Understanding Diabetes Symptoms and Treatment

2020-07-24T15:03:00.001+08:00

About Diabetes and Pre-diabetes

Diabetes is a serious chronic disease that can be managed through lifestyle changes and medication. According to the National Diabetes Education Program (NDEP), more than 23 million Americans have diabetes. Also, about 57 million American adults aged 20 and older have pre-diabetes. Whether you just found out you have diabetes or have been dealing with it for years, you can control your diabetes and live a long and active life. If you are at risk or have pre-diabetes, you can take small steps to prevent the disease. (National Diabetes Education Program, National Institutes of Health)

What Is Diabetes?
If you just found out you have diabetes or want to know more about the disease, this section will help answer your questions. Learn more about the different types of diabetes, including their causes, risk factors, symptoms, and complications.

Diabetes Prevention
Diabetes prevention is proven, possible, and powerful. Learn more about the risks for developing type 2 diabetes and the "small steps" you can take to delay or prevent the disease before it starts.

More Diabetes Resources
Get more information and resources about diabetes control and prevention.

Diabetes Organizations (Opens in a new window)
Diabetes may be difficult to manage, but you don't have to do it alone. Learn about organizations in your community that can help. (Note: The link will take you to the National Diabetes Information Clearinghouse Directory of Diabetes Organizations)

Photo Credit: National Institute of Aging, National Institutes of Health and the Administration on Aging, Department of Health and Human Services.
This Page Last Updated: September 5, 2010
Last Reviewed : September 5, 2010
By: David Mangusan Jr., PTRP

Diabetes Risk at School

2010-09-08T09:09:00.000+08:00

School Environment Affects Diabetes Risk, According to an NIH-funded Study

Healthier foods at school, longer and more intense physical activity and lessons in healthy lifestyles can reduce obesity and other risk factors for diabetes. These findings, from a National Institutes of Health (NIH)-funded study, suggest that school-based changes might help at-risk kids improve their health.

Nearly 1 in 5 school-age children in the U.S. is obese. This excess weight can lead to many health problems. The most serious is type 2 diabetes.

The new study was conducted at 42 middle schools where many students are minorities or from low-income families. Half the schools were randomly chosen to use the study’s “intervention” program: longer gym classes, more nutritious foods and education in healthy behaviors.

About 4,600 students were tracked from the beginning of 6th to the end of 8th grade. At the start, nearly half were overweight or obese. Many had other signs of high diabetes risk.

At the end of the study, kids who had been overweight or obese at the intervention schools had a 21% lower obesity rate than those at the comparison schools. Other diabetes risk factors, like larger waist size, also fell more at the intervention schools.

“The study shows that a school-based program can help lower obesity and certain risk factors for type 2 diabetes in youth at high risk for the disease,” says Dr. Griffin P. Rodgers, director of NIH’s National Institute of Diabetes and Digestive and Kidney Diseases.

Source: The above health article is reprinted, with editorial adaptations, from materials provided by the NIH News in Health. Accessed on September 7, 2010.

NIH Study Shows How Insulin Stimulates Fat Cells to Take in Glucose

2010-09-08T00:37:00.001+08:00

"The new findings could aid in understanding diabetes and other related conditions."

Using high-resolution microscopy, researchers at the National Institutes of Health have shown how insulin prompts fat cells to take in glucose in a rat model. The findings were reported in the Sept. 8 issue of the journal Cell Metabolism.

By studying the surface of healthy, live fat cells in rats, researchers were able to understand the process by which cells take in glucose. Next, they plan to observe the fat cells of people with varying degrees of insulin sensitivity, including insulin resistance — considered a precursor to type 2 diabetes. These observations may help identify the interval when someone becomes at risk for developing diabetes.

"What we're doing here is actually trying to understand how glucose transporter proteins called GLUT4 work in normal, insulin-sensitive cells," said Karin G. Stenkula, Ph.D., a researcher at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and a lead author of the paper. "With an understanding of how these transporters in fat cells respond to insulin, we could detect the differences between an insulin-sensitive cell and an insulin-resistant cell, to learn how the response becomes impaired. We hope to identify when a person becomes pre-diabetic, before they go on to develop diabetes."

Glucose, a simple sugar, provides energy for cell functions. After food is digested, glucose is released into the bloodstream. In response, the pancreas secretes insulin, which directs the muscle and fat cells to take in glucose. Cells obtain energy from glucose or convert it to fat for long-term storage.

Like a key fits into a lock, insulin binds to receptors on the cell's surface, causing GLUT4 molecules to come to the cell's surface. As their name implies, glucose transporter proteins act as vehicles to ferry glucose inside the cell.

To get detailed images of how GLUT4 is transported and moves through the cell membrane, the researchers used high-resolution imaging to observe GLUT4 that had been tagged with a fluorescent dye.

The researchers then observed fat cells suspended in a neutral liquid and later soaked the cells in an insulin solution, to determine the activity of GLUT4 in the absence of insulin and in its presence.

In the neutral liquid, the researchers found that individual molecules of GLUT4 as well as GLUT4 clusters were distributed across the cell membrane in equal numbers. Inside the cell, GLUT4 was contained in balloon-like structures known as vesicles. The vesicles transported GLUT4 to the cell membrane and merged with the membrane, a process known as fusion.

After fusion, the individual molecules of GLUT4 are the first to enter the cell membrane, moving at a continuous but relatively infrequent rate. The researchers termed this process fusion with release.

When exposed to insulin, however, the rate of total GLUT4 entry into the cell membrane peaked, quadrupling within three minutes. The researchers saw a dramatic rise in fusion with release — 60 times more often on cells exposed to insulin than on cells not exposed to insulin.

After exposure to insulin, a complex sequence occurred, with GLUT4 shifting from clusters to individual GLUT4 molecules. Based on the total amount of glucose the cells took in, the researchers deduced that glucose was taken into the cell by individual GLUT4 molecules as well as by clustered GLUT4. The researchers also noted that after four minutes, entry of GLUT4 into the cell membrane started to decrease, dropping to levels observed in the neutral liquid in 10 to 15 minutes.

"The magnitude of this change shows just how important the regulation of this process is for the survival of the cell and for the normal function of the whole body," said Joshua Zimmerberg, Ph.D., M.D., the paper's senior author and director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Program in Physical Biology.

The research team next plans to examine the activity of glucose transporters in human fat cells, Zimmerberg said. "Understanding how insulin prepares the cell for glucose uptake may lead to ideas for stimulating this activity when the cells become resistant to insulin."

Stenkula and Samuel W. Cushman, Ph.D., of NIDDK worked with NICHD investigators Vladimir A. Lizunov, Ph.D. and Zimmerberg to complete the research.

Source:
The above health news story is reprinted from materials provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Accessed on September 8, 2010

Glucose Meter: What to Consider When Buying Your Own

2010-02-17T09:34:00.002+08:00

Millions of people get diagnosed with diabetes each year worldwide. Moreover, there are many people who don’t even know that they have the disease. Getting tested for diabetes is necessary as complications of the disease could be prevented.

A glucose meter can be used to detect if you have elevated blood sugar. A glucose meter is a blood sugar testing device that can be used at home. Most of the glucose meters today have results that are comparable with laboratory results.

Pharmaceutical companies have developed home-use glucose meters that can be used to monitor blood sugar. However, these glucose meters differ from one another in terms of how much blood sample is needed, easy usability, testing speed and costs, among others.

So how do you choose a glucose meter that’s right for you? What should you consider when buying your own glucose meter?

In choosing a glucose meter or blood sugar testing device, several factors have to be considered.

How easy is it to use the glucose meter. Easy usability of the glucose meter should be considered when choosing a meter. Certain meters may have so many additional features. However, additional features may equate to a higher price. Also, some glucose meter features may be so complex that it takes time to get used to.

Consider buying a glucose meter that’s able to store glucose readings, which can be easily accessed for future comparison.

The cost of the glucose meter. This is probably one of the most common factor being considered by diabetics in choosing a glucose meter. Many glucose meters differ in prices. However, a higher-priced meter does not mean it is more effective in detecting blood sugar than the low-cost one.

Make sure that when you buy a glucose meter, it has been approved by the US Food and Drug Administration (FDA) and has passed quality standards.

The cost of glucose test strips. While some glucose meters may have lower-prices, the test strips that are used may be high-priced. Choosing a high priced meter with lower-priced test strips may be more beneficial for the diabetic in the long run.

Some of the glucose meters may accept generic strips, which are far cheaper than the recommended manufacturer’s test strips. However, make sure that the glucose meter does accept generic strips and it works well with it.

Health care provider’s recommendation. The best source for information about what glucose meter is best for you and how to use it is your doctor or healthcare provider.

Other things that you may want to consider when choosing the right glucose meter for you are: the overall size of the meter; accuracy and testing speed; and screen display size.

The ability to measure one’s blood sugar is essential, especially for people with diabetes. Even people who are not diagnosed with diabetes but with a family member who has it can test their own blood sugar. Early recognition of diabetes is important to prevent future complications.

One important thing to consider, though, is that the results from your glucose meter should not be used to diagnose yourself but rather important information that you should share with your healthcare provider. Only the doctor can tell you if you have diabetes or not.

Source:
Glucose Testing Devices (February 2010). Retrieved on February 11, 2010 from http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/InVitroDiagnostics/GlucoseTestingDevices/default.htm

Insulin Pens and Insulin Cartridges Must Not be Shared

2009-03-19T07:29:00.002+08:00

Insulin pens are safe, only if used for one patient (one device for only one patient). Sharing of insulin pens may cause transmission of blood-borne pathogens such as HIV and hepattis viruses.

Insulin pens are pen-shaped injector devices that contain a disposable needle and either an insulin reservoir or an insulin cartridge. The devices typically contain enough insulin for a patient to self-administer several doses of insulin before the reservoir or cartridge is empty.

The U.S. Food and Drug Administration today issued an alert to health care professionals reminding them that single-patient insulin pens and insulin cartridges should not be used to administer medication to multiple patients due to the potential risk of transmitting blood-borne pathogens such as HIV and the hepatitis viruses.

The FDA is aware of incidents at two undisclosed hospitals involving more than 2,000 people in which the cartridge component of the insulin pens were used to administer insulin to multiple patients, although the disposable needles were reportedly changed among patients.

“Insulin pens are designed to be safe for one patient to use one pen multiple times with a new, fresh needle for each injection,” said Amy Egan, M.D., deputy director of safety at the FDA’s Division of Metabolism and Endocrinology Products in the Center for Drug Evaluation and Research. “Insulin pens are not designed, and are not safe, for one pen to be used by more than one patient, even if needles are changed between patients due to the risk of transmitting blood-borne pathogens.”

Patients exposed to shared insulin pens are being contacted by the two hospitals and are being offered testing for hepatitis and HIV. Some of the potentially exposed patients have reportedly tested positive for the hepatitis C virus, although it is not known if the virus was spread as a result of insulin pen sharing.

The FDA is working with the Centers for Disease Control and Prevention and professional organizations to address infection control issues related to insulin pens.

Source: US FDA News, March 19, 2009

Diabetes in Teens

2009-02-15T13:34:00.002+08:00

According to the National Diabetes Education Program (NDEP), about 186,300 young people under 20 years of age have type 1 and type 2 diabetes. As obesity rates in children continue to soar, type 2 diabetes, a disease that used to be seen primarily in adults over age 45, is becoming more common in young people. Children with diabetes and their families, health care providers, and school personnel face unique challenges when dealing with diabetes. Learn more about diabetes in young people and how to help them manage the disease and ensure their health and well-being.

What is Diabetes?

Diabetes, or diabetes mellitus, means that your blood sugar, also called blood glucose, is too high. Glucose formed from the food you eat and is needed to fuel our bodies. Glucose is also stored in our liver and muscles. Your blood always has some glucose in it because your body needs glucose for energy. But having too much glucose in your blood is not healthy.

Insulin (IN-suh-lin), made by an organ called pancreas, helps glucose get from your blood into your cells. The cells then take the glucose and turn it into energy

If you have diabetes, the pancreas makes little or no insulin or your cells cannot use insulin very well. Glucose builds up in your blood and cannot get into your cells. Having too high blood sugar levels can damage many parts of the body, such as the heart, kidneys, nerves, and eyes.

Are there different types of diabetes?

Yes. The three main types of diabetes are type 1, type 2, and gestational diabetes.

In type 1 diabetes, the cells in the pancreas that make insulin are destroyed. If you have type 1 diabetes, you need to get insulin from shots or a pump everyday. Most teens can learn to adjust the amount of insulin they take according to their physical activity and eating patterns. This makes it easier to manage your diabetes when you have a busy schedule. Type 1 used to be called “insulin dependent” or “juvenile” diabetes.

In type 2 diabetes, the pancreas still makes some insulin but cells cannot use it very well. If you have type 2 diabetes, you may need to take insulin or pills to help your body’s supply of insulin work better. Type 2 used to be called “adult onset diabetes.” Now more teens are getting type 2, especially if they are overweight.

Gestational (jes-TAY-shon-al) diabetes is a type of diabetes that occurs when women are pregnant. Having it raises their risk for getting diabetes, mostly type 2, for the rest of their lives. It also raises their child’s risk for being overweight and for getting type 2 diabetes.

Why do teens get diabetes?

Both genes and things like viruses and toxins may cause a person to get type 1 diabetes. Studies are being done to identify the causes of type 1 diabetes and to stop the process that destroys the pancreas. According to the NDEP, researchers can now predict who is at risk for developing type 1 diabetes and in the future may be able to prevent or delay the onset of the disease.

Being overweight increases the risk for type 2 diabetes. Teens who make unhealthy food choices, are not physically active, or who have a family member with diabetes are more likely to get type 2 diabetes. Some racial groups have a greater chance of getting diabetes—American Indians, Alaska Natives, African Americans, Hispanics/Latinos, Asian Americans, and Pacific Islanders. It is not true that eating too much sugar causes diabetes.

Things you can do to take care of your diabetes.

The key to taking care of your diabetes is to keep your blood glucose as close to normal as possible. The best way to do this is to:

make healthy food choices

eat the right amounts of food

be active everyday

stay at a healthy weight

take your medicines and check your blood glucose as planned with your health care team

Your doctor will tell you what blood glucose level is right for you. Your goal is to keep your blood glucose as close to this level as you can. Your doctor or diabetes educator will teach you how to check your blood glucose with a glucose meter.

It helps to know what affects your blood glucose level. Food, illness, and stress raise your blood glucose. Insulin or pills and being physically active lower your blood glucose. Talk with your doctor or diabetes educator about how these things change your blood glucose levels and how you can make changes in your diabetes plan.

Carbohydrates (CAR-boh-HY-drates), or carbs for short, are a good source of energy for our bodies.But if you eat too many carbs at one time, your blood glucose can get too high. Many foods contain carbs. Great carb choices include whole grain foods, nonfat or low-fat milk, and fresh fruits and vegetables. Eat more of them rather than white bread, whole milk, sweetened fruit drinks, regular soda, potato chips, sweets, and desserts.

You need to take care of your diabetes.

