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Archive for the ‘Diabetes’ Category

Diabetes | Nutrition.gov

Saturday, August 29th, 2015

MedlinePlus: Diabetes

DHHS. NIH. National Library of Medicine.

Read information related to diabetes, including a definition, causes and risk factors, symptoms, treatments, complications, and more. Also in Spanish.

DHHS. National Institutes of Health; Centers for Disease Control and Prevention.

Find resources, statistics, news and more to help with diabetes prevention and management.

DHHS. CDC. National Center for Chronic Disease Prevention and Health Promotion.

Read about national estimates and general information on diabetes and prediabetes in the United States, 2011.

DHHS. National Institutes of Health.

See statistics and the status of current research and knowledge on Type 1 diabetes. Also discusses possible future discoveries in Type 1 diabetes prevention and management.

DHHS. NIH. National Diabetes Education Program.

Take this quiz to learn more about how to manage your diabetes.

DHHS. NIH. National Institute of Diabetes and Digestive and Kidney Diseases.

Learn about type 2 diabetes including the risks, complications, and prevention strategies. Also in PDF|757 KB and in Spanish.

DHHS. CDC. NCCDPH. Division of Diabetes Translation.

Learn the basics about diabetes from the Center for Disease Control. Also find:

DHHS. CDC. National Center on Birth Defects and Developmental Disabilities.

Get answers to frequently asked questions about diabetes and pregnancy.

DHHS. NIH. National Institute of Diabetes and Digestive and Kidney Diseases.

Get definitions of diabetes-related words. Also in PDF|703 KB and in Spanish.

DHHS. NIH. National Diabetes Information Clearinghouse.

Find several resources on diabetes for Hispanics and Latino Americans, including Spanish language versions.

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Diabetes | Nutrition.gov

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NJDOH – Family Health services

Saturday, August 29th, 2015

Behavioral Risk Factor Surveillance System (BRFSS) data for 2003-2005 estimate that 473,000 adults 18 years and older, 7.2 % (margin of sampling error .3%) of the population, have been diagnosed with diabetes. It is estimated that 190,000 individuals have diabetes but have not been diagnosed.

For a variety of reasons, it is anticipated that the trend of increasing numbers and rates of people with diabetes will continue unless measures are taken that are geared toward prevention. Among people at the highest risk are persons over the age of 45, persons who are obese, and minorities. New Jersey 's population is aging. The number of persons over the age of 45 went from 2,594,232 in 1990 to an estimated 3,340,127 in 2005. Obesity rates, as estimated by BRFSS, went from 10% in 1991 to 22.1% in 2005. The state has always been diverse and is becoming more so. The percentage of black-non-Hispanics in New Jersey went from 12.7% in 1990 to 13.3% in 2005; while the percentage of the population that is Hispanic went from 9.6% to 14.5%. The Asian population had the fastest rate of growth increasing from 3% to 7.3% of the total population in 2005. The fastest growing subgroup among Asians is Asian-Indians. That group increased from 79,440 in 1990 to 169,180 in 2000.

According to the BRFSS for the period of 2003-2005, the highest rate by age of diagnosed diabetes was for persons 65 and over. For that group, the rate was 16.7% (margin of sampling error .9) compared to 7.2% (margin of error.3) for all persons over age 18. The survey shows blacks have the highest rate by race/ethnicity. The rate among non- Hispanic blacks of all ages was 12.2% (margin of sampling error 1.3).

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Diabetes, Type 2 Medication | Drugs.com

Saturday, August 29th, 2015

Definition of Diabetes, Type 2:

Type 2 diabetes is characterized by "insulin resistance" as body cells do not respond appropriately when insulin is present. This is a more complex problem than type 1, but is sometimes easier to treat, since insulin is still produced, especially in the initial years. Type 2 may go unnoticed for years in a patient before diagnosis, since the symptoms are typically milder (no ketoacidosis) and can be sporadic. However, severe complications can result from unnoticed type 2 diabetes, including renal failure, and coronary artery disease. Type 2 diabetes was formerly known by a variety of partially misleading names, including "adult-onset diabetes", "obesity-related diabetes", "insulin-resistant diabetes", or "non-insulin-dependent diabetes" (NIDDM). It may be caused by a number of diseases, such as hemochromatosis and polycystic ovary syndrome, and can also be caused by certain types of medications (e.g. long-term steroid use). About 90-95% of all North American cases of diabetes are type 2, and about 20% of the population over the age of 65 is a type 2 diabetic. The fraction of type 2 diabetics in other parts of the world varies substantially, almost certainly for environmental and lifestyle reasons. There is also a strong inheritable genetic connection in type 2 diabetes: having relatives (especially first degree) with type 2 is a considerable risk factor for developing type 2 diabetes. The majority of patients with type 2 diabetes mellitus are obese - chronic obesity leads to increased insulin resistance that can develop into diabetes, most likely because adipose tissue is a (recently identified) source of chemical signals (hormones and cytokines).

The following drugs and medications are in some way related to, or used in the treatment of Diabetes, Type 2. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.

See sub-topics

See 58 generic medications used to treat this condition

Alternative treatments for Diabetes, Type 2

The following products are considered to be alternative treatments or natural remedies for Diabetes, Type 2. Their efficacy may not have been scientifically tested to the same degree as the drugs listed in the table above. However there may be historical, cultural or anecdotal evidence linking their use to the treatment of Diabetes, Type 2.

Micromedex Care Notes:

Drugs.com Health Center:

Mayo Clinic Reference:

Synonym(s): Diabetes; Noninsulin-dependent Diabetes; Type 2 Diabetes

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Diabetes mellitus – Lab Tests Online

Saturday, August 29th, 2015

Note: This article addresses diabetes mellitus, not . Although the two share the same reference term "diabetes" (which means increased urine production), diabetes insipidus is much rarer and has a different underlying cause.

Diabetes is a group of conditions linked by an inability to produce enough insulin and/or to respond to insulin. This causes high blood glucose levels () and can lead to a number of and health problems, some of them life-threatening.

Diabetes is the seventh leading cause of death in the United States. According to the Centers for Disease Control and Prevention, about 29 million people in the U.S. currently have diabetes, but as many as 8 million are not yet aware that diabetes is affecting their health.

People with diabetes are unable to process glucose, the body's primary energy source, effectively. Normally, after a meal, carbohydrates are broken down into glucose and other simple sugars. This causes blood glucose levels to rise and stimulates the pancreas to release insulin into the bloodstream. Insulin is a produced by the in the pancreas. It regulates the transport of glucose into most of the body's cells and works with glucagon, another pancreatic hormone, to maintain blood glucose levels within a narrow range.

If someone is unable to produce enough insulin, or if the body's cells are resistant to its effects (insulin resistance), then less glucose is transported from the blood into cells. Blood glucose levels remain high but the body's cells "starve." This can cause both short-term and long-term health problems, depending on the severity of the insulin deficiency and/or resistance. Diabetics typically have to control their blood glucose levels on a daily basis and over time to avoid health problems and complications. Treatment, which may involve specialized diets, exercise and/or medications, including insulin, aims to ensure that blood glucose does not get too high or too low.

Chronic high blood glucose can cause long-term damage to blood vessels, nerves, and organs throughout the body and can lead to other conditions such as kidney disease, loss of vision, strokes, cardiovascular disease, and circulatory problems in the legs. Damage from hyperglycemia is cumulative and may begin before a person is aware that he or she has diabetes. The sooner that the condition is detected and treated, the better the chances are of minimizing long-term complications.

The following table summarizes some types of diabetes. Click on the links to read more about the various types.

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Diabetes | Overview

Saturday, August 29th, 2015

If you just found out you have diabetes, you probably have a lot of questions and you may feel a little uncertain. But you're not alone. In the United States, 23.6 million people have diabetes. Most of these people lead full, healthy lives. One of the best things you can do for yourself is to learn all you can about diabetes. This article will tell you some of the basics about diabetes.

Diabetes is a disease that occurs when a persons body doesnt make enough of the hormone insulin or cant use insulin properly. There are 2 types of diabetes. Type 1 diabetes occurs when your bodys pancreas doesnt produce any insulin. Type 2 diabetes occurs when the pancreas either doesnt produce enough insulin or your bodys cells ignore the insulin. Between 90% and 95% of people who are diagnosed with diabetes have type 2 diabetes.

Type 1 diabetes is also called insulin-dependent diabetes. It is sometimes called juvenile diabetes because it is usually discovered in children and teenagers, but adults may also have it.

Type 2 diabetes occurs when the body doesnt produce enough insulin or the bodys cells ignore the insulin.

Yes. In the past, doctors thought that only adults were at risk of developing type 2 diabetes. However, an increasing number of children in the United States are now being diagnosed with the disease. Doctors think this increase is mostly because more children are overweight or obese and are less physically active.

Pre-diabetes occurs when blood sugar levels are higher than they should be, but not so high that your doctor can say you have diabetes. Pre-diabetes is becoming more common in the United States. It greatly increases the risk of developing type 2 diabetes.

The good news is that you can take steps to prevent or delay the onset of full-blown type 2 diabetes by making lifestyle changes, such as eating a healthy diet, reaching and maintaining a healthy weight, and exercising regularly.

Yes, you can live a normal life. You can stay healthy if you do what it takes to control your diabetes.

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About Diabetes – American Heart Association

Saturday, August 29th, 2015

"Diabetes mellitus," more commonly referred to as "diabetes," is a condition that causes blood sugar to rise to dangerous levels: a fasting blood glucose of 126 milligrams per deciliter (mg/dL) or more.

How Diabetes Develops

Types of Diabetes

Type 1DiabetesType 1 diabetes is a serious condition that occurs when the pancreas makes little or no insulin. Without insulin, the body is unable to take the glucose (blood sugar) it gets from food into cells to fuel the body. So without daily injections of insulin, people with type 1 diabetes won't survive. For that reason, this type of diabetes is also referred to as insulin-dependent diabetes.

Type 1 diabetes was previously known as juvenile diabetes because it's usually diagnosed in children and young adults. However, this chronic, lifelong disease can strike at any age, and those with a family history of it are particularly at risk.

Health Risks for Type 1 Diabetes

During the development of type 1 diabetes, the body's immune system attacks certain cells (called beta cells) in the pancreas. Although the reasons this occurs are still unknown, the effects are clear. Once these cells are destroyed, the pancreas produces little or no insulin, so the glucose stays in the blood. When there's too much glucose in the blood, especially for prolonged periods, all the organ systems in the body suffer long-term damage. Learn more about the health consequences of diabetes and how to treat it.

Type2DiabetesType 2 diabetes is the most common form of diabetes. Historically, type 2 diabetes has been diagnosed primarily in middle-aged adults. Today, however, adolescents and young adults are developing type 2 diabetes at an alarming rate. This correlates with the increasing incidence of obesity and physical inactivity in this population, both of which are risk factors for type 2 diabetes.

This type of diabetes can occur when:

Precursors to Diabetes

Pre-diabetesPre-diabetes means your body is not fully able to handle the job of converting sugars into energy. If youve been told by your healthcare provider that you have pre-diabetes it also means that without making some healthy changes, your body will most likely eventually develop diabetes. Learn more about pre-diabetes. Insulin Resistance Both type 2 diabetes and pre-diabetes usually result from insulin resistance.

Insulin resistance, which is a condition that affects more than 60 million Americans, occurs when the body can't use insulin efficiently. To compensate, the pancreas releases more and more insulin to try to keep blood sugar levels normal. Gradually, the insulin-producing cells in the pancreas become defective and ultimately decrease in total number. As a result, blood sugar levels begin to rise, causing pre-diabetes and, eventually, type 2 diabetes to develop.

When a fasting individual has too much glucose in the blood (hyperglycemia) or too much insulin in the blood (hyperinsulinemia), it indicates a person may have insulin resistance.

Health Risks of Insulin Resistance

People with insulin resistance are at greater risk of developing type 2 diabetes. They also are more likely to have too much LDL ("bad") cholesterol, not enough HDL ("good") cholesterol, and high triglycerides, which cause atherosclerosis.

Untreated diabetes can lead to many serious medical problems, including heart disease and stroke. That's why it's important to be aware of the symptoms as well as the risk factors and to take appropriate steps to prevent and treat insulin resistance and diabetes.

This content was last reviewed on 6/28/2012.

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Diabetes center – US News

Saturday, August 29th, 2015

Type 1 Diabetes

Many people have this type of diabetes, which usually develops in children and young adults when their immune systems attack cells in the pancreas that produce insulin, a hormone that helps cells absorb glucose from the bloodstream. More

People with this disease don't produce enough insulin and/or are unable to use it properly. Unless diet and medications are carefully managed, glucose can build up in the bloodstream. Possible complications include heart attacks and kidney failure. More

Studies show that most people with prediabetes will develop type 2 diabetes within 10 years if they don't make some lifestyle changes such as losing weight and starting a program of moderate physical activity. They also have a higher risk of developing cardiovascular disease. More

As it grows, the placenta secretes hormones that make it harder for a woman's body to use insulin normally. She needs an increasingly large amount of insulin to maintain normal blood glucose levels. When Mom's pancreas can't keep up with the higher demand, the body falls behind in processing glucose, and gestational diabetes results. More

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Diabetes mellitus type 2 – Wikipedia, the free encyclopedia

Saturday, August 29th, 2015

Diabetes mellitus type2 (formerly noninsulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes) is a metabolic disorder that is characterized by hyperglycemia (high blood sugar) in the context of insulin resistance and relative lack of insulin.[2] This is in contrast to diabetes mellitus type1, in which there is an absolute lack of insulin due to breakdown of islet cells in the pancreas.[3] The classic symptoms are excess thirst, frequent urination, and constant hunger. Type2 diabetes makes up about 90% of cases of diabetes, with the other 10% due primarily to diabetes mellitus type 1 and gestational diabetes. Obesity is thought to be the primary cause of type2 diabetes in people who are genetically predisposed to the disease (although this is not the case in people of East-Asian ancestry).

