all about diabetes

ذائقہ دار اور صحت مند ترکیبیں

2026-02-26T20:13:00.000-08:00

ذائقہ دار اور صحت مند ترکیبیں

چکن اور ہمس لٹیس ورپس

لٹیس کے پتوں کو رپ کے طور پر استعمال کریں، جس میں میرینیٹڈ چکن اور چنے سے بنی ہمس سپریڈ لگائیں۔ ہمس میں تل، چنے، زیتون کا تیل اور لیموں شامل ہوتے ہیں۔ دو ٹکڑوں میں تقریباً 200 کیلوری ہوتی ہیں۔

ہلکی تلی ہوئی مونگ دال پیٹیز

یہ چھوٹی پیٹیز پیلے دال (مونگ دال) سے بنتی ہیں اور انہیں ہلکی تیل میں تلا یا ایئر فرائر میں تیار کیا جا سکتا ہے۔ چار پیٹیز میں تقریباً 280 کیلوری ہوتی ہیں۔

چکن اور دال کے شامی کباب

یہ کباب چکن اور دال کو ملا کر بنائیں، بغیر کسی آٹے یا بریڈ کرامبز کے لیے۔ دو ہلکی تلی ہوئی کبابوں میں 150 سے 200 کیلوری ہوتی ہیں۔

کوٹیج چیز کے ساتھ بھری ہوئی چکن اسٹرپس

چکن کی پٹیوں میں کوٹیج چیز (पनیر) بھریں، اسے لپیٹیں، اور انڈے میں ڈبو کر تلا دیں – بریڈ کرامبز استعمال کرنے سے گریز کریں۔

گوسفند کے چپس

جن لوگوں کو گوشت پسند ہے، ان کے لیے خشک گوسفند کے چپس (2 سے 4 ٹکڑے) تقریباً 250 کیلوری فراہم کرتے ہیں

رمضان روزے کے دوران ذیابیطس کے مریضوں کے لیے

2026-02-25T19:34:00.000-08:00

رمضان روزے کے دوران ذیابیطس کے مریضوں کے لیے عمومی کھانے کا پلان خون کی شکر کو مستحکم رکھنے پر زور دیتا ہے، جس میں کم GI والے کھانے، پیچیدہ کاربوہائیڈریٹس، لیَن پروٹین اور صحت مند چکنائیاں شامل ہیں۔

بنیادی اصول

سحری آپ کا سب سے بڑا کھانا ہونا چاہیے جس میں آہستہ انرجی دینے والے کاربس، پروٹین اور چکنائیاں ہوں تاکہ پورا دن چلے۔ افطار ہلکا شروع کریں اور آہستہ آہستہ بڑھائیں۔ خون کی شکر کو بار بار چیک کریں، افطار سے سحری تک 2-3 لیٹر پانی پئیں، اور افطار کے بعد ہلکی چہل قدمی کریں۔ میٹھے مشروبات، تلے ہوئے کھانوں اور زیادہ کھانے سے بچیں—روزانہ 45-60% کاربس، 20-30% پروٹین، 20-30% صحت مند چکنائی کا ہدف رکھیں۔

روزانہ کا نمونہ پلان

سحری (فجر سے پہلے، مثلاً 3-4 بجے):

دلیہ یا جو/گندم کی براؤن روٹی کے ساتھ ابلا انڈا، مٹھی بھر بادام یا اخروٹ، کم چکنائی والا دہی یا پنیر، ککڑی/ٹماٹر سلاد، اور آووکاڈو۔ کافی پانی یا پتلا دودھ پئیں۔

افطار کا آغاز (غروب آفتاب پر):

1-2 تازہ کھجوریں + پانی کا گلاس، پھر سبزیوں یا دال کا سوپ۔

افطار کا مرکزی کھانا (غروب کے 30-60 منٹ بعد):

گرلڈ چکن، مچھلی (جیسے سالمن) یا دال کے ساتھ براؤن چاول/کینوا/گندم کی روٹی کا چھوٹا حصہ، مکس سلاد (پتہ گوبھی، پالک، زیتون) زیتون کے تیل/لیموں کے ڈریسنگ کے ساتھ، اور بروکلی جیسی ابلی سبزیاں۔

افطار کے بعد کی ناشتہ (2 گھنٹے بعد، اگر ضرورت ہو):

سیب یا بیر، چند مٹھی بھر خشک میوہ جات/بیج، یا یونانی دہی۔

یہ پلان روزانہ دہرائیں، کیلوریز کے مطابق حصوں کو ایڈجسٹ کریں (مثلاً 1800-2200 kcal)۔ دوائیوں، سرگرمی اور شکر کی سطح کے مطابق تبدیلی کریں اور ڈاکٹر سے مشورہ ضرور کریں کیونکہ روزہ رکھنے سے کم/زیادہ شکر کا خطرہ ہوتا ہے۔ یہ ذیابیطس ایسوسی ایشنز کے معیاری رہنما خطوط پر مبنی ہے۔

Prompt

2026-02-21T20:37:00.000-08:00

> "A high-quality, cinematic full-body shot of a middle aged man standing next to a vintage Rolls Royce. He is wearing a formal black traditional shalwar kameez paired with a sharp black structured waistcoat/blazer. His expression is natural and dignified. The scene is bathed in a strong, vibrant emerald green ambient light that reflects off the polished chrome grille and the gold Spirit of Ecstasy hood ornament of the luxury car. The background features a green slatted window/gate and a textured white wall. The ground is a circular patterned stone pavement. The overall mood is prestigious and authoritative, captured with the clarity of a modern high-end smartphone camera."

Key Elements Deconstructed

* Subject Identity: Specifically identifies the person to ensure facial features and proportions remain consistent with the provided ID.

* Attire: Describes the fusion of traditional Pakistani clothing with formal outerwear.

* The Car: Highlights the Rolls Royce with specific focus on the chrome grille and gold ornament, which are central to the image's status.

* Color Grading: Emphasizes the emerald green tint which is the most striking visual characteristic of this particular photograph.

* Composition: Mentions the circular pavement and slatted background to anchor the subject in space.

Total coherence in physical, facial, and bone structure.”

