Side Effects of Western Drugs

Western Diabetes Medications & Their Possible Side Effects

The following are the main Western medicines currently used for the treatment of diabetes mellitus.

1. Sulfonylureas

Suflonylureas are a class of orally administered medications which simulate the pancreatic production of insulin and help the body utilize the insulin it makes, thus lowering blood glucose. For these medications to be effective, the pancreas must still be producing insulin on its own.

Generic names Brand names
acetohexamide Dymelor
chlorpropaminde Diabinese
glimepiride Amaryl
glipizide Glucotrol, Glucotrol XL
glyburide DiaBeta, Glynase PreTab, Micronase
tolazamide Tolinase
tolbutamide Orinase

Possible side effects from sulfonylureas include hypoglycemia, upset stomach, skin rashes and/or itching, and weight gain and especially tolazamide and tolbutamide have been associated with atherogenesis leading to coronary artery disease.

2. Biguanides

Biguanides are orally administered medications which decrease the amount of sugar made by the liver and increase the peripheral uptake of glucose. They also help correct insulin resistance and decrease lipids. They are the drug of choice for “prediabetics.”

Generic names Brand names
metformin Glucophage

Possible side effects from biguanides include nausea, vomiting, and diarrhea initially, fatigue, weakness, trouble breathing, a metallic taste in the mouth, aggravation of kidney problems, and lactic acidosis.

3. Alpha-glucosidase inhibitors

Alpha-glucosidase inhibitors are orally administered medications which slow the absorption of starches consumed.

Generic names Brand names
acarbose Precose
miglitol Glyset

Possible side effects of alpha-glucosidase inhibitors include stomach problems and flatulence.

4. Thiazolidinediones

Thiazolidinediones are orally administered medications which make one more sensitive to insulin. Therefore, insulin can move more easily from the blood into the cells for energy. They also increase high density lipids, preserve B cell function, and protect vascular function.

Generic names Brand names
pioglitazone Actos
rosiglitazone Avandia

Possible side effects of thiazolidinediones include nausea, vomiting, stomach pain, lack of appetite, fatigue, yellowing of the skin and/or whites of the eyes, or dark-colored urine, possible hypoglycemia, infertility, weight gain, and edema of the lower limbs. Liver monitoring is required during use of this class of medications.

5. Meglitinides

Meglitinides are orally administered medications which stimulate the pancreas to make more insulin.

Generic names Brand names
repaglinide Prandin

Possible side effects of meglitinides include hypoglycemia and weight gain. Meglitinides are contraindicated in sulfa-sensitive patients, and should be used cautiously in those with hepatic and renal problems.

6. Insulins

Insulins are, as of this writing, primarily injectable medications. It is also used in insulin pumps. However, oral and inhalable insulins are currently being developed. Insulin is used for patients whose pancreases no longer make their own insulin (type 1 DM) or for type 2 DM patients under stress, during interecurrent illness, undergoing surgery, and for gestational diabetes. Insulin lower blood glucose by moving sugar from the blood into the cells to provide energy for life activities.

Types   Brand names
quick-acting Humalog
short-acting Regular (R) insulin
intermediate-acting NPH (N), Lente (L), or Humulin-N
long-acting Ultalente
mixed NPH & Regular insulin mixture

Intermediate-acting is the most frequently used of these types of insulin.

Possible side effects of insulin include hypoglycemia, insulin allergy, fat atrophy, and fat hypertrophy

Glossary of diabetes

Acetone: A chemical substance produced during the breakdown of body fat and checked in the urine when poorly controlled

Acidosis: The abnormal state of too much acid in the blood. This condition can be a serious complication of type 1 diabetes or treatment with metformin.

Albumin: A type of water soluble blood protein that may appear in the urine when the kidneys are damaged

Albuminuria: The presence of albumin in the urine

Alpha cells: A type of cell found in the islets of Langerhans which produce and secrete a hormone called glucagon (the main counter-regulatory hormone) which raises the level of glucose in the blood

Amaurosis diabetica:  Complete loss of vision, especially when there is no known pathology of the eye.

Arthropathy:  Any joint disease with or without pain (arthralgia)

Atherosclerosis: A chronic disease in which excessive amounts of fats and cholesterol remaining in the bloodstream collect on the inside walls of the arteries, forming plaque that gradually thickens and hardens the arterial walls, thus slowing down and interfering with the circulation of blood until a blockage occurs.

Athlete’s foot: A fungal infection of the feet, also called tinea pedis and Hong Kong foot

Autoimmune process: A process where the body’s immune system attacks and destroys the body’s own tissue, mistaking it for foreign matter based on molecular mimicry

Autonomic neuropathy: Dysfunction of the nerves of the autonomic nervous system, including those that affect the function of the stomach, intestines, esophagus, bladder, genitalia, sweat glands, and even the heart and which regulate the blood pressure

Background diabetic retinopathy (a.k.a. nonproliferative retinopathy): The earliest stage of diabetic retinopathy in its mildest form. In this condition, the fine blood vessels and capillaries within the retina become narrowed, clogged, and swollen and form balloon-like sacs. These altered vessels leak blood and fluid, causing the retina to swell or form deposits called exudates the center of the retina or macula.

Balanitis diabetica:  Inflammation of the glans penis and under the prepuce with purulent discharge present

Beta cells: Insulin-producing and secreting cells in the islets of Langerhans

Blood glucose: The main sugar in the blood that the body makes from food and is used by the cells for energy or stored as glycogen for future energy needs. However, cells cannot make use of this sugar without the help of insulin.

Blood lipid: Fat present in the blood, including triglycerides and cholesterol

Blood pressure: The force of the blood against the artery walls

Blood urea nitrogen (BUN): A common blood test that can determine the level of urea in the blood which, in turn, is a rough measure of hydration and kidney function

Brittle diabetes (a.k.a. labile or unstable diabetes): Marked fluctuations in blood glucose concentrations which are difficult to control, causing frequent episodes of insulin reactions or coma despite good therapy for management and medical supervision

Calorie: Unit used to express the heat or energy value of food

Carbohydrate: One of three major sources of calories in the diet. Carbohydrate is broken down into glucose during digestion and is the main nutrient that raises blood glucose levels. Carbohydrates come primarily from sugar (i.e., simple carbohydrate) and starch (i.e., complex carbohydrate).

Cardiovascular disease: Disease processes affecting the peripheral circulation and the heart muscle

Cerebrovascular disease: Disease processes affecting the blood supply to the brain, particularly with reference to pathologic changes such as stroke and other cognitive defects

Cerebral vascular accident (i.e., stroke): Impaired cerebral blood supply

Cholesterol: A wax-like fatty substance found in foods and manufactured internally by the liver found in blood, muscle, the liver, brain, and other tissues. Cholesterol is a form of lipid. In the correct amount, it performs important functions as a building block for cells and certain hormones. When its levels in the blood become too high, it causes atherosclerosis.

Chronic hyperglycemia: Excessively high blood glucose that is slowly progressing and long continuing and may result in diabetic ketoacidosis or nonketotic hyperosmolar coma

Claudication: A condition caused by local temporary deficiency of blood to the muscles due to atherosclerosis of the arteries (peripheral vascular disease) and characterized by attacks of tightness or pain in the affected thigh, calf, or other muscles brought on by walking or other exercise and always associated with the same amount of effort

Coma: Loss of consciousness

Coronary artery disease: Atherosclerosis of the large blood vessels leading to the heart resulting in decreased blood supply to the heart muscle. Its symptoms include arrhythmias, fatigue, congestive heart failure, enlarged heart, syncope or collapse, angina, dyspnea, myocardial infarction, or thrombosis. It is the most common form of heart disease.

Creatinine clearance: A proportional test using a 24 hour urine sample and a blood sample showing how well the kidneys are working to cleanse the blood

Crystalline insulin: Regular insulin

Cystitis: Inflammation of the bladder

Diabetes: Either diabetes insipidus or diabetes mellitus, disease having the symptoms of polyuria in common. However, when used without qualification and by common usage, this term refers to diabetes mellitus characterized by high glucose levels.

Diabetes complications: Either short term (acute) or long-term (chronic) impairments which affect the microvascular or macrovascular blood vessels in persons with diabetes, such as (acute) hypoglycemia, hyperglycemia, diabetic ketoacidosis, and nonketotic hyperosmolar coma; and (chronic) visual impairments, diabetic nephropathy, cardiovascular and cerebrovascular disease, and diabetic neuropathy

Diabetes education: Approved American Diabetes Association patient and family education for self-management and treatment of diabetes by 1) diet, 2) exercise, 3) self-monitoring of glucose levels, and 4) taking diabetes medications as prescribed

Diabetes insipidus: Chronic excretion of very large amounts of urine causing dehydration and extreme thirst ordinarily resulting from pituitary dysfunction, damage, or injury

Diabetes mellitus: A disorder which prevents the body from converting digested food into the energy needed for daily activities. It is caused by either an absolute or relative deficiency of insulin. either the body cannot make enough insulin or it cannot use the insulin it does produce properly. Diabetes is a metabolic disorder of fat metabolism which changes the way our bodies break down and use starches and glucose. It is a disease of the pancreas characterized by excessive thirst, hunger, urination, weakness, acidosis, and, without treatment, coma and death.

Diabetic: Relating to or suffering from diabetes

Diabetic coma: Loss of consciousness due to brain edema developing when insulin and blood glucose are so out of balance that ketones accumulate in the blood. It is marked by high blood glucose levels and ketones in the urine and occurs almost exclusively in persons with type 1 diabetes.

Diabetic ketoacidosis (DKA): A life-threatening metabolic emergency resulting from either an absolute deficiency of insulin or acute resistance to insulin developing when absolute insulin deficiency and excess counter-regulatory hormones increase liver glucose production, decrease peripheral glucose utilization, and stimulate release of fatty acids from fat cells and the production of ketones by the liver. These changes cause hyperglycemia, osmotic diuresis, volume depletion, and acidosis.

Diabetic neuropathy: Damage to the nervous system which affects either or both the peripheral and autonomic nervous systems. Damage to the peripheral nervous system causes impairment of the motor nerve affecting voluntary movement and sensory nerves affecting touch and feeling sensations, especially the ability to feel pain impulses. Autonomic neuropathy has been discussed above.

Diabetic retinitis: Inflammation of the retina of the eye caused or complicated by diabetes

Diabetic retinopathy: A progressive disorder of the retina damaging the receptor cells and small blood vessels in the eye that can lead to vision changes and, eventually, complete blindness

Diabetologist: A physician specializing in the study and treatment of diabetes, an internist/endocrinologist

Dialysis: A method of removing waste from the body and maintaining the chemical balance of the blood when the kidneys have become damaged and are no longer functioning properly. There are two basic types: hemodialysis and peritoneal dialysis. In hemodialysis, the person is connected to an artificial kidney blood filtering machine three times per week. Peritoneal dialysis enables people to do dialysis without an articifial kidney blood filtering machine practically anywhere clean.

Diplopia: Double vision. This can occur with cerebral vascular accident (CVA) affecting posterior (vertebral) circulation.

Emergency measures (emergency diabetic assistance): The regimen of treatment fro the rapid onset of hypoglycemia. There are three degrees of hypoglycemia requiring such emergency measures: 1) a mild range of severity requiring emergency self-treatment, 2) a moderate range of severity which may require assistance in treatment, and 3) a severe ranged with usually requires immediate attention and assistance by someone else.

Endocrinologist: A internal medicine physician specializing in the study and treatment of the endocrine glands and their pathologies, including the pancreas and diabetes mellitus

Fasting blood sugar (FBG): A laboratory test taken after at least eight hours of fasting useful in making a diagnosis of diabetes

Fat: One of the three groups of nutrients which supply energy to the body. Fat in the blood is measured as triglycerides and cholesterol.

