Type 1 Diabetes Mellitus Clinical Presentation
History The most common symptoms of type 1 diabetes mellitus (DM) are polyuria, polydipsia, and polyphagia, along with lassitude, nausea, and blurred vision, all of which result from the hyperglycemia itself. Polyuria is caused by osmotic diuresis secondary to hyperglycemia. Severe nocturnal enuresis secondary to polyuria can be an indication of onset of diabetes in young children. Thirst is a response to the hyperosmolar state and dehydration. Fatigue and weakness may be caused by muscle wasting from the catabolic state of insulin deficiency, hypovolemia, and hypokalemia. Muscle cramps are caused by electrolyte imbalance. Blurred vision results from the effect of the hyperosmolar state on the lens and vitreous humor. Glucose and its metabolites cause osmotic swelling of the lens, altering its normal focal length. Symptoms at the time of the first clinical presentation can usually be traced back several days to several weeks. However, beta-cell destruction may have started months, or even years, before the onset of clinical symptoms. The onset of symptomatic disease may be sudden. It is not unusual for patients with type 1 DM to present with diabetic ketoacidosis (DKA), which may occur de novo or secondary to the stress of illness or surgery. An explosive onset of symptoms in a young lean patient with ketoacidosis always has been considered diagnostic of type 1 DM. Over time, patients with new-onset type 1 DM will lose weight, despite normal or increased appetite, because of depletion of water and a catabolic state with reduced glycogen, proteins, and triglycerides. Weight loss may not occur if treatment is initiated promptly after the onset of the disease. Gastrointestinal (GI) symptoms of type 1 DM are as follows: Neuropathy affects up to 50% of patients with type 1 D Continue reading >>
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Patient Education On Vision Effects For Diabetics
It is possible to have a diabetic eye disease and not experience any vision changes. However, if left untreated, diabetes in the eye can lead to blurred vision and ultimately vision loss. At Novus Clinic, our doctors put the health of your eyes first and can help you learn how to protect yourself from the devastating effects that untreated diabetes can have on your vision. What you need to know… Patients whom have been diagnosed with diabetes should have an annual eye exam. High blood sugar levels can affect your retina and macula, leading to vision loss. This is called diabetic retinopathy. In its early stages, diabetic retinopathy often has no symptoms. But as it gets worse, eye damage from diabetes leads to vision loss. Treatment for diabetic retinopathy may include medication, eye injections and surgery. Vision loss is largely preventable… Patients with diabetes need to know that today with improved methods of diagnosis and treatment, a smaller percentage of people whom develop retinopathy have serious vision problems. Early detection of diabetic retinopathy is the best protection against loss of vision. Patients can significantly lower their risk of vision loss by maintaining strict control of blood sugar and visiting their eye care provider every year. Pregnant women with diabetes should schedule an appointment in their first trimester because retinopathy can progress quickly during pregnancy. Newly diagnosed diabetic patients over 30 should have an exam within a few months of diagnosis. Changes… Patients should have their vision checked promptly if experiencing any of these changes: A change affecting either one or both eyes That last more than a few days That are not associated with change in blood sugar To help maintain healthy vision, schedule a comprehe Continue reading >>
Blurry Vision And Diabetes: What's The Connection?
