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Type 2 Diabetes Progression To Insulin

Retinopathy Progression And Sudden Lowering Of Hba1c , Etc

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 >>

Diabetes & Insulin

Diabetes & Insulin

If you’ve been diagnosed with diabetes, you are certainly not alone. Diabetes affects more than 29 million people in the United States and approximately 415 million people worldwide. Although diabetes is a very common diagnosis, managing your disease is a very personal experience. Learning about your diabetes and treatment options such as insulin can help. Diabetes is a disease where your blood sugar can be higher than normal. When you have diabetes: Your pancreas makes little, not enough, or no insulin, or Your body prevents the insulin you do make from working correctly As a result, sugar can’t get into your cells, so it stays in your blood. This causes your blood sugar to stay too high (also called hyperglycemia). Both high and low blood sugar can result in serious complications. That’s why controlling your blood sugar is an essential part of managing your diabetes. Follow your health care provider's recommendation about the best time of day to check your blood sugar. Once you get a little practice checking your blood sugar, it will become part of your routine. No compatible source was found for this video. What are the symptoms of diabetes? If you have diabetes, you may have some or all of these symptoms: Increased thirst and hunger Frequent urination Weight loss Blurry vision Feeling tired You may also have problems with: Scrapes or bruises healing slower than usual Tingling or numbness in the limbs Or you may have no symptoms at all. What are the types of diabetes? Your health care provider may have spoken with you about your type of diabetes, but you may not know about the other types. Some of the types of diabetes are: Type 1 diabetes. In type 1 diabetes, the body makes little or no insulin. People with this type of diabetes must take insulin every day. Ty Continue reading >>

Ï‚™ Relative Indications For Insulin Therapy Include The Following:

Ï‚™ Relative Indications For Insulin Therapy Include The Following:

6 Insulin Therapy 1. Indications for Insulin Therapy ï¬ Patients with Type 1 diabetes, diabetic coma (diabetic ketoacidosis, hyperosmolar hyperglycemic syndrome) and pregnancy with pre-existing diabetes must be in insulin therapy. When diet therapy is not effective, insulin therapy is also recommended when patients are in severe infection and at the time of the surgical procedure with whole-body management is needed. (grade A; consensus) ï‚™ Relative indications for insulin therapy include the following: ïª If conspicuous hyperglycemia (e.g., a fasting glucose level of 250 mg/dL or higher or a casual glucose level of 350 mg/dL or higher) or a tendency toward ketosis (e.g., positive urine ketones ) is noted. ï« If favorable glycemic control is not obtained with glucose-lowering agents (e.g., primary or secondary sulfonylurea failure). ï¬ If adequate glycemic control is not achievable with diet therapy in patients with severe hepatic damage or renal failure. ï¬ Insulin therapy is also used in type 2 diabetic patients when glycemic control is not obtained with diet/exercise therapy and glucose-lowering agents or when glucotoxicity needs to be resolved in these patients (grade A; consensus). 2. Risks Associated with Insulin Therapy ï¬ Insulin therapy may generally be associated with hypoglycemia or aggravation of diabetic retinopathy or neuropathy in some patients.1 Attention needs also to be given to weight gain as a potential risk associated with long-term insulin therapy.2 (grade A) ï‚™ Risk of intensive insulin therapy includes severe hypoglycemia, which is increased as glycemic control improves.3 To prevent this, appropriate measures against potential hypoglycemia as well as patient education on effective prevention of hypoglycemia based on self-m Continue reading >>

