Mellitus

Diabetes mellitus is blood sugar is high chaotic is unusual because the body does not produce enough insulin l ‘. Normally, levels of blood glucose are tightly controlled by insulin, a hormone produced by the pancreas. The insulin lowers blood glucose levels. When a student blood glucose, insulin is secreted by the pancreas to normalize blood sugar. In patients with diabetes, the absence or insufficient production of insulin causes high blood sugar. Diabetes is the leading cause of blindness in adults non-elderly, the leading cause of non-traumatic amputation in adults, and diabetic kidney disease is the leading kidney disease requiring dialysis the USA. Therefore, insulin deficiency or insensitivity of its receptors plays a central role in all forms of diabetes mellitus.

Grave or recurrent pancreatitis and other diseases that directly damage the pancreas can lead to diabetes. As indicated above, in patients with diabetes, insulin is either absent, relatively insufficient for the needs of the body, or not used properly by the body. All these factors cause high levels of glucose in the blood. People with diabetes May experience numerous and serious, long-term complications. Some of these complications begin in the months following the onset of diabetes, although most tend to develop after a few years. Most complications are progressive. High levels of blood sugar spill glucose in urine. People with diabetes often develop bacterial and fungal infections, typically of the skin. When sugar levels in the blood are high, white blood cells can not fight effectively against infections.

Diabetes can cause many complications. The strong can prevent complications if the disease is not adequately controlled. Diabetes mellitus is characterized by disordered metabolism and too high blood sugar is caused by low levels of the hormone insulin or abnormal insulin resistance effects associated with inadequate secretion insulin to compensate. Diabetes is also an important factor in accelerating the hardening and narrowing of the arteries, which leads to strokes, heart disease and other major diseases of the blood vessels. This is known as macrovascular disease. The characteristic symptoms are excessive production of urine, excessive thirst and increased liquid, and blurred vision. These symptoms may be absent if blood sugar is slightly elevated. Poor healing of wounds, especially feet, can lead to gangrene, requiring amputation May.

Diabetes mellitus is now an old type of illness, did not address, and the medical service must be essential to the emphasis is to avoid possible short-and long-term problems associated with diabetes. Diabetes screening is recommended for many people in various stages of life, and for those with one or more risk factors. The test varies depending on circumstances and local policies, May and be a random blood glucose, a fasting blood sugar test or a more formal test of glucose tolerance. An adequate treatment of diabetes, and putting more emphasis on blood pressure control and lifestyle, May improve the risk profile of complications above. Another treatment option is the use of insulin pump with some of the most popular pump brands: Cozmo, animas, Medtronic MiniMed and omnipod.

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Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels, which result from defects in insulin secretion, or action, or both. Diabetes mellitus, commonly referred to as diabetes (as it will be in this article) was first identified as a disease associated with â??sweet urine,” and excessive muscle loss in the ancient world.

Diabetes is a serious, lifelong condition that affects an estimated 20.8 million people. About 30 percent (6.2 million) do not know they have it. Each year, about 1.5 million people find out they have diabetes (1) and probably have had the disease for seven years before it was diagnosed.

Diabetes is a metabolic disorder affecting the way the body uses digested food for growth and energy. As a person eats, digestive juices break down the food into a simple sugar called glucose. Glucose is the main source of fuel for the body.

Types of Diabetes Mellitus:

Type 1 diabetes mellitus can occur at any age and is characterized by the marked and progressive inability of the pancreas to secrete insulin because of autoimmune destruction of the beta cells. It commonly occurs in children, with a fairly abrupt onset; however, newer antibody tests have allowed for the identification of more people with the new-onset adult form of type 1 diabetes mellitus called latent autoimmune diabetes of the adult (LADA).

Symptoms of type 1 diabetes:

· Increased thirst

· Increased urination

· Weight loss in spite of increased appetite

Type 2 diabetes mellitus was once called adult-onset diabetes. Now, because of the epidemic of obesity and inactivity in children, type 2 diabetes mellitus is occurring at younger and younger ages. Although type 2 diabetes mellitus typically affects individuals older than 40 years, it has been diagnosed in children as young as 2 years of age who have a family history of diabetes.