Blurry vision is being unable to see the fine details. Another way of describing it is seeing a lack of sharpness. Blurred eyesight is similar to seeing things as if they are in the out-of-focus parts of a photograph. The blurriness can be subtle or obvious, can change through the day, and can come on slowly or quickly. It depends on the cause. Diabetes can cause blurry vision for a variety of reasons. Both short-term and long-term complications can affect the vision of someone with diabetes. Contents of this article: How does diabetes affect the eyes? Long-term uncontrolled diabetes can lead to high blood sugar levels that cause damage to small blood vessels over time. This damage can lead to problems with part of the eye called the retina which can create blurred vision. Short-term blurriness in people with diabetes is due to a different cause. Fluid shifts into and out of the eye due to high blood sugar levels, causing the lens of the eye to swell. This change in its shape causes blurriness as the lens is the part that focuses light onto the back of the eye. This short-term issue will resolve once blood sugar levels are lowered. Can diabetes treatment cause blurriness? Diabetes can also cause short-term blurriness if blood sugar levels fall too low (hypoglycemia). This can happen due to the timing of food or a change in activity levels in people who take medication that increases insulin in the body. Rather than being caused by changes in the eye, blurriness from low blood sugars is caused by the effects of hypoglycemia on the brain. Vision affected in this way will return to normal after glucose levels return to normal. Is blurry vision with diabetes temporary? As stated above, blurry vision can be caused by both short-term and long-term complications of diabetes. L Continue reading >>
Diabetes And Your Eyes
What is Diabetic Retinopathy? Over time, diabetes can damage small blood vessels throughout the body. This blood vessel damage can cause foot ulcers, nerve numbness and kidney failure. In the eye, it can cause retinal damage, known as diabetic retinal disease, or diabetic retinopathy. Causes of Diabetic Retinopathy People lose vision from diabetic retinopathy due to two major causes: swelling and bleeding. Swelling of the retina can occur when blood vessels leak fluid. When fluid leakage causes swelling in the central retina, or macula, vision becomes blurred. If diabetic retinopathy is severe, the retina becomes starved for oxygen. Blood vessels may then grow out of the retina or optic nerve into the vitreous jelly that fills the inside of the eye. These fragile vessels can cause bleeding into the eye and block light from reaching the retina. Without adequate light, vision is impaired. Bleeding can result in severe scarring, leading to retinal detachment. Anyone with diabetes is at risk for diabetic retinopathy. The risk of developing diabetic retinopathy is related to the length of time one has diabetes and the severity of the disease. However, even people with newly diagnosed diabetes can have retinal disease that needs treatment. In addition, diabetic retinopathy can develop in people with excellent blood sugar control, even if the diabetes is mild and can be managed by proper diet. Women who have diabetes during pregnancy should be examined for diabetic retinopathy each trimester. Pregnancy sometimes can worsen diabetic eye disease. Symptoms of Diabetic Retinopathy Unfortunately, diabetic retinopathy typically has no symptoms in its earliest, treatable stages. By the time people notice a problem with their vision, retinal disease may be advanced and difficult to tr Continue reading >>
Diabetes Basics
Basics of diabetes Diabetes is a condition caused by lack of a chemical in the body (a hormone) called insulin. There are two major forms of diabetes. In type 1 diabetes eventually no insulin is produced and individuals require insulin injections for survival. It used to be thought this only presented in children, but it is now clear this can occur at any age. The other more common form of diabetes called type 2 diabetes occurs due to the body's resistance to the effects of insulin in addition to an insufficient quantity of insulin. However, in this type of diabetes there is usually some insulin produced. For both types of diabetes, blood glucose levels are elevated. Furthermore, people with diabetes are prone to certain complications not seen in those without diabetes. These complications involve the eye (retinopathy), kidney (nephropathy) and nerves (neuropathy). People with diabetes also get early hardening of the arteries (atherosclerosis), leading to early heart attacks and strokes. The good news for people with diabetes is that with proper care all of these problems can be avoided. Immediate medical attention Uncontrolled diabetes presents with frequent thirst and urination. Over time, patients will become dehydrated as the glucose is "spilling" over into the urine. If insulin deficiency is severe enough, fat stores are used for energy as glucose cannot get into cells. This problem is much more common with type 1 diabetes and is called "ketoacidosis". It can be diagnosed at home with a simple urine test. When significant ketones are found in the urine, it is important to be in touch with a physician immediately. There are other conditions that require immediate attention. Blurry vision in someone with known diabetic eye disease or someone with a long history of di Continue reading >>
