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Infections In Patients With Diabetes Mellitus: A Review Of Pathogenesis

Infections In Patients With Diabetes Mellitus: A Review Of Pathogenesis

Go to: Diabetes mellitus (DM) is a clinical syndrome associated with deficiency of insulin secretion or action. It is considered one of the largest emerging threats to health in the 21st century. It is estimated that there will be 380 million persons with DM in 2025.[1] Besides the classical complications of the disease, DM has been associated with reduced response of T cells, neutrophil function, and disorders of humoral immunity.[2–4] Consequently, DM increases the susceptibility to infections, both the most common ones as well as those that almost always affect only people with DM (e.g. rhinocerebral mucormycosis).[4] Such infections, in addition to the repercussions associated with its infectivity, may trigger DM complications such as hypoglycemia and ketoacidosis. This article aims to critically review the current knowledge on the mechanisms associated with the greater susceptibility of DM for developing infectious diseases and to describe the main infectious diseases associated with this metabolic disorder. Continue reading >>

Diabetes Mellitus

Diabetes Mellitus

"Diabetes" redirects here. For other uses, see Diabetes (disambiguation). Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic disorders in which there are high blood sugar levels over a prolonged period.[7] Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger.[2] If left untreated, diabetes can cause many complications.[2] Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic state, or death.[3] Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, and damage to the eyes.[2] Diabetes is due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced.[8] There are three main types of diabetes mellitus:[2] Type 1 DM results from the pancreas's failure to produce enough insulin.[2] This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes".[2] The cause is unknown.[2] Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to insulin properly.[2] As the disease progresses a lack of insulin may also develop.[9] This form was previously referred to as "non insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes".[2] The most common cause is excessive body weight and insufficient exercise.[2] Gestational diabetes is the third main form, and occurs when pregnant women without a previous history of diabetes develop high blood sugar levels.[2] Prevention and treatment involve maintaining a healthy diet, regular physical exercise, a normal body weight, and avoiding use of tobacco.[2] Control of blood pressure and maintaining proper foot care are important for people with t Continue reading >>

The Science Of Hypoglycemia In Patients With Diabetes.

The Science Of Hypoglycemia In Patients With Diabetes.

The science of hypoglycemia in patients with diabetes. Department of Medicine, Division of Endocrinology, Metabolism, and Molecular Medicine, Feinberg School of Medicine, Northwestern University, 211 E. Chicago Avenue, Suite 1050, Chicago IL 60611, USA. [email protected] Curr Diabetes Rev. 2013 May;9(3):195-208. The risk of hypoglycemia with anti-hyperglycemic agents is an important limiting factor in the management of type 1 (T1DM) and type 2 (T2DM) diabetes mellitus. While hypoglycemia is more common in T1DM, the incidence is high in T2DM patients who use insulin or secretagogues, particularly patients with longer duration of diabetes. The underlying cause of hypoglycemia in diabetes is a complex interaction between hyperinsulinemia and compromised physiologic and behavioral responses to falling glucose levels. Pancreatic dysfunction also causes loss of normal therapeutic response to hypoglycemia--a reduction in circulating insulin (in T2DM only) and an increase in glucagon secretion. In T1DM and advanced T2DM, the third defense against hypoglycemia is increase in adrenomedullary sympathoadrenal epinephrine secretion, which is also compromised, causing the syndrome of defective glucose counterregulation. Diminished increase in epinephrine, also called hypoglycemia-associated autonomic failure (HAAF), is largely responsible for defective glucose counterregulation. HAAF can result in recurrent hypoglycemia and lowering of glycemic threshold that typically triggers sympathoadrenal response to hypoglycemia. This results in hypoglycemia without warning symptoms, or "hypoglycemia unawareness," which increases the risk of severe hypoglycemia associated with substantial morbidity and mortality. Long-term effects of severe hypoglycemia, aside from causing accidents, may inc Continue reading >>