Fiber: The indigestible portion of plant foods such as fruit, vegetables, cereals, and grains

Food exchange: Foods grouped together due to similarities in nutritional value. Food exchanging is a way to help people stay on special foods plans by letting them replace items from one food group with items from another food group.

Foot ulceration: A wound with superficial loss of tissue from trauma which may become ulcerated is infection occurs. Such a foot ulceration may go undetected in persons with diabetes who have diabetic neuropathy because of loss of sensation and inability to feel the pain normally associated with such wounds and ulcers.

Fructose: A carbohydrate sugar found in fruits and candy

Gangrene: The death of body tissue, often caused by loss of blood flow, as in arteriosclerosis or peripheral vascular disease

Gestational diabetes (GDM): Diabetes mellitus that develops during pregnancy and usually goes away spontaneously after delivery. However, 60% of women experiencing GDM will eventually develop type 1 diabetes.

Glaucoma: A disease of the eye characterized by high intraocular pressure, damaged optic disk, atrophy of the optic nerve, and hardening of the eyeball resulting in partial defect in the field of or complete loss of vision. Glaucoma is associated with high blood pressure, diabetes, atherosclerosis, and optic nerve damage.

Glomerulopathy:  Any disease of the glomerulus of the kidney

Glomerulosclerosis diabetica:  Fibrosis of the renal glomeruli seen in some cases of diabetes

Glucagon: A hormone produced by the alpha cells which stimulates release of glycogen stored in the liver and muscles, thus raising the level of blood glucose when the blood glucose falls to levels below normal. Glucagon is available as an injectible preparation for very severe low blood glucose reactions.

Glucose: A simple form of sugar that acts as the body’s fuel. It is produced when foods are metabolized in the digestive system and carried by the blood to the cells for energy. The amount of glucose in the blood is know as the blood glucose level or glycemia.

Glucose tolerance test: A blood test utilizing 4-5 specimens over 3-4 hours used to make the diagnosis of diabetes, including gestational diabetes

Glycogen: The stored form of glucose found in the liver and muscles

Glycosuria: The urinary secretion of glucose, usually in enhanced quantities

Glycosylated hemoglobin (HbA1c): A test administered to review average blood glucose control for the past 3-4 months

Hemodialysis: The most common form of treatment for end stage renal failure. After surgically implanting a piece of graft material tubing , an artificial kidney is used to remove waste from the person’s blood.

Hemoglobin: A substance in red blood cells that picks up oxygen in the lungs and supplies oxygen to the cells of the body

High density lipoprotein (HDL): Called, the “good” cholesterol, high density lipoprotein removes cholesterol from the blood stream, thus preventing it from accumulating in the blood vessels

Hormone: A chemical substance produced in tiny quantities by the body’s endocrine glands and circulated by the blood

Hyperglycemia: A high blood glucose level

Hyperglycemic episode or reaction: Refers to slow onset of severe elevation in blood glucose levels causing acute complications, such as stupor, lethargy, blurred vision, disorientation, slow responses, weakness, diabetic ketoacidosis, and nonketotic hyperosmolar coma

Hyperinsulinism (hyperinsulinemia): Increased levels of insulin in the plasma due to increased secretion of insulin by the beta cells of the pancreatic islets and decreased liver removal of insulin or insulin resistance. This condition is most commonly found in obese persons with hyperglycemia.

Hyperlipidemia: The presence of abnormally large amounts of lipids or fats in the circulating blood

Hypertension: High blood pressure

Hypertriglyceridemia: High levels of triglycerides in the blood

Hypoglycemia (glucopenia): A condition in which blood glucose drops too low and which can occur slowly (CNS symptoms) or rapidly (sympathetic symptoms). Hypoglycemia may cause cognitive dysfunction and loss of consciousness if untreated.

Hypoglycemia unawareness: The lack of ability to recognize warning signs of hypoglycemia, such as weakness, nervousness, sweating, increased heart rate, and irritability. This condition is found in the elderly, long-term diabetes patients, and those using beta-blockers.

