The Stages Of Type 1 Diabetes (it Starts Earlier Than We Thought)
My daughter Bisi was diagnosed with type 1 diabetes three years ago at the age of six. The first night after she was diagnosed, once she finally fell asleep in her hospital bed, tossing and turning despite the IV in her arm, I remember standing outside in the hall with my husband and a couple of medical residents, talking with them about her diagnosis. “Could this have been coming on for a while?” we asked them. I described how for a couple of years, Bisi had been almost unbearably cranky when she was hungry—to the point where I’d asked her pediatrician more than once if something might be wrong. No, the residents told us. Type 1 diabetes comes on very suddenly, in a matter of weeks, as the body’s beta cells suddenly die out under attack from the immune system. Every doctor or nurse we spoke with during the three days in the hospital (except for one, who said that our instincts were probably right), echoed what the two residents, fresh from medical school, told us. But it turns out they were wrong. JDRF and the American Diabetes Association, supported by other organizations in the field, recently put forth a new staging system for type 1 diabetes, where full-blown disease, like what landed Bisi in the hospital, is characterized as stage 3, part of an extended auto-immune process that often starts in infancy. This fall, Dr. Richard Insel, JDRF’s Chief Scientific Officer, explained the classification system to a group of reporters, talking through the importance of early diagnosis, and the hope that diagnosing the disease at an earlier stage could lead to breakthroughs in stopping the beta-cell destruction process—essentially, stopping the disease before it starts. Insel explained that stage 1 is when people test positive for multiple pancreatic islet auto-a Continue reading >>
Patient Education: Preventing Complications In Diabetes Mellitus (beyond The Basics)
DIABETES OVERVIEW Diabetes mellitus is a chronic condition that can lead to complications over time. These complications can include: Coronary heart disease, which can lead to a heart attack Cerebrovascular disease, which can lead to stroke Retinopathy (disease of the eye), which can lead to blindness Nephropathy (disease of the kidney), which can lead to kidney failure and the need for dialysis Neuropathy (disease of the nerves), which can lead to, among other things, ulceration of the foot requiring amputation (see "Patient education: Diabetic neuropathy (Beyond the Basics)") Many of these complications produce no symptoms in the early stages, and most can be prevented or minimized with a combination of regular medical care and blood sugar monitoring. CARDIOVASCULAR COMPLICATIONS IN DIABETES A number of measures are important to reduce the risk of cardiovascular (heart and blood vessel) disease. Quit smoking. Manage high blood pressure with lifestyle modifications and/or medication(s). Have a blood test to measure cholesterol and triglyceride levels, and modify the diet if needed. Some people will also need a medication to lower their low-density lipoprotein (LDL) ("bad cholesterol") or triglycerides. If medication is needed, a statin drug should be included whenever possible. The statin drugs have been shown to decrease the future risk of heart attacks, strokes, and death in people with diabetes who are over age 40 years, even when cholesterol levels are normal. The initiation of statins should be based upon cardiovascular risk rather than an LDL cholesterol level. Statins are recommended for anyone with clinical cardiovascular disease or over age 40 years, regardless of baseline lipid levels. For patients without clinical cardiovascular disease and under age 40 year Continue reading >>
Long-term Complications Of Diabetes
The long-term or chronic effects of diabetes include significant and permanent damage to a variety of organs and tissue, but most directly the kidneys and the nerves and blood vessels that feed the eyes, limbs and gastro-intestinal tract . These effects are known as microvascular complications because the injury to these organs stems from damage to the tiny blood vessels that feed these tissues and nerves. These complications can begin to develop early in the diagnosis of diabetes but generally take years to become clinically significant. There are also non-sugar related effects of diabetes mellitus which include heart disease, stroke, and peripheral vascular disease. Having diabetes increases the risks of these medical problems substantially. These are called macrovascular complications. The likelihood that these microvascular complications will arise seem to increase with the duration and severity of the diabetes- those with very high blood sugars for many years have a much higher chance of already having or developing microvascular complications than those with mild, new-onset diabetes. Even more importantly, studies have shown that controlling high-blood sugars with diet, exercise and medication over the long-term can drastically reduce the chances of developing these complications. Kidney damage from diabetes (known as Diabetic Nephropathy) is one of the most common and worrisome microvascular complications and is the most common cause of chronic kidney failure and the need for life-long dialysis in the United States . Generally it takes up to 10-15 years for clinically significant diabetic nephropathy to occur but . By the time damage to the kidneys from diabetes is detected (usually by way of testing the protein content of the urine), there has already been some Continue reading >>
