Mention the word diabetes and the vast majority of people will assume that you are talking about either type 1 diabetes, which affects about 10% of diabetes sufferers, or type 2 diabetes, which is the most commonly seen form of the disease and is currently growing alarmingly. But did you know that there is a third type of diabetes which has no connection whatsoever with either type 1 or type 2 diabetes, apart from sharing the name diabetes.

Diabetes, whether type 1 or type 2, is a condition in which the body is unable to process sugar satisfactorily and, for this reason, it is sometimes known as sugar diabetes. By contrast, diabetes insipidus, is a condition in which the body is unable to process water correctly and, accordingly, it is sometimes known water diabetes.

Diabetes insipidus is characterized by an unusually high intake of fluid, high output of urine and, in some cases, an excessive thirst. The symptoms of diabetes insipidus include the frequent need to urinate, awakening at night to urinate or involuntary urination while sleeping. Also, the volume of urine output increases because the body is unable to concentrate it and it is usually very pale in color or colorless in appearance.

There are four types of diabetes insipidus:

Neurogenic Diabetes Insipidus

Neurogenic diabetes insipidus (also commonly referred to as pituitary diabetes insipidus) is caused by a lack of the hormone vasopressin, which is produced by the pituitary gland and is needed in order for the kidneys to function properly and to concentrate urine.

Gestagenic Diabetes Insipidus

Gestagenic diabetes insipidus (also known as gestational diabetes insipidus) occurs during pregnancy and is often the result of destruction of vasopressin within the placenta.

Nephrogenic Diabetes Insipidus

Nephrogenic diabetes insipidus occurs when, in spite of the normal production of vasopressin, the kidneys still fail to properly concentrate urine. This form of diabetes insipidus can be inherited and can also be the result of kidney disease and taking certain types of drug.

Dipsogenic Diabetes Insipidus

Dipsogenic diabetes insipidus is a type of primary polydipsia in which an excessive fluid intake suppresses the effects of the hormone vasopressin. This is usually caused by an abnormality in the part of the brain that regulates thirst. Dipsogenic diabetes insipidus is easily confused with neurogenic diabetes insipidus and the only way to identify which form of the disease you are looking at is to measure the body's production of vasopressin.

There is also a second type of primary polydipsia known as psychogenic polydipsia which, as its name would suggest, has a variety of psychosomatic causes.

Despite the fact that there is some similarity in the symptoms of diabetes and diabetes insipidus it seems strange, and more than a little confusing, that the medical profession should have decided to give these two quite different conditions the same name.

By Donald Saunders

The word diabetes was coined by the 2nd-century A.D. Greek physician, Aretus the Cappadocian, meaning 'the siphon' as the condition is characterized by excessive urination.

According to the World Health Organization (WHO), diabetes is a chronic disease that occurs when the pancreas either does not produce enough insulin or when the body cannot effectively use the insulin it produces. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels. The word mellitus was added to diabetes in 1675 by Thomas Willis. Mel in Latin means honey and refers to the excess of glucose in the urine and blood of people with diabetes.

Types of diabetes

According to WHO, there are three main types of diabetes:

Diabetes Type 1 - The body does not produce insulin at all. Also called early onset or juvenile diabetes, it requires the person to inject insulin throughout his/her life. People suffering from this types of diabetes are also very prone to ketoacidosis. The cause is not certain and could be genetic, viral, or multifactorial.

Diabetes Type 2 - Also called maturity onset, Type 2 diabetes is a result of insulin resistance. The body doesn't produce enough insulin, or is not able to utilize insulin effectively.

Gestational Diabetes - A form of diabetes that develops during pregnancy.

Diabetes Types 1 & 2 are chronic, lifelong medical conditions. Gestational diabetes usually disappears after the birth of a child but can later lead to type 2 diabetes.

Juvenile diabetes may be either Type 1 or Type 2, and is seen in children or adolescents.