Type 2 Diabetes Mellitus In Childhood: Obesity And Insulin Resistance

Type 2 Diabetes Mellitus In Childhood: Obesity And Insulin Resistance

As rates of childhood obesity climb, type 2 diabetes mellitus has increasingly been diagnosed in children and adolescents, with the highest incidence occurring among youth from racial and ethnic minority backgrounds. The serious complications associated with type 2 diabetes mellitus make it essential for physicians to be aware of risk factors and screening guidelines, allowing for earlier patient diagnosis and treatment. It is also important for physicians to be aware of the treatment options available, including weight control through diet and exercise as well as common pharmacotherapeutic options. According to the SEARCH for Diabetes in Youth Study Group,8 incidence rates among American Indians aged 15 to 19 years is 49.4%, compared to 5.6% in non-Hispanic whites of the same age group. Among youth in the United States, Pima Indian adolescents have the highest reported prevalence of type 2 diabetes mellitus. For Pima Indian children aged 5 to 9 years, the incidence rate is less than 0.5%; for children and adolescents aged 10 to 14 years, 1.5% to 3%; and for adolescents and young adults aged 15 to 19 years, 4% to 5%.7 Neel9 postulated that, when humans were hunter-gatherers and did not know when the next meal was expected, some individuals developed “thrifty genes.” These genes caused the body to become insulin resistant by interfering with mechanisms that allowed blood glucose to be transported into cells where it would be phosphorylated and used for energy. Consequently, the pancreas had to make more insulin. The excess insulin allowed cells to store fat for use during times of relative famine, leading to a much higher survival rate.9-11 These genes may include uncoupling proteins, PPAR-γ and PPAR-α, CALPAIN 10, and adrenergic receptor polymorphisms.12-14 Athero Continue reading >>

What Is Diabetes Mellitus?

What Is Diabetes Mellitus?

Diabetes mellitus is a common disease where there is too much sugar (glucose) floating around in your blood. This occurs because either the pancreas can’t produce enough insulin or the cells in your body have become resistant to insulin. When you eat food, the amount of glucose in your blood skyrockets. That’s because the food you eat is converted into glucose (usable energy for your cells) and enters your blood to be transported to your cells around the body. Special cells in your pancreas sense the increase of glucose and release insulin into your blood. Insulin has a lot of different jobs, but one of its main tasks is to help decrease blood glucose levels. It does this by activating a system which transports glucose from your blood into your cells. It also decreases blood glucose by stimulating an enzyme called glycogen synthase in the liver. This molecule is responsible for making glycogen, a long string of glucose, which is then stored in the liver and used in the future when there is a period of low blood glucose. As insulin works on your body, the amount of glucose in the blood slowly returns to the same level it was before you ate.. This glucose level when you haven’t eaten recently (called fasting glucose) sits around 3.5-6 mmol/L (70-110 mg/dL). Just after a meal, your blood glucose can jump as high as 7.8mmol/L (140 mg/dL) depending on how much and what you ate. There are two types of diabetes mellitus, type 1 and type 2. In both types, your body has trouble transporting sugar from your blood into your cells. This leads to high levels of glucose in your blood and a deficiency of glucose in your cells. The main difference between type 1 and type 2 diabetes mellitus is the underlying mechanisms that cause your blood sugar to stray from the normal range. T Continue reading >>

Treatment Of Type 2 Diabetes Mellitus In The Older Patient

Treatment Of Type 2 Diabetes Mellitus In The Older Patient

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc. All topics are updated as new evidence becomes available and our peer review process is complete. INTRODUCTION — The prevalence of type 2 diabetes continues to increase steadily as more people live longer and grow heavier. Older adults with diabetes are at risk of developing a similar spectrum of macrovascular and microvascular complications as their younger counterparts with diabetes. In addition, they are at high risk for polypharmacy, functional disabilities, and common geriatric syndromes that include cognitive impairment, depression, urinary incontinence, falls, and persistent pain [1]. This topic will review diabetes management in older patients and how management priorities and treatment choices may differ between older and younger patients. The general management of type 2 diabetes is reviewed separately. (See "Overview of medical care in adults with diabetes mellitus" and "Initial management of blood glucose in adults with type 2 diabetes mellitus" and "Management of persistent hyperglycemia in type 2 diabetes mellitus".) TREATMENT GOALS — The overall goals of diabetes management in older adults are similar to those in younger adults and include management of both hyperglycemia and risk factors. Older adults with diabetes are a heterogeneous population that includes persons residing independently in communities, in assisted care facilities, or in nursing homes. They can be fit and healthy or frail with many como Continue reading >>