If you take care of your diabetes you can lower your risk for other health problems. High blood glucose can harm blood vessels and cause heart attacks or strokes. It can also damage organs in the body and cause blindness, kidney failure, loss of toes or feet, gum problems, or loss of teeth.

The good news is that when you take care of your diabetes, you can reduce or avoid these problems.

Do not let diabetes stop you! You can do all the things your friends do and live a long and healthy life.

Source: Adapted from the National Diabetes Education Program (NDEP) available at www.ndep.nih.gov

Erectile Dysfunction (ED)

2008-03-03T15:51:00.004+08:00

Erectile dysfunction, sometimes called "impotence," is the repeated inability or difficulty to get or keep an erection firm enough for sexual intercourse. But the word "impotence" may also be used to describe problems, such as lack of sexual desire and problems with ejaculation or orgasm that interfere with sexual intercourse and reproduction. Using the term erectile dysfunction makes it clear that those other problems are not involved.

Erectile dysfunction, or ED, can be a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief erections. These variations make defining ED and estimating its incidence difficult. Estimates range from 15 million to 30 million, depending on the definition used. According to the National Ambulatory Medical Care Survey (NAMCS), for every 1,000 men in the United States, 7.7 physician office visits were made for ED in 1985. By 1999, that rate had nearly tripled to 22.3. The increase happened gradually, presumably as treatments such as vacuum devices and injectable drugs became more widely available and discussing erectile function became accepted. Perhaps the most publicized advance was the introduction of the oral drug sildenafil citrate (Viagra) in March 1998. NAMCS data on new drugs show an estimated 2.6 million mentions of Viagra at physician office visits in 1999, and one-third of those mentions occurred during visits for a diagnosis other than ED.

In older men, ED usually has a physical cause, such as disease, injury, or side effects of drugs. Any disorder that causes injury to the nerves or impairs blood flow in the penis has the potential to cause ED. Incidence increases with age: About 5 percent of 40-year-old men and between 15 and 25 percent of 65-year-old men experience ED. But it is not an inevitable part of aging.

ED is treatable at any age, and awareness of this fact has been growing. More men have been seeking help and returning to normal sexual activity because of improved, successful treatments for ED. Urologists, who specialize in problems of the urinary tract, have traditionally treated ED; however, urologists accounted for only 25 percent of Viagra mentions in 1999.

Source: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) (December 2005). Erectile Dysfunction (NIH Publication No. 06–3923). Retrieved March 3, 2008, from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health of the U.S. Department of Health and Human Services. Web site: http://kidney.niddk.nih.gov/kudiseases/pubs/impotence/index.htm

How does an erection occur?

2008-03-03T15:43:00.003+08:00

The penis contains two chambers called the corpora cavernosa, which run the length of the organ. A spongy tissue fills the chambers. The corpora cavernosa are surrounded by a membrane, called the tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosa and is surrounded by the corpus spongiosum.

Erection begins with sensory or mental stimulation, or both. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the spaces. The blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps trap the blood in the corpora cavernosa, thereby sustaining erection. When muscles in the penis contract to stop the inflow of blood and open outflow channels, erection is reversed.

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Erectile Dysfunction: Causes

2008-03-03T15:36:00.002+08:00

What causes erectile dysfunction (ED)?

Since an erection requires a precise sequence of events, ED can occur when any of the events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and area around the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.

Damage to nerves, arteries, smooth muscles, and fibrous tissues, often as a result of disease, is the most common cause of ED. Diseases—such as diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular disease, and neurologic disease—account for about 70 percent of ED cases. Between 35 and 50 percent of men with diabetes experience ED.

Lifestyle choices that contribute to heart disease and vascular problems also raise the risk of erectile dysfunction. Smoking, being overweight, and avoiding exercise are possible causes of ED.

Also, surgery (especially radical prostate and bladder surgery for cancer) can injure nerves and arteries near the penis, causing ED. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to ED by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa.

In addition, many common medicines—blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine (an ulcer drug)—can produce ED as a side effect.

Experts believe that psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure cause 10 to 20 percent of ED cases. Men with a physical cause for ED frequently experience the same sort of psychological reactions (stress, anxiety, guilt, depression). Other possible causes are smoking, which affects blood flow in veins and arteries, and hormonal abnormalities, such as not enough testosterone.

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ED: Diagnosis

2008-03-03T15:30:00.003+08:00

How is ED diagnosed?

Patient History

Medical and sexual histories help define the degree and nature of ED. A medical history can disclose diseases that lead to ED, while a simple recounting of sexual activity might distinguish among problems with sexual desire, erection, ejaculation, or orgasm.

Using certain prescription or illegal drugs can suggest a chemical cause, since drug effects account for 25 percent of ED cases. Cutting back on or substituting certain medications can often alleviate the problem.

Physical Examination

A physical examination can give clues to systemic problems. For example, if the penis is not sensitive to touching, a problem in the nervous system may be the cause. Abnormal secondary sex characteristics, such as hair pattern or breast enlargement, can point to hormonal problems, which would mean that the endocrine system is involved. The examiner might discover a circulatory problem by observing decreased pulses in the wrist or ankles. And unusual characteristics of the penis itself could suggest the source of the problem—for example, a penis that bends or curves when erect could be the result of Peyronie's disease.

Laboratory Tests

Several laboratory tests can help diagnose ED. Tests for systemic diseases include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes. Measuring the amount of free testosterone in the blood can yield information about problems with the endocrine system and is indicated especially in patients with decreased sexual desire.

Other Tests

Monitoring erections that occur during sleep (nocturnal penile tumescence) can help rule out certain psychological causes of ED. Healthy men have involuntary erections during sleep. If nocturnal erections do not occur, then ED is likely to have a physical rather than psychological cause. Tests of nocturnal erections are not completely reliable, however. Scientists have not standardized such tests and have not determined when they should be applied for best results.

Psychosocial Examination

A psychosocial examination, using an interview and a questionnaire, reveals psychological factors. A man's sexual partner may also be interviewed to determine expectations and perceptions during sexual intercourse.

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ED: Treatment

2008-03-03T15:23:00.003+08:00

How is ED treated?

Most physicians suggest that treatments proceed from least to most invasive. For some men, making a few healthy lifestyle changes may solve the problem. Quitting smoking, losing excess weight, and increasing physical activity may help some men regain sexual function.

Cutting back on any drugs with harmful side effects is considered next. For example, drugs for high blood pressure work in different ways. If you think a particular drug is causing problems with erection, tell your doctor and ask whether you can try a different class of blood pressure medicine.

Psychotherapy and behavior modifications in selected patients are considered next if indicated, followed by oral or locally injected drugs, vacuum devices, and surgically implanted devices. In rare cases, surgery involving veins or arteries may be considered.

Psychotherapy

Experts often treat psychologically based ED using techniques that decrease the anxiety associated with intercourse. The patient's partner can help with the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when ED from physical causes is being treated.

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ED: Treatment - Drug Therapy

2008-03-03T15:08:00.003+08:00

Drugs for treating ED can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis. In March 1998, the Food and Drug Administration (FDA) approved Viagra, the first pill to treat ED. Since that time, vardenafil hydrochloride (Levitra) and tadalafil (Cialis) have also been approved. Additional oral medicines are being tested for safety and effectiveness.

Viagra, Levitra, and Cialis all belong to a class of drugs called phosphodiesterase (PDE) inhibitors. Taken an hour before sexual activity, these drugs work by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow.

While oral medicines improve the response to sexual stimulation, they do not trigger an automatic erection as injections do. The recommended dose for Viagra is 50 mg, and the physician may adjust this dose to 100 mg or 25 mg, depending on the patient. The recommended dose for either Levitra or Cialis is 10 mg, and the physician may adjust this dose to 20 mg if 10 mg is insufficient. A lower dose of 5 mg is available for patients who take other medicines or have conditions that may decrease the body's ability to use the drug. Levitra is also available in a 2.5 mg dose.

None of these PDE inhibitors should be used more than once a day. Men who take nitrate-based drugs such as nitroglycerin for heart problems should not use either drug because the combination can cause a sudden drop in blood pressure. Also, tell your doctor if you take any drugs called alpha-blockers, which are used to treat prostate enlargement or high blood pressure. Your doctor may need to adjust your ED prescription. Taking a PDE inhibitor and an alpha-blocker at the same time (within 4 hours) can cause a sudden drop in blood pressure.

Oral testosterone can reduce ED in some men with low levels of natural testosterone, but it is often ineffective and may cause liver damage. Patients also have claimed that other oral drugs—including yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone—are effective, but the results of scientific studies to substantiate these claims have been inconsistent. Improvements observed following use of these drugs may be examples of the placebo effect, that is, a change that results simply from the patient's believing that an improvement will occur.

Many men achieve stronger erections by injecting drugs into the penis, causing it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine, and alprostadil (marketed as Caverject) widen blood vessels. These drugs may create unwanted side effects, however, including persistent erection (known as priapism) and scarring. Nitroglycerin, a muscle relaxant, can sometimes enhance erection when rubbed on the penis.

A system for inserting a pellet of alprostadil into the urethra is marketed as Muse. The system uses a prefilled applicator to deliver the pellet about an inch deep into the urethra. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes. The most common side effects are aching in the penis, testicles, and area between the penis and rectum; warmth or burning sensation in the urethra; redness from increased blood flow to the penis; and minor urethral bleeding or spotting.

Research on drugs for treating ED is expanding rapidly. Patients should ask their doctor about the latest advances.

*NOTE:Do not self medicate. Consult your doctor regarding medications for treating erectile dysfunction.

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ED: Treatment - Vacuum Devices

2008-03-03T15:01:00.002+08:00

Mechanical vacuum devices cause erection by creating a partial vacuum, which draws blood into the penis, engorging and expanding it. The devices have three components: a plastic cylinder, into which the penis is placed; a pump, which draws air out of the cylinder; and an elastic band, which is placed around the base of the penis to maintain the erection after the cylinder is removed and during intercourse by preventing blood from flowing back into the body.

One variation of the vacuum device involves a semirigid rubber sheath that is placed on the penis and remains there after erection is attained and during intercourse.

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ED: Treatment - Surgery

2008-03-03T14:45:00.003+08:00

Surgery usually has one of three goals:

to implant a device that can cause the penis to become erect
to reconstruct arteries to increase flow of blood to the penis
to block off veins that allow blood to leak from the penile tissues

Implanted devices, known as prostheses, can restore erection in many men with ED. Possible problems with implants include mechanical breakdown and infection, although mechanical problems have diminished in recent years because of technological advances.

Malleable implants usually consist of paired rods, which are inserted surgically into the corpora cavernosa. The user manually adjusts the position of the penis and, therefore, the rods. Adjustment does not affect the width or length of the penis.

Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid. Tubes connect the cylinders to a fluid reservoir and a pump, which are also surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. Inflatable implants can expand the length and width of the penis somewhat. They also leave the penis in a more natural state when not inflated.

Surgery to repair arteries can reduce ED caused by obstructions that block the flow of blood. The best candidates for such surgery are young men with discrete blockage of an artery because of an injury to the crotch or fracture of the pelvis. The procedure is almost never successful in older men with widespread blockage.

Surgery to veins that allow blood to leave the penis usually involves an opposite procedure—intentional blockage. Blocking off veins (ligation) can reduce the leakage of blood that diminishes the rigidity of the penis during erection. However, experts have raised questions about the long-term effectiveness of this procedure, and it is rarely done.

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Frequently Asked Questions About Diabetes

2007-07-24T14:35:00.000+08:00

Q. How can I reduce my chance of getting diabetes?

A. A study funded by the Federal government of 3,234 persons at high risk for diabetes showed that diet and exercise can sharply lower the risk of getting type 2 diabetes.

The Diabetes Prevention Program (DPP) was a major clinical study of ways to prevent or delay diabetes in persons at high risk for type 2 diabetes. Patients were overweight and had higher than normal levels of blood glucose, called impaired glucose tolerance. Both conditions are strong risk factors for type 2 diabetes. Because of the high risk among some minority groups, about half of the DPP participants were African American, American Indian, Asian American, Pacific Islander, or Hispanic.

The DPP compared two methods for preventing diabetes: (1) an intensive program of healthy eating and exercise and (2) the use of metformin, a diabetes drug. Persons who engaged in moderate physical activity for about 30 minutes a day, followed a low-fat and low-calorie diet, and lost 5 to 7 percent of their body weight (or about 12 pounds for someone who weighs 200 pounds) cut their risk of getting type 2 diabetes by about one half (58%). Those persons receiving metformin reduced their risk by one third (31%).

Source:
Diabetes Information. Questions and Answers About Diabetes and FDA. US Food and Drug Administration. April 2002.

Frequently Asked Questions About Diabetes

2007-07-24T14:02:00.000+08:00

Q. How will my doctor test me for diabetes?

A. Although the amount of glucose in your blood varies depending on when and what you eat, the range should be relatively narrow. In general, your blood sugar is highest after you eat and lowest after you have not eaten for 8-10 hours. After fasting all night, most persons have blood glucose levels between 70 and 110 milligrams of glucose per deciliter of blood (mg/dL). After eating a large meal, a person's blood sugar will rise, but generally not above 140 mg/dL. People with untreated diabetes will have higher blood sugars after fasting and after eating.

To check if you have diabetes, your doctor will test your blood sugar levels. The results of these tests and other clinical findings will be used to decide if you have diabetes and what type. Doctors cannot diagnose diabetes on the basis of one single test. Instead, they will perform two or more glucose tests before confirming your diagnosis. The most common tests to measure glucose are the fasting plasma glucose test, the random blood sugar test, and the oral glucose tolerance test.

Fasting plasma glucose test. Most experts recommend using a fasting plasma glucose test to diagnose diabetes. Before taking this test, you cannot eat anything for 8 to 10 hours. Blood will be drawn from a vein in your arm and sent to a laboratory for testing. If your fasting blood glucose is 126 mg/dL or higher, your doctor will probably diagnose you with diabetes.
Random blood sugar test. Many cases of diabetes are found during routine physical exams when blood is drawn for other tests. Since you don't necessarily fast before these physical exams, you may have just eaten and your blood sugar may be high. Even so, it shouldn't be higher than 200 mg/dL. If your random blood glucose is higher than 200 mg/dL, your doctor will probably suspect diabetes and may want to give you a fasting plasma glucose test.
Oral glucose tolerance test. In this test, a person consumes a drink containing glucose dissolved in water. Blood is then drawn in timed intervals over a three-hour period. If plasma glucose levels rise more than expected, the person is diagnosed with diabetes. This test is often used to check pregnant women for gestational diabetes. It is rarely used to diagnose diabetes in other patients, because it is cumbersome and time-consuming.

Source:
Diabetes Information. Questions and Answers About Diabetes and FDA. US Food and Drug Administration. April 2002.

Frequently Asked Questions About Diabetes

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Q. How do I know if I have diabetes?

A. As many as 50 percent (one-half) of persons with type 2 diabetes are unaware that they have the disease. For this reason, it is particularly important to pay attention to the signs and symptoms of diabetes and its risk factors.