Diabetic coma

2012-05-24T18:55:00.000-07:00

Definition
A coma is a state of unconsciousness. A diabetic coma is a life-threatening
diabetes complication.
If you have diabetes, dangerously high blood sugar (hyperglycemia) or
dangerously low blood sugar (hypoglycemia) can lead to a diabetic coma. If you
lapse into a diabetic coma, you're alive — but you can't awaken or respond
purposefully to sights, sounds or other types of stimulation. Left untreated, a
diabetic coma can be fatal.
The prospect of a diabetic coma is scary, but there's good news. The risk of a
diabetic coma is small — and prevention is in your hands. Start by following your
diabetes treatment plan.
Symptoms
A diabetic coma doesn't strike out of the blue. You'll first experience signs and
symptoms of high blood sugar or low blood sugar.
High blood sugar
If your blood sugar level is too high, you may experience:
■ Increased thirst
■ Frequent urination
■ Dry mouth
■ Nausea
■ Vomiting
■ Shortness of breath
Low blood sugar
If your blood sugar level is too low, you may feel:
■ Shaky or nervous
■ Tired
■ Sweaty
■ Hungry
■ Irritable
■ Confused
Causes
Prolonged blood sugar extremes — blood sugar that's either too high or too low
for too long — may cause various conditions, all of which can lead to a diabetic
coma.
Diabetic ketoacidosis. If your muscle cells become starved for energy,
your body may respond by breaking down fat stores. This process forms
toxic acids known as ketones. Left untreated, diabetic ketoacidosis can
lead to a diabetic coma. Diabetic ketoacidosis is most common in people
who have type 1 diabetes, but it can also affect people who have type 2
diabetes or gestational diabetes.
■Diabetic hyperosmolar syndrome. If your blood sugar level tops 600
milligrams per deciliter (mg/dL), or 33 millimoles per liter (mmol/L), the
condition is known as diabetic hyperosmolar syndrome. When your blood
sugar gets this high, your blood becomes thick and syrupy. The excess
sugar passes from your blood into your urine, which triggers a filtering
process that draws tremendous amounts of fluid from your body. Left
untreated, diabetic hyperosmolar syndrome can cause life-threatening
dehydration and loss of consciousness. Diabetic hyperosmolar syndrome is
most common in older adults who have type 2 diabetes.
■Hypoglycemia. Your brain needs glucose to function. In severe cases, low
blood sugar may cause you to pass out. Hypoglycemia is most common in
people who take too much insulin or skip meals or snacks. Exercising too
vigorously or drinking too much alcohol can have the same effect. How
quickly your blood sugar drops influences the symptoms of hypoglycemia.
For example, if it takes a few hours for your blood sugar to drop 50 mg/dL
(3 mmol/L), the symptoms may be minimal. If your blood sugar drops the
same amount in a few minutes, the symptoms will be more pronounced
Risk factors
Anyone who has diabetes is at risk of a diabetic coma. Risk factors for the
conditions that may lead to a diabetic coma vary, however.
For example, diabetic ketoacidosis is most common in people who have type 1
diabetes. Diabetic hyperosmolar syndrome is most common in older adults who
have type 2 diabetes — especially those who don't monitor their blood sugar or
who don't know they have diabetes.
When to seek medical advice
A diabetic coma is a medical emergency. If you pass out, you'll need someone to
request emergency medical help.
Tests and diagnosis
If you experience a diabetic coma, prompt diagnosis is essential. The emergency
medical team will do a physical exam and may ask those who are with you about
your medical history.
You may need various lab tests as well. The doctor may measure:
Your
■ blood sugar level
■ Your ketone level The amount of nitrogen or creatinine (a breakdown product of creatine, an
important part of muscle) in your blood
■ The proportion of red blood cells and fluid in your blood (hematocrit)
■ The amount of potassium in your blood
Complications
Left untreated, a diabetic coma can lead to permanent brain damage. In some
cases, an untreated diabetic coma can be fatal.
Treatments and drugs
Emergency treatment for a diabetic coma depends on whether your blood sugar
level is too high or too low.
If your blood sugar level is too high, you may be given intravenous fluids to
restore water to your tissues. You may need potassium, sodium or chlorine
supplements to help your cells function correctly. When enough fluid has been
replaced, short-acting insulin may be used to help your tissues absorb glucose
again. Any underlying infections will be treated as well
If your blood sugar level is too low, you may be given an injection of the hormone
glucagon. The injection will cause your blood sugar level to quickly rise.
Consciousness typically returns when blood sugar reaches a normal level.
Prevention
Good day-to-day control of your diabetes can help you prevent a diabetic coma.
Keep these tips in mind:
Follow your meal plan. Consistent snacks and meals can help you control
your blood sugar level.
■Keep an eye on your blood sugar level. Frequent blood sugar tests can
tell you whether you're keeping your blood sugar level in your target range
— and alert you to dangerous highs or lows.
■Take your medication as directed. If you have frequent episodes of high
or low blood sugar, your doctor may adjust the dosage or timing of your
medication. Your doctor may recommend regular glycated hemoglobin
tests to determine how well you're managing your blood sugar.
■Educate your loved ones, friends and co-workers. Teach loved ones
and other close contacts how to recognize early signs and symptoms of
blood sugar extremes — and how to summon emergency help should you
pass out.
■Wear a medical ID bracelet or necklace. If you're unconscious, the ID
can provide valuable information to your loved ones, co-workers and others
— including emergency personnel.
■Above all, keep your perspective. For most people who have diabetes, the risk of
a diabetic coma is small. Take good care of yourself to help prevent diabetes complications.

