Type 2 Diabetes Testosterone Trial
According to the U. Diabetes doubles the risk for developing liver, pancreatic, or endometrial cancer. The anticonvulsant drug pregabalin Lyrica is a first-line treatment for painful diabetic neuropathy, according to recent guidelines released by the American Academy of Neurology AAN. Studies have found that this risk is more likely with high doses of statins. However, for most people with diabetes the benefits of statin drugs still outweigh the risks.
Other types of cholesterol drugs, such as niacin, can also increase blood sugar levels. The hepatitis B virus is transmitted through blood. Unvaccinated patients with diabetes can become infected with hepatitis B through sharing fingerstick or blood glucose monitoring devices.
Insulin is a key regulator of the body’s metabolism. It works in the following way: The pancreas is located behind the liver and is where the hormone insulin is produced. Insulin is used by the body to store and use glucose. The condition is usually first diagnosed in hood or cence. It usually develops during the third trimester of pregnancy. Because glucose crosses the placenta, a pregnant woman with diabetes can pass high levels of blood glucose to the fetus. This can cause excessive fetal weight gain, which can cause delivery complications as well as increased risk of breathing problems.
In addition to endangering the fetus, gestational diabetes can also cause serious health risks for the mother, such as preeclampsia, a condition that involves high blood pressure during pregnancy.
Genetic mutations likely affect parts of the insulin gene and various other physiologic components involved in the regulation of blood sugar.
# Prediabetes Ymca # Diabetes Free Ceus
Some rare types of diabetes are directly linked to genes. Diabetes Secondary to Other Conditions. Conditions that damage or destroy the pancreas, such as pancreatitis inflammationpancreatic surgery, or certain industrial chemicals, can cause diabetes. Certain genetic and hormonal disorders are associated with or increase the risk of diabetes.
Some types of drugs can also cause temporary diabetes including corticosteroids, beta blockers, and phenytoin. Obesity is likely the major factor behind this dramatic growth rate.
According to the National Institutes of Health, people have an increased risk for diabetes or pre-diabetes if they have: Obesity and Metabolic Syndrome.
# Type 2 Diabetes Quizlet # Treatment For Diabetic Nerve Pain
Excess body fat appears to play a strong role in insulin resistance, but the way the fat is distributed is also significant. Weight concentrated around the abdomen and in the upper part of the body apple-shaped is associated with insulin resistance and diabetes, heart disease, high blood pressure, stroke, and unhealthy cholesterol levels.
People with a “pear-shape” – fat that settles around the hips and flank – appear to have a lower risk for these conditions. Metabolic syndrome is a pre-diabetic condition that is significantly associated with heart disease and higher mortality rates from all causes.
The syndrome consists of abdominal obesity, unhealthy cholesterol and triglyceride levels, high blood pressure, and insulin resistance. Women with PCOS are at higher risk for insulin resistance, and about half of PCOS patients also have diabetes.
While no definitive association has been established, research has suggested an increased background risk of diabetes among people with schizophrenia. In addition, many of the new generation of antipsychotic medications may elevate blood glucose levels. Patients taking antipsychotic medications such as clozapine, olanzapine, risperidone, aripiprazole, quetiapine fumarate, and ziprasidone should receive a baseline blood glucose level test and be monitored for any increases during therapy.
Gestational diabetes is a type of diabetes that develops during the last trimester of pregnancy. Patients with diabetes have higher death rates than people who do not have diabetes regardless of sex, age, or other factors. Heart disease and stroke are the leading causes of death in these patients. All lifestyle and medical efforts should be made to reduce the risk for these conditions.
Such abnormalities produce complications over time in many organs and structures in the body. There is an association between high blood pressure hypertensionunhealthy cholesterol levels, and diabetes. People with diabetes are more likely than non-diabetics to have heart problems, and to die from heart complications.
Diabetes affects the heart in many ways: ney disease nephropathy is a very serious complication of diabetes. With this condition, the tiny filters in the ney called glomeruli become damaged and leak protein into the urine. Over time, this can lead to ney failure. Urine tests showing microalbuminuria small amounts of protein in the urine are important markers for ney damage. Diabetic nephropathy is the leading cause of end-stage renal disease ESRD.
If the neys fail, dialysis is required. Symptoms of ney failure may include swelling in the feet and ankles, itching, fatigue, and pale skin color. Diabetes reduces or distorts nerve function, causing a condition called neuropathy. Neuropathy refers to a group of disorders that affect nerves. The two main types of neuropathy are: Peripheral neuropathy particularly affects sensation.
