diabetestalk.net

Diabetes Liver Complications

Nonalcoholic Fatty Liver Disease And Chronic Vascular Complications Of Diabetes Mellitus

Nonalcoholic Fatty Liver Disease And Chronic Vascular Complications Of Diabetes Mellitus

Nonalcoholic fatty liver disease and chronic vascular complications of diabetes mellitus Nature Reviews Endocrinology volume 14, pages 99114 (2018) Nonalcoholic fatty liver disease (NAFLD) and diabetes mellitus are common diseases that often coexist and might act synergistically to increase the risk of hepatic and extra-hepatic clinical outcomes. NAFLD affects up to 7080% of patients with type 2 diabetes mellitus and up to 3040% of adults with type 1 diabetes mellitus. The coexistence of NAFLD and diabetes mellitus increases the risk of developing not only the more severe forms of NAFLD but also chronic vascular complications of diabetes mellitus. Indeed, substantial evidence links NAFLD with an increased risk of developing cardiovascular disease and other cardiac and arrhythmic complications in patients with type 1 diabetes mellitus or type 2 diabetes mellitus. NAFLD is also associated with an increased risk of developing microvascular diabetic complications, especially chronic kidney disease. This Review focuses on the strong association between NAFLD and the risk of chronic vascular complications in patients with type 1 diabetes mellitus or type 2 diabetes mellitus, thereby promoting an increased awareness of the extra-hepatic implications of this increasingly prevalent and burdensome liver disease. We also discuss the putative underlying mechanisms by which NAFLD contributes to vascular diseases, as well as the emerging role of changes in the gut microbiota (dysbiosis) in the pathogenesis of NAFLD and associated vascular diseases. Subscribe to Nature Reviews Endocrinology for full access: European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD) & European Association for the Study of Obesity (EASO). EASL-EASD-EAS Continue reading >>

Metformin, The Liver, And Diabetes

Metformin, The Liver, And Diabetes

Most people think diabetes comes from pancreas damage, due to autoimmune problems or insulin resistance. But for many people diagnosed “Type 2,” the big problems are in the liver. What are these problems, and what can we do about them? First, some basic physiology you may already know. The liver is one of the most complicated organs in the body, and possibly the least understood. It plays a huge role in handling sugars and starches, making sure our bodies have enough fuel to function. When there’s a lot of sugar in the system, it stores some of the excess in a storage form of carbohydrate called glycogen. When blood sugar levels get low, as in times of hunger or at night, it converts some of the glycogen to glucose and makes it available for the body to use. Easy to say, but how does the liver know what to do and when to do it? Scientists have found a “molecular switch” called CRTC2 that controls this process. When the CRTC2 switch is on, the liver pours sugar into the system. When there’s enough sugar circulating, CRTC2 should be turned off. The turnoff signal is thought to be insulin. This may be an oversimplification, though. According to Salk Institute researchers quoted on RxPG news, “In many patients with type II diabetes, CRTC2 no longer responds to rising insulin levels, and as a result, the liver acts like a sugar factory on overtime, churning out glucose [day and night], even when blood sugar levels are high.” Because of this, the “average” person with Type 2 diabetes has three times the normal rate of glucose production by the liver, according to a Diabetes Care article. Diabetes Self-Management reader Jim Snell brought the whole “leaky liver” phenomenon to my attention. He has frequently posted here about his own struggles with soarin Continue reading >>

The Intestinal And Liver Complications Of Diabetes Mellitus.

The Intestinal And Liver Complications Of Diabetes Mellitus.

The intestinal and liver complications of diabetes mellitus. Department of Medicine, New England Deaconess Hospital, Harvard Medical School, Boston, Massachusetts. Gastroparesis, constipation, diarrhea, and fecal incontinence occur frequently in diabetics with long-standing and often poorly controlled insulin-dependent diabetes. These motor abnormalities of the gastrointestinal tract tend to be associated in these patients with evidence of autonomic neuropathy and other diabetes-related complications such as peripheral neuropathy, nephropathy, and retinopathy. The management of these derangements of motility is generally frustrating and very difficult. The prokinetic agents currently available have fewer side effects than previously used drugs, and have expanded the treatment options for diabetics with motility disorders of the gastrointestinal tract. The treatment of diabetic diarrhea remains aimed at the symptom because the cause is often unknown. The diagnosis of diabetic diarrhea depends on a careful and judicious assessment, which allows for the distinction of this condition from other causes of diarrhea. For example, celiac disease can occur in insulin-dependent diabetics, but it is specifically treated by the elimination of gluten from the diet. In recent years, we have also gained a better understanding of the liver and biliary tree abnormalities that occur in the diabetic. The most common hepatobiliary lesions found in these patients include excessive glycogen deposition, fatty liver, and gallstones. Cirrhosis of the liver can develop in diabetics as a result of progressive fatty steatosis, pericentral hepatic fibrosis, and, at times, central hyaline sclerosis. Future study of the underlying pathogenesis of diabetes may one day allow us to find common threads Continue reading >>

