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What Is Uncontrolled Diabetes Mellitus

Ketonaemia In Uncontrolled Diabetes Mellitus

Ketonaemia In Uncontrolled Diabetes Mellitus

Abstract Blood ketone bodies, serum insulin levels, and plasma free fatty acids were examined in a series of patients with “non-ketotic diabetic coma” and compared with the findings in ketoacidotic subjects. Serum insulin levels in six “non ketotic” patients ranged between 1 and 25 μu./ml. and were not significantly different from levels reported in patients with ketoacidosis. In addition, plasma free fatty acids were shown to be unrelated to the degree of ketonaemia. The investigation shows that neither the levels of serum insulin nor those of free fatty acids can explain the absence of hyperketonaemia in some cases. Continue reading >>

Prevalence Of Controlled And Uncontrolled Diabetes Mellitus And Associated Factors Of Controlled Diabetes Among Diabetic Adults In The Hohoe Municipality Of Ghana

Prevalence Of Controlled And Uncontrolled Diabetes Mellitus And Associated Factors Of Controlled Diabetes Among Diabetic Adults In The Hohoe Municipality Of Ghana

Author(s): Fiagbe J, Bosoka S, Opong J, Takramah W, Axame WK, Owusu R, Parbey PA, Adjuik M, Tarkang E & Kweku M* Background: When diabetes is uncontrolled, it has dire consequences on the health and well-being. Diabetes of all types can lead to numerous long-term complications in many parts of the body and can increase the overall risk of dying prematurely. Methods: A hospital-based cross-sectional survey that involved adults aged 18 years and above with diabetes and were attending the diabetic clinic at the Hohoe Municipal hospital in May and June 2017. Pre-tested semi-structured questionnaires were used to collect data. Blood Pressure, Blood glucose level and information on the last visit to the clinic were extracted from the diabetes card. Means were compared using t-test. Chi-square was used to determine the associations between type 2 diabetes and socio-demographic characteristics. Binary logistic regression was used to determine the strength of the associations between type 2 diabetes and some lifestyle risk factors. A p-value less than 0.05 was considered statistically significant. Results: The prevalence of controlled type 2 diabetes was 13.6%, and 86.4% of diabetics could not control their blood glucose level. There was a significant association between age, occupation, hypertension status, defaulter rate and control of diabetes (χ2=6.65, p=0.038), (χ2=12.43, p=0.014), (χ2=4.07, p=0.044) and (χ2=3.98, p=0.046) respectively. Of the 63 respondents who defaulted, only 6.3% were able to control their blood glucose level as compared to 16.6% of the 131 respondents who did not default (p=0.032). Respondents who were civil servants were 84% times less likely to have their blood glucose controlled as compared to those who were unemployed (AOR=0.16, p=0.031). Respon Continue reading >>

Controlled Vs. Uncontrolled Diabetes

Controlled Vs. Uncontrolled Diabetes

Diabetes affects over 20 million Americans, and this group is growing by the year. Diabetes can be defined as controlled or uncontrolled, and each distinction comes with its own risks. Identification Controlled diabetes is when someone is eating the right foods, exercising and taking his prescribed medication to keep his glucose levels in a safe and healthy range. Uncontrolled diabetes is when someone is not regulating his lifestyle to keep glucose levels in a safe and healthy range. Types There are two types of diabetes. Type 1 diabetes, also called juvenile diabetes, is when a person does not produce enough insulin and must take daily insulin injections. Type 2 diabetes, also called adult onset diabetes, is when a person does make enough insulin, but she's become insulin resistant. Risks People who have uncontrolled diabetes are at higher risk of heart disease, blood vessel disease, eye disease and blindness, gum disease and tooth loss, kidney failure, stroke and nerve damage. People who tightly control their diabetes may be at a higher risk for hypoglycemia. Benefits A person with uncontrolled diabetes might think that she will live a fuller life by continuing her dangerous lifestyle. The benefit of controlled diabetes is a longer and healthier life. Considerations Losing weight can help control your diabetes, if your weight is a factor. Losing 5 percent of your body weight will get you well on your way, and losing 10 percent of your body weight may make your diabetes easier to manage and control. Continue reading >>

Uncontrolled Diabetes Mellitus: Prevalence And Risk Factors Among People With Type 2 Diabetes Mellitus In An Urban District Of Karachi, Pakistan.