Some of the signs of either type 1 or type 2 diabetes are:

being very thirsty
urinating often
feeling very hungry or tired
losing or gaining weight without trying
having sores that heal slowly
having dry, itchy skin
losing the feeling in your feet or having tingling in your feet
having blurry eyesight

Symptoms of type 1 diabetes often develop over a short period of time. In type 2 diabetes, symptoms develop more slowly, and some persons never have any symptoms of the disease. If you are regularly having any of these signs and symptoms, you should tell your doctor.

Source:
Diabetes Information. Questions and Answers About Diabetes and FDA. US Food and Drug Administration. April 2002

Hyperglycemia

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What You Need to Know About Hyperglycemia

If your blood glucose stays over 180, it may be too high. High blood glucose means you don’t have enough insulin in your body. High blood glucose, or “hyperglycemia,” can happen if you miss taking your diabetes medicine, eat too much, or don’t get enough exercise. Sometimes, the medicines you take for other problems cause high blood glucose. Be sure to tell your doctor about other medicines you take.

Having an infection, being sick, or under stress can also make your blood glucose too high. That’s why it’s very important to check your blood glucose and keep taking your diabetes medicines when you’re sick.

If you're very thirsty and tired, have blurry vision, and have to go to the bathroom often, your blood glucose may be too high. Very high blood glucose may also make you feel sick to your stomach.

If your blood glucose is high much of the time, or if you have symptoms of high blood glucose, call your doctor. You may need a change in your diabetes medicines, or a change in your meal plan.

Information provided by the National Diabetes Information Clearinghouse. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health. U.S. Department of Health and Human Services. NIH Publication No. 07– 4016, October 2006

Last Reviewed: June 15, 2007
By: David Mangusan Jr., PTRP

What’s the desirable blood glucose level?

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Everyone’s blood has some glucose in it. In people who don’t have diabetes, the normal range is about 70 to 120. Blood glucose goes up after eating but 1 or 2 hours later returns to the normal range.

Ask your health care team when you should check your blood glucose with a meter. Talk about whether the blood glucose targets listed below are best for you.

Blood glucose targets for most people with diabetes

Before meals
90 to 130

1 to 2 hours after the start of a meal
less than 180

It may be hard to reach your target range all of the time. But the closer you get to your goal, the more you will reduce your risk of diabetes-related problems and the better you will feel. Every step helps.

Information provided by the National Diabetes Information Clearinghouse. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health. U.S. Department of Health and Human Services. NIH Publication No. 07– 4016, October 2006

Last Reviewed: June 15, 2007
By: David Mangusan Jr., PTRP

Signs and Symptoms of Diabetes

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What are the signs and symptoms of diabetes?

The signs and symptoms of diabetes are

being very thirsty

urinating often

feeling very hungry or tired

losing weight without trying

having sores that heal slowly

having dry, itchy skin

losing the feeling in your feet or having tingling in your feet

having blurry eyesight

You may have had one or more of these signs before you found out you had diabetes. Or you may have had no signs at all. A blood test to check your glucose levels will show if you have pre-diabetes or diabetes.

Information provided by the National Diabetes Information Clearinghouse. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health of the U.S. Department of Health and Human Services. NIH Publication No. 07– 4016, October 2006.

Image Credit: NIDDK Image Library. National Institute of Diabetes and Digestive and Kidney Diseases.

Frequently Asked Questions

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What is Diabetes?

Who gets Diabetes?

How do I know if I have diabetes?

How will my doctor test me for diabetes?

What's the desirable blood glucose level?

Frequently Asked Questions About Diabetes Complications.

How can I reduce my chance of getting diabetes?

Frequently Asked Questions About Exercise and Diabetes.

Image Credit: National Institute of Aging, National Institutes of Health and the Administration on Aging, Department of Health and Human Services.
This Page Last Updated: July 24, 2007
This Page Last Reviewed: July 24, 2007
Reviewed by: D.K. Mangusan Jr., PTRP

Hypoglycemia

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Overview

Hypoglycemia, also called low blood sugar, occurs	Related Topics
when your blood glucose (blood sugar) level drops too low to provide enough energy for your body's activities. In adults or children older than 10 years, hypoglycemia is uncommon except as a side effect of diabetes treatment, but it can result from other medications or diseases, hormone or enzyme deficiencies, or tumors.	Hypoglycemia in People Who Have Diabetes Hypoglycemia in People Who Do Not Have Diabetes **Treatment of Hypoglycemia

Glucose, a form of sugar, is an important fuel for your body. Carbohydrates are the main dietary sources of glucose. Rice, potatoes, bread, tortillas, cereal, milk, fruit, and sweets are all carbohydrate-rich foods.

After a meal, glucose molecules are absorbed into your bloodstream and carried to the cells, where they are used for energy. Insulin, a hormone produced by your pancreas, helps glucose enter cells. If you take in more glucose than your body needs at the time, your body stores the extra glucose in your liver and muscles in a form called glycogen. Your body can use the stored glucose whenever it is needed for energy between meals. Extra glucose can also be converted to fat and stored in fat cells.

When blood glucose begins to fall, glucagon, another hormone produced by the pancreas, signals the liver to break down glycogen and release glucose, causing blood glucose levels to rise toward a normal level. If you have diabetes, this glucagon response to hypoglycemia may be impaired, making it harder for your glucose levels to return to the normal range.

Symptoms

Symptoms of hypoglycemia include

 hunger
 nervousness and shakiness
 perspiration
 dizziness or light-headedness
 sleepiness
 confusion
 difficulty speaking
 feeling anxious or weak

Hypoglycemia can also happen while you are sleeping. You might

 cry out or have nightmares
 find that your pajamas or sheets are damp from perspiration
 feel tired, irritable, or confused when you wake up

References:
Diabetes Dictionary. National Diabetes Information Clearinghouse. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health of the U.S. Department of Health and Human Services. NIH Publication No. 07–3016, October 2006

National Diabetes Information Clearinghouse. Hypoglycemia. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health of the U.S. Department of Health and Human Services. NIH Publication No. 03–3926, March 2003

Hypoglycemia and Diabetes

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Hypoglycemia: A Side Effect of Diabetes Medications

Hypoglycemia can occur in people with diabetes who take certain medications to keep their blood glucose levels in control. Usually hypoglycemia is mild and can easily be treated by eating or drinking something with carbohydrate. But left untreated, hypoglycemia can lead to loss of consciousness. Although hypoglycemia can happen suddenly, it can usually be treated quickly, bringing your blood glucose level back to normal.

Causes of Hypoglycemia

In people taking certain blood-glucose lowering medications, blood glucose can fall too low for a number of reasons:

 meals or snacks that are too small, delayed, or skipped
 excessive doses of insulin or some diabetes medications, including sulfonylureas and meglitinides (Alpha-glucosidase inhibitors, biguanides, and thiazolidinediones alone should not cause hypoglycemia but can when used with other diabetes medicines.)
 increased activity or exercise
 excessive drinking of alcohol

Prevention

Your diabetes treatment plan is designed to match your medication dosage and schedule to your usual meals and activities. If you take insulin but then skip a meal, the insulin will still lower your blood glucose, but it will not find the food it is designed to break down. This mismatch might result in hypoglycemia.

To help prevent hypoglycemia, you should keep in mind several things:

 Your diabetes medications. Some medications can cause hypoglycemia. Ask your health care provider if yours can. Also, always take medications and insulin in the recommended doses and at the recommended times.

What to Ask Your Doctor About Your Diabetes Medications

 Could my diabetes medication cause hypoglycemia?
 When should I take my
diabetes medication?
 How much should I take?
 Should I keep taking my
diabetes medication if I am sick?
 Should I adjust my medication before exercise?

 Your meal plan. Meet with a registered dietitian and agree on a meal plan that fits your preferences and lifestyle. Do your best to follow this meal plan most of the time. Eat regular meals, have enough food at each meal, and try not to skip meals or snacks.

 Your daily activity. Talk to your health care team about whether you should have a snack or adjust your medication before sports or exercise. If you know that you will be more active than usual or will be doing something that is not part of your normal routine—shoveling snow, for example—consider having a snack first.

 Alcoholic beverages. Drinking, especially on an empty stomach, can cause hypoglycemia, even a day or two later. If you drink an alcoholic beverage, always have a snack or meal at the same time.

 Your diabetes management plan. Intensive diabetes management—keeping your blood glucose as close to the normal range as possible to prevent long-term complications—can increase the risk of hypoglycemia. If your goal is tight control, talk to your health care team about ways to prevent hypoglycemia and how best to treat it if it does occur.

Normal and target blood glucose ranges	(mg/dL)
Normal blood glucose levels in people who do not have diabetes
Upon waking (fasting)	70 to 110
After meals	70 to 140
Target blood glucose levels in people who have diabetes
Before meals	90 to 130
1 to 2 hours after the start of a meal	less than 180
Hypoglycemia (low blood glucose)	70 or below

(Source: National Diabetes Information Clearinghouse, March 2003.)

Hypoglycemia and Diabetes- Treatment

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Treatment

Normal and target blood glucose ranges	(mg/dL)
Normal blood glucose levels in people who do not have diabetes
Upon waking (fasting)	70 to 110
After meals	70 to 140
Target blood glucose levels in people who have diabetes
Before meals	90 to 130
1 to 2 hours after the start of a meal	less than 180
Hypoglycemia (low blood glucose)	70 or below

(Source: National Diabetes Information Clearinghouse, March 2003.)

If you think your blood glucose is too low, use a blood glucose meter to check your level. If it is 70 mg/dL or below, have one of these "quick fix" foods right away to raise your blood glucose:

 2 or 3 glucose tablets
 1/2 cup (4 ounces) of any fruit juice
 1/2 cup (4 ounces) of a regular (not diet) soft drink
 1 cup (8 ounces) of milk
 5 or 6 pieces of hard candy
 1 or 2 teaspoons of sugar or honey

After 15 minutes, check your blood glucose again to make sure that it is no longer too low. If it is still too low, have another serving. Repeat these steps until your blood glucose is at least 70. Then, if it will be an hour or more before your next meal, have a snack.

If you take insulin or a diabetes medication that can cause hypoglycemia, always carry one of the quick-fix foods with you. Wearing a medical identification bracelet or necklace is also a good idea.

Exercise can also cause hypoglycemia. Check your blood glucose before you exercise.

Severe hypoglycemia can cause you to lose consciousness. In these extreme cases when you lose consciousness and cannot eat, glucagon can be injected to quickly raise your blood glucose level. Ask your health care provider if having a glucagon kit at home and at work is appropriate for you. This is particularly important if you have type 1 diabetes. Your family, friends, and co-workers will need to be taught how to give you a glucagon injection in an emergency.

Prevention of hypoglycemia while you are driving a vehicle is especially important. Checking blood glucose frequently and snacking as needed to keep your blood glucose above 70 mg/dL will help prevent accidents.

Reference:
National Diabetes Information Clearinghouse. Hypoglycemia. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health of the U.S. Department of Health and Human Services. NIH Publication No. 03–3926, March 2003

Hypoglycemia in People Who Do Not Have Diabetes

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Two types of hypoglycemia can occur in people who do not have diabetes: reactive (postprandial, or after meals) and fasting (postabsorptive). Reactive hypoglycemia is not usually related to any underlying disease; fasting hypoglycemia often is.

Symptoms

Symptoms of both types resemble the symptoms that people with diabetes and hypoglycemia experience: hunger, nervousness, perspiration, shakiness, dizziness, light-headedness, sleepiness, confusion, difficulty speaking, and feeling anxious or weak.

If you are diagnosed with hypoglycemia, your doctor will try to find the cause by using laboratory tests to measure blood glucose, insulin, and other chemicals that play a part in the body's use of energy.

View Topics About:

References:
Diabetes Dictionary. National Diabetes Information Clearinghouse. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health of the U.S. Department of Health and Human Services. NIH Publication No. 07–3016, October 2006

National Diabetes Information Clearinghouse. Hypoglycemia. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health of the U.S. Department of Health and Human Services. NIH Publication No. 03–3926, March 2003

Reactive Hypoglycemia

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In reactive hypoglycemia, symptoms appear within 4 hours after you eat a meal.

Diagnosis

To diagnose reactive hypoglycemia, your doctor may

 ask you about signs and symptoms
 test your blood glucose while you are having symptoms (The doctor will take a blood sample from your arm and send it to a laboratory for analysis. A personal blood glucose monitor cannot be used to diagnose reactive hypoglycemia.)
 check to see whether your symptoms ease after your blood glucose returns to 70 or above (after eating or drinking)

A blood glucose level of less than 70 mg/dL at the time of symptoms and relief after eating will confirm the diagnosis.

The oral glucose tolerance test is no longer used to diagnose hypoglycemia; experts now know that the test can actually trigger hypoglycemic symptoms.

Causes and Treatment

The causes of most cases of reactive hypoglycemia are still open to debate. Some researchers suggest that certain people may be more sensitive to the body's normal release of the hormone epinephrine, which causes many of the symptoms of hypoglycemia. Others believe that deficiencies in glucagon secretion might lead to hypoglycemia.

A few causes of reactive hypoglycemia are certain, but they are uncommon. Gastric (stomach) surgery, for instance, can cause hypoglycemia because of the rapid passage of food into the small intestine. Also, rare enzyme deficiencies diagnosed early in life, such as hereditary fructose intolerance, may cause reactive hypoglycemia.

To relieve reactive hypoglycemia, some health professionals recommend taking the following steps:

 eat small meals and snacks about every 3 hours
 exercise regularly
 eat a variety of foods, including meat, poultry, fish, or nonmeat sources of protein; starchy foods such as whole-grain bread, rice, and potatoes; fruits; vegetables; and dairy products
 choose high-fiber foods
 avoid or limit foods high in sugar, especially on an empty stomach

Your doctor can refer you to a registered dietitian for personalized meal planning advice. Although some health professionals recommend a diet high in protein and low in carbohydrates, studies have not proven the effectiveness of this kind of diet for reactive hypoglycemia.

See Also:

Fasting Hypoglycemia

Frequently Asked Questions

2007-06-02T10:45:00.000+08:00

Diabetes- Complications and Other Related Health Concerns

I. Heart and Blood Vessels

II. Eyes

III. Kidneys

IV. Nerves

V. Feet

VI. Digestion and Oral Health

VII. Others

View Online References for Diabetes- Complications and Other Related Health Concerns

This Page Last Updated: June 6, 2007
This Page Last Reviewed: June 6, 2007
Reviewed By: D.K. Mangusan Jr., PTRP

Diabetes- Complications and Other Related Health Concerns cont'd...

2007-06-02T09:05:00.000+08:00

On this page:

How can diabetes affect cardiovascular health?
How are cholesterol, triglyceride, weight, and blood pressure problems related to diabetes?
How can I be “heart healthy” and avoid cardiovascular disease if I have diabetes?

How can diabetes affect cardiovascular health?

Cardiovascular disease is the leading cause of early death among people with diabetes. Adults with diabetes are two to four times more likely than people without diabetes to have heart disease or experience a stroke. At least 65% of people with diabetes die from heart disease or stroke. About 70% of people with diabetes also have high blood pressure.