Fatty Liver (nonalcoholic Fatty Liver Disease, Nonalcoholic Steatohepatitis)

Fatty Liver (nonalcoholic Fatty Liver Disease, Nonalcoholic Steatohepatitis)

Nonalcoholic fatty liver disease definition facts Nonalcoholic fatty liver disease (non-alcoholic fatty liver disease, NAFLD) is the accumulation of abnormal amounts of fat within the liver. Nonalcoholic fatty liver disease can be divided into isolated fatty liver in which there is only accumulation of fat, and nonalcoholic steatohepatitis (NASH) in which there is fat, inflammation, and damage to liver cells. NASH progresses to scarring and ultimately to cirrhosis, with all the complications of cirrhosis, for example, gastrointestinal bleeding, liver failure, and liver cancer. The development of nonalcoholic fatty liver disease is intimately associated with and is probably caused by obesity and diabetes. Nonalcoholic fatty liver disease is considered a manifestation of the metabolic syndrome. The symptoms of nonalcoholic fatty liver disease are primarily those of the complications of cirrhosis in patients with NASH; isolated fatty liver infrequently causes symptoms and usually is discovered incidentally. The complications of cirrhosis include: The differentiation of isolated fatty liver from NASH usually requires a liver biopsy. The most promising treatments for nonalcoholic fatty liver disease are Several drugs have been studied in the treatment of NASH. There is little evidence that any drug is effective in slowing the disease progression of NASH. Many diseases are associated with NASH and are part of the metabolic syndrome. These diseases should be screened for and treated, for example, high blood pressure, dyslipidemia and diabetes. Isolated fatty liver rarely progresses to NASH or cirrhosis. Nonalcoholic fatty liver disease, including NASH affects young children as well. NASH will become the number one reason for liver transplantation unless effective and safe trea Continue reading >>

Diabetes Mellitus In Patients With Cirrhosis: Clinical Implications And Management

Diabetes Mellitus In Patients With Cirrhosis: Clinical Implications And Management

Diabetes mellitus in patients with cirrhosis: clinical implications and management Service de Gastroentrologie et Hpatologie, Hpitaux Universitaires de Genve, Genve, Suisse Dr Laure Elkrief, Service de Gastroentrologie et Hpatologie, Avenue GabriellePerretGentil 4, 1211 Geneva, Switzerland. Tel: +41 79 55 33 704; Fax: +41 22 37 29366 DHU UNITY, Service d'Hpatologie, Hpital Beaujon, APHP, Clichy, France Universit ParisDiderot, Sorbonne Paris Cit, Paris, France Inserm U970, Paris Research Cardiovascular Center, Paris, France DHU UNITY, Service d'Hpatologie, Hpital Beaujon, APHP, Clichy, France Universit ParisDiderot, Sorbonne Paris Cit, Paris, France Inserm U1149, Centre de Recherche sur l'Inflammation CRI, Clichy, France Universit ParisDiderot, Sorbonne Paris Cit, Paris, France Inserm U1149, Centre de Recherche sur l'Inflammation CRI, Clichy, France DHU UNITY, Pathology Department, Hpital Beaujon, APHP, Clichy, France DHU UNITY, Service d'Hpatologie, Hpital Beaujon, APHP, Clichy, France Universit ParisDiderot, Sorbonne Paris Cit, Paris, France Inserm U1149, Centre de Recherche sur l'Inflammation CRI, Clichy, France Service de Gastroentrologie et Hpatologie, Hpitaux Universitaires de Genve, Genve, Suisse Dr Laure Elkrief, Service de Gastroentrologie et Hpatologie, Avenue GabriellePerretGentil 4, 1211 Geneva, Switzerland. Tel: +41 79 55 33 704; Fax: +41 22 37 29366 DHU UNITY, Service d'Hpatologie, Hpital Beaujon, APHP, Clichy, France Universit ParisDiderot, Sorbonne Paris Cit, Paris, France Inserm U970, Paris Research Cardiovascular Center, Paris, France DHU UNITY, Service d'Hpatologie, Hpital Beaujon, APHP, Clichy, France Universit ParisDiderot, Sorbonne Paris Cit, Paris, France Inserm U1149, Centre de Recherche sur l'Inflammation CRI, Clichy, France Universit ParisDider Continue reading >>