Symptoms of type 2 diabetes:

· Blurred vision

· Slow-healing infections

· Impotence in men

Genetic causes â?? Many people with type 2 diabetes have a family member with type 2 diabetes or conditions commonly associated with diabetes, such as high blood lipid levels, high blood pressure, or obesity. As an example, 39 percent of patients with type 2 diabetes have at least one parent with the disease. The lifetime risk that a first-degree relative (sister, brother, son, daughter) will develop diabetes is five to ten times higher than that of a person of a similar age and weight who has no family history of diabetes.

Complications:

People with diabetes may experience many serious, long-term complications. Some of these complications begin within months of the onset of diabetes, although most tend to develop after a few years. Most of the complications are progressive. The more tightly a person with diabetes is able to control the levels of sugar in the blood, the less likely it is that these complications will develop or become worse.

The eyes can be affected in several ways by diabetes mellitus. Diabetic retinopathy is one of the leading causes for irreversible blindness in the United States. This retinopathy can occur with either type I or type II diabetes mellitus, usually a decade or so after the onset of diabetes. Most persons with type I diabetes and many of those with type II diabetes develop some background (non-proliferative ) retinopathy. Proliferative retinopathy is more ominous and is more likely to occur when diabetes mellitus is poorly controlled.

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Special areas in the pancreas gland, the islets of Langerhans, produce a hormone called insulin. This hormone is a protein of small size. Insulin stimulates muscle cells and other body cells to take up glucose from the blood and convert the glucose to glycogen, a kind of starch, and then store the glycogen. By need the body cells convert the glycogen to glucose and use it as fuel. In this way insulin keeps the glucose level in the blood at a normal size.

By diabetes type I the cells producing insulin are destroyed. Then less glucose is taken up from the blood into the body cells and utilized there, and glucose accumulates in the blood.

THE CAUSES AND MECHANISMS OF DIABETES TYPE I

The cause of the disease is not well known. An auto-immune response attacking the insulin producing cells in the langerhansian islets may be a cause. Virus infection may be another cause. The disease also is to some extend inherited.

When the glucose uptake into the body cells is reduced, but glucose instead accumulates in the blood, the following physiological effects occur:

-The body cells do not get enough fuel for the work they shall do.

-The molecular thickness (osmality) of the blood increases. This causes water to be pulled out from the body tissues and into the blood. The tissues thus get dried out and the urine production increases.

-The tissues begin to break down protein and fat to get energy, causing weight loss and muscular reduction.

The symptoms of diabetes type 1 are a consequence of these mechanisms.

SYMPTOMS OF DIABETES TYPE 1

The disease often starts suddenly. Often children or young people are attacked by the disease. The lack of insulin causes an increased amount of blood sugar. Early symptoms of the disease are:

-Increased urine production

-Dehydration (lack of water in the body)

-Abnormally high thirst as a consequence of increased urine production

-Dryness in the mouth

-An abnormal high appetite

-Feeling extremely tired and weak

-Weight loss, even when one eats well

-Impaired vision

If the blood sugar level is not stabilized to a normal value, there will be an accumulation of chemicals in the body called ketones, and this condition is called diabetic ketoacidosis. This serious condition can lead to coma and death. The signs of ketoacidosis are:

-Vomiting,

-Pain in the stomach

-Rapid breathing,

-High pulse rate

-Somnolence (abnormal tendency to sleep)

In the long term, diabetes type 1 can severely hurt the blood vessels in vital organs. This can further cause damage to the heart, eyes, kidneys or other body organs.

TREATMENTS OF DIABETES TYPE 1

Diabetes type 1 is treated with insulin injections. Implanting insuline cells in the pancreas is an experimental treatment. Another experimental treatment is to implant stem cells in the pancreas that can develop into new insulin producing cells.

Another important module of the treatment is regulation of the amount of sugar and fat consumed through the diet so that it fits together with the insulin-amount injected. Also regular monitoring of the blood sugar level to regulate the insulin amount is an important part of the treatment.

There are also natural products in the market that can help to normalize the blood sugar level by diabetes type 2. Those products cannot heal the disease or replace insulin injections, but they can help the body to regulate the blood sugar level. These products contain minerals that are working components of enzymes that stimulate the glucose metabolism in the body. They also contain herbs that have been used for a long time in traditional medicine to regulate the glucose level and that have proven their effects in scientific studies.