Symptoms

Common symptoms of diabetes are:
* Frequent urination
* Disproportionate thirst
* Intense hunger
* Weight gain
* Unusual weight loss (More common among people with Diabetes Type 1)
* Increased fatigue
* Irritability
* Blurred vision
* Cuts and bruises don't heal properly or quickly
* More skin and/or yeast infections
* Itchy skin
* Red or swollen gums
* Numbness or tingling, especially in the feet and hands

Diabetes is typically detected by carrying out a urine test, followed by a blood test

High risk groups of diabetes

Certain people are at higher risk of getting Type 2 diabetes. High risk groups include those who:-
* Are over 55
* Have a family history of diabetes
* Are overweight or obese
* Have high blood pressure
* Had diabetes during pregnancy or gave birth to a big baby (more than 9 pounds)
* Are Southeast Asian, Asian Indian, Afro-American, Hispanic American or Native American
* Have polycystic ovarian syndrome (PCOS)
* Have heart disease

There is only one way to check if you have diabetes: get your blood sugar level tested.

Diabetes related complications

Diabetes is a chronic, life-long condition that requires careful monitoring and management. Left untreated, it can lead to various complications such as kidney failure, cardiovascular disease, and blindness in some cases. Diabetes causes about 5% of all deaths globally each year. Diabetes deaths are likely to increase by more than 50% in the next 10 years without urgent action and preventive measures.

Short-term complications:

Low blood sugar (hypoglycaemia)

Anyone who suffers from diabetes and takes insulin is going to face the problem of blood sugar falling too low at some point. This state is called hypoglycaemia and can be corrected quickly by eating something sweet, like candy or plain sugar. If it is not corrected, hypoglycaemia can lead to the person losing consciousness.

The typical signs of hypoglycemia are:
* hunger
* shakiness
* sweating
* dizziness or light-headedness
* confusion
* weakness

Ketoacidosis
This is a severe condition caused by lack of insulin. It mostly affects people with type 1 diabetes. Acidic waste products called ketones are produced when the body breaks down fats. In the absence of insulin, the body cannot release all the ketones and they build up in your blood, causing ketoacidosis.

Lactic acidosis
Lactic acidosis is the build-up of lactic acid in the body. Too much lactic acid in the body makes people feel ill. Otherwise, Lactic acidosis is a rare ailment. It mainly affects people with type 2 diabetes.

Bacterial / fungal infections
Patients are more prone to fungal and bacterial and infections like boils, boils, athlete's foot, sties, ring worm, and vaginal infections.

Long-term complications:

Eye disease (retinopathy)
As per statistics, about 2% of all people who have had diabetes for 15 years or more become blind, while about 10% develop a severe visual impairment.

Kidney disease (nephropathy)
Diabetes is the leading cause of kidney disease (nephropathy) and failure. About one third of all people with diabetes develop kidney disease and approximately 20% of people with type 1 diabetes develop kidney failure.

Nerve disease (neuropathy)
Diabetic nerve disease, or neuropathy, affects at least half of all people with diabetes. Common complaints are loss of sensation in the feet or in some cases the hands, pain in the foot and problems with the functioning of different parts of the body including the heart, the eye, the stomach, the bladder and the penis. A lack of sensation in the feet and hands can lead to patients to injure themselves without realizing it.

Diseases of the circulatory system
The risk of heart disease is 2-4 times higher in diabetes patients than for those who do not have diabetes. It is the main cause of disability and death for people with type 2 diabetes in industrialized countries.

Amputation
Diabetics are more likely (20 to 35 times) to require lower-limb amputation.

Prevention & Lifestyle modification

Experts and doctors believe that while there is yet no evidence to suggest that Type 1 diabetes can be prevented, primary prevention of type 2 diabetes is possible.

Weight control, a balanced diet, and increased physical activity are important in the prevention of type 2 diabetes. The benefits of reducing body weight and increasing physical activity also play a role in reducing heart disease, high blood pressure, etc.

Secondary prevention involves the early detection and prevention of complications, therefore reducing the need for treatment. Regular annual check-ups go a long way in timely detection of diabetes. Periodic check of blood glucose levels is a must as are the monitoring of blood pressure and cholesterol levels.

Healthy eating, regular exercise, weight control all contribute to good cardiovascular health. Diabetics should also quit smoking.

According to the Mayo Clinic, daily intake of calories should consist of:
* Carbohydrates 45% to 65%
* Proteins 15% to 20%
* Fats 20% to 35%

Patients are advised to adhere to meal plans for portion sizes and eating times. This will keep blood sugar and your weight ideal.

Treatment

Though there is no known cure for diabetes, all types of diabetes are treatable. The main treatment for a Type 1 diabetic is injected insulin, along with some dietary and exercise adherence.