Type2 diabetes is initially managed by increasing exercise and dietary changes. If blood sugar levels are not adequately lowered by these measures, medications such as metformin or insulin may be needed. In those on insulin, there is typically the requirement to routinely check blood sugar levels.

Rates of type2 diabetes have increased markedly since 1960 in parallel with obesity. As of 2010 there were approximately 285million people diagnosed with the disease compared to around 30million in 1985.[4][5] Type 2 diabetes is typically a chronic disease associated with a ten-year-shorter life expectancy.[4] Long-term complications from high blood sugar can include heart disease, strokes, diabetic retinopathy where eyesight is affected, kidney failure which may require dialysis, and poor blood flow in the limbs leading to amputations. The acute complication of ketoacidosis, a feature of type1 diabetes, is uncommon,[6] however hyperosmolar hyperglycemic state may occur.

The classic symptoms of diabetes are polyuria (frequent urination), polydipsia (increased thirst), polyphagia (increased hunger), and weight loss.[7] Other symptoms that are commonly present at diagnosis include a history of blurred vision, itchiness, peripheral neuropathy, recurrent vaginal infections, and fatigue.[3] Many people, however, have no symptoms during the first few years and are diagnosed on routine testing.[3] People with type2 diabetes mellitus may rarely present with hyperosmolar hyperglycemic state (a condition of very high blood sugar associated with a decreased level of consciousness and low blood pressure).[3]

Type 2 diabetes is typically a chronic disease associated with a ten-year-shorter life expectancy.[4] This is partly due to a number of complications with which it is associated, including: two to four times the risk of cardiovascular disease, including ischemic heart disease and stroke; a 20-fold increase in lower limb amputations, and increased rates of hospitalizations.[4] In the developed world, and increasingly elsewhere, type2diabetes is the largest cause of nontraumatic blindness and kidney failure.[8] It has also been associated with an increased risk of cognitive dysfunction and dementia through disease processes such as Alzheimer's disease and vascular dementia.[9] Other complications include acanthosis nigricans, sexual dysfunction, and frequent infections.[7]

The development of type2 diabetes is caused by a combination of lifestyle and genetic factors.[8][10] While some of these factors are under personal control, such as diet and obesity, other factors are not, such as increasing age, female gender, and genetics.[4] A lack of sleep has been linked to type2 diabetes.[11] This is believed to act through its effect on metabolism.[11] The nutritional status of a mother during fetal development may also play a role, with one proposed mechanism being that of altered DNA methylation.[12]

A number of lifestyle factors are known to be important to the development of type2 diabetes, including obesity and being overweight (defined by a body mass index of greater than 25), lack of physical activity, poor diet, stress, and urbanization.[4][13] Excess body fat is associated with 30% of cases in those of Chinese and Japanese descent, 60-80% of cases in those of European and African descent, and 100% of cases in Pima Indians and Pacific Islanders.[3] Those who are not obese often have a high waisthip ratio.[3]

Dietary factors also influence the risk of developing type2 diabetes. Consumption of sugar-sweetened drinks in excess is associated with an increased risk.[14][15] The type of fats in the diet are also important, with saturated fats and trans fatty acids increasing the risk, and polyunsaturated and monounsaturated fat decreasing the risk.[10] Eating lots of white rice appears to also play a role in increasing risk.[16] A lack of exercise is believed to cause 7% of cases.[17]Persistent organic pollutants may also play a role.[18]

Most cases of diabetes involve many genes, with each being a small contributor to an increased probability of becoming a type2 diabetic.[4] If one identical twin has diabetes, the chance of the other developing diabetes within his lifetime is greater than 90%, while the rate for nonidentical siblings is 2550%.[3] As of 2011, more than 36genes had been found that contribute to the risk of type2 diabetes.[19] All of these genes together still only account for 10% of the total heritable component of the disease.[19] The TCF7L2 allele, for example, increases the risk of developing diabetes by 1.5times and is the greatest risk of the common genetic variants.[3] Most of the genes linked to diabetes are involved in beta cell functions.[3]

There are a number of rare cases of diabetes that arise due to an abnormality in a single gene (known as monogenic forms of diabetes or "other specific types of diabetes").[3][4] These include maturity onset diabetes of the young (MODY), Donohue syndrome, and Rabson-Mendenhall syndrome, among others.[4] Maturity onset diabetes of the young constitute 15% of all cases of diabetes in young people.[20]

There are a number of medications and other health problems that can predispose to diabetes.[21] Some of the medications include: glucocorticoids, thiazides, beta blockers, atypical antipsychotics,[22] and statins.[23] Those who have previously had gestational diabetes are at a higher risk of developing type2 diabetes.[7] Other health problems that are associated include: acromegaly, Cushing's syndrome, hyperthyroidism, pheochromocytoma, and certain cancers such as glucagonomas.[21]Testosterone deficiency is also associated with type2 diabetes.[24][25]

Type2 diabetes is due to insufficient insulin production from beta cells in the setting of insulin resistance.[3] Insulin resistance, which is the inability of cells to respond adequately to normal levels of insulin, occurs primarily within the muscles, liver, and fat tissue.[26] In the liver, insulin normally suppresses glucose release. However, in the setting of insulin resistance, the liver inappropriately releases glucose into the blood.[4] The proportion of insulin resistance versus beta cell dysfunction differs among individuals, with some having primarily insulin resistance and only a minor defect in insulin secretion and others with slight insulin resistance and primarily a lack of insulin secretion.[3]

Other potentially important mechanisms associated with type2 diabetes and insulin resistance include: increased breakdown of lipids within fat cells, resistance to and lack of incretin, high glucagon levels in the blood, increased retention of salt and water by the kidneys, and inappropriate regulation of metabolism by the central nervous system.[4] However, not all people with insulin resistance develop diabetes, since an impairment of insulin secretion by pancreatic beta cells is also required.[3]

The World Health Organization definition of diabetes (both type1 and type2) is for a single raised glucose reading with symptoms, otherwise raised values on two occasions, of either:[29]

A random blood sugar of greater than 11.1mmol/l (200mg/dL) in association with typical symptoms[7] or a glycated hemoglobin (HbA1c) of 48mmol/mol (6.5 DCCT%) is another method of diagnosing diabetes.[4] In 2009 an International Expert Committee that included representatives of the American Diabetes Association (ADA), the International Diabetes Federation (IDF), and the European Association for the Study of Diabetes (EASD) recommended that a threshold of 48mmol/mol (6.5 DCCT%) should be used to diagnose diabetes.[30] This recommendation was adopted by the American Diabetes Association in 2010.[31] Positive tests should be repeated unless the person presents with typical symptoms and blood sugars >11.1mmol/l (>200mg/dl).[30]

Threshold for diagnosis of diabetes is based on the relationship between results of glucose tolerance tests, fasting glucose or HbA1c and complications such as retinal problems.[4] A fasting or random blood sugar is preferred over the glucose tolerance test, as they are more convenient for people.[4] HbA1c has the advantages that fasting is not required and results are more stable but has the disadvantage that the test is more costly than measurement of blood glucose.[32] It is estimated that 20% of people with diabetes in the United States do not realize that they have the disease.[4]

Diabetes mellitus type2 is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency.[2] This is in contrast to diabetes mellitus type 1 in which there is an absolute insulin deficiency due to destruction of [islet cells in the pancreas and gestational diabetes mellitus that is a new onset of high blood sugars associated with pregnancy.[3] Type1 and type2 diabetes can typically be distinguished based on the presenting circumstances.[30] If the diagnosis is in doubt antibody testing may be useful to confirm type1 diabetes and C-peptide levels may be useful to confirm type2 diabetes,[33] with C-peptide levels normal or high in type2 diabetes, but low in type1 diabetes.[34]

No major organization recommends universal screening for diabetes as there is no evidence that such a program improve outcomes.[35][36] Screening is recommended by the United States Preventive Services Task Force (USPSTF) in adults without symptoms whose blood pressure is greater than 135/80mmHg.[37] For those whose blood pressure is less, the evidence is insufficient to recommend for or against screening.[37] There is no evidence that it changes the risk of death in this group of people.[38]

The World Health Organization recommends testing those groups at high risk[35] and in 2014 the USPSTF is considering a similar recommendation.[39] High-risk groups in the United States include: those over 45 years old; those with a first degree relative with diabetes; some ethnic groups, including Hispanics, African-Americans, and Native-Americans; a history of gestational diabetes; polycystic ovary syndrome; excess weight; and conditions associated with metabolic syndrome.[7] The American Diabetes Association recommends screening those who have a BMI over 25 (in people of Asian descent screening is recommending for a BMI over 23.[40]

Onset of type2 diabetes can be delayed or prevented through proper nutrition and regular exercise.[41][42] Intensive lifestyle measures may reduce the risk by over half.[8][43] The benefit of exercise occurs regardless of the person's initial weight or subsequent weight loss.[44] Evidence for the benefit of dietary changes alone, however, is limited,[45] with some evidence for a diet high in green leafy vegetables[46] and some for limiting the intake of sugary drinks.[14] In those with impaired glucose tolerance, diet and exercise either alone or in combination with metformin or acarbose may decrease the risk of developing diabetes.[8][47] Lifestyle interventions are more effective than metformin.[8] While low vitamin D levels are associated with an increased risk of diabetes, correcting the levels by supplementing vitamin D3 does not improve that risk.[48]

Management of type2 diabetes focuses on lifestyle interventions, lowering other cardiovascular risk factors, and maintaining blood glucose levels in the normal range.[8] Self-monitoring of blood glucose for people with newly diagnosed type2 diabetes may be used in combination with education,[49] however the benefit of self monitoring in those not using multi-dose insulin is questionable.[8][50] In those who do not want to measure blood levels, measuring urine levels may be done.[49] Managing other cardiovascular risk factors, such as hypertension, high cholesterol, and microalbuminuria, improves a person's life expectancy.[8] Decreasing the systolic blood pressure to less than 140mmHg is associated with a lower risk of death and better outcomes.[51] Intensive blood pressure management (less than 130/80mmHg) as opposed to standard blood pressure management (less than 140/85100mmHg) results in a slight decrease in stroke risk but no effect on overall risk of death.[52]

Intensive blood sugar lowering (HbA1c<6%) as opposed to standard blood sugar lowering (HbA1c of 77.9%) does not appear to change mortality.[53][54] The goal of treatment is typically an HbA1c of around 7% or a fasting glucose of less than 7.2mmol/L (130mg/dL); however these goals may be changed after professional clinical consultation, taking into account particular risks of hypoglycemia and life expectancy.[55][56] It is recommended that all people with type2 diabetes get regular ophthalmology examination.[3] Treating gum disease in those with diabetes may result in a small improvement in blood sugar levels.[57]

A proper diet and exercise are the foundations of diabetic care,[7] with a greater amount of exercise yielding better results.[58]Aerobic exercise leads to a decrease in HbA1c and improved insulin sensitivity.[58]Resistance training is also useful and the combination of both types of exercise may be most effective.[58] A diabetic diet that promotes weight loss is important.[59] While the best diet type to achieve this is controversial,[59] a low glycemic index diet or low carbohydrate diet has been found to improve blood sugar control.[60][61] Culturally appropriate education may help people with type2 diabetes control their blood sugar levels, for up to six months at least.[62] If changes in lifestyle in those with mild diabetes has not resulted in improved blood sugars within six weeks, medications should then be considered.[7] There is not enough evidence to determine if lifestyle interventions affect mortality in those who already have DM2.[43]

There are several classes of anti-diabetic medications available. Metformin is generally recommended as a first line treatment as there is some evidence that it decreases mortality;[8] however, this conclusion is questioned.[63] Metformin should not be used in those with severe kidney or liver problems.[7]

A second oral agent of another class or insulin may be added if metformin is not sufficient after three months.[55] Other classes of medications include: sulfonylureas, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, SGLT2 inhibitors, and glucagon-like peptide-1 analog.[55] There is no significant difference between these agents.[55]Rosiglitazone, a thiazolidinedione, has not been found to improve long-term outcomes even though it improves blood sugar levels.[64] Additionally it is associated with increased rates of heart disease and death.[65]Angiotensin-converting enzyme inhibitors (ACEIs) prevent kidney disease and improve outcomes in those with diabetes.[66][67] The similar medications angiotensin receptor blockers (ARBs) do not.[67]

Injections of insulin may either be added to oral medication or used alone.[8] Most people do not initially need insulin.[3] When it is used, a long-acting formulation is typically added at night, with oral medications being continued.[7][8] Doses are then increased to effect (blood sugar levels being well controlled).[8] When nightly insulin is insufficient, twice daily insulin may achieve better control.[7] The long acting insulins glargine and detemir are equally safe and effective,[68] and do not appear much better than neutral protamine Hagedorn (NPH) insulin, but as they are significantly more expensive, they are not cost effective as of 2010.[69] In those who are pregnant insulin is generally the treatment of choice.[7]