Uncontrolled Diabetes Mellitus: Prevalence And Risk Factors Among People With Type 2 Diabetes Mellitus In An Urban District Of Karachi, Pakistan.

Siddiqui, FJ; Avan, BI; Mahmud, S; Nanan, DJ; Jabbar, A; Assam, PN; (2014) Uncontrolled diabetes mellitus: Prevalence and risk factors among people with type 2 diabetes mellitus in an Urban District of Karachi, Pakistan. Diabetes research and clinical practice. ISSN 0168-8227 DOI: 10.1016/j.diabres.2014.09.025 Full text not available from this repository. Abstract This study aimed to explore the prevalence of, and factors associated with, uncontrolled diabetes mellitus (UDM) in a community setting in Pakistan. A single-center, cross-sectional study, conducted in a community-based specialized care center (SCC) for diabetes in District Central Karachi, in 2003, registered 452 type 2 DM participants, tested for HbA1c and interviewed face-to-face for other information. Logistic regression analysis was conducted to identify factors associated with UDM. Prevalence of UDM among diabetes patients was found to be 38.9% (95% CI: 34.4-43.4%). Multivariable logistic regression model analysis indicated that age <50 years (OR: 1.9; 95% CI: 1.2-2.9), being diagnosed in a hospital (vs. a clinic) (OR: 1.8; 95% CI: 1.1-2.8), diabetes information from a doctor or nurse only (vs. multiple sources) (OR: 1.8; 95% CI: 1.2-2.9), higher monthly treatment cost (OR: 1.3; 95% CI: 1.1-1.6; for every extra 500 PKR), and higher consumption of tea (OR: 1.5; 95% CI: 1.0-2.2; for every 2 extra cups) were independently associated with UDM. The prevalence of UDM was approximately 39% among persons with type 2 diabetes visiting a community based SCC for diabetes. Modifiable risk factors such as sources of diabetes information and black tea consumption can be considered as potential targets of interventions in Karachi. Item Type: Article Faculty and Department: Faculty of Epidemiology and Population Health Continue reading >>

Symptoms

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 >>

Uncontrollable Diabetes Mellitus: A Rare Paraneoplastic Manifestation Of Renal Cell Carcinoma

Uncontrollable Diabetes Mellitus: A Rare Paraneoplastic Manifestation Of Renal Cell Carcinoma

Sir, Paraneoplastic syndromes are well-known manifestations of renal cell carcinoma (RCC). They can occur in up to 20% of patients with RCC and can sometimes be responsible for the presenting symptoms of RCC. The most common ones are fever, hypercalcaemia, anaemia, hypertension, cachexia and hepatic dysfunction (Stauffer's syndrome). We report on a patient who presented uncontrollable deterioration of glycaemic control of pre-existing insulin dependent diabetes mellitus (IDDM) as a paraneoplastic manifestation of RCC. Case. A 35-year-old man with a 12-year history of IDDM was admitted because of uncontrolled diabetes, thought to be secondary to a urinary tract infection (UTI). Insulin demand had risen from 80 units subcutaneously to more than 600 units intravenously. The patient mentioned some right flank pain. Clinical examination was normal apart from mild fever. Laboratory tests revealed an elevated white blood cell count and a high erythrocyte sedimentation rate and CRP. Urine analysis showed microscopic haematuria. Cultures of blood and urine remained negative. Cortisol and glucagon were normal, as were adrenocorticotropic hormone, growth hormone, insulin-like growth factor 1 and parathyroid hormone. Ultrasonography of the abdomen showed a cyst in both kidneys which had been known for years. When comparing a computerized tomography (CT) of the kidneys with a CT performed 4 years earlier, both cysts had become hyperdense, suggesting haemorrhage or infection and the cyst in the right kidney had clearly grown (Figure 1). A needle biopsy of the cyst on the right showed, unexpectedly, a papillary RCC. No metastases were found after staging. There were no stigmata or family history of von Hippel–Lindau disease. Because of the identical radiologic aspect of the bilatera Continue reading >>

The Treatment Of Severely Uncontrolled Diabetes Mellitus.

