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Diabetes Complications

The Pathobiology Of Diabetic Complications

The Pathobiology Of Diabetic Complications

A Unifying Mechanism It’s a great honor to join the exceptional club of Banting Award winners, many of whom were my role models and mentors. In addition, giving the Banting Lecture also has a very personal meaning to me, because without Frederick Banting, I would have died from type 1 diabetes when I was 8 years old. However, it was already apparent at the time I was diagnosed that for too many people like me, Banting’s discovery of insulin only allowed them to live just long enough to develop blindness, renal failure, and coronary disease. For example, when I started college, the American Diabetes Association’s Diabetes Textbook had this to say to my parents: “The person with type 1 diabetes can be reassured that it is highly likely that he will live at least into his 30s.” Not surprisingly, my parents did not find this particularly reassuring. At the same time we were reading this in 1967, however, the first basic research discovery about the pathobiology of diabetic complications had just been published in Science the previous year. In my Banting Lecture today, I am thus going to tell you a scientific story that is also profoundly personal. I’ve divided my talk into three parts. The first part is called “pieces of the puzzle,” and in it I describe what was learned about the pathobiology of diabetic complications starting with that 1966 Science paper and continuing through the end of the 1990s. In the second part, I present a unified mechanism that links together all of the seemingly unconnected pieces of the puzzle. Finally, in the third part, I focus on three examples of novel therapeutic approaches for the prevention and treatment of diabetic complications, which are all based on the new paradigm of a unifying mechanism for the pathogenesis of diabe Continue reading >>

Type 2 Diabetes Complications You Can Avoid

Type 2 Diabetes Complications You Can Avoid

Type 2 Diabetes Complications You Can Avoid Cut Your Risks With Better Diabetes Management Without a solid management plan,type 2 diabetescan be like a house of cards, causing your overall health to come crashing down. Thats because when your blood sugar isnt under control, the excess glucose in your body can increase your chance of developing serious related health conditions. Heart disease, kidney disease, vision issues, and nerve damage are among the problems that can result from poorly managed diabetes, says William Sullivan, MD , a senior physician at the Joslin Diabetes Center and an assistant professor of medicine at Harvard Medical School in Boston. And the longer your diabetes goes uncontrolled, the higher your risk of developing related complications. If left unmanaged, these related health conditions can be disabling or even life-threatening. The good news: There are steps you can take to prevent or delay these health complications. Step one: Work with your doctor to set up a diabetes management plan that focuses on eating a healthy diet, exercising regularly, managing stress, avoiding smoke, and following your treatment plan. This will not only help you manage your diabetes, but also reduce your risk of diabetes complications. Step two: Get educated about the various health complications related to diabetes, and taking steps to reduce your risk. Here are potential type 2 diabetes health risks and serious complications you can help prevent by working with your doctor and living a healthy diabetes lifestyle. High blood sugar levels in the bloodstream can cause the blood to thicken, forcing the heart to work harder to pump blood, says Lori Zanini, RD, CDE , a Manhattan Beach, California-based certified diabetes educator and spokesperson for the Academy of Nutr Continue reading >>

Complications Of Diabetes Mellitus

Complications Of Diabetes Mellitus

The complications of diabetes mellitus are far less common and less severe in people who have well-controlled blood sugar levels. Acute complications include hypoglycemia and hyperglycemia, diabetic coma and nonketotic hyperosmolar coma. Chronic complications occur due to a mix of microangiopathy, macrovascular disease and immune dysfunction in the form of autoimmune disease or poor immune response, most of which are difficult to manage. Microangiopathy can affect all vital organs, kidneys, heart and brain, as well as eyes, nerves, lungs and locally gums and feet. Macrovascular problems can lead to cardiovascular disease including erectile dysfunction. Female infertility may be due to endocrine dysfunction with impaired signalling on a molecular level. Other health problems compound the chronic complications of diabetes such as smoking, obesity, high blood pressure, elevated cholesterol levels, and lack of regular exercise which are accessible to management as they are modifiable. Non-modifiable risk factors of diabetic complications are type of diabetes, age of onset, and genetic factors, both protective and predisposing have been found. Overview[edit] Complications of diabetes mellitus are acute and chronic. Risk factors for them can be modifiable or not modifiable. Overall, complications are far less common and less severe in people with well-controlled blood sugar levels.[1][2][3] However, (non-modifiable) risk factors such as age at diabetes onset, type of diabetes, gender and genetics play a role. Some genes appear to provide protection against diabetic complications, as seen in a subset of long-term diabetes type 1 survivors without complications .[4][5] Statistics[edit] As of 2010, there were about 675,000 diabetes-related emergency department (ED) visits in the Continue reading >>