Weight loss surgery in those who are obese is an effective measure to treat diabetes.[70] Many are able to maintain normal blood sugar levels with little or no medications following surgery[71] and long-term mortality is decreased.[72] There however is some short-term mortality risk of less than 1% from the surgery.[73] The body mass index cutoffs for when surgery is appropriate are not yet clear.[72] It is recommended that this option be considered in those who are unable to get both their weight and blood sugar under control.[74]

no data

7.5

7.515

1522.5

22.530

3037.5

37.545

4552.5

52.560

6067.5

67.575

7582.5

82.5

Globally as of 2010 it was estimated that there were 285million people with type2 diabetes making up about 90% of diabetes cases.[4] This is equivalent to about 6% of the world's adult population.[75] Diabetes is common both in the developed and the developing world.[4] It remains uncommon, however, in the underdeveloped world.[3]

Women seem to be at a greater risk as do certain ethnic groups,[4][76] such as South Asians, Pacific Islanders, Latinos, and Native Americans.[7] This may be due to enhanced sensitivity to a Western lifestyle in certain ethnic groups.[77] Traditionally considered a disease of adults, type2 diabetes is increasingly diagnosed in children in parallel with rising obesity rates.[4] Type2 diabetes is now diagnosed as frequently as type1 diabetes in teenagers in the United States.[3]

Rates of diabetes in 1985 were estimated at 30million, increasing to 135million in 1995 and 217million in 2005.[5] This increase is believed to be primarily due to the global population aging, a decrease in exercise, and increasing rates of obesity.[5] The five countries with the greatest number of people with diabetes as of 2000 are India having 31.7million, China 20.8million, the United States 17.7million, Indonesia 8.4million, and Japan 6.8million.[78] It is recognized as a global epidemic by the World Health Organization.[79]

Diabetes is one of the first diseases described[80] with an Egyptian manuscript from c. 1500 BCE mentioning "too great emptying of the urine."[81] The first described cases are believed to be of type1 diabetes.[81] Indian physicians around the same time identified the disease and classified it as madhumeha or honey urine noting that the urine would attract ants.[81] The term "diabetes" or "to pass through" was first used in 230BCE by the Greek Appollonius Of Memphis.[81] The disease was rare during the time of the Roman empire with Galen commenting that he had only seen two cases during his career.[81]

Type1 and type2 diabetes were identified as separate conditions for the first time by the Indian physicians Sushruta and Charaka in 400-500AD with type1 associated with youth and type2 with being overweight.[81] The term "mellitus" or "from honey" was added by the Briton John Rolle in the late 1700s to separate the condition from diabetes insipidus which is also associated with frequent urination.[81] Effective treatment was not developed until the early part of the 20th century when the Canadians Frederick Banting and Charles Best discovered insulin in 1921 and 1922.[81] This was followed by the development of the long acting NPH insulin in the 1940s.[81]

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Diabetes Symptoms: Common Symptoms of Diabetes

Saturday, August 29th, 2015

knowledge center home diabetes diabetes symptoms

Last updated: Tuesday 16 June 2015

Last updated: Tue 16 Jun 2015

People can often have diabetes and be completely unaware. The main reason for this is that the symptoms, when seen on their own, seem harmless. However, the earlier diabetes is diagnosed the greater the chances are that serious complications, which can result from having diabetes, can be avoided.

The most common signs and symptoms of diabetes are:

We will examine each of these symptoms in more detail below.

Have you been going to the bathroom to urinate more often recently? Do you notice that you spend most of the day going to the toilet? When there is too much glucose (sugar) in your blood you will urinate more often. If your insulin is ineffective, or not there at all, your kidneys cannot filter the glucose back into the blood. The kidneys will take water from your blood in order to dilute the glucose - which in turn fills up your bladder.

If you are urinating more than usual, you will need to replace that lost liquid. You will be drinking more than usual. Have you been drinking more than usual lately?

As the insulin in your blood is not working properly, or is not there at all, and your cells are not getting their energy, your body may react by trying to find more energy - food. You will become hungry.

This might be the result of the above symptom (intense hunger).

This is more common among people with Diabetes Type 1. As your body is not making insulin it will seek out another energy source (the cells aren't getting glucose). Muscle tissue and fat will be broken down for energy. As Type 1 is of a more sudden onset and Type 2 is much more gradual, weight loss is more noticeable with Type 1.

If your insulin is not working properly, or is not there at all, glucose will not be entering your cells and providing them with energy. This will make you feel tired and listless.

Irritability can be due to your lack of energy.

This can be caused by tissue being pulled from your eye lenses. This affects your eyes' ability to focus. With proper treatment this can be treated. There are severe cases where blindness or prolonged vision problems can occur.

Do you find cuts and bruises take a much longer time than usual to heal? When there is more sugar (glucose) in your body, its ability to heal can be undermined.

When there is more sugar in your body, its ability to recover from infections is affected. Women with diabetes find it especially difficult to recover from bladder and vaginal infections.

A feeling of itchiness on your skin is sometimes a symptom of diabetes.

If your gums are tender, red and/or swollen this could be a sign of diabetes. Your teeth could become loose as the gums pull away from them.

As well as the previous gum symptoms, you may experience more frequent gum disease and/or gum infections.

If you are over 50 and experience frequent or constant sexual dysfunction (erectile dysfunction), it could be a symptom of diabetes.

If there is too much sugar in your body your nerves could become damaged, as could the tiny blood vessels that feed those nerves. You may experience tingling and/or numbness in your hands and feet.

Diabetes can often be detected by carrying out a urine test, which finds out whether excess glucose is present. This is normally backed up by a blood test, which measures blood glucose levels and can confirm if the cause of your symptoms is diabetes.

If you are worried that you may have some of the above symptoms, you are recommended to talk to your Doctor or a qualified health professional.

This diabetes information section was written by Christian Nordqvist. It was first published on 15 September 2010 and last updated on 19 May 2015.

Disclaimer: This informational section on Medical News Today is regularly reviewed and updated, and provided for general information purposes only. The materials contained within this guide do not constitute medical or pharmaceutical advice, which should be sought from qualified medical and pharmaceutical advisers.

Please note that although you may feel free to cite and quote this article, it may not be re-produced in full without the permission of Medical News Today. For further details, please view our full terms of use

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Diabetes Symptoms: Common Symptoms of Diabetes

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Questions & Answers about Diabetes in the Workplace and …

Saturday, August 29th, 2015

INTRODUCTION

The Americans with Disabilities Act (ADA), which was amended by the ADA Amendments Act of 2008 ("Amendments Act" or "ADAAA"), is a federal law that prohibits discrimination against qualified individuals with disabilities. Individuals with disabilities include those who have impairments that substantially limit a major life activity, have a record (or history) of a substantially limiting impairment, or are regarded as having a disability.1

Title I of the ADA covers employment by private employers with 15 or more employees as well as state and local government employers. Section 501 of the Rehabilitation Act provides similar protections related to federal employment. In addition, most states have their own laws prohibiting employment discrimination on the basis of disability. Some of these state laws may apply to smaller employers and may provide protections in addition to those available under the ADA.2

The U.S. Equal Employment Opportunity Commission (EEOC) enforces the employment provisions of the ADA. This document, which is one of a series of question-and-answer documents addressing particular disabilities in the workplace,3 explains how the ADA applies to job applicants and employees who have or had diabetes. In particular, this document explains:

Diabetes is a group of diseases characterized by high blood glucose or sugar levels that result from defects in the body's ability to produce and/or use insulin.4 Insulin is a hormone that helps the glucose enter the body's cells to give them energy. With Type 1 diabetes, the body does not make insulin. With Type 2 diabetes, the more common type, the body does not make or use insulin well. Some women develop a type of diabetes called gestational diabetes during pregnancy when their bodies are not able to make and use all the insulin it needs, but may not have diabetes after giving birth. Without enough insulin, the glucose stays in the blood.5

Although diabetes cannot be cured, it can be managed. Some people are able to control their diabetes by eating a balanced diet, maintaining a healthy body weight, and exercising regularly. Many individuals, however, must take oral medication and/or administer insulin injections to manage their diabetes.6

With nearly two million new cases diagnosed each year, diabetes is becoming more prevalent in the United States and is the most common endocrine disease.7 Today, an estimated 18.8 million adults in the United States have diabetes.8

As a result of changes made by the ADAAA, individuals who have diabetes should easily be found to have a disability within the meaning of the first part of the ADA's definition of disability because they are substantially limited in the major life activity of endocrine function.9 Additionally, because the determination of whether an impairment is a disability is made without regard to the ameliorative effects of mitigating measures, diabetes is a disability even if insulin, medication, or diet controls a person's blood glucose levels. An individual with a past history of diabetes (for example, gestational diabetes) also has a disability within the meaning of the ADA.10 Finally, an individual is covered under the third ("regarded as") prong of the definition of disability if an employer takes a prohibited action (for example, refuses to hire or terminates the individual) because of diabetes or because the employer believes the individual has diabetes.11

Title I of the ADA limits an employer's ability to ask questions related to diabetes and other disabilities and to conduct medical examinations at three stages: pre-offer, post-offer, and during employment.

Before an Offer of Employment Is Made

1. May an employer ask a job applicant whether she has or had diabetes or about her treatment related to diabetes before making a job offer?

No. An employer may not ask questions about an applicant's medical condition12 or require an applicant to have a medical examination before it makes a conditional job offer. This means that an employer cannot legally ask an applicant questions such as:

Of course, an employer may ask questions pertaining to the qualifications for, or performance of, the job, such as:

2. Does the ADA require an applicant to disclose that she has or had diabetes or some other disability before accepting a job offer?

No. The ADA does not require applicants to voluntarily disclose that they have or had diabetes or another disability unless they will need a reasonable accommodation for the application process (for example, a break to eat a snack or monitor their glucose levels). Some individuals with diabetes, however, choose to disclose their condition because they want their co-workers or supervisors to know what to do if they faint or experience other symptoms of hypoglycemia (low blood sugar), such as weakness, shakiness, or confusion. 13

Sometimes, the decision to disclose depends on whether an individual will need a reasonable accommodation to perform the job (for example, breaks to take medication or a place to rest until blood sugar levels become normal). A person with diabetes, however, may request an accommodation after becoming an employee even if she did not do so when applying for the job or after receiving the job offer.

3. May an employer ask any follow-up questions if an applicant voluntarily reveals that she has or had diabetes?

No. An employer generally may not ask an applicant who has voluntarily disclosed that she has diabetes any questions about her diabetes, its treatment, or its prognosis. However, if an applicant voluntarily discloses that she has diabetes and the employer reasonably believes that she will require an accommodation to perform the job because of her diabetes or treatment, the employer may ask whether the applicant will need an accommodation and what type. The employer must keep any information an applicant discloses about her medical condition confidential. (See "Keeping Medical Information Confidential.")

After an Offer of Employment Is Made

After making a job offer, an employer may ask questions about the applicant's health (including questions about the applicant's disability) and may require a medical examination, as long as all applicants for the same type of job are treated equally (that is, all applicants are asked the same questions and are required to take the same examination). After an employer has obtained basic medical information from all individuals who have received job offers, it may ask specific individuals for more medical information if it is medically related to the previously obtained medical information. For example, if an employer asks all applicants post-offer about their general physical and mental health, it can ask individuals who disclose a particular illness, disease, or impairment for more medical information or require them to have a medical examination related to the condition disclosed.

4. What may an employer do when it learns that an applicant has or had diabetes after she has been offered a job but before she starts working?

When an applicant discloses after receiving a conditional job offer that she has diabetes, an employer may ask the applicant additional questions such as how long she has had diabetes; whether she uses insulin or oral medication; whether and how often she experiences hypoglycemic episodes; and/or whether she will need assistance if her blood sugar level drops while at work. The employer also may send the applicant for a follow-up medical examination or ask her to submit documentation from her doctor answering questions specifically designed to assess her ability to perform the job's functions safely. Permissible follow-up questions at this stage differ from those at the pre-offer stage when an employer only may ask an applicant who voluntarily discloses a disability whether she needs an accommodation to perform the job and what type.

An employer may not withdraw an offer from an applicant with diabetes if the applicant is able to perform the essential functions of the job, with or without reasonable accommodation, without posing a direct threat (that is, a significant risk of substantial harm) to the health or safety of himself or others that cannot be eliminated or reduced through reasonable accommodation. ("Reasonable accommodation" is discussed at Questions 10 through 15. "Direct threat" is discussed at Questions 6 and 16 through 18.)

The ADA strictly limits the circumstances under which an employer may ask questions about an employee's medical condition or require the employee to have a medical examination. Once an employee is on the job, her actual performance is the best measure of ability to do the job.

5. When may an employer ask an employee whether diabetes, or some other medical condition, may be causing her performance problems?

Generally, an employer may ask disability-related questions or require an employee to have a medical examination when it knows about a particular employee's medical condition, has observed performance problems, and reasonably believes that the problems are related to a medical condition. At other times, an employer may ask for medical information when it has observed symptoms, such as extreme fatigue or irritability, or has received reliable information from someone else (for example, a family member or co-worker) indicating that the employee may have a medical condition that is causing performance problems. Often, however, poor job performance is unrelated to a medical condition and generally should be handled in accordance with an employer's existing policies concerning performance.15

Example 4: A normally reliable secretary with diabetes has been coming to work late and missing deadlines. The supervisor observed these changes soon after the secretary started going to law school in the evenings. The supervisor can ask the secretary why his performance has declined but may not ask him about his diabetes unless there is objective evidence that his poor performance is related to his medical condition.

6. May an employer require an employee on leave because of diabetes to provide documentation or have a medical examination before allowing her to return to work?

Yes. If the employer has a reasonable belief that the employee may be unable to perform her job or may pose a direct threat to herself or others, the employer may ask for medical information. However, the employer may obtain only the information needed to make an assessment of the employee's present ability to perform her job and to do so safely.