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To compare the role of glibenclamide and pioglitazone drugs in type 11 non- insulin dependent diabetes mellitus patients.
Introduction:-

Diabetes comes from the greek word for ‘SIPHON” which one is the first term and implies for a lot of urine is made .The trm “mellitus” comes from a laton word, “met” which means “honey” and was used because the urine was sweet (Wheeler,2004)

Diabetic ketaocidosis is one of life threatening condition requiring some data hospitalization and treatment. Recognition of this condition is of almost importance, because even small delays can have an impact on survival (Nattrass, 2006). Hypoglycaemia are involved in insulin induced episodes in individuals with diabetes. Probably the major factor prescribing, insulin treated patient from achieving the glucose targets needed to prevent diabetic complications. The incidence of hypoglycaemia reflects the inadequancy of current mathods of insulin delievery which lead ot inappropriately high insulin concentration, particularly some persons after eating more foods at night onset of blindness and also a major risk factor heart disease and stroke

(Heller, 2003).

TYPES OF DIABETE MELLITUS

TYPE 1 DIABETES MELLITUS (IDDM):

Type I diabetes affect children of all ages, both sexes and all athenic groups. type 1 diabetes usually occurs by mechanisms. It is most common metabolic condition in children and adolescents (Bui, 2004). Type1diabetes is characterized by immune mediated destruction of pancreatic b -cells resulting in insulin deficiency. This results in a common biochemical end point of hyperglycaemia and risk of ketoacidosis, but the clinical presentaion varies, widely depending on the rate and degree of b -cells failure (Lambert & Bingley. 2005).

Type II diabetes mellitus (NIDDM):

Type II diabetes is a complex metabolic disorder associated with, b -cells dysfunction and with varying degree of insulin resistance primary pathogenic factors leading insulin resistance leading to type 2 diabetes and decreased insulin, secretion which arise from abnormalities with in liver, skeletal muscle and pancreatic b -cells (charles & clark, 1996).

GESTATIONAL DIABETUS MELLITUS

Women who develop glucose intolerance in late pregnancy and womens who with previously undiagnosed diabetes.
SECONDARY DIABETUS MELLITUS:
Secondary diabetes is due to disease of the pancreatic and endocrime system, genetic disorders, or exposure to chemical agents.

Type – I diabetes formerly known as insluin dependent diabetes mellitus (IDDM), is characterized by the destruction of the pancreatic beta cells that produces inslulin

Type – I diabetes formerly known as insulin dependent diabetes(IDDM),is characterized by the destruction of pancreatic beta cells that produces insulin.Type-1 diabetes occures most often in children and young adults but it can occures at any age.(Anderson et al 2007).

Type-11 diabetes is not straight uprward. A pancreas that does not produce enough insulin. Liver that release too much glucose,muscle cells that do not readily take in glucose.(Carren 2008)

Many genetic factors are involved in the development of diabetes.Because of new genetic methodology researchers are closers to identifying all of the cadidate gene for both non –insulin dependent and insulin dependent diabetes(Bernhard,1995).

Woman who had gestation diabetes are more likely to develop Type-11diabetes themselves.Pergnant women with diabetes are another disadvantaged group.They need much more intensive antenatal care and close monitoring of blood sugar,blood pressure and weight.(jawed2006)

Over weight children the progression of child obesity into adulthood is associated with early develop of complications, including IgpG2 diabetes and cardiovascular disease.Type diabetes is the most common clinical form of diabetes accountingforabout 90% of all cases,it is currently undergoing world wide epidemic. Type 11diabetes mellitus is caused by body’s infective use of insulin, it is often results from excess body weight and physical inactivity(WHO 2007).