The most serious consequences of neuropathy occur in the legs and feet and pose a risk for ulcers and, in unusually severe cases, amputation. Peripheral neuropathy usually starts in the fingers and toes and moves up to the arms and legs called a stocking-glove distribution.
Symptoms include: Heart disease risk factors may increase the likelihood of developing neuropathy. Lowering triglycerides, losing weight, reducing blood pressure, and quitting smoking may help prevent the onset of neuropathy. They are the leading cause of hospitalizations for these patients. Diabetes is responsible for more than half of all lower limb amputations performed in the U. Most amputations start with foot ulcers. Those most at risk are people with a long history of diabetes, and people with diabetes who are overweight or who smoke.
Related conditions that put people at risk include peripheral neuropathy, peripheral artery diseasefoot deformities, and a history of ulcers. Foot ulcers usually develop from infections, such as those resulting from blood vessel injury.
Foot infections often develop from injuries, which can dramatically increase the risk for amputation. Even infections can develop into severe complications. Numbness from nerve damage, which is common in diabetes, compounds the danger since the patient may not be aware of injuries. About a third of foot ulcers occur on the big toe. Charcot foot or Charcot joint medically referred to as neuropathic arthropathy is a degenerative condition that affects the bones and joints in the feet.
It is associated with the nerve damage that occurs with neuropathy. Early changes appear similar to an infection, with the foot becoming swollen, red, and warm. Gradually, the affected foot can become deformed. The bones may crack, splinter, and erode, and the joints may shift, change shape, and become unstable. It typically develops in people who have neuropathy to the extent that they cannot feel sensation in the foot and are not aware of an existing injury.
Instead of resting an injured foot or seeking medical help, the patient often continues normal activity, causing further damage. People with diabetes are prone to foot problems because the disease can cause damage to the blood vessels and nerves, which may result in decreased ability to sense trauma to the foot.
The immune system is also altered, so that the patient cannot efficiently fight infection. The most common eye disorder in diabetes is retinopathy. People with diabetes are also at higher risk for developing cataracts and certain types of glaucomasuch as primary-open angle glaucoma POAG. Retinopathy is a condition in which the retina in the eye becomes damaged. Diabetes can also cause problems with attention and memory. People with diabetes face a higher risk for influenza and its complications, including pneumonia.
Everyone with diabetes should have annual influenza vaccinations and a vaccination against pneumococcal pneumonia. Women with diabetes face a significantly higher risk for urinary tract infections, which are likely to be more complicated and difficult to treat than in the general population. Patients with diabetes are at increased risk for contracting the hepatitis B virus, which is transmitted through blood and other bodily fluids. Exposure to the virus can occur through sharing finger-stick devices or blood glucose monitors.
Diabetes doubles the risk for depression. Tight blood sugar glucose control increases the risk of low blood sugar hypoglycemia. Hypoglycemia, also called insulin shock, occurs if blood glucose levels fall below normal.
Hypoglycemia may also be caused by insufficient intake of food, or excess exercise or alcohol. Usually the condition is manageable, but occasionally, it can be severe or even life threatening, particularly if the patient fails to recognize the symptoms, especially while continuing to take insulin or other hypoglycemic drugs. Still, all patients who intensively control blood sugar glucose levels should be aware of warning symptoms. Mild symptoms usually occur at moderately low and easily correctable levels of blood glucose.
They include: [For information on preventing hypoglycemia or managing an attack, see Home Management section of this report. In DKA, the body produces abnormally high levels of blood acids called ketones.
Ketones are byproducts of fat breakdown that build up in the blood and appear in the urine. They are produced when the body burns fat instead of glucose for energy. The buildup of ketones in the body is called ketoacidosis. Extreme stages of diabetic ketoacidosis can lead to coma and death. In such cases, it is nearly always due to noncompliance with insulin treatments. Hyperglycemic hyperosmolar nonketonic syndrome HHNS is a serious complication of diabetes that involves a cycle of increasing blood sugar levels and dehydration, without ketones.
It is often triggered by a serious infection or another severe illness, or by medications that lower glucose tolerance or increase fluid loss especially in people who are not drinking enough fluids. Symptoms of HHNS include high blood sugar levels, dry mouth, extreme thirst, dry skin, and high fever. HHNS can lead to loss of consciousness, seizures, coma, and death. Diabetes can cause specific complications in women.
