Consider This Case: An Uncontrolled Diabetic Cat
Ann Della Maggiore, DVM, Diplomate ACVIM University of California—Davis Sugar, a 12-year-old spayed female Maine Coon cat, presented for poorly controlled diabetes and diabetic neuropathy. HISTORY Sugar was diagnosed with diabetes mellitus 2 years prior to presentation. Initially, her diabetes was moderately controlled on 5 to 6 units of recombinant human protamine zinc insulin (PZI) (40 U/mL; ProZinc, bi-vetmedica.com), but over the year prior to presentation the insulin dose had been progressively increased with no improvement in glycemic control. Upon presentation, Sugar was receiving 14 units of recombinant human PZI. The owner was performing blood glucose curves at home, but struggling to maintain Sugar’s blood glucose below 300 mg/dL. In addition to diabetes mellitus, Sugar had concurrent hypertrophic cardiomyopathy and chronic rhinitis, and persistent polyuria, polydipsia, polyphagia, and weakness. Key Points: Feline Diabetes Mellitus Diabetes is a disease of insulin deficiency. Diabetes in cats is most commonly classified as type 2-like diabetes—a disease process in which insufficient insulin production from beta cells takes place in the setting of insulin resistance. Insulin requirements can be altered by obesity, inflammation, or concurrent endocrine disease, such as hypersomatotropism (acromegaly) or hyperadrenocorticism. Some refer to a subclass of diabetic cats with secondary diabetes—patients in which diabetes occurs subsequent to (1) another endocrine disease (eg, acromegaly, hyperadrenocorticism) or (2) administration of diabetogenic drugs (eg, glucocorticoids).1 PHYSICAL EXAMINATION Physical examination revealed a symmetrically muscled cat, weighing 7.7 kg, with a body condition score of 6/9. Sugar had an unkempt hair coat, mild prognathia infer Continue reading >>
Coding Tip: Uncontrolled Diabetes Mellitus In Icd-10
Kim Carrier RHIT, CDIP, CCS, CCS-P Director of Coding Quality Assurance AHIMA Approved ICD-10-CM/PCS Trainer How do coders report uncontrolled DM in ICD-10-CM? First, coders will need to have further documentation of hyperglycemia or hypoglycemia as there is no default code for uncontrolled diabetes. Uncontrolled diabetes is classified by type and whether it is hyperglycemia or hypoglycemia. The term “uncontrolled” is not synonymous with hyperglycemia. The term “poorly controlled” is synonymous with hyperglycemia when referring to diabetes in ICD-10-CM. In ICD-9-CM, uncontrolled diabetes had a specific 5th digit to show that the diabetes was controlled or uncontrolled. This is no longer the case in ICD-10-CM. If the patient has documented uncontrolled diabetes, without further clarification of hyperglycemia and/or hypoglycemia, a query is necessary to clarify which type the patient has. If the patient does have documented hyperglycemia or hypoglycemia in addition to the diagnosis of uncontrolled diabetes, ICD-10-CM codes would be used to show that the diabetes is with hyperglycemia and/or hypoglycemia. Is uncontrolled and poorly controlled DM the same? No, uncontrolled and poorly controlled are not interchangeable when describing diabetes in ICD-10-CM. Uncontrolled can mean either hyperglycemia or hypoglycemia and is indexed as such in ICD-10-CM. Poorly controlled means hyperglycemia per the ICD-10-CM index. From the ICD-10-CM Index: Diabetes, diabetic (mellitus) (sugar) Poorly controlled-code to Diabetes, by type with hyperglycemia Diabetes, diabetic (mellitus) (sugar) Meaning Hyperglycemia-see Diabetes, by type, with hyperglycemia Hypoglycemia-see Diabetes, by type, with hypoglycemia Please see question and answer in AHA Coding Clinic, First Quarter 2017 Page: Continue reading >>
12 Signs Of Uncontrolled Diabetes
12 Signs of Uncontrolled Diabetes Blood tests tell you and your doctor when your glucose levels are too high. But signs of uncontrolled diabetes can appear all over your body. High blood glucose can damage nerves, blood vessels, and organs, resulting in a wide array of symptoms. Talk with your doctor if you spot any of them, so you can stay in control of your diabetes and improve your quality of life. © 2016 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement. You Might Also Like Continue reading >>
Classification, Pathophysiology, Diagnosis And Management Of Diabetes Mellitus