Why Doctors Believe This Toxic Myth

Why Doctors Believe This Toxic Myth

The single most dangerous idea you are likely to encounter after getting a diabetes diagnosis is the belief that science has proven, beyond a doubt, that no matter what you do, your Type 2 Diabetes will get worse. Your doctors probably believe this. Though they may give lip service to the idea that you can control your disease through diet, exercise, and drugs, most family doctors actually believe that nothing you can do will make much difference in your long-term outcome. This is why they are not likely to urge you to take an aggressive approach to managing your disease but merely write prescriptions for drugs that, if they do anything at all, do a mediocre job of controlling your blood sugars. They've Seen Poor Outcomes Among Their Own Patients Doctors will tell you that they've treated lots of patients with type 2 diabetes and that few, if any, of their patients can control their diabetes with diet. They'll say that their patients cannot lose weight, and that even with good control they end up with complications. What they don't understand is that the diet they have been recommending, thanks to the American Diabetes Association's partnership with so many national and state health authorities, is a high carbohydrate, low fat diet that contains so much sugar and starch it would raise the blood sugar of most normal people. Bananas and whole wheat bread won't control diabetes, but a diet that lowers your intake of starches and sugars often will--no matter how much fat it contains. They Think the UKPDS Study "Proved" People with Good Control Deteriorate Doctors will also tell you that a large-scale study, the UKPDS (United Kingdom Prospective Diabetes Study) proved that even with good control patients with Type 2 diabetes inevitably deteriorated over time. The UKPDS, they Continue reading >>

Insulin For Type 2 Diabetes

Insulin For Type 2 Diabetes

Considering insulin? What you should know. By the dLife Editors Many people with type 2 diabetes will eventually require insulin to keep their diabetes in control. In fact, most experts believe we wait too long in the progression of type 2 diabetes before starting people on insulin. Progressing to insulin does not mean you are failing, but just that your body needs a little more help to keep your blood sugar in range. How much insulin you need, and when you take it, depends on several factors: the type of insulin your doctor has prescribed, your nutrition and exercise habits, and other co-existing medical conditions, and medications you may be taking. Types of Insulin Insulin can be divided into three main categories. The first is long-acting, also known as basal or background insulin. It is usually given once (or sometimes twice) daily, and is intended to help control blood sugar over a twenty-four-hour period. The second category is shorter-acting insulins. These are used to help control blood sugar spikes after eating, and also to “correct” an unusually high blood sugar reading. Depending on the type, they start to work within fifteen to thirty minutes, and last for three to six hours. Many people with type 2 diabetes do well with just a long-acting insulin combined with oral medicines, while others will need to add a mealtime dose of shorter-acting insulin to control after-meal blood sugar spikes. The third category is made up of combinations of long- and shorter-acting insulin. These insulin mixtures are usually given twice daily. The long-acting insulins now approved for use in the United States are Lantus, Levemir, Toujeo, Tresiba, and Basaglar. Novolin N and Humulin N are older forms of insulin that are not as long-acting as the newer ones, and their activit Continue reading >>

New Insights Into The Progression Of Type 1 Diabetes

New Insights Into The Progression Of Type 1 Diabetes

If you have Type 1 diabetes or know someone who does, you’re likely aware that this type of diabetes is an autoimmune disorder that results in the destruction of the beta cells (the cells that make insulin) in the pancreas. Having Type 1 diabetes means having to take lifelong insulin injections, and people who are diagnosed with this condition must start on insulin right away. Type 1 diabetes progresses Type 2 diabetes, the “other” type of diabetes, is a whole different ball of wax. This type of diabetes partly stems from insulin resistance, meaning that the pancreas produces insulin but the body has a hard time using it. Type 2 diabetes is often described as being “progressive”: caught in the early stages, for example, it’s possible to manage it through healthy eating, weight loss (if necessary), and physical activity. But over time, many people require the help of medication, often in the form of diabetes pills, and then, perhaps, noninsulin injectable meds. Eventually, insulin injections may be needed. In the case of Type 1 diabetes, researchers now believe that this disease also progresses at predictable rates and stages before a person develops signs and symptoms. The discovery of these stages is a big deal, as it will enable researchers to find ways to intervene to delay and hopefully prevent progression to the onset of symptoms and lifelong insulin dependence. Stages of Type 1 diabetes The discovery of the various stages leading up to symptomatic Type 1 diabetes are outlined in the October 2015 issue of the journal Diabetes Care. The paper is entitled “Staging Presymptomatic Type 1 Diabetes: A Scientific Statement of JDRF, the Endocrine Society, and the American Diabetes Association.” Here’s a closer look at the crux of this paper. Stage 1: Auto Continue reading >>