PREVALACES& IINCIDENCE

Diabetes mellitus increases with aging, in 200 the prevalance of diabetes,it was estimated to be 0.19% people<20 years old and 8.6% in people>20 years old.There is considered geographic variation in the incidence of both type-1 and type-11 diabetes mellitus.Scavandinvian has the highest incidence of type-1 diabetes mellitus e.g in Finland, the incidence is 35/100,000 per year the pacific rim has a much lower rate in japan and china the incidence is 1 to 3/100,00 per year of type-1 diabetes mellitus, Northern Europe and the United States share an intermediate rate (8to17/100,000 per year).The prevalence of type 11 diabeties mellitus is highest in certain pacific island, intermediate in countries such as India and the United States, and relatively low in Russia and China.This variability is likely due to genetic, beharioral and enviromental factors(Power 2005).Diabettes mellitus prevalance also arises among different ethic population within a given countries it is common inall ethnic groups its prevalance increased with age and more than 5% of individuals of more than 65 years of age have diabetes mellitus (David Owerback 1988).The World wide prevalence of diabetes mellitus has risen dramatically over past two decades.The prevalence of type11 diabettes mellitus is expected, type 11 diabetes mellitus is more prevalent among Hispanies Native Americas,African,American,and Asians, pacific Islanders than in non- Hispanic whites,the incidence is essentially equal in woman and men in all populations. Type 11 diabetes is becoming increasingly common because people are living longer,and the prevalence of diabetes increases with age it is also seen more frequently now than before in young people, in association with the rising prevalenceof childhood obesity although type11 diabetes still countries with the estimated nubers of cases of diabetes in 2000and 2030.

Rank Country

2000 Individuals country with diabetes (milloins)

Country

2030 Individuals with diabtes (Million)

India

31.7

India

79.47

China

20.8

China

42.3

USA

17.7

USA

30.3

Indonesia

8.4

Indonesia

21.3

Japan

6.8

Pakistan

13.9

Pakistan

5.2

Brazil

11.3

Russian federation

4.6

Bangladesh

11.1

Brazil

4.6

Japan

8.9

Italy

4.3

Philippines

7.8

Bangladesh

3.2

Egypt

6.7

(Wareham& FOROUHI 2OO6)

DRUG TREATMENT OF DIABETIES MELLITUS
Biguanides lower blood glucose, they increase glucose uptake and utilize in skeletal muscle there by reducing insulin resistance, and reduce hepatic glucose production (gluconeogenesis).Lower blood glucose, addionally reduces low denisity and very low denisity lipoproteins (LDL and VLDL) respectively. Metformin has a half life of about 3 hours and is excreted unchanged in the urine.Clinically metformin used in type 2 diabetic who are obese and who fail treatment with diet alone.Adverse effects are produced dose related gastrointestinal disturbances e.g anorexia,diarrhoea,nausea,lactic acidosis rare but potentially fatal toxic effect.(Dale,2003).

Improving insulin sensitivity by activating certain genes involved in fat synthesis and carbohydrate metabolism Rosigilitazone and Piogiltazone are currently approved.Thiazolidinediones. Thiazolidinediones do not cause hypoglycemia when used alone,although they are usually taken in combination with sulfonylurease.

In some incouraging studies, thaiazolidiniones have produced very favorable effects on the heart, including reducing blood pressure and improving triglycerides and cholestrol levels including increasing HDL level,the good cholestrol. They may also block a molecule called 11 Best HSK that may play a significant role in metabolic syndrome,as well as diabetes type11. One study also sugessted that Rosiglitazone may even improve beta cells functions and so help prevent progression of diabetes.Anemia, weight gain, increased risk of fluid buildup, may worson heart failure.Troglitazone,was withdrawn after a few reports of heart failure.Liver failure abd death.Current Thiazoldinediones don not appear to pose the same effects on the liver although there have been a few reports of liver injury.

In patients with dietry failur the choice of a sulfonylurea agent or insulin therapy has been controversial and empric in favour of insulin therapy are the studies, who reported marked improvement post receptor diagnostic after intensive short term therapy in untreated type 2 diabetes mellitus (Scarlett et al,1984) Sulfonylureas further classified into two groups or generations based on their potency,duration,drug interaction,side effects profiles. Sulfonylureas enhance insulin action in cells in culture and stimulate the synthesis of glucose transporters (Jacobes et al 1998).A sulfonylurea drug should normally be the insulin secretagogue of choice, NICE (National Institute for Clinical Excellence) also recommends that a generic ,drug should be perscribed (Scsade et al1998).
RESEARCH DESIGN AND MATERIAL AND METHODS:
This study was conducted in the deprtment of Pharmacololgy and Therapeutics,Basic Medical Science Institute,Jinnah,Postgraduate Medical Centre,karachi under kind supervision od DRr:GhulamRsool Mashori,Associate Professoer and Head OF Department Of Pharmacology and Therapeutics in colloboration with Medical Outpatient Department Unit111 and Filter Clinic, Medical Department, JPMC,Karachi.