University of Gondar, Ethopia *Corresponding Author: Habtamu Wondifraw Baynes Lecturer Clinical Chemistry University of Gondar, Gondar Amhara 196, Ethiopia Tel: +251910818289 E-mail: [email protected] Citation: Baynes HW (2015) Classification, Pathophysiology, Diagnosis and Management of Diabetes Mellitus. J Diabetes Metab 6:541. doi:10.4172/2155-6156.1000541 Copyright: © 2015 Baynes HW. 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 (DM) is a metabolic disorder characterized by the presence of chronic hyperglycemia either immune-mediated (Type 1 diabetes), insulin resistance (Type 2), gestational or others (environment, genetic defects, infections, and certain drugs). According to International Diabetes Federation Report of 2011 an estimated 366 million people had DM, by 2030 this number is estimated to almost around 552 million. There are different approaches to diagnose diabetes among individuals, The 1997 ADA recommendations for diagnosis of DM focus on fasting Plasma Glucose (FPG), while WHO focuses on Oral Glucose Tolerance Test (OGTT). This is importance for regular follow-up of diabetic patients with the health care provider is of great significance in averting any long term complications. Keywords Diabetes mellitus; Epidemiology; Diagnosis; Glycemic management Abbreviations DM: Diabetes Mellitus; FPG: Fasting Plasma Glucose; GAD: Glutamic Acid Decarboxylase; GDM: Gestational Diabetes Mellitus; HDL-cholesterol: High Density Lipoprotein cholesterol; HLA: Human Leucoid Antigen; IDD Continue reading >>
Diagnosis And Classification Of Diabetes Mellitus
Go to: DEFINITION AND DESCRIPTION OF DIABETES MELLITUS— Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels. Several pathogenic processes are involved in the development of diabetes. These range from autoimmune destruction of the β-cells of the pancreas with consequent insulin deficiency to abnormalities that result in resistance to insulin action. The basis of the abnormalities in carbohydrate, fat, and protein metabolism in diabetes is deficient action of insulin on target tissues. Deficient insulin action results from inadequate insulin secretion and/or diminished tissue responses to insulin at one or more points in the complex pathways of hormone action. Impairment of insulin secretion and defects in insulin action frequently coexist in the same patient, and it is often unclear which abnormality, if either alone, is the primary cause of the hyperglycemia. Symptoms of marked hyperglycemia include polyuria, polydipsia, weight loss, sometimes with polyphagia, and blurred vision. Impairment of growth and susceptibility to certain infections may also accompany chronic hyperglycemia. Acute, life-threatening consequences of uncontrolled diabetes are hyperglycemia with ketoacidosis or the nonketotic hyperosmolar syndrome. Long-term complications of diabetes include retinopathy with potential loss of vision; nephropathy leading to renal failure; peripheral neuropathy with risk of foot ulcers, amputations, and Charcot joints; and autonomic neuropathy causing gastrointestinal, genitourinary, and c Continue reading >>
- Diagnosis and treatment of diabetes mellitus in chronic pancreatitis
- Complicated urinary tract infections associated with diabetes mellitus: Pathogenesis, diagnosis and management
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
Diabetes Mellitus: Management Of Microvascular And Macrovascular Complications
The management of type 1 and 2 diabetes mellitus (DM) requires addressing multiple goals, with the primary goal being glycemic control. Maintaining glycemic control in patients with diabetes prevents many of the microvascular and macrovascular complications associated with diabetes. This chapter presents a review of the prevalence, screening, diagnosis, and management of these complications. Definitions Microvascular complications of diabetes are those long-term complications that affect small blood vessels. These typically include retinopathy, nephropathy, and neuropathy. Retinopathy is divided into two main categories: Nonproliferative retinopathy and proliferative retinopathy. Nonproliferative retinopathy is the development of microaneurysms, venous loops, retinal hemorrhages, hard exudates, and soft exudates. Proliferative retinopathy is the presence of new blood vessels, with or without vitreous hemorrhage. It is a progression of nonproliferative