Analysis Shows BYDUREON Was Not Associated with Clinically Relevant QT Prolongation in Patients with Type 2 Diabetes …
Amylin Pharmaceuticals, Inc. , Eli Lilly and Company and Alkermes, Inc. today announced results from an analysis of the DURATION-1 study that showed the investigational type 2 diabetes medication BYDUREON⢠was not associated with clinically relevant QT prolongation in patients with type 2 diabetes.

Read more on PR Newswire via Yahoo! Finance

Increased Health Risk of Premature Death
According to CDC researchers, an estimated 300,000 American deaths a year are related to obesity, but see note, below. The risk of premature death rises with increasing weight. Even moderate weight gain (10 to 20 pounds for a person of average height) increases the risk of death, particularly among adults aged 30 to 64 years. Individuals who are obese (BMI greater than 30) have a 50 to 100 percent increased risk of premature death from all causes, compared to individuals with a healthy weight.

Increased Health Risk of Heart Disease
The risk of heart attack, congestive heart failure, sudden cardiac death, angina or chest pain is increased in persons who are overweight or obese. High blood pressure is twice as common in adults who are obese than in those who are at a healthy weight. Obesity is associated with high triglycerides and decreased HDL cholesterol.

Increased Health Risk of Stroke
Atherosclerosis, or narrowing of the arteries, which may lead to the formation of an arterial blood clot, is an important pre-condition of many strokes. Atherosclerosis is accelerated by high blood pressure, smoking, high cholesterol and lack of exercise. Obesity, especially morbid obesity is frequently associated with a high-fat diet, raised blood pressure and lack of exercise. Thus obesity is now considered an important secondary risk factor for strokes.

Increased High Blood Pressure
This may then also lead to:

Headaches
Ear noise & buzzing
Tiredness
Shortness of breath
Excessive sweating
Confusion
Vision changes
Nose bleeds
Blood in urine
Kidney damage / failure
Strokes

Increased Health Risk of Type 2 Diabetes
A weight increase of 11-18 pounds raises a person’s risk of developing type 2 diabetes to twice that of individuals who have not gained weight. Over 80 percent of people with diabetes are overweight or obese. This may account for the newly invented word, “diabesity”®, which signifies the close association between obesity and diabetes.

Increased Health Risk of Cancers
Obesity is associated with an increased risk for some types of cancer including endometrial (cancer of the lining of the uterus), colon, gall bladder, prostate, kidney, and post-menopausal breast cancer. Women gaining more than 20 pounds from age 18 to midlife double their risk of post-menopausal breast cancer, compared to women whose weight remains stable.

Increased risk of Erectile Dysfunction

This stressful disorder is often linked to Insulin Resistance, an imbalance in blood glucose and insulin levels associated with excess weight and obesity. Being overweight can place extra strain on the cardiovascular system and disrupt the delicate balance required to achieve an erection and, therefore, cause ED.

Excess insulin created by Insulin Resistance is implicated in ED because it damages the endothelium of cardiovascular vessels. The endothelium is the layer on the inside of the vessel which secretes chemical mediators that instruct the vessel to contract or relax. To achieve an erection, a release of nitric oxide from the endothelium creates vascular dilation, which allows vessels to fill with blood. This influx of blood is necessary to achieve an erection. Any decrease in nitric oxide supply to the penis caused by the insulin-damaged endothelium lessens or prevents vascular dilation and contributes to erectile dysfunction.

If neglected, excess weight gain can also lead to other conditions linked to ED like the cluster of increased risk factors for cardiovascular disease called Metabolic Syndrome (Syndrome X) as well as Pre-Diabetes, which, if neglected, can lead to irreversible Type 2 Diabetes. Between 35-50% of men with Diabetes experience ED because the disease can damage nerves and arteries, making it difficult to achieve an erection. However, major weight loss can be achieved can by reversing Insulin Resistance, thus removing major factors in the onset of ED.

As many as 70% of ED cases are caused by cardiovascular diseases such as atherosclerosis. This disorder is a type of hardening of the arteries in which cholesterol, fat and other blood components build up in artery walls via poor diet and lack of regular exercise resulting in excess weight gain.

As the condition progresses, the arteries to the heart may narrow, reducing the flow of oxygen-rich blood and nutrients to the heart and brain. This restriction can also reduce blood flow to the tissues of the penis, causing ED.

Other excess weight and obesity-linked cardiovascular diseases that can cause ED are hypertension (high blood pressure) and high levels of triglycerides and LDL “bad” cholesterol in combination with low levels of HDL “good” cholesterol – all factors in reversible Metabolic Syndrome.

Increased Health Risk of Fatty Liver Disease
The main cause of non alcoholic fatty liver disease is insulin resistance, a metabolic disorder in which cells become insensitive to the effect of insulin. One of the most common risk factors for insulin resistance is obesity, especially central abdominal obesity. Studies indicate a correlation between body mass index (BMI) and the degree of liver damage. The higher the BMI the worse the liver disease.

Obesity is a Risk Factor for Chronic Venous Insufficiency
Although obesity is not a direct cause of chronic venous insufficiency, it is an important risk factor. This is because obesity, especially morbid obesity, leads to raised blood pressure, a sedentary lifestyle and musculoskeletal problems (hampering mobility and use of leg muscles), all of which are contributory factors in the development of chronic venous insufficiency. Obese patients also have an increased health risk of other vascular disorders (eg. lower-limb ischemia), caused by inadequate blood flow to the extremities.

Increased Health Risk of Gallbladder Disease
The risk of gallstones is approximately 3 times greater for obese patients than in non-obese people. Indeed, the risk of symptomatic gallstones appears to correlate with a rise in body mass index (BMI).

Increased Health Risk of Breathing Problems
Obstructive sleep apnea (that is, interrupted breathing during sleeping) is more common in obese persons. Obesity is associated with a higher prevalence of asthma and severe bronchitis, as well as obesity hypoventilation syndrome and respiratory insufficiency.

Obesity and Deep Vein Thrombosis
Risk factors for deep vein thrombosis include prior history of the disease, vascular damage, hypertension and predisposition to blood clotting. Although obesity (BMI 30+) has traditionally been recognized as a risk factor for deep vein thrombosis and pulmonary embolism, experts now consider that the evidence supporting this association is inadequate, as much depends on other factors such as history, illness, immobility, and age.

Increased Health Risk of Arthritis
Musculoskeletal disorders, including osteoarthritis, are much more prevalent among obese patients, especially patients diagnosed with severe clinical or morbid obesity. Health studies show that obesity is a strong predictor for symptoms of osteoarthritis, especially in the knees. The risk of osteoarthritis increases with every 2-pound gain in weight.

Increased Health Risks for Expectant Mother and Baby
Obesity has a strong detrimental effect on the health of both mother and new-born baby, both during and after pregnancy. Obesity while pregnant is associated with a higher risk of death in both the baby and the mother. It also raises the risk of high blood pressure in the Mom, by 10 times. Obesity during pregnancy is also associated with an increased risk of birth defects, such as spina bifida. Obesity-related health problems occurring after childbirth include higher risk of wound and endometrial infection, endometritis and urinary tract infection.

Psychological and Social Effects of Obesity
Emotional suffering may be one of the most painful parts of obesity. American society emphasizes physical appearance and often equates attractiveness with slimness, especially for women. Such messages make overweight people feel unattractive.

Other Risks:
- Elevated serum cholesterol levels
- Elevated LDL (“bad” cholesterol) levels
- Decreased HDL (“good” cholesterol) levels
- Elevated triglyceride levels
- Decreased blood oxygen
- Decreased testosterone levels
- Irregular menstrual cycles
- Incontinence
- Increased surgical risks
- Tinnitus
- Reduced immune function
- Swollen joints / fluid retention
- Muscular aches and pains, particularly:

Neck
Shoulders
Chest
- Biomechanical injuries & faults, including:

Sunken arches / flat foot
Heel spurs
Plantar fasciitis
Shin soreness
Creaking knees
Achilles tendonitis
Calcific tendonopathy
Sprained ankles
Bone chips
- Impotence
- Infertility
- Loss of libido

Health Improvements after Weight Reduction
The good news is that losing a small amount of weight can reduce your chances of developing heart disease or a stroke. Reducing your weight by 10 percent can decrease your chance of developing heart disease by improving how your heart works, blood pressure, and levels of blood cholesterol and triglycerides. Studies show that you can improve your health by losing as little as 10 to 20 pounds.