Type 2 Diabetes

Type 2 Diabetes

Whether you have type 2 diabetes, are a caregiver or loved one of a person with type 2 diabetes, or just want to learn more, the following page provides an overview of type 2 diabetes. New to type 2 diabetes? Check out “Starting Point: Type 2 Diabetes Basics” below, which answers some of the basic questions about type 2 diabetes: what is type 2 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 2 diabetes. These pages provide helpful tips for living with type 2 diabetes, drug and device overviews, information about diabetes complications, nutrition and food resources, and some extra pages we hope you’ll find useful! Starting Point: Type 2 Diabetes Basics Who is at risk of developing type 2 diabetes? What is the risk of developing type 2 diabetes if it runs in the family? What is type 2 diabetes and prediabetes? Behind type 2 diabetes is a disease where the body’s cells have trouble responding to insulin – this is called insulin resistance. Insulin is a hormone needed to store the energy found in food into the body’s cells. In prediabetes, insulin resistance starts growing and the beta cells in the pancreas that release insulin will try to make even more insulin to make up for the body’s insensitivity. This can go on for a long time without any symptoms. Over time, though, the beta cells in the pancreas will fatigue and will no longer be able to produce enough insulin – this is called “beta burnout.” Once there is not enough insulin, blood sugars will start to rise above normal. Prediabetes causes people to have higher-than-normal blood sugars (and an increased risk for heart disease and stroke). Left unnoticed or Continue reading >>

Targeting The Underlying Pathophysiology Of Type 2 Diabetes

Targeting The Underlying Pathophysiology Of Type 2 Diabetes

Type 2 diabetes Characterized by chronic hyperglycemia Associated with microvascular and macrovascular complications Generally arises from a combination of insulin resistance and ï¢-cell dysfunction Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Department of Noncommunicable Disease Surveillance, World Health Organization, Geneva 1999. Available at: Type 2 diabetes is a metabolic disorder with multiple causes, characterized by chronic hyperglycemia with disturbances of carbohydrate, fat and protein metabolism. It generally results from a combination of insulin resistance and loss of ï¢-cell function.1 Insulin resistance places an increased secretory demand upon the ï¢-cell, leading to ï¢-cell dysfunction as the disease progresses.2 In the long term, type 2 diabetes affects a number of organs and is associated with microvascular complications such as retinopathy, nephropathy and neuropathy. In addition, individuals with type 2 diabetes are at increased risk of macrovascular disease.1 Often diagnosis of type 2 diabetes is made after the condition has been present for some years. In fact, more than 50% of individuals have evidence of vascular disease at diagnosis.3 1Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Department of Noncommunicable Disease Surveillance, World Health Organization, Geneva 1999. Available at: 2International Diabetes Center (IDC), Minneapolis, 2000. Available at: 3Laakso M. Int J Clin Pract Suppl. 2001; 121:8–12. Continue reading >>

How Type 2 Diabetes Can Change Over Time

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 >>

How Apps Help You Beating Your Diabetes Type 2

How Apps Help You Beating Your Diabetes Type 2

Your phone can help you with a healthy lifestyle and effective use of Metformin & Co. More than 28 million people in the US live with type 2 diabetes, in the UK 3.6 million are living with the chronic disease. With type 2 diabetes, the body does not sufficiently take up glucose from the blood. As a result, the level of glucose in the blood is too high. If not treated properly, this can cause long-term health problems such as kidney and eye damage, heart problems ,and stroke. In the early stage of the disease, a strict diet and exercise may be sufficient for keeping blood sugar levels in the right range. If this does not suffice, diabetes medications such as Metformin, Januvia, Jardiance and others can help. If the condition continues to progress, insulin injections may also be required. A high treatment compliance in the early stages can significantly reduce the disease's progression, but a healthy lifestyle and regular intake of medication can prove difficult in an everyday setting. Smartphone apps such as 'MyTherapy' can provide valuable support in this respect: Designed as app for people with type 2 diabetes, they remind patients of their diabetes tablets as well as healthy activities. At the same time they serve as a diabetes diary, tracking medications, weight, blood pressure, blood glucose and other measurements. More than a diabetes diary: This app covers all meds and measurements (free, iOS and Android MyTherapy has been developed for people living with type 2 diabetes. Similar to a personal health assistant, the app reminds of elements of diabetes treatment, e.g. regular exercise and tracking blood glucose. Also, MyTherapy reminds of diabetes medications. The app supports medications reminders for all diabetes pills / tablets (e.g. Januvia, Janumet, Trajenta, M Continue reading >>

Is Retinopathy & Progression To Insulin Inevitable For Type 2 Diabetics?

Is Retinopathy & Progression To Insulin Inevitable For Type 2 Diabetics?

Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community Is retinopathy & progression to Insulin inevitable for Type 2 diabetics? I receive the "Type 2 and you" newsletter from The Independent Diabetes Trust. Today, the September, issue 24, landed on my doormat. Having just read it, I am distressed & disturbed by what has been written. And I quote: "On average, people with Type 2 diabetes will need to start taking insulin seven years after diagnosis." I had NO idea that this is my future with this damn disease. It's frightening. The article on Diabetic Retinopathy States "After 20 years of Diabetes, nearly all patients with Type 1 diabetes and >60% of patients with Type 2 diabetes will have some degree of retinopathy." Again, this frightens & saddens me. Of course, I know about diabetic complications. I made it my business to educate & inform myself, via this forum and other resources, when I was diagnosed earlier this year. Am I really so naive not to be aware of this prognosis. I'm angry! Rightly or wrongly so. The Independent Diabetes Trust is a competent, trustworthy & reliable organisation with a good reputation, who educate and support those with this disease. I've no reason not to believe their statistics. I'm gutted to be honest. All advice, views, personal experience & opinions will be gratefully received. Oh, and here's a link to the newsletter. Dunno about you, but I don't consider myself "average", and I have no intention of willingly becoming one of their averages. I receive the "Type 2 and you" newsletter from The Independent Diabetes Trust. Today, the September, issue 24, landed on my doormat. Having just read it, I am distressed & disturbed by what has been written. And I quote: "On average, Continue reading >>

Type 2 Diabetes Faqs

Type 2 Diabetes Faqs

Common questions about type 2 diabetes: How do you treat type 2 diabetes? When you have type 2 diabetes, you first need to eat a healthy diet, stay physically active and lose any extra weight. If these lifestyle changes cannot control your blood sugar, you also may need to take pills and other injected medication, including insulin. Eating a healthy diet, being physically active, and losing any extra weight is the first line of therapy. “Diet and exercise“ is the foundation of all diabetes management because it makes your body’s cells respond better to insulin (in other words, it decreases insulin resistance) and lowers blood sugar levels. If you cannot normalize or control the blood sugars with diet, weight loss and exercise, the next treatment phase is taking medicine either orally or by injection. Diabetes pills work in different ways – some lower insulin resistance, others slow the digestion of food or increase insulin levels in the blood stream. The non-insulin injected medications for type 2 diabetes have a complicated action but basically lower blood glucose after eating. Insulin therapy simply increases insulin in the circulation. Don’t be surprised if you have to use multiple medications to control the blood sugar. Multiple medications, also known as combination therapy is common in the treatment of diabetes! If one medication is not enough, you medical provider may give you two or three or more different types of pills. Insulin or other injected medications also may be prescribed. Or, depending on your medical condition, you may be treated only with insulin or injected medication therapy. Many people with type 2 diabetes have elevated blood fats (high triglycerides and cholesterol) and blood pressure, so you may be given medications for these problem Continue reading >>

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