Diabetes mellitus

2012-05-24T18:40:00.000-07:00

Diabetes mellitus is a disorder in which blood sugar (glucose) levels are abnormally high because the body does not produce enough insulin.
Diabetes is condition in which an insufficient amount of insulin is made.
Typical symptoms include excessive thirst, urination, and fatigue.
The diagnosis is based on symptoms and urine and blood tests.
Treatment includes changes in diet, exercise, weight loss (if overweight), and insulin injections or drugs taken by mouth.
The symptoms, diagnosis, and treatment of diabetes are similar in children and adults (see Diabetes Mellitus (DM): Diabetes Mellitus). However,
management of diabetes in children may be more complex. It must be tailored to the child's physical and emotional maturity level and to constant
variations in food intake, physical activity, and stress.
Insulin is a hormone that is released by the pancreas. Insulin controls the amount of sugar (glucose) in the blood. A child with diabetes has high blood
sugar levels either because the pancreas produces little or no insulin (type 1 diabetes, formerly called juvenile-onset diabetes) or because the body is
insensitive to the amount of insulin that is produced (type 2 diabetes). In either case, the amount of insulin available is insufficient for the body's needs.
Type 1 diabetes can develop at any time during childhood, even during infancy, but it usually begins between ages 6 and 13 years. Type 2 diabetes
occurs mainly in adolescents but is becoming increasingly common in overweight or obese children.
Up until the 1990s, more than 95% of children who developed diabetes had type 1 diabetes, usually because the immune system attacked the cells in
the pancreas that make insulin (islet cells). Such an attack may be triggered by environmental factors in people whose genetic make-up leaves them
susceptible. Recently, the number of children, especially adolescents, with type 2 diabetes has been steadily increasing. Today, 10 to 50% of children
newly diagnosed with diabetes have type 2 diabetes. The increase in childhood type 2 diabetes has been particularly prominent among Native
Americans, blacks, and Hispanics. Obesity and a family history of type 2 diabetes are major factors in the development of type 2 diabetes (but not type
1).
Which Children Are at Risk of Type 2 Diabetes?
Children and adolescents meeting these criteria should be tested with a fasting blood sugar test every 2 years beginning at about age 10:
Being overweight (weighing more than 85% of children of similar age, sex, and height or weighing more than 120% of the ideal weight for height)
Plus any two of the following factors:
Having a close relative with type 2 diabetes
Being Native American, black, Hispanic, or Asian/Pacific Islander
Having high blood pressure, high blood levels of lipids (fats), or polycystic ovary syndrome
In newborns who are very underweight, blood sugar levels may be elevated transiently, usually because they are given intravenous infusions of glucose
too rapidly. The infusions are given to increase the newborn's weight. This problem usually resolves on its own.
Symptoms
High blood sugar levels are responsible for a variety of immediate symptoms and long-term complications.
Symptoms develop quickly in type 1 diabetes, usually over 2 to 3 weeks or less, and tend to be quite obvious. High blood sugar levels cause the child to
urinate excessively. This fluid loss causes an increase in thirst and the consumption of fluids. Some children become dehydrated, resulting in weakness,
lethargy, and a rapid pulse. Vision may become blurred.
Diabetic ketoacidosis occurs at the beginning of the disease in about one third of children with type 1 diabetes. Without insulin, cells cannot use the
sugar that is in the blood. Cells switch to a back-up mechanism to obtain energy and break down fat, producing compounds called ketones as byproducts.
Ketones make the blood too acidic (ketoacidosis), causing nausea, vomiting, fatigue, and abdominal pain. The ketones make the child's
breath smell like nail polish remover. Breathing becomes deep and rapid as the body attempts to correct the blood's acidity (see Acid-Base Balance:
Introduction). Some children develop a headache and may become confused or less alert. These symptoms may be caused by accumulation of fluid in the brain (cerebral edema). Diabetic ketoacidosis can progress to coma and death. Children with diabetic ketoacidosis are also dehydrated and often
have other chemical imbalances in the blood, such as an abnormal level of potassium and high levels of lipids (fats).
Symptoms in children with type 2 diabetes are milder than those in type 1 diabetes and develop more slowly?over weeks or even a few months. Parents
may notice an increase in the child's thirst and urination or only vague symptoms, such as fatigue. Typically, children with type 2 diabetes do not develop
ketoacidosis or severe dehydration.
Diagnosis
Doctors suspect diabetes when children have typical symptoms or when a urine test done during a routine physical examination reveals sugar. The
diagnosis is confirmed by measurement of the blood sugar level. Preferably, the blood test is done after the child fasts overnight. A child is considered
to have diabetes if the fasting blood sugar level is 126 milligrams per deciliter (mg/dL) or higher. Sometimes, doctors also do tests to see whether the
blood is too acidic or contains ketones. Rarely, doctors order a blood test that detects antibodies to islet cells to help distinguish type 1 diabetes from
type 2.
Because prompt measures (such as dietary changes, an increase in physical activity, and weight loss) may help prevent or delay the onset of type 2
diabetes, children at risk should be screened with a blood test. Nothing can be done to prevent type 1 diabetes Breaking Down Sugar
There are many kinds of sugar. The white granules of table sugar are known as sucrose. Sucrose occurs naturally in sugar cane and sugar beets.
Another kind of sugar, lactose, occurs in milk. Sucrose consists of two different simple sugars, glucose and fructose. Lactose consists of the simple
sugars glucose and galactose. Sucrose and lactose must be broken down by the intestine into their simple sugars before they can be absorbed.
Glucose is the main sugar the body uses for energy, so during and after absorption, most sugars are turned into glucose. Thus, when doctors talk about
blood sugar, they are really talking about blood glucose.
Treatment
The main goal of treatment is to keep blood sugar levels as close to the normal range as can be done safely. To control blood sugar, children with type
1 diabetes take insulin, and children with type 2 diabetes take drugs given by mouth. Children with either type of diabetes need to change their diet,
exercise regularly, and, if overweight, lose weight.
When type 1 diabetes is first diagnosed, children are usually hospitalized, and those with diabetic ketoacidosis are treated in an intensive care unit.
Children with type 1 diabetes are given fluids (to treat dehydration) and insulin. They always require insulin because nothing else is effective. Those with
ketoacidosis require insulin intravenously for a brief time. Those without ketoacidosis typically receive two or more daily injections of insulin, although
some children may need to receive insulin continuously by a small infusion pump through a needle under the skin. Insulin treatment is usually begun in
the hospital so that blood sugar levels can be tested often and doctors can change insulin dosage in response. Rarely, treatment is started at home.
Children with type 2 diabetes do not usually need to receive treatment in the hospital. They do require treatment with drugs to lower blood sugar levels
(antihyperglycemic drugs), which are taken by mouth. The drugs used for adults with type 2 diabetes (see Oral Antihyperglycemic Drugs) are safe for
children, although some of the side effects?particularly diarrhea?cause more problems in children. Some children with type 2 diabetes need insulin. A
few children who lose weight, improve their diet, and exercise regularly may be able to stop taking the drugs.
Nutritional management and education are particularly important for all children with diabetes. Because carbohydrates in food are turned into glucose by
the body, variations in carbohydrate intake cause variations in blood sugar levels. Large amounts of sugar, as is present in soda, candy, and pastries,
are discouraged because blood sugar may rise too high. Parents and older children are taught how to gauge the carbohydrate content of food and
adjust what children eat as needed to maintain a consistent daily intake of carbohydrates. Children of all ages may find it difficult to consistently follow a
properly balanced meal plan (consumed at regular intervals) and avoid the temptations of sugary snacks. Infants and preschool-aged children present a
particular challenge to parents because of the concern arising from the dangers of frequent and very low blood levels sugar (hypoglycemia).
Adolescence: Adolescents may have particular problems controlling their blood sugar levels because of:
Hormonal changes during puberty: These changes affect how the body responds to insulin. As a result, higher doses are usually needed during this
time.
Adolescent lifestyle: Peer pressure, increased activities, erratic schedules, concern about body image, or eating disorders may interfere with the
prescribed treatment regimen, particularly their meal plan.
Experimentation with alcohol, cigarettes, and illicit drugs: Adolescents who experiment with these substances may neglect their treatment regimen.
Conflicts with parents and other authority figures: Such conflicts may make adolescents less willing to follow their treatment regimen.
Thus, some adolescents need for a parent or another adult to recognize these issues and give them the opportunity to discuss problems with a health
care practitioner. The practitioner can make sure adolescents remain appropriately focused on keeping their blood sugar levels under control. Parents
and health care practitioners should encourage adolescents to check their blood sugar levels frequently.
Support: Emotional issues affect children with diabetes and their families. The realization that they have a lifelong condition may cause some children to
become sad or angry, and sometimes even deny that they have an illness. A doctor, psychologist, or counselor needs to address these emotions to
secure the child's cooperation in adhering with the required regimen of meal plan, physical activity, blood sugar testing, and drugs. Failure to resolve secure the child's cooperation in adhering with the required regimen of meal plan, physical activity, blood sugar testing, and drugs. Failure to resolve
these issues can lead to difficulties with blood sugar control.
Summer camps for children with diabetes allow these children to share their experiences with one another while learning how to become personally
more responsible for their condition.
For the treatment of diabetes, the child's primary care doctor usually enlists the aid of a team of other professionals, possibly including a pediatric
endocrinologist, dietitian, diabetes educator, social worker, or psychologist. Family support groups may also help. The doctor may provide parents with
information to bring to school so that school personnel understand their roles.
Did You Know...
Type 2 diabetes is almost always associated with obesity.
Monitoring Treatment: Children and parents are taught to monitor the blood sugar level at least 4 times a day using a blood sample obtained by pricking
a fingertip or the forearm with a small implement called a lancet. Once experience is gained, parents and many children can adjust the insulin dose as
needed to achieve the best control. In general, by 10 years of age, children start to become interested in testing their own blood sugar levels and
injecting insulin themselves. Parents should encourage this independence but make sure the child is being responsible. Doctors teach most children
how to adjust their insulin dosage in accordance with the patterns of their home blood sugar records.
Children with diabetes typically see their doctor 4 times a year. The doctor evaluates their growth and development, reviews blood sugar records that the
family member keeps, provides guidance and counseling about nutrition, and measures glycosylated hemoglobin (hemoglobin A1c)?a substance in the
blood that reflects blood sugar levels over the long term. The doctor screens for long-term complications (see Diabetes Mellitus (DM): Complications)
once a year by measuring protein in the urine, assessing function of the thyroid gland, and performing neurologic and eye examinations.
Some children with diabetes do very well and control their diabetes without undue effort or conflict. In others, diabetes becomes a constant source of
stress within the family, and control of the condition deteriorates. Adolescents in particular often find it difficult to follow the prescribed treatment regimen
given the demands on their schedule and the limitations on their freedom that arise from diabetes. An adolescent benefits if the doctor considers the
adolescent's desired schedule and activities and takes a flexible approach to problem solving?working with the adolescent rather than imposing
solutions.
Did You Know...
Children with type 1 diabetes always need insulin injections, regardless of whether they lose weight or change their diet.
Complications of Treatment and Illness: No treatment completely maintains blood sugar at normal levels. The goal of treatment is to avoid blood sugar
levels that are too high and too low. The complications of diabetes include coronary artery disease, kidney failure, blindness, peripheral vascular
disease, and other serious disorders. Although these events take years to develop, the better the control of diabetes, the less likely that complications
will ever occur.
Low blood sugar (hypoglycemia (see Hypoglycemia) occurs when too much insulin or too much of an antihyperglycemic drug is taken or when the child
does not eat regularly or engages in unusually vigorous and sustained exercise. Hypoglycemia produces weakness, confusion, and even coma. In
adults, adolescents, and older children, episodes of hypoglycemia rarely cause long-term problems. However, frequent episodes of hypoglycemia in
children younger than 5 may permanently impair intellectual development. Also, young children may not be aware of the warning symptoms of
hypoglycemia. To minimize the possibility of hypoglycemia, doctors and parents monitor young children with diabetes particularly closely and use a
slightly higher target range for their blood sugar level.
Children and adolescents with type 1 diabetes who miss insulin injections may develop diabetic ketoacidosis within days. The long-term insufficient or
inadequate use of insulin can lead to a syndrome of stunted growth, delayed puberty, and an enlarged liver (Mauriac syndrome).