Diabetes Complications

Diabetes Complications

Complications caused by diabetes People with diabetes must routinely monitor and regulate their blood sugar. No matter how careful you may be, there’s still a possibility that a problem might arise. There are two types of complications you may experience: acute and chronic. Acute complications require emergency care. Examples include hypoglycemia and ketoacidosis. If left untreated, these conditions can cause: seizures loss of consciousness death Chronic complications occur when diabetes isn’t managed properly. Diabetes causes high blood sugar levels. If not controlled well over time, high blood sugar levels can damage various organs, including the: eyes kidneys heart skin Unmanaged diabetes can also cause nerve damage. People with diabetes can experience sudden drops in their blood sugar. Skipping a meal or taking too much insulin or other medications that increase insulin levels in the body are common causes. People who are on other diabetes medications that do not increase insulin levels are not at risk for hypoglycemia. Symptoms can include: blurry vision rapid heartbeat headache shaking dizziness If your blood sugar gets too low, you can experience fainting, seizures, or coma. This is a complication of diabetes that occurs when your body cannot use sugar, or glucose, as a fuel source because your body has no insulin or not enough insulin. If your cells are starved for energy, your body begins to break down fat. Potentially toxic acids called ketone bodies, which are byproducts of fat breakdown, build up in the body. This can lead to: dehydration abdominal pain breathing problems Diabetes can damage blood vessels in the eyes and cause various problems. Possible eye conditions may include: Cataracts Cataracts are two to five times more likely to develop in people Continue reading >>

Avoiding Complications Of Diabetes

Avoiding Complications Of Diabetes

It can take work to get your diabetes under control, but the results are worth it. If you don't make the effort to get a handle on it, you could set yourself up for a host of complications. Diabetes can take a toll on nearly every organ in your body, including the: Heart and blood vessels Eyes Kidneys Nerves Gastrointestinal tract Gums and teeth Heart and Blood Vessels Heart disease and blood vessel disease are common problems for many people who don’t have their diabetes under control. You're at least twice as likely to have heart problems and strokes as people who don’t have the condition. Blood vessel damage or nerve damage may also cause foot problems that, in rare cases, can lead to amputations. People with diabetes are ten times likelier to have their toes and feet removed than those without the disease. Symptoms: You might not notice warning signs until you have a heart attack or stroke. Problems with large blood vessels in your legs can cause leg cramps, changes in skin color, and less sensation. The good news: Many studies show that controlling your diabetes can help you avoid these problems, or stop them from getting worse if you have them. Diabetes is the leading cause of new vision loss among adults ages 20 to 74 in the U.S. It can lead to eye problems, some of which can cause blindness if not treated: Glaucoma Cataracts Diabetic retinopathy, which involves the small blood vessels in your eyes Symptoms: Vision problems or sudden vision loss. The good news: Studies show that regular eye exams and timely treatment of these kinds of problems could prevent up to 90% of diabetes-related blindness. *CGM-based treatment requires fingersticks for calibration, if patient is taking acetaminophen, or if symptoms/expectations do not match CGM readings, and if not pe Continue reading >>

Diabetes Complications

Diabetes Complications

If you have diabetes, your blood glucose, or blood sugar, levels are too high. Over time, this can cause problems with other body functions, such as your kidneys, nerves, feet, and eyes. Having diabetes can also put you at a higher risk for heart disease and bone and joint disorders. Other long-term complications of diabetes include skin problems, digestive problems, sexual dysfunction, and problems with your teeth and gums. Very high or very low blood sugar levels can also lead to emergencies in people with diabetes. The cause can be an underlying infection, certain medicines, or even the medicines you take to control your diabetes. If you feel nauseated, sluggish or shaky, seek emergency care. NIH: National Institute of Diabetes and Digestive and Kidney Diseases Continue reading >>