If you have Type 1 and follow a healthy eating plan, do adequate exercise, and take insulin, you can lead a normal life. Larry King, Halle Berry, and several well known diabetic US baseball and basketball players lead normal lives. Type 2 patients need to eat healthily, be physically active, and test their blood glucose regularly. They may also be prescribed oral medication to control blood glucose levels. Sometimes, Type 2 patients may also require insulin injections.

Herbal Remedies for Diabetes

Diabet Guard Effective in controlling blood sugar and allied complications. It contains the goodness of Jamun, Karela, Methi, Neem, Purified Shilajit and Gurmar leaves.

Amalaki or Indian gooseberry is a rich concentrated source of Vitamin C and is effective in controlling diabetes. A tablespoon of amla juice, along with a cup of bitter gourd juice, stimulates the pancreas to produce insulin.

By Beverleigh H Piepers

Statins are a group of anti-cholesterol medication primarily used for lowering elevated total cholesterol levels and LDL, a type of "bad" cholesterol.

Over the years, statins have served as the mainstay for the prevention of cardiovascular diseases in people with Type 2 diabetes. In fact, as mentioned in a study published in October 2009 by the American Diabetes Association's official journal, Diabetes Care, statins must be added to the lifestyle therapy of anyone with diabetes regardless of their baseline lipid levels. As well, a study released in the October 2006 issue of the American Journal of Cardiology stated the cardiovascular outcome due to the use of statin therapy is significantly more positive in those diabetics who took this anti-cholesterol medication compared to those with Type 2 diabetes who had not been prescribed statins.

However, this is interesting to Type 2 diabetics: in a study, the results of which were published in the Journal of Investigative Medicine in March 2009, researchers noted the intake of statins may result in the elevation of fasting blood sugar levels of people with, and even without, diabetes!

As was also mentioned in an article published by the Journal of the American College of Cardiology, the exact mechanism how statins cause an increase in blood sugar levels is still unclear. And it is still in question whether the hyperglycemia or high blood sugar noted in those people, is the result of a medication that was prescribed to them months earlier.

Here are the statin medications:

* atorvastatin (Lipitor, Advicor)
* simvastatin (Zocor, Lipex, Simcor, Vytorin)
* lovastatin (Mevacor)
* pravastatin (Pravachol)
* rosuvastatin (Crestor)
* fluvastatin (Lescol)

With this rising dilemma due to the intake of statins, there is still one question that still needs to be answered: "How else can cholesterol levels be reduced? "

1. Natural cholesterol reduction through lifestyle modification: Even without the existence of statins in the market, one of the best options for cholesterol control is still available for free: lifestyle modification. Shifting to:

* a low cholesterol
* low saturated-fat
* high fiber

diet is a must to lower the direct effects and the possible complications associated with high cholesterol levels.

Regular physical activity is also necessary to combat this problem. Another lifestyle modification that is very much needed is weight management. As mentioned by the National Heart Lung and Blood Institute, if you are overweight, losing those extra pounds can decrease the level of LDL.

2. Quit Smoking: The National Heart Lung and Blood Institute mentions that smoking can trigger the formation of plaques in the blood vessels resulting in atherosclerosis and possible heart attack. Smoking can also decrease the levels of HDL, the good cholesterol, resulting in an array of cardiovascular diseases.

3. Other medications for cholesterol control: Statins are not the only group of medications that can decrease the "bad" cholesterol within your body. Other medications that can effectively lower blood cholesterol levels include fibrates, niacin and omega-3 fatty acids.

For everyone who is diabetic it is very important to be aware of his or her blood glucose readings and never fail to keep up with them. This tracking of blood glucose readings usually requires a whole armory of diabetic testing supplies. Diabetics should always have on hand these diabetic supplies. The common diabetic supplies include an accurate glucometer, alcohol wipes, lancets, and test strips.

Depending on the type of your insurance, you may be able to choose where to take your diabetic supplies. For example, at first Medicare and Medicaid will cover the expenses for your diabetic supplies. The trick is that if you happen to damage your diabetic supplies, they may not allow you to take more diabetic supplies for a certain period. So, if you lose your diabetic supplies or if you destroy them in any way, you will not be able to take new diabetic supplies. If you have insurance, it will cover most of the expenses for the diabetic supplies. However, if you have no insurance, the diabetic supplies will be at your expenses. Nowadays, online medical stores are available. Such stores are libertymedical.com, diabeticsupplies.com and diabeticexpress.com. They all offer diabetic supplies at low price. In addition, they offer answers to any question you may ask about their products.