Diabetes And Palliative Care Information For Patients

Diabetes And Palliative Care Information For Patients

Why it is important to care for diabetes when you are receiving palliative care. What to tell health professionals and your family/carers about your diabetes care preferences Why is it important to care for diabetes during palliative care? The aim of diabetes care is to make sure you are comfortable and not in too much pain. Your diabetes will still need to be managed because both high and low blood glucose can: make the symptoms of other conditions worse When you are very unwell you might not notice your blood glucose is too high or too low, and sometimes it is hard to know whether you feel unwell because of your diabetes, the medicines you are taking, or your other illness. Checking your blood glucose levels is a way of finding out whether your blood glucose level could be contributing to the problem. Thus, checking blood glucose levels will help health professionals know how to make you more comfortable. Palliative care aims to maintain your comfort and dignity, and includes your diabetes care to avoid the unpleasant symptoms of high and low blood glucose. Therefore, checking blood glucose levels is important. Health professionals should respect your wishes and knowledge about your diabetes. It is very important to write down your wishes in an Advance Care Plan . When you are not able to tell health professionals your wishes they should talk to your family members or carers. If you have an Advance Care Plan it is easier for everyone to know your wishes. Your usual diabetes care may change during palliative care It may be more comfortable for you if your blood glucose is a little higher than when you were well. A suggested range for blood glucose for most people at the end of life is 6 to 11 mmol/L. Your medicines may change when you are very unwell. You may need mor Continue reading >>

Food Safety For Diabetes Patients

Food Safety For Diabetes Patients

In addition to cardiovascular disease and kidney problems, diabetes also affects the immune system. These affects leave diabetes patients more prone to infectious disease, such as foodborne illness. A diabetic patient’s immune system may not immediately recognize harmful foodborne pathogens increasing a person’s risk for infection. Glucose Levels High glucose levels suppress the function of white blood cells that fight off infection, increasing one’s risk of contracting a foodborne illness. If someone with diabetes contracts a foodborne illness, their blood glucose levels may be affected because the illness impacts what and how much the person can eat. Gastrointestinal Tract (GI) Diabetes may cause the stomach to produce low amounts of digestive acid. In addition, nerves may not move food through the GI tract as quickly as in non-diabetic persons. When the stomach holds on to food longer than necessary, bacteria start to multiply. If the amount of unhealthy bacteria in the stomach gets too high, it can lead to foodborne illness. Kidneys Kidneys usually work to cleanse the body. For many diabetes patients, their kidneys may not function properly, giving unhealthy bacteria the opportunity to grow out of control. What You Can Do Learn about safety tips for those at increased risk of foodborne illness. Those living with diabetes should always follow the four steps: Separate: Separate raw meat and poultry from ready-to-eat foods Chill: Chill raw meat and poultry as well as cooked leftovers promptly (within 2 hours) If you or someone you care for receives prepared meals, visit our home delivered meals page for information on how to keep these safe. Download our FoodKeeper application to make sure you are storing food and beverages properly, and using them within recomme Continue reading >>

Diabetes Patients At Risk From Rising Insulin Prices

Diabetes Patients At Risk From Rising Insulin Prices

Diabetes Patients at Risk From Rising Insulin Prices A Yale study found that one in four patients admitted to cutting back on insulin use because of cost. The consequences can be deadly. By Randi Hutter Epstein, M.D. and Rachel Strodel A surprisingly large number of people with diabetes are using less insulin than prescribed because of the rising cost of the drug, putting themselves in danger of serious complications. Those are the findings of a small new study by researchers at Yale University, who found that at one clinic in New Haven, Conn., one in four patients admitted to cutting back on insulin use because of cost. Everyone with Type 1 diabetes needs to take insulin, while about a third of those with Type 2 diabetes do. Not getting enough insulin can have severe consequences for someone with diabetes who does not produce enough of the hormone, which regulates levels of glucose in the blood. Within a week or so without insulin, people with Type 1 diabetes die. Between 2002 and 2013, the price of insulin jumped , with the typical cost for patients increasing from about $40 a vial to $130. The amount of insulin a person needs varies, but one vial typically lasts about a week or two. The Yale team launched the recent study to assess how many people are affected by the rising prices. They surveyed 199 patients in the New Haven area who had either Type 1 or Type 2 diabetes, asking them six questions about their ability to afford insulin, including Did you use less insulin than prescribed because of cost? and Did you not fill an insulin prescription because of cost? A positive response to any of the six questions counted as insulin underuse. The researchers also used medical records to determine participants HbA1c level, a measure of blood sugar control. Unsurprisingly, Continue reading >>