The Treatment Of Severely Uncontrolled Diabetes Mellitus.

Abstract Patients with severely uncontrolled diabetes mellitus must be cared for by physicians and nurses who understand the pathophysiology of ketoacidosis and nonketotic hyperglycemia, who carefully seek and treat precipitating or underlying illnesses, and who can provide the patients with continuous clinical attention and laboratory monitoring. Most patients with diabetic ketoacidosis survive the acute metabolic disorder; the infrequent deaths are usually due to serious underlying illnesses. The latter are more common in patients with nonketotic hyperglycemia, who are usually older than those with ketoacidosis and who usually also have serious underlying chronic diseases. The essential features of treatment for either of the foregoing acute metabolic disorders are administration of insulin (especially gingerly in the older patients with nonketotic hyperglycemia, despite their commonly remarkable hyperglycemia); rehydration with NaCl solutions; and IV administration of K+, usually not until after a few hours of treatment with insulin and NaCl solutions. Administration of NaHCO3 is usually not necessary except in patients with a blood pH less than 7.1. Administration of phosphate has been recommended as part of the treatment for ketoacidosis, but its need is uncertain. Although patients with nonketotic hyperglycemia are often more severely dehydrated and hyperglycemic than those with ketoacidosis, they usually should be given smaller amounts of insulin, NaCl solutions, and K+, and less rapidly. Continue reading >>

Diabetes Mellitus Signs And Symptoms

Diabetes Mellitus Signs And Symptoms

There are three main types of diabetes: Type 1 Diabetes: About 5 to 10 percent of those with diabetes have type 1 diabetes. It's an autoimmune disease, meaning the body's own immune system mistakenly attacks and destroys the insulin-producing cells in the pancreas. Patients with type 1 diabetes have very little or no insulin, and must take insulin everyday. Although the condition can appear at any age, typically it's diagnosed in children and young adults, which is why it was previously called juvenile diabetes. Type 2 Diabetes: Accounting for 90 to 95 percent of those with diabetes, type 2 is the most common form. Usually, it's diagnosed in adults over age 40 and 80 percent of those with type 2 diabetes are overweight. Because of the increase in obesity, type 2 diabetes is being diagnosed at younger ages, including in children. Initially in type 2 diabetes, insulin is produced, but the insulin doesn't function properly, leading to a condition called insulin resistance. Eventually, most people with type 2 diabetes suffer from decreased insulin production. Gestational Diabetes: Gestational diabetes develops during pregnancy. It occurs more often in African Americans, Native Americans, Latinos and people with a family history of diabetes. Typically, it disappears after delivery, although the condition is associated with an increased risk of developing diabetes later in life. If you think that you have diabetes, visit your doctor immediately for a definite diagnosis. Common symptoms include the following: Frequent urination Excessive thirst Unexplained weight loss Extreme hunger Sudden vision changes Tingling or numbness in the hands or feet Feeling very tired much of the time Very dry skin Sores that are slow to heal More infections than usual Some people may experience o Continue reading >>

Uncontrolled Diabetes Mellitus: Prevalence And Risk Factors Among People With Type 2 Diabetes Mellitus In An Urban District Of Karachi, Pakistan

Uncontrolled Diabetes Mellitus: Prevalence And Risk Factors Among People With Type 2 Diabetes Mellitus In An Urban District Of Karachi, Pakistan