Complications of Diabetes

2011-11-17T11:53:00.001-08:00

Type 2 diabetes

2011-11-17T11:48:00.001-08:00

Type 2 diabetes is a lifelong (chronic) disease in which there are high levels of sugar (glucose) in the blood. Type 2 diabetes is the most common form of diabetes.
See also:

Causes

Diabetes is caused by a problem in the way your body makes or uses insulin. Insulin is needed to move blood sugar (glucose) into cells, where it is stored and later used for energy.
When you have type 2 diabetes, your fat, liver, and muscle cells do not respond correctly to insulin. This is called insulin resistance. As a result, blood sugar does not get into these cells to be stored for energy.
When sugar cannot enter cells, high levels of sugar build up in the blood. This is called hyperglycemia.
Type 2 diabetes usually occurs slowly over time. Most people with the disease are overweight when they are diagnosed. Increased fat makes it harder for your body to use insulin the correct way.
Type 2 diabetes can also develop in people who are thin. This is more common in the elderly.
Family history and genes play a large role in type 2 diabetes. Low activity level, poor diet, and excess body weight around the waist increase your risk. See also: Type 2 diabetes for a list of risk factors.

Symptoms

Often, people with type 2 diabetes have no symptoms at first. They may not have symptoms for many years.
The early symptoms of diabetes may include:

Bladder, kidney, skin, or other infections that are more frequent or heal slowly
Fatigue
Hunger
Increased thirst
Increased urination

The first symptom may also be:

Blurred vision
Erectile dysfunction
Pain or numbness in the feet or hands

Exams and Tests

Your health care provider may suspect that you have diabetes if your blood sugar level is higher than 200 mg/dL. To confirm the diagnosis, one or more of the following tests must be done.
Diabetes blood tests:

Fasting blood glucose level -- diabetes is diagnosed if it is higher than 126 mg/dL two times
Hemoglobin A1c test --
- Normal: Less than 5.7%
- Pre-diabetes: 5.7% - 6.4%
- Diabetes: 6.5% or higher
Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours

Diabetes screening is recommended for:

Overweight children who have other risk factors for diabetes, starting at age 10 and repeated every 2 years
Overweight adults (BMI greater than 25) who have other risk factors
Adults over age 45 every 3 years

You should see your health care provider every 3 months. At these visits, you can expect your health care provider to:

Check your blood pressure
Check the skin and bones on your feet and legs
Check to see if your feet are becoming numb
Examine the back part of the eye with a special lighted instrument called an ophthalmoscope

The following tests will help you and your doctor monitor your diabetes and prevent problems:

Have your blood pressure checked at least every year (blood pressure goals should be 130/80 mm/Hg or lower).
Have your hemoglobin A1c test (HbA1c) every 6 months if your diabetes is well controlled; otherwise every 3 months.
Have your cholesterol and triglyceride levels checked yearly (aim for LDL levels below 70-100 mg/dL).
Get yearly tests to make sure your kidneys are working well (microalbuminuria and serum creatinine).
Visit your eye doctor at least once a year, or more often if you have signs of diabetic eye disease.
See the dentist every 6 months for a thorough dental cleaning and exam. Make sure your dentist and hygienist know that you have diabetes.