Seventy NIDDM (type-II)diabetic patients were initially enrolled in the study from the filter clinic/ out patient department Medical Unit III ,and diabetic clinic.Out of this 60 diabetic patients were associated in whole period of study, remaining 10 patients were dropped due to poor comlpiance or change in residential place.All the patients were divided in two main groups,groupI and in group II these patients were selected in this study according of inclusion and exclusion criteria.

INCLUSION CRITERIA

Newly diagnose patients of non Insulin Dependent Diabtes Mellitus.

Diagnsed patients of diabetes also including having no any history medication.

Having either sex of age between 30 to 60 years.

Diagnosed patients who were Non Insulin Depedent Diabetes Mellitus who were treated with Pioglitazone.

Diagnosed patients who were Non Imsulin Depedent Mellitus, who were treated with drug Glibenclamide.

EXCLUSION CRIRERIA

Patients suffering from blood pressure.

Patients suffering from liver disease.

Patients suffering from cardiac disease.

Pregnancies and lactating women.

Patient suffering from renal disorders.

Patients having serious complications.

MATERIAL:

Lacets.

Lancet Hlder(Abbots easy touch TM2 lot 03 Asee).

Glucometer(Medisense) optilim one touch(Abbotts).

Blood glucose nest trpis (IVD for Invitro diagnostic use (Abbott Labortries,Medisense UK Ltd,Abigngdon,Ox14ITR,Masde in UK). Stored between minimum 30?, (4°-30° C) and Maximum 40°C (39°-86°F).

Weight Machine Model No 1101 Lot No.312. TANTIATA.

DRUGS

Tab:Daonil 5 mg (Aventis Pharma)

Drug category:Sulphonylurea.

Generic Name: Glibenclamide.

MFGLIC:No.000007 RegistrationNO.000220

MFG Date:0-06

EXP Date:7-10

Lot NO:B230

Tab:piozer (Hilton Pharm) PvtLTd.

Tab:Poizer 15mg

Drug category:Thaiazolinedione.

Generic Name:Pioglitazone Hydrochloride.

MFG LIC: O.000136 Registration No.03270

MFG Date:3-06

EXP Date:3-o9

Lot No:6287

Tab: Poizer (Hilton Pharma)pvt ltd.

PARAMETERS:

Fasting Blood Sugar (FBS).

Random Blood Sugar (RBS).

Weight.

Key words:Diabetes mellitus,Non-insulin diabetes mellitus,Insulin depedent diabetes mellitus, Daonil,poizer,Insulin.

RESULTS:

Table 1

Weight and Blood Sugar level observed on baseline day 0

In group1 and group11

Group 1

Group 11

Pioglitazone n=27

Glibenclamide n=33

Weight

63.37

+ 2.25

¯

62.7

+ 15.56

¯

Fasting Blood Sugar

172.7

+ 13.32

¯

188.42

+ 12.o5

¯

Random Blood Sugar

285.11

+ 15 .532

¯

284.18

+ 17.07

¯

All Values are expressed in Means± SEM.

FIGURE-1 weight and blood sugar levels observed on baseline (day-o)

In table No shpwing the weight (KG’S) and blood sugar (msg/dl0 levels which is observed on baseline (day-0) in both groups 9group: 1 & group11)

Group: 1 Weight in (Kg’s) mean + SEM) IS 63.37±2.25 Fasting blood sugar 172.7±13.32,and Random

blood sugar 285.11±15.32

Group:11

Weight (KG’s0 (mean +SEM)62.7±1.56 Fasting blood sugar (mg/dl0 188.42±12.05, Random blood sugar is 284.18±17.03.

Figure 2: showing the weight and blood sugar levels observed in base line (day-0) in group: 1 and group 11 weight in 9kg’s) its mean values are 63.37,62.7, Fasting blood sugar in (mg/dl) is 172.71, 188.42 Random blood sugar (mg/dl) is 285.11 &284.18.

TABLE: 2

Peroidic Observation In All Parameters Group1

Goup1(Pioglitazon) n=27

P-value

Day-0

Day-45

Day-90

Day-0to45

Day-45-90

Weight

63.37

±2.25

63.63

±2.26

63.63

±2.23

>0.05

(NS)

>0.05

(NS)

Fasting blood sugar

172.7

±13.32

165.04

±8.98

153.37

±7.59

>0.05

(NS)

0.05

(NS)

Randomblood sugar

285.11

±15.32

279.78

±13.63

255.56

±12.65

>0.05

(NS)

>0.05

(NS)

All values are expressed in Mean±SEM .(NS) Non significant.