Abstract This study aimed to explore the prevalence of, and factors associated with, uncontrolled diabetes mellitus (UDM) in a community setting in Pakistan. A single-center, cross-sectional study, conducted in a community-based specialized care center (SCC) for diabetes in District Central Karachi, in 2003, registered 452 type 2 DM participants, tested for HbA1c and interviewed face-to-face for other information. Logistic regression analysis was conducted to identify factors associated with UDM. Prevalence of UDM among diabetes patients was found to be 38.9% (95% CI: 34.4–43.4%). Multivariable logistic regression model analysis indicated that age <50 years (OR: 1.9; 95% CI: 1.2–2.9), being diagnosed in a hospital (vs. a clinic) (OR: 1.8; 95% CI: 1.1–2.8), diabetes information from a doctor or nurse only (vs. multiple sources) (OR: 1.8; 95% CI: 1.2–2.9), higher monthly treatment cost (OR: 1.3; 95% CI: 1.1–1.6; for every extra 500 PKR), and higher consumption of tea (OR: 1.5; 95% CI: 1.0–2.2; for every 2 extra cups) were independently associated with UDM. The prevalence of UDM was approximately 39% among persons with type 2 diabetes visiting a community based SCC for diabetes. Modifiable risk factors such as sources of diabetes information and black tea consumption can be considered as potential targets of interventions in Karachi. Continue reading >>

Uncontrolled Diabetes Mellitus In Adults: Experience In Treating Diabetic Ketoacidosis And Hyperosmolar Nonketotic Coma With Low-dose Insulin And A Uniform Treatment Regimen.

Uncontrolled Diabetes Mellitus In Adults: Experience In Treating Diabetic Ketoacidosis And Hyperosmolar Nonketotic Coma With Low-dose Insulin And A Uniform Treatment Regimen.

Abstract A number of changes in therapy of uncontrolled diabetes have occurred in recent years. These include low-dose insulin regimens, often routine phosphate repletion, more cautious bicarbonate replacement, infusion of larger fluid volumes, the use of hypotonic solutions in hyperosmolar states, and recently magnesium repletion. These modalities (with the exception of routine magnesium repletion) have been employed at North Central Bronx Hospital since its opening in 1976. Through this retrospective analysis of 275 cases of uncontrolled diabetes we have tried to answer the following questions: What is the outcome of all episodes of uncontrolled diabetes in a municipal hospital population with a uniform treatment protocol? What are the results of treatment with new modalities in various age groups? Are the causes of death different from those tabulated in previous reports? Our results indicate a good outcome in those under the age of 50 yr regardless of the diagnosis of hyperosmolar nonketotic coma (HNC) or diabetic ketoacidosis (DKA). Mortality from DKA was 2% in those under age 50 yr and 26% in the older age group. Surprising was the low mortality in the hyperosmolar group with 0% mortality under age 50 yr and 14% in patients over this age. The major categories of causes of death in the series included sepsis, adult respiratory distress syndrome (ARDS), metabolic, cardiovascular, and shock. With the exception of ARDS, these categories were not different from other reported series. There were few thromboembolic events in this series.(ABSTRACT TRUNCATED AT 250 WORDS). Continue reading >>

Type 2 Diabetes Complications

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 >>

Ten Signs Of Uncontrolled Diabetes

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 >>

Consider This Case An Uncontrolled Diabetic Dog

Consider This Case An Uncontrolled Diabetic Dog

Ann DellaMaggiore, DVM, DACVIM University of California, Davis QUESTIONS: Investigating the Unstable Diabetic Dog What are possible causes of poor diabetic control in this dog? Are there problems with insulin handling and administration? Is this dog receiving an appropriate insulin type and dose? What and when is the dog being fed, and does the dog receive any additional treats or table scraps? What are possible causes of insulin resistance in this dog? What additional diagnostics would help in better assessing diabetic control? Buster, a 7-year-old male castrated beagle mix weighing 18 kg, was presented for evaluation of uncontrolled diabetes. HISTORY Previous Diagnosis Six months before presentation, Buster was presented to his primary veterinarian for polyuria, polydipsia, and weight loss. Physical examination and complete blood count (CBC) were unremarkable, while the serum biochemical profile (Table 1) demonstrated: Mildly increased alkaline phosphatase (ALP) Mild hypercholesterolemia Hyperglycemia The urinalysis showed glucosuria, with no evidence of ketones, white blood cells, or bacteria. Based on these findings, Buster was diagnosed with diabetes mellitus. Medical Therapy After diagnosis, Buster’s primary veterinarian initiated therapy with neutral protamine Hagedorn (NPH) insulin at 9 U (0.5 U/kg) SC q12h. Intermittent spot blood glucose monitoring was used to determine adjustments in insulin dose and, based on variably high results (>350 mg/dL), Buster’s insulin dose was increased approximately every 3 days. Upon presentation for a second opinion on diabetic control, Buster was receiving 30 U of NPH insulin q12h. The insulin was from a new prescription, stored in the refrigerator, and the administration technique (visualized as part of history collection) Continue reading >>