Women with diabetes have an increased risk of recurrent yeast infections. In terms of sexual health, diabetes may cause decreased vaginal lubrication, which can lead to pain or discomfort during intercourse. Women with diabetes should also be aware that certain types of medication can affect their blood glucose levels. For example, birth control pills can raise blood glucose levels. Thiazolidinedione drugs such as rosiglitazone Avandia and pioglitazone Actos can prompt renewed ovulation in premenstrual women who are not ovulating, and can weaken the effect of birth control pills.
Both temporary diabetes that occurs during pregnancy gestational diabetes and pregnancy in a patient with existing diabetes can increase the risk for birth defects. It is also important for women to closely monitor their blood sugar levels during pregnancy. Insulin dosing may also need to be adjusted during and following delivery. The changes in estrogen and other hormonal levels that occur during perimenopause can cause major fluctuations in blood glucose levels.
Women with diabetes also face an increased risk of menopause, which can lead to higher risk of heart disease. Patients who have certain risk factors should ask their doctors about testing at an earlier age and more frequently.
People who have pre-diabetes have fasting blood glucose levels that are higher than normal, but not yet high enough to be classified as diabetes. The fasting plasma glucose FPG test has been the standard test for diabetes. FPG levels indicate: The FPG test is not always reliable, so a repeat test is recommended if the initial test suggests the presence of diabetes, or if the test is normal in people who have symptoms or risk factors for diabetes. The oral glucose tolerance test OGTT is more complex than the FPG and may over-diagnose diabetes in people who do not have it.
Some doctors recommend it as a follow-up after FPG, if the latter test results are normal but the patient has symptoms or risk factors of diabetes. Your doctor may adjust this goal depending on your individual health profile. Screening for Heart Disease. All patients with diabetes should be tested for high blood pressure hypertension and unhealthy cholesterol and lipid levels and given an electrocardiogram. Other tests may be needed in patients with signs of heart disease.
The electrocardiogram ECG or EKG is used extensively in the diagnosis of heart disease, from congenital heart disease in infants to myocardial infarction and myocarditis in adults.
Several different types of electrocardiogram exist. Screening for ney Damage. The earliest manifestation of ney damage is microalbuminuria, in which tiny amounts of a protein called albumin are found in the urine. The American Diabetes Association recommends that people with diabetes receive an annual microalbuminuria urine test. Patients should also have their blood creatinine tested at least once a year.
Creatinine is a waste product that is removed from the blood by the neys. High levels of creatinine may indicate ney damage. A doctor uses the results from a creatinine blood test to calculate the glomerular filtration rate GFR.
The eye exam should include dilation to check for signs of retinal disease retinopathy. In addition to a comprehensive eye exam, fundus photography may be used as a screening tool.
Fundus photography uses a special type of camera to take images of the back of the eye. All patients should be screened for nerve damage neuropathyincluding a comprehensive foot exam. Good nutrition and regular exercise can help prevent or manage medical complications of diabetes such as heart disease and stroke and help patients live longer and healthier lives. There is no such thing as a single diabetes diet. Patients should meet with a professional dietitian to plan an individualized diet within the general guidelines that takes into consideration their own health needs.
Healthy eating habits along with good control of blood glucose are the basic goals, and several good dietary methods are available to meet them. Aerobic exercise has significant and particular benefits for people with diabetes.
Regular aerobic exercise, even of moderate intensity, improves insulin sensitivity. The heart-protective effects of aerobic exercise are also important, even if patients have no risk factors for heart disease other than diabetes itself. Strength training, which increases muscle and reduces fat, is also helpful for people with diabetes who are able to do this type of exercise. The American Diabetes Association recommends performing resistance exercise three times a week. Be sure that your strength training targets all of the major muscle groups.
These dietary supplements have not been studied or approved. The FDA warns patients with diabetes not to be duped by bogus and unproven remedies. Management of Pre-Diabetes Treatment of pre-diabetes is very important. Research shows that lifestyle and medical interventions can help prevent, or at least delay, the progression to diabetes, as well as lower their risk for heart disease. Different goals may be necessary for specific individuals, including pregnant women, very old and very people, and those with accompanying serious medical conditions.
Metformin is approved for ren. Formerly, only insulin was approved for treating ren with diabetes. The American Diabetes Association does not recommend tight blood glucose control for ren because glucose is necessary for brain development. Elderly people should not generally be placed on tight control as low blood sugar can increase the risk of stroke or heart attack.