Late Stage Complications Of Diabetes And Insulin Resistance
1Department of Microbiology, Chaitanya Postgraduate College, Kakatiya University, Warangal, India 2Department of Biotechnology, Presidency College, Bangalore University, India *Corresponding Author: Department Of Microbiology, Chaitanya Postgraduate College affiliated to Kakatiya University, Warangal, India E-mail: [email protected] Citation: Soumya D, Srilatha B (2011) Late Stage Complications of Diabetes and Insulin Resistance. J Diabetes Metab 2:167. doi:10.4172/2155-6156.1000167 Copyright: © 2011 Soumya D, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Visit for more related articles at Journal of Diabetes & Metabolism Abstract Diabetes mellitus is considered one of the main threats to human health in the 21st century. Diabetes is a metabolic disorder or a chronic condition where the sugar levels in blood are high. Diabetes is associated with long-term complications that affect almost every part of the body and often leads to blindness, heart and blood vessel disease, stroke, kidney failure, amputations, and nerve damage. Also it is associated with significantly accelerated rates of several debilitating microvascular complications such as nephropathy, retinopathy, and neuropathy, and macrovascular complications such as atherosclerosis and stroke. In the present article it has been discussed about the resistance of insulin and its consequences in diabetic patients. Insulin resistance results in various disorders. Metabolic syndrome is predicted to become a major public health problem in many developed, as well as developing countries. Keywords Diabetes; Complications Continue reading >>
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Diabetic Nephropathy Overview
Diabetic nephropathy is kidney disease that develops as a result of diabetes mellitus (DM). According to the American Diabetes Association, diabetes affects approximately 9.3 percent of the U.S. population (29.1 million people as of 2012). This disease damages many organs, including the eyes, nerves, blood vessels, heart, and kidneys. Diabetes is the most common cause of kidney failure in the United States and accounts for over one-third of all patients who are on dialysis. Diabetes mellitus is a disorder in which the body is unable to metabolize carbohydrates (e.g., food starches, sugars, cellulose) properly. The disease is characterized by excessive amounts of sugar in the blood (hyperglycemia) and urine; inadequate production and/or utilization of insulin; and by thirst, hunger, and loss of weight. Diabetics who require daily insulin shots to maintain life have insulin-dependent diabetes mellitus, or type 1 diabetes . In this type of diabetes, the pancreas secretes little or no insulin and the blood sugar level remains high, unless treated. Type 1 diabetes usually occurs in children and young adults, but it may occur at any age. In the past, this condition was also called juvenile onset diabetes. Onset of type 1 diabetes is abrupt. The patient becomes very sick and requires immediate insulin therapy. Approximately 3 million people in the United States have type 1 diabetes and each year, about 30, 000 people are diagnosed with the condition. Non-insulin-dependent diabetes, or type 2 diabetes , differs from type 1 in that the main problem is a peripheral resistance to the action of the insulin. DM 2 usually occurs in adults over the age of 40 who are overweight and have a family history of the disease. Some patients can manage their diabetes with weight loss and chang Continue reading >>
Insulin Changes Occur Years Before Diabetes
blood sugar linked to type 2 diabetes can be measured more than a decade before the disease occurs, new research confirms. The findings suggest that diabetes prevention efforts that focus on people with prediabetes may come too late to make a big difference. The findings were presented today at the 69th Scientific Sessions of the American Diabetes Association in New Orleans, and they also appear in the latest online issue of the journal The Lancet. Researchers followed more than 6,500 British civil servants without diabetes for up to 13 years, during which time they repeatedly measured insulin sensitivity and fasting and non-fasting glucose levels. During an average follow-up of 10 years, 505 of the study participants developed type 2 diabetes. The study showed a steady upward trajectory in metabolic changes in participants who did not develop diabetes. In contrast, these changes tended to occur at different periods in those who did go on to have diabetes, and these changes were often abrupt. Specifically, the findings revealed: A steady trend in fasting glucose as early as 13 years prior to the diagnosis of type 2 diabetes, with fasting glucose levels rising rapidly three years before diagnosis Glucose levels after eating (post-meal glucose) began to increase rapidly starting three years prior to diagnosis Insulin sensitivity began to decline steeply five years before diagnosis Beta-cell function -- a measure of insulin production -- began to increase three to four years prior to diagnosis, as the pancreas tried to compensate for increases in blood glucose by producing more insulin. Insulin production dropped precipitously in the three years prior to a diagnosis of type 2 diabetes. “The main addition of this study is that it shows for the first time a clear picture o Continue reading >>