How are cholesterol, triglyceride, weight, and blood pressure problems related to diabetes?

People with type 2 diabetes have high rates of cholesterol and triglyceride abnormalities, obesity, and high blood pressure, all of which are major contributors to higher rates of cardiovascular disease. Many people with diabetes have several of these conditions at the same time. This combination of problems is often called metabolic syndrome (formerly known as Syndrome X). The metabolic syndrome is often defined as the presence of any three of the following conditions:

1) excess weight around the waist;
2) high levels of triglycerides;
3) low levels of HDL, or "good," cholesterol;
4) high blood pressure; and
5) high fasting blood glucose levels.

If you have one or more of these conditions, you are at an increased risk for having one or more of the others. The more conditions that you have, the greater the risk to your health.

How can I be “heart healthy” and avoid cardiovascular disease if I have diabetes?

To protect your heart and blood vessels, eat right, get physical activity, don’t smoke, and maintain healthy blood glucose, blood pressure, and cholesterol levels. Choose a healthy diet, low in salt. Work with a dietitian to plan healthy meals. If you’re overweight, talk about how to safely lose weight. Ask about a physical activity or exercise program. Quit smoking if you currently do. Get a hemoglobin A1C test at least twice a year to determine what your average blood glucose level was for the past 2 to 3 months. Get your blood pressure checked at every doctor’s visit, and get your cholesterol checked at least once a year. Take medications if prescribed by your doctor.

View Online References for Diabetes- Complications and Other Related Health Concerns.

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This Page Last Reviewed: June 2, 2007

Diabetes- Complications and Other Related Health Concerns cont'd...

2007-06-02T08:58:00.000+08:00

On this page:

How can diabetes affect the eyes?
How can I keep my eyes healthy if I have diabetes?

How can diabetes affect the eyes?

In diabetic eye disease, high blood glucose and high blood pressure cause small blood vessels to swell and leak liquid into the retina of the eye, blurring the vision and sometimes leading to blindness. People with diabetes are also more likely to develop cataracts – a clouding of the eye’s lens, and glaucoma – optic nerve damage. Laser surgery can help these conditions.

How can I keep my eyes healthy if I have diabetes?

There’s a lot you can do to prevent eye problems. A recent study shows that keeping your blood glucose level closer to normal can prevent or delay the onset of diabetic eye disease. Keeping your blood pressure under control is also important. Finding and treating eye problems early can help save sight.

It is best to have an eye doctor give you a dilated eye exam at least once a year. The doctor will use eye drops to enlarge (dilate) your pupils to examine the backs of your eyes. Your eyes will be checked for signs of cataracts or glaucoma, problems that people with diabetes are more likely to get.

Because diabetic eye disease may develop without symptoms, regular eye exams are important for finding problems early. Some people may notice signs of vision changes. If you’re having trouble reading, if your vision is blurred, or if you’re seeing rings around lights, dark spots, or flashing lights, you may have eye problems. Be sure to tell your health care team or eye doctor about any eye problems you may have.

View Online References for Diabetes- Complications and Other Related Health Concerns.

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This Page Last Reviewed: June 2, 2007

Diabetes- Complications and Other Related Health Concerns cont'd...

2007-06-02T08:51:00.002+08:00

On this Page:

How can diabetes affect the kidneys?
How can I keep my kidneys healthy if I have diabetes?

How can diabetes affect the kidneys?

In diabetic kidney disease (also called diabetic nephropathy), cells and blood vessels in the kidneys are damaged, affecting the organs’ ability to filter out waste. Waste builds up in your blood instead of being excreted. In some cases this can lead to kidney failure. When the kidneys fail, a person has to have his or her blood filtered through a machine (a treatment called dialysis) several times a week, or has to get a kidney transplant.

How can I keep my kidneys healthy if I have diabetes?

There’s a lot you can do to prevent kidney problems. A recent study shows that controlling your blood glucose can prevent or delay the onset of kidney disease. Keeping your blood pressure under control is also important.

Diabetic kidney disease happens slowly and silently, so you might not feel that anything is wrong until severe problems have developed. Therefore, it is important to get your blood and urine checked for kidney problems each year.

Your doctor can learn how well your kidneys are working by testing every year for microalbumin (a protein) in the urine. Microalbumin in the urine is an early sign of diabetic kidney disease. Your doctor can also do a yearly blood test to measure your kidney function.

Go to the doctor if you develop a bladder or kidney infection; symptoms include cloudy or bloody urine, pain or burning when you urinate, an urgent need to urinate often, back pain, chills, or fever.

The Kidney Health Care web site has more comprehensive discussions about kidney disease and diabetic nephropathy.

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This Page Last Reviewed: June 2, 2007

Diabetes- Complications and Other Related Health Concerns cont'd...

2007-06-02T08:42:00.000+08:00

On this page:

How can diabetes affect nerve endings?
How can I prevent nerve damage if I have diabetes?

How can diabetes affect nerve endings?

Having high blood glucose for many years can damage the blood vessels that bring oxygen to some nerves, as well as the nerve coverings. Damaged nerves may stop sending messages, or send messages too slowly or at the wrong times. Numbness, pain, and weakness in the hands, arms, feet, and legs may develop. Problems may also occur in various organs, including the digestive tract, heart, and sex organs. Diabetic neuropathy is the medical term for damage to the nervous system from diabetes. The most common type is peripheral neuropathy, which affects the arms and legs.

An estimated 50% of those with diabetes have some form of neuropathy, but not all with neuropathy have symptoms. People with diabetes can develop nerve problems at any time, but the longer a person has diabetes, the greater the risk. The highest rates of neuropathy are among people who have had the disease for at least 25 years.

Diabetic neuropathy also appears to be more common in people who have had problems controlling their blood glucose levels, in those with high levels of blood fat and blood pressure, in overweight people, and in people over the age of 40.

How can I prevent nerve damage if I have diabetes?

You can help keep your nervous system healthy by keeping your blood glucose as close to normal as possible, getting regular physical activity, not smoking, taking good care of your feet each day (see below), having your health care provider examine your feet at least 4 times a year, and getting your feet tested for nerve damage at least once a year.

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2007-06-02T08:24:00.000+08:00

On this page:

Why is it especially important to take care of my feet if I have diabetes?
What should I do on a regular basis to take care of my feet?

Why is it especially important to take care of my feet if I have diabetes?

Nerve damage, circulation problems, and infections can cause serious foot problems for people with diabetes. Sometimes nerve damage can deform or misshape your feet, causing pressure points that can turn into blisters, sores, or ulcers. Poor circulation can make these injuries slow to heal. Sometimes this can lead to amputation of a toe, foot, or leg.

What should I do on a regular basis to take care of my feet?

Look for cuts, cracks, sores, red spots, swelling, infected toenails, splinters, blisters, and calluses on the feet each day. Call your doctor if such wounds do not heal after one day.
If you have corns and calluses, ask your doctor or podiatrist about the best way to care for them.
Wash your feet in warm—not hot—water and dry them well.
Cut your toenails once a week or when needed. Cut toenails when they are soft from washing. Cut them to the shape of the toe and not too short. File the edges with an emery board.
Rub lotion on the tops and bottoms of feet—but not between the toes—to prevent cracking and drying.
Wear shoes that fit well. Break in new shoes slowly, by wearing them 1 to 2 hours each day for the first 1 to 2 weeks.
Wear stockings or socks to avoid blisters and sores.
Wear clean, lightly padded socks that fit well; seamless socks are best.
Always wear shoes or slippers, because when you are barefoot it is easy to step on something and hurt your feet.
Protect your feet from extreme heat and cold.
When sitting, keep the blood flowing to your lower limbs by propping your feet up and moving your toes and ankles for a few minutes at a time.
Avoid smoking, which reduces blood flow to the feet.
Keep your blood sugar, blood pressure, and cholesterol under control by eating healthy foods, staying active, and taking your diabetes medicines.

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Diabetes- Complications and Other Related Health Concerns cont'd...

2007-06-01T15:58:00.000+08:00

On this page:

How can diabetes affect the digestion?
How can diabetes affect oral health?
How can I keep my mouth, gums, and teeth healthy if I have diabetes?

How can diabetes affect the digestion?

Gastroparesis, otherwise known as delayed gastric emptying, is a disorder where, due to nerve damage, the stomach takes too long to empty itself. It frequently occurs in people with either type 1 or type 2 diabetes.

Symptoms of gastroparesis include heartburn, nausea, vomiting of undigested food, an early feeling of fullness when eating, weight loss, abdominal bloating, erratic blood glucose levels, lack of appetite, gastroesophageal reflux, and spasms of the stomach wall.

How can diabetes affect oral health?

Because of high blood glucose, people with diabetes are more likely to have problems with their teeth and gums. And like all infections, dental infections can make your blood glucose go up. Sore, swollen, and red gums that bleed when you brush your teeth are a sign of a dental problem called gingivitis. Another problem, called periodontitis, happens when your gums shrink or pull away from your teeth.

People with diabetes can have tooth and gum problems more often if their blood glucose stays high. Also, smoking makes it more likely for you to get a bad case of gum disease, especially if you have diabetes and are age 45 or older.
People with diabetes are also prone to other mouth problems, like fungal infections, poor post-surgery healing, and dry mouth.

How can I keep my mouth, gums, and teeth healthy if I have diabetes?

You can help maintain your oral health by keeping your blood glucose as close to normal as possible, brushing your teeth at least twice a day, and flossing once a day. Keep any dentures clean. Get a dental cleaning and exam twice a year, and tell your dentist that you have diabetes. Call your dentist with any problems, such as gums that are red, sore, bleeding, or pulling away from the teeth; any possible tooth infection; or soreness from dentures.

View Online References for Diabetes- Complications and Other Related Health Concerns.

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Diabetes- Complications and Other Related Health Concerns cont'd...

2007-06-01T15:43:00.000+08:00

On this page:

How can diabetes affect my sexual response?
How can diabetes affect my mood?
How does diabetes affect how I respond to a cold or flu?
What should I do when I am sick?

How can diabetes affect my sexual response?

Many people with diabetic nerve damage have trouble having sex. For example, men can have trouble maintaining an erection and ejaculating. Women can have trouble with sexual response and vaginal lubrication. Both men and women with diabetes can get urinary tract infections and bladder problems more often than average.

How can diabetes affect my mood?

Several studies suggest that diabetes doubles the risk of depression, although it’s still unclear why. The psychological stress of having diabetes may contribute to depression, but diabetes’ metabolic effect on brain function may also play a role. At the same time, people with depression may be more likely to develop diabetes.
The risk of depression increases as more diabetes complications develop. When you are depressed, you do not function as well, physically or mentally; this makes you less likely to eat properly, exercise, and take your medication regularly.

Psychotherapy, medication, or a combination of both can treat depression effectively. In addition, studies show that successful treatment for depression also helps improve blood glucose control.

How does diabetes affect how I respond to a cold or flu?

Being sick by itself can raise your blood glucose. Moreover, illness can prevent you from eating properly, which further affects blood glucose.

In addition, diabetes can make the immune system more vulnerable to severe cases of the flu. People with diabetes who come down with the flu may become very sick and may even have to go to a hospital. You can help keep yourself from getting the flu by getting a flu shot every year. Everyone with diabetes—even pregnant women—should get a yearly flu shot. The best time to get one is between October and mid-November, before the flu season begins.

What should I do when I am sick?

Be sure to continue taking your diabetes pills or insulin. Don’t stop taking them even if you can’t eat. Your health care provider may even advise you to take more insulin during sickness.

Test your blood glucose every four hours, and keep track of the results.

Drink extra (calorie-free) liquids, and try to eat as you normally would. If you can’t, try to have soft foods and liquids containing the equivalent amount of carbohydrates that you usually consume.

Weigh yourself every day. Losing weight without trying is a sign of high blood glucose.

Check your temperature every morning and evening. A fever may be a sign of infection.

Call your health care provider or go to an emergency room if any of the following happen to you:

 You feel too sick to eat normally and are unable to
keep down food for more than 6 hours.
 You're having severe diarrhea.
 You lose 5 pounds or more.
 Your temperature is over 101 degrees F.
 Your blood glucose is lower than 60 mg/dL or
remains over 300 mg/dL.
 You have moderate or large amounts of ketones in
your urine.
 You're having trouble breathing.
 You feel sleepy or can't think clearly.

View Online References for Diabetes- Complications and Other Related Health Concerns.

Return to FAQ about Diabetes- Complications and Other Related Health Concerns: Index

This Page Last Reviewed: June 2, 2007

Online Resources

2007-06-01T15:07:00.000+08:00

These publications were sources for this document (Diabetes- Complications and Other Related Health Concerns):

Effects of Diabetes
http://www.cdc.gov/diabetes/human_body.htm

Diabetes Problems
http://www.cdc.gov/diabetes/consumer/diabproblems.htm

Frequently Asked Questions: Diabetes-Related Health Concerns
http://www.cdc.gov/diabetes/faq/concerns.htm

Take Charge of Your Diabetes
http://www.cdc.gov/diabetes/pubs/tcyd/index.htm

National Diabetes Fact Sheet 2003
http://www.cdc.gov/diabetes/pubs/factsheet.htm

The Link Between Diabetes and Cardiovascular Disease
http://www.ndep.nih.gov/campaigns/BeSmart/BeSmart_overview.htm

Insulin Resistance and Pre-Diabetes
http://www.diabetes.niddk.nih.gov/dm/pubs/insulinresistance/index.htm

Prevent Diabetes Problems: Keep Your Eyes Healthy
http://www.diabetes.niddk.nih.gov/dm/pubs/complications_eyes/index.htm

Kidney Disease of Diabetes
http://kidney.niddk.nih.gov/kudiseases/pubs/kdd/index.htm

Prevent Diabetes Problems: Keep Your Kidneys Healthy
http://www.diabetes.niddk.nih.gov/dm/pubs/complications_kidneys/index.htm

Prevent Diabetes Problems: Keep Your Feet and Skin Healthy http://www.diabetes.niddk.nih.gov/dm/pubs/complications_feet/index.htm

Prevent Diabetes Problems: Keep Your Teeth and Gums Healthy
http://www.diabetes.niddk.nih.gov/dm/pubs/complications_teeth/index.htm

Sexual and Urologic Problems of Diabetes
http://www.diabetes.niddk.nih.gov/dm/pubs/sup/index.htm

This Page Last Reviewed: June 2, 2007

Frequently Asked Questions: Exercise and Diabetes

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Why is it important for people with diabetes to be physically active?

Physical activity can help you control your blood glucose, weight, and blood pressure, as well as raise your “good” cholesterol and lower your “bad” cholesterol. It can also help prevent heart and blood flow problems, reducing your risk of heart disease and nerve damage, which are often problems for people with diabetes.

How much and how often should people with diabetes exercise?

Experts recommend moderate-intensity physical activity for at least 30 minutes on 5 or more days of the week. Some examples of moderate-intensity physical activity are walking briskly, mowing the lawn, dancing, swimming, or bicycling.