7. Are there any other instances when an employer may ask an employee with diabetes about his condition?

Yes. An employer also may ask an employee about diabetes when it has a reasonable belief that the employee will be unable to safely perform the essential functions of his job because of diabetes. In addition, an employer may ask an employee about his diabetes to the extent the information is necessary:

With limited exceptions, an employer must keep confidential any medical information it learns about an applicant or employee. Under the following circumstances, however, an employer may disclose that an employee has diabetes:

8. May an employer tell employees who ask why their co-worker is allowed to do something that generally is not permitted (such as eat at his desk or take more breaks) that she is receiving a reasonable accommodation?

No. Telling co-workers that an employee is receiving a reasonable accommodation amounts to a disclosure that the employee has a disability. Rather than disclosing that the employee is receiving a reasonable accommodation, the employer should focus on the importance of maintaining the privacy of all employees and emphasize that its policy is to refrain from discussing the work situation of any employee with co-workers. Employers may be able to avoid many of these kinds of questions by training all employees on the requirements of equal employment opportunity laws, including the ADA.

Additionally, an employer will benefit from providing information about reasonable accommodations to all of its employees. This can be done in a number of ways, such as through written reasonable accommodation procedures, employee handbooks, staff meetings, and periodic training. This kind of proactive approach may lead to fewer questions from employees who misperceive co-worker accommodations as "special treatment."

9. If an employee experiences an insulin reaction at work, may an employer explain to other employees or managers that the employee has diabetes?

No. Although the employee's co-workers and others in the workplace who witness the reaction naturally may be concerned, an employer may not reveal that the employee has diabetes. Rather, the employer should assure everyone present that the situation is under control. An employee, however, may voluntarily choose to tell her co-workers that she has diabetes and provide them with helpful information, such as how to recognize when her blood sugar may be low, what to do if she faints or seems shaky or confused (for example, offer a piece of candy or gum), or where to find her glucose monitoring kit. However, even when an employee voluntarily discloses that she has diabetes, the employer must keep this information confidential consistent with the ADA. An employer also may not explain to other employees why an employee with diabetes has been absent from work if the absence is related to her diabetes or another disability.

The ADA requires employers to provide adjustments or modifications -- called reasonable accommodations -- to enable applicants and employees with disabilities to enjoy equal employment opportunities unless doing so would be an undue hardship (that is, a significant difficulty or expense). Accommodations vary depending on the needs of the individual with a disability. Not all employees with diabetes will need an accommodation or require the same accommodations, and most of the accommodations a person with diabetes might need will involve little or no cost. An employer must provide a reasonable accommodation that is needed because of the diabetes itself, the effects of medication, or both. For example, an employer may have to accommodate an employee who is unable to work while learning to manage her diabetes or adjusting to medication. An employer, however, has no obligation to monitor an employee to make sure that she is regularly checking her blood sugar levels, eating, or taking medication as prescribed.

10. What other types of reasonable accommodations may employees with diabetes need?

Some employees may need one or more of the following accommodations:

Although these are some examples of the types of accommodations commonly requested by employees with diabetes, other employees may need different changes or adjustments. Employers should ask the particular employee requesting an accommodation what he needs that will help him do his job. There also are extensive public and private resources to help employers identify reasonable accommodations. For example, the website for the Job Accommodation Network (JAN)(http://askjan.org/media/Diabetes.html) provides information about many types of accommodations for employees with diabetes.

11. How does an employee with diabetes request a reasonable accommodation?

There are no "magic words" that a person has to use when requesting a reasonable accommodation. A person simply has to tell the employer that she needs an adjustment or change at work because of her diabetes. A request for a reasonable accommodation also can come from a family member, friend, health professional, or other representative on behalf of a person with diabetes.

12. May an employer request documentation when an employee who has diabetes requests a reasonable accommodation?

Yes. An employer may request reasonable documentation where a disability or the need for reasonable accommodation is not known or obvious. An employer, however, is entitled only to documentation sufficient to establish that the employee has diabetes and to explain why an accommodation is needed. A request for an employee's entire medical record, for example, would be inappropriate as it likely would include information about conditions other than the employee's diabetes.20

13. Does an employer have to grant every request for a reasonable accommodation?

No. An employer does not have to provide an accommodation if doing so will be an undue hardship. Undue hardship means that providing the reasonable accommodation will result in significant difficulty or expense. An employer also does not have to eliminate an essential function of a job as a reasonable accommodation, tolerate performance that does not meet its standards, or excuse violations of conduct rules that are job-related and consistent with business necessity and that the employer applies consistently to all employees (such as rules prohibiting violence, threatening behavior, theft, or destruction of property).

If more than one accommodation will be effective, the employee's preference should be given primary consideration, although the employer is not required to provide the employee's first choice of reasonable accommodation. If a requested accommodation is too difficult or expensive, an employer may choose to provide an easier or less costly accommodation as long as it is effective in meeting the employee's needs.

14. May an employer be required to provide more than one accommodation for the same employee with diabetes?

Yes. The duty to provide a reasonable accommodation is an ongoing one. Although some employees with diabetes may require only one reasonable accommodation, others may need more than one. For example, an employee with diabetes may require leave to attend a class on how to administer insulin injections and later may request a part-time or modified schedule to better control his glucose levels. An employer must consider each request for a reasonable accommodation and determine whether it would be effective and whether providing it would pose an undue hardship.

15. May an employer automatically deny a request for leave from someone with diabetes because the employee cannot specify an exact date of return?

No. Granting leave to an employee who is unable to provide a fixed date of return may be a reasonable accommodation. Although diabetes can be successfully treated, some individuals experience serious complications that may be unpredictable and do not permit exact timetables. An employee requesting leave because of diabetes or resulting complications (for example, a foot or toe amputation), therefore, may be able to provide only an approximate date of return (e.g., "in six to eight weeks," "in about three months"). In such situations, or in situations in which a return date must be postponed because of unforeseen medical developments, employees should stay in regular communication with their employers to inform them of their progress and discuss the need for continued leave beyond what originally was granted. The employer also has the right to require that the employee provide periodic updates on his condition and possible date of return. After receiving these updates, the employer may reevaluate whether continued leave constitutes an undue hardship.

When it comes to safety concerns, an employer should be careful not to act on the basis of myths, fears, or stereotypes about diabetes. Instead, the employer should evaluate each individual on her skills, knowledge, experience and how having diabetes affects her.

16. When may an employer refuse to hire, terminate, or temporarily restrict the duties of a person who has diabetes because of safety concerns?

An employer only may exclude an individual with diabetes from a job for safety reasons when the individual poses a direct threat. A "direct threat" is a significant risk of substantial harm to the individual or others that cannot be eliminated or reduced through reasonable accommodation.21 This determination must be based on objective, factual evidence, including the best recent medical evidence and advances in the treatment of diabetes.

In making a direct threat assessment, the employer must evaluate the individual's present ability to safely perform the job. The employer also must consider:

The harm must be serious and likely to occur, not remote or speculative. Finally, the employer must determine whether any reasonable accommodation (for example, temporarily limiting an employee's duties, temporarily reassigning an employee, or placing an employee on leave) would reduce or eliminate the risk.23

Example 13: When an actor forgets his lines and stumbles during several recent play rehearsals, he explains that the fluctuating rehearsal times are interfering with when he eats and takes his insulin. Because there is no reason to believe that the actor poses a direct threat, the director cannot terminate the actor or replace him with an understudy; rather, the director should consider whether rehearsals can be held at a set time and/or whether the actor can take a break when needed to eat, monitor his glucose, or administer his insulin

17. May an employer require an employee who has had an insulin reaction at work to submit periodic notes from his doctor indicating that his diabetes is under control?

Yes, but only if the employer has a reasonable belief that the employee will pose a direct threat if he does not regularly see his doctor. In determining whether to require periodic documentation, the employer should consider the safety risks associated with the position the employee holds, the consequences of the employee's inability or impaired ability to perform his job, how long the employee has had diabetes, and how many insulin reactions the employee has had on the job.

Example 15:The owner of a daycare center knows that one of her teachers has diabetes and that she once had an insulin reaction at work when she skipped lunch. When the owner sees the teacher eat a piece of cake at a child's birthday party, she becomes concerned that the teacher may have an insulin reaction. Although many people believe that individuals with diabetes should never eat sugar or sweets, this is a myth. The owner, therefore, cannot require the teacher to submit periodic notes from her doctor indicating that her diabetes is under control because she does not have a reasonable belief, based on objective evidence, that the teacher will pose a direct threat to the safety of herself or others.

18. What should an employer do when another federal law prohibits it from hiring anyone who uses insulin?

If a federal law prohibits an employer from hiring a person who uses insulin, the employer is not be liable under the ADA. The employer should be certain, however, that compliance with the law actually is required, not voluntary. The employer also should be sure that the law does not contain any exceptions or waivers. For example, the Department of Transportation's Federal Motor Carrier Safety Administration (FMCSA) issues exemptions to certain individuals with diabetes who wish to drive commercial motor vehicles (CMVs).24

The ADA prohibits harassment, or offensive conduct, based on disability just as other federal laws prohibit harassment based on race, sex, color, national origin, religion, age, and genetic information. Offensive conduct may include, but is not limited to, offensive jokes, slurs, epithets or name calling, physical assaults or threats, intimidation, ridicule or mockery, insults or put-downs, offensive objects or pictures, and interference with work performance. Although the law does not prohibit simple teasing, offhand comments, or isolated incidents that are not very serious, harassment is illegal when it is so frequent or severe that it creates a hostile or offensive work environment or when it results in an adverse employment decision (such as the victim being fired or demoted).

19. What should employers do to prevent and correct harassment?

Employers should make clear that they will not tolerate harassment based on disability or on any other basis. This can be done in a number of ways, such as through a written policy, employee handbooks, staff meetings, and periodic training. The employer should emphasize that harassment is prohibited and that employees should promptly report such conduct to a manager. Finally, the employer should immediately conduct a thorough investigation of any report of harassment and take swift and appropriate corrective action. For more information on the standards governing harassment under all of the EEO laws, see http://www.eeoc.gov/policy/docs/harassment.html.

The ADA prohibits retaliation by an employer against someone who opposes discriminatory employment practices, files a charge of employment discrimination, or testifies or participates in any way in an investigation, proceeding, or litigation related to a charge of employment discrimination. It is also unlawful for an employer to retaliate against someone for requesting a reasonable accommodation. Persons who believe that they have experienced retaliation may file a charge of retaliation as described below.

Any person who believes that his or her employment rights have been violated on the basis of disability and wants to make a claim against an employer must file a charge of discrimination with the EEOC. A third party may also file a charge on behalf of another person who believes he or she experienced discrimination. For example, a family member, social worker, or other representative can file a charge on behalf of someone who is incapacitated because of diabetes. The charge must be filed by mail or in person with the local EEOC office within 180 days from the date of the alleged violation. The 180-day filing deadline is extended to 300 days if a state or local anti-discrimination agency has the authority to grant or seek relief as to the challenged unlawful employment practice.

The EEOC will send the parties a copy of the charge and may ask for responses and supporting information. Before formal investigation, the EEOC may select the charge for EEOC's mediation program. Both parties have to agree to mediation, which may prevent a time consuming investigation of the charge. Participation in mediation is free, voluntary, and confidential.

If mediation is unsuccessful, the EEOC investigates the charge to determine if there is "reasonable cause" to believe discrimination has occurred. If reasonable cause is found, the EEOC will then try to resolve the charge with the employer. In some cases, where the charge cannot be resolved, the EEOC will file a court action. If the EEOC finds no discrimination, or if an attempt to resolve the charge fails and the EEOC decides not to file suit, it will issue a notice of a "right to sue," which gives the charging party 90 days to file a court action. A charging party can also request a notice of a "right to sue" from the EEOC 180 days after the charge was first filed with the Commission, and may then bring suit within 90 days after receiving the notice. For a detailed description of the process, you can visit our website at http://www.eeoc.gov/employees/howtofile.cfm.

If you are a federal employee or job applicant and you believe that a federal agency has discriminated against you, you have a right to file a complaint. Each agency is required to post information about how to contact the agency's EEO Office. You can contact an EEO Counselor by calling the office responsible for the agency's EEO complaints program. Generally, you must contact the EEO Counselor within 45 days from the day the discrimination occurred. In most cases the EEO Counselor will give you the choice of participating either in EEO counseling or in an alternative dispute resolution (ADR) program, such as a mediation program.

If you do not settle the dispute during counseling or through ADR, you can file a formal discrimination complaint against the agency with the agency's EEO Office. You must file within 15 days from the day you receive notice from your EEO Counselor about how to file.

Once you have filed a formal complaint, the agency will review the complaint and decide whether or not the case should be dismissed for a procedural reason (for example, your claim was filed too late). If the agency doesn't dismiss the complaint, it will conduct an investigation. The agency has 180 days from the day you filed your complaint to finish the investigation. When the investigation is finished, the agency will issue a notice giving you two choices: either request a hearing before an EEOC Administrative Judge or ask the agency to issue a decision as to whether the discrimination occurred. For a detailed description of the process, you can visit our website at http://www.eeoc.gov/federal/fed_employees/complaint_overview.cfm.

Footnotes

1 See 42 U.S.C. 12102(2); 29 C.F.R. 1630.2(g).

2 For example, disability laws in California, Pennsylvania, New Jersey, and New York apply to employers with fewer than 15 employees.

3 See "The Question and Answer Series" under "Available Resources" on EEOC's website at http://www.eeoc.gov/laws/types/disability.cfm.