Defining And Characterizing The Progression Of Type 2 Diabetes
Go to: Progression from pre-diabetes to overt diabetes Because glucose is a continuous variable, the use of thresholds to make a diagnosis is somewhat arbitrary. The term “pre-diabetes” has become well established and implies a risk of progression to overt diabetes. However, although such progression is well studied in prevention trials, little is known about the rate of progression and the characteristics of such progression in the population at large. Table 1 summarizes some of the factors associated with such progression. Nichols et al. (2) studied the progression of pre-diabetes to overt disease and observed that 8.1% of subjects whose initial abnormal fasting glucose was 100–109 mg/dl and 24.3% of subjects whose initial abnormal fasting glucose was 110–125 mg/dl developed diabetes over an average of 29.0 months (1.34 and 5.56% per year, respectively). A steeper rate of increasing fasting glucose; higher BMI, blood pressure, and triglycerides; and lower HDL cholesterol predicted diabetes development. The Baltimore Longitudinal Study of Aging (3) concluded that although phenotypic differences in rates of progression are partly a function of diagnostic thresholds, fasting and postchallenge hyperglycemia may represent phenotypes with distinct natural histories in the evolution of type 2 diabetes. Does hyperglycemia evolve from normoglycemia gradually over time or as a step increase? Ferrannini et al. (4) measured plasma glucose and insulin levels during oral glucose testing at baseline and after 3 and 7 years of follow-up. In subjects with normal glucose tolerance on all three occasions (nonconverters), FPG increased only slightly over 7 years. In contrast, conversion to both impaired glucose tolerance (IGT) and diabetes among normal glucose tolerance subjects Continue reading >>
Retinopathy Progression And Sudden Lowering Of Hba1c , Etc
Generally retinopathy progresses according to the parameters below. There are very few exceptions. Once background retinopathy develops, unless diabetic control is improved as below, the retinopathy will deteriorate, laser will be needed, and even with laser sight may be affected. glucose level/HbA1c, linear relationship with retinopathy progression blood pressure, linear relationship lipid level, probably a near linear relationship smoking, probable linear relationship (some work suggests 20 cigarettes a day triples/quadruples retinopathy, others less so) pregnancy may cause a rapid deterioration sudden improvement (lowering to normal) of glucose levels in a person whose diabetes has been poorly controlled for sometime see and here . Certain clinical situations are recognised: Some people never seem to develop retinopathy: a suggestion has been made that these patients have ultra-low blood pressures, and this is what protects them. There are genes controlling retinopathy progression, and these may act through blood pressure effects. Retinopathy may run in families; there is certainly a genetic contribution All of a sudden a patient's retinopathy may start to get much worse: this may be because of a relatively sudden rise in blood pressure, which is quite common. Sometimes this seems to occur as renal function decreases. Some people's retinopathy never seems to get worse. I am not convinced this situation exists, but if it does it could be explained: a person whose diabetes was reasonably, but not well, controlled, perhaps an HbA1c of 8% with a low blood pressure, develops retinopathy, but then starts to control their diabetes and blood pressure really well, achieving an HbA1c of 7%, then the retinopathy does not progress. When a patient with poorly controlled type 2 di Continue reading >>
The 3 Stages Of Type 1 Diabetes Development
