الريم اتمني ان ها الموضوع يريحك
وعندك ابو عبدالله دام انه يعرف خليه يترجم واعتقد انه حول موضوعك
A New Kind of Diabetes that is Often Misdiagnosed
Up to 20% of people diagnosed with Type 2 diabetes are not overweight. If you are one of them, it's worth doing some research to make sure that you don't, in fact, have another kind of diabetes, one that many doctors don't even know about.
This kind of diabetes, called "Maturity Onset Diabetes of the Young" is a genetic form of diabetes causing failure of the beta cells, It is believed to affect up to 5% of all people diagnosed with both type 1 and type 2 diabetes.
Recent Research Has Changed Our Understanding of MODY
Until very recently, this form of diabetes was thought to only affect people under age 25. However, more recent genetic studies where the family members of people diagnosed with MODY were given genetic testing turned up the fact that people with MODY are often misdiagnosed as having Type 1 or Type 2 diabetes, and that MODY can develop into full-fledged diabetes as late as age 50. The Klupa study, referenced below, found that in one kind of MODY diabetes developed in 65% by age 25 years and in 100% by age 50 years, so more than 1/3 of all people with this kind of diabetes do not develop it in youth.
In the case of other forms of MODY, the blood sugar problems may be so mild as to escape diagnosis. So while a person must have a parent with the MODY gene to develop MODY, the fact that your parent was not diagnosed does not rule out the possibility that you have it. Especially if you got your MODY gene from your father. If the MODY gene comes from your mother, it is much more likely that she would have developed gestational diabetes during pregnancy and been diagnosed, but even here you can't be sure as testing and treatment of gestational diabetes in people who were not obese was very lax as recently as the 1980s.
How do You Get Diagnosed with MODY?
Unfortunately, the only way to get a definitive diagnosis it to take a series of up to 6 genetic tests, each one of which costs around $500. But these tests may be inconclusive since there are still a significant percentage of people with MODY symptoms who don't test positive on these tests. The Joslin Diabetes Center web site states that one thired the families with MODY diabetes it is following do not have a diabetes that can be diagnosed as one of the six forms already diagnosed.
Even worse, most health insurers will not pay for these genetic tests, so you may have to approach a diagnosis by looking at your family history, your personal history, your weight history, and indications of how insulin resistant you are.
Here are some issues to consider in deciding whether there is some possiblity you have MODY:
If you have diabetes through you have always been of a normal or near normal weight or were at a normal weight until shortly before your diabetes diagnosis. (In some forms of MODY the high blood sugars can cause mild insulin resistance which can lead to weight gain.).
If you have a history of gestational diabetes that occurred when you were at a normal weight
If you have close relatives who had adult onset diabetes who were of normal weight.
If taking drugs that improve insulin resistance like Metformin or Avandia don't make a significant change to your A1c.
What are the Characteristics of MODY Diabetes?
First of all, it's important to know that MODY comprises a variety of genetic flaws and new ones are being discovered every year. The ADA document cited above, which was published in 1998 reports there are 3 such mutations known. Today a web search will turn up the information that there are 6 known genetic flaws that produce MODY. A researcher from the Joslin Diabetes Clinic told me that they are currently doing a study of families with possible MODY to identify new MODY genes and that they expect to find dozens of them.
There are subtle differences between how the different versions of MODY manifest. But here are some of the traits they have in common:
People with MODY are usually of normal weight, at least until shortly before their diabetes diagnosis. Thuis can lead to their being misdiagnosed as having a late-onset form of Type 1 diabetes (LADA). However, people with MODY do not have the GAD antibodies characteristic of people with LADA.
People with MODY often have normal fasting blood sugar and very high post-meal blood sugars.
The age of onset of diabetes in at least one form of MODY, depends on the parent who passed on the mutant allele. It is significantly younger if it was the mother who passed on the gene and if she had diabetes during the pregnancy. If you have been diagnosed with Type 2 diabetes but your child developes diabetes in her 20s without obesity, MODY may be a possibility.
MODY may develop at any age up to 55. Unfortunately, many documents about MODY repeat the outdated information that MODY only strikes people under 25, and many doctors continue to believe this. More recent research has shown this is not true, especially for people with milder, harder to diagnose, versions of MODY.
Women with MODY are often first diagnosed during a first pregnancy. Though not obese, they develop gestational diabetes very quickly.