12 Silent Diabetes Complications You Need To Know About—and How To Avoid Them

12 Silent Diabetes Complications You Need To Know About—and How To Avoid Them

Diabetes complications: Serious, but preventable Purestock/Thinkstock Everyone knows about the worst-worst-worst case scenarios. But the experts Reader’s Digest interviewed assured us that they’re rare—and very preventable. “Just because you have diabetes doesn’t mean you will lose your sight or your kidneys or your legs,” says Aaron Cypess, MD, PhD, investigator at the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health. “None of these things has to happen. You can stop or reverse the progression and get back your quality of life.” The key is to be aware of the risks that can happen when diabetes isn’t well controlled (these everyday habits can ruin diabetes control)—and work with your doctors to make sure yours is. iStock/Thinkstock People with diabetes don’t have as much saliva, which can lead to dry mouth and a greater risk of cavities and gum disease, says George L. King, MD, research director at Joslin Diabetes Center, a professor of medicine at Harvard Medical School, and author of The Diabetes Reset. And you need a normal blood sugar to maintain proper oral health, says Dr. Cypess. “It’s very important for people with diabetes to have regular evaluations of their teeth and gums, or else they could lose them. People with diabetes need to be more vigilant about brushing, flossing, and seeing a dentist than a person ordinarily would be.” Here are some things your dentist wishes you would do differently. Fuse/Thinkstock Almost 10 percent of people with type 2 diabetes get urinary tract infections, almost double the number of people without diabetes who get them, according to recent data. Sugar in the urine becomes a breeding ground for bacteria. Diabetes also contributes to nerve damage in Continue reading >>

Type 2 Diabetes Complications

Type 2 Diabetes Complications

With type 2 diabetes (also called type 2 diabetes mellitus), if you don’t work hard to keep your blood glucose level under control, there are short- and long-term complications to contend with. However, by watching the amount and types of food you eat (your meal plan), exercising, and taking any necessary medications, you may be able to prevent these complications. And even if you have some of the long-term, more serious complications discussed below when you’re first diagnosed, getting tight control of your blood glucose will help prevent the complications from becoming worse. (It is possible with type 2 diabetes to already have some of these complications when you’re first diagnosed. That’s because type 2 develops gradually, and you may not realize that you have high blood glucose for quite some time. Over time, high blood glucose can cause serious damage. You can learn more about that in this article on the symptoms of type 2 diabetes.) Short-term Diabetes Complications Hypoglycemia is low blood glucose (blood sugar). It is possible for your blood glucose to drop, especially if you’re taking insulin or a sulfonylurea drug (those make your body produce insulin throughout the day). With these medications, if you eat less than usual or were more active, your blood glucose may dip too much. Other possible causes of hypoglycemia include certain medications (aspirin, for example, lowers the blood glucose level if you take a dose of more than 81mg) and too much alcohol (alcohol keeps the liver from releasing glucose). Rapid heartbeat Sweating Whiteness of skin Anxiety Numbness in fingers, toes, and lips Sleepiness Confusion Headache Slurred speech Mild cases of hypoglycemia can be treated by drinking orange juice or eating a glucose tablet—those will quickly rai Continue reading >>

What Are The Complications Of Diabetes?

What Are The Complications Of Diabetes?

This section is meant to familiarize you with some of the most common diabetes-related complications and other problems. Keeping blood glucose levels as near normal as possible, along with getting regular check-ups and blood tests may help delay or prevent complications of diabetes. Eye disease* Many people with diabetes develop some form of eye disease (retinopathy), caused by damage to the network of blood vessels that supply the retina. This can damage vision or cause blindness. Retinopathy can be quite advanced before it affects vision, so it is important that people with diabetes have regular eye screenings. If caught early, treatment can prevent blindness. Oral health* There is an increased risk of inflammation of the tissue surrounding the teeth (periodontitis) in people with poor glucose control. Periodontitis is a major cause of tooth loss and is associated with an increased risk of cardiovascular disease. Management of periodontitis is very important in people with diabetes because good oral hygiene can prevent tooth loss and improve glucose control. Cardiovascular disease* Cardiovascular disease is the most common cause of death and disability among people with diabetes. The types that accompany diabetes include: angina (chest pain or discomfort); myocardial infarction (heart attack); stroke; peripheral artery disease (reduced blood flow to limbs); and congestive heart failure (heart weakness that leads to a build-up of fluid in the lungs and surrounding body tissues). High blood pressure, high cholesterol, and high blood glucose (all common in diabetes) are some of the factors that increase the risk of cardiovascular disease. Kidney disease* Kidney disease (nephropathy) is more common in people with diabetes. Diabetes is one of the leading causes of chronic Continue reading >>