Type 1 Diabetes
Whether you have type 1 diabetes, are a caregiver or loved one of a person with type 1 diabetes, or just want to learn more, the following page provides an overview of type 1 diabetes. New to type 1 diabetes? Check out "Starting Point: Type 1 Diabetes Basics," which answers some of the basic questions about type 1 diabetes: what is type 1 diabetes, what are its symptoms, how is it treated, and many more! Want to learn a bit more? See our “Helpful Links” page below, which provides links to diaTribe articles focused on type 1 diabetes. These pages provide helpful tips for living with type 1 diabetes, our patient-perspective column by Adam Brown, drug and device overviews, information about diabetes complications, and some extra pages we hope you’ll find useful! Starting Point: Type 1 Diabetes Basics What is the risk of developing type 1 diabetes if it runs in my family? What is Type 1 Diabetes? Type 1 diabetes is disease in which the body can no longer produce insulin. Insulin is normally needed to convert sugar (also called glucose) and other food sources into energy for the body’s cells. It is believed that in people with type 1 diabetes, the body’s own immune system attacks and kills the beta cells in the pancreas that produce insulin. Without insulin, the body cannot control blood sugar, and people can suffer from dangerously high blood sugar levels (called hyperglycemia). To control their blood glucose levels, people with type 1 diabetes take insulin injections. Before the discovery of insulin, type 1 diabetes was a death sentence (and it still is for patients with poor access to insulin). Can Type 1 Diabetes Be Prevented? Unfortunately, the genetic and environmental triggers for the immune attack that causes type 1 diabetes are not well understood, althoug Continue reading >>
Clinical Presentation And Diagnosis Of Diabetes Mellitus In Adults
INTRODUCTION The term diabetes mellitus describes several diseases of abnormal carbohydrate metabolism that are characterized by hyperglycemia. It is associated with a relative or absolute impairment in insulin secretion, along with varying degrees of peripheral resistance to the action of insulin. Every few years, the diabetes community reevaluates the current recommendations for the classification, diagnosis, and screening of diabetes, reflecting new information from research and clinical practice. The American Diabetes Association (ADA) issued diagnostic criteria for diabetes mellitus in 1997, with follow-up in 2003 and 2010 [1-3]. The diagnosis is based on one of four abnormalities: glycated hemoglobin (A1C), fasting plasma glucose (FPG), random elevated glucose with symptoms, or abnormal oral glucose tolerance test (OGTT) (table 1). Patients with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) are referred to as having increased risk for diabetes or prediabetes. (See 'Diagnostic criteria' below.) Screening for and prevention of diabetes is reviewed elsewhere. The etiologic classification of diabetes mellitus is also discussed separately. (See "Screening for type 2 diabetes mellitus" and "Prevention of type 2 diabetes mellitus" and "Prevention of type 1 diabetes mellitus" and "Classification of diabetes mellitus and genetic diabetic syndromes".) CLINICAL PRESENTATION Type 2 diabetes is by far the most common type of diabetes in adults (>90 percent) and is characterized by hyperglycemia and variable degrees of insulin deficiency and resistance. The majority of patients are asymptomatic, and hyperglycemia is noted on routine laboratory evaluation, prompting further testing. The frequency of symptomatic diabetes has been decreasing in parallel wi Continue reading >>
Symptoms, Diagnosis & Monitoring Of Diabetes
According to the latest American Heart Association's Heart Disease and Stroke Statistics, about 8 million people 18 years and older in the United States have type 2 diabetes and do not know it. Often type 1 diabetes remains undiagnosed until symptoms become severe and hospitalization is required. Left untreated, diabetes can cause a number of health complications. That's why it's so important to both know what warning signs to look for and to see a health care provider regularly for routine wellness screenings. Symptoms In incidences of prediabetes, there are no symptoms. People may not be aware that they have type 1 or type 2 diabetes because they have no symptoms or because the symptoms are so mild that they go unnoticed for quite some time. However, some individuals do experience warning signs, so it's important to be familiar with them. Prediabetes Type 1 Diabetes Type 2 Diabetes No symptoms Increased or extreme thirst Increased thirst Increased appetite Increased appetite Increased fatigue Fatigue Increased or frequent urination Increased urination, especially at night Unusual weight loss Weight loss Blurred vision Blurred vision Fruity odor or breath Sores that do not heal In some cases, no symptoms In some cases, no symptoms If you have any of these symptoms, see your health care provider right away. Diabetes can only be diagnosed by your healthcare provider. Who should be tested for prediabetes and diabetes? The U.S. Department of Health and Human Services recommends that you should be tested if you are: If your blood glucose levels are in normal range, testing should be done about every three years. If you have prediabetes, you should be checked for diabetes every one to two years after diagnosis. Tests for Diagnosing Prediabetes and Diabetes There are three ty Continue reading >>