Tze Khit

Read more on News-Medical-Net

Read more on The New Zealand Herald

Read more on PRWeb via Yahoo! News

Read more on Washington Post

To compare the role of glibenclamide and pioglitazone drugs in type 11 non- insulin dependent diabetes mellitus patients.

Introduction:-

Diabetes comes from the greek word for ‘SIPHON” which one is the first term and implies for a lot of urine is made .The trm “mellitus” comes from a laton word, “met” which means “honey” and was used because the urine was sweet (Wheeler,2004)

Diabetic ketaocidosis is one of life threatening condition requiring some data hospitalization and treatment. Recognition of this condition is of almost importance, because even small delays can have an impact on survival (Nattrass, 2006). Hypoglycaemia are involved in insulin induced episodes in individuals with diabetes. Probably the major factor prescribing, insulin treated patient from achieving the glucose targets needed to prevent diabetic complications. The incidence of hypoglycaemia reflects the inadequancy of current mathods of insulin delievery which lead ot inappropriately high insulin concentration, particularly some persons after eating more foods at night onset of blindness and also a major risk factor heart disease and stroke

(Heller, 2003).

TYPES OF DIABETE MELLITUS

Type II diabetes is a complex metabolic disorder associated with, b -cells dysfunction and with varying degree of insulin resistance primary pathogenic factors leading insulin resistance leading to type 2 diabetes and decreased insulin, secretion which arise from abnormalities with in liver, skeletal muscle and pancreatic b -cells (charles & clark, 1996).

GESTATIONAL DIABETUS MELLITUS

SECONDARY DIABETUS MELLITUS:

Secondary diabetes is due to disease of the pancreatic and endocrime system, genetic disorders, or exposure to chemical agents.

Type – I diabetes formerly known as insluin dependent diabetes mellitus (IDDM), is characterized by the destruction of the pancreatic beta cells that produces inslulin

Type – I diabetes formerly known as insulin dependent diabetes(IDDM),is characterized by the destruction of pancreatic beta cells that produces insulin.Type-1 diabetes occures most often in children and young adults but it can occures at any age.(Anderson et al 2007).

Type-11 diabetes is not straight uprward. A pancreas that does not produce enough insulin. Liver that release too much glucose,muscle cells that do not readily take in glucose.(Carren 2008)

Many genetic factors are involved in the development of diabetes.Because of new genetic methodology researchers are closers to identifying all of the cadidate gene for both non –insulin dependent and insulin dependent diabetes(Bernhard,1995).

Woman who had gestation diabetes are more likely to develop Type-11diabetes themselves.Pergnant women with diabetes are another disadvantaged group.They need much more intensive antenatal care and close monitoring of blood sugar,blood pressure and weight.(jawed2006)

Over weight children the progression of child obesity into adulthood is associated with early develop of complications, including IgpG2 diabetes and cardiovascular disease.Type diabetes is the most common clinical form of diabetes accountingforabout 90% of all cases,it is currently undergoing world wide epidemic. Type 11diabetes mellitus is caused by body’s infective use of insulin, it is often results from excess body weight and physical inactivity(WHO 2007).

PREVALACES& IINCIDENCE

:

Diabetes mellitus increases with aging, in 200 the prevalance of diabetes,it was estimated to be 0.19% people<20 years old and 8.6% in people>20 years old.There is considered geographic variation in the incidence of both type-1 and type-11 diabetes mellitus.Scavandinvian has the highest incidence of type-1 diabetes mellitus e.g in Finland, the incidence is 35/100,000 per year the pacific rim has a much lower rate in japan and china the incidence is 1 to 3/100,00 per year of type-1 diabetes mellitus, Northern Europe and the United States share an intermediate rate (8to17/100,000 per year).The prevalence of type 11 diabeties mellitus is highest in certain pacific island, intermediate in countries such as India and the United States, and relatively low in Russia and China.This variability is likely due to genetic, beharioral and enviromental factors(Power 2005).Diabettes mellitus prevalance also arises among different ethic population within a given countries it is common inall ethnic groups its prevalance increased with age and more than 5% of individuals of more than 65 years of age have diabetes mellitus (David Owerback 1988).The World wide prevalence of diabetes mellitus has risen dramatically over past two decades.The prevalence of type11 diabettes mellitus is expected, type 11 diabetes mellitus is more prevalent among Hispanies Native Americas,African,American,and Asians, pacific Islanders than in non- Hispanic whites,the incidence is essentially equal in woman and men in all populations. Type 11 diabetes is becoming increasingly common because people are living longer,and the prevalence of diabetes increases with age it is also seen more frequently now than before in young people, in association with the rising prevalenceof childhood obesity although type11 diabetes still countries with the estimated nubers of cases of diabetes in 2000and 2030.