retinopathy. Diabetic nephropathy is defined as persistent proteinuria. It can progress to overt nephropathy, which is characterized by progressive decline in renal function resulting in end-stage renal disease. Neuropathy is a heterogeneous condition associated with nerve pathology. The condition is classified according to the nerves affected and includes focal, diffuse, sensory, motor, and autonomic neuropathy. Macrovascular complications of diabetes are primarily diseases of the coronary arteries, peripheral arteries, and cerebrovasculature. Early macrovascular disease is associated with atherosclerotic plaque in the vasculature supplying blood to the heart, brain, limbs, and other organs. Late stages of macrovascular disease involve complete obstruction of these vessels, which can increase the risks of myocardial infar Continue reading >>
- Association of Glycemic Variability in Type 1 Diabetes With Progression of Microvascular Outcomes in the Diabetes Control and Complications Trial
- Olive oil in the prevention and management of type 2 diabetes mellitus: a systematic review and meta-analysis of cohort studies and intervention trials
- Diabetes management 3: the pathogenesis and management of diabetic foot ulcers
Medical Definition Of Diabetes Mellitus
Diabetes mellitus: More commonly referred to as "diabetes" -- a chronic disease associated with abnormally high levels of the sugar glucose in the blood. Diabetes is due to one of two mechanisms: Inadequate production of insulin (which is made by the pancreas and lowers blood glucose), or Inadequate sensitivity of cells to the action of insulin. The two main types of diabetes correspond to these two mechanisms and are called insulin dependent (type 1) and non-insulin dependent (type 2) diabetes. In type 1 diabetes there is no insulin or not enough of it. In type 2 diabetes, there is generally enough insulin but the cells upon which it should act are not normally sensitive to its action. The signs and symptoms of both types of diabetes include increased urine output and decreased appetite as well as fatigue. Diabetes is diagnosed by blood glucose testing, the glucose tolerance test, and testing of the level of glycosylated hemoglobin (glycohemoglobin or hemoglobin A1C). The mode of treatment depends on the type of the diabetes. The major complications of diabetes include dangerously elevated blood sugar, abnormally low blood sugar due to diabetes medications, and disease of the blood vessels which can damage the eyes, kidneys, nerves, and heart. Type 2 Diabetes Diagnosis, Treatment, Medication Last Editorial Review: 1/26/2017 Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Role of Medical Nutrition Therapy in the Management of Gestational Diabetes Mellitus
- American Diabetes Association® Releases 2018 Standards of Medical Care in Diabetes, with Notable New Recommendations for People with Cardiovascular Disease and Diabetes
Uncontrolled Diabetes Increases The Risk Of Alzheimer’s Disease: A Population-based Cohort Study
Abstract Diabetes has been related to Alzheimer’s disease with inconsistent findings. We aimed to clarify the association of diabetes with different dementing disorders taking into account glycaemic control, and to explore the link between glucose dysregulation and neurodegeneration. A dementia-free cohort (n = 1,248) aged ≥75 years was longitudinally examined to detect dementia, Alzheimer’s disease and vascular dementia (VaD) cases (Diagnostic and Statistical Manual of Mental Disorders, revised third edition [DSM-III-R] criteria). The Alzheimer’s disease diagnoses were subdivided into Alzheimer’s disease with stroke and Alzheimer’s disease without hypertension, heart disease and stroke. Diabetes was ascertained based on medical history, or hypoglycaemic medication use, or a random blood glucose level ≥11.0 mmol/l, which included undiagnosed diabetes when neither a history of diabetes nor hypoglycaemic drugs use was present. Uncontrolled diabetes was classified as a random blood glucose level ≥11.0 mmol/l in diabetic patients. Borderline diabetes was defined as a random blood glucose level of 7.8–11.0 mmol/l in diabetes-free individuals. Cox models were used to estimate HRs. During the 9 year follow-up, 420 individuals developed dementia, including 47 with VaD and 320 with Alzheimer’s disease (of the 320 Alzheimer’s disease cases, 78 had previous, temporally unrelated stroke, and 137 had no major vascular comorbidities). Overall diabetes was only related to VaD (HR 3.21, 95% CI 1.20–8.63). Undiagnosed diabetes led to an HR of 3.29 (95% CI 1.20–9.01) for Alzheimer’s disease. Diabetic patients with random blood glucose levels <7.8 mmol/l showed no increased dementia risk. Uncontrolled and borderline diabetes were further associated with Alzheim Continue reading >>