Treatment

The goal of treatment at first is to lower high blood glucose levels. The long-term goals of treatment are to prevent problems from diabetes.
The main treatment for type 2 diabetes is exercise and diet.
LEARN THESE SKILLS
You should learn basic diabetes management skills. They will help prevent problems and the need for medical care. These skills include:

How to test and record your blood glucose (See: Blood glucose monitoring)
What to eat and when
How to take medications, if needed
How to recognize and treat low and high blood sugar
How to handle sick days
Where to buy diabetes supplies and how to store them

It may take several months to learn the basic skills. Always keep learning about diabetes, its complications, and how to control and live with the disease. Stay up-to-date on new research and treatments.
MANAGING YOUR BLOOD SUGAR
Self testing means that you check your blood sugar at home yourself. Checking your blood sugar levels at home and writing down the results will tell you how well you are managing your diabetes.
A device called a glucometer can give you an exact blood sugar reading. There are different types of devices. Usually, you prick your finger with a small needle called a lancet. This gives you a tiny drop of blood. You place the blood on a test strip and put the strip into the device. Results are given in 30 - 45 seconds.
A health care provider or diabetes educator will help set up an at-home testing schedule for you. Your doctor will help you set your blood sugar goals.

Most people with type 2 diabetes only need to check their blood sugar once or twice a day.
If your blood sugar levels are under control, you may only need to check them a few times a week.
You may test yourself when you wake up, before meals, and at bedtime.
You may need to test more often when you are sick or under stress.

The results of the test can be used to change your meals, activity, or medications to keep your blood sugar levels in the right range. Testing can identify high and low blood sugar levels before you have serious problems.
Keep a record of your blood sugar for yourself and your health care provider. This will help if you are having trouble managing your diabetes.
DIET AND WEIGHT CONTROL
Work closely with your doctor, nurse, and dietitian to learn how much fat, protein, and carbohydrates you need in your diet. Your meal plans should fit your daily lifestyle and habits, and should try to include foods that you like.
Managing your weight and eating a well-balanced diet are important. Some people with type 2 diabetes can stop taking medications after losing weight (although they still have diabetes).
See also:

Very overweight patients whose diabetes is not well managed with diet and medicine may consider bariatric (weight loss) surgery.
See:

REGULAR PHYSICAL ACTIVITY
Regular exercise is important for everyone. It is even more important you have diabetes. Exercise in which your heart beats faster and you breathe faster helps lower your blood sugar level without medication. It also burns extra calories and fat so you can manage your weight.
Exercise can help your health by improving blood flow and blood pressure. Exercise also increases the body's energy level, lowers tension, and improves your ability to handle stress.
Ask your health care provider before starting any exercise program. People with type 2 diabetes must take special steps before, during, and after intense physical activity or exercise. See also: Diabetes and exercise
MEDICATIONS TO TREAT DIABETES
If diet and exercise do not help keep your blood sugar at normal or near-normal levels, your doctor may prescribe medication. Since these drugs help lower your blood sugar levels in different ways, your doctor may have you take more than one drug.
Some of the most common types of medication are listed below. They are taken by mouth or injection.

Alpha-glucosidase inhibitors (such as acarbose)
Biguanides (Metformin)
Injectable medicines (including exenatide, mitiglinide, pramlintide, sitagliptin, and saxagliptin)
Meglitinides (including repaglinide and nateglinide)
Sulfonylureas (like glimepiride, glyburide, and tolazamide)
Thiazolidinediones (such as rosiglitazone and pioglitazone). (Rosiglitazone may increase the risk of heart problems. Talk to your doctor.)

These drugs may be given with insulin, or insulin may be used alone. You may need insulin if you continue to have poor blood glucose control. It must be injected under the skin using a syringe or insulin pen device. It cannot be taken by mouth. See also: Type 1 diabetes
It is not known whether hyperglycemia medications taken by mouth are safe for use in pregnancy. Women who have type 2 diabetes and become pregnant may be switched to insulin during their pregnancy and while breast-feeding.
PREVENTING COMPLICATIONS
Your doctor may prescribe medications or other treatments to reduce your chances of developing eye disease, kidney disease, and other conditions that are more common in people with diabetes.
See also:

FOOT CARE
People with diabetes are more likely to have foot problems. Diabetes can damage nerves, which means you may not feel an injury to the foot until you get a large sore or infection. Diabetes can also damage blood vessels.
Diabetes also decreases the body's ability to fight infection. Small infections can quickly get worse and cause the death of skin and other tissues.
To prevent injury to your feet, check and care for your feet every day. See also: Diabetes foot care

Support Groups

For more information, see diabetes resources.

Outlook (Prognosis)

After many years, diabetes can lead to serious problems with your eyes, kidneys, nerves, heart, blood vessels, or other areas in your body.
If you have diabetes, your risk of a heart attack is the same as that of someone who has already had a heart attack. Both women and men with diabetes are at risk. You may not even have the normal signs of a heart attack.
If you control your blood sugar and blood pressure, you can reduce your risk of death, stroke, heart failure, and other diabetes problems.
Some people with type 2 diabetes no longer need medicine if they lose weight and become more active. When they reach their ideal weight, their body's own insulin and a healthy diet can control their blood sugar levels.

Possible Complications

After many years, diabetes can lead to serious problems:

You could have eye problems, including trouble seeing (especially at night), and light sensitivity. You could become blind.
Your feet and skin can develop sores and infections. After a long time, your foot or leg may need to be removed. Infection can also cause pain and itching in other parts of the body.
Diabetes may make it harder to control your blood pressure and cholesterol. This can lead to a heart attack, storke, and other problems. It can become harder for blood to flow to your legs and feet.
Nerves in your body can get damaged, causing pain, tingling, and a loss of feeling.
Because of nerve damage, you could have problems digesting the food you eat. You could feel weakness or have trouble going to the bathroom. Nerve damage can make it harder for men to have an erection.
High blood sugar and other problems can lead to kidney damage. Your kidneys may not work as well, and they may even stop working.

Infections of the skin, female genital tract, and urinary tract are also more common.
To prevent problems from diabetes, visit your health care provider or diabetes educator at least four times a year. Talk about any problems you are having.