Most of these online shopping companies offer free delivery for their products. If you prefer to buy your diabetic medications together with the diabetic supplies, you can order them online with the new service the company Liberty Medical offers. The prescription medications service is available in order not to waste time by shopping online.

I think it is not necessary to remind how important for every diabetic is to have diabetic supplies available. Ask your physician about the regular basis of the blood glucose levels. Then, keep your blood glucose levels on this regular basis, as this is the only way to control this chronic disease. Monitoring of blood glucose levels is only possible with diabetic supplies. Your diabetic supplies should be always somewhere around you.

It is very important to test your blood glucose levels often enough. If the blood glucose levels are either too high or too low, something must be done. For insulin dependant diabetics the blood glucose reading is necessary because in this way they get to know what quantity of insulin is needed. You can be sure that diabetic treatment is working only by blood glucose testing.

Testing is best way to cope with the diabetic disease and that is why having on hand enough diabetic supplies is so important. Of course, some diabetic medications and food diabetic diets will be necessary but can only be sure that they are effective if you test your blood glucose levels with your diabetic supplies. With proper diabetic supplies, diabetes is an entirely manageable disease.

Diabetic Supplies and Medicare
Diabetes is a disease whereby the body does not produce insulin or cannot use the insulin it creates effectively. Insulin reduces the amount of glucose in the blood. A high glucose level in the blood is harmful to the body and indicates that the body can't convert glucose into energy that it needs to function. Consequently diabetics with type 1 diabetes have to monitor their glucose levels and inject insulin into the body to perform this function. Diabetics with type 2 diabetes also have to monitor their condition but don't have to inject insulin. They might take medication that makes the body more responsive to the insulin that their body creates or simply exercise regularly and eat a specialized diet. As yet there is no cure for diabetes so this treatment and care is a lifelong task. This article will outline some of the supplies needed to treat diabetes and how Medicare helps with the costs of the supplies.

Medicare and Diabetes
Medicare is a Federal health insurance program run by the Health Care Financing Administration of the Department of Health and Human Services. Medicare covers people over 65 and people with disabilities. It comes in two forms: Part A and Part B.

Part A Medicare covers costs like hospital bills, nursing homes and hospices. Most people eligible for Medicare get Part A for no cost. Part B is concerned with diagnostic and screening tests and medical supplies and equipment. Most people eligible for Medicare have to pay a monthly premium to receive the benefits of Medicare Part B. Screening for diabetes is free under Medicare. Diabetic testing supplies like a glucose monitor, testing strips and lancets are covered by Part B of Medicare. You pay 20% of the Medicare approved cost for these items. Before you can take advantage of this saving you have to get a certified statement from your health care provider. This can be given to the pharmacy where you get your supplies from along with a Medicare claim.

Training and education on treating diabetes is also covered by Part B. Your health care provider must approve that you need assistance with your management of diabetes. You will pay 20% of the costs of the approved Medicare programs.

Medicare does not cover things like insulin, syringes, insulin pumps or diabetic medication.

You might have heard that the many advances occurring with some of the blood glucose meters allow you to perform blood test monitoring on different parts of your body, like the palm, forearm, upper arm, thigh, or even calf.

Because the skin of these other parts of your body contains fewer nerves, testing can feel much more comfortable. This is what is called Alternative Site Testing, or AST. It's vital to know that while blood from your fingertip can be tested at anytime, there are times when testing from alternative sites aren’t ideal. That's why you should get the information about alternative site testing and talk with your doctor prior to your decision of alternative testing.

Let's go info further detail:

• In comparison with your fingertip, you might see differences in blood sugar results from the palm, forearm, upper arm, thigh, or even calf.
• Blood taken from the fingertip shows changes in blood sugar levels faster than blood taken from the other sites of the body.
• These differences in blood sugar occur because the fingertips have more blood vessels than the alternative sites.