Hypoglycemic coma: Loss of consciousness resulting from excessive doses of exogenous insulin or oral hypoglycemic agents

Hyponatremiae: Low blood sodium

Impaired glucose tolerance: A condition in which blood sugar levels are higher than normal but are not high enough to be classified as diabetes. However, this is a risk factor for type 2 diabetes.

Impotence: Inability to achieve and/or sustain and erection

Insulin: A hormone manufactured by the pancreas in the beta cells of the islets of Langerhans which facilitate the entry of glucose into the cells of the body. This hormone is needed to convert glucose, starches, and other food into energy needed for daily life.

Insulin deliver (insulin injections): The method of injecting exogenous insulin into the body’s bloodstream

Insulin-dependent diabetes (IDDM, type 1 diabetes): A chronic condition in which a person is unable to properly metabolize glucose leading to severe hyperglycemia. Persons with this type of diabetes must take exogenous insulin to prevent the development of ketoacidosis.

Insulin reactions: (diabetic shock or hypoglycemic reaction): Severe hypoglycemia produced by administration of insulin, manifested by sweating, tremor, anxiety, vertigo, and diplopia (double vision), followed by delirium, convulsions, and collapse

Insulin receptors: Proteins that extend through the cells membranes that bind insulin which then transports glucose into the cell

Insulin resistance: A partial blocking of the effect of insulin thus preventing the glucose in the blood from entering the cells for use as energy or storage for future use

Islets of Langerhans: Clusters of alpha, beta, delta, and polypeptide cells throughout the pancreas

Juvenile diabetes: An old term for type 1 or insulin-dependent diabetes. While the onset of type 1 diabetes is typically detected in children, it may also occur in adults.

Ketoacidosis:  Acidosis due to an excess of ketone bodies

Ketones: Acids produced when the body breaks down fat for fuel. This occurs when there is not enough insulin to permit glucose to enter the cells.

Ketonemia: The presence of recognizable concentrations of ketone bodies in the plasma

Ketonuria: The presence of ketones in the urine

Ketosis: An enhanced production of ketone bodies secondary to the breakdown of fat

Keto-stix: A test for ketones in the urine

Kidney threshold: The level at which sugar spills over into the urine. This level is very variable among individuals.

Kussmaul breathing: Deep, rapid breathing seen in diabetic acidosis

Labile diabetes: A term used to indicate that a person’s blood glucose often swings quickly from high to low and from low to high. This is also known as brittle diabetes.

Labored breathing: Kussmaul breathing

Lactic acidosis: The accumulation of excessive lactic acid in the blood resulting from the muscles burning glucose in anaerobic conditions. It is characterized by bicarbonate levels less than 10mmol/L and normal plasma ketones.

Lactose: Milk sugar

Latent diabetes (chemical diabetes): A mild form of diabetes mellitus in which the person displays no overt symptoms but does display certain abnormal responses to diagnostic procedures, such as elevated fasting blood glucose concentration or reduced glucose tolerance. A diet high in glucose and simple carbohydrates may cause latent diabetes to become evident.

Lipid: A term for fat. there are many types of lipids in the body

Lipoatrophy: Dents or depressions in the skin that may form when insulin is constantly injected into the same place. This can cause problems with absorption of insulin.

Lipodystrophy: Lumps or depressions in the skin that may develop when insulin is constantly injected into the same place

Lipohypertrophy: Lumps in the skin that may develop when insulin is constantly injected into the same place

Low density lipoprotein (LDL): Called the “bad” cholesterol because it carries most of the cholesterol in the blood

Maculopathy (macular edema): Clogging and swelling of the retinal capillaries causing leaking of fluid into the retina where it pools in the center of the retina or macula

Macrosomia: Literally, this term means “large body.” It refers to a baby who is considered larger than normal due to the mother’s higher than normal blood sugar levels during pregnancy.