- New study finds that sitting for protracted periods increases the risk of diabetes, heart disease and death
- Conjoint Associations of Gestational Diabetes and Hypertension With Diabetes, Hypertension, and Cardiovascular Disease in Parents: A Retrospective Cohort Study
- High meat intake increases diabetes risk, study shows
Symptoms
Print Overview Diabetes mellitus refers to a group of diseases that affect how your body uses blood sugar (glucose). Glucose is vital to your health because it's an important source of energy for the cells that make up your muscles and tissues. It's also your brain's main source of fuel. If you have diabetes, no matter what type, it means you have too much glucose in your blood, although the causes may differ. Too much glucose can lead to serious health problems. Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes — when your blood sugar levels are higher than normal, but not high enough to be classified as diabetes — and gestational diabetes, which occurs during pregnancy but may resolve after the baby is delivered. Diabetes symptoms vary depending on how much your blood sugar is elevated. Some people, especially those with prediabetes or type 2 diabetes, may not experience symptoms initially. In type 1 diabetes, symptoms tend to come on quickly and be more severe. Some of the signs and symptoms of type 1 and type 2 diabetes are: Increased thirst Frequent urination Extreme hunger Unexplained weight loss Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there's not enough available insulin) Fatigue Irritability Blurred vision Slow-healing sores Frequent infections, such as gums or skin infections and vaginal infections Although type 1 diabetes can develop at any age, it typically appears during childhood or adolescence. Type 2 diabetes, the more common type, can develop at any age, though it's more common in people older than 40. When to see a doctor If you suspect you or your child may have diabetes. If you notice any poss Continue reading >>
The Rising Trend Of Invasive Zygomycosis In Patients With Uncontrolled Diabetes Mellitus
Zygomycosis is an emerging infection worldwide. A study was conducted to understand its spectrum in the Indian scenario. All patients diagnosed for invasive zygomycosis at a tertiary care center in north India from 2000–2004, were retrospectively analyzed. A total of 178 cases (mean average of 35.6 cases/year) of zygomycosis were diagnosed. Rhino-orbito-cerebral type (54.5%) was the commonest presentation followed by cutaneous (14.6%), disseminated (9.0%), and gastrointestinal (8.4%) zygomycosis. Renal and pulmonary zygomycosis were seen in 6.7% patients each. Uncontrolled diabetes mellitus (in 73.6% of cases) was the significant risk factor in all types (Odds Ratio 1.5–8.0) except renal zygomycosis. Breach of skin was the risk factor in 46.2% patients with cutaneous zygomycosis. However, no risk factor could be detected in 11.8% patients. Antemortem diagnosis was possible in 83.7% cases. The commonest (61.5%) isolate was Rhizopus oryzae followed by Apophysomyces elegans in 27% patients. Combination of debridement surgery and amphotericin B therapy was significantly better in survival of the patients (P<0.005) than amphotericin B alone (79.6% vs. 51.7% survival). Thus, a rising trend of invasive zygomycosis was observed in patients with uncontrolled diabetes mellitus in India. Consistent diagnosis of renal zygomycosis in apparently healthy hosts and the emergence of A. elegans in India demand further study. We have reported earlier that Aspergillus fumigatus is inhibited in vitro by Candida albicans which also interferes in its isolation from sputum experimentally seeded with predetermined graded inocula of the two fungi. It was further shown that this interference was neutralized by employing peptone glucose agar with incorporation of fluconazole which is more inhi Continue reading >>
Feline Diabetes