Symptoms

Symptoms

Print Overview Diabetes mellitus refers to a group of diseases that affect how your body uses blood sugar (glucose). Glucose is vital to your health because it's an important source of energy for the cells that make up your muscles and tissues. It's also your brain's main source of fuel. If you have diabetes, no matter what type, it means you have too much glucose in your blood, although the causes may differ. Too much glucose can lead to serious health problems. Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes — when your blood sugar levels are higher than normal, but not high enough to be classified as diabetes — and gestational diabetes, which occurs during pregnancy but may resolve after the baby is delivered. Diabetes symptoms vary depending on how much your blood sugar is elevated. Some people, especially those with prediabetes or type 2 diabetes, may not experience symptoms initially. In type 1 diabetes, symptoms tend to come on quickly and be more severe. Some of the signs and symptoms of type 1 and type 2 diabetes are: Increased thirst Frequent urination Extreme hunger Unexplained weight loss Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there's not enough available insulin) Fatigue Irritability Blurred vision Slow-healing sores Frequent infections, such as gums or skin infections and vaginal infections Although type 1 diabetes can develop at any age, it typically appears during childhood or adolescence. Type 2 diabetes, the more common type, can develop at any age, though it's more common in people older than 40. When to see a doctor If you suspect you or your child may have diabetes. If you notice any poss Continue reading >>

How To Prevent Type 2 Diabetes Complications

How To Prevent Type 2 Diabetes Complications

Your type 2 diabetes puts you at an increased risk of a range of serious health problems, including heart attack, high blood pressure, stroke, vision loss, dental problems, and foot problems. By keeping your diabetes in check — most importantly, keeping your blood sugar at a healthy level through diet, exercise, and medication — you can prevent many of these serious complications. You can also help avoid these dangers by learning to recognize a problem and what to do about it if it develops. The most common complications of type 2 diabetes include: Heart disease is the top cause of death in people with diabetes. Heart attack symptoms may appear suddenly or be subtle, with only mild pain and discomfort. If you experience the heart attack warning signs, call 911 immediately. Stroke. As with a heart attack, immediate treatment can be the difference between life and death. Call 911 immediately if you experience any of the stroke warning signs. Nerve damage, or diabetic neuropathy, due to uncontrolled high blood sugar is another potential consequence for those with type 2 diabetes. Diabetes can also make it more difficult for your body to fight infections, causing skin problems. Kidney disease. Type 2 diabetes increases your risk of kidney disease, or diabetic nephropathy, a condition in which the blood vessels in your kidneys are damaged to the point that they cannot filter out waste properly. If left untreated, dialysis (a treatment to filter out waste products from the blood) or even a kidney transplant may be necessary. Eye problems. People with type 2 diabetes are at risk of several eye conditions, including diabetic retinopathy (which affects the blood vessels in the eye), glaucoma, and cataracts. If left untreated, these conditions can cause vision loss. Hypoglyce Continue reading >>

Diabetes: Preventing Complications

Diabetes: Preventing Complications

Diabetes complications can be divided into two types: acute (sudden) and chronic (long-term). This article discusses these complications and strategies to prevent the complications from occurring in the first place. Acute complications Diabetic ketoacidosis (DKA) Hyperglycemic hyperosmolar non-ketotic syndrome (HHNS) Acute complications of diabetes can occur at any time in the course of the disease. Chronic complications Cardiovascular: Heart disease, peripheral vascular disease, stroke Eye: Diabetic retinopathy, cataracts, glaucoma Nerve damage: Neuropathy Kidney damage: Nephropathy Chronic complications are responsible for most illness and death associated with diabetes. Chronic complications usually appear after several years of elevated blood sugars (hyperglycemia). Since patients with Type 2 diabetes may have elevated blood sugars for several years before being diagnosed, these patients may have signs of complications at the time of diagnosis. Basic principles of prevention of diabetes complications: Take your medications (pills and/or insulin) as prescribed by your doctor. Monitor your blood sugars closely. Follow a sensible diet. Do not skip meals. Exercise regularly. See your doctor regularly to monitor for complications. Results from untreated hyperglycemia. Blood sugars typically range from 300 to 600. Occurs mostly in patients with Type 1 diabetes (uncommon in Type 2). Occurs due to a lack of insulin. Body breaks down its own fat for energy, and ketones appear in the urine and blood. Develops over several hours. Can cause coma and even death. Typically requires hospitalization. Nausea, vomiting Abdominal pain Drowsiness, lethargy (fatigue) Deep, rapid breathing Increased thirst Fruity-smelling breath Dehydration Inadequate insulin administration (not getting Continue reading >>