If you are not accustomed to physical activity, you may want to start with a little exercise, and work your way up. As you become stronger, you can add a few extra minutes to your physical activity. Do some physical activity every day. It’s better to walk 10 or 20 minutes each day than one hour once a week.

Talk to your health care provider about a safe exercise plan. He or she may check your heart and your feet to be sure you have no special problems. If you have high blood pressure, eye, or foot problems, you may need to avoid some kinds of exercise.

What are some good types of physical activity for people with diabetes?

Walking vigorously, hiking, climbing stairs, swimming, aerobics, dancing, bicycling, skating, skiing, tennis, basketball, volleyball, or other sports are just some examples of physical activity that will work your large muscles, increase your heart rate, and make you breathe harder – important goals for fitness.

In addition, strength training exercises with hand weights, elastic bands, or weight machines can help you build muscle. Stretching helps to make you flexible and prevent soreness after other types of exercise.

Do physical activities you really like. The more fun you have, the more likely you will do it each day. It can be helpful to exercise with a family member or friend.

Are there any safety considerations for people with diabetes when they exercise?

Exercise is very important for people with diabetes to stay healthy, but there are a few things to watch out for.

You should avoid some kinds of physical activity if you have certain diabetes complications. Exercise involving heavy weights may be bad for people with blood pressure, blood vessel, or eye problems. Diabetes-related nerve damage can make it hard to tell if you’ve injured your feet during exercise, which can lead to more serious problems. If you do have diabetes complications, your health care provider can tell you which kinds of physical activity would be best for you. Fortunately, there are many different ways to get exercise.

Physical activity can lower your blood glucose too much, causing hypoglycemia, especially in people who take insulin or certain oral medications. Hypoglycemia can happen at the time you’re exercising, just afterward, or even up to a day later. You can get shaky, weak, confused, irritable, anxious, hungry, tired, or sweaty. You can get a headache, or even lose consciousness.
To help prevent hypoglycemia during physical activity, check your blood glucose before you exercise. If it's below 100, have a small snack. In addition, bring food or glucose tablets with you when you exercise just in case. It is not good for people with diabetes to skip meals at all, but especially not prior to exercise. After you exercise, check to see how it has affected your blood glucose level. If you take insulin, ask your health care provider if there is a preferable time of day for you to exercise, or whether you should change your dosage before physical activity, before beginning an exercise regimen.

On the other hand, you should not exercise when your blood glucose is very high because your level could go even higher. Do not exercise if your blood glucose is above 300, or your fasting blood glucose is above 250 and you have ketones in your urine.

When you exercise, wear cotton socks and athletic shoes that fit well and are comfortable. After you exercise, check your feet for sores, blisters, irritation, cuts, or other injuries.

Drink plenty of fluids during physical activity, since your blood glucose can be affected by dehydration.

These online publications were the sources for this document:

Take Charge of Your Diabetes: Controlling Your Diabetes
http://www.cdc.gov/diabetes/pubs/tcyd/control.htm

Diabetes and Me: Be Active
http://www.cdc.gov/diabetes/consumer/beactive.htm

NCCDPHP Nutrition & Physical Activity Recommendations
http://www.cdc.gov/nccdphp/dnpa/physical/recommendations/index.htm

What I Need to Know About Physical Activity and Diabetes
http://www.diabetes.niddk.nih.gov/dm/pubs/physical_ez/index.htm

Frequently Asked Questions: Exercise and Diabetes
http://www.cdc.gov/diabetes/faq/exercise.htm

This Page Last Reviewed: June 1, 2007
Reviewed By: D.K.Mangusan Jr., PTRP

Fasting Hypoglycemia

2007-05-31T21:08:00.000+08:00

Diagnosis

Fasting hypoglycemia is diagnosed from a blood sample that shows a blood glucose level of less than 50 mg/dL after an overnight fast, between meals, or after exercise.

Causes and Treatment

Causes include certain medications, alcohol, critical illnesses, hormonal deficiencies, some kinds of tumors, and certain conditions occurring in infancy and childhood.

Medications

Medications, including some used to treat diabetes, are the most common cause of hypoglycemia. Other medications that can cause hypoglycemia include

 salicylates, including aspirin, when taken in large doses
 sulfa medicines, which are used to treat infections
 pentamidine, which treats a very serious kind of pneumonia
 quinine, which is used to treat malaria

If using any of these medications causes your blood glucose to drop, your doctor may advise you to stop using the drug or change the dosage.

Alcohol

Drinking, especially binge drinking, can cause hypoglycemia because your body's breakdown of alcohol interferes with your liver's efforts to raise blood glucose. Hypoglycemia caused by excessive drinking can be very serious and even fatal.

Critical Illnesses

Some illnesses that affect the liver, heart, or kidneys can cause hypoglycemia. Sepsis (overwhelming infection) and starvation are other causes of hypoglycemia. In these cases, treatment targets the underlying cause.

Hormonal Deficiencies

Hormonal deficiencies may cause hypoglycemia in very young children, but usually not in adults. Shortages of cortisol, growth hormone, glucagon, or epinephrine can lead to fasting hypoglycemia. Laboratory tests for hormone levels will determine a diagnosis and treatment. Hormone replacement therapy may be advised.

Tumors

Insulinomas, insulin-producing tumors, can cause hypoglycemia by raising your insulin levels too high in relation to your blood glucose level. These tumors are very rare and do not normally spread to other parts of the body. Laboratory tests can pinpoint the exact cause. Treatment involves both short-term steps to correct the hypoglycemia and medical or surgical measures to remove the tumor.

Conditions Occurring in Infancy and Childhood

Children rarely develop hypoglycemia. If they do, causes may include

 Brief intolerance to fasting, often in conjunction with an illness that disturbs regular eating patterns. Children usually outgrow this tendency by age 10.
 Hyperinsulinism, which is the excessive production of insulin. This condition can result in transient neonatal hypoglycemia, which is common in infants of mothers with diabetes. Persistent hyperinsulinism in infants or children is a complex disorder that requires prompt evaluation and treatment by a specialist.
 Enzyme deficiencies that affect carbohydrate metabolism. These deficiencies can interfere with the body's ability to process natural sugars, such as fructose and galactose, glycogen, or other metabolites.
 Hormonal deficiencies such as lack of pituitary or adrenal hormones.

See Also:

Reactive Hypoglycemia

References:
Diabetes Dictionary. National Diabetes Information Clearinghouse. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health of the U.S. Department of Health and Human Services. NIH Publication No. 07–3016, October 2006

National Diabetes Information Clearinghouse. Hypoglycemia. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health of the U.S. Department of Health and Human Services. NIH Publication No. 03–3926, March 2003

What do I need to know about insulin?

2007-05-31T20:05:00.000+08:00

If your pancreas no longer makes enough insulin, then you need to take insulin as a shot. You inject the insulin just under the skin with a small, short needle.

Can insulin be taken as a pill?

Insulin is a protein. If you took insulin as a pill, your body would break it down and digest it before it got into your blood to lower your blood glucose.

How does insulin work?

Insulin lowers blood glucose by moving glucose from the blood into the cells of your body. Once inside the cells, glucose provides energy. Insulin lowers your blood glucose whether you eat or not. You should eat on time if you take insulin.

How often should I take insulin?

Most people with diabetes need at least two insulin shots a day for good blood glucose control. Some people take three or four shots a day to have a more flexible diabetes plan.

When should I take insulin?

You should take insulin 30 minutes before a meal if you take regular insulin alone or with a longer-acting insulin. If you take a rapid-acting insulin, you should take your shot just before you eat.

Are there several types of insulin?

Yes. There are six main types of insulin. They each work at different speeds. Many people take two types of insulin.

Does insulin work the same all the time?

After a short time, you will get to know when your insulin starts to work, when it works its hardest to lower blood glucose, and when it finishes working.
You will learn to match your mealtimes and exercise times to the time when each insulin dose you take works in your body.

How quickly or slowly insulin works in your body depends on

your own response
the place on your body where you inject insulin
the type and amount of exercise you do and the length of time between your shot and exercise

Where on my body should I inject insulin?

You can inject insulin into several places on your body. Insulin injected near the stomach works fastest. Insulin injected into the thigh works slowest. Insulin injected into the arm works at medium speed. Ask your doctor or diabetes teacher to show you the right way to take insulin and in which parts of the body to inject it.

These are good places to give yourself insulin shots.

How should I store insulin?

If you use a whole bottle of insulin within 30 days, keep that bottle of insulin at room temperature. On the label, write the date that is 30 days away. That is when you should throw out the bottle with any insulin left in it.
If you do not use a whole bottle of insulin within 30 days, then store it in the refrigerator all the time.
If insulin gets too hot or cold, it breaks down and does not work. So, do not keep insulin in very cold places such as the freezer, or in hot places, such as by a window or in the car's glove compartment during warm weather.
Keep at least one extra bottle of each type of insulin you use in your house. Store extra insulin in the refrigerator.

What are possible side effects of insulin?

hypoglycemia
weight gain

Source: National Diabetes Information Clearinghouse. Medicines for People With Diabetes. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health: U.S. Department of Health and Human Services. NIH Publication No. 03–4222, December 2002.

Image Credit: National Institute of Diabetes and Digestive and Kidney Diseases.

This Page Last Reviewed: May 31, 2007

Making Changes to Lower Risk for Type 2 Diabetes

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Making big changes in your life is hard, especially if you are faced with more than one change. You can make it easier by taking these steps:

Make a plan to change behavior.
Decide exactly what you will do and when you will do it.
Plan what you need to get ready.
Think about what might prevent you from reaching your goals.
Find family and friends who will support and encourage you.
Decide how you will reward yourself when you do what you have planned.

Your doctor, a dietitian, or a counselor can help you make a plan. Consider making changes to lower your risk of diabetes.

Reach and Maintain a Reasonable Body Weight

Your weight affects your health in many ways. Being overweight can keep your body from making and using insulin properly. Excess body weight can also cause high blood pressure.

If you are overweight or obese, choose sensible ways to get in shape.

Avoid crash diets. Instead, eat less of the foods you usually have. Limit the amount of fat you eat.
Increase your physical activity. Aim for at least 30 minutes of exercise most days of the week.
Set a reasonable weight-loss goal, such as losing 1 pound a week. Aim for a long-term goal of losing 5 to 7 percent of your total body weight.

Make Wise Food Choices Most of the Time

What you eat has a big impact on your health. By making wise food choices, you can help control your body weight, blood pressure, and cholesterol.

Take a look at the serving sizes of the foods you eat. Reduce serving sizes of main courses such as meat, desserts, and foods high in fat. Increase the amount of fruits and vegetables.
Limit your fat intake to about 25 percent of your total calories. For example, if your food choices add up to about 2,000 calories a day, try to eat no more than 56 grams of fat. Your doctor or a dietitian can help you figure out how much fat to have. You can also check food labels for fat content.
Limit your sodium intake to less than 2,300 mg—about 1 teaspoon of salt—each day.
Talk with your doctor about whether you may drink alcoholic beverages. If you choose to drink alcoholic beverages, limit your intake to one drink—for women—or two drinks—for men—per day.
You may also wish to reduce the number of calories you have each day. People in the DPP lifestyle change group lowered their daily calorie total by an average of about 450 calories. Your doctor or dietitian can help you with a meal plan that emphasizes weight loss.
Keep a food and exercise log. Write down what you eat, how much you exercise—anything that helps keep you on track.
When you meet your goal, reward yourself with a nonfood item or activity, like watching a movie.

Information courtesy of the National Diabetes Information Clearinghouse. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health of the U.S. Department of Health and Human Services. NIH Publication No. 07–4805, December 2006.

This Page Last Reviewed: May 31, 2007

Reducing the risk for Type 2 Diabetes

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How can I reduce my risk?

You can do a lot to lower your chances of getting diabetes. Exercising regularly, reducing fat and calorie intake, and losing a little weight can help you reduce your risk of developing type 2 diabetes. Lowering blood pressure and cholesterol levels also helps you stay healthy.

If you are overweight

Then take these steps:

Reach and maintain a reasonable body weight.
Make wise food choices most of the time.
Be physically active every day.

If you are fairly inactive

Then take this step:

Be physically active every day.

If your blood pressure is too high

Then take these steps:

Reach and maintain a reasonable body weight.
Make wise food choices most of the time.
Reduce your intake of sodium and alcohol.
Be physically active every day.
Talk with your doctor about whether you need medicine to control your blood pressure.

If your cholesterol or triglyceride levels are too high

Then take these steps:

Make wise food choices most of the time.
Be physically active every day.
Talk with your doctor about whether you need medicine to control your cholesterol levels.

This Page Last Reviewed: May 31, 2007

Am I at risk for Type 2 Diabetes?

2007-05-31T13:17:00.002+08:00

Many people do not find out they have the disease until they have diabetes complications, such as blurry vision or heart trouble. If you find out early that you have diabetes, then you can get treatment to prevent damage to the body.

Risk Factors:

1. Old Age
2. Overweight
3. Having Pre-diabetes (See Information Below)
4. Other Factors (See checklist below)

What is Pre-diabetes?

Pre-diabetes means your blood glucose is higher than normal but lower than the diabetes range. It also means you are at risk for getting type 2 diabetes and heart disease. However, you can reduce the risk of getting diabetes and even return to normal blood glucose levels with modest weight loss and moderate physical activity. If you are told you have pre-diabetes, have your blood glucose checked again in 1 to 2 years.

Besides being older and overweight, what other factors increase my risk for type 2 diabetes?

To find out your risk for type 2 diabetes, check each item that applies to you.

_____1. I have a parent, brother, or sister with diabetes.

_____2. My family background is Alaska Native, American Indian, African American,

_____3. Hispanic/Latino, Asian American, or Pacific Islander.

_____4. I have had gestational diabetes, or I gave birth to at least one baby weighing more than 9 pounds.

_____5. My blood pressure is 140/90 mm Hg or higher, or I have been told that I have high blood pressure.

_____6. My cholesterol levels are not normal. My HDL cholesterol—“good” cholesterol—is below 35 mg/dL, or my triglyceride level is above 250 mg/dL.

_____7. I am fairly inactive. I exercise fewer than three times a week.

_____8. I have polycystic ovary syndrome, also called PCOS—women only.

_____9. On previous testing, I had impaired glucose tolerance (IGT) or impaired fasting glucose (IFG).

_____10. I have other clinical conditions associated with insulin resistance, such as acanthosis nigricans.

_____11. I have a history of cardiovascular disease.

The more items you checked, the higher your risk.

See Also:

Reducing the risk for Type 2 Diabetes
Making changes to lower risk for Type 2 Diabetes

Heart and Blood Vessel Diseases Related to Diabetes

2007-05-27T20:59:00.001+08:00

What types of heart and blood vessel disease occur in people with diabetes?

Two major types of heart and blood vessel disease, also called cardiovascular disease, are common in people with diabetes: coronary artery disease (CAD) and cerebral vascular disease. People with diabetes are also at risk for heart failure. Narrowing or blockage of the blood vessels in the legs, a condition called peripheral arterial disease, can also occur in people with diabetes.

Coronary Artery Disease

Coronary artery disease, also called ischemic heart disease, is caused by a hardening or thickening of the walls of the blood vessels that go to your heart. Your blood supplies oxygen and other materials your heart needs for normal functioning. If the blood vessels to your heart become narrowed or blocked by fatty deposits, the blood supply is reduced or cut off, resulting in a heart attack.

Cerebral Vascular Disease

Cerebral vascular disease affects blood flow to the brain, leading to strokes and TIAs. It is caused by narrowing, blocking, or hardening of the blood vessels that go to the brain or by high blood pressure.

Stroke

A stroke results when the blood supply to the brain is suddenly cut off, which can occur when a blood vessel in the brain or neck is blocked or bursts. Brain cells are then deprived of oxygen and die. A stroke can result in problems with speech or vision or can cause weakness or paralysis. Most strokes are caused by fatty deposits or blood clots—jelly-like clumps of blood cells—that narrow or block one of the blood vessels in the brain or neck. A blood clot may stay where it formed or can travel within the body. People with diabetes are at increased risk for strokes caused by blood clots.

A stroke may also be caused by a bleeding blood vessel in the brain. Called an aneurysm, a break in a blood vessel can occur as a result of high blood pressure or a weak spot in a blood vessel wall.

TIAs

TIAs are caused by a temporary blockage of a blood vessel to the brain. This blockage leads to a brief, sudden change in brain function, such as temporary numbness or weakness on one side of the body. Sudden changes in brain function also can lead to loss of balance, confusion, blindness in one or both eyes, double vision, difficulty speaking, or a severe headache. However, most symptoms disappear quickly and permanent damage is unlikely. If symptoms do not resolve in a few minutes, rather than a TIA, the event could be a stroke. The occurrence of a TIA means that a person is at risk for a stroke sometime in the future. See page 3 for more information on risk factors for stroke.

Heart Failure

Heart failure is a chronic condition in which the heart cannot pump blood properly—it does not mean that the heart suddenly stops working. Heart failure develops over a period of years, and symptoms can get worse over time. People with diabetes have at least twice the risk of heart failure as other people. One type of heart failure is congestive heart failure, in which fluid builds up inside body tissues. If the buildup is in the lungs, breathing becomes difficult.

Blockage of the blood vessels and high blood glucose levels also can damage heart muscle and cause irregular heart beats. People with damage to heart muscle, a condition called cardiomyopathy, may have no symptoms in the early stages, but later they may experience weakness, shortness of breath, a severe cough, fatigue, and swelling of the legs and feet. Diabetes can also interfere with pain signals normally carried by the nerves, explaining why a person with diabetes may not experience the typical warning signs of a heart attack.

Peripheral Arterial Disease

Another condition related to heart disease and common in people with diabetes is peripheral arterial disease (PAD). With this condition, the blood vessels in the legs are narrowed or blocked by fatty deposits, decreasing blood flow to the legs and feet. PAD increases the chances of a heart attack or stroke occurring. Poor circulation in the legs and feet also raises the risk of amputation. Sometimes people with PAD develop pain in the calf or other parts of the leg when walking, which is relieved by resting for a few minutes.

Sources:
National Diabetes Information Clearinghouse: Diabetes, Heart Disease, and Stroke. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health. U.S. Department of Health and Human Services. NIH Publication No. 06–5094, December 2005.

Diabetes Dictionary. National Diabetes Information Clearinghouse. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health. U.S. Department of Health and Human Services.

Complementary and Alternative Medical Therapies for Diabetes

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Some people with diabetes use complementary or alternative therapies to treat diabetes. Although some of these therapies may be effective, others can be ineffective or even harmful.¹

The National Center for Complementary and Alternative Medicine, part of the National Institutes of Health, defines complementary and alternative medicine as a "group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine."²

Complementary medicine is used with conventional therapy. An example of a complementary therapy is using aromatherapy to help lessen a patient's discomfort following surgery.²

Alternative medicine, on the other hand, is used instead of conventional medicine. An example of an alternative therapy is using a special diet to treat cancer instead of undergoing surgery, radiation, or chemotherapy that has been recommended by a conventional doctor.²

Patients who use complementary and alternative medicine need to let their health care providers know what they are doing.

Some complementary and alternative medicine therapies are discussed below. For more information, talk with your health care provider.

Acupuncture

Acupuncture is a procedure in which a practitioner inserts needles into designated points on the skin. Some scientists believe that acupuncture triggers the release of the body's natural painkillers. Acupuncture has been shown to offer relief from chronic pain. Acupuncture is sometimes used by people with neuropathy, the painful nerve damage of diabetes.¹

Biofeedback

Biofeedback is a technique that helps a person become more aware of and learn to deal with the body's response to pain. This alternative therapy emphasizes relaxation and stress-reduction techniques. Guided imagery is a relaxation technique that some professionals who use biofeedback do. With guided imagery, a person thinks of peaceful mental images, such as ocean waves. A person may also include the images of controlling or curing a chronic disease, such as diabetes. People using this technique believe their condition can be eased with these positive images.¹

Chromium

The benefit of added chromium for diabetes has been studied and debated for several years. Several studies report that chromium supplementation may improve diabetes control. Chromium is needed to make glucose tolerance factor, which helps insulin improve its action. Because of insufficient information on the use of chromium to treat diabetes, no recommendations for supplementation yet exist.¹

Ginseng

Several types of plants are referred to as ginseng but most studies of ginseng and diabetes have used American ginseng. Those studies have shown some glucose-lowering effects in fasting and post-prandial (after meal) blood glucose levels as well as in A1C levels (average blood glucose levels over a 3-month period). However, larger and more long-term studies are needed before general recommendations for use of ginseng can be made. Researchers also have determined that the amount of glucose-lowering compound in ginseng plants varies widely.¹

Magnesium

Although the relationship between magnesium and diabetes has been studied for decades, it is not yet fully understood. Studies suggest that a deficiency in magnesium may worsen blood glucose control in type 2 diabetes. Scientists believe that a deficiency of magnesium interrupts insulin secretion in the pancreas and increases insulin resistance in the body's tissues. Evidence suggests that a deficiency of magnesium may contribute to certain diabetes complications. A recent analysis showed that people with higher dietary intakes of magnesium (through consumption of whole grains, nuts, and green leafy vegetables) had a decreased risk of type 2 diabetes.¹

Vanadium

Vanadium is a compound found in tiny amounts in plants and animals. Early studies showed that vanadium normalized blood glucose levels in animals with type 1 and type 2 diabetes. A recent study found that when people with diabetes were given vanadium, they developed a modest increase in insulin sensitivity and were able to decrease their insulin requirements.

Currently researchers want to understand how vanadium works in the body, discover potential side effects, and establish safe dosages.¹

References:

1. National Diabetes Information Clearinghouse. Complementary and Alternative Medical Therapies for Diabetes. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health. U.S. Department of Health and Human Services. NIH Publication No. 04–4552, May 2004.

2. National Center for Complementary and Alternative Medicine. What is CAM?. National Institutes of Health. NCCAM Publication No. D347, Updated February, 2007

Diabetic Neuropathies

2007-05-27T11:42:00.000+08:00

Diabetic Neuropathies are nerve disorders caused by chronic, uncontrolled diabetes. People with chronic, uncontrolled diabetes can, over time, have complications affecting the nerves of the body. The longer a person has diabetes, the greater the risk of having diabetic diabetic neuropathies.

This online publication discusses about the growing health concern about diabetic neuropathies, its diagnosis, treatment and points to remember about this disorder.

Topics on Diabetic Neuropathies:

Diabetic Neuropathies: A growing Health Concern

Diagnosis

Treatment

Points to Remember

Diabetes Definitions

2007-05-23T13:24:00.000+08:00

Blood glucose is the main sugar found in the blood and the body’s main source of energy. The A1c blood test is used to measure a person’s average blood sugar level over the past 2 to 3 months.

Blood pressure is the force of blood on the inside walls of blood vessels, measured by analyzing both the systolic blood pressure, the pressure when the heart pushes blood out into the arteries, and the diastolic blood pressure, when the heart is at rest.

Blood lipid is a term for fat in the blood stream, and is measured with a lipid profile blood test. The lipid profile test measures total cholesterol, the fat produced by the liver and found in some foods, triglycerides, the storage form of fat in the body, HDL cholesterol, fat that takes extra cholesterol from the blood to the liver for removal, and LDL cholesterol, fat that takes excess cholesterol around the body to where it’s needed, but excess ultimately rests on the inside of artery walls.

Diabetic ketoacidosis is a condition in which very high blood sugar levels along with a very low level of insulin result in a dangerous accumulation of ketones -- substances produced when the body breaks down fat for energy -- in the blood and urine. Hyperosmolar nonketotic syndrome is another condition in which one’s blood sugar levels become very high and necessary ketones are not present in the blood or urine. Coma or death can result if both of these conditions are not treated.

Insulin is a hormone that is needed to convert sugar, starches, and other food into energy needed for daily life.

Metformin is a medicine pill used to treat type 2 diabetes because it lowers blood sugar levels by reducing the amount of sugar produced by the liver and helping the body respond better to insulin.

Maturity-onset diabetes of the young is a kind of type 2 diabetes that accounts for 1 to 5 percent of people with diabetes and is a result of a defect in a single gene.

Non-traumatic lower-limb amputation is a procedure to remove through surgery damaged feet or legs, where the injury was not caused by trauma (e.g., the injury was not caused by a car accident).

Diabetic retinopathy is diabetic eye disease that results from damage to the small blood vessels in the retina, the back part of the eye that contains the cells that respond to light. It may lead to loss of eyesight. Laser therapy, one possible treatment option, uses a strong beam of light to seal the leaking blood vessels in the eye.

End-stage renal disease is kidney failure requiring dialysis or a transplant to survive.

Glucose intolerance is a condition in which the body has blood sugar levels higher than normal, but not high enough to classify as diabetes. It is diagnosed using an oral glucose tolerance test which requires a fasting period of 8 to 12 hours and the blood sugar is measured both fasting and 2 hours after drinking a high-sugar drink.

Source:

Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2005. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2005.

Diabetic Neuropathy: Diagnosis

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Neuropathy is diagnosed on the basis of symptoms and a physical exam. During the exam, the doctor may check blood pressure and heart rate, muscle strength, reflexes, and sensitivity to position, vibration, temperature, or a light touch.

The doctor may also do other tests to help determine the type and extent of nerve damage.

A comprehensive foot exam assesses skin, circulation, and sensation. The test can be done during a routine office visit. To assess protective sensation or feeling in the foot, a nylon monofilament (similar to a bristle on a hairbrush) attached to a wand is used to touch the foot. Those who cannot sense pressure from the monofilament have lost protective sensation and are at risk for developing foot sores that may not heal properly. Other tests include checking reflexes and assessing vibration perception, which is more sensitive than touch pressure.

Nerve conduction studies check the transmission of electrical current through a nerve. With this test, an image of the nerve conducting an electrical signal is projected onto a screen. Nerve impulses that seem slower or weaker than usual indicate possible damage. This test allows the doctor to assess the condition of all the nerves in the arms and legs.

Electromyography (EMG) shows how well muscles respond to electrical signals transmitted by nearby nerves. The electrical activity of the muscle is displayed on a screen. A response that is slower or weaker than usual suggests damage to the nerve or muscle. This test is often done at the same time as nerve conduction studies.

Quantitative sensory testing (QST) uses the response to stimuli, such as pressure, vibration, and temperature, to check for neuropathy. QST is increasingly used to recognize sensation loss and excessive irritability of nerves.

A check of heart rate variability shows how the heart responds to deep breathing and to changes in blood pressure and posture.

Ultrasound uses sound waves to produce an image of internal organs. An ultrasound of the bladder and other parts of the urinary tract, for example, can show how these organs preserve a normal structure and whether the bladder empties completely after urination.

Nerve or skin biopsy involves removing a sample of nerve or skin tissue for examination by microscope. This test is most often used in research settings.

<<A Growing Health Concern

Diabetic Neuropathies: Home

Treatment>>

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Diabetic Neuropathy: Treatment

2007-05-21T22:48:00.000+08:00

What is the treatment for Diabetic Neuropathy?

The first step is to bring blood glucose levels within the normal range. Controlling or bringing the blood glucose levels with normal range would help prevent further nerve damage. Blood glucose monitoring, meal planning, exercise, and oral drugs or insulin injections are needed to control blood glucose levels. Although symptoms may get worse when blood glucose is first brought under control, over time, maintaining lower blood glucose levels helps lessen neuropathic symptoms.

Importantly, good blood glucose control may also help prevent or delay the onset of further problems.

Additional treatment depends on the type of nerve problem and symptom, as described in the following sections.

Foot Care

People with neuropathy need to take special care of their feet. The nerves to the feet are the longest in the body and are the ones most often affected by neuropathy. Loss of sensation in the feet means that sores or injuries may not be noticed and may become ulcerated or infected. Circulation problems also increase the risk of foot ulcers.

More than half of all lower limb amputations in the United States occur in people with diabetes—86,000 amputations per year. Doctors estimate that nearly half of the amputations caused by neuropathy and poor circulation could have been prevented by careful foot care. Here are the steps to follow:

Clean your feet daily, using warm—not hot—water and a mild soap. Avoid soaking your feet. Dry them with a soft towel; dry carefully between your toes.

Inspect your feet and toes every day for cuts, blisters, redness, swelling, calluses, or other problems. Use a mirror (laying a mirror on the floor works well) or get help from someone else if you cannot see the bottoms of your feet. Notify your health care provider of any problems.

Moisturize your feet with lotion, but avoid getting it between your toes.

After a bath or shower, file corns and calluses gently with a pumice stone.

Each week or when needed, cut your toenails to the shape of your toes and file the edges with an emery board.

Always wear shoes or slippers to protect your feet from injuries. Prevent skin irritation by wearing thick, soft, seamless socks.

Wear shoes that fit well and allow your toes to move. Break in new shoes gradually by wearing them for only an hour at a time at first.

Before putting your shoes on, look them over carefully and feel the insides with your hand to make sure they have no tears, sharp edges, or objects in them that might injure your feet.

If you need help taking care of your feet, make an appointment to see a foot doctor, also called a podiatrist.

Pain Relief

To relieve pain, burning, tingling, or numbness, the doctor may suggest aspirin, acetaminophen, or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. (People with renal disease should use NSAIDs only under a doctor's supervision.) A topical cream called capsaicin is another option. Tricyclic antidepressant medications such as amitriptyline, imipramine, and nortriptyline, or anticonvulsant medications such as carbamazepine or gabapentin may relieve pain in some people. Codeine may be prescribed for a short time to relieve severe pain. Also, mexiletine, used to regulate heartbeat, has been effective in treating pain in several clinical trials.

Other pain treatments include transcutaneous electronic nerve stimulation (TENS), which uses small amounts of electricity to block pain signals, as well as hypnosis, relaxation training, biofeedback, and acupuncture. Walking regularly or using elastic stockings may also help leg pain.

Gastrointestinal Problems

To relieve mild symptoms of gastroparesis—indigestion, belching, nausea, or vomiting—doctors suggest eating small, frequent meals, avoiding fats, and eating less fiber. When symptoms are severe, the doctor may prescribe erythromycin to speed digestion, metoclopramide to speed digestion and help relieve nausea, or other drugs to help regulate digestion or reduce stomach acid secretion.

To relieve diarrhea or other bowel problems, the doctor may prescribe an antibiotic such as tetracycline, or other medications as appropriate.

Dizziness and Weakness

Sitting or standing slowly may help prevent the light-headedness, dizziness, or fainting associated with blood pressure and circulation problems. Raising the head of the bed or wearing elastic stockings may also help. Some people may benefit from increased salt in the diet and treatment with salt-retaining hormones. Others may benefit from high blood pressure medications. Physical therapy can help when muscle weakness or loss of coordination is a problem.

Urinary and Sexual Problems

To clear up a urinary tract infection, the doctor will probably prescribe an antibiotic. Drinking plenty of fluids will help prevent another infection. People who have incontinence should try to urinate at regular intervals (every 3 hours, for example) since they may not be able to tell when their bladder is full.

To treat erectile dysfunction in men, the doctor will first do tests to rule out a hormonal cause. Several methods are available to treat erectile dysfunction caused by neuropathy, including taking oral drugs, using a mechanical vacuum device, or injecting a drug called a vasodilator into the penis before sex. The vacuum and vasodilator raise blood flow to the penis, making it easier to have and maintain an erection. Another option is to surgically implant an inflatable or semirigid device in the penis. A constriction ring or penile sling may be helpful.

Vaginal lubricants may be useful for women when neuropathy causes vaginal dryness. To treat problems with arousal and orgasm, the doctor may refer the woman to a gynecologist.

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Diabetic Neuropathies: Home

Points to Remember>>

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Diabetic Neuropathies: Points to Remember

2007-05-21T22:32:00.001+08:00

Diabetic neuropathies are nerve disorders caused by many of the abnormalities common to diabetes, such as high blood glucose.
Neuropathy can affect nerves throughout the body, causing numbness and sometimes pain in the hands, arms, feet, or legs, and problems with the digestive tract, heart, and sex organs.
Treatment first involves bringing blood glucose levels within the normal range. Good blood glucose control may help prevent or delay the onset of further problems.
Foot care is another important part of treatment. People with neuropathy need to inspect their feet daily for any injuries. Untreated injuries increase the risk of infected foot sores and amputation.
Treatment also includes pain relief and other medications as needed, depending on the type of nerve damage.
Smoking significantly increases the risk of foot problems and amputation. If you smoke, ask your health care provider for help in quitting.

<<Treatment

Diabetic Neuropathies: Home

Source Excerpted From the National Diabetes Information Clearinghouse (NDIC). Diabetic Neuropathies: The Nerve Damage of Diabetes. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health .U.S. Department of Health and Human Services. NIH Publication No. 02–3185: May 2002.

Diabetic Neuropathies: A growing Health Concern

2007-05-21T22:18:00.000+08:00

Diabetic neuropathies are a family of nerve disorders caused by diabetes. People with chronic (long-standing) diabetes can, over time, have damage to nerves throughout the body. Neuropathies lead to numbness and sometimes pain and weakness in the hands, arms, feet, and legs. Problems may also arise in other organs of the body, including the digestive tract, heart, and sex organs. People with diabetes can develop nerve problems at any time, but the longer a person has diabetes, the greater the risk.

An estimated 50 percent of those with diabetes have some form of neuropathy, but not all with neuropathy have symptoms. The highest rates of neuropathy are among people who have had the disease for at least 25 years¹.

Diabetic neuropathy also appears to be more common in people who have had problems controlling their blood glucose levels, in those with high levels of blood fat and blood pressure, in overweight people, and in people over the age of 40. The most common type is peripheral neuropathy, also called distal symmetric neuropathy, which affects the arms and legs¹.

Diabetic Neuropathies: Home

Diagnosis>>

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Content Reviewed By: D.K. Mangusan Jr., PTRPMay 21, 2007

Resources For Topics About Diabetes

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Most of the topics presented here are compiled from a variety of sources including the ones listed below. The information on this website is not intended as a substitute for medical professional help or advice but is to be used only as an aid in understanding diabetes and the diseases associated with it. A physician should always be consulted for any health problem. Please read our Disclaimer and Privacy Policy.

Diabetes and Associated Diseases:

1. National Diabetes Information Clearinghouse. Diabetes-Overview. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health. U.S. Department of Health and Human Services.NIH Publication No. 06–3873, September 2006.

2. Centers for Disease Control and Prevention. National Diabetes Fact Sheet 2003. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2003.

3. Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2005. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2005.

4. U.S. Food and Drug Administration. Diabetes Information - Questions and Answers. April 4, 2007.

Complementary and Alternative Medical Therapies for Diabetes

1. National Diabetes Information Clearinghouse. Complementary and Alternative Medical Therapies for Diabetes. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health. U.S. Department of Health and Human Services. NIH Publication No. 04–4552, May 2004.

2. National Center for Complementary and Alternative Medicine. What is CAM?. National Institutes of Health. NCCAM Publication No. D347, Updated February, 2007

Take advantage of all of the information, resources, and tools about diabetes prevention and control available from the National Institutes of Health and the Centers for Disease Control and Prevention.

National Diabetes Information Clearinghouse
Centers for Disease Control and Prevention

This Page Last Reviewed: June 15, 2007
This Page Last Updated: June 15, 2007
By: David Mangusan Jr., PTRP

Diabetic Retinopathy

2007-05-21T21:40:00.000+08:00

The Problem:

When diabetes is uncontrolled, chronic high blood sugar levels can damage the blood vessels that feed the retina of the eye. In nonproliferative diabetic retinopathy (NPDR), an early stage of diabetic eye disease, the blood vessels may leak fluid. This may cause the retina to swell and vision to blur, a condition called diabetic macular edema. In what's known as advanced or proliferative diabetic retinopathy (PDR), abnormal new blood vessels grow on the surface of the retina. The abnormal blood vessels don't supply the retina with normal blood flow, and in addition may eventually pull on the retina and cause detachment.

Diabetic retinopathy is the leading cause of new cases of blindness, accounting for about 8,000 cases each year. It's the most common and serious threat to vision that people with diabetes face. Nearly half of all people with diabetes eventually develop some degree of diabetic retinopathy. It usually occurs in both eyes. There may be no early signs of the disease. More advanced cases may be signaled by floaters, blurred vision, eye pain, or gradual vision loss.
Experts say the rate of diabetic retinopathy is likely to get worse because the number of people with diabetes is increasing. About 16 million people have diabetes and many don't know it. In one recent National Institutes of Health study of Mexican-Americans over age 40, 23 percent of those who didn't know they had diabetes also had early to moderate diabetic retinopathy.

Risk Factors:

Uncontrolled diabetes is the prime risk factor for retinopathy. Diabetic retinopathy can usually be managed with a combination of tight blood sugar control, appropriate exercise and diet, and early detection. People who are diagnosed with diabetes before age 30 should begin having dilated exams every year beginning five years after diagnosis. All others with diabetes should have an eye exam every year. A recent study in the AAO's journal Ophthalmology showed that more than one-third of Americans with diabetes don't get a yearly dilated exam as recommended, putting them at risk for vision loss.

Treatment:

Some cases of diabetic retinopathy can be treated with laser surgery that aims a strong beam of light onto the retina to shrink or seal leaking or abnormal vessels. But it can't restore vision already lost, which is why early detection is important. In some advanced cases of PDR, a vitrectomy is recommended, in which the surgeon removes the vitreous portion of the eye and replaces it with a clear solution.

Sources:
Michelle Meadows. Saving Your Sight--Early Detection Is Critical. U.S. Food and Drug Administration. FDA Consumer magazine. March-April 2002

Images Courtesy of: The National Eye Institute. National Institutes of Health. Downloaded May 21, 2007.

Diabetes and Foot Ulcers

2007-05-21T20:14:00.000+08:00

Adults with chronic (long-term, long-standing) diabetes need to take special care of their feet.

People with diabetes are at risk for foot injuries due to numbness caused by nerve damage (diabetic neuropathy) and low blood flow to the legs and feet. The most serious injury is a foot ulcer. Diabetic foot ulcers are at very high risk of becoming infected, and sometimes they cannot be healed. Non-healing foot ulcers are a frequent cause of amputation in people with diabetes. Patients with foot ulcers may use wound dressings, skin substitutes, or other treatments to protect and heal their skin.

Wound dressings are medical devices that are used to protect ulcerated skin and assist in its healing. They can range from simple bandages that you can buy in the drug store to complex materials that contain antibacterial and antiviral substances.

Skin substitutes are products that help in closing the wounds of slow healing ulcers in patients with diabetes. They are made from human cells known as fibroblasts that are placed on a dissolvable mesh material. When the mesh material is placed on the ulcer, it is gradually absorbed and the human cells grow and replace the damaged tissue in the ulcer.

FDA has cleared one gel product (becaplermin) that is used as a treatment for diabetic foot ulcers. This product contains genetically engineered platelet-derived growth factor, one of the proteins the body produces to encourage new tissue growth. Clinical studies of the product indicated that the likelihood of complete ulcer closure, after up to 20 weeks of treatment, was greater when becaplermin is used. (US Food and Drug Administration, 2002)

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Diabetes and Kidney Failure

2007-05-21T20:12:00.001+08:00

Over time, high blood sugar levels can damage the kidneys. Even when drugs and diet are able to control diabetes, the disease can lead to kidney disease (diabetic nephropathy) and kidney failure.

Healthy kidneys act like filters to clean the blood of waste products and extra fluid. Damaged kidneys do not clean the blood well. Instead, waste products and fluid build up in the blood.

People with kidney failure must either have dialysis treatment (to substitute for some of the filtering functions of the kidneys) or receive a kidney transplant.

FDA regulates dialysis equipment. The agency does not inspect dialysis clinics--that is the responsibility of each state health department--but FDA approves the equipment used in dialysis. Recently, the agency has begun requiring that hemodialyzer filters and tubes be tested and approved in realistic clinical situations. For example, in about eight out of 10 hemodialysis treatments, the equipment is reused to cut costs, although it was originally tested, labeled and approved for one-time use only. FDA is now requiring manufacturers to prove that filters and tubes are safe and effective when reused. FDA is also taking a closer look at water purifying equipment used in dialysis. Pure water is crucial to hemodialysis, since impurities can kill a patient. FDA has recently begun enforcing regulations that require the manufacturers of water purifiers to prove their devices are safe and effective.(U.S. Food and Drug Administration, 2002)

The Kidney Health Care web site has a more comprehensive discussion about kidney failure and other kidney related conditions or disorders.

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Diabetes and Blindness

2007-05-21T20:08:00.000+08:00

Adults with diabetes should have yearly eye exams to ensure the health of their eyes and to protect their vision.

Over time, high blood sugar levels can damage the blood vessels that feed the retina of the eye. In nonproliferative diabetic retinopathy (NPDR), an early stage of diabetic eye disease, the blood vessels may leak fluid. This may cause the retina to swell and vision to blur, a condition called diabetic macular edema. In advanced or proliferative diabetic retinopathy (PDR), abnormal new blood vessels grow on the surface of the retina. The abnormal blood vessels don't supply the retina with normal blood flow. In addition, they may eventually pull on the retina and cause it to detach.

Some cases of diabetic retinopathy can be treated with laser surgery. In this procedure, doctors aim a strong beam of light onto the patient's retina to shrink or seal leaking or abnormal vessels. Laser surgery can't restore vision already lost, so early detection is important. In some advanced cases of PDR, a surgeon may remove the vitreous portion of the eye and replace it with a clear solution (called a vitrectomy).(U.S. Food and Drug Administration, 2002)

Learn more about: Diabetic Retinopathy

Resources:
U.S. Food and Drug Administration. Diabetes Information-Complications of Diabetes. Updated 5/21/02. Downloaded May 21, 2007.

Image Credit: National Eye Institute, National Institutes of Health. Ref#: NEA09. Downloaded May 21, 2007.

Heart and Blood Vessel Disease

2007-05-21T19:02:00.000+08:00

Heart disease is the leading cause of death for people with diabetes.

Three out of four diabetes-related deaths are caused by heart and blood vessel (cardiovascular) disease. People with diabetes are 2-4 times more likely to have heart disease than persons without diabetes. Even people with type 2 diabetes who do not have heart disease have an increased risk of having a heart attack. People with diabetes also tend to have other risk factors for heart disease including obesity, high blood pressure, and hardening of the arteries (atherosclerosis).

In recent years, FDA has approved drugs that lower blood pressure and reduce the risk of heart attacks and strokes. It has also approved lipid-altering drugs that target abnormalities of cholesterol and triglycerides.(U.S. Food and Drug Administration, 2002)

See: Heart and Blood Vessel Diseases Related to Diabetes

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Complications of Diabetes

2007-05-21T18:54:00.000+08:00

Over time, diabetes can lead to heart and blood vessel disease, blindness, kidney failure, and foot ulcers, among other conditions. The USFDA regulates many products to treat these conditions.

Complications of Diabetes

Heart and Blood Vessel Disease

Blindness

Kidney Failure

Foot Ulcers

Diabetic Neuropathy

See Also Frequently Asked Questions about Diabetes- Complications and Other Related Health Concerns

Page Last Reviewed: June 2, 2007
Reviewed By: D.K. Mangusan Jr., PTRP

Management of Diabetes

2007-05-21T17:34:00.001+08:00

How is diabetes managed?

Before the discovery of insulin in 1921, everyone with type 1 diabetes died within a few years after diagnosis. Although insulin is not considered a cure, its discovery was the first major breakthrough in diabetes treatment.

Today, healthy eating, physical activity, and taking insulin are the basic therapies for type 1 diabetes. The amount of insulin must be balanced with food intake and daily activities. Blood glucose levels must be closely monitored through frequent blood glucose checking. People with diabetes also monitor blood glucose levels several times a year with a laboratory test called the A1C. Results of the A1C test reflect average blood glucose over a 2- to 3-month period.

Healthy eating, physical activity, and blood glucose testing are the basic management tools for type 2 diabetes. In addition, many people with type 2 diabetes require oral medication, insulin, or both to control their blood glucose levels.
Adults with diabetes are at high risk for cardiovascular disease (CVD). In fact, at least 65 percent of those with diabetes die from heart disease or stroke. Managing diabetes is more than keeping blood glucose levels under control—it is also important to manage blood pressure and cholesterol levels through healthy eating, physical activity, and use of medications (if needed). By doing so, those with diabetes can lower their risk. Aspirin therapy, if recommended by the health care team, and smoking cessation can also help lower risk.

People with diabetes must take responsibility for their day-to-day care. Much of the daily care involves keeping blood glucose levels from going too low or too high. When blood glucose levels drop too low—a condition known as hypoglycemia—a person can become nervous, shaky, and confused. Judgment can be impaired, and if blood glucose falls too low, fainting can occur.

A person can also become ill if blood glucose levels rise too high, a condition known as hyperglycemia.

People with diabetes should see a health care provider who will help them learn to manage their diabetes and who will monitor their diabetes control. Most people with diabetes get care from primary care physicians—internists, family practice doctors, or pediatricians. Often, having a team of providers can improve diabetes care. A team can include

 a primary care provider such as an internist, a family practice doctor, or a pediatrician

 an endocrinologist (a specialist in diabetes care)

 a dietitian, a nurse, and other health care providers who are certified diabetes educators—experts in providing information about managing diabetes

 a podiatrist (for foot care)

 an ophthalmologist or an optometrist (for eye care)

and other health care providers, such as cardiologists and other specialists. In addition, the team for a pregnant woman with type 1, type 2, or gestational diabetes should include an obstetrician who specializes in caring for women with diabetes. The team can also include a pediatrician or a neonatologist with experience taking care of babies born to women with diabetes.

The goal of diabetes management is to keep levels of blood glucose, blood pressure, and cholesterol as close to the normal range as safely possible. A major study, the Diabetes Control and Complications Trial (DCCT), sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), showed that keeping blood glucose levels close to normal reduces the risk of developing major complications of type 1 diabetes.

This 10-year study, completed in 1993, included 1,441 people with type 1 diabetes. The study compared the effect of two treatment approaches—intensive management and standard management—on the development and progression of eye, kidney, nerve, and cardiovascular complications of diabetes. Intensive treatment aimed to keep A1C levels as close to normal (6 percent) as possible. Researchers found that study participants who maintained lower levels of blood glucose through intensive management had significantly lower rates of these complications. More recently, a follow-up study of DCCT participants showed that the ability of intensive control to lower the complications of diabetes has persisted more than 10 years after the trial ended.

The United Kingdom Prospective Diabetes Study, a European study completed in 1998, showed that intensive control of blood glucose and blood pressure reduced the risk of blindness, kidney disease, stroke, and heart attack in people with type 2 diabetes.

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This Page Last Reviewed: May 23, 2007

Who gets diabetes?

2007-05-21T17:30:00.001+08:00

Diabetes is not contagious. People cannot “catch” it from each other. However, certain factors can increase the risk of developing diabetes.

Type 1 diabetes occurs equally among males and females but is more common in whites than in non-whites. Data from the World Health Organization’s Multinational Project for Childhood Diabetes indicate that type 1 diabetes is rare in most African, American Indian, and Asian populations. However, some northern European countries, including Finland and Sweden, have high rates of type 1 diabetes. The reasons for these differences are unknown. Type 1 diabetes develops most often in children but can occur at any age.

Type 2 diabetes is more common in older people, especially in people who are overweight, and occurs more often in African Americans, American Indians, some Asian Americans, Native Hawaiians and other Pacific Islander Americans, and Hispanics/Latinos. National survey data in 2007 indicate a range in the prevalence of diagnosed and undiagnosed diabetes in various populations ages 20 years or older:

• Age 20 years or older: 23.5 million, or 10.7 percent, of all people in this age group have diabetes.

• Age 60 years or older: 12.2 million, or 23.1 percent, of all people in this age group have diabetes.

• Men: 12.0 million, or 11.2 percent, of all men ages 20 years or older have diabetes.

• Women: 11.5 million, or 10.2 percent, of all women ages 20 years or older have diabetes.

• Non-Hispanic whites: 14.9 million, or 9.8 percent, of all non-Hispanic whites ages 20 years or older have diabetes.

• Non-Hispanic blacks: 3.7 million, or 14.7 percent, of all non-Hispanic blacks ages 20 years or older have diabetes.

According to the National Diabetes Information Clearinghouse, diabetes prevalence in the United States is likely to increase for several reasons. First, a large segment of the population is aging. Also, Hispanics/Latinos and other minority groups at increased risk make up the fastest-growing segment of the U.S. population. Finally, Americans are increasingly overweight and sedentary. According to recent estimates from the Centers for Disease Control and Prevention (CDC), diabetes will affect one in three people born in 2000 in the United States. The CDC also projects the prevalence of diagnosed diabetes in the United States will increase 165 percent by 2050.

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This Page Last Updated: October 31, 2009

Impact of Diabetes

2007-05-21T17:28:00.001+08:00

Diabetes is associated with long-term complications that affect almost every part of the body. The disease often leads to blindness, heart and blood vessel disease, stroke, kidney failure, amputations, and nerve damage. Uncontrolled diabetes can complicate pregnancy, and birth defects are more common in babies born to women with diabetes.

In 2002, diabetes cost the United States $132 billion. Indirect costs, including disability payments, time lost from work, and premature death, totaled $40 billion; direct medical costs for diabetes care, including hospitalizations, medical care, and treatment supplies, totaled $92 billion. (National Diabetes Information Clearinghouse, 2006)

In 2007, diabetes cost the United States increase to about $174 billion. Indirect costs totaled $58 billion. Direct medical $116 billion. (National Diabetes Information Clearinghouse, 2006)

Content Source:
National Diabetes Information Clearinghouse. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health. U.S. Department of Health and Human Services. NIH Publication No. 06–3873, September 2006

National Diabetes Information Clearinghouse. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health. U.S. Department of Health and Human Services. NIH Publication No. 09–3873, November 2008

Page Last Updated: October 31, 2009

Scope of Diabetes

2007-05-21T17:21:00.002+08:00

Diabetes is widely recognized as one of the leading causes of death and disability in the United States. In 2002, it was the sixth leading cause of death. This, however, changed in 2006 where diabetes was the seventh leading cause of death in the U.S., according to the National Diabetes Information Clearinghouse (NDIC). However, diabetes is likely to be underreported as the underlying cause of death on death certificates. About 65 percent of deaths among those with diabetes are attributed to heart disease and stroke. (National Diabetes Information Clearinghouse, 2006)

Diabetes is associated with long-term complications that affect almost every part of the body. The disease often leads to blindness, heart and blood vessel disease, stroke, kidney failure, amputations, and nerve damage. Uncontrolled diabetes can complicate pregnancy, and birth defects are more common in babies born to women with diabetes.

Pre-Diabetes

2007-05-21T17:15:00.001+08:00

What is pre-diabetes?

People with pre-diabetes have blood glucose levels that are higher than normal but not high enough for a diagnosis of diabetes. This condition raises the risk of developing type 2 diabetes, heart disease, and stroke.

Pre-diabetes is also called impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), depending on the test used to diagnose it. Some people have both IFG and IGT.

 IFG is a condition in which the blood glucose level is high (100 to 125 mg/dL) after an overnight fast, but is not high enough to be classified as diabetes. (The former definition of IFG was 110 mg/dL to 125 mg/dL.)

 IGT is a condition in which the blood glucose level is high (140 to 199 mg/dL) after a 2-hour oral glucose tolerance test, but is not high enough to be classified as diabetes.

Pre-diabetes is becoming more common in the United States, according to new estimates provided by the U.S. Department of Health and Human Services. About 40 percent of U.S. adults ages 40 to 74—or 41 million people—had pre-diabetes in 2000. The U.S. Department of Health and Human Services estimates that at least 57 million U.S. adults ages 20 or older had pre-diabetes in 2007. Many people with pre-diabetes go on to develop type 2 diabetes within 10 years, unless they take steps to prevent or delay the development of the disease.

The good news is that if you have pre-diabetes, you can do a lot to prevent or delay diabetes. Studies have clearly shown that you can lower your risk of developing diabetes by losing 5 to 7 percent of your body weight through diet and increased physical activity. A major study of more than 3,000 people with IGT, a form of pre-diabetes, found that diet and exercise resulting in a 5 to 7 percent weight loss—about 10 to 14 pounds in a person who weighs 200 pounds—lowered the incidence of type 2 diabetes by nearly 60 percent. Study participants lost weight by cutting fat and calories in their diet and by exercising (most chose walking) at least 30 minutes a day, 5 days a week.

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This Page Last Reviewed: October 31, 2009
Last Revised: October 31, 2009

Diabetes: Diagnosis

2007-05-21T17:11:00.000+08:00

How is diabetes diagnosed?

The fasting blood glucose test is the preferred test for diagnosing diabetes in children and nonpregnant adults. It is most reliable when done in the morning. However, a diagnosis of diabetes can be made based on any of the following test results, confirmed by retesting on a different day:

 A blood glucose level of 126 milligrams per deciliter (mg/dL) or more after an 8-hour fast. This test is called the fasting blood glucose test.

 A blood glucose level of 200 mg/dL or more 2 hours after drinking a beverage containing 75 grams of glucose dissolved in water. This test is called the oral glucose tolerance test (OGTT).

 A random (taken at any time of day) blood glucose level of 200 mg/dL or more, along with the presence of diabetes symptoms.

Gestational diabetes is diagnosed based on blood glucose levels measured during the OGTT. Glucose levels are normally lower during pregnancy, so the cutoff levels for diagnosis of diabetes in pregnancy are lower. Blood glucose levels are measured before a woman drinks a beverage containing glucose. Then levels are checked 1, 2, and 3 hours afterward. If a woman has two blood glucose levels meeting or exceeding any of the following numbers, she has gestational diabetes: a fasting blood glucose level of 95 mg/dL, a 1-hour level of 180 mg/dL, a 2-hour level of 155 mg/dL, or a 3-hour level of 140 mg/dL.

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Image Credit: National Institutes of Health
This Page Last Reviewed: May 23, 2007

Gestational Diabetes

2007-05-21T17:08:00.001+08:00

Gestational diabetes is a form of glucose intolerance that is diagnosed in some women during pregnancy. During pregnancy, gestational diabetes requires treatment to normalize maternal blood glucose levels to avoid complications in the infant.² Although this form of diabetes usually disappears after the birth of the baby, women who have had gestational diabetes have a 40 to 60 percent chance of developing type 2 diabetes within 5 to 10 years. Maintaining a reasonable body weight and being physically active may help prevent development of type 2 diabetes.⁴

About 3 to 8 percent of pregnant women in the United States develop gestational diabetes. As with type 2 diabetes, gestational diabetes occurs more often in some ethnic groups and among women with a family history of diabetes.⁴Gestational diabetes occurs more frequently among African Americans, Hispanic/Latino Americans, and American Indians. It is also more common among obese women and women with a family history of diabetes.²

Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin. Women with gestational diabetes may not experience any symptoms.⁴

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Page Last Reviewed: October 31, 2009
Last Revised: October 31, 2009

Type 2 Diabetes

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The most common form of diabetes is type 2 diabetes^{2 USFDA}. Type 2 diabetes was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. Type 2 diabetes may account for about 90% to 95% of all diagnosed cases of diabetes.².

Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Native Hawaiians or Other Pacific Islanders are at particularly high risk for type 2 diabetes. Type 2 diabetes is increasingly being diagnosed in children and adolescents.²However, nationally representative data on prevalence of type 2 diabetes in youth are not available.⁴

About 80 percent of people with type 2 diabetes are overweight.⁴

When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin, but for unknown reasons the body cannot use the insulin effectively, a condition called insulin resistance. After several years, insulin production decreases. The result is the same as for type 1 diabetes—glucose builds up in the blood and the body cannot make efficient use of its main source of fuel.⁴

The symptoms of type 2 diabetes develop gradually. Their onset is not as sudden as in type 1 diabetes. Symptoms may include fatigue, frequent urination, increased thirst and hunger, weight loss, blurred vision, and slow healing of wounds or sores. Some people have no symptoms.⁴

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This page Last Reviewed: May 23, 2007

Type 1 Diabetes

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Type 1 diabetes is an autoimmune disease. Type 1 diabetes was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes. An autoimmune disease occurs when the body’s system for fighting infection (the immune system) turns against a part of the body. Type 1 diabetes develops when the body's immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin, which regulates blood glucose.

Experts are not really sure why the body's immune system attacks the beta cells of the pancreas. However, they believe that certain autoimmune diseases, genetic and environmental factors may be involved. Also, experts believe that viruses may also be involved in the development of diabetes.⁴

This form of diabetes usually strikes children and young adults, although disease onset can occur at any age. Type 1 diabetes accounts for about 5% to 10% of all diagnosed cases of diabetes in the United States. ²

Persons with type 1 diabetes make no insulin and must take insulin every day.⁴

Symptoms of type 1 diabetes usually develop over a short period, although beta cell destruction can begin years earlier. Symptoms may include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue. If not diagnosed and treated with insulin, a person with type 1 diabetes can lapse into a life-threatening diabetic coma, also known as diabetic ketoacidosis.⁴

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This Page Last Revised: October 31, 2009

Types of Diabetes

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Diabetes is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. Diabetes can be associated with serious complications and premature death, but people with diabetes can take steps to control the disease and lower the risk of complications.

The three main types of diabetes are

 Type 1 diabetes (Caused by an Autoimmune Disease)

 Type 2 diabetes (Most common form of Diabetes)

 Gestational diabetes (Pregnancy Related Diabetes)

Other specific types of diabetes result from specific genetic conditions (such as maturity-onset diabetes of youth), surgery, drugs, malnutrition, infections, and other illnesses. Such types of diabetes may account for 1% to 5% of all diagnosed cases of diabetes^1cdc.

Page Last Reviewed: May 23, 2007
Page Last Revised: October 31, 2009

Diabetes: Overview

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Diabetes is a disorder of metabolism—the way our body uses digested food for growth and energy. Diabetes Mellitus is more commonly known as Diabetes. Most of the food we eat is broken down into glucose, the form of sugar in the blood. Glucose is the body's main source of fuel for the body cells.

After food has been digested and converted into glucose, the glucose then passes into the bloodstream, where it is used by cells for growth and energy. Insulin must be present in order for glucose to get into cells. Insulin is a hormone produced by the beta cells of the pancreas, a large organ (gland) behind the stomach.

When we eat, the pancreas automatically produces the right amount of insulin to move glucose from blood into our cells. In people with diabetes, however, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced. Glucose builds up in the blood, overflows into the urine, and passes out of the body in the urine. Thus, the body loses its main source of fuel even though the blood contains large amounts of glucose.

Diabetes Mellitus should never be confused with Diabetes Insipidus. Although they have similarity in its signs and symptoms, the glands involved are different.

Diabetes is a serious disease, which, if not controlled, can have debilitating effects. It is often associated with long-term complications that can affect other parts of the body. Long term Diabetes can contribute to heart disease, stroke, kidney failure, eye disorders and blindness, amputation, nerve damage and can affect pregnancy and cause birth defects, as well.

Although diabetes is a chronic and incurable disease (with the exception of gestational diabetes), with proper medical care, lifestyle changes, diet, hygiene, and exercise, the symptoms and complications can be successfully treated and managed.

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Content Reviewed By: D.K. Mangusan Jr, PTRP
October 31, 2009

Page Last Revised: October 31, 2009

About Us

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The publisher, David Mangusan Jr., is a licensed Physical Therapist based in the Philippines and is also a college instructor at the University of the Cordilleras in Baguio City, Philippines. He is currently taking up his Master's Degree Major in Biology at the Graduate School of the University of the Cordilleras.

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Privacy Statement, Mission and Disclaimer, Advertisement Policy, Pop-Up Advertisements, Accreditation, and Site Maintenance: Updated: March 18, 2009