High Blood Pressure and Heart Disease All patients with diabetes and high blood pressure should make lifestyle changes. However, patients with diabetes and high blood pressure need an individualized approach to drug treatment, based on their particular health profile. Dozens of anti-hypertensive drugs are available.
The most beneficial fall into the following categories: Nearly all patients who have diabetes and high blood pressure should take an ACE inhibitor or ARB as part of their regimen for treating hypertension.
These drugs help prevent ney damage. Improving Cholesterol and Lipid Levels. Abnormal cholesterol and lipid levels are common in diabetes. Patients with diabetes and heart disease should strive for even lower LDL levels. For medications, statins are the best cholesterol-lowering drugs. They include atorvastatin Lipitor, genericlovastatin Mevacor, Altoprev, Advicor, genericspravastatin Pravachol, genericsimvastatin Zocor, Simcor, Vytorin, and genericsfluvastatin Lescolrosuvastatin Crestorand pitavastatin Livalo.
Juvisync is a two-in-one pill that combines the statin simvastatin with the diabetes drug sitagliptin Juvisync. These drugs are very effective for lowering LDL cholesterol levels.
However, they may increase blood glucose levels in some patients, especially when taken in high doses. Still, statin drugs are considered generally safe and the best first choice for managing high cholesterol. The primary safety concern with statins has involved myopathy, an uncommon condition that can cause muscle damage and, in some cases, muscle and joint pain. A specific myopathy called rhabdomyolysis can lead to ney failure. People with diabetes and risk factors for myopathy should be monitored for muscle symptoms.
Although lowering LDL cholesterol is beneficial, statins are not as effective as other medications – such as niacin and fibrates – in addressing HDL and triglyceride imbalances. Combining a statin with one of these drugs may be helpful for people with diabetes who have heart disease, low HDL levels, and near-normal LDL levels.
Although combinations of statins and fibrates or niacin increase the risk of myopathy, both combinations are considered safe if used with extra care. It is still unclear if high HDL levels can prevent heart disease. Studies consistently report that low LDL is the main predictor of heart health. Fibrates such as gemfibrozil Lopid, genericfenofibrate Tricor, genericand fenofibric acid Trilipix are usually the second choice after statins although it is unclear if they have much benefit in reducing the risk for heart attack and stroke in people with diabetes.
In addition, some research strongly suggests that high-risk patients with diabetes should not take fenofibrate as it does little to affect heart outcomes and can worsen ney function. Niacin has the most favorable effect on raising HDL and lowering triglycerides of all the cholesterol drugs. However, some patients who take high-dose niacin experience increased blood glucose levels. Moderate doses of niacin can achieve lipid control without causing serious blood glucose problems.
While niacin may increase HDL levels, it is unclear whether it helps much in preventing heart attacks and stroke. Aspirin for Heart Disease Prevention. For patients with diabetes who have additional heart disease risk factors, taking a daily aspirin can reduce the risk for blood clotting and may help protect against heart attacks.
There is not enough evidence to indicate that aspirin prevention is helpful for patients at lower risk. These risk factor include a family history of heart disease, high blood pressure, smoking, unhealthy cholesterol levels, or excessive urine levels of the protein albumin albuminuria.
Talk to your doctor, particularly if you are at risk for aspirin side effects such as gastrointestinal bleeding and ulcers. Patients with severe diabetic retinopathy or macular edema swelling of the retina should be sure to see an eye specialist who is experienced in the management and treatment of diabetic retinopathy. Once damage to the eye develops, laser or photocoagulation eye surgery may be needed.
Laser surgery can help reduce vision loss in high-risk patients. Some treatments are as follows: Other Treatments for Foot Ulcers. Doctors are also using or investigating other treatments to heal ulcers. These include: The only FDA-approved drugs for treating neuropathy are pregabalin Lyrica and duloxetine Cymbalta.
Other drugs and treatments are used on an off-label basis. Percutaneous electrical nerve stimulation PENS may help some patients. PENS uses electrodes attached to precisely placed acupuncture-type needles to deliver electrical current to peripheral sensory nerves.
Doctors also recommend lifestyle measures, such as walking and wearing elastic stockings. Treatments for Other Complications of Neuropathy. Neuropathy also impacts other functions, and treatments are needed to reduce their effects.
If diabetes affects the nerves in the autonomic nervous system, then abnormalities of blood pressure control and bowel and bladder function may occur. Erythromycin, domperidone Motiliumor metoclopramide Reglan may be used to relieve delayed stomach emptying caused by neuropathy. Patients need to watch their nutrition if the problem is severe. Erectile dysfunction is also associated with neuropathy. Good control of blood sugar and blood pressure is essential for preventing the onset of ney disease and for slowing the progression of the disease.
ACE inhibitors are the best class of blood pressure medications for delaying ney disease and slowing disease progression in patients with diabetes. Angiotensin-receptor blockers ARBs are also very helpful. The calcium channel blockers diltiazem and verapamil can also reduce protein excretion by diabetic neys. A doctor may recommend a low-protein diet for patients whose ney disease is progressing despite tight blood sugar and blood pressure control. Protein-restricted diets can help slow disease progression and delay the onset of end-stage renal disease ney failure.
However, patients with end-stage renal disease who are on dialysis generally need higher amounts of protein. Anemia is a common complication of end-stage ney disease.
Patients on dialysis usually need injections of erythropoiesis-stimulating drugs to increase red blood cell counts and control anemia.
However, these drugs – darbepoetin alfa Aranesp and epoetin alfa Epogen and Procrit – can increase the risk of blood clots, stroke, heart attack, and heart failure in patients with end-stage ney disease when they are given at higher than recommended doses.
Peginesatide Omontys is a new erythropoiesis-stimulating drug approved specifically for patients with chronic ney disease who are on dialysis. It is given as a once-a-month injection. Most of these drugs are aimed at using or increasing sensitivity to the patient’s own natural stores of insulin.
For the most part older oral hypoglycemic drugs – particularly metformin – are less expensive and work as well as newer diabetes drugs. Metformin is generally recommended as the first-line drug. Adding a second oral hypoglycemic drug is usually recommended if adequate control is not achieved with the first medication. For the most part, doctors should add a second drug rather than trying to push the first drug dosage to the highest levels.
Metformin Glucophage, generic is a biguanide, which works by reducing glucose production in the liver and by making tissues more sensitive to insulin. Metformin may also be used in combination with other drugs. Metformin also appears to have beneficial effects on cholesterol and lipid levels and may help protect the heart.
It is also the first choice for ren who need oral drugs. Certain people should not use this drug, including anyone with heart failure or ney or liver disease.
Sulfonylureas are oral drugs that stimulate the pancreas to release insulin. A number of brands are available including chlorpropamide Diabinese, generictolazamide Tolinase, genericglipizide Glucotrol, generictolbutamide Orinase, genericglyburide Micronase, genericand glimepiride Amaryl, generic. Combinations with small amounts of insulin or other oral anti-hyperglycemic drugs such as metformin or a thiazolidinedione may extend their benefits.
A combination of glyburide and metformin in one pill Glucovance is available. Side Effects and Complications. In general, women who are pregnant or nursing or by individuals who are allergic to sulfa drugs should not use sulfonylureas. Side effects may include: Sulfonylureas interact with many other drugs, and patients must inform their doctor of any medications they are taking, including over-the-counter drugs or herbal supplements.
Meglitinides stimulate beta cells to produce insulin. They include repaglinide Prandin and nateglinide Starlix, generic. These drugs are rapidly metabolized and short-acting. If taken before every meal, they mimic the normal effects of insulin after eating.
Patients, then, can vary their meal times with this drug. These drugs often used in combination with metformin or other drugs. Side effects include diarrhea and headache.
As with the sulfonylureas, repaglinide poses a slightly increased risk for cardiac events. Newer drugs, such as nateglinide, may pose less of a risk. People with heart failure or liver disease should use them with caution and be monitored. Thiazolidinediones, also known as peroxisome proliferator-activated receptor PPAR agonists, include pioglitazone Actos and rosiglitazone Avandia.
Thiazolidinediones are taken as pills, usually in combination with other oral drugs or insulin. Thiazolidinediones can have serious side effects. They can increase fluid build-up, which can cause or worsen heart failure in some patients.
Combinations with insulin increase the risk. Patients with heart failure should not use them. People with risk factors for heart failure should use these drugs with caution. In particular, rosiglitazone has been associated with increased risks for heart attack and heart failure. The FDA advises that due to its cardiovascular risks, rosiglitazone should only be used by patients who are already taking the drug or patients whose blood sugar is not well controlled by other diabetes medications and who do not wish to take pioglitazone.
Patients who take rosiglitazone, especially those who have heart failure, heart disease, or who are at high risk for heart attack, should talk to their doctor about their treatment options.