Maturity onset diabetes in youth (MODY): Type 2 or noninsulin-dependent diabetes occurring in children and young people

Melituria:  The presence of  sugar in the urine

Metabolism: The complex physical breakdown and synthesis of chemical changes occurring in the tissues of the body and especially the conversion of food substances into energy

mg/dl: Abbreviation for milligrams per deciliters, the unit of measurement used in the U.S. when referring to blood glucose levels

mmol/L: Abbreviation for millimoles per liter, the unit of measurement used in Europe and the People’s Republic of China when referring to blood glucose levels. Diabetes is diagnosed when the level of glucose in the blood is greater than 7.0mmol/L (fasting) or greater than 11.1mmol/L (random).

Moniliasis (candidiasis): A fungal infection common in people with diabetes, frequently in the vagina

Neovascularization: Growth of tiny new abnormal blood vessels in areas where circulation is impaired, e.g., the retina of the eye in diabetic retinopathy. This condition leads to loss of vision.

Nephropathy: Damage to the nephrons or filtering portions of the kidneys, a degenerative kidney disease that may occur in long-term diabetes

Neuropathy: Damage to nerve tissue causing loss of sensation and reflexes and/or burning or stabbing pain, especially at night. Neuropathy can affect many parts of the body and is one of the common long-term complications of diabetes.

Noninsulin-dependent diabetes mellitus (NIDDM): Type 2 diabetes

NPH insulin: Intermediate-acting insulin

Obesity: The condition of being more than 20% in excess of ideal body weight

Oral glucose tolerance test (OGTT): A three hour test used to diagnose diabetes mellitus which includes glucose loading after fasting for eight hours and then determining blood glucose levels every hour afterwards for three hours

Oral hypoglycemic: Any orally administered medication meant to lower blood glucose in patients with type 2 diabetes. Such oral hypoglycemic agents are not insulin or a substitute for insulin.

Overweight: The condition of being less than 20% in excess of ideal body weight

Pancreas: The endocrine gland located in the abdomen behind the stomach that produces insulin and digestive enzymes

Peripheral artery disease: Blockage of the arteries of the extremities (mostly the lower extremities) by atherosclerotic plaques causing intermittent claudication and leading to infections, gangrene, and possible amputation

Peripheral neuropathy: Neuropathy affecting the peripheral nervous system. It is further subdivided into: 1) distal symmetrical polyneuropathy, 2) mononeuropathy, 3) cranial mononeuropathy, 4) truncal monneuropathy, 5) proximal motor neuropathy, and 6) focal neuropathy depending on which nerves are affected in which areas of the body

Phthisis:  Any wasting or atrophic disease

Polydipsia: Excessive thirst, due in turn to excessive urination with subsequent dehydration, leading to excessive drinking that is relatively chronic

Polyphagia: Excessive appetite, literally “numerous eating”

Polyuria (hydruria): Excessive urination

Postprandial blood glucose (PPBG): A blood test performed 1-2 hours after a meal to detect blood glucose level

Prediabetes:  The condition prior to the development of clinical diabetes

Proliferative retinopathy: A disease of the small blood vessels of the retina of the eye caused by retinal neovascularization. These new vessels are quite fragile and may break and bleed into the clear fluid that fills the center of the eye causing vision changes.

Protein: One of the three major food substances which is used to build body tissues

Pruritus: Itching

Rebound hyperglycemia (Somogyi effect): An abnormally high rise in blood glucose after an episode of low blood glucose that may result from over-treatment of hypoglycemia or from secretion of counter-regulatory hormones that raise the blood glucose level in reactive hypoglycemia

Regular insulin: Fast-acting insulin

Renal failure: As a result of excessive glucose in the bloodstream, the capillary walls overwork in filtering the waste products and build up scar-like material that eventually collapse the glomeruli filtering process, causing kidney damage. The kidneys almost completely stop cleaning wastes from the blood. Therefore, wastes build up to poisonous levels and can cause death. When creatinine and blood urea nitrogen levels in the blood are high, kidney failure will likely progress more rapidly unless treated. the two choices for renal failure are dialysis or transplant.