4 See Diabetes Basics, http://www.diabetes.org/diabetes-basics (last visited January 10, 2013); see also http://www.diabetes.org/diabetes-basics/gestational/

5 Id.; see also information on diabetes from the National Institutes of Health, http://www.nlm.nih.gov/medlineplus/diabetes.html.

6 Diabetes Basics, supra note 4.

7 According to the Centers for Disease Control and Prevention (CDC), about 1.9 million people aged 20 or older were newly diagnosed with diabetes in the United States in 2010. See National Diabetes Fact Sheet (2011), http://www.cdc.gov/diabetes/pubs/factsheet11.htm (last visited January 10, 2013);see also Endocrine Diseases, http://www.nim.nih.gov/medlineplus/endocrinediseases.html#cat1.

8 See 2011 National Diabetes Fact Sheet (released January 26, 2011), http://www.diabetes.org/diabetes-basics/diabetes-statistics (last visited January 13, 2013).

9 See 29 C.F.R. 1630.2(j)(3)(iii).

10 Id. at 1630.2(k).

11 Id. at 1630.2(l).

12 Federal contractors are required under 41 C.F.R. 60-741.42, a regulation issued by the Office of Federal Contract Compliance Programs (OFCCP), to invite applicants to voluntarily self-identify as persons with disabilities for affirmative action purposes. The ADA prohibition on asking applicants about medical conditions at the pre-offer stage does not prevent federal contractors from complying with the OFCCP's regulation. See Letter from Peggy R. Mastroianni, EEOC Legal Counsel, to Patricia A. Shiu, Director of OFCCP, http://www.dol.gov/ofccp/regs/compliance/section503.htm#bottom.

13 Insulin and some oral medications can sometimes cause a person's blood sugar levels to drop too low. A person experiencing hypoglycemia (low blood sugar) may feel weak, shaky, confused, or faint. Most people with diabetes, however, recognize these symptoms and will immediately drink or eat something sweet. Many individuals with diabetes also carry a blood glucose monitoring kit with them at all times and test their blood sugar levels as soon as they feel minor symptoms such as shaking or sweating. Often, a person's blood sugar returns to normal within 15 minutes of eating or drinking something sweet. See generally information from the American Association of Diabetes, http://www.diabetes.org.

14 Asking an applicant or employee about family medical history also violates Title II of the Genetic Information Nondiscrimination Act (GINA), 42 U.S.C. 2000ff et seq., which prohibits employers from requesting, requiring, or purchasing genetic information (including family medical history) about applicants or employees. 29 C.F.R. 1635.8(a).

15 An employer also may ask an employee about his diabetes or send the employee for a medical examination when it reasonably believes the employee may pose a direct threat because of his diabetes. See "Concerns About Safety."

16 An employer also may ask an employee for periodic updates on his condition if the employee has taken leave and has not provided an exact or fairly specific date of return or has requested leave in addition to that already granted. See also Q&A 15. Of course, an employer may call employees on extended leave to check on their progress or to express concern for their health without violating the ADA.

17 The ADA allows employers to conduct voluntary medical examinations and activities, including obtaining voluntary medical histories, which are part of an employee wellness program (such as a smoking cessation or diabetes detection screening and management program), as long as any medical records (including, for example, the results any diagnostic tests) acquired as part of the program are kept confidential. See Q&A 22 in EEOC Enforcement Guidance on Disability-Related Inquiries and Medical Examinations of Employees Under the ADA, http://www.eeoc.gov/policy/docs/guidance-inquiries.html

18 An employee with diabetes who needs continuing or intermittent leave, or a part-time or modified schedule, as a reasonable accommodation also may be entitled to leave under the Family and Medical Leave Act (FMLA). For a discussion of how employers should treat situations in which an employee may be covered both by the FMLA and the ADA, see Questions 21 and 23 in the EEOC Enforcement Guidance on Reasonable Accommodation and Undue Hardship Under the Americans with Disabilities Act (rev. Oct. 17, 2002) at http://www.eeoc.gov/policy/docs/accommodation.html.

19 Diabetic neuropathy is a common complication of diabetes in which nerves are damaged as a result of high blood sugar levels (hyperglycemia). See National Center for Biotechnology Information, U.S. National Library of Medicine, http://www.ncbi.nlm.nih.gov.

20 Requests for documentation to support a request for accommodation may violate Title II of GINA where they are likely to result in the acquisition of genetic information, including family medical history. 29 C.F.R. 1635.8(a). For this reason employers may want to include a warning in the request for documentation that the employee or the employee's doctor should not provide genetic information. Id. at 1635.8(b)(1)(i)(B).

21 See 29 C.F.R. 1630.2(r).

22 Id.

23 Id.

24 Under FMCSA's Diabetes Exemption Program, an individual who intends to operate a CMV in interstate commerce may apply for an exemption from the diabetes standard if he or she meets all medical standards and guidelines, other than diabetes, in accordance with 49 CFR 391.41 (b) (1-13).

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Type 2 Diabetes: Causes, Symptoms, Prevention, and More

Thursday, August 27th, 2015

Diabetes is a life-long disease that affects the way your body handles glucose, a kind of sugar, in your blood.

Most people with the condition have type 2. There are about 27 million people in the U.S. with it. Another 86 million have prediabetes: Their blood glucose is not normal, but not high enough to be diabetes yet.

Diabetes is a serious disease that can cause debilitating nerve pain.

Here's some helpful information:

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Your pancreas makes a hormone called insulin. It's what lets your cells turn glucose from the food you eat into energy. People with type 2 diabetes make insulin, but their cells don't use it as well as they should. Doctors call this insulin resistance.

At first, the pancreas makes more insulin to try to get glucose into the cells. But eventually it can't keep up, and the sugar builds up in your blood instead.

Usually a combination of things cause type 2 diabetes, including:

Genes. Scientists have found different bits of DNA that affect how your body makes insulin.

Extra weight. Being overweight or obese can cause insulin resistance, especially if you carry your extra pounds around the middle. Now type 2 diabetes affects kids and teens as well as adults, mainly because of childhood obesity.

Metabolic syndrome. People with insulin resistance often have a group of conditions including high blood glucose, extra fat around the waist, high blood pressure, and high cholesterol and triglycerides.

Too much glucose from your liver. When your blood sugar is low, your liver makes and sends out glucose. After you eat, your blood sugar goes up, and usually the liver will slow down and store its glucose for later. But some people's livers don't. They keep cranking out sugar.

Bad communication between cells. Sometimes cells send the wrong signals or don't pick up messages correctly. When these problems affect how your cells make and use insulin or glucose, a chain reaction can lead to diabetes.

Broken beta cells. If the cells that make the insulin send out the wrong amount of insulin at the wrong time, your blood sugar gets thrown off. High blood glucose can damage these cells, too.

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Type 2 Diabetes: Causes, Symptoms, Prevention, and More

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Diabetes management – Wikipedia, the free encyclopedia

Monday, August 24th, 2015

The term diabetes mellitus includes several different metabolic disorders that all, if left untreated, result in abnormally high concentration of a sugar called glucose in the blood. Diabetes mellitus type 1 results when the pancreas no longer produces significant amounts of the hormone insulin, usually owing to the autoimmune destruction of the insulin-producing beta cells of the pancreas. Diabetes mellitus type 2, in contrast, is now thought to result from autoimmune attacks on the pancreas and/or insulin resistance. The pancreas of a person with type 2 diabetes may be producing normal or even abnormally large amounts of insulin. Other forms of diabetes mellitus, such as the various forms of maturity onset diabetes of the young, may represent some combination of insufficient insulin production and insulin resistance. Some degree of insulin resistance may also be present in a person with type 1 diabetes.

The main goal of diabetes management is, as far as possible, to restore carbohydrate metabolism to a normal state. To achieve this goal, individuals with an absolute deficiency of insulin require insulin replacement therapy, which is given through injections or an insulin pump. Insulin resistance, in contrast, can be corrected by dietary modifications and exercise. Other goals of diabetes management are to prevent or treat the many complications that can result from the disease itself and from its treatment.

The treatment goals are related to effective control of blood glucose, blood pressure and lipids, to minimize the risk of long-term consequences associated with diabetes. They are suggested in clinical practice guidelines released by various national and international diabetes agencies.

The targets are:

Goals should be individualized based on:[3]

In older patients, clinical practice guidelines by the American Geriatrics Society states "for frail older adults, persons with life expectancy of less than 5 years, and others in whom the risks of intensive glycemic control appear to outweigh the benefits, a less stringent target such as HbA1c of 8% is appropriate".[4]

The primary issue requiring management is that of the glucose cycle. In this, glucose in the bloodstream is made available to cells in the body; a process dependent upon the twin cycles of glucose entering the bloodstream, and insulin allowing appropriate uptake into the body cells. Both aspects can require management.

The main complexities stem from the nature of the feedback loop of the glucose cycle, which is sought to be regulated:

As diabetes is a prime risk factor for cardiovascular disease, controlling other risk factors which may give rise to secondary conditions, as well as the diabetes itself, is one of the facets of diabetes management. Checking cholesterol, LDL, HDL and triglyceride levels may indicate hyperlipoproteinemia, which may warrant treatment with hypolipidemic drugs. Checking the blood pressure and keeping it within strict limits (using diet and antihypertensive treatment) protects against the retinal, renal and cardiovascular complications of diabetes. Regular follow-up by a podiatrist or other foot health specialists is encouraged to prevent the development of diabetic foot. Annual eye exams are suggested to monitor for progression of diabetic retinopathy.

Late in the 19th century, sugar in the urine (glycosuria) was associated with diabetes. Various doctors studied the connection. Frederick Madison Allen studied diabetes in 1909-12, then published a large volume, Studies Concerning Glycosuria and Diabetes, (Boston, 1913). He invented a fasting treatment for diabetes called the Allen treatment for diabetes. His diet was an early attempt at managing diabetes.

Modern approaches to diabetes primarily rely upon dietary and lifestyle management, often combined with regular ongoing blood glucose level monitoring.

Diet management allows control and awareness of the types of nutrients entering the digestive system, and hence allows indirectly, significant control over changes in blood glucose levels. Blood glucose monitoring allows verification of these, and closer control, especially important since some symptoms of diabetes are not easy for the patient to notice without actual measurement.

Other approaches include exercise and other lifestyle changes which impact the glucose cycle.

In addition, a strong partnership between the patient and the primary healthcare provider general practitioner or internist is an essential tool in the successful management of diabetes. Often the primary care doctor makes the initial diagnosis of diabetes and provides the basic tools to get the patient started on a management program. Regular appointments with the primary care physician and a certified diabetes educator are some of the best things a patient can do in the early weeks after a diagnosis of diabetes. Upon the diagnosis of diabetes, the primary care physician, specialist, or endocrinologist will conduct a full physical and medical examination. A thorough assessment covers topics such as:

Diabetes can be very complicated, and the physician needs to have as much information as possible to help the patient establish an effective management plan. Physicians may often experience data overload resulting from hundreds of blood-glucose readings, insulin dosages and other health factors occurring between regular office visits which must be deciphered during a relatively brief visit with the patient to determine patterns and establish or modify a treatment plan.[5]

The physician can also make referrals to a wide variety of professionals for additional health care support. In the UK a patient training course is available for newly diagnosed diabetics (see DESMOND). In big cities, there may be diabetes centers where several specialists, such as diabetes educators and dietitians, work together as a team. In smaller towns, the health care team may come together a little differently depending on the types of practitioners in the area. By working together, doctors and patients can optimize the healthcare team to successfully manage diabetes over the long term.

The 10 countries with the largest populations of diabetic patients are China, India, the U.S., Brazil, Russia, Mexico, Indonesia, Germany, Egypt and Japan.[6]

Blood sugar level is measured by means of a glucose meter, with the result either in mg/dL (milligrams per deciliter in the USA) or mmol/L (millimoles per litre in Canada and Europe) of blood. The average normal person should have a glucose level of around 4.5 to 7.0mmol/L (80 to 125mg/dL).

Optimal management of diabetes involves patients measuring and recording their own blood glucose levels. By keeping a diary of their own blood glucose measurements and noting the effect of food and exercise, patients can modify their lifestyle to better control their diabetes. For patients on insulin, patient involvement is important in achieving effective dosing and timing.

Some edible mushrooms are noted for the ability to lower blood sugar levels including Reishi,[7][8]Maitake[9][10][11][12][13][14]Agaricus blazei[15][16][17][18] as well as some others.

Levels which are significantly above or below this range are problematic and can in some cases be dangerous. A level of <3.8mmol/L (<70mg/dL) is usually described as a hypoglycemic attack (low blood sugar). Most diabetics know when they are going to "go hypo" and usually are able to eat some food or drink something sweet to raise levels. A patient who is hyperglycemic (high glucose) can also become temporarily hypoglycemic, under certain conditions (e.g. not eating regularly, or after strenuous exercise, followed by fatigue). Intensive efforts to achieve blood sugar levels close to normal have been shown to triple the risk of the most severe form of hypoglycemia, in which the patient requires assistance from by-standers in order to treat the episode.[19] In the United States, there were annually 48,500 hospitalizations for diabetic hypoglycemia and 13,100 for diabetic hypoglycemia resulting in coma in the period 1989 to 1991, before intensive blood sugar control was as widely recommended as today.[20] One study found that hospital admissions for diabetic hypoglycemia increased by 50% from 1990-1993 to 1997-2000, as strict blood sugar control efforts became more common.[21] Among intensively controlled type 1 diabetics, 55% of episodes of severe hypoglycemia occur during sleep, and 6% of all deaths in diabetics under the age of 40 are from nocturnal hypoglycemia in the so-called 'dead-in-bed syndrome,' while National Institute of Health statistics show that 2% to 4% of all deaths in diabetics are from hypoglycemia.[22] In children and adolescents following intensive blood sugar control, 21% of hypoglycemic episodes occurred without explanation.[23] In addition to the deaths caused by diabetic hypoglycemia, periods of severe low blood sugar can also cause permanent brain damage.[24] Interestingly, although diabetic nerve disease is usually associated with hyperglycemia, hypoglycemia as well can initiate or worsen neuropathy in diabetics intensively struggling to reduce their hyperglycemia.[25]

Levels greater than 13-15mmol/L (230270mg/dL) are considered high, and should be monitored closely to ensure that they reduce rather than continue to remain high. The patient is advised to seek urgent medical attention as soon as possible if blood sugar levels continue to rise after 2-3 tests. High blood sugar levels are known as hyperglycemia, which is not as easy to detect as hypoglycemia and usually happens over a period of days rather than hours or minutes. If left untreated, this can result in diabetic coma and death.