Mechanisms Of Diabetes-induced Liver Damage

Mechanisms Of Diabetes-induced Liver Damage

Go to: Abstract Diabetes mellitus is a non-communicable disease that occurs in both developed and developing countries. This metabolic disease affects all systems in the body, including the liver. Hyperglycaemia, mainly caused by insulin resistance, affects the metabolism of lipids, carbohydrates and proteins and can lead to non-alcoholic fatty liver disease, which can further progress to non-alcoholic steatohepatitis, cirrhosis and, finally, hepatocellular carcinomas. The underlying mechanism of diabetes that contributes to liver damage is the combination of increased oxidative stress and an aberrant inflammatory response; this activates the transcription of pro-apoptotic genes and damages hepatocytes. Significant involvement of pro-inflammatory cytokines—including interleukin (IL)-1β, IL-6 and tumour necrosis factor-α—exacerbates the accumulation of oxidative damage products in the liver, such as malondialdehyde, fluorescent pigments and conjugated dienes. This review summarises the biochemical, histological and macromolecular changes that contribute to oxidative liver damage among diabetic individuals. Keywords: Diabetes Mellitus, Liver Diseases, Inflammation, Oxidative Stress Diabetes mellitus (dm) is a major global public health problem with an escalating incidence and prevalence, particularly in developing and newly industrialised countries.1 Concern regarding this chronic disease is focused on serious DM-related complications which can affect multiple vital organ systems, thereby leading to more severe and irreversible pathological conditions such as nephropathy, retinopathy, vasculopathy, neuropathy and cardiovascular diseases, as well as hepatopathy.2 Research indicates that DM is associated with a number of liver abnormalities, such as abnormal glycogen Continue reading >>

Type 2 Diabetes And Fatty Liver Disease

Type 2 Diabetes And Fatty Liver Disease

Non-alcoholic fatty liver disease is a group of conditions in which fat builds up in the liver, leading to inflammation of the cells where it is stored and causing the liver to get bigger. It can progress to more serious conditions, including fibrosis and cirrhosis of the liver. Fatty liver disease "is so common. It’s present arguably in a majority of type 2 diabetics,” says Daniel Einhorn, MD, clinical professor of medicine at the University of California, San Diego and the medical director of the Scripps Whittier Diabetes Institute. “None of us thought about it more than about 10 years ago, then all of a sudden we discovered it and see it all the time.” Fatty Liver Disease and Type 2 Diabetes: The Connection Diabetes does not cause fatty liver disease. Instead, the two diseases tend to occur in the same people because the same conditions cause both problems. “So, it’s not the diabetes per se. People with diabetes also have obesity and insulin resistance, and so the fatty liver is thought to be part of that,” Dr. Einhorn explains. Einhorn says that most cases of fatty liver disease do not cause any harm. However, since type 2 diabetes and obesity are so common in the United States, fatty liver disease is now a leading cause of end-stage (fatal) liver disease requiring a liver transplant, along with alcohol abuse and hepatitis. Fatty Liver Disease Diagnosis Fatty liver disease has no symptoms. People who are being treated for diabetes will have liver enzyme tests as part of their routine blood work during medical exams. Ninety-nine percent of the cases of fatty liver disease are detected by this test, says Einhorn. In some cases it will be picked up during the physical exam or in imaging studies, like a computed tomography scan of the abdomen or a liver ul Continue reading >>

Diabetes: How Do I Help Protect My Liver?

Diabetes: How Do I Help Protect My Liver?

