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Tagamet (Cimetidine)

Diabetes is a common condition. In all of its types, the amount of sugar (glucose) in the blood is too high. This may be continuous or may occur only after eating. Diabetes was once a grave disease and diabetics seldom survived more than five years after the diagnosis was made before dying in a coma. In 1922, however, the hormone insulin was first used successfully to treat diabetes and today diabetic coma can be prevented or regulated by insulin. Another hazard for diabetics, tuberculosis, has now largely been conquered; so their life span has been greatly improved.
But diabetics are still prone to disease of the arteries and nerves, and we shall now consider current ideas as to how these risks may be minimized.
It is not possible to say just how common diabetes is, because -as with blood pressure and cholesterol levels – the obviously normal part of the population merges gradually with the obviously diabetic part. By measuring blood-glucose levels it seems that some 2 per cent of us are clearly diabetic, and another 10 per cent are on the borderline. The condition becomes commoner with advancing age, being perhaps ten times more frequent in the over-seventies than in young adults. Some groups are more prone than others, for example South Africans of Indian extraction, and certain indigenous American tribes.
At all ages, diabetes increases the risk of heart attack. The risk of certain forms of stroke is also greater. Diabetics studied in Framingham had about double the risk of these conditions, and about a fourfold increase in the chance of developing symptoms of atherosclerosis in the legs (e.g. intermittent claudication). The heart-attack risk is due (wholly or partly) to severe atherosclerosis: this is evident from the work of Dr Henry McGill, who compared the coronary arteries in a large number of diabetics and non-diabetics.
These problems in diabetics can partly be blamed on other risk factors to which diabetics are prone. For unknown reasons high blood pressure is common in diabetics; and triglyceride levels are often high. In the majority these levels are reduced by conventional treatment of the diabetes. Diabetics are also often obese. Diabetics tend to have too little HDL, the substance which appears to reduce the risk of heart attack. When diabetes is treated HDL levels improve.
There is another form of arterial narrowing in diabetics, affecting the fine arteries; it is this which can harm the kidney and eye, as well as contributing to the more familiar forms of cardiovascular disease. Diabetic animals accumulate a sugar-like substance, sorbitol, in the eye, kidney and nerves, and this may be responsible for some of the ill-effects. This is a hopeful possibility, for insulin treatment of diabetic animals restores their handling of sorbitol to normal; presumably this is also true in man. Recent studies on animals (summarized in a report by Dr Crofford) have made it clear that insulin treatment lessens the ill-effects of diabetes on the eyes, kidneys and nerves.

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