Prolonged and elevated levels of glucose in the blood, which is left unchecked and untreated, will, over time, result in serious diabetic complications in those susceptible and sometimes even death. There is currently no way of testing for susceptibility to complications. Diabetics are therefore recommended to check their blood sugar levels either daily or every few days. There is also diabetes management software available from blood testing manufacturers which can display results and trends over time. Type 1 diabetics normally check more often, due to insulin therapy.

A history of blood sugar level results is especially useful for the diabetic to present to their doctor or physician in the monitoring and control of the disease. Failure to maintain a strict regimen of testing can accelerate symptoms of the condition, and it is therefore imperative that any diabetic patient strictly monitor their glucose levels regularly.

Glycemic control is a medical term referring to the typical levels of blood sugar (glucose) in a person with diabetes mellitus. Much evidence suggests that many of the long-term complications of diabetes, especially the microvascular complications, result from many years of hyperglycemia (elevated levels of glucose in the blood). Good glycemic control, in the sense of a "target" for treatment, has become an important goal of diabetes care, although recent research suggests that the complications of diabetes may be caused by genetic factors[26] or, in type 1 diabetics, by the continuing effects of the autoimmune disease which first caused the pancreas to lose its insulin-producing ability.[27]

Because blood sugar levels fluctuate throughout the day and glucose records are imperfect indicators of these changes, the percentage of hemoglobin which is glycosylated is used as a proxy measure of long-term glycemic control in research trials and clinical care of people with diabetes. This test, the hemoglobin A1c or glycosylated hemoglobin reflects average glucoses over the preceding 23 months. In nondiabetic persons with normal glucose metabolism the glycosylated hemoglobin is usually 4-6% by the most common methods (normal ranges may vary by method).

"Perfect glycemic control" would mean that glucose levels were always normal (70130mg/dl, or 3.9-7.2mmol/L) and indistinguishable from a person without diabetes. In reality, because of the imperfections of treatment measures, even "good glycemic control" describes blood glucose levels that average somewhat higher than normal much of the time. In addition, one survey of type 2 diabetics found that they rated the harm to their quality of life from intensive interventions to control their blood sugar to be just as severe as the harm resulting from intermediate levels of diabetic complications.[28]

Accepted "target levels" of glucose and glycosylated hemoglobin that are considered good control have been lowered over the last 25 years, because of improvements in the tools of diabetes care, because of increasing evidence of the value of glycemic control in avoiding complications, and by the expectations of both patients and physicians. What is considered "good control" also varies by age and susceptibility of the patient to hypoglycemia.

In the 1990s the American Diabetes Association conducted a publicity campaign to persuade patients and physicians to strive for average glucose and hemoglobin A1c values below 200mg/dl (11mmol/l) and 8%. Currently many patients and physicians attempt to do better than that.

Poor glycemic control refers to persistently elevated blood glucose and glycosylated hemoglobin levels, which may range from 200500mg/dl (11-28mmol/L) and 9-15% or higher over months and years before severe complications occur. Meta-analysis of large studies done on the effects of tight vs. conventional, or more relaxed, glycemic control in type 2 diabetics have failed to demonstrate a difference in all-cause cardiovascular death, non-fatal stroke, or limb amputation, but decreased the risk of nonfatal heart attack by 15%. Additionally, tight glucose control decreased the risk of progression of retinopathy and nephropathy, and decreased the incidence peripheral neuropathy, but increased the risk of hypoglycemia 2.4 times.[29]

Relying on their own perceptions of symptoms of hyperglycemia or hypoglycemia is usually unsatisfactory as mild to moderate hyperglycemia causes no obvious symptoms in nearly all patients. Other considerations include the fact that, while food takes several hours to be digested and absorbed, insulin administration can have glucose lowering effects for as little as 2 hours or 24 hours or more (depending on the nature of the insulin preparation used and individual patient reaction). In addition, the onset and duration of the effects of oral hypoglycemic agents vary from type to type and from patient to patient.

Control and outcomes of both types 1 and 2 diabetes may be improved by patients using home glucose meters to regularly measure their glucose levels.[citation needed] Glucose monitoring is both expensive (largely due to the cost of the consumable test strips) and requires significant commitment on the part of the patient. The effort and expense may be worthwhile for patients when they use the values to sensibly adjust food, exercise, and oral medications or insulin. These adjustments are generally made by the patients themselves following training by a clinician.

Regular blood testing, especially in type 1 diabetics, is helpful to keep adequate control of glucose levels and to reduce the chance of long term side effects of the disease. There are many (at least 20+) different types of blood monitoring devices available on the market today; not every meter suits all patients and it is a specific matter of choice for the patient, in consultation with a physician or other experienced professional, to find a meter that they personally find comfortable to use. The principle of the devices is virtually the same: a small blood sample is collected and measured. In one type of meter, the electrochemical, a small blood sample is produced by the patient using a lancet (a sterile pointed needle). The blood droplet is usually collected at the bottom of a test strip, while the other end is inserted in the glucose meter. This test strip contains various chemicals so that when the blood is applied, a small electrical charge is created between two contacts. This charge will vary depending on the glucose levels within the blood. In older glucose meters, the drop of blood is placed on top of a strip. A chemical reaction occurs and the strip changes color. The meter then measures the color of the strip optically.

Self-testing is clearly important in type I diabetes where the use of insulin therapy risks episodes of hypoglycaemia and home-testing allows for adjustment of dosage on each administration.[30] However its benefit in type 2 diabetes is more controversial as there is much more variation in severity of type 2 cases.[31] It has been suggested that some type 2 patients might do as well with home urine-testing alone.[32] The best use of home blood-sugar monitoring is being researched.[33]

Benefits of control and reduced hospital admission have been reported.[34] However, patients on oral medication who do not self-adjust their drug dosage will miss many of the benefits of self-testing, and so it is questionable in this group. This is particularly so for patients taking monotherapy with metformin who are not at risk of hypoglycaemia. Regular 6 monthly laboratory testing of HbA1c (glycated haemoglobin) provides some assurance of long-term effective control and allows the adjustment of the patient's routine medication dosages in such cases. High frequency of self-testing in type 2 diabetes has not been shown to be associated with improved control.[35] The argument is made, though, that type 2 patients with poor long term control despite home blood glucose monitoring, either have not had this integrated into their overall management, or are long overdue for tighter control by a switch from oral medication to injected insulin.[36]

Continuous Glucose Monitoring (CGM) CGM technology has been rapidly developing to give people living with diabetes an idea about the speed and direction of their glucose changes. While it still requires calibration from SMBG and is not indicated for use in correction boluses, the accuracy of these monitors are increasing with every innovation.

A useful test that has usually been done in a laboratory is the measurement of blood HbA1c levels. This is the ratio of glycated hemoglobin in relation to the total hemoglobin. Persistent raised plasma glucose levels cause the proportion of these molecules to go up. This is a test that measures the average amount of diabetic control over a period originally thought to be about 3 months (the average red blood cell lifetime), but more recently[when?] thought to be more strongly weighted to the most recent 2 to 4 weeks. In the non-diabetic, the HbA1c level ranges from 4.0-6.0%; patients with diabetes mellitus who manage to keep their HbA1c level below 6.5% are considered to have good glycemic control. The HbA1c test is not appropriate if there has been changes to diet or treatment within shorter time periods than 6 weeks or there is disturbance of red cell aging (e.g. recent bleeding or hemolytic anemia) or a hemoglobinopathy (e.g. sickle cell disease). In such cases the alternative Fructosamine test is used to indicate average control in the preceding 2 to 3 weeks.

The first CGM device made available to consumers was the GlucoWatch biographer in 1999. This product is no longer sold. It was a retrospective device rather than live. Several live monitoring devices have subsequently been manufactured which provide ongoing monitoring of glucose levels on an automated basis during the day, for example:

For Type 1 diabetics there will always be a need for insulin injections throughout their life. However, both Type 1 and Type 2 diabetics can see dramatic effects on their blood sugars through controlling their diet, and some Type 2 diabetics can fully control the disease by dietary modification. As diabetes can lead to many other complications it is critical to maintain blood sugars as close to normal as possible and diet is the leading factor in this level of control.

The American Diabetes Association in 1994 recommended that 60-70% of caloric intake should be in the form of carbohydrates. This is somewhat controversial, with some researchers claiming that 40% is better,[37] while others claim benefits for a high-fiber, 75% carbohydrate diet.[38]

An article summarizing the view of the American Diabetes Association[39] gives many recommendations and references to the research. One of the conclusions is that caloric intake must be limited to that which is necessary for maintaining a healthy weight. The methodology of the dietary therapy has attracted lots of attentions from many scientific researchers and the protocols are ranging from nutritional balancing to ambulatory diet-care.[40][41][42]

Currently, one goal for diabetics is to avoid or minimize chronic diabetic complications, as well as to avoid acute problems of hyperglycemia or hypoglycemia. Adequate control of diabetes leads to lower risk of complications associated with unmonitored diabetes including kidney failure (requiring dialysis or transplant), blindness, heart disease and limb amputation. The most prevalent form of medication is hypoglycemic treatment through either oral hypoglycemics and/or insulin therapy. There is emerging evidence that full-blown diabetes mellitus type 2 can be evaded in those with only mildly impaired glucose tolerance.[43]

Patients with type 1 diabetes mellitus require direct injection of insulin as their bodies cannot produce enough (or even any) insulin. As of 2010, there is no other clinically available form of insulin administration other than injection for patients with type 1: injection can be done by insulin pump, by jet injector, or any of several forms of hypodermic needle. Non-injective methods of insulin administration have been unattainable as the insulin protein breaks down in the digestive tract. There are several insulin application mechanisms under experimental development as of 2004, including a capsule that passes to the liver and delivers insulin into the bloodstream.[44] There have also been proposed vaccines for type I using glutamic acid decarboxylase (GAD), but these are currently not being tested by the pharmaceutical companies that have sublicensed the patents to them.

For type 2 diabetics, diabetic management consists of a combination of diet, exercise, and weight loss, in any achievable combination depending on the patient. Obesity is very common in type 2 diabetes and contributes greatly to insulin resistance. Weight reduction and exercise improve tissue sensitivity to insulin and allow its proper use by target tissues.[45] Patients who have poor diabetic control after lifestyle modifications are typically placed on oral hypoglycemics. Some Type 2 diabetics eventually fail to respond to these and must proceed to insulin therapy. A study conducted in 2008 found that increasingly complex and costly diabetes treatments are being applied to an increasing population with type 2 diabetes. Data from 1994 to 2007 was analyzed and it was found that the mean number of diabetes medications per treated patient increased from 1.14 in 1994 to 1.63 in 2007.[46]

Patient education and compliance with treatment is very important in managing the disease. Improper use of medications and insulin can be very dangerous causing hypo- or hyper-glycemic episodes.

Insulin therapy requires close monitoring and a great deal of patient education, as improper administration is quite dangerous. For example, when food intake is reduced, less insulin is required. A previously satisfactory dosing may be too much if less food is consumed causing a hypoglycemic reaction if not intelligently adjusted. Exercise decreases insulin requirements as exercise increases glucose uptake by body cells whose glucose uptake is controlled by insulin, and vice versa. In addition, there are several types of insulin with varying times of onset and duration of action.

Insulin therapy creates risk because of the inability to continuously know a person's blood glucose level and adjust insulin infusion appropriately. New advances in technology have overcome much of this problem. Small, portable insulin infusion pumps are available from several manufacturers. They allow a continuous infusion of small amounts of insulin to be delivered through the skin around the clock, plus the ability to give bolus doses when a person eats or has elevated blood glucose levels. This is very similar to how the pancreas works, but these pumps lack a continuous "feed-back" mechanism. Thus, the user is still at risk of giving too much or too little insulin unless blood glucose measurements are made.

A further danger of insulin treatment is that while diabetic microangiopathy is usually explained as the result of hyperglycemia, studies in rats indicate that the higher than normal level of insulin diabetics inject to control their hyperglycemia may itself promote small blood vessel disease.[25] While there is no clear evidence that controlling hyperglycemia reduces diabetic macrovascular and cardiovascular disease, there are indications that intensive efforts to normalize blood glucose levels may worsen cardiovascular and cause diabetic mortality.[47]

Studies conducted in the United States[48] and Europe[49] showed that drivers with type 1 diabetes had twice as many collisions as their non-diabetic spouses, demonstrating the increased risk of driving collisions in the type 1 diabetes population. Diabetes can compromise driving safety in several ways. First, long-term complications of diabetes can interfere with the safe operation of a vehicle. For example, diabetic retinopathy (loss of peripheral vision or visual acuity), or peripheral neuropathy (loss of feeling in the feet) can impair a drivers ability to read street signs, control the speed of the vehicle, apply appropriate pressure to the brakes, etc.