If I have diabetes, is there anything special I need to do to take care of my liver? Answers from M. Regina Castro, M.D. You're wise to wonder about steps to protect your liver. Diabetes raises your risk of nonalcoholic fatty liver disease, a condition in which excess fat builds up in your liver even if you drink little or no alcohol. This condition occurs in at least half of those with type 2 diabetes. It isn't clear whether the condition appears more often in people with type 1 diabetes than in the general population because obesity, which is a risk factor, occurs with similar frequency in both groups. Other medical conditions, such as high cholesterol and high blood pressure, also raise your risk of nonalcoholic fatty liver disease. Fatty liver disease itself usually causes no symptoms. But it raises your risk of developing liver inflammation or scarring (cirrhosis). It's also linked to an increased risk of liver cancer, heart disease and kidney disease. Fatty liver disease may even play a role in the development of type 2 diabetes. Once you have both conditions, poorly managed type 2 diabetes can make fatty liver disease worse. Your best defense against fatty liver disease includes these strategies: Work with your health care team to achieve good control of your blood sugar. Lose weight if you need to, and try to maintain a healthy weight. Take steps to reduce high blood pressure. Keep your low-density lipoprotein (LDL, or "bad") cholesterol and triglycerides — a type of blood fat — within recommended limits. Don't drink too much alcohol. If you have diabetes, your doctor may recommend an ultrasound examination of your liver when you're first diagnosed and regular follow-up blood tests to monitor your liver function. Continue reading >>

The Liver & Blood Sugar

The Liver & Blood Sugar

During a meal, your liver stores sugar for later. When you’re not eating, the liver supplies sugar by turning glycogen into glucose in a process called glycogenolysis. The liver both stores and produces sugar… The liver acts as the body’s glucose (or fuel) reservoir, and helps to keep your circulating blood sugar levels and other body fuels steady and constant. The liver both stores and manufactures glucose depending upon the body’s need. The need to store or release glucose is primarily signaled by the hormones insulin and glucagon. During a meal, your liver will store sugar, or glucose, as glycogen for a later time when your body needs it. The high levels of insulin and suppressed levels of glucagon during a meal promote the storage of glucose as glycogen. The liver makes sugar when you need it…. When you’re not eating – especially overnight or between meals, the body has to make its own sugar. The liver supplies sugar or glucose by turning glycogen into glucose in a process called glycogenolysis. The liver also can manufacture necessary sugar or glucose by harvesting amino acids, waste products and fat byproducts. This process is called gluconeogenesis. When your body’s glycogen storage is running low, the body starts to conserve the sugar supplies for the organs that always require sugar. These include: the brain, red blood cells and parts of the kidney. To supplement the limited sugar supply, the liver makes alternative fuels called ketones from fats. This process is called ketogenesis. The hormone signal for ketogenesis to begin is a low level of insulin. Ketones are burned as fuel by muscle and other body organs. And the sugar is saved for the organs that need it. The terms “gluconeogenesis, glycogenolysis and ketogenesis” may seem like compli Continue reading >>

Non-alcoholic Fatty Liver Disease

Non-alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is the generic term used to describe conditions that cause fat to build up within the liver. It is a common disease that often occurs in people who are overweight or obese, including those with type 2 diabetes. How serious is non-alcoholic fatty liver disease? For most people, having small amounts of fat in the liver cells usually causes no problems. But for others, the build-up of liver fat can lead to serious health problems. NAFLD, in particular, increases the risk of cardiovascular issues such as heart attack and stroke, which makes it particularly dangerous for people with type 2 diabetes who already have a greater risk of cardiovascular disease. I have diabetes, how do I avoid non-alcoholic fatty liver disease? Lowering the risk of non-alcoholic fatty liver disease is generally a matter of gradual weight loss and maintaining regular exercise. This also helps to lower the risk of cardiovascular problems. What is the function of the liver? The liver helps to store fuel (glycogen) made from sugars, breaking it down and releasing it to the bloodstream. Fats and proteins are processed and toxins are removed by the liver. Bile, which breaks down the fat in foods, is also created by the liver. What are the stages of NAFLD? Non-alcoholic fatty liver disease (NAFLD) can be broken down into four different stages: Stage 1: Steatosis (simple fatty liver) Steatosis is where there is excess fat in the liver but not to an extent to cause symptoms to appear. As a result, fatty liver disease is often not picked up until a later stage. Stage 2: Non-alcoholic steatohepatitis (NASH) Steatohepatitis (NASH) occurs if the liver becomes damaged causing it to become inflamed. Symptoms such as a pain in the top right of your abdomen may be felt at Continue reading >>