Renal threshold: The concentration of plasma substance above which the substance appears in the urine

Rest pain: An unpleasant sensation associated with actual or potential tissue damage usually occurring in the extremities during bodily inactivity, such as sitting or lying down

Retinopathy: Disorders of the retina or nerve tissue in the eye often seen in diabetes

Secondary diabetes: A type of diabetes caused by another disease or damage to the pancreas from chemicals, certain medicines, or disease of the pancreas, such as pancreatic cancer. Secondary diabetes may occur as a consequence of acromegaly, Cushing’s syndrome, hyperthyroidism, or surgical removal of the pancreas.

Semi-lente insulin: Rapid-acting insulin

Senile diabetes: Also known as adult onset diabetes, this is an old term for type 2 or noninsulin-dependent diabetes.

Serum creatinine: A test to determine the amount of creatinine in the blood. Increases may signal renal failure, urinary obstruction, dehydration, and/or hyperthyroidism.

Stroke: Damage to part of the brain that happens when the blood vessels supplying that part of the brain are blocked, as occurs with atherosclerosis and thrombus/embolus (dry stroke) or as a result of vessel rupture (wet stroke)

Stupor: Marked cessation of mental activity or feeling, often produced by sleepiness, illness, or the effects of alcohol or narcotics

Sucrose: Ordinary table sugar which breaks down to glucose and fructose in the body

Sulfonylureas: A class of oral medications for type 2 diabetes, also known as oral hypoglycemic agents. They lower blood sugar primarily by improving insulin production and tissue sensitivity to insulin.

Syncope: A brief loss of consciousness from a transient deficiency in the oxygen-carrying capacity of the blood to the brain due to brainstem dysfunction, cardiac valve disease, or heart block dysrrhythmias (Stokes-Adams syndrome)

Syndrome X: A combination of central obesity, high blood pressure, insulin resistance, and a high HDL to total cholesterol ratio predisposing a person to heart disease

Tabes: A gradual, progressive wasting in any chronic disease

Tabes diabetica: Peripheral neuritis affecting the spinal cord

Temporary precipitating factor: A transient, unforseen or unknown event that contributes to or results in insulin reaction episodes in spite of conscious efforts by a person with diabetes and their health care team

Tes-tape: A test for sugar in the urine

Tight management: A treatment regimen suggested by the American Diabetes Association as a way to delay the onset and dramatically slow the progression of microvascular complications from diabetes. This consists of intensive insulin therapy, strict monitoring of blood glucose levels, lifestyle changes, exercise, and healthier diet.

Tissue damage: Impairment of the usefulness of the four basic tissues in the body: 1) epithelium, 2) connective tissue, including blood, bone, and cartilage, 3) muscle tissue, and 4) nerve tissue, any of which may be affected as a result of diabetes

Triglyceride: A type of blood fat which requires insulin to remove it from the bloodstream

Type 1 diabetes: A condition in which the pancreas makes so little insulin that the body cannot use blood glucose as energy and which must be controlled by daily injection of insulin

Type 2 diabetes: A condition in which the body either makes too little insulin or cannot use the insulin it does make to convert blood glucose into energy. This type of diabetes can often be controlled through proper meal plans, exercise, and either oral hypoglycemic agents or insulin.

Ulcer: A break or deep sore in the skin

Ultralente: Long-acting insulin

Urine test (urinanalysis): The analysis of the fluid and dissolved substances excreted by the kidneys and found in the urine. Urine tests for ketones are the only test for measuring ketones and are important in preventing ketoacidosis.

Vascular changes: Complications relating to or consisting of the thickening of the blood vessel linings causing decreased blood flow of nutrients through narrowed arteries (atherosclerosis) to the heart (cardiovascular), brain (cerebrovascular), and extremities (peripheral vascular).

Visual changes: Diabetes-induced alteration from normal in vision due to pathological changes in the small arteries that provide blood to the retina. Diabetic vision complications include: 1) cataracts, 2) background retinopathy, 3) macular edema, 4) retinitis, 5) proliferative retinopathy, 6) glaucoma, 7) retinal detachment, and 8) blindness.

Vitrectomy: A surgical operation to remove blood that sometimes collects at the back of the eyes when a person has eye disease

Xanthoma diabetica: Cutaneous tumorous disease associated with uncontrolled diabetes mellitus