Blurred Vision
SHARE RATE★★★★★ Both type 1 and type 2 diabetes are associated with both short-term and long-term effects on our eyes. Blurred vision is one of the most common symptoms of poorly controlled blood glucose and can affect a person at any stage of diabetes. Blurred vision results from a major change in plasma glucose level, which creates a change in osmotic pressure within the eyeball.1,2 Blurred vision typically occurs after an abrupt change in blood glucose resulting in a change in osmotic pressure within the eye. Blurring of vision may worsen initially even after you have taken steps to control your blood glucose, because a rapid correction in blood glucose will cause a further change in osmotic pressure within the eye. If you experience this symptom, work with your doctor to correct your blood glucose. Be patient and do not change vision correction prescriptions. Your vision may remain blurred for a short period of time until the pressure within your eye has normalized.2 Does blurred vision mean that I am losing my eyesight? Vision problems are one of the most frightening complications of diabetes. However, the early symptom of blurred vision due to uncontrolled high blood glucose usually does not mean that you are losing your eyesight. What blurred vision does mean is that your blood glucose is not controlled and that you need to take steps to prevent serious vision complications from occurring. Learn more about diabetes-related vision problems, including blurred vision. What should I do if I experience blurred vision? If you experience blurred vision and you have not been diagnosed with diabetes, you should see your doctor and discuss your symptoms. Your doctor will evaluate you and identify the cause of the symptom. As part of this evaluation, your doctor w Continue reading >>
Diabetes And Blurred Vision
Don't run out and buy a new pair of glasses as soon as you notice you have blurred vision. It could just be a temporary problem that develops rapidly and is caused by high blood sugar levels. High blood sugar causes the lens of the eye to swell, which changes your ability to see. To correct this kind of blurred vision, you need to get your blood sugar back into the target range. For many people this is from70 mg/dL to 130 mg/dL before meals and less than 180 mg/dL one to two hours after the start of a meal. Ask your doctor what your personal target range should be. Blurred vision can also be a symptom of more serious eye problems. If your vision is blurred, contact your doctor. The American Diabetes Association offers these eye care guidelines for people with diabetes: Adults with type 1 diabetes should have a full dilated eye exam within 5 years of their diagnosis. Adults with type 2 diabetes should have a complete eye exam soon after they have been diagnosed. Get a dilated eye exam if you are pregnant or planning to get pregnant. Continue reading >>
Diabetes
Sort 1. A 54-year-old patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse? A. "With type 2 diabetes, the body of the pancreas becomes inflamed." B. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." C."With type 2 diabetes, the patient is totally dependent on an outside source of insulin." D. "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas." B."With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." Rationale: In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced, and/or the cells of the body become resistant to insulin. The pancreas becomes inflamed with pancreatitis. The patient is totally dependent on exogenous insulin and may have had autoantibodies destroy the β-cells in the pancreas with type 1 diabetes mellitus. 2. The nurse caring for a patient hospitalized with diabetes mellitus would look for which laboratory test result to obtain information on the patient's past glucose control? A. Prealbumin level B. Urine ketone level C. Fasting glucose level D. Glycosylated hemoglobin level D. Glycosylated hemoglobin level Rationale. A glycosylated hemoglobin level detects the amount of glucose that is bound to red blood cells (RBCs). When circulating glucose levels are high, glucose attaches to the RBCs and remains there for the life of the blood cell, which is approximately 120 days. Thus the test can give an indication of glycemic control over approximately 2 to 3 months. The prealbumin level is used to establish nutritional status and is unrelated to past glucose control. The urine ketone level will only show that hyperglycemia or starvation is pr Continue reading >>
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Blurred Vision