Rank Country

2000 Individuals country with diabetes (milloins)

Country

2030 Individuals with diabtes (Million)

India

31.7

India

79.47

China

20.8

China

42.3

USA

17.7

USA

30.3

Indonesia

8.4

Indonesia

21.3

Japan

6.8

Pakistan

13.9

Pakistan

5.2

Brazil

11.3

Russian federation

4.6

Bangladesh

11.1

Brazil

4.6

Japan

8.9

Italy

4.3

Philippines

7.8

Bangladesh

3.2

Egypt

6.7

(Wareham& FOROUHI 2OO6)

DRUG TREATMENT OF DIABETIES MELLITUS

:

Biguanides lower blood glucose, they increase glucose uptake and utilize in skeletal muscle there by reducing insulin resistance, and reduce hepatic glucose production (gluconeogenesis).Lower blood glucose, addionally reduces low denisity and very low denisity lipoproteins (LDL and VLDL) respectively. Metformin has a half life of about 3 hours and is excreted unchanged in the urine.Clinically metformin used in type 2 diabetic who are obese and who fail treatment with diet alone.Adverse effects are produced dose related gastrointestinal disturbances e.g anorexia,diarrhoea,nausea,lactic acidosis rare but potentially fatal toxic effect.(Dale,2003).

Improving insulin sensitivity by activating certain genes involved in fat synthesis and carbohydrate metabolism Rosigilitazone and Piogiltazone are currently approved.Thiazolidinediones. Thiazolidinediones do not cause hypoglycemia when used alone,although they are usually taken in combination with sulfonylurease.

In some incouraging studies, thaiazolidiniones have produced very favorable effects on the heart, including reducing blood pressure and improving triglycerides and cholestrol levels including increasing HDL level,the good cholestrol. They may also block a molecule called 11 Best HSK that may play a significant role in metabolic syndrome,as well as diabetes type11. One study also sugessted that Rosiglitazone may even improve beta cells functions and so help prevent progression of diabetes.Anemia, weight gain, increased risk of fluid buildup, may worson heart failure.Troglitazone,was withdrawn after a few reports of heart failure.Liver failure abd death.Current Thiazoldinediones don not appear to pose the same effects on the liver although there have been a few reports of liver injury.

In patients with dietry failur the choice of a sulfonylurea agent or insulin therapy has been controversial and empric in favour of insulin therapy are the studies, who reported marked improvement post receptor diagnostic after intensive short term therapy in untreated type 2 diabetes mellitus (Scarlett et al,1984) Sulfonylureas further classified into two groups or generations based on their potency,duration,drug interaction,side effects profiles. Sulfonylureas enhance insulin action in cells in culture and stimulate the synthesis of glucose transporters (Jacobes et al 1998).A sulfonylurea drug should normally be the insulin secretagogue of choice, NICE (National Institute for Clinical Excellence) also recommends that a generic ,drug should be perscribed (Scsade et al1998).

RESEARCH DESIGN AND MATERIAL AND METHODS:

This study was conducted in the deprtment of Pharmacololgy and Therapeutics,Basic Medical Science Institute,Jinnah,Postgraduate Medical Centre,karachi under kind supervision od DRr:GhulamRsool Mashori,Associate Professoer and Head OF Department Of Pharmacology and Therapeutics in colloboration with Medical Outpatient Department Unit111 and Filter Clinic, Medical Department, JPMC,Karachi.