When to Contact a Medical Professional

Call 911 right away if you have:

Chest pain or pressure
Fainting or unconsciousness
Seizure
Shortness of breath

These symptoms can quickly get worse and become emergency conditions (such as convulsions or hypoglycemic coma).
Call your doctor if you have:

Numbness, tingling, or pain in your feet or legs
Problems with your eyesight
Sores or infections on your feet
Symptoms of high blood sugar (being very thirsty, having blurry vision, having dry skin, feeling weak or tired, needing to urinate a lot)
Symptoms of low blood sugar (feeling weak or tired, trembling, sweating, feeling irritable, having trouble thinking clearly, fast heartbeat, double or blurry vision, feeling uneasy)

Prevention

You can help prevent type 2 diabetes by keeping a healthy body weight and an active lifestyle.
Stay up-to-date with all your vaccinations and get a flu shot every year.

Alternative Names

Noninsulin-dependent diabetes; Diabetes - type 2; Adult-onset diabetes

References

American Diabetes Association. Standards of medical care in diabetes--2011. Diabetes Care. 2011;34 Suppl 1:S11-S61.
Eisenbarth GS, Polonsky KS, Buse JB. Type 1 Diabetes Mellitus. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR. Kronenberg: Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 31.
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. Circulation. 2010;121:2694-2701.
Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP, Sledge I. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009 Mar;122(3):248-256.e5. Review. PubMed PMID: 19272486.
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. 2011;364:818-828.
Alemzadeh R, Ali O. Diabetes Mellitus. In: Kliegman R, ed. 19th ed. Nelson Textbook of Pediatrics. Philadelphia, Pa: Saunders Elsevier; 2011: chap 583.

Update Date: 6/28/2011

Updated by: Ari S. Eckman, MD, Chief, Division of Endocrinology, Diabetes and Metabolism, Trinitas Regional Medical Center, Elizabeth, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Diabetes

2011-11-17T11:41:00.001-08:00

Diabetes is a lifelong (chronic) disease in which there are high levels of sugar in the blood.
See also:

Causes

Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both.
To understand diabetes, it is important to first understand the normal process by which food is broken down and used by the body for energy. Several things happen when food is digested:

A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body.
An organ called the pancreas makes insulin. The role of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be used as fuel.

People with diabetes have high blood sugar because their body cannot move sugar into fat, liver, and muscle cells to be stored for energy. This is because either:

Their pancreas does not make enough insulin
Their cells do not respond to insulin normally
Both of the above

There are three major types of diabetes. The causes and risk factors are different for each type:

Type 1 diabetes can occur at any age, but it is most often diagnosed in children, teens, or young adults. In this disease, the body makes little or no insulin. Daily injections of insulin are needed. The exact cause is unknown.
Type 2 diabetes makes up most of diabetes cases. It most often occurs in adulthood, but teens and young adults are now being diagnosed with it because of high obesity rates. Many people with type 2 diabetes do not know they have it.
Gestational diabetes is high blood sugar that develops at any time during pregnancy in a woman who does not have diabetes.

Diabetes affects more than 20 million Americans. Over 40 million Americans have pre-diabetes (early type 2 diabetes).

Symptoms

High blood sugar levels can cause several symptoms, including:

Blurry vision
Excess thirst
Fatigue
Frequent urination
Hunger
Weight loss

Because type 2 diabetes develops slowly, some people with high blood sugar have no symptoms.
Symptoms of type 1 diabetes develop over a short period of time. People may be very sick by the time they are diagnosed.

Exams and Tests

A urine analysis may be used to look for high blood sugar. However, a urine test alone does not diagnose diabetes.
Your health care provider may suspect that you have diabetes if your blood sugar level is higher than 200 mg/dL. To confirm the diagnosis, one or more of the following tests must be done.
Blood tests:

Fasting blood glucose level -- diabetes is diagnosed if it is higher than 126 mg/dL twice. Levels between 100 and 126 mg/dL are called impaired fasting glucose or pre-diabetes. These levels are risk factors for type 2 diabetes.
Hemoglobin A1c test --
- Normal: Less than 5.7%
- Pre-diabetes: 5.7% - 6.4%
- Diabetes: 6.5% or higher
Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours. (This test is used more often for type 2 diabetes.)

Screening for type 2 diabetes in people who have no symptoms is recommended for:

Overweight children who have other risk factors for diabetes, starting at age 10 and repeated every 2 years
Overweight adults (BMI greater than 25) who have other risk factors
Adults over age 45, repeated every 3 years

Treatment

There is no cure for diabetes. Treatment involves medicines, diet, and exercise to control blood sugar and prevent symptoms and problems.
For more information on how to take care of your diabetes, see also:

Support Groups

For more information, see diabetes resources.

Outlook (Prognosis)

Studies have shown that better control of blood sugar, cholesterol, and blood pressure levels in persons with diabetes helps reduce the risk of kidney disease, eye disease, nervous system disease, heart attack, and stroke.

Possible Complications

Emergency complications include:

Diabetic hyperglycemic hyperosmolar coma
Diabetic ketoacidosis

After many years, diabetes can lead to other serious problems:

You could have eye problems, including trouble seeing (especially at night) and light sensitivity. You could become blind.
Your feet and skin can develop sores and infections. After a long time, your foot or leg may need to be removed. Infection can also cause pain and itching in other parts of the body.
Diabetes may make it harder to control your blood pressure and cholesterol. This can lead to a heart attack, stroke, or other problems. It can become harder for blood to flow to your legs and feet.
Nerves in the body can become damaged, causing pain, tingling, and a loss of feeling.
Because of nerve damage, you could have problems digesting the food you eat. You could feel weakness or have trouble going to the bathroom. Nerve damage can also make it harder for men to have an erection.
High blood sugar and other problems can lead to kidney damage. The kidneys might not work as well, and they may even stop working.

Prevention

Keeping an ideal body weight and an active lifestyle may prevent type 2 diabetes.
There is no way to prevent type 1 diabetes.
To prevent complications of diabetes, visit your health care provider or diabetes educator at least four times a year. Talk about any problems you are having.

References

Alemzadeh R, Ali O. Diabetes Mellitus. In: Kliegman RM, ed. Kliegman: Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders;2011:chap 583.
American Diabetes Association. Standards of medical care in diabetes -- 2011. Diabetes Care. 2010; 34 Suppl 1:S11-S61.
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. Circulation. 2010;121:2694-2701.
Eisenbarth GS, Polonsky KS, Buse JB. Type 1 Diabetes Mellitus. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR. Kronenberg: Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 31.

Update Date: 8/31/2011

Updated by: A.D.A.M. Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by Ari S. Eckman, MD, Chief, Division of Endocrinology, Diabetes, and Metabolism, Trinitas Regional Medical Center, Elizabeth, NJ. Review provided by VeriMed Healthcare Network (6/28/2011).

living with diabetes

2011-10-31T11:18:00.000-07:00

stop diabetes

2011-10-31T11:14:00.000-07:00

what is diabetes

2011-10-31T11:04:00.000-07:00

fatty acids

2011-10-31T11:01:00.000-07:00

4Steps to Control Your Diabetes for Life

2011-10-24T03:40:00.000-07:00

4Steps
to Control
Your Diabetes
for Life
Contents
Introduction . . . . . . . . . . . . . . . . . . . . .1
Step 1: Learn about diabetes . . . . . . . .2
Step 2: Know your diabetes ABCs . . . .4
Step 3: Manage your diabetes . . . . . . .6
Step 4: Get routine care . . . . . . . . . . . .8
Notes . . . . . . . . . . . . . . . . . . . . . . . . . .10
My Diabetes Care Record . . . . . . . . . .11
Where to Get Help . . .Inside Back Cover
1
Step 1 Learn about diabetes.
Step 2 Know your diabetes ABCs.
Step 3 Manage your diabetes.
Step 4 Get routine care.
4 Steps to Control
Your Diabetes for Life
This booklet presents four key steps to help you
control your diabetes and live a long and active life.
Diabetes is a serious disease. It affects almost every part of
the body. That is why a team of people may help you take
care of your diabetes:
● doctors
● diabetes educators
● nurses
● dietitians
● eye and foot doctors
● pharmacists
● dentists
● mental health and
social workers
● your friends and family
✔ Talk to your health care team about your
special needs.
✔ Work with your team to manage your diabetes.
The ✔marks in this booklet show actions you could take.
2
Diabetes means that your blood glucose
(blood sugar) is too high. There are two
main types of diabetes.
Type 1 diabetes—the body does not make insulin.
Insulin helps the body use glucose from food for energy.
People with type 1 need to take insulin every day.
Type 2 diabetes—the body does not make or use
insulin well. People with type 2 often need to take pills or
insulin. Type 2 is the most common form of diabetes.
All people with diabetes need to eat healthy foods, stay at a
healthy weight, and be active every day.
Diabetes is a serious disease.
Terms such as “a touch of diabetes” or “your sugar is a
little high” suggest that diabetes is not a serious disease.
That is not correct and these terms should not be used.
Taking good care of diabetes will help you feel better and
avoid the health problems diabetes can cause such as:
● heart disease and stroke
● eye disease that can lead to vision problems or even
going blind
● nerve damage that can cause your hands and feet to feel
numb or tingle and that can lead to loss of a foot or a leg
● kidney problems
● gum disease and loss of teeth
When your diabetes is in good control, you are more likely
to feel better and:
● be less tired and thirsty
Step 1 Learn about diabetes.
3
● urinate less often
● heal better and have fewer gum, skin, or bladder
infections
● be less likely to have blurry vision or numb hands or feet
Some people are more likely to get diabetes.
Some people may have a higher chance of getting diabetes.
They should ask their doctor if they need to be tested for
diabetes.
These include people who
● are ages 45 and older
● are overweight
● are African American, Hispanic/Latino American, Asian
American or Pacific Islander, or American Indian
● have a parent, brother, or sister with diabetes
● have high blood pressure (above 140/90)
● have low HDL (good cholesterol) and high levels of
blood fats
● have had diabetes when pregnant or gave birth to a large
baby (over 9 pounds)
● are active less than three times a week
✔ Ask your health care team what type of diabetes
you have or if you should be tested for diabetes.
✔ Know why diabetes is serious.
✔ Know who is more likely to get diabetes.
4
Manage your A1C (blood glucose or
sugar), Blood pressure, and Cholesterol.
This will help lower your chances of
having a heart attack, a stroke, or other
diabetes problems. These are called the
ABCs of diabetes.
Ais for the A1C test.
It shows how well your blood glucose has
been controlled over the last 3 months.
It should be checked at least twice a year.
The goal for most people is less than 7.
High blood glucose levels can harm your kidneys, feet,
and eyes.
Bis for blood pressure.
The goal for most people is 130/80.
High blood pressure makes your heart work too hard.
It can cause heart attack, stroke, and kidney disease.
Step 2 Know your diabetes ABCs.
5
✔ Ask your health care team:
● What are my A1C (blood glucose), Blood
pressure, and Cholesterol numbers?
● What should my ABC numbers be?
✔ Write down your numbers on the record card
at the back of this booklet.
Cis for cholesterol.
The LDL goal for most people is less than100.
Bad cholesterol, or LDL, can build up and clog your blood
vessels. It can cause a heart attack or a stroke.
6
Many people avoid the long-term problems of diabetes by
taking good care of themselves and the ABCs of diabetes.
Work with your health care team, friends, and family to
make healthy lifestyle choices and reach your ABC goals.
❤Follow your diabetes food plan. If you do not
have one, ask your health care team about it.
❤Eat the right portions of healthy foods such
as fruits and vegetables (5 to 9 servings a day), fish, lean
meats, dry beans, whole grains, and low-fat or skim
milk and cheese.
❤Eat foods that have less salt and fat.
❤Get 30 to 60 minutes of activity on most days
of the week.
❤Stay at a healthy weight—by being active and
eating the right amounts of healthy foods.
❤Stop smoking—seek help to quit.
❤Take medicines the way your doctor tells you. Ask
if you need aspirin to prevent heart attack or stroke.
Step 3 Manage your diabetes.
7
❤Check your feet every day for cuts, blisters, red
spots, and swelling. Call your health care team right
away about any sores that won’t heal.
❤Brush your teeth and floss every day to
avoid problems with your mouth, teeth, or gums.
❤Check your blood glucose the way your doctor
tells you to.
✔ Work with your health care team to manage
your diabetes and stay healthy.
✔ If you have Medicare Part B, ask your health
care team how to get some of the cost paid for
● learning about diabetes self-care.
● special shoes, if you need them.
8
See your health care team at least
twice a year to find and treat
problems early. Follow this plan.
At each visit get a:
❏ Blood pressure check (if over 130/80, ask what steps to
take to reach your goal)
❏ Weight check
❏ Foot check
Two times each year get:
❏ A1C check (check more often if over 7)
❏ Dental exams to prevent gum disease and loss of teeth.
Tell your dentist you have diabetes.
Step 4 Get routine care.
9
✔ Ask your team about these and other tests you
may need.
✔ Use the diabetes care record at the back of this
booklet to keep a record of your diabetes care.
Once each year get a:
❏ Cholesterol check (if LDL is over 100,
ask what steps to take to reach your
goal)
❏ Dilated eye exam to check for eye problems
❏ Complete foot exam to check on foot health
❏ Urine and blood tests to check for kidney problems
❏ Flu shot
At least once get a:
❏ Pneumonia shot
10
Notes
11
My Diabetes Care Record
A1C (Blood Glucose) – At least twice each year
Usual goal: less than 7 My Goal:_______
Date
Result
BLOOD PRESSURE (BP) – Each visit
Usual goal: less than 130/80 My Goal:_______
Date
Result
CHOLESTEROL (LDL) – Once each year
Usual goal: less than 100 My Goal:_______
Date
Result
WEIGHT – Each visit My Goal:_______
Date
Result
✃Cut this out and keep your diabetes care record.
12
Diabetes Care Date Result
Each visit
Foot check _________ _________
Weight check _________ _________
Twice each year
Dental exam _________ _________
Once each year
Dilated eye exam _________ _________
Complete foot exam _________ _________
Kidney check _________ _________
Flu shot _________ _________
At least once
Pneumonia shot _________ _________
My Diabetes Care Record
Where to get help:
American Association of Diabetes Educators
1-800-TEAM-UP4 (800-832-6874)
www.diabeteseducator.org
American Diabetes Association
1-800-DIABETES (800-342-2383)
www.diabetes.org
American Dietetic Association
1-800-366-1655 (in English and Spanish)
www.eatright.org
Centers for Disease Control and Prevention
1-877-232-3422
www.cdc.gov/diabetes
Centers for Medicare & Medicaid Services
1-800-MEDICARE or (800-633-4227)
www.medicare.gov/health/diabetes.asp
National Diabetes Education Program
1-800-438-5383
www.ndep.nih.gov
National Institute of Diabetes and Digestive
and Kidney Diseases / National Diabetes
Information Clearinghouse
1-800-860-8747 (in English and Spanish)
www.niddk.nih.gov
National Diabetes Education Program
1-800-438-5383
www.ndep.nih.gov
The National Diabetes Education Program (NDEP) is
a joint program of the National Institutes of Health and
the Centers for Disease Control and Prevention.
NIH Publication No. 04-5492
December 2003