Tweet One of the common signs of diabetes mellitus is blurred vision, which refers to the loss of sharpness of vision and the inability to see fine details. Blurred vision can affect one eye (unilateral blurred vision) or both (bilateral blurred vision) eyes, and can occur often or rarely. Regardless of how often it occurs, it should never go untreated as it could be an indicator of another, more serious eye problem. Causes of blurred vision Blurred vision can occur by simply forgetting to wear your prescribed corrective lenses. But in many cases, it is usually a sign of an underlying eye disease. Eye diseases include: Age-related macular degeneration High blood sugar levels Other causes of blurry vision include: Cataracts and other eye conditions such as conjunctivitis, dry eye syndrome, and retinal detachment Certain medications (including cortisone, some antidepressants and some heart medications) Diabetes mellitus Migraines Diabetes and blurred vision High levels of blood sugar resulting from diabetes can affect your ability to see by causing the lens inside the eye to swell, which can result in temporary blurring of eyesight. Blurring of vision may also occur as a result of very low blood sugar levels. If this is the case, your vision should return once your blood glucose levels have returned to the normal range. If your blood sugar levels are fluctuating over time, you may notice that your vision improves and worsens for periods of time. Recognising blurred vision There are various different interpretations/understandings of what blurred vision is, but in most cases the term is used to describe the inability to see fine details and a lack of sharpness of vision. When to see your doctor If you’re experiencing sudden blurred vision together with eye pain, you shou Continue reading >>
Refractive Errors In Patients With Newly Diagnosed Diabetes Mellitus
Go to: INTRODUCTION Although the benefits of aggressive glucose control on refractive error in type 2 diabetes mellitus patients are well established, management of the effects can be complicated, particularly due to difficult glycaemic control in new cases. Therefore, we will discuss in some detail the process of diabetes mellitus diagnosis and optics refraction. Diabetes mellitus is a complex metabolic disorder that involves the small blood vessels, often causing widespread damage to tissues, including the eyes, kidneys (end stage renal disease; ESRD), etc.1,2 Ocular complications arise approximately 20 years after onset despite apparently adequate diabetic control. Improved treatment measures (e.g., improved insulin, antibiotics) that have lengthened the life span of diabetics have actually resulted in a marked increase in the incidence of retinopathy and other ocular complications. The possibility of diabetes should be considered in all patients with unexplained retinopathy, cataracts, extra-ocular muscle palsy, optic neuropathy, or sudden changes in refractive error. Absence of glycosuria or a normal fasting plasma glucose (fpg) level does not rule out a diagnosis of diabetes.3 In the post-absorptive state, the concentration of plasma glucose in healthy individuals is within the range 4.5-5.5 mmol/L (65-95 mg/dL). After the ingestion of a carbohydrate meal, it may rise to 6.5-7.2 mmol/L. During fasting, the levels fall to around 3.3-3.9 mmol/L.4 A sudden decrease in blood glucose will cause seizures, as in insulin overdose, owing to the immediate dependence on glucose of the brain. However, much lower concentrations can be tolerated, provided adaptation is progressive; e.g., rats fed a high-fat diet behave normally with a plasma glucose concentration as low as 1.1 Continue reading >>
Type 1 Diabetes In Children
Overview Type 1 diabetes in children is a condition in which your child's body no longer produces an important hormone (insulin). Your child needs insulin to survive, so you'll have to replace the missing insulin. Type 1 diabetes in children used to be known as juvenile diabetes or insulin-dependent diabetes. The diagnosis of type 1 diabetes in children can be overwhelming at first. Suddenly you and your child — depending on his or her age — must learn how to give injections, count carbohydrates and monitor blood sugar. Type 1 diabetes in children requires consistent care. But advances in blood sugar monitoring and insulin delivery have improved the daily management of the condition. Symptoms The signs and symptoms of type 1 diabetes in children usually develop quickly, over a period of weeks. These signs and symptoms include: Increased thirst and frequent urination. Excess sugar building up in your child's bloodstream pulls fluid from tissues. As a result your child might be thirsty — and drink and urinate more than usual. A young, toilet-trained child might suddenly experience bed-wetting. Extreme hunger. Without enough insulin to move sugar into your child's cells, your child's muscles and organs lack energy. This triggers intense hunger. Weight loss. Despite eating more than usual to relieve hunger, your child may lose weight — sometimes rapidly. Without the energy sugar supplies, muscle tissues and fat stores simply shrink. Unexplained weight loss is often the first sign of type 1 diabetes to be noticed in children. Fatigue. Lack of sugar in your child's cells might make him or her tired and lethargic. Irritability or behavior changes. In addition to mood problems, your child might suddenly have a decline in performance at school. Fruity-smelling breath. Bu Continue reading >>
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