Thiazolidinediones may cause more weight gain than other diabetes medications or insulin. Any patient who has sudden weight gain, water retention, or shortness of breath should immediately call their doctor. These drugs have also been linked to increased risks for bone fracture. The FDA is currently investigating whether pioglitazone may increase the risk for bladder cancer. There have been rare reports of rosiglitazone causing or worsening diabetic macular edema.
This is an eye condition associated with diabetic retinopathy that causes swelling in the macular area of the retina. Symptoms include blurred vision and decreased color sensitivity. Most patients who had this side effect also had swelling in the feet and legs peripheral edema. The condition resolved or improved when patients stopped taking the drug. Thiazolidinediones can also cause liver damage. Patients who take these drugs should have their liver enzymes checked regularly.
Alpha-glucosidase inhibitors, including acarbose Precose, generic and miglitol Glysetreduce glucose levels by interfering with the absorption of starch in the small intestine. Acarbose tends to lower insulin levels after meals, a particular advantage, since higher levels of insulin after meals are associated with an increased risk for heart disease. These medications need to be taken with meals.
Unfortunately, about a third of patients stop taking the drug because of flatulence and diarrhea, particularly after high-carbohydrate meals. The drug may also interfere with iron absorption. Alpha-glucosidase inhibitors do not cause hypoglycemia when used alone, but combinations with other drugs do.
In such cases, it is important that the patient receive a solution that contains glucose or lactose, not table sugar. This is because acarbose inhibits the breakdown of complex sugar and starches, which includes table sugar. Incretin mimetics belong to a new class of drugs that help improve blood sugar control. They can be taken in combination with these drugs or alone. It is a synthetic version of the hormone found in the saliva of the Gila monster, a venomous desert lizard.
Bydureon is an extended-release version of Byetta that requires injection only once a week. These drugs stimulate insulin secretion only when blood sugar levels are high and so have less risk for causing low blood sugar hypoglycemia when they are taken alone. There does not appear to be a risk for hypoglycemia when they are used along with metformin.
Other side effects may include nausea, vomiting, and diarrhea. Exenatide and liraglutide have been associated with cases of acute pancreatitis, which is sudden inflammation of the pancreas. Symptoms of acute pancreatitis include severe abdominal pain that may radiate to the back. The pain may or may not be accompanied by nausea and vomiting. Patients who feel severe stomach pain that does not go away should seek prompt medical attention.
These drugs may also increase the risk for thyroid cancer. Exenatide may cause new or worse problems with ney function, including ney failure. Patients with severe ney problems should not use this drug. They include sitagliptin Januviasaxagliptin Onglyzaand linagliptin Tradjenta.
They can be used alone or in combination with another oral diabetes drug metformin, thiazolidinediones, or sulfonylureas. Janumet is a two-in-one pill that combines sitagliptin with metformin. Juvisync is a two-in-one pill that combines sitagliptin with the cholesterol drug simvastatin.
Kombiglyze XR combines saxagliptin and metformin. The most common side effects include upper respiratory tract infection, sore throat, and diarrhea.
Sitagliptin has been linked to cases of acute pancreatitis inflammation of the pancreas. Patients should be monitored for signs of pancreatitis after treatment begins or the dosage is increased.
Pramlintide Symlin is an injectable drug that may help patients who take insulin but still need better blood sugar control. Pramlintide is a synthetic form of amylin, a hormone that is related to insulin. Bromocriptine mesylate Cycloset is an oral drug that may help improve blood sugar control in addition to diet and exercise.
Bromocriptine helps boost levels of dopamine, a nerve chemical neurotransmitter. Common side effects may include nausea, vomiting, headache, dizziness, and fatigue.
Insulin replacement may be necessary when natural insulin reserves are depleted. It is typically started in combination with an oral drug usually metformin. However, when a single oral drug fails to control blood sugar it is not clear whether it is better to add insulin replacement or a second or third oral drug.
Some doctors advocate using insulin as early as possible for optimal control. However, in patients who still have insulin reserves, there is concern that extra natural insulin will have adverse effects. Low blood sugar hypoglycemia and weight gain are the main side effects of insulin therapy. It is still not clear if insulin replacement improves survival rates compared to oral drugs, notably metformin.
Monitoring Glucose Blood Sugar Levels Both low blood sugar hypoglycemia and high blood sugar hyperglycemia are of concern, especially for patients who take insulin. For patients who have become insulin-dependent, more intensive monitoring is necessary. Patients should aim for the following measurements: Different goals may be required for specific individuals, including pregnant women, very old and very people, and those with accompanying serious medical conditions.