Type 2 Diabetes Mellitus Treatment & Management

Type 2 Diabetes Mellitus Treatment & Management

Approach Considerations The goals in caring for patients with diabetes mellitus are to eliminate symptoms and to prevent, or at least slow, the development of complications. Microvascular (ie, eye and kidney disease) risk reduction is accomplished through control of glycemia and blood pressure; macrovascular (ie, coronary, cerebrovascular, peripheral vascular) risk reduction, through control of lipids and hypertension, smoking cessation, and aspirin therapy; and metabolic and neurologic risk reduction, through control of glycemia. New abridged recommendations for primary care providers The American Diabetes Association has released condensed recommendations for Standards of Medical Care in Diabetes: Abridged for Primary Care Providers, highlighting recommendations most relevant to primary care. The abridged version focusses particularly on the following aspects: The recommendations can be accessed at American Diabetes Association DiabetesPro Professional Resources Online, Clinical Practice Recommendations – 2015. [117] Type 2 diabetes care is best provided by a multidisciplinary team of health professionals with expertise in diabetes, working in collaboration with the patient and family. [2] Management includes the following: Ideally, blood glucose should be maintained at near-normal levels (preprandial levels of 90-130 mg/dL and hemoglobin A1C [HbA1c] levels < 7%). However, focus on glucose alone does not provide adequate treatment for patients with diabetes mellitus. Treatment involves multiple goals (ie, glycemia, lipids, blood pressure). Aggressive glucose lowering may not be the best strategy in all patients. Individual risk stratification is highly recommended. In patients with advanced type 2 diabetes who are at high risk for cardiovascular disease, lowering Hb Continue reading >>

Diabetes Mellitus

Diabetes Mellitus

Diabetes mellitus can affect lens clarity, as well as the refractive index and accommodative amplitude of the lens. As the blood glucose level increases, so also does the glucose content in the aqueous humor. Because glucose from the aqueous enters the lens by diffusion, glucose content in the lens will likewise be increased. Some of the glucose is converted to sorbitol, the sugar alcohol of glucose, by the enzyme aldose reductase. Sorbitol is metabolized slowly by the lens and accumulates in the lens cell cytoplasm. The resulting increase in osmotic pressure may cause an influx of water, which leads to swelling of the lens fibers. The state of lenticular hydration can affect the refractive power of the lens. Patients with uncontrolled diabetes may show transient refractive changes owing to large changes in their blood glucose level. Acute myopic shifts may indicate undiagnosed or poorly controlled diabetes. People with diabetes have a decreased amplitude of accommodation compared to age-matched controls, and presbyopia may present at a younger age in patients with diabetes than in those without. Cataract is a common cause of visual impairment in patients with diabetes. Acute diabetic cataract, or snowflake cataract, consists of bilateral, widespread subcapsular lens changes of abrupt onset, typically in young people with uncontrolled diabetes mellitus (Fig 5-16). Multiple gray-white subcapsular opacities that have a snowflake appearance are seen initially in the superficial anterior and posterior lens cortex. Vacuoles and clefts form in the underlying cortex. Intumescence and maturity of the cortical cataract follow shortly thereafter. Researchers believe that the underlying metabolic changes associated with the acute diabetic cataract in humans are closely allied to t Continue reading >>

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