Seventy NIDDM (type-II)diabetic patients were initially enrolled in the study from the filter clinic/ out patient department Medical Unit III ,and diabetic clinic.Out of this 60 diabetic patients were associated in whole period of study, remaining 10 patients were dropped due to poor comlpiance or change in residential place.All the patients were divided in two main groups,groupI and in group II these patients were selected in this study according of inclusion and exclusion criteria.

INCLUSION CRITERIA

:

• Newly diagnose patients of non Insulin Dependent Diabtes Mellitus.
• Diagnsed patients of diabetes also including having no any history medication.
• Having either sex of age between 30 to 60 years.
• Diagnosed patients who were Non Insulin Depedent Diabetes Mellitus who were treated with Pioglitazone.
• Diagnosed patients who were Non Imsulin Depedent Mellitus, who were treated with drug Glibenclamide.

EXCLUSION CRIRERIA

:

• Patients suffering from blood pressure.
• Patients suffering from liver disease.
• Patients suffering from cardiac disease.
• Pregnancies and lactating women.
• Patient suffering from renal disorders.
• Patients having serious complications.

MATERIAL:

1. Lacets.
2. Lancet Hlder(Abbots easy touch TM2 lot 03 Asee).
3. Glucometer(Medisense) optilim one touch(Abbotts).
4. Blood glucose nest trpis (IVD for Invitro diagnostic use (Abbott Labortries,Medisense UK Ltd,Abigngdon,Ox14ITR,Masde in UK). Stored between minimum 30?, (4°-30° C) and Maximum 40°C (39°-86°F).
5. Weight Machine Model No 1101 Lot No.312. TANTIATA.

DRUGS

Tab:Daonil 5 mg (Aventis Pharma)

Drug category:Sulphonylurea.

Generic Name: Glibenclamide.

MFGLIC:No.000007 RegistrationNO.000220

MFG Date:0-06

EXP Date:7-10

Lot NO:B230

Tab:piozer (Hilton Pharm) PvtLTd.

Tab:Poizer 15mg

Drug category:Thaiazolinedione.

Generic Name:Pioglitazone Hydrochloride.

MFG LIC: O.000136 Registration No.03270

MFG Date:3-06

EXP Date:3-o9

Lot No:6287

Tab: Poizer (Hilton Pharma)pvt ltd.

PARAMETERS:

Fasting Blood Sugar (FBS).

Random Blood Sugar (RBS).

Weight.

Key words:Diabetes mellitus,Non-insulin diabetes mellitus,Insulin depedent diabetes mellitus, Daonil,poizer,Insulin.

RESULTS:

Table 1

Weight and Blood Sugar level observed on baseline day 0

In group1 and group11

Group 1

Group 11

Pioglitazone n=27

Glibenclamide n=33

Weight

63.37

+ 2.25

¯

62.7

+ 15.56

¯

Fasting Blood Sugar

172.7

+ 13.32

¯

188.42

+ 12.o5

¯

Random Blood Sugar

285.11

+ 15 .532

¯

284.18

+ 17.07

¯

All Values are expressed in Means± SEM.

FIGURE-1 weight and blood sugar levels observed on baseline (day-o)

In table No shpwing the weight (KG’S) and blood sugar (msg/dl0 levels which is observed on baseline (day-0) in both groups 9group: 1 & group11)

Group: 1 Weight in (Kg’s) mean + SEM) IS 63.37±2.25 Fasting blood sugar 172.7±13.32,and Random

blood sugar 285.11±15.32

Group:11

Weight (KG’s0 (mean +SEM)62.7±1.56 Fasting blood sugar (mg/dl0 188.42±12.05, Random blood sugar is 284.18±17.03.

Figure 2: showing the weight and blood sugar levels observed in base line (day-0) in group: 1 and group 11 weight in 9kg’s) its mean values are 63.37,62.7, Fasting blood sugar in (mg/dl) is 172.71, 188.42 Random blood sugar (mg/dl) is 285.11 &284.18.