Practical.Diabetes.Care

2011-10-22T07:19:00.001-07:00

http://www.4shared.com/document/c0wByoHL/PracticalDiabetesCare.html

"Machine Learning and Robot Perception (Studies in Computational Intelligence)"

2011-09-19T10:16:00.001-07:00

Bruno Apolloni, Ashish Ghosh, Ferda Alpaslan and Srikanta Patnaik, "Machine Learning and Robot Perception (Studies in Computational Intelligence)"
ISBN: 354026549X | edition 2005 | File type: PDF | 357 pages | 23,2 mb

This book presents some of the most recent research results in the area of machine learning and robot perception. The chapters represent new ways of solving real-world problems. The book covers topics such as intelligent object detection, foveated vision systems, online learning paradigms, reinforcement learning for a mobile robot, object tracking and motion estimation, 3D model construction, computer vision system and user modelling using dialogue strategies. This book will appeal to researchers, senior undergraduate/postgraduate students, application engineers and scientists.

Download links:

http://www.filesonic.com/file/227976372/354026549X.pdf

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Bedside Rounds: How Do You Diagnose and Treat Diabetic Neuropathy

2009-10-18T01:14:00.001-07:00

Commentary by Judith Brenner MD, Associate Program Director, NYU Internal Medicine Residency Program

Diabetic neuropathy is one of the most commonly encountered complications of diabetes mellitus. It is seen in up to 20% of diabetics. Patients typically present with neuropathic pain in a ?glove and stocking? distribution with the earliest signs in the feet. Night time complaints of ?my feet are on fire? are common. Relying on a patient?s complaint of ?pain? or ?numbness? is inadequate in the diagnosis of peripheral neuropathy since almost half of patients with ulceration lack these complaints.

To briefly review, physical examination centers on assessment of vibration since it is often one of the earliest neurological signs. A 128-Hz tuning fork is applied to the bony prominence on the dorsal aspect of the first toe just proximal to the nail bed, over the interphalangeal joint. The patient is asked what he or she feels. If impairment exists at this distal bony prominence, the examiner can proceed to test more proximal prominences (such as the malleollus, patella, etc) to assess the extent. Testing the Achilles reflex is also useful. In Sapira?s text, ?Art and Science of Bedside Diagnosis?, 15% of patients lack an Achilles reflex. Of those 15%, almost 80% have diabetes. The best technique for eliciting the reflex requires that the patient sit comfortably with legs dangling over the table. The examiner dorsiflexes the ankle and then taps the tendon. Dorsiflexion adds tone to the system, thus accentuating the reflex.

Today, the monofilament test is used most often because of its operating characteristics. It has been found that the inability to sense the monofilament is predictive of ulceration (LR of 2.9). Conversely, the presence of sensation argues against subsequent amputation.

As for treatment, it was first shown in DCCT in 1993(1) that intensive insulin therapy in type I DM reduced the risk of developing clinical neuropathy by 61%. The treatment goal is to slow the progression of neuropathy rather than to overcome pain. Beyond glucose control, treatment has traditionally included antidepressants and anticonvulsants. In a recent systematic review, Wong et al (2) investigated the analgesic efficacy of several different classes of analgesics in managing neuropathy. Studies included in this review included adult patients over 18 years of age who were treated with oral or topical analgesics for short periods of time (2 weeks- 6 months). The drugs investigated included antidepressants (TCAs and SSRIs), opioids, tramadol, capsaicin, anticonvulsants, and NMDA antagonists. In each study, the investigated drug was compared to a placebo. The primary outcome that the investigators were interested in was a 50% reduction of pain, which translated into a ?moderate? improvement in global pain. The secondary outcome was the number of patients who withdrew secondary to adverse events.

The most dramatic results were in the classes of tricyclic antidepressants (amitriptyline, desipramine and imipramine) where the pooled odds ratio of the primary outcome (50% reduction of pain) was 22.24. More simply, the odds of a 50% reduction in pain in the treatment group was 22.24 times more likely that in the placebo group. The pooled odds ratio of the secondary outcome (number of patients who withdrew from adverse events) was 2.32. The most common adverse events were dry mouth and sedation.

Other drugs that had favorable findings included traditional anticonvulsants (sodium valproate, carbamazepine) with a pooled odds ratio of treatment efficacy of 5.33 and withdrawal secondary to adverse events, 1.51. In comparison, the pooled odds ratio of treatment efficacy with newer anticonvulsants (including gabapentin) was 3.25, but the ratio of withdrawal secondary to adverse events was 2.98. In other words, the odds of someone achieving a ?moderate improvement in global pain? was only slightly more likely than needing to withdraw secondary to an adverse event. Of the remaining drugs studied, the efficacy compared with likelihood of withdrawal in descending order is as follows: opioids, newer generation anticonvulsants and lastly, capsaicin.

References:

1. DCCT: The effect of intensive treatment of diabetes on the development and progression of long-term complications in IDDM. NEJM 329:977-986, 1993.