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Who Diabetes Guidelines

Diabetes Mellitus

Diabetes Mellitus

See also: Background: Diabetic ketoacidosis (DKA) is the combination of hyperglycemia, metabolic acidosis, and ketonaemia. It may be the first presentation for a child with previously undiagnosed diabetes. It can also be precipitated by illness, or poor compliance with taking insulin. All patients presenting with a blood glucose level (BGL) ≥ 11.1mmol/l should have blood ketones tested on a capillary sample using a bedside OptiumTM meter. If this test is positive (>0.6 mmol/l), assess for acidosis to determine further management. Urinalysis can be used for initial assessment if blood ketone testing is not available. The biochemical criteria for DKA are: 1. Venous pH < 7.3 or bicarbonate <15 mmol/l 2. Presence of blood or urinary ketones If ketones are negative, or the pH is normal in the presence of ketones, patients can be managed with subcutaneous (s.c.) insulin (see ' new presentation, mildly ill' below). Assessment of children and adolescents with DKA 1. Degree Of Dehydration (often over-estimated) None/Mild ( < 4%): no clinical signs Moderate (4-7%): easily detectable dehydration eg. reduced skin turgor, poor capillary return Severe(>7%): poor perfusion, rapid pulse, reduced blood pressure i.e. shock 3. Investigations Venous blood sample (place an i.v. line if possible as this will be needed if DKA is confirmed) for the following: FBE Blood glucose, urea, electrolytes (sodium, potassium, calcium, magnesium, phosphate) Blood ketones (bedside test) Venous blood gas (including bicarbonate) Investigations for precipitating cause: if clinical signs of infection consider septic work up including blood culture For all newly diagnosed patients: Insulin antibodies, GAD antibodies, coeliac screen (total IgA, anti-gliadin Ab, tissue transglutaminase Ab) and thyroid function Continue reading >>

Criteria For Diagnosing Diabetes - Topic Overview

Criteria For Diagnosing Diabetes - Topic Overview

To be diagnosed with diabetes, you must meet one of the following criteria:1 Have symptoms of diabetes (increased thirst, increased urination, and unexplained weight loss) and a blood sugar level equal to or greater than 200 milligrams per deciliter (mg/dL). The blood sugar test is done at any time, without regard for when you last ate (random plasma glucose test or random blood sugar test). Have a fasting blood sugar level that is equal to or greater than 126 mg/dL. A fasting blood sugar test (fasting plasma glucose) is done after not eating or drinking anything but water for 8 hours. Have a 2-hour oral glucose tolerance test (OGTT) result that is equal to or greater than 200 mg/dL. An OGTT is most commonly done to check for diabetes that occurs with pregnancy (gestational diabetes). Have a hemoglobin A1c that is 6.5% or higher. Your doctor may repeat the test to confirm the diagnosis of diabetes. If the results of your fasting blood sugar test are between 100 mg/dL and 125 mg/dL, your OGTT result is between 140 to 199 mg/dL (2 hours after the beginning of the test), or your hemoglobin A1c is 5.7% to 6.4%, you have prediabetes. This means that your blood sugar is above normal but not high enough to be diabetes. Discuss with your doctor how often you need to be tested.1 Continue reading >>

Diagnosis And Classification Of Diabetes Mellitus

Diagnosis And Classification Of Diabetes Mellitus

Go to: DEFINITION AND DESCRIPTION OF DIABETES MELLITUS Diabetes 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 differentorgans, 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 cardiovascul Continue reading >>

Diabetes In Pregnancy (nice Clinical Guideline 3)

Diabetes In Pregnancy (nice Clinical Guideline 3)

This guideline was produced by the National Collaborating Centre for Women’s and Children’s Health (NCC-WCH) on behalf of the National Institute of Health and Care Excellence (NICE). The guideline focuses on areas where additional or different care should be offered to women with diabetes and their newborn babies. Where the evidence supports it, the guideline makes separate recommendations for women with pre‑existing diabetes and women with gestational diabetes. Continue reading >>

How Reversible Is Prediabetes?