So, alternative site testing is recommended when blood sugar is stable, such as:

• When fasting
• Near bedtime

Times when alternative site testing isn't recommended:

• 2 hours following a meal, when blood sugar values are rising quickly
• After exercise
• When you think your blood sugar is incredibly low or falling quickly (hypoglycemia)
• If you have a history of not noticing when you have low blood sugar (hypoglycemia)
• During the peak action time of the basal insulin
• Up to 2 hours after when injecting rapid-acting insulin
• If you check your blood sugar and the blood sugar test doesn't match the way you feel, then you should perform a fingertip to confirm your result.
• Don't change your course of action based on just 1 blood sugar result.
• Your success in getting an adequate drop of blood from alternate sites will deviate.

When you select a site, stick with it. If you try out on the forearm, always check out on the forearm.

The only exception should be fingertip tests.
Please note: Please talk to your doctor prior to trying alternative sites other than your fingertip for testing blood sugar.

I find the best place to use alternative testing is the palm next to the thumb. You can try other approved alternative sites and see which one works the best for you.

Hypoglycemia (Low Blood Sugar), Diabetes Testing and Driving
Because hypoglycemia can effect your driving performance (even modestly low blood sugar can do this), if you are at all prone to hypoglycemia, I personally would strongly recommend you check out your blood sugar level each time you are about to drive.

Prior to you putting the key in the ignition, test your blood sugar. There are some great glucometers out there, like the Accu-Check Compact with the Accu-Check Multi-clix lancet pen.
The Accu-Check Compact has a 17 strip drum inside so you don't have to take any extra strips with you. The Accu-Check Multi-clix lancet pen has a drum that automatically holds 6 lancets within the pen to use quickly and easily. If your blood sugar is low, treat yourself to some juice or hard candy and don't drive until your blood sugar is back to normal. Then try and eat a small meal, like a low fat cheese and/or turkey sandwich.

Usually in 15 minutes taking 15-20 grams of Carbohydrate (CHO) will usually bring up your blood sugar to normal range. You can have a 4-6 ounce glass of juice, glucose tablets or 2-3 pieces of hard candy. Don't overdo it because your blood sugar will then go sky high. If it doesn't return within normal limits in 15 minutes, repeat the 15-20 grams of CHO and then check your blood sugar in 15 minutes.

Usually if your blood sugar is above 80 mg/dl, you should feel fine but sometimes going above 100 mg/dl, you'll feel better. You should always follow with a small meal that contains CHO, protein that contains a small amount of fat.

I tell my father to put 2-3 peppermint candy right in his pocket and have a supply of hard candy or peppermint candy always stashed in his car. It is best if you eat 6-8 small meals a day. This would include a CHO, protein food that contains a little fat included. Example would be a cheese sandwich that contains 1 or 2 slices of bread, a cheese that is low fat or turkey low in fat but not fat free. The protein and fat does help to stabilize your blood sugar over a period of time instead of a quick spike in your blood sugar and a quick drop in blood sugar like juice would do.

During your trip if you need to take an insulin injection or an oral blood sugar medication, and then make sure you eat as prescribed with your medication, otherwise your blood sugar can go low. I will be writing about how insulin and certain oral blood sugar medications can make your sugar go low. Not all insulin, esp. Lantus, or oral diabetic medications make your blood sugar low.

Signs of Hypoglycemia:

• Cold sweat, faintness, dizziness
• Headache
• Pounding of heart, trembling, nervousness
• blurred vision
• hunger
• Irritability
• Personality Change
• Not able to awaken

Now you can also have problems driving if your blood sugar is over 200 mg/dl. The police officer told me that a diabetic's license can be revoked if an accident is caused by diabetes. I don't know if that is true but why risk losing your license altogether if this is the case. When it comes to driving: if in doubt, check out your blood sugar & eat!

History and physical examination are most important tools for diagnosing diabetes Mellitus, however to confirm diagnosis one should have following laboratory tests.
Urine sugar test

Urine ketenes test

OGTT-Oral Glucose Tolerance Test, (also called glucose challenge test)

Blood glucose tests

FPG-Fasting plasma glucose Test

Random plasma glucose Test

Tests for ongoing monitoring of diabetes control:
HbA1c blood test - an average blood sugar measure over about 3 months.
Fructosamine blood test - an average blood sugar measure over about 2 weeks.
How frequently a person must check his sugar level is the decision of your doctor. It mainly depends upon patient’s age and number of risk factors like blood pressure, higher cholesterol or smoking. If you are above 45 years then you should have your blood sugar level after every 3 years.