TABLE NO:2

Showing the periodic observations in all parameters in group 1 (piogiltazone) (n+27) weight P.value (day 0 to day 45)>0.05 (NS). Fasting blood sugar >0.05 (NS) Random blood sugar >0.05 (NS) P.values day 90 weight >0.05 (N.S), FBS>0.05 (N.S) 7RBS >0.05(N.S) NON SIGNIFICANT

FIGURE:2 Showing the periodic observation in all parameters in group 1 on day0 day 45& day-90.Mean values in weight (Kg) is 63.37,63.26,63.63, fbs (mg/dl) 172.7,165.04,153.37,RBS(mg/dl) 285.11,279.78,255.56.

TABLE NO3

Peroidic Observation in All Parameters Group11

Group 11 (Glibenclamide)

N=33

P-value

Day-0

Day-45

Day-90

Day-0 to 45

Day-45 to 90

Weight

62.7

±1.56

65.64

±2.10

64.55

±1.92

>0.05(NS)

0.05(NS0

Fasting blood sugar

188.42

±12.05

168.45

±10.99

140.06

±5.68

>0.05(NS)

>0.05(S)

Random blood sugar

284.18

±17.03

220.12

±13.39

170.94

±5.80

<0.005 (MS)

0.002(MS0

(s) significant, (MS) moderate significant

All values are expressed in Mean±SEM.

Table No3:

Showing the periodic observation in all parameter in goup:11, Group:11 containing drug (Glibenclamide),no of patients (n=33).It’s P-value on day 0 to day 45 on weight >0.05(NS),FBS>0.05(N.S) RBS<0.005 (MS) <0.01- AND DAY 45 TO DAY 90 WEIGHT >0.05 (NS) FBS (0.05) RBS <0.002(M.S0 moderately significant.

Figure 3:Shwing the periodic observations in all parameters in Group 11 weight 62.7,65.64,64.55,FBS (MG/DL) 188.42,168.45 140.06,RBS(mg/dl) 284.18 220.12, 170.94 (on day-0-day 45 to 90).

DISCUSSION:

In Denmark Beck-Nielsenet al,skillman TG (1981) published studies demonstation that glyburide increased he number of receptors on the monocytes of patients with type 11 diabetes mellitus. Some patients were treated with diet and in cobination of second generation sulfonyureas agents Wie. The numbers of insulin receptors all patients were measured before and after the treatment.Intrvenous glucose test shows the persistent impairent of insulin secretion afterthe starting of drug therapy.However those patient who were on drug Pioglitazone some results were obtained of insulin secretion in the impairment in early drug drug therapy.Clinical observations have suggested that the second generation sulfonylureas may exert their effects by potentiating insulin released by other primary stimulators Insulin secreting drug.

According to the study of WilliamC Dukworth et al(1972), aftr the chronic treatment with sulfonylureas it is well documented that plasma insulin levels were decreased in response to oral glucose load. This apparently occures even though glucose tolerance is improved over pre-treatment, levels,present study clearly support that study.

The result og group 11 correlates with the research conducted by Bonnie &Kimmel (2005) produces the same results as FBS reduces from baseline, and at the end of study,with an overall 23.44%,reduction,while with the results showed at the end of study peroid p-value were (p<0,001).

Similarly Michael Alvarsson et al (2003) conducted a similar type of study and the found and overall changes of change of 22.11% in Fbs and 40.88% in Rbs at the end of trial p-value were (p<0.001).

However a study conducted by (Stone &Brown in (2003) didnot match to our results in the parameter of FBS and observer a reduction of 26.22%.

CONCLUSION:

In the light of study discussion it is obiovus the glibenclamide was more effective,tolerable and safer than pioglitzone in a short duration.Diabetes Mellitus is chronic prolong disease for whole life.Poor community can afford it easily,on base of marketing of this drug in pakistan diabetes patients easily go and purchase economically,in fact ,mostly people buy it from pharmacy without dr’s perscription,because pharmacist and patient both of know about this disease.Just like dispirin as analgesic,it is famous anti-diabetic drug in our states as compared of other anti-diabetic drugs.

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Bui H- Type 1 diabetes in childhood-Medicine 2006,3 ,1-3

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