What Everyone With Diabetes Should Know About Liver Disease

What Everyone With Diabetes Should Know About Liver Disease

It’s well known that diabetes increases the risk of kidney disease, nerve damage, blood vessel damage, infections, blindness and heart disease, but you may not realize diabetes can have profound effects on the liver as well. Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease that affects up to one-third of the entire adult population in industrialized countries. And if you have type 2 diabetes mellitus -- the diabetes in which your own insulin does not work properly, compounded by increasingly less and less insulin made in the pancreas — you are even more at risk of having NAFLD. Recognition and description of NAFLD dates back to only 30 years ago, when scientists noted the appearance of liver tissue that reminded them of alcoholic hepatitis, with findings resembling chronic alcohol use, but in individuals that had no history of alcohol abuse or even alcohol intake. Although once thought uncommon, today’s medical professionals recognize that if one was looking for 20 patients with NAFLD, given the high prevalence of the disease, this number could likely be recruited within one day in a lobby of a hotel. NAFLD is an umbrella term that includes several subtypes of liver cell appearances and clinically distinct conditions, including fatty liver (referred to as NAFL or steatosis hepatis) and more serious steatohepatitis (NASH), with or without fibrosis (scarring), that can progress to liver cirrhosis and, in a few cases, to liver cancer. Precisely differentiating between these different liver conditions can be challenging: usually a liver biopsy is needed to look at the actual appearance of the liver cells, the fat content of the liver, and any scarring or other specific tissue changes. Hepatic steatosis is de-fined as liver fat content above 5.5 per Continue reading >>

Can Diabetes Cause Liver And Kidney Issues In Patients?

Can Diabetes Cause Liver And Kidney Issues In Patients?

Can Diabetes Cause Complications to the Liver and Kidneys written by: DulceCorazon edited by: Diana Cooper updated: 8/23/2010 Can diabetes cause liver and kidney issues? Uncontrolled diabetes is known to cause diabetic nephropathy. But liver disease? Find out. Can diabetes cause liver and kidney issues? This is a common question among diabetics. By definition, diabetes is a disease characterized by high levels of blood sugar due to the lack of insulin in the body or to the body's inability to respond to the presence of insulin. Insulin is the hormone that allows the sugar to get to the cells and provide them with energy. Uncontrolled diabetes can frequently result in many complications which cause damage to important body organs like the liver, kidneys, eyes and nerves. It can also result in other conditions like heart disease and stroke. It can lead to diabetic ketoacidosis as the body fats are being used for energy. Diabetic ketoacidosis, if not managed early, can become life threatening. Other complications of diabetes are skin and mouth infections, bone problems, like osteoporosis, and foot damage. Diabetes may put a person at risk of developing liver and kidney disease. Some of the more common liver and kidney complications of diabetes are non-alcoholic cirrhosis and diabetic nephropathy. Cirrhosis, or the scarring of the liver, is often associated with alcohol abuse, but it can also be a complication of diabetes. Non-alcoholic cirrhosis is a general term for the scarring of the liver not due to excess alcohol consumption. In this condition, the liver is hardened is unable to function normally.High levels of sugar and cholesterol in the blood, as well as obesity, are considered contributing factors to the development of non-alcoholic liver cirrhosis in diabetic pa Continue reading >>

How Does Diabetes Affect The Liver?

How Does Diabetes Affect The Liver?