People with MODY often are not insulin resistant. They will respond to very small doses of insulin or drugs that stimulate insulin production. However, this is not always true. In one version of MODY, high blood sugars apparently cause insulin resistance, though the genetic defect is thought to be the primary cause of the diabetes.
Some versions of MODY respond very well to sulfonylurea drugs, however these drugs are controversial as recent research suggests that they may actually cause heart attacks.
People with severe MODY are sometimes misdiagnosed as having Type 1 diabetes. However people with MODY often make normal or near-normal amounts of C-peptide despite having very high blood sugars. Most importantly, people with MODY who are treated as Type 1 diabetics tend to stay in the "honeymoon period" and continue to use very small doses of insulin for many years after diagnosis--less than .5units/kg of body weight. They also do NOT have GAD-antibodies.
In one common form of MODY, fasting blood sugar is normal, but insulin secretion begins to fail as blood sugars go over 144 mg/dl. This can lead to a difficult to diagnose form of diabetes as fasting blood sugar may remain normal for many years.
Here's a journal article that describes a family where a father is misdiagnosed as having type 2 and his daughter as having type 1. After genetic testing, both turned out to have MODY-1.Identification of MODY:
The implications for Holly. Journal of Diabetes Nursing, Jan, 2004 by Jo Dalton, Maggie Shepherd
http://www.findarticles.com/p/articl..._8/ai_n6178372
What if You Have MODY?
MODY is very like Type 2 diabetes in its effect on your body. Elevated blood sugars injure you slowly over many years, causing neuropathy, retinopathy, heart disease and the other ugly complications of diabetes.
The recommended treatment for MODY depends on the severity of the diabetes. Some people with MODY can maintain normal blood sugar levels by restricting carbohydrates. The Glucokinase version of MODY is the one most amenable to dietary control. Others, however, require low dose insulin or a sulfonylurea drug. If your doctor wants you to use one of the sulfonylurea drugs like Amaryl, please read up on the increased risk of heart attack that comes with these drugs before going ahead with that treatment.
If you suspect you have MODY and your doctor wants you to start insulin or a sulfonylurea drug, be sure to start at a very low dose.The starting dose that is appropriate for a person who is an insulin resistant Type 2 may be anywhere from two to six times higher than the dose that works well for a person with MODY and a typical type 2 dose may cause dramatic hypos.
If you suspect you have MODY diabetes and are of childbearing age, and if there is diabetes in your spouse's family consider genetic testing. Though it is very rare to have two copies of the same MODY gene, a child who inherits two copies of the same MODY gene will be born with a severe form of diabetes.
REFERENCES
Determinants of the Development of Diabetes (Maturity-Onset Diabetes of the Young-3) in Carriers of HNF-1{alpha} Mutations
Evidence for parent-of-origin effectTomasz Klupa, MD1, James H. Warram, MD, Anthony Antonellis, Marcus Pezzolesi, Moonsuk Nam, MD, Maciej T. Malecki, MD, PHD, Alessandro Doria, MD, PHD, Stephen S. Rich, PHD and Andrzej S. Krolewski, MD, PHD
http://care.diabetesjournals.org/cgi...act/25/12/2292
Altered insulin secretory responses to glucose in diabetic and nondiabetic subjects with mutations in the diabetes susceptibility gene MODY3 on chromosome 12MM Byrne, J Sturis, S Menzel, K Yamagata, SS Fajans, MJ Dronsfield, SC Bain, AT Hattersley, G Velho, P Froguel, GI Bell and KS Polonsky
http://diabetes.diabetesjournals.org...e2=tf_ipsecsha
Assessment of insulin sensitivity in glucokinase-deficient subjects.Clement K, Pueyo ME, Vaxillaire M, Rakotoambinina B, Thuillier F, Passa P, Froguel P, Robert JJ, Velho G.
http://care.diabetesjournals.org/cgi...act/25/12/2292
Sulfonylureas Linked to Heart Deaths - Diabetes in Control Newsletter
http://www.diabetesincontrol.com/mod...ticle&sid=3442
Dose–response relation between sulfonylurea drugs and mortality in type 2 diabetes mellitus: a population-based cohort studyScot H. Simpson, Sumit R. Majumdar, Ross T. Tsuyuki, Dean T. Eurich and Jeffrey A. Johnson
http://www.cmaj.ca/cgi/content/abstract/174/2/169
07-03-2006, 01:21 PM
يضطر الاب الى انه يذب ولده في البيت و يروح للاستراحة يروق هناك مع الشلة العتيدة و اللي جلستهم لا تخلو من القنوات اللبنانية