A- Urine sample for sugar and Ketenes
You may have your urine analysis for sugar or ketenes which are produced by breakdown of fat and muscle cells to diagnose diabetes but you should keep in mind that if you are having positive urine test for sugar then it is not necessary that you are suffering from diabetes because there are other conditions as well which also cause sugar to appear in urine.

B-THE FASTING BLOOD GLUCOSE (SUGAR) TEST
For diagnosing Diabetes Mellitus one must have this test because it is best, easy and comfortable to perform. You should have overnight fast (at-least 8 hours) before performing this test. If fasting blood glucose is below 100mg/dl, then you don't have diabetes. Between 100mg/dl to 125mg/dl is called a Pre-diabetes or Impaired fasting glucose condition. If fasting blood glucose is above 126mg/dl on more than two occasions then you are suffering from diabetes.

C-RANDOM (NON-FASTING) BLOOD GLUCOSE TEST
It is also a good test for diagnosing diabetes. In this test we take sample of blood shortly after taking a meal and then check glucose level in blood.

D-ORAL GLUCOSE TOLERANCE TEST (OGTT)
Though this test is not commonly used these days but it is still a gold standard for diagnosing diabetes. For diagnosing gestational diabetes this is best test.

Person is not taking anti diabetic drugs or any drug which alters blood sugar level.
Before test, person should eat high carbohydrate diet for three days.
No alcoholic beverages.
On test day one should not smoke or take coffee.

Glucose Tolerance Test Procedure
First normal blood glucose is tested. Then person drinks 75gm of glucose, for pregnant woman dose of glucose is 100 gm. Then blood samples are taken at particular intervals for measuring blood glucose level. Blood glucose level is measured five times over a period of 3 hours. In simple words, in normal person, this blood sugar level gets higher value by taking 75gm of glucose; however it falls down quickly, but in person having diabetes the blood sugar level rises higher than normal but does not come down quickly. If a person has fasting blood glucose above 140mg/dl and 2 hours value after 75gm of oral glucose greater than 200mg/dl and considered as diabetics. If 2 hours blood glucose value between 140-200mg/dl is labeled as Pre-diabetic condition or impaired fasting glucose. During pregnancy, 2 hours blood glucose value between 140-200mg/dl is treated as a case of diabetes.

OTHER TESTS
Glycosylated hemoglobin Test or HB A1 Test:
Very important test which tells you how good you are in controlling your blood sugar. It shows your blood sugar control during the past 2 to 3 months. Intravenous GTT:
This test is performed in individuals who have intestinal disease or malabsorption.

Extended GTT:
In this the oral Glucose Tolerance Test is extended to 3-4 hours rather than 2 hours, for appearance of symptoms of hyperglycemia. In short if your fasting blood glucose is more than 126mg/dl on two or more days, or your random blood glucose is above 200mg/dl or your oral glucose tolerance test is positive i.e. 2 hours blood glucose value between above 200mg/dl after 75gm of glucose, then you are suffering from Diabetes Mellitus.

Always Get Your Blood Sugar Levels Tested To Monitor Diabetes
Although it is now common hearsay that one can easily detect the symptoms of this disease, but one cannot be perfectly sure of being diabetic. It requires a blood test to establish for certain that one has diabetes.

The blood test that is done for checking diabetes is a test to check the blood sugar levels in the body. The test is carried out in two phases on the same day. The first blood test is carried out on the patient’s blood when he is fasting. So, a patient coming for the test arrives without taking his breakfast or even a cup of morning tea or coffee. If the blood sugar levels are found to be 126 milligrams per deciliter or higher, on two separate occasions, after fasting, then there is a likelihood of diabetes.

Following this, another blood test is taken after the patient has had his breakfast and a cup of tea or coffee. This time the blood sugar levels should not go above 200 milligrams per deciliter. In case it is above this mark, then the likelihood of diabetes is high. At times the patient is given 75 gram glucose solution to drink. Then the blood sugar levels are checked for monitoring the blood sugar levels as well as the measurement of ketenes, which are the products from the breakdown of fats.

Once these tests have been successfully carried out, the patient is prescribed a course of treatment which involves both the physical and emotional aspects of his being, as diabetes is not a malaise of the physical body alone. It is also a disease that affects one’s emotions and reactions.