Diabetes Type 2: Young Patients

Diabetes Type 2: Young Patients

Generation Diabetes: Why the Youngest Type 2 Diabetes Patients Are the Sickest Written by Gillian Mohney on July 18, 2018 In just 30 years, doctors have seen the rise of an entirely new kind of diabetes patient. Gail Punongbayan, 17, was first diagnosed with type 2 diabetes at age 14. | Image by Gabriela Hasbun Wearing a maroon sweatshirt with San Leandro Rebels emblazoned on the front, 17-year-old Gail Punongbayan didnt flinch when a physicians assistant drew blood. One, two, three, four, showtime! Jonathan Ramos, a physicians assistant at UCSF Benioff Childrens Hospital, called out as he pricked Gails finger to smear a bright red drop of blood on a small card to check her blood sugar. The high school junior knows the routine. For four years, shes been going to the childrens diabetes clinic at UCSF Benioff Childrens Hospital in Oakland, California, every three months for checkups. At this one, Ramos first checks her height, then her weight and blood sugar. The routine may seem normal, but Gail has a condition that is extremely rare for kids or teens her age. Today, Gail is part of a growing number of kids and teens living with type 2 diabetes. Despite their young age, many of them are experiencing complications and disease progression four times faster than adults with the same condition, setting off alarm bells for the diabetes experts treating them. Stories like Gails are no longer a rare occurrence. The Centers for Disease Control and Prevention (CDC) estimated in 2012 that there were 5,300 new pediatric type 2 cases diagnosed that year in the United States. That number is far lower than the 17,900 kids receiving diagnoses of type 1 diabetes, but its a big increase from essentially zero, which was the case in 1990. The increase mirrors the trend of rising type 2 di Continue reading >>

Phone Apps For Patients With Diabetes

Phone Apps For Patients With Diabetes

Among approximately 280 commercially available mobile phone apps for self-management of diabetes, only 11 had been studied for effectiveness, and only 5 of those were associated with clinically significant improvement in blood glucose control as measured by hemoglobin A1c tests, according to a recent report by the Agency for Healthcare Research and Quality (AHRQ). Rubin R. Phone Apps for Patients With Diabetes. JAMA. 2018;319(24):2469. doi:10.1001/jama.2018.8164 New! JAMA Network Open is now accepting submissions. Learn more. Customize your JAMA Network experience by selecting one or more topics from the list below. Challenges in Clinical Electrocardiography Clinical Implications of Basic Neuroscience Health Care Economics, Insurance, Payment Scientific Discovery and the Future of Medicine United States Preventive Services Task Force JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Facial Plastic Surgery JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA OtolaryngologyHead & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) AMA Manual of Style Art and Images in Psychiatry Breast Cancer Screening Guidelines Colorectal Screening Guidelines Declaration of Helsinki Depression Screening Guidelines Evidence-Based Medicine: An Oral History Fishbein Fellowship Genomics and Precision Health Health Disparities Hypertension Guidelines JAMA Network Audio JAMA Network Conferences Med Men Medical Education Opioid Management Guidelines Peer Review Congress Research Ethics Sepsis and Septic Shock Statins and Dyslipidemia Topics and Collections Continue reading >>

Diabetes Patients Seeing Better Outcomes Through Technology

Diabetes Patients Seeing Better Outcomes Through Technology

Tuesday, June 06, 2017 |by Paul Wynn, special to AAMCNews Diabetes Patients Seeing Better Outcomes Through Technology When David Klonoff, MD, started practicing endocrinology more than 35 years ago, urine tests were the standard for diabetes screenings. We had to mix chemicals with the urine to get a resultand it wasnt very accurate, said Klonoff, a clinical professor at the University of California, San Francisco (UCSF), School of Medicine and founding editor in chief of the Journal of Diabetes Science and Technology. Fast-forward to 2017. Continuous glucose monitoring systems can measure blood glucose every five minutes or up to 300 times a day. Sensors built into advanced systems enable patients to sidestep the need to prick their fingers to collect blood. Klonoff, a specialist in diabetes technology, coauthored a study on the first-generation system of an artificial pancreas that can automatically send information to an insulin pump to adjust unhealthy blood glucose levels. He was lead investigator for the first in-home pivotal trial of a closed-loop product for managing type 1 diabetes, and he participated in developing the first dedicated diabetes telemedicine system cleared by the Food and Drug Administration. The system increases access to expertise for people in remote areas or without transportation. "The new technologies for the testing and treatment of diabetes in the past few decades have been astounding and are making a major difference in improving the outcomes. Academic medical centersUCSF and othersare uniquely positioned to bring together technology research and clinical care to advance diabetes care. David Armstrong, DPM, MD, PhD, professor of surgery at the University of Arizona College of Medicine and director of the Southern Arizona Limb Salvage A Continue reading >>

Heart Health Tests For Diabetes Patients

Heart Health Tests For Diabetes Patients

If you have diabetes, you are at greater risk for developing cardiovascular disease . That's why your health care provider may recommend one or more of the following tests to check your heart health. Non-invasive tests do not involve inserting instruments or fluids in the body. They include: Electrocardiogram ("EKG" or "ECG"): This test measures the electrical activity of the heart. The heart beats because an electrical impulse (or "wave") travels through it. This wave causes the muscle to squeeze and pump blood from the heart into the arteries. Learn more about electrocardiograms . Echocardiogram ("echo"): This safe and painless ultrasound test uses sound waves to examine the heart's structure and motion. During this test, the patient lies still while a technician moves a device over the chest. The device emits a silent sound wave that bounces off the heart, creating images of its chambers and valves. The echo can tell the doctor how thick the heart muscle is and how well the heart pumps. Learn more about echocardiograms . Exercise stress test ("treadmill test" or "exercise test"): This type of test helps determine how well your heart handles work. As your body works harder during the test, it requires more oxygen, so your heart must pump more blood. The test can show if the blood supply is reduced in the arteries that supply the heart. It also helps doctors know the kind and level of physical activity appropriate for a patient. Learn more about exercise stress tests . Invasive tests require inserting instruments or fluids like injectable dyes into the body. Such tests to check cardiovascular health include: Thallium stress test: A type of nuclear scanning test or myocardial perfusion imaging test, the thallium stress test shows how well blood flows to the heart muscl Continue reading >>

The 16 Best Foods To Control Diabetes

The 16 Best Foods To Control Diabetes

Figuring out the best foods to eat when you have diabetes can be tough. The main goal is to keep blood sugar levels well-controlled. However, it's also important to eat foods that help prevent diabetes complications like heart disease. Here are the 16 best foods for diabetics, both type 1 and type 2. Fatty fish is one of the healthiest foods on the planet. Salmon, sardines, herring, anchovies and mackerel are great sources of the omega-3 fatty acids DHA and EPA, which have major benefits for heart health. Getting enough of these fats on a regular basis is especially important for diabetics, who have an increased risk of heart disease and stroke (1). DHA and EPA protect the cells that line your blood vessels, reduce markers of inflammation and improve the way your arteries function after eating (2, 3, 4, 5). A number of observational studies suggest that people who eat fatty fish regularly have a lower risk of heart failure and are less likely to die from heart disease (6, 7). In studies, older men and women who consumed fatty fish 5–7 days per week for 8 weeks had significant reductions in triglycerides and inflammatory markers (8, 9). Fish is also a great source of high-quality protein, which helps you feel full and increases your metabolic rate (10). Fatty fish contain omega-3 fats that reduce inflammation and other risk factors for heart disease and stroke. Leafy green vegetables are extremely nutritious and low in calories. They're also very low in digestible carbs, which raise your blood sugar levels. Spinach, kale and other leafy greens are good sources of several vitamins and minerals, including vitamin C. In one study, increasing vitamin C intake reduced inflammatory markers and fasting blood sugar levels for people with type 2 diabetes or high blood pressure Continue reading >>

Standards Of Medical Care For Patients With Diabetes Mellitus

Standards Of Medical Care For Patients With Diabetes Mellitus

Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested persons with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Skyler (Ed.): Medical Management of Type 1 Diabetes (1) and Zimmerman (Ed.): Medical Management of Type 2 Diabetes (2). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E. CLASSIFICATION, DIAGNOSIS, AND SCREENING Classification In 1997, the ADA issued new diagnostic and classification criteria (3). The classification of diabetes mellitus includes four clinical classes: Type 1 diabetes (results from β Continue reading >>

Type 2 Diabetes

Type 2 Diabetes

Type 2 diabetes occurs mostly in people aged over 40 years. However, an increasing number of younger people, even children, are being diagnosed with type 2 diabetes. The first-line treatment is diet, weight control and physical activity. If the blood sugar (glucose) level remains high despite these measures then tablets to reduce the blood glucose level are usually advised. Insulin injections are needed in some cases. Other treatments include reducing blood pressure if it is high, lowering high cholesterol levels and also using other measures to reduce the risk of complications. Although diabetes cannot be cured, it can be treated successfully. If a high blood sugar level is brought down to a normal level, your symptoms will ease. You still have some risk of complications in the long term if your blood glucose level remains even mildly high - even if you have no symptoms in the short term. However, studies have shown that people who have better glucose control have fewer complications (such as heart disease or eye problems) compared with those people who have poorer control of their glucose level. Therefore, the main aims of treatment are: To keep your blood glucose level as near normal as possible. To reduce any other risk factors that may increase your risk of developing complications. In particular, to lower your blood pressure if it is high and to keep your blood lipids (cholesterol) low. To detect any complications as early as possible. Treatment can prevent or delay some complications from becoming worse. Type 2 diabetes is usually initially treated by following a healthy diet, losing weight if you are overweight, and having regular physical activity. If lifestyle advice does not control your blood sugar (glucose) levels then medicines are used to help lower your Continue reading >>

Diabetes: Symptoms, Causes And Treatments

Diabetes: Symptoms, Causes And Treatments

Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both. Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia). Here are some key points about diabetes. More detail and supporting information is in the main article. Diabetes is a long-term condition that causes high blood sugar levels. In 2013 it was estimated that over 382 million people throughout the world had diabetes (Williams textbook of endocrinology). Type 1 Diabetes - the body does not produce insulin. Approximately 10% of all diabetes cases are type 1. Type 2 Diabetes - the body does not produce enough insulin for proper function. Approximately 90% of all cases of diabetes worldwide are of this type. Gestational Diabetes - this type affects females during pregnancy. The most common diabetes symptoms include frequent urination, intense thirst and hunger, weight gain, unusual weight loss, fatigue, cuts and bruises that do not heal, male sexual dysfunction, numbness and tingling in hands and feet. If you have Type 1 and follow a healthy eating plan, do adequate exercise, and take insulin, you can lead a normal life. Type 2 patients need to eat healthily, be physically active, and test their blood glucose. They may also need to take oral medication, and/or insulin to control blood glucose levels. As the risk of cardiovascular disease is much higher for a diabetic, it is crucial that blood pressure and cholesterol levels are monitored regularly. As smoking might have a serious effect on c Continue reading >>

Diabetes Symptoms, (type 1 And Type 2)

Diabetes Symptoms, (type 1 And Type 2)

Diabetes type 1 and type 2 definition and facts Diabetes is a chronic condition associated with abnormally high levels of sugar (glucose) in the blood. Insulin produced by the pancreas lowers blood glucose. Absence or insufficient production of insulin, or an inability of the body to properly use insulin causes diabetes. The two types of diabetes are referred to as type 1 and type 2. Former names for these conditions were insulin-dependent and non-insulin-dependent diabetes, or juvenile onset and adult onset diabetes. Symptoms of type 1 and type 2 diabetes include increased urine output, excessive thirst, weight loss, hunger, fatigue, skin problems slow healing wounds, yeast infections, and tingling or numbness in the feet or toes. Some of the risk factors for getting diabetes include being overweight or obese, leading a sedentary lifestyle, a family history of diabetes, hypertension (high blood pressure), and low levels of the "good" cholesterol (HDL) and elevated levels of triglycerides in the blood. If you think you may have prediabetes or diabetes contact a health-care professional. Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels that result from defects in insulin secretion, or its action, or both. Diabetes mellitus, commonly referred to as diabetes (as it will be in this article) was first identified as a disease associated with "sweet urine," and excessive muscle loss in the ancient world. Elevated levels of blood glucose (hyperglycemia) lead to spillage of glucose into the urine, hence the term sweet urine. Normally, blood glucose levels are tightly controlled by insulin, a hormone produced by the pancreas. Insulin lowers the blood glucose level. When the blood glucose elevates (for example, after eating food Continue reading >>

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