Second, hypoglycemia can affect a persons thinking process, coordination, and state of consciousness.[50][51] This disruption in brain functioning is called neuroglycopenia. Studies have demonstrated that the effects of neuroglycopenia impair driving ability.[50][52] A study involving people with type 1 diabetes found that individuals reporting two or more hypoglycemia-related driving mishaps differ physiologically and behaviorally from their counterparts who report no such mishaps.[53] For example, during hypoglycemia, drivers who had two or more mishaps reported fewer warning symptoms, their driving was more impaired, and their body released less epinephrine (a hormone that helps raise BG). Additionally, individuals with a history of hypoglycemia-related driving mishaps appear to use sugar at a faster rate[54] and are relatively slower at processing information.[55] These findings indicate that although anyone with type 1 diabetes may be at some risk of experiencing disruptive hypoglycemia while driving, there is a subgroup of type 1 drivers who are more vulnerable to such events.

Given the above research findings, it is recommended that drivers with type 1 diabetes with a history of driving mishaps should never drive when their BG is less than 70mg/dl (3.9mmol/l). Instead, these drivers are advised to treat hypoglycemia and delay driving until their BG is above 90mg/dl (5mmol/l).[53] Such drivers should also learn as much as possible about what causes their hypoglycemia, and use this information to avoid future hypoglycemia while driving.

Studies funded by the National Institutes of Health (NIH) have demonstrated that face-to-face training programs designed to help individuals with type 1 diabetes better anticipate, detect, and prevent extreme BG can reduce the occurrence of future hypoglycemia-related driving mishaps.[56][57][58] An internet-version of this training has also been shown to have significant beneficial results.[59] Additional NIH funded research to develop internet interventions specifically to help improve driving safety in drivers with type 1 diabetes is currently underway.[60]

The U.S. Food and Drug Administration (FDA) has approved a treatment called Exenatide, based on the saliva of a Gila monster, to control blood sugar in patients with type 2 diabetes.

Artificial Intelligence researcher Dr. Cynthia Marling, of the Ohio University Russ College of Engineering and Technology, in collaboration with the Appalachian Rural Health Institute Diabetes Center, is developing a case based reasoning system to aid in diabetes management. The goal of the project is to provide automated intelligent decision support to diabetes patients and their professional care providers by interpreting the ever increasing quantities of data provided by current diabetes management technology and translating it into better care without time consuming manual effort on the part of an endocrinologist or diabetologist.[61] This type of Artificial Intelligence-based treatment shows some promise with initial testing of a prototype system producing best practice treatment advice which anaylizing physicians deemed to have some degree of benefit over 70% of the time and advice of neutral benefit another nearly 25% of the time.[5]

Use of a "Diabetes Coach" is becoming an increasingly popular way to manage diabetes. A Diabetes Coach is usually a Certified diabetes educator (CDE) who is trained to help people in all aspects of caring for their diabetes. The CDE can advise the patient on diet, medications, proper use of insulin injections and pumps, exercise, and other ways to manage diabetes while living a healthy and active lifestyle. CDEs can be found locally or by contacting a company which provides personalized diabetes care using CDEs. Diabetes Coaches can speak to a patient on a pay-per-call basis or via a monthly plan.

High blood glucose in diabetic people is a risk factor for developing gum and teeth problems, especially in post puberty and aging individuals. Diabetic patients have greater chances of developing oral health problems such as tooth decay, salivary gland dysfunction, fungal infections, inflammatory skin disease, periodontal disease or taste impairment and thrush of the mouth.[62] The oral problems in persons suffering from diabetes can be prevented with a good control of the blood sugar levels, regular check-ups and a very good oral hygiene. By maintaining a good oral status, diabetic persons prevent losing their teeth as a result of various periodontal conditions.

Diabetic persons must increase their awareness towards the oral infections as they have a double impact on one's health. Firstly, people with diabetes are more likely to develop periodontal disease which causes increased blood sugar levels, often leading to diabetes complications. Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts diabetics at increased risk for diabetic complications.[63]

The first symptoms of gum and teeth infections in diabetic persons are decreased salivary flow, burning mouth or tongue. Also, patients may experience signs as dry mouth which increases the incidence of decay. Poorly controlled diabetes usually leads to gum problems recession as plaque creates more harmful proteins in the gums.

Tooth decay and cavities are some of the first oral problems that individuals with diabetes are at risk for. Increased blood sugar levels translate into greater sugars and acids that attack the teeth and lead to gum diseases. Gingivitis can also occur as a result of increased blood sugar levels along with an inappropriate oral hygiene. Periodontitis is an oral disease caused by untreated gingivitis and which destroys the soft tissue and bone that support the teeth. This disease may cause the gums to pull away from the teeth which may eventually loosen and fall out. Diabetic people tend to experience more severe periodontitis because diabetes lowers the ability to resist infection[64] and also slows healing. At the same time, an oral infection such as periodontitis can make diabetes more difficult to control because it causes the blood sugar levels to rise.[65]

To prevent further diabetic complications as well as serious oral problems, diabetic persons must keep their blood sugar levels under control and have a proper oral hygiene. A study in the Journal of Periodontology found that poorly controlled type 2 diabetic patients are more likely to develop periodontal disease than well-controlled diabetics are.[63] At the same time, diabetic patients are recommended to have regular checkups with a dental care provider at least once in three to four months. Diabetics who receive good dental care and have good insulin control typically have a better chance at avoiding gum disease to help prevent tooth loss.[66]

Dental care is therefore even more important for diabetic patients than for healthy individuals. Maintaining the teeth and gum healthy is done by taking some preventing measures such as regular appointments at a dentist and a very good oral hygiene. Also, oral health problems can be avoided by closely monitoring the blood sugar levels. Patients who keep better under control their blood sugar levels and diabetes are less likely to develop oral health problems when compared to diabetic patients who control their disease moderately or poorly.

Poor oral hygiene is a great factor to take under consideration when it comes to oral problems and even more in people with diabetes. Diabetic people are advised to brush their teeth at least twice a day, and if possible, after all meals and snacks. However, brushing in the morning and at night is mandatory as well as flossing and using an anti-bacterial mouthwash. Individuals who suffer from diabetes are recommended to use toothpaste that contains fluoride as this has proved to be the most efficient in fighting oral infections and tooth decay. Flossing must be done at least once a day, as well because it is helpful in preventing oral problems by removing the plaque between the teeth, which is not removed when brushing.

Diabetic patients must get professional dental cleanings every six months. In cases when dental surgery is needed, it is necessary to take some special precautions such as adjusting diabetes medication or taking antibiotics to prevent infection. Looking for early signs of gum disease (redness, swelling, bleeding gums) and informing the dentist about them is also helpful in preventing further complications. Quitting smoking is recommended to avoid serious diabetes complications and oral diseases.

Diabetic persons are advised to make morning appointments to the dental care provider as during this time of the day the blood sugar levels tend to be better kept under control. Not least, individuals who suffer from diabetes must make sure both their physician and dental care provider are informed and aware of their condition, medical history and periodontal status.

Because many patients with diabetes have two or more comorbidities, they often require multiple medications. The prevalence of medication nonadherence is high among patients with chronic conditions, such as diabetes, and nonadherence is associated with public health issues and higher health care costs. One reason for nonadherence is the cost of medications. Being able to detect cost-related nonadherence is important for health care professionals, because this can lead to strategies to assist patients with problems paying for their medications. Some of these strategies are use of generic drugs or therapeutic alternatives, substituting a prescription drug with an over-the-counter medication, and pill-splitting. Interventions to improve adherence can achieve reductions in diabetes morbidity and mortality, as well as significant cost savings to the health care system.[67]

Diabetes type1 is caused by the destruction of enough beta cells to produce symptoms; these cells, which are found in the Islets of Langerhans in the pancreas, produce and secrete insulin, the single hormone responsible for allowing glucose to enter from the blood into cells (in addition to the hormone amylin, another hormone required for glucose homeostasis). Hence, the phrase "curing diabetes type1" means "causing a maintenance or restoration of the endogenous ability of the body to produce insulin in response to the level of blood glucose" and cooperative operation with counterregulatory hormones.

This section deals only with approaches for curing the underlying condition of diabetes type1, by enabling the body to endogenously, in vivo, produce insulin in response to the level of blood glucose. It does not cover other approaches, such as, for instance, closed-loop integrated glucometer/insulin pump products, which could potentially increase the quality-of-life for some who have diabetes type1, and may by some be termed "artificial pancreas".

A biological approach to the artificial pancreas is to implant bioengineered tissue containing islet cells, which would secrete the amounts of insulin, amylin and glucagon needed in response to sensed glucose.

When islet cells have been transplanted via the Edmonton protocol, insulin production (and glycemic control) was restored, but at the expense of continued immunosuppression drugs. Encapsulation of the islet cells in a protective coating has been developed to block the immune response to transplanted cells, which relieves the burden of immunosuppression and benefits the longevity of the transplant.[68]

Research is being done at several locations in which islet cells are developed from stem cells.

Stem cell research has also been suggested as a potential avenue for a cure since it may permit regrowth of Islet cells which are genetically part of the treated individual, thus perhaps eliminating the need for immuno-suppressants.[48] This new method autologous nonmyeloablative hematopoietic stem cell transplantation was developed by a research team composed by Brazilian and American scientists (Dr. Julio Voltarelli, Dr. Carlos Eduardo Couri, Dr Richard Burt, and colleagues) and it was the first study to use stem cell therapy in human diabetes mellitus This was initially tested in mice and in 2007 there was the first publication of stem cell therapy to treat this form of diabetes.[69] Until 2009, there was 23 patients included and followed for a mean period of 29.8 months (ranging from 7 to 58 months). In the trial, severe immunosuppression with high doses of cyclophosphamide and anti-thymocyte globulin is used with the aim of "turning off" the immunologic system", and then autologous hematopoietic stem cells are reinfused to regenerate a new one. In summary it is a kind of "immunologic reset" that blocks the autoimmune attack against residual pancreatic insulin-producing cells. Until December 2009, 12 patients remained continuously insulin-free for periods ranging from 14 to 52 months and 8 patients became transiently insulin-free for periods ranging from 6 to 47 months. Of these last 8 patients, 2 became insulin-free again after the use of sitagliptin, a DPP-4 inhibitor approved only to treat type 2 diabetic patients and this is also the first study to document the use and complete insulin-independendce in humans with type 1 diabetes with this medication. In parallel with insulin suspension, indirect measures of endogenous insulin secretion revealed that it significantly increased in the whole group of patients, regardless the need of daily exogenous insulin use.[70]

Technology for gene therapy is advancing rapidly such that there are multiple pathways possible to support endocrine function, with potential to practically cure diabetes.[71]

Type2 diabetes is usually first treated by increasing physical activity, and eliminating saturated fat and reducing sugar and carbohydrate intake with a goal of losing weight. These can restore insulin sensitivity even when the weight loss is modest, for example around 5kg (10 to 15lb), most especially when it is in abdominal fat deposits. Diets that are very low in saturated fats have been claimed to reverse insulin resistance.[75][76]

Testosterone replacement therapy may improve glucose tolerance and insulin sensitivity in diabetic hypogonadal men. The mechanisms by which testosterone decreases insulin resistance is under study.[77] Moreover, testosterone may have a protective effect on pancreatic beta cells, which is possibly exerted by androgen-receptor-mediated mechanisms and influence of inflammatory cytokines.[78]

Recently[when?] it has been suggested that a type of gastric bypass surgery may normalize blood glucose levels in 80-100% of severely obese patients with diabetes. The precise causal mechanisms are being intensively researched; its results may not simply be attributable to weight loss, as the improvement in blood sugars seems to precede any change in body mass. This approach may become a treatment for some people with type2 diabetes, but has not yet been studied in prospective clinical trials.[79] This surgery may have the additional benefit of reducing the death rate from all causes by up to 40% in severely obese people.[80] A small number of normal to moderately obese patients with type2 diabetes have successfully undergone similar operations.[81][82]

MODY is another classification of diabetes and it can be treated by early lifesyle management and medical management. it has to be treated in the early stage, so as to provide a good health.

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Type 1 Diabetes: Causes, Tests, Symptoms and Treatments

Sunday, August 23rd, 2015

Type 1 Diabetes

Understanding type 1 diabetes is the first step to managing it. Get information on type 1 diabetes causes, risk factors, warning signs, and prevention tips.

Normally, the body's immune system fights off foreign invaders like viruses or bacteria. But for unknown reasons, in people with type 1 diabetes, the immune system attacks various cells in the body.

Symptoms of type 1 diabetes usually develop quickly, over a few days to weeks, and are caused by blood sugar levels rising above the normal range (hyperglycemia).

You can inherit a tendency to develop type 1 diabetes, but most people who have the disease have no family history of it.

If a person is not in ketoacidosis, the American Diabetes Association's criteria for symptoms, a medical history, a physical exam, and blood tests are used to diagnose type 1 diabetes.

Type 1 diabetes requires lifelong treatment to keep blood sugar levels within a target range.

There are many forms of insulin to treat diabetes. They are classified by how fast they start to work and how long their effects last.

Currently there is no way to prevent type 1 diabetes, but ongoing studies are exploring ways to prevent diabetes in those who are most likely to develop it.

See animated illustrations of how type 1 diabetes works.

WebMD offers a pictorial overview of the symptoms, diagnosis, and treatment of type 1 diabetes.

This type 1 diabetes assessment was designed to explore and evaluate your personal health and lifestyle history to help you manage your health and your familys health better.

Test your Type 1 Diabetes knowledge.