Putting The Brakes On Diabetes Complications

Putting The Brakes On Diabetes Complications

Encouraging news: People with diabetes are living longer, healthier lives with fewer complications. What’s the driving force? Greater awareness and better control of risk factors are moving the needle. We’ve come a long way in reducing the impact of diabetes on people’s lives. In the last 20 years, rates of several major complications have decreased among US adults with diabetes. The greatest declines were for two leading causes of death: heart attack and stroke. (People with diabetes are at higher risk for heart disease, and they may get it more severely and at a younger age than people who don’t have diabetes.) This is meaningful progress. It’s important to note that during that same 20 years, the number of adults diagnosed with diabetes has more than tripled as the American population has aged. Diabetes complications still take a heavy toll on the health of millions of people and on our health care system. Why Complications Are So … Complicated Diabetes complications often share the same risk factors, and one complication can make other complications worse. For example, many people with diabetes also have high blood pressure, which in turn worsens eye and kidney diseases. Diabetes tends to lower HDL (“good”) cholesterol and raise triglycerides and LDL (“bad”) cholesterol, which increases the risk for heart disease and stroke. Smoking doubles the risk of heart disease in people with diabetes. Take a closer look at these major diabetes complications: Heart disease and stroke: People with diabetes are twice as likely to have heart disease or a stroke as people without diabetes. Blindness and other eye problems: Diabetic retinopathy[327 KB] (damage to blood vessels in the retina), cataract (clouding of the lens), and glaucoma (increase in fluid pressu Continue reading >>

Complications

Complications

Know the difference between acute and chronic complications. Acute complications can arise quickly. Chronic complications tend to arise over years or decades. Know the differences and you will be able to take effective precautions against both. Acute Complications Serious, life-threatening complications can arise quickly. Fortunately, such complications can go away just as quickly if you – and those closest to you — know what to do and how to do it. Acute complications arise from uncontrolled high blood sugars (hyperglycemia) and low blood sugars (hypoglycemia) caused by a mismatching of available insulin and need. In short, you either have taken too much diabetes medication or too little. Some acute complications require immediate medical attention. These emergencies include: Chronic Complications Chronic complications tend to arise over years or decades. Often, there is damage before there are symptoms so routine screening is recommended to catch and treat problems before they occur or get worse. Learn more about chronic complications. Problems include: VIGILANCE AND A HEALTHY LIFESTYLE PUT YOU IN CONTROL Self-assessment Quiz Self assessment quizzes are available for topics covered in this website. To find out how much you have learned about Diabetes Complications, take our self assessment quiz when you have completed this section. The quiz is multiple choice. Please choose the single best answer to each question. At the end of the quiz, your score will display. If your score is over 70% correct, you are doing very well. If your score is less than 70%, you can return to this section and review the information. Continue reading >>

About Diabetes

About Diabetes

Complications of diabetes Diabetes complications are divided into microvascular (due to damage to small blood vessels) and macrovascular (due to damage to larger blood vessels). Microvascular complications include damage to eyes (retinopathy) leading to blindness, to kidneys (nephropathy) leading to renal failure and to nerves (neuropathy) leading to impotence and diabetic foot disorders (which include severe infections leading to amputation). Macrovascular complications include cardiovascular diseases such as heart attacks, strokes and insufficiency in blood flow to legs. There is evidence from large randomized-controlled trials that good metabolic control in both type 1 and 2 diabetes can delay the onset and progression of these complications. Diabetic retinopathy (eye disease) Etiology Diabetic retinopathy is a leading cause of blindness and visual disability. It is caused by small blood vessel damage to the back layer of the eye, the retina, leading to progressive loss of vision, even blindness. Symptoms Usually the patient complains of blurred vision, although other visual symptoms may also be present. Diagnosis Diagnosis of early changes in the blood vessels of the retina can be made through regular eye examinations. Treatment Good metabolic control can delay the onset and progression of diabetic retinopathy. As well, early detection and treatment of vision-threatening retinopathy can prevent or delay blindness. This involves regular eye examinations and timely intervention Nephropathy (kidney disease) Etiology Diabetic kidney disease is also caused by damage to small blood vessels in the kidneys. This can cause kidney failure, and eventually lead to death. In developed countries, this is a leading cause of dialysis and kidney transplant. Symptoms Patients usually Continue reading >>

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