Diabetes--------

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The diagnosis of diabetes in an asymptomaticsubject should never be made on the basis of a singleabnormal blood glucose value .According to an article WHO reports for the asymptomatic person,at least one additional plasma/blood glucose test result with avalue in the diabetic range is essential, either fasting, from arandom (casual) sample, or from the oral glucose tolerancetest (OGTT).

If such samples fail to confirm the diagnosis ofdiabetes mellitus, it will usually be advisable to maintainsurveillance with periodic re–testing until the diagnostic situation becomes clear. In these circumstances, the clinician should take into consideration such additional factors asethnicity, family history, age, adiposity, and concomitantdisorders, before deciding on a diagnostic or therapeuticcourse of action.

An alternative to blood glucose estimationor the OGTT has long been sought to simplify the diagnosisof diabetes. Glycated haemoglobin, reflecting averageglycaemia over a period of weeks, was thought to provide such a test.

Although in certain cases it gives equal or almostequal sensitivity and specificity to glucose measurement (6),it is not available in many parts of the world and is not wellenough standardized for its use to be recommended at thistime

Diagnosis for both type 1 and type 2 diabetes can occur in a number of different ways. Usually type 2 is diagnosed by diabetes symptoms, such as polyuria (excessive urination) and polydipsia (excessive thirst).

Otherwise, diabetes is picked up through screening, hyperglycaemia when doctor investigates a complication, or signs and symptoms prompted by diabetes.

What is a diabetes screening test?

Diabetes screening should be more widespread, and more people should be screened for diabetes. A screening test determines whether a person has diabetes, and how serious it is. Depending on where you are and what your circumstances are, the screening test will vary. Tests include random blood glucose tests, fasting blood glucose tests, formal glucose tolerance tests, and others. For adults aged between 40 and 50, screening should be considered. For people who have higher risk factors (ethnicity, family history, obesity) screening should be conducted beforehand.

Risk Factors
To be eligible for the diabetes screening tests beneficiaries must have any of the following risk factors or at least two of the following characteristics:

Individuals are considered at risk for diabetes if they have any of the following risk factors:

• Hypertension
• Dyslipidemia
• Obesity (a body mass index greater than or equal to 30kg/m2)
• Previous identification of an elevated impaired fasting glucose or glucose intolerance

OR

Individuals who have a risk factor consisting of at least 2 of the following characteristics:

• Overweight (a body mass index greater than 25 but less than 30kg/m2
• Family history of diabetes
• Age 65 or older
• A history of gestational diabetes mellitus, or delivery of a baby weighing greater than 9 pounds

What kind of conditions are usually related to diabetes?

A number of medical conditions are said to be associated with diabetes, and when they are discovered patients should be screened for the disease. These conditions include (alongside others):

• High blood pressure
  
• Elevated cholesterol levels
  
• Coronary artery disease
  
• Prior gestational diabetes
  
• Polycystic ovary syndrome
  
• Chronic pancreatitis
  
• Fatty liver
  
• Haemochromatosis
  
• Cystic fibrosis
  
• Mitochondrial neuropathies and myopathies
  
• Myotonic dystrophy
  
• Friedreich's ataxia
  
• Inherited forms of neonatal hyperinsulinism

Can some drugs cause diabetes?

This is a contentious issue, but the risk of developing diabetes is regarded as being greater following the chronic use of some medications. These include high-level doses of glucocortinoids, chemotherapy agents, antipsychotics and mood stabilisers.

What kind of problems could indicate diabetes?

Diabetes diagnosis often occurs when a person is suffering from a problem known to be caused by diabetes. The type of problems leading to this conclusion include heart attacks, strokes, neuropathy, failure of wounds to heal properly, foot ulcers, eye problems, fungal infections, and giving birth to a child with hypoglycaemia.