Home monitors are less accurate than laboratory monitors and many do not meet the standards of the American Diabetes Association. However, they are usually accurate enough to indicate when blood sugar is too low. For patients who have trouble controlling hypoglycemia low blood sugar or fluctuating blood sugar levels, continuous glucose sensor monitors are also available.
Continuous glucose sensor monitors do not replace fingerstick glucose meters and test strips, but are used in combination with them. The procedure is quite simple and can often be done at home. Patients are encouraged to wear at all times a medical alert ID bracelet or necklace that states they have diabetes.
If patients take insulin, that information should be included as well. Measures to Prevent Foot Ulcers. Preventive foot care can significantly reduce the risk of ulcers and amputation.
Some tips for preventing problems include: www.urbanmessenger.org – American Diabetes Association www.urbanmessenger.org – National Institute of Diabetes and Digestive and ney Diseases www.urbanmessenger.org – American Heart Association www.urbanmessenger.org – National ney Foundation www.urbanmessenger.org – National Eye Institute www.urbanmessenger.org – Medic Alert www.urbanmessenger.org – American Dietetic Association ACCORD Study Group, Gerstein HC, Miller ME, Genuth S, Ismail-Beigi F, Buse JB, et al.
Long-term effects of intensive glucose lowering on cardiovascular outcomes. N Engl J Med. Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, Byington RP, Goff DC Jr, Bigger JT, et al.
Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. ASH position paper: treatment of hypertension in patients with diabetes – an update. J Clin Hypertens Greenwich. Bril V, England J, Franklin GM, Backonja M, Cohen J, Del Toro D, et al. Evidence-based guideline: Treatment of painful diabetic neuropathy: report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation.
Centers for Disease Control and Prevention. Centers for Disease Control and Prevention CDC. Use of hepatitis B vaccination for adults with diabetes mellitus: recommendations of the Advisory Committee on Immunization Practices ACIP. MMWR Morb Mortal Wkly Rep. Long-term effect of diabetes and its treatment on cognitive function.
Garber AJ, Handelsman Y, Einhorn D, Bergman DA, Bloomgarden ZT, Fonseca V, et al. Diagnosis and management of prediabetes in the continuum of hyperglycemia: when do the risks of diabetes begin? A consensus statement from the American College of Endocrinology and the American Association of Clinical Endocrinologists. Giovannucci E, Harlan DM, Archer MC, Bergenstal RM, Gapstur SM, Habel LA, et al. Diabetes and cancer: a consensus report. CA Cancer J Clin.
Graham DJ, Ouellet-Hellstrom R, MaCurdy TE, Ali F, Sholley C, Worrall C, et al. Risk of acute myocardial infarction, stroke, heart failure, and death in elderly Medicare patients treated with rosiglitazone or pioglitazone.
Holman RR, Thorne KI, Farmer AJ, Davies MJ, Keenan JF, Paul S, et al. Inzucchi SE, Bergenstal RM, Buse JB, Diamant, M, Ferrannini E, Nauck M, et al.
Position statement of the American Diabetes Association ADA and the European Association for the Study of Diabetes EASD.
Thiazolidinedione drugs and cardiovascular risks. Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, et al. Pignone M, Alberts MJ, Colwell JA, Cushman M, Inzucchi SE, Mukherjee D, et al. Aspirin for primary prevention of cardiovascular events in people with diabetes: a position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation.
Preiss D, Seshasai SR, Welsh P, Murphy SA, Ho JE, Waters DD, et al. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis. Rosenzweig JL, Ferrannini E, Grundy SM, Haffner SM, Heine RJ, Horton ES, et al. J Clin Endocrinol Metab. Skyler JS, Bergenstal R, Bonow RO, Buse J, Deedwania P, Gale EA, et al.
Intensive glycemic control and the prevention of cardiovascular events:implications of the ACCORD, ADVANCE, and VA diabetes trials: a position statement of the American Diabetes Association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association.
Preventive Services Task Force. Screening for gestational diabetes mellitus: U. Preventive Services Task Force recommendation statement. Waters DD, Ho JE, DeMicco DA, Breazna A, Arsenault BJ, Wun CC, et al.
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Highlights Diabetes Statistics According to the U. Guidelines for Treatment of Diabetic Neuropathy The anticonvulsant drug pregabalin Lyrica is a first-line treatment for painful diabetic neuropathy, according to recent guidelines released by the American Academy of Neurology AAN. New Drug Approvals Juvisync is a two-in-one pill that combines the diabetes medication sitagliptin Januvia with the cholesterol drug simvastatin.