TABLE: 2

Peroidic Observation In All Parameters Group1

Goup1(Pioglitazon) n=27

P-value

Day-0

Day-45

Day-90

Day-0to45

Day-45-90

Weight

63.37

±2.25

63.63

±2.26

63.63

±2.23

>0.05

(NS)

>0.05

(NS)

Fasting blood sugar

172.7

±13.32

165.04

±8.98

153.37

±7.59

>0.05

(NS)

0.05

(NS)

Randomblood sugar

285.11

±15.32

279.78

±13.63

255.56

±12.65

>0.05

(NS)

>0.05

(NS)

All values are expressed in Mean±SEM .(NS) Non significant.

Showing the periodic observations in all parameters in group 1 (piogiltazone) (n+27) weight P.value (day 0 to day 45)>0.05 (NS). Fasting blood sugar >0.05 (NS) Random blood sugar >0.05 (NS) P.values day 90 weight >0.05 (N.S), FBS>0.05 (N.S) 7RBS >0.05(N.S) NON SIGNIFICANT

FIGURE:2 Showing the periodic observation in all parameters in group 1 on day0 day 45& day-90.Mean values in weight (Kg) is 63.37,63.26,63.63, fbs (mg/dl) 172.7,165.04,153.37,RBS(mg/dl) 285.11,279.78,255.56.

TABLE NO3

Peroidic Observation in All Parameters Group11

Group 11 (Glibenclamide)

N=33

P-value

Day-0

Day-45

Day-90

Day-0 to 45

Day-45 to 90

Weight

62.7

±1.56

65.64

±2.10

64.55

±1.92

>0.05(NS)

0.05(NS0

Fasting blood sugar

188.42

±12.05

168.45

±10.99

140.06

±5.68

>0.05(NS)

>0.05(S)

Random blood sugar

284.18

±17.03

220.12

±13.39

170.94

±5.80

<0.005 (MS)

0.002(MS0

(s) significant, (MS) moderate significant

All values are expressed in Mean±SEM.

Table No3:

Showing the periodic observation in all parameter in goup:11, Group:11 containing drug (Glibenclamide),no of patients (n=33).It’s P-value on day 0 to day 45 on weight >0.05(NS),FBS>0.05(N.S) RBS<0.005 (MS) <0.01- AND DAY 45 TO DAY 90 WEIGHT >0.05 (NS) FBS (0.05) RBS <0.002(M.S0 moderately significant.

Figure 3:Shwing the periodic observations in all parameters in Group 11 weight 62.7,65.64,64.55,FBS (MG/DL) 188.42,168.45 140.06,RBS(mg/dl) 284.18 220.12, 170.94 (on day-0-day 45 to 90).

DISCUSSION:

In Denmark Beck-Nielsenet al,skillman TG (1981) published studies demonstation that glyburide increased he number of receptors on the monocytes of patients with type 11 diabetes mellitus. Some patients were treated with diet and in cobination of second generation sulfonyureas agents Wie. The numbers of insulin receptors all patients were measured before and after the treatment.Intrvenous glucose test shows the persistent impairent of insulin secretion afterthe starting of drug therapy.However those patient who were on drug Pioglitazone some results were obtained of insulin secretion in the impairment in early drug drug therapy.Clinical observations have suggested that the second generation sulfonylureas may exert their effects by potentiating insulin released by other primary stimulators Insulin secreting drug.

According to the study of WilliamC Dukworth et al(1972), aftr the chronic treatment with sulfonylureas it is well documented that plasma insulin levels were decreased in response to oral glucose load. This apparently occures even though glucose tolerance is improved over pre-treatment, levels,present study clearly support that study.

The result og group 11 correlates with the research conducted by Bonnie &Kimmel (2005) produces the same results as FBS reduces from baseline, and at the end of study,with an overall 23.44%,reduction,while with the results showed at the end of study peroid p-value were (p<0,001).

Similarly Michael Alvarsson et al (2003) conducted a similar type of study and the found and overall changes of change of 22.11% in Fbs and 40.88% in Rbs at the end of trial p-value were (p<0.001).

However a study conducted by (Stone &Brown in (2003) didnot match to our results in the parameter of FBS and observer a reduction of 26.22%.