Liver disease may occur as a result of diabetes, and the reverse is true as well. Non-alcoholic liver disease may also be caused by obesity, protein deficiency, HIV infection and exposure to toxic chemicals. Drugs such as corticosteroids, tamoxifen and estrogens also may damage the liver. Diabetics who have concurrent hepatitis C infection are at high risk of complications. Video of the Day The liver plays a role in glucose regulation. Glucose is transported from the intestines to the liver, which stores it as glycogen or uses it for fuel. Insulin receptors in fat, liver, and muscle cells facilitate the use of glucose. Insulin regulates the entry of glucose into tissues and promotes glycogen storage. Insulin is metabolized in the liver, where it promotes the production of glycogen, protein, cholesterol, and triglycerides and stimulates the formation of low density lipoproteins, or LDL, which transport cholesterol into the arteries. In diabetes, excessive output of glucose by the liver contributes to elevated fasting blood sugars. Fat accumulation in the liver may be linked to excess glycogen, which is common among diabetics. Fatty deposits may be due to the increased transport of fat to the liver from the intestines or to decreased removal of fat from the liver. The condition occurs secondary to obesity as well as diabetes, but the exact reasons are unknown. The National Institute of Diabetes and Digestive and Kidney Disease reports that 10 to 20 percent of Americans have fatty liver. Diagnosis may depend on blood work, CT scan or ultrasound imaging and biopsy. Although there may be no symptoms, an enlarged liver and enzyme abnormalities are characteristic of fatty liver. The condition may also cause abdominal pain, nausea and vomiting, or--rarely--fluid accumulation ar Continue reading >>

What Every Diabetic Should Know About Liver Disease

What Every Diabetic Should Know About Liver Disease

What Every Diabetic Should Know About Liver Disease Did you know that diabetics are 50% more likely to develop liver disease? Particularly fatty liver disease. Fatty liver disease is incredibly common in overweight people; nearly everyone with excess weight on their abdomen has some degree of fatty liver. Type 2 diabetics are prone to carrying excess weight on their abdomen, but even slim diabetics often have a fatty liver. It is well known that diabetes increases the risk of kidney disease, nerve damage, blood vessel damage, infections, blindness, erectile problems and heart disease, but you may not realise diabetes has terrible effects on the liver. You can’t see or feel the effects it’s having on your liver until liver cells become damaged. According to Gillian Booth, MD, MSc, of St. Michael’s Hospital in Toronto, in a population-based study, newly diagnosed diabetes was linked with a near doubling in the rate of cirrhosis, liver failure or liver transplant compared with non-diabetics. Clearly these are significant findings that should be taken seriously. Insulin resistance (syndrome X) is the driving force behind the development of fatty liver. Insulin resistance is a forerunner to type 2 diabetes. If the insulin resistance becomes severe enough, a person usually develops type 2 diabetes. Type 1 diabetes usually develops in childhood, although by the time they are in their mid 30s, most type 1 diabetics have developed insulin resistance as well, and they face the same risks as type 2 diabetics when they get older. People with insulin resistance have high levels of insulin in their bloodstream. Insulin signals to your liver to manufacture fat, especially triglycerides and cholesterol. This promotes the accumulation of fat inside the liver, inside other organs, Continue reading >>

Diabetes And Nonalcoholic Fatty Liver Disease: A Pathogenic Duo

Diabetes And Nonalcoholic Fatty Liver Disease: A Pathogenic Duo

Limitation of Use: The safety and efficacy of Humulin R U-500 used in combination with other insulins has not been determined. The safety and efficacy of Humulin R U-500 delivered by continuous subcutaneous infusion has not been determined. For the Humulin R U-500 vial, particular attention should be paid to the 20-mL vial size, prominent “U-500” and warning statements on the vial label, and distinctive coloring on the vial and carton. Dosing errors have occurred when Humulin R U-500 was administered with syringes other than a U-500 insulin syringe. Patients should be prescribed U-500 syringes for use with Humulin R U-500 vials. The dose of Humulin R U-500 should always be expressed in units of insulin. DO NOT transfer Humulin R U-500 from the Humulin R U-500 KwikPen into any syringe for administration. Overdose and severe hypoglycemia can occur. Hyperglycemia or Hypoglycemia with Changes in Insulin Regimen: Changes in insulin, manufacturer, type, or method of administration should be made cautiously and only under medical supervision and the frequency of blood glucose monitoring should be increased. Hypoglycemia: Hypoglycemia is the most common adverse reaction associated with insulin, including Humulin R U-500. Severe hypoglycemia can cause seizures, may be life-threatening, or cause death. Severe hypoglycemia may develop as long as 18 to 24 hours after an injection of Humulin R U-500. Hypoglycemia can impair concentration ability and reaction time; this may place an individual and others at risk in situations where these abilities are important, such as driving or operating other machinery. Early warning symptoms of hypoglycemia may be less pronounced in patients with longstanding diabetes, in patients with diabetic nerve disease, in patients using medications th Continue reading >>

More in diabetes