How Reversible Is Prediabetes?

Prediabetes entails a somewhat compromised pancreas, brought about by insulin resistance. There are certain things you can do right away to stabilize your condition within 100 hours, and to start the mending: Resolve never to eat poultry again: Turkey is not necessarily that bad, but chicken is murder for your pancreas. Chicken contains a specific type of lectin (protein antinutrients similar to antibodies, which bind to organ systems and destroy them in the long term) that is destructive to the human pancreas. In addition, the same lectin could be contributing to a leptin resistance in your body, leading to obesity. The effects of these scenarios are dramatically multiplied if you have Type B blood. Switch to a blood-specific nutritional program: Eating food that is amenable to your blood type will help heal the damage done by preventing further lectins from attacking your pancreas. Increase your consumption of turmeric and ginger: Both spices are powerful pancreatic tonics. Begin to drink half your body weight in ounces of water on a daily basis: This will help your kidneys clear the byproducts of protein assimilation, and it will help all other organs systems in the process. Start your day by consuming around 20 percent of your daily protein requirements within one hour of waking. This will virtually get rid of your cravings later in the day, and help stabilize your blood sugar. Try the following ritual in the morning if you don't have time to cook yourself a high protein breakfast when you wake up: Angelic Whey Protein Smoothie 1 cup unflavored pediatric electrolyte solution 1 scoop of protein powder 1/4 teaspoon powdered ginger 1/4 teaspoon powdered cinnamon Blend all ingredients, drink the smoothie, wait 15 minutes, then engage in exercise you enjoy if you seek to Continue reading >>

What Is A Good Sugar Level?

What Is A Good Sugar Level?

The Diabetes Forum - find support, ask questions and share your experiences with 250,009 people. Join the Forum A A blood sample for a random plasma glucose test can be taken at any time. This doesnt require as much planning and is therefore used in the diagnosis of type 1 diabetes when time is of the essence. The NICE guidelines regard a fasting plasma glucose result of 6.1 to 6.9 mmol/l as putting someone at higher risk of developing type 2 diabetes, particularly when accompanied by other risk factors for type 2 diabetes. An oral glucose tolerance test involves taking a first taking a fasting sample of blood and then taking a very sweet drink containing 75g of glucose. An HbA1c test does not directly measure the level of blood glucose, however, the result of the test is influenced by how high or low your blood glucose levels have tended to be over a period of 2 to 3 months. The second is the HbA1c reading, which gives a good idea of our average control over a period of 2 to 3 months. The target blood glucose levels vary a little bit depending on your type of diabetes and between adults and children. Where possible, try to achieve levels of between 4 and 7 mmol/L before meals and under 8.5 mmol/L after meals. The target level for HbA1c is under 48 mmol/mol (or 6.5% in the old units). Keeping blood glucose above 4 mmol/l for people on insulin or certain medications for type 2 diabetes is important to prevent hypos occurring, which can be dangerous. Continue reading >>

Do You Think The Nutritional Guidelines For Diabetics Should Be Changed To Low-carb?

Do You Think The Nutritional Guidelines For Diabetics Should Be Changed To Low-carb?

No. Not until we have a more comprehensive knowledge about what a sustained low carb diet does to a diabetic body. Yes, it can give a better glycemic control, but we don't know what other effects it has. I know studies are being done, presently, so hopefully we will know sooner rather than later! Continue reading >>

Guidelines For The Detection Of Diabetes Mellitus - Diagnostic Criteria And Rationale For Screening

Guidelines For The Detection Of Diabetes Mellitus - Diagnostic Criteria And Rationale For Screening

Go to: Rationale for Guidelines for the Detection of Diabetes Diagnostic cut-off levels for diabetes have been determined using blood glucose concentrations which are associated with increased prevalence of diabetic complications. One study examined the prevalence of retinopathy and nephropathy in Pima Indians, a population with a very high frequency of type 2 diabetes mellitus. Fasting plasma glucose, 2-hour plasma glucose during an oral glucose tolerance test (OGTT) and haemoglobin A1C were all similarly predictive in identifying patients with an increased risk of future complications of hyperglycaemia.3 The old diagnostic cut-points for diabetes were higher than the currently used ones (see Table 1) and represent threshold values above which microvascular complications (particularly retinopathy) begin to occur, and below which these complications are very rare. However, if one looks at cardiovascular disease, which is a much greater cause of morbidity and mortality in patients with type 2 diabetes than are the specific diabetic complications, no such easy threshold can be defined. The risk of cardiovascular disease starts to rise at levels well below those at which diabetes is diagnosed and the relationship is continuous without a clear threshold effect. Studies comparing the value of fasting glucose with the diagnostic 2-hour value found that typically only 25% of individuals with a 2-hour plasma glucose of ≥11.1 mmol/L also had a fasting plasma glucose ≥7.8 mmol/L while over 90% of those with a fasting plasma glucose of ≥7.8 mmol/L had a 2-hour plasma glucose ≥11.1 mmol/L. This is consistent with the view that the fasting threshold of 7.8 mmol/L represented a more severe degree of hyperglycaemia than did the 2-hour post OGTT value of 11.1 mmol/L. Investigat Continue reading >>

World Diabetes Day 2017: Women And Diabetes

World Diabetes Day 2017: Women And Diabetes

Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys, and nerves. The most common is type 2 diabetes, usually in adults, which occurs when the body becomes resistant to insulin or doesn't make enough insulin. In the past three decades the prevalence of type 2 diabetes has risen dramatically in countries of all income levels. Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself. For people living with diabetes, access to affordable treatment, including insulin, is critical to their survival. There is a globally agreed target to halt the rise in diabetes and obesity by 2025. Continue reading >>

2. Classification And Diagnosis Of Diabetes

2. Classification And Diagnosis Of Diabetes

Classification Diabetes can be classified into the following general categories: Type 1 diabetes (due to β-cell destruction, usually leading to absolute insulin deficiency) Type 2 diabetes (due to a progressive insulin secretory defect on the background of insulin resistance) Gestational diabetes mellitus (GDM) (diabetes diagnosed in the second or third trimester of pregnancy that is not clearly overt diabetes) Specific types of diabetes due to other causes, e.g., monogenic diabetes syndromes (such as neonatal diabetes and maturity-onset diabetes of the young [MODY]), diseases of the exocrine pancreas (such as cystic fibrosis), and drug- or chemical-induced diabetes (such as in the treatment of HIV/AIDS or after organ transplantation) This section reviews most common forms of diabetes but is not comprehensive. For additional information, see the American Diabetes Association (ADA) position statement “Diagnosis and Classification of Diabetes Mellitus” (1). Assigning a type of diabetes to an individual often depends on the circumstances present at the time of diagnosis, with individuals not necessarily fitting clearly into a single category. For example, some patients cannot be clearly classified as having type 1 or type 2 diabetes. Clinical presentation and disease progression may vary considerably in both types of diabetes. The traditional paradigms of type 2 diabetes occurring only in adults and type 1 diabetes only in children are no longer accurate, as both diseases occur in both cohorts. Occasionally, patients with type 2 diabetes may present with diabetic ketoacidosis (DKA). Children with type 1 diabetes typically present with the hallmark symptoms of polyuria/polydipsia and occasionally with DKA. The onset of type 1 diabetes may be variable in adults and may Continue reading >>

What Are The Advancements In The Treatments Of Diabetes?

What Are The Advancements In The Treatments Of Diabetes?

Up until relatively recently doctors were on the wrong track with diabetes. Some were still injecting insulin into patients with type 2 diabetes. They now know this is not the best first course of action. Three types of diabetes in layman’s terms Type 1 is where the pancreas can not secrete enough insulin Type 2 where too much insulin is produced because receptors are resistant to insulin. Reversible in the majority of cases through diet alone. Type 3 is Alzheimer’s (due to glycated proteins) Recent discoveries mean that diagnosis of type 1 and type 2 are not as clear as once thought. I’m a specialist practitioner in obesity and diabetes. Yes that’s right, type 2 diabetes can be reversed through diet. Absolutely. Firstly this is what is a normal insulin reaction looks like: Insulin is manufactured in the pancreas and secreted when your blood sugar levels rise. Blood sugar needs to be not too high and not too low. Insulin’s mechanism to remove sugar from blood is to put it into cells, like your muscles. If there is an excess after blood glucose has gone into cells it is then put in the liver and further excess becomes fat. What happens with type 2 When insulin is secreted the body’s cells have ‘‘receptors’ that accept the insulin’s key that then open the doors to the cell to let the glucose in. Sadly in type 2 the receptors become resistant to the insulin key. Therefore not enough energy gets into the cell. The body has a negative feedback system. Once the cells do not get enough energy a signal is sent back to the pancreas to manufacture even more insulin. This is a vicious cycle. Insulin keeps going up and resistance keeps getting worse. A drug, called metformin works by making cells receptive again but it has limitations and eventually other drugs Continue reading >>

Wisconsin Diabetes Mellitus Essential Care Guidelines

Wisconsin Diabetes Mellitus Essential Care Guidelines

Diabetes Care Guidelines The Wisconsin Diabetes Advisory Group recommends use of the American Diabetes Association (ADA) Clinical Practice Recommendations (link is external) for guidance on high-quality, evidence-based diabetes clinical care. The ADA also offers an abridged version for primary care providers, Standards of Medical Care in Diabetes: Abridged for Primary Care Providers (link is external). ADA Clinical Practice Recommendations are based on a complete review of the relevant literature by a diverse group of highly trained clinicians and researchers. After weighing the quality of evidence, from rigorous double-blind clinical trials to expert opinion, recommendations are drafted, reviewed, and submitted for approval to the ADA Executive Committee; they are then revised on a regular basis, and published annually in Diabetes Care. Wisconsin Provider Supplements for Diabetes Care Patient Education Materials Diabetes Self-Care Booklet: This 12-page booklet explains diabetes, diabetes self-care, and lists the tests, exams, and medical checks you need to have in order to take care of your diabetes. Personal Diabetes Care Record: This two-page wallet card provides a place for the person with diabetes to record tests, exams, and medical checks necessary for good self-management. Blood Sugar Log Booklet: This booklet provides a place to record three months of blood sugar test results. All Diabetes Prevention and Control Program resources are copyright-free. Please duplicate and distribute as many copies of these materials as needed. Continue reading >>

Is There Any Book About Diabetes Or Metabolism That Can Explain It From Scratch?

Is There Any Book About Diabetes Or Metabolism That Can Explain It From Scratch?

The Diabetes Forum - find support, ask questions and share your experiences with 250,009 people. Join the Forum A The good news is for very many people with type 2 diabetes this is all they have to do to stay well. If you can keep your blood sugar lower by avoiding dietary sugar, likely you will never need long-term medication. Type 2 diabetes is a serious medical condition that often requires the use of anti-diabetic medication, or insulin to keep blood sugar levels under control. However, the development of type 2 diabetes and its side effects (complications) can be prevented if detected and treated at an early stage. In recent years, it has become apparent that many people with type 2 diabetes are able to reverse diabetes through methods including low-carb diets, very-low-calorie diets and exercise. Type 2 diabetes occurs when the hormone insulin is not used effectively by the cells in your body. Insulin is needed for cells to take in glucose (sugar) from the bloodstream and convert it into energy. Ineffective use of insulin results in the body becoming resistant to insulin - also known as insulin resistance, which in turn causes blood sugar levels to rise (hyperglycemia). Type 2 diabetes has become one of the biggest long term health conditions in the UK and the world. Over 2 million people in the UK have type 2 diabetes. Age: peoples risk of type 2 diabetes goes up with age. Having a close family member such as a parent or sibling with type 2 diabetes. Some of these symptoms are the same for type 1 diabetes, but in type 2 diabetes they tend to develop more slowly over a period of months or years, making it harder sometimes for people to recognise them as signs of an underlying illness. Type 2 diabetes is frequently diagnosed following the results of either a fastin Continue reading >>

Diabetes Mellitus: Screening And Diagnosis

Diabetes Mellitus: Screening And Diagnosis

Diabetes mellitus is one of the most common diagnoses made by family physicians. Uncontrolled diabetes can lead to blindness, limb amputation, kidney failure, and vascular and heart disease. Screening patients before signs and symptoms develop leads to earlier diagnosis and treatment, but may not reduce rates of end-organ damage. Randomized trials show that screening for type 2 diabetes does not reduce mortality after 10 years, although some data suggest mortality benefits after 23 to 30 years. Lifestyle and pharmacologic interventions decrease progression to diabetes in patients with impaired fasting glucose or impaired glucose tolerance. Screening for type 1 diabetes is not recommended. The U.S. Preventive Services Task Force recommends screening for abnormal blood glucose and type 2 diabetes in adults 40 to 70 years of age who are overweight or obese, and repeating testing every three years if results are normal. Individuals at higher risk should be considered for earlier and more frequent screening. The American Diabetes Association recommends screening for type 2 diabetes annually in patients 45 years and older, or in patients younger than 45 years with major risk factors. The diagnosis can be made with a fasting plasma glucose level of 126 mg per dL or greater; an A1C level of 6.5% or greater; a random plasma glucose level of 200 mg per dL or greater; or a 75-g two-hour oral glucose tolerance test with a plasma glucose level of 200 mg per dL or greater. Results should be confirmed with repeat testing on a subsequent day; however, a single random plasma glucose level of 200 mg per dL or greater with typical signs and symptoms of hyperglycemia likely indicates diabetes. Additional testing to determine the etiology of diabetes is not routinely recommended. Clinical r Continue reading >>

8.4 Type 2 Diabetes

8.4 Type 2 Diabetes

Aboriginal and Torres Strait Islander peoples Age 0-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-79 > 80 Abnormal blood glucose is a modifiable risk factor for CVD and a diagnosis of diabetes substantially increases a person’s absolute CVD risk score. The Australian type 2 diabetes risk assesment tool (AUSDRISK) is useful in assessing risk of diabetes. Preventive interventions (refer to Table 8.4.3) have been shown to reduce progression to diabetes in patients with impaired fasting glucose. Patients at high risk should be screened for diabetes every three years from 40 years of age. Aboriginal and Torres Strait Islander peoples should have their risk of diabetes assessed every three years from 18 years of age. Screening should be part of a comprehensive CVD assessment including BP, lipids, smoking, physical activity, diet, overweight and obesity. Table 8.4.1. Type 2 diabetes: Identifying risk Who is at risk? What should be done? How often? Increased risk ≥40 years of age Aboriginal and Torres Strait Islander peoples aged ≥18 years AUSDRISK* (III, B)56 Every three years (III, C) High risk ≥40 years of age and being overweight or obese (refer to Section 7.2. Overweight) AUSDRISK score of 12 or more Consider screening the following groups because they may be at increased risk for diabetes at an earlier age or lower body mass index (BMI): first-degree relative with diabetes high-risk race/ethnicity (Indian subcontinent or Pacific Islanders) all people with a history of a previous cardiovascular event (eg acute myocardial infarction or stroke) women with a history of gestational diabetes mellitus women with polycystic ovary syndrome patients on antipsychotic drugs Fasting blood glucose (III, B) 57–59 OR glycated haemoglobin (HbA1c) E Continue reading >>

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