Home / The 3 Stages of Type 1 Diabetes Development The 3 Stages of Type 1 Diabetes Development Type 1 diabetes is a medical disorder characterized by the autoimmune destruction of the pancreatic islet cells, eventually leading to the absence of the production of insulin and other important hormones. The lack of insulin results in a decreased ability of glucose to enter the cells, leading to hyperglycemia , or high blood glucose levels. Type 1 diabetes is believed to be caused by the combination of a genetic predisposition and an environmental trigger. Formerly known as juvenile diabetes, type 1 diabetes can be diagnosed in childhood, as well as in adulthood. In fact, between 25% and 50% of type 1 diabetes diagnoses today occur in individuals over 18 years old. The main symptoms of untreated type 1 diabetes include: Frequent infections and slow wound healing Individuals with type 1 diabetes must monitor their blood glucose levels and administer exogenous insulin via injections or an insulin pump to allow for glucose metabolism. Left untreated, the condition is deadly and suboptimal management can result in numerous complications, including micro- and macrovascular problems in numerous organ systems as well as nerve damage. However, with optimal blood glucose control, the likelihood of complications can be minimized. There are several main steps in the typical pattern of developing of type 1 diabetes: Islet cell autoimmunity, characterized by the presence of autoantibodies, A decrease in beta cell mass that reduces insulin production and results in slightly elevated blood glucose levels, and Overt hyperglycemia accompanied by the clinical symptoms of diabetes. A diabetes diagnosis is typically made based on blood glucose levels and the hemoglobin A1c test. In general, tw Continue reading >>
How Type 2 Diabetes Can Change Over Time
You probably already know that type 2 diabetes can cause long-term damage if you don’t control it, but it’s also important to understand that even well-controlled diabetes progresses over time — meaning you may have to adjust your treatment plan more than once. The key to learning about the progression of diabetes is to understand the role of your pancreas, which produces insulin. For people with type 1 diabetes, the pancreas does not make any insulin, so they must take it through injections. With type 2, the pancreas doesn’t make enough insulin or the cells don’t respond to it adequately, according to the American Academy of Family Physicians. This means that the body has trouble moving sugar from the blood into cells to be used for energy. Diet, exercise, and medication, if prescribed, can all help those with type 2 diabetes lower their blood sugar levels and help their bodies use insulin made by the pancreas, according to the American Diabetes Association (ADA). If blood sugar levels remain high, the ADA says, you may be at risk for such diabetes complications as vision loss, heart disease, nerve damage, foot or leg amputation, and kidney disease. However, proper diabetes management can help prevent or delay the onset of these complications. How Your Diabetes Treatment Plan Might Change Over time, your medications, diet, and exercise goals may need to be adjusted. “Initially the pancreas produces extra insulin to make up for insulin resistance, but in most people, the pancreas eventually is unable to make the extra insulin to keep blood sugar levels normal,” says Marc Jaffe, MD, a San Francisco endocrinologist in practice with Kaiser Permanente in Northern California. After a type 2 diabetes diagnosis, your doctor will set blood sugar goals for you, rec Continue reading >>
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 >>
Complication Progression Rate
Registration is fast, simple and absolutely free so please,join our community todayto contribute and support the site. This topic is now archived and is closed to further replies. Does anyone know if there's a sort of standardised timeline of progression for complications? Not things like 'you WILL have screwy eyes after 10 years' etc. more like "retinopathy tends to show up before neuropathy' etc. The reason I ask is I've just had confirmation from my clinic that I don't show any signs of retinopathy, which frankly I think is bloody brilliant for 14 years with diabetes, high blood pressure and never having had what could be considered a non-diabetic A1c. I'm just wondering if retinopathy would be one of the usual first complications to show up in T1 - because it if so, it looks like I might be doing something right! I don't know if there is a stadardized timeline. I would doubt it, but who knows. I started showing some signs of retinopathy after 20 years or so. I am at year 26 and my eyes are no worse, actually a bit better. My first signs of retinopathy occurred in the mid/late 1990s, even though I was diagnosed in 1945. I was seeing my ophthalmologist every six months back then, and the little spots would come and go. My A1c's were very good (in the 6's back then). The problem never required laser treatment. In the new century my A1c's improved, and were consistently 6.1, or less. I started pumping in 2007 and had far fewer highs and lows. I have not had any signs of retinopathy for 5 years. This is strictly anecdotal...but I think retinopathy is like the canary in the coal mine. I think it's like a 'marker' that gets your attention far sooner than peripheral neuropathy would. I would acquaint it to getting the BSD, the 'blue screen of death' on a computer just afte Continue reading >>
Natural Progression Of Type 2 Diabetes
