Category Archives: Diabetes

EDMONTON -- "I wanted to just be part of the solution,"Kathleen Cesarin says.

The specialized LