups rarely, and usually, these were not severe hypoglycemia. The self-discipline and the satisfaction with the therapy in both groups were also roughly equal.

Results are not fully meaningful
As a result, the insulin / metformin therapy and the combination of three anti-diabetic agents also equal. However, a combination of three different anti-diabetic agents in Germany is practiced only in emergencies, because the blood glucose in most patients even with a tablet can be adjusted very well. In addition, a study with only 60 patients compared to the experience of millions of diabetics is not meaningful.

The device, produced through a collaboration of experts from Boston University, Massachusetts General Hospital and Harvard Medical School has two hormones that are deficient among Type 1 diabetic, insulin, which prevents levels blood sugar get too high after a meal, and glucagon, a hormone that occurs naturally that prevents blood sugar levels fall too far.

Because the device does not depend on a human will provide information, it is called a “closed loop.”

“A closed-loop system bihormonal is possible and can help maintain a good average blood sugar readings,” said Edward Damiano, one of the designers of the device, associate professor of biomedical engineering at Boston University and father of a child with type 1 diabetes.

“What we developed is an automated software that makes decisions and uses mathematical formulas to inject various amounts of insulin and glucagon when necessary,” he said.

Type 1 diabetes is a disease in which the body’s immune system that normally protects against infections and other diseases attacking healthy cells. In type 1 diabetes, the immune system attacks the pancreatic beta cells, which in effect destroys the body’s ability to produce insulin and control blood sugar levels.

However, many people do not know beta cells are not the only ones affected by the autoimmune attack. The alpha cells, which produce the hormone glucagon, also damaged. Dr. Steven Russell, of Harvard and Damiano colleague said “there is a deficiency in alpha-cell function in type 1 diabetes, so do not act as they should. No glucagon secreted properly, so you lose a level Additional safety and body compensates with hypoglycemia, a condition that can cause big scares and even put life at risk. ”

For that reason, decided to add artificial pancreas glucagon to provide an additional level of protection, said Russell.

In the current version of the device, the researchers tracked the blood glucose through a special sensor placed inside a vein. Future versions will use the device monitors blood glucose continuous (CGM, for its acronym in English) that are already available, but for this test, the researchers wanted an extremely accurate way to measure blood sugar levels, so the only variable was the mathematical formulation used to program the administration of insulin and glucagon.

Eleven people with type 1 diabetes participated in the initial tests and experiments were performed in 27 hours. During that time, were connected to artificial pancreas and ate foods high in carbohydrates (carbohydrates are converted into glucose in the body).
The device responded to the increase in blood sugar levels with insulin administration. In six, the device reached a level of average blood glucose of 140 milligrams per deciliter (mg / dl), which is within the range established guidelines for the care of the American Diabetes Association. However, five insulin absorbed much more slowly than expected, which led to severe drops in blood sugar, so it was necessary to use extra food.

The researchers were surprised by the significant difference in the rates of absorption of blood sugar, so turned back, the mathematical formula adjusted and re-test the device in a second experiment. This time, reached a level of average blood glucose of 164 mg / dl, which is slightly above the target of the ADA. However, there were no cases of hypoglycemia that needed intervention.

The researchers said that people who use the pump is freed from daily injections. On the other hand, might need to change the pump site every three days and the place of glucose monitoring once a week. Yet integration has been developed in one place for the administration of hormones and glucose monitoring, although the ultimate goal.
In the following essay, researchers hope to give at least some insulin before a meal, which is the standard treatment. Damiano noted that this could be achieved with a button before the meal and the user could choose whether the carbohydrate meal will be short, medium or large.

The next series of trials will also evaluate a device that includes only insulin, it is likely to be available faster. The reason is that now glucagon is only approved by the FDA in a freeze-dried injection as rescue medication. But not to be administered via an insulin pump in small doses, as in the case of the artificial pancreas. Both Damian and Russell believe it is possible to have a closed-loop system only insulin to patients within five years or so.

“The goal of artificial pancreas is to try to restore normal physiology as closely as possible to the real organ, and this study shows that this technology is a reality and it works on real people,” said Aaron Kowalski, assistant vice president for research Glucose Control and director of the Artificial Pancreas Project of the Juvenile Diabetes Research Foundation (JDRF). “Many years ago we talked about the theoretical potential of closed-loop system and now we see the real potential. These technologies will become real systems and have the potential to transform the management of diabetes.”

The study results are published in the April 14 edition of Science Translational Medicine.

When we eat something, a lot of digested food is converted into glucose, the main energy source of the body. The pancreas then responds to blood sugar levels by secreting insulin in increasing the flow of blood. Most cells in your body contain insulin receptors that help insulin bind to the cell. Once insulin binds to the cell, activate other receptor sites, allowing glucose to enter the cell and provide energy for life.

Insulin also plays other vital roles in the body such as storage of excess food and magnesium, sodium retention and management of other hormones in the body including growth hormones, testosterone, and progesterone. Insulin is also responsible for stopping the liver to release fat, a potential metabolic fuel in the blood after a meal.

Insulin resistance occurs when even though the body produces insufficient amounts of insulin in the body cells become resistant to its effects. When this happens, the body requires more than the normal amount of insulin to take effect, and consequently, the pancreas produces more insulin.

While the pancreas can continue with the high demands of insulin, blood sugar levels remain normal, however, rising levels of insulin may have other negative health effects such as weight gain, high blood pressure, osteoporosis, fatty liver disease and hormone-related conditions such as polycystic ovarian syndrome (PCOS). If the pancreas can no longer continue with the demands of insulin, Type II diabetes can ocurrit.

Scientists at the National Marine Mammal Foundation of America (NMMF) found that the bottlenose dolphin (Tursiops truncatus) is resistant to insulin, the hormone that regulates glucose levels in the blood-like people suffering type 2 diabetes .

But this resistance in animals can turn on and off, the scientists reported in the Annual Conference of the American Association for the Advancement of Science (AAAS) held in San Diego, USA.

Researchers believe that this mechanism “on” works because of the diet of fish high protein and little sugar-feeding whales.

Scientists hope to collaborate with experts in diabetes to see if you can find even control an equivalent in humans.

The team, based in San Diego, took blood samples from trained dolphins consuming “snacks” continuously during the day and fasted overnight.

“The overnight changes in blood chemistry were equal to the changes occurring in human diabetics” he told the BBC Stephanie Venn-Watson, director of veterinary medicine of the Foundation.

“Some people with diabetes eat a diet high in protein to help control their disease, but the dolphins seem to have developed a condition similar to diabetes to consume a high protein diet.

This means, scientists say, that this mechanism allows the dolphins on simulate a state of diabetes when they fast without side effects.

In the morning, when the animals take their breakfast, simply revert to normal without diabetes.

Big brain
Just like humans, dolphins need sugar in the blood to their brains to function properly.

People with type 2 diabetes develops a resistance to insulin and thus loses the ability to control the levels of blood sugar.

Insulin Injection
People with diabetes need to inject insulin to control blood glucose.

If the condition is left unchecked can damage the heart, vision, kidneys and nervous system. According to the World Health Organization this disease causes 5% of all deaths that occur worldwide each year.

So with diabetes need to carefully control the levels of glucose and is often achieved with a diet low in sugar to avoid complications of the disease.

But dolphins insulin resistance seems to offer an advantage.

As explained by Dr. Venn-Watson, cetaceans appear to have evolved with the mechanism that allows them to simulate diabetes because it helps them maintain a high level of blood sugar when food is scarce.

“Bottlenose dolphins have large brains need sugar,” explains the researcher.

“Because his fish diet is low in sugar, the genetic mechanism allows them to keep blood sugar (even fast) to keep the brain well supplied.”

Among mammals, humans and dolphins have bigger brains and both have red cells that are exceptionally permeable to glucose and capable of carrying large amounts of it to the brain.

As already sequenced the genome of the dolphin, scientists hope to compare the genes of the whale with the human being to seek a similar mechanism in the latter.

According to Dr. Venn-Watson, “the fundamental difference so far is that dolphins are able to turn on and off the mechanism of insulin resistance, and humans do not”.

“But we hope that this discovery could lead to new ways to prevent, treat and perhaps even curing diabetes in humans” says the researcher.

What is perceived by the patients at the beginning is often a nuisance, is after some time routine and obvious help to regulate carefree everyday life. Especially in our fast-paced and stressful time and our world crowded with goodies facilitates regular monitoring of blood values in everyday life. It helps to assess what can increase or decrease blood sugar levels and prevents unwelcome surprises. The advantage seems to be so recognized that the measurement also increases from type 2 diabetes, which is carried inject insulin.

Blood glucose self-doubt
Currently there are no reliable knowledge about the medical benefits of glucose monitoring for patients with type 2 diabetes. Because of this situation has been the Institute for Quality and Efficiency in Health Care (IQWiG) deals with the question of whether benefit type 2 diabetics from the measurement. In the treatment of diabetes type-2 plays in addition to drug treatment, both the food and the movement a major role. Medical experts estimate that supports the blood glucose self-regulation many patients in changing their lifestyle. The measurement shows you instantly how physical activity affects on blood sugar and thus sharpen the awareness of the relationship between private behavior and glucose. The Institute has now six comparative studies that have investigated the benefits of fingerstick – integrated with and without self-monitoring – in the evaluation and concluded that the available studies demonstrate the unique benefits not possible. Three loud statements of the Institute of evaluation: The goals of treatment would not receive enough attention in the studies, there was no evidence of better results on blood glucose control and the advantage of hypoglycemia was due to the studies also not detectable.

Doctor / patient: collaboration benefits
In practice, however, can be several advantages of the blood glucose self-regulation also evidently diabetics. The measurement is for the doctor as a reliable basis for therapeutic decisions, which often can prevent secondary illnesses. Moreover, can a stable metabolic condition of the patient to prove because of improved blood glucose levels. The advantages for the patient can not be mistaken as well. He recognizes the connection between nutrition, exercise and blood sugar can increase the motivation on the one hand, the treatment of diabetes also be observed also in strengthening the awareness of risk and, secondly, can increase the quality of life through better lead values.

Cost-benefit evaluation
International is regarded as the fingerstick for type 2 diabetes standard in diabetes management. In Germany, however, is still a distinction between insulin-treated and non-insulin-treated patients. The blood glucose self-regulation also has considerable impact on our health care spending.
In relation to the results are different opinions. Based on the identified results, the question arises whether patients with type 2 diabetes, the insulin injections, the cost of blood glucose self-regulation should not be adopted. This would save lots of money, inter alia, health insurance, which would have less recipes are tender. On the other hand, the use of the blood glucose self-regulation type-2 diabetes also benefit the health system. Proponents argue that the costly complications avoided, and in turn, causes relatively low cost. The factor should any further decisions about whether the blood glucose self-regulation to be abolished by prescription for type 2 diabetes, should be carefully weighed.

Quintessence
As a conclusion of various studies, it can be said that the blood glucose measurement as an end in itself is not documented. However, it is useful especially when it is embedded in a plot structure. That is, if it is applied in the context of the physician-prescribed diabetes therapy. Prerequisite for long-term success of the measurement is the understanding of the patients in the displayed values. Only then can deduce the consequences for his future actions and adjust his diet and exercise with the values. And this in turn brings motivation to support the treatment compliance, ensures a better quality of life and helps prevent secondary diseases. According to Professor Oliver Schnell of the Institute for the Study of Diabetes (Munich), this is just a huge advantage in patients with type 2 diabetes because they can run the diabetes symptoms can develop over years and those affected only by concrete experiences a risk awareness.

Since liraglutide acts over a relatively long period of time, diabetics have to inject only once a day under the skin. In the long term the drug may reduce the long-term value of sugar (HbA1c) by up to 1.2 percentage points. Studies were conducted to test the new medicament, have shown that often arise, however, side effects such as nausea or diarrhea, which usually subside with continued treatment. “Since the drug is new, we know nothing about long-term side effects,” adds Dr. Nühlen “were observed in the studies, although some 1000 patients, but only over a period of six months to a maximum of two years. Therefore, for a patient should Treatment with liraglutide are carefully selected and closely monitored in order to get it to further that perception. ”

Basically, the only drug for type 2 diabetes is likely to already taking tablets for diabetes and require no insulin. “Some people believe that they could simply switch to liraglutide and then never again need to inject insulin. However, this is a mistake,” says Dr. Matthias Riedel, liraglutide is no insulin rate. ” Even for a combination with insulin, the new drug is currently not allowed. In some years, could this combination, after appropriate investigations, however, turn out to be effective. Due to lack of experience liraglutide in patients with heart failure or inflammatory bowel disease should be prescribed with caution. Even in gastric paralysis of the drug should not be used. If symptoms of pancreatitis, liraglutide would be discontinued.

Because liraglutide compared with other diabetes medication is relatively expensive, it can be ordered from fi-nancial reasons, only in obese diabetic patients who transfer without the new drug would be dependent on insulin need and there because of their weight on very high doses. Here, liraglutide may also have a positive effect because the drug induces a feeling of satiety, which can lead to weight loss. Dr. Nühlen indicates that it is by no means the new drug is a miracle cure for obesity: “In the trials that patients have up to two percent of their body weight lost. The change in lifestyle is absolutely necessary with liraglutide . These include above all, more exercise and a balanced diet. ” In practice, it also showed significantly greater weight loss. The new product needs to be applied correctly and carefully.

“It is important containing that patients are well trained, so they know what not accompanying drug-free measures are necessary. This includes in addition to lifestyle changes such as the blood glucose self-monitoring”, explains Dr. Nühlen. “When patients leave due to insufficient training only on the drug, it will not work properly.” Organized the professional association of diabetologists doctors are able to share emerging findings in the regulation of new drugs with each other and immediately draw conclusions from them.

Background: The BdSN have the professional association of North Rhine diabetological Schwerpunktpraxen (BdSN) organized over 100 established diabetologists and helped shape the current favorable trends in the care of diabetes patients. The aim is to improve patient care suffering from diabetes further.