Type 2 diabetes is not a stable disease—it is progressive in nature. In fact, by the time someone is diagnosed with type 2 diabetes, many changes may have already occurred in the body, including the start of heart disease. These changes continue over the years, potentially making the complications of diabetes more difficult to control. For this reason, you need to know what changes to expect when you have type 2 diabetes. This article will help you and your health care provider manage your diabetes every step of the way. A LONG TIME COMING Experts today believe that people who are diagnosed with type 2 diabetes have had blood glucose levels that were high enough to diagnose diabetes, on average, seven to 10 years earlier. That’s bad news because high blood glucose levels for so long can cause damage to the heart, kidneys, eyes and nerves. So in reality, people with “newly” diagnosed type 2 diabetes may already have diabetes-related problems. But what happens during this period leading up to a diagnosis of diabetes? Initially, the pancreas produces the correct amount of insulin the body needs to keep blood glucose levels where they ought to be. However, at some point, cells begin to resist this naturally occurring insulin. This is referred to as “insulin resistance,” meaning the cells have a hard time using the insulin the body produces. The pancreas, in turn, receives a message that even more insulin is needed, and it begins to produce more than before to overcome this resistance. At some point, the pancreas is not able to keep up and blood glucose levels begin to increase. This is what’s known as pre-diabetes. Pre-diabetes means that blood glucose levels are higher than normal, but not high enough to be classified as diabetes. It is in this stage that 10 Continue reading >>
Diabetes And Kidney Disease (stages 1-4)
What is diabetes? Diabetes happens when your body does not make enough insulin or cannot use insulin properly. Insulin is a hormone. It controls how much sugar is in your blood. A high level of sugar in your blood can cause problems in many parts of your body, including your heart, kidneys, eyes, and brain. Over time, this can lead to kidney disease and kidney failure. There are two main types of diabetes. Type 1 diabetes generally begins when people are young. In this case, the body does not make enough insulin. Type 2 diabetes is usually found in adults over 40, but is becoming more common in younger people. It is usually associated with being overweight and tends to run in families. In type 2 diabetes, the body makes insulin, but cannot use it well. What is chronic kidney disease (CKD)? Your kidneys are important because they keep the rest of your body in balance. They: Remove waste products from the body Balance the body’s fluids Help keep blood pressure under control Keep bones healthy Help make red blood cells. When you have kidney disease, it means that the kidneys have been damaged. Kidneys can get damaged from a disease like diabetes. Once your kidneys are damaged, they cannot filter your blood nor do other jobs as well as they should. When diabetes is not well controlled, the sugar level in your blood goes up. This is called hyperglycemia. Hyperglycemia (high blood sugar) can cause damage to many parts of your body, especially the kidneys, heart, blood vessels, eyes, feet, nerves. Diabetes can harm the kidneys by causing damage to: Blood vessels inside your kidneys. The filtering units of the kidney are filled with tiny blood vessels. Over time, high sugar levels in the blood can cause these vessels to become narrow and clogged. Without enough blood, the kid Continue reading >>
Type 2 Diabetes
Print Overview Type 2 diabetes, once known as adult-onset or noninsulin-dependent diabetes, is a chronic condition that affects the way your body metabolizes sugar (glucose), your body's important source of fuel. With type 2 diabetes, your body either resists the effects of insulin — a hormone that regulates the movement of sugar into your cells — or doesn't produce enough insulin to maintain a normal glucose level. More common in adults, type 2 diabetes increasingly affects children as childhood obesity increases. There's no cure for type 2 diabetes, but you may be able to manage the condition by eating well, exercising and maintaining a healthy weight. If diet and exercise aren't enough to manage your blood sugar well, you also may need diabetes medications or insulin therapy. Symptoms Signs and symptoms of type 2 diabetes often develop slowly. In fact, you can have type 2 diabetes for years and not know it. Look for: Increased thirst and frequent urination. Excess sugar building up in your bloodstream causes fluid to be pulled from the tissues. This may leave you thirsty. As a result, you may drink — and urinate — more than usual. Increased hunger. Without enough insulin to move sugar into your cells, your muscles and organs become depleted of energy. This triggers intense hunger. Weight loss. Despite eating more than usual to relieve hunger, you may lose weight. Without the ability to metabolize glucose, the body uses alternative fuels stored in muscle and fat. Calories are lost as excess glucose is released in the urine. Fatigue. If your cells are deprived of sugar, you may become tired and irritable. Blurred vision. If your blood sugar is too high, fluid may be pulled from the lenses of your eyes. This may affect your ability to focus. Slow-healing sores o Continue reading >>