Bydureon is a longer-lasting version of exenatide Byetta that requires injection only once a week. Byetta is injected twice a day. Similar anemia drugs require more frequent injections. It works in the following way: During and immediately after a meal the process of digestion breaks down carbohydrates into sugar molecules including glucose and proteins into amino acids.
Right after the meal, glucose and amino acids are absorbed directly into the bloodstream, and blood glucose levels rise sharply. The rise in blood glucose levels signals important cells in the pancreas, called beta cellsto secrete insulin, which pours into the bloodstream. Insulin enables glucose to enter cells in the body, particularly muscle and liver cells.
Here, insulin and other hormones direct whether glucose will be burned for energy or stored for future use. When insulin levels are high, the liver stops producing glucose and stores it in other forms until the body needs it again. As blood glucose levels reach their peak, the pancreas reduces the production of insulin. The blood glucose levels are then referred to as fasting blood glucose concentrations.
The pancreas is located behind the liver and is where the hormone insulin is produced. Insulin is used by the body to store and use glucose. Click the icon to see an image of the Islets of Langerhans.
Neuropathy may mask angina, the warning chest pain for heart disease and heart attack. Patients with diabetes should be aware of other warning signs of a heart attack, including sudden fatigue, sweating, shortness of breath, nausea, and vomiting.
The immune system is also altered, so that the patient cannot efficiently fight infection. Click the icon to see an image of diabetic retinopathy. Click the icon to see an animation about retinal problems associated with diabetes.
The type and amount of carbohydrates are both important. Best choices are vegetables, fruits, beans, and whole grains. These foods are also high in fiber. Patients with diabetes should monitor their carbohydrate intake either through carbohydrate counting or meal planning exchange lists. Choose nonfat or low-fat dairy instead of whole milk products. Fish, soy, and poultry are better protein choices than red meat.
Reducing sodium can lower blood pressure and decrease the risk of heart disease and heart failure. Because people with diabetes are at higher than average risk for heart disease, they should always check with their doctors before undertaking vigorous exercise. For fastest results, regular moderate to high-intensity not high-impact exercises are best for people who are cleared by their doctors.
For people who have been sedentary or have other medical problems, lower-intensity exercises are recommended. Strenuous strength training or high-impact exercise is not recommended for people with uncontrolled diabetes. Such exercises can strain weakened blood vessels in the eyes of patients with retinopathy.
High-impact exercise may also injure blood vessels in the feet. Monitor glucose levels before, during, and after workouts glucose levels swing dramatically during exercise. To help avoid hypoglycemia, inject insulin in sites away from the muscles used during exercise. Some blood pressure drugs can interfere with exercise capacity.
Patients who use blood pressure medication should talk to their doctors about how to balance medications and exercise. Patients with high blood pressure should also aim to breathe as normally as possible during exercise. Holding the breath can increase blood pressure, especially during strength training. The most important lifestyle treatment for people with pre-diabetes is to lose weight through diet and regular exercise. Quitting smoking is also essential. It is also important to have your doctor check your cholesterol and blood pressure levels on a regular basis.
In addition to lifestyle measures, the insulin-regulating drug metformin Glucophage, generic may be recommended for patients who may be at very high risk for developing diabetes.
Patients who have a history of severe hypoglycemia, vascular complications or other diseases, or longstanding diabetes may benefit from looser control of blood sugar. Patients should discuss individualized treatment goals with their doctors.
Lifestyle modifications diet, exercise, weight loss are the first methods for improving blood glucose levels. If lifestyle modifications are not enough, the oral anti-hyperglycemic drug metformin is first recommended. A second drug may be added to metformin if necessary. Use of various drugs to control high blood pressure such as ACE inhibitors and diuretics and to lower cholesterol statins and possibly fibrates. Daily aspirin is not recommended for patients with diabetes who are er than these ages and who do not have cardiovascular risk factors.
Diuretics rid the body of extra sodium salt and water. There are three main types of diuretics: Potassium-sparing, thiazide, and loop. Angiotensin-converting enzyme ACE inhibitors reduce the production of angiotensin, a chemical that causes arteries to narrow. Calcium-channel blockers CCBs decrease the contractions of the heart and widen blood vessels.
Contact their doctors if they experience such symptoms as shortness of breath, pain, swelling in the legs, or increases in blood pressure To monitor the amount of glucose within the blood a person with diabetes should test their blood regularly. The procedure is quite simple and can often be done at home. Click the icon to see an image about emergency treatment for diabetes.
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