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Washington, DC – American Diabetes Association

Friday, August 21st, 2015

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People in the DMV region are increasingly feeling the effects of diabetes as thousands of people suffer from the disease, and many others may have diabetes and don't know it! It is estimated that one out of every three children born after 2000 in the United States will be directly affected by diabetes.

That is why the American Diabetes Association's Washington office is so committed to educating the public about how to stop diabetes and support those living with the disease.

We are here to help.

The American Diabetes Association has established a program to train volunteers to implement diabetes/wellness education workshops in the Washington DC Metro Area. The idea is to give people who are passionate about health promotion the resources they need to act by leading workshops on diabetes/wellness in their communities. These workshops will help get the word out about prevention strategies and the dangers of uncontrolled diabetes. The Association also hopes these workshops become places community members can exchange ideas about what they are doing to stay healthy. The ideal audience will be people that you know from your communities. Ambassador volunteers have the opportunity to motivate friends, family and members of the community to join the fight to Stop Diabetes!

If you, or someone you know, is interested in serving as an American Diabetes Association Ambassador, please contact Tiffany Ingram at 202-331-8303 ext. 4540 or tingram@diabetes.org.

We welcome your help.

Your involvement as an American Diabetes Association volunteer whether on a local or national level will help us expand our community outreach and impact, inspire healthy living, intensify our advocacy efforts, raise critical dollars to fund our mission, and uphold our reputation as the moving force and trusted leader in the diabetes community.

Find volunteer opportunities in our area through the Volunteer Center.

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Type 2 Diabetes: Everything You Need to Know

Thursday, July 23rd, 2015

Type 2 diabetes is a chronic disease in which people have problems regulating their blood sugar. People with diabetes have high blood sugar because their bodies:

Type 2 diabetes is extremely common. The Centers for Disease Control and Prevention (CDC) estimates that over 29 million children and adults in the United States have some form of diabetes. That is about 9 percent of the population. The vast majority of these people have type 2 diabetes.

When you eat food, the body digests the carbohydrates in into a type of sugar called glucose. Glucose is the main source of energy for cells. Cells rely on the hormone insulin to absorb and use glucose as a form of energy. Insulin is produced by the pancreas.

People usually develop type 2 diabetes because their cells have become resistant to insulin. Then, over time, their body may stop making sufficient insulin as well. These problems lead to blood sugar, or glucose, building up in the blood

There are several different types of diabetes:

Type 1 diabetes used to be known as juvenile onset diabetes because it is usually first diagnosed in childhood, though it can be diagnosed later in life as well.. People with type 1 diabetes cannot make insulin and are insulin dependent. They must use insulin injections to control their blood sugar.

According to the CDC, only about five percent of people with diabetes have type 1 diabetes (CDC).

There is no known way to prevent type 1 diabetes.

Type 2 diabetes is the most common type of diabetes, and was once known as adult onset diabetes. However, in recent years, the rate of type 2 diagnoses in children has been growing.

Type 2 diabetes usually starts as insulin resistance. Cells stop responding properly to insulin and sugar is unable to get from the blood into the cells. Over time, the pancreas cannot make enough insulin to keep blood sugars in the normal range and the body becomes progressively less able to regulate blood sugar.

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Diabetes mellitus type 1 – Wikipedia, the free encyclopedia

Tuesday, July 14th, 2015

Diabetes mellitus type1 (also known as type1 diabetes, or T1D; formerly insulin-dependent diabetes or juvenile diabetes) is a form of diabetes mellitus that results from the autoimmune destruction of the insulin-producing beta cells in the pancreas.[2] The subsequent lack of insulin leads to increased blood and urine glucose. The classical symptoms are polyuria (frequent urination), polydipsia (increased thirst), polyphagia (increased hunger) and weight loss.[3]

The cause of diabetes mellitus type 1 is unknown.[4] Type1 diabetes can be distinguished from type2 by autoantibody testing. The C-peptide assay, which measures endogenous insulin production, can also be used.

Administration of insulin is essential for survival. Insulin therapy must be continued indefinitely and does not usually impair normal daily activities. People are usually trained to manage their diabetes independently; however, for some this can be challenging. Untreated, diabetes can cause many complications.[4]Acute complications include diabetic ketoacidosis and nonketotic hyperosmolar coma. Serious long-term complications include heart disease, stroke, kidney failure, foot ulcers and damage to the eyes.[4] Furthermore, complications may arise from low blood sugar caused by excessive treatment.

Diabetes mellitus type 1 accounts for between 5% and 10% of cases of diabetes.[5][6] Globally, the number of people with DM type 1 is unknown,[7] although it is estimated that about 80,000 children develop the disease each year.[7] Within the United States the number of affected persons is estimated at one to three million.[7][8] The development of new cases vary by country and region; the lowest rates appears to be in Japan and China with approximately 1 person per 100,000 per year; the highest rates are found in Scandinavia where it is closer to 35 new cases per 100,000 per year.[9] The United States and northern Europe[clarification needed] fall somewhere in between with 8-17 new cases per 100,000 per year.[9]

The classical symptoms of type 1 diabetes include: polyuria (excessive urination), polydipsia (increased thirst), xerostomia (dry mouth), polyphagia (increased hunger), fatigue, and weight loss.[3]

Many type 1 diabetics are diagnosed when they present with diabetic ketoacidosis. The signs and symptoms of diabetic ketoacidosis include xeroderma (dry skin), rapid deep breathing, drowsiness, abdominal pain, and vomiting.[10]

About 12 percent of people with type 1 diabetes have clinical depression.[11]

The cause of type 1 diabetes is unknown.[4] A number of explanatory theories have been put forward, and the cause may be one or more of the following: genetic susceptibility, a diabetogenic trigger, and/or exposure to an antigen.[12]

Type1 diabetes is a disease that involves many genes. Depending on locus or combination of loci, they can be dominant, recessive, or somewhere in between. The strongest gene, IDDM1, is located in the MHC Class II region on chromosome 6, at staining region 6p21. Certain variants of this gene increase the risk for decreased histocompatibility characteristic of type1. Such variants include DRB1 0401, DRB1 0402, DRB1 0405, DQA 0301, DQB1 0302 and DQB1 0201, which are common in North Americans of European ancestry and in Europeans.[13] Some variants also appear to be protective.[13]

The risk of a child developing type 1 diabetes is about 10% if the father has it, about 10% if a sibling has it, about 4% if the mother has type 1 diabetes and was aged 25 or younger when the child was born, and about 1% if the mother was over 25 years old when the child was born.[14]

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Diabetes: Causes, Symptoms and Treatments

Sunday, July 12th, 2015

knowledge center home diabetes what is diabetes?

Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both. Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia).

Fast facts on diabetes

Here are some key points about diabetes. More detail and supporting information is in the main article.

There are three types of diabetes:

The body does not produce insulin. Some people may refer to this type as insulin-dependent diabetes, juvenile diabetes, or early-onset diabetes. People usually develop type 1 diabetes before their 40th year, often in early adulthood or teenage years.

Type 1 diabetes is nowhere near as common as type 2 diabetes. Approximately 10% of all diabetes cases are type 1.

Patients with type 1 diabetes will need to take insulin injections for the rest of their life. They must also ensure proper blood-glucose levels by carrying out regular blood tests and following a special diet.

Between 2001 and 2009, the prevalence of type 1 diabetes among the under 20s in the USA rose 23%, according to SEARCH for Diabetes in Youth data issued by the CDC (Centers for Disease Control and Prevention). (Link to article)

The body does not produce enough insulin for proper function, or the cells in the body do not react to insulin (insulin resistance).

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Diabetes – Type 1 Diabetes, Type 2 Diabetes, Gestational …

Tuesday, June 2nd, 2015

Diabetes is a common group of chronic metabolic diseases that cause high blood sugar (glucose) levels in the body due to defects in insulin production and/or function. Insulin is a hormone released by the pancreas when we eat food. Insulin allows sugar to go from the blood into the cells. If the cells of the body are not using insulin well, or if the body is unable to make any or enough insulin, sugar builds up in the blood.

Symptoms include excessive thirst, hunger, and urination; fatigue; slow-healing sores or cuts; and blurry vision.

If diabetes develops quickly, as happens with type 1 diabetes, people may also experience quick weight loss. If diabetes develops slowly, as in type 2 diabetes, people may not be diagnosed until symptoms of longer-term problems appear, such as a heart attack or pain, numbness, and tingling in the feet.

Long-term complications of diabetes can include kidney failure, nerve damage, and blindness.

Diabetes is categorized into categories:

This type of diabetes is categorized as an autoimmune disease and occurs when the bodys misdirected immune system attacks and destroys insulin-producing beta cells in the pancreas. Although genetic or environmental triggers are suspected, the exact cause of type 1 diabetes is not completely understood. Type 1 accounts for only five to 10 percent of diabetes cases in the United States, and while it can occur at any age, most patients are diagnosed as children or young adults. People with type 1 diabetes must take insulin daily to manage their condition.

This type of diabetes most often develops gradually with age and is characterized by insulin resistance in the body. For reasons not yet totally understood, the cells of the body stop being able to use insulin effectively. Because of this resistance, the bodys fat, liver, and muscle cells are unable to take in and store glucose, which is used for energy. The glucose remains in the blood. The abnormal buildup of glucose (blood sugar), called hyperglycemia, impairs body functions. Type 2 diabetes occurs most often in people who are overweight and sedentary, two things thought to lead to insulin resistance. Family history and genetics play a major role in type 2 diabetes.

Gestational diabetes is defined as blood-sugar elevation during pregnancy; it is known to affect about three to eight percent of women. Left undiagnosed or untreated, it can lead to problems such as high birth weight and breathing problems for the baby. All pregnant women are tested for gestational diabetes at between 24 and 28 weeks of pregnancy, as this is when this problem usually develops. Gestational diabetes usually resolves in the mother after the baby is born, but statistics show that women who have gestational diabetes have a much greater chance of developing type 2 diabetes within five to 10 years.

Although prediabetes is not technically diabetes, some experts now consider it to be the first step to type 2 diabetes. This condition is marked by blood sugar levels that are too high to be considered normal but are not yet high enough to be in the range of a typical diabetes diagnosis. Prediabetes increases not only your risk of developing diabetes but also your risk of heart disease and stroke.

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Diabetes mellitus

Saturday, May 30th, 2015

This information is not meant to be a substitute for veterinary care. Always follow the instructions provided by your veterinarian.

Diabetes mellitus occurs when the pancreas doesn't produce enough insulin. Insulin is required for the body to efficiently use sugars, fats and proteins.

Diabetes most commonly occurs in middle age to older dogs and cats, but occasionally occurs in young animals. When diabetes occurs in young animals, it is often genetic and may occur in related animals. Diabetes mellitus occurs more commonly in female dogs and in male cats.

Certain conditions predispose a dog or cat to developing diabetes. Animals that are overweight or those with inflammation of the pancreas are predisposed to developing diabetes. Some drugs can interfere with insulin, leading to diabetes. Glucocorticoids, which are cortisone-type drugs, and hormones used for heat control are drugs that are most likely to cause diabetes. These are commonly used drugs and only a small percentage of animals receiving these drugs develop diabetes after long term use.

The body needs insulin to use sugar, fat and protein from the diet for energy. Without insulin, sugar accumulates in the blood and spills into the urine. Sugar in the urine causes the pet to pass large amounts of urine and to drink lots of water. Levels of sugar in the brain control appetite. Without insulin, the brain becomes sugar deprived and the animal is constantly hungry, yet they may lose weight due to improper use of nutrients from the diet. Untreated diabetic pets are more likely to develop infections and commonly get bladder, kidney, or skin infections. Diabetic dogs, and rarely cats, can develop cataracts in the eyes. Cataracts are caused by the accumulation of water in the lens and can lead to blindness. Fat accumulates in the liver of animals with diabetes. Less common signs of diabetes are weakness or abnormal gait due to nerve or muscle dysfunction. There are two major forms of diabetes in the dog and cat: 1) uncomplicated diabetes and 2) diabetes with ketoacidosis. Pets with uncomplicated diabetes may have the signs just described but are not extremely ill. Diabetic pets with ketoacidosis are very ill and may be vomiting and depressed.

The diagnosis of diabetes is made by finding a large increase in blood sugar and a large amount of sugar in the urine. Animals, especially cats, stressed by having a blood sample drawn, can have a temporary increase in blood sugar, but there is no sugar in the urine. A blood screen of other organs is obtained to look for changes in the liver, kidney and pancreas. A urine sample may be cultured to look for infection of the kidneys or bladder. Diabetic patients with ketoacidosis may have an elevation of waste products that are normally removed by the kidneys.

The treatment is different for patients with uncomplicated diabetes and those with ketoacidosis. Ketoacidotic diabetics are treated with intravenous fluids and rapid acting insulin. This treatment is continued until the pet is no longer vomiting and is eating, then the treatment is the same as for uncomplicated diabetes.

the inset picture shows the top of the insulin bottle

Diabetes is managed long term by the injection of insulin by the owner once or twice a day. Some diabetic cats can be treated with oral medications instead of insulin injections, but the oral medications are rarely effective in the dog. There are three general types of insulin used in dogs and cats:

In general, cats and small dogs need insulin injections more frequently, usually twice daily, compared to large breed dogs that may only require one dose of insulin daily. The action of insulin varies in each individual and some large dogs will need 2 insulin shots daily. The insulin needs of the individual animal are determined by collecting small amounts of blood for glucose (sugar) levels every 1-2 hours for 12-24 hours. This is called an insulin-glucose-response curve. When insulin treatment is first begun, it is often necessary to perform several insulin-glucose-response curves to determine:

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