Insulin injections are the preferred method of managing diabetes in cats. Figure 1: To administer an injection, pull the loose skin between the shoulder blades with one hand. With the other hand, insert the needle directly into the indentation made by holding up the skin, draw back on the plunger slightly, and if no blood appears in the syringe, inject gently. Tips for Treatment 1. You can do it! Treating your cat may sound difficult, but for most owners it soon becomes routine. 2. Work very closely with your veterinarian to get the best results for your cat. 3. Once your cat has been diagnosed, it's best to start insulin therapy as soon as possible. 4. Home glucose monitoring can be very helpful. 5. Tracking your cat's water intake, activity level, appetite, and weight can be beneficial. 6. A low carbohydrate diet helps diabetic cats maintain proper glucose levels. 7. With careful treatment, your cat's diabetes may well go into remission. 8. If your cat shows signs of hypoglycemia (lethargy, weakness, tremors, seizures, vomiting) apply honey, a glucose solution, or dextrose gel to the gums and immediately contact a veterinarian. Possible Complications Insulin therapy lowers blood glucose, possibly to dangerously low levels. Signs of hypoglycemia include weakness, lethargy, vomiting, lack of coordination, seizures, and coma. Hypoglycemia can be fatal if left untreated, so any diabetic cat that shows any of these signs should be offered its regular food immediately. If the cat does not eat voluntarily, it should be given oral glucose in the form of honey, corn syrup, or proprietary dextrose gels (available at most pharmacies) and brought to a veterinarian immediately. It is important, however, that owners not attempt to force fingers, food, or fluids into the mouth of a Continue reading >>
7 Signs Your Blood Sugar Is Out Of Control
Thinkstock A Silent Danger When you have type 2 diabetes, your main goal should be controlling your blood sugar. Without adequate blood sugar control, your risk for serious health complications — stroke, heart disease, nerve damage, blindness, and more — skyrockets. But here’s the tricky part: You might not even know your blood sugar levels are out of control. “Not everyone will have the same symptoms, and some individuals have no symptoms at all,” says Lori Zanini, RD, CDE, a spokesperson for the Academy of Nutrition and Dietetics. Because proper blood sugar maintenance is vital to your overall health with type 2 diabetes, you need to take action if you think your levels may be out of control. “Since symptoms of uncontrolled diabetes may not appear until prolonged hyperglycemia has been present, it’s important for individuals with diabetes to monitor their glucose and adjust their medication based on the results,” explains Mary Ann Emanuele, MD, an endocrinologist, professor, and medical director of Inpatient Diabetes at Loyola University Medical Center in Mayfield, Illinois. Here are signs of uncontrolled blood sugar to look for: Continue reading >>
Diabetes Mellitus And Pregnancy
Practice Essentials Gestational diabetes mellitus (GDM) is defined as glucose intolerance of variable degree with onset or first recognition during pregnancy. A study by Stuebe et al found this condition to be associated with persistent metabolic dysfunction in women at 3 years after delivery, separate from other clinical risk factors. [1] Infants of mothers with preexisting diabetes mellitus experience double the risk of serious injury at birth, triple the likelihood of cesarean delivery, and quadruple the incidence of newborn intensive care unit (NICU) admission. Gestational diabetes mellitus accounts for 90% of cases of diabetes mellitus in pregnancy, while preexisting type 2 diabetes accounts for 8% of such cases. Screening for diabetes mellitus during pregnancy Gestational diabetes The following 2-step screening system for gestational diabetes is currently recommended in the United States: Alternatively, for high-risk women or in areas in which the prevalence of insulin resistance is 5% or higher (eg, the southwestern and southeastern United States), a 1-step approach can be used by proceeding directly to the 100-g, 3-hour OGTT. The US Preventive Services Task Force (USPSTF) recommends screening for gestational diabetes mellitus after 24 weeks of pregnancy. The recommendation applies to asymptomatic women with no previous diagnosis of type 1 or type 2 diabetes mellitus. [2, 3] The recommendation does not specify whether the 1-step or 2-step screening approach would be preferable. Type 1 diabetes The disease is typically diagnosed during an episode of hyperglycemia, ketosis, and dehydration It is most commonly diagnosed in childhood or adolescence; the disease is rarely diagnosed during pregnancy Patients diagnosed during pregnancy most often present with unexpected Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Diabetes and Pregnancy: Fluctuating Hormones and Glucose Management