CONCLUSION:

In the light of study discussion it is obiovus the glibenclamide was more effective,tolerable and safer than pioglitzone in a short duration.Diabetes Mellitus is chronic prolong disease for whole life.Poor community can afford it easily,on base of marketing of this drug in pakistan diabetes patients easily go and purchase economically,in fact ,mostly people buy it from pharmacy without dr’s perscription,because pharmacist and patient both of know about this disease.Just like dispirin as analgesic,it is famous anti-diabetic drug in our states as compared of other anti-diabetic drugs.

REFERNCES:

1. Anderson J,Kendall,Perryman.S etal,”Diet and Diabettes” Diabetes 2006,16(3):17-19-
2. Bui H- Type 1 diabetes in childhood-Medicine 2006,3 ,1-3
3. Bernhard –Diabetes-type 11 diabetes mellitus Diabetes care 1995,19(100:12-17-
4. Clark CM-Oral therapyin type11 diabetes-pharmacological properties and clinical use of current use of currently available agents-Diabetes spectrum 1998,11(4):211-221.
5. Carren M.Types of Diabetes mellitus-Diabettes 2006 10 (3),07-
6. David Owerback NJ-Prevalence in diabetes population-Diabetes 1988,02(6):31-32
7. Dale MM,-Treatment of Diabetes mellitus –pharmacology 20035th edition:287-391.
8. Heller SR –Hypoglycemic in diabetes Ketoacidosis and hypoglycemic-Medicine 2006:34(03):102-110.
9. Jawad F Untraveling the mystry of Diabetes’Diabetes 2006;15(3):13-15.
10. Jacobes D-Insulin-Diabetes 1998;6(3);1160126.
11. Lambert and Bingliy-basic facts-medicine 2006,34(6):3-7.
12. Natters M-Ketoacdosis and hyperglycemia-Medicine 2006;34(3):104-106.
13. Power AC-Epidemiology of type11 diabetes Basic facts of diabetes –Diabetes 2005;1(1)7-9
14. Scarlet Oral therapy in type 11 diabetes sulfonylureas 1984;16(10);3-9.
15. Schade DS et al A placebo controlled randomized study of glimepiride in patients of Diabetes mellitus- Diabetes 19998, 38(7);636-641.
16. Warchman and Forouhi-Epidimology of Diabetes- Diabetes basic facts- Medicine 2006 ;34(2);57-60
17. Wheeler Gd- Aaccident dicovery led to the noble prize for canadian reseachers,2005,01-02.
18. WHO Report-Health-Diabetes Mellitus-Defiition and types of Diabetes 2007;1:1-4.

lalaghulamrasool bhurgri

Choosing healthy food is one of the most important parts of anyone’s diet, but for the diabetic it can literally be the difference between life and death. Without proper blood sugar control the list of complications suffered by those with diabetes is quite scary. It is also important to remember that while some people can control their diabetes with diet and exercise, others who are at higher risk may also need to make food choices based on the medications they are currently taking.

For many diabetics trying to figure out the exact amount of carbohydrates they can eat can be a little frustrating. In the past everyone followed the same general guidelines but in recent years that thinking has changed. Diet plans for diabetic are now individualized and are based on each person’s ability to tolerate and maintain good blood sugar control. One thing that helps individuals keep good glucose maintenance is the ability to measure blood sugar levels with personal portable blood glucose monitors that are quick and easy to use. The ultimate goal of a type 2 diabetic diet is to provide the necessary calories and nutrients needed while keeping blood glucose levels in the normal range and allowing the diabetic to lose weight.

The good news is a diabetic diet because of it very nature easily allows those who follow it the ability to lose the weight that can cause so many health problems and may be a contributor to their diabetes. The diet is low in saturated fat, cholesterol, and simple sugars while emphasizing leafy green vegetables, fruits in moderation because of their high sugar and starch content, and whole grains high in fiber. Protein from lean sources is also important, particularly those that are high in omega-3 fatty acids such as can be found in certain fish like salmon. A good starting point for anyone with diabetes is the diabetic food pyramid that can be found of the American Diabetes Association website.

Type 2 diabetes is becoming a rapidly increasing epidemic with the current obesity problem that is affecting nearly every region of the world. Because of this being able to control blood glucose levels along with effective weight loss and control is vitally important for anyone who must follow a diabetic weight loss diet.