- Olive oil in the prevention and management of type 2 diabetes mellitus: a systematic review and meta-analysis of cohort studies and intervention trials
Management Of Persistent Hyperglycemia In Type 2 Diabetes Mellitus
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 — Initial treatment of patients with type 2 diabetes mellitus includes education, with emphasis on lifestyle changes including diet, exercise, and weight reduction when appropriate. Monotherapy with metformin is indicated for most patients, and insulin may be indicated for initial treatment for some [1]. Although several studies have noted remissions of type 2 diabetes mellitus that may last several years, most patients require continuous treatment in order to maintain normal or near-normal glycemia. Bariatric surgical procedures in obese patients that result in major weight loss have been shown to lead to remission in a substantial fraction of patients. Regardless of the initial response to therapy, the natural history of most patients with type 2 diabetes is for blood glucose concentrations to rise gradually with time. Treatment for hyperglycemia that fails to respond to initial monotherapy and long-term pharmacologic therapy in type 2 diabetes is reviewed here. Options for initial therapy and other therapeutic issues in diabetes management, such as the frequency of monitoring and evaluation for microvascular and macrovascular complications, are discussed separately. (See "Initial management of blood glucose in adults with type 2 diabetes mellitus" and "Overview of medical care in adults with diabetes mellitus". Continue reading >>
- Management of Inpatient Hyperglycemia and Diabetes in Older Adults
- The Impact of Bariatric Surgery on Type 2 Diabetes Mellitus and the Management of Hypoglycemic Events
- Olive oil in the prevention and management of type 2 diabetes mellitus: a systematic review and meta-analysis of cohort studies and intervention trials
Ten Signs Of Uncontrolled Diabetes
Uncontrolled diabetes can be fatal. It can also lower quality of life. In 2010, diabetes and its complications were responsible for 12 percent of deaths worldwide. Many of these deaths were avoidable. Although diabetes is a chronic condition, it can be managed with lifestyle changes and the right medication. People who do not manage the condition well may develop uncontrolled diabetes, which causes dangerously high blood glucose. This can trigger a cascade of symptoms, ranging from mood changes to organ damage. People with type 1 diabetes, a disease that causes the body to attack insulin-producing cells in the pancreas, are diagnosed, typically, in childhood. However, as many as a third of adults with the most common type 2 diabetes variant of the disorder, do not know they have it. Without taking measures to treat it, these people can develop uncontrolled diabetes. The following 10 symptoms are signs of uncontrolled diabetes. Anyone experiencing them should consult a doctor promptly. Contents of this article: High blood glucose readings High blood glucose readings are the most obvious symptom of uncontrolled diabetes. As diabetes raises blood sugar levels, many people with diabetes think it is normal to have high blood glucose. Normally, however, diabetes medication and lifestyle changes should bring blood glucose within target ranges. If blood glucose is still uncontrolled, or if it is steadily rising, it may be time for an individual to review their management plan. Frequent infections Diabetes can harm the immune system, making people more prone to infections. A person with diabetes who suddenly gets more infections, or who takes longer to heal from an infection they have had before, should see a doctor. Some of the most common infections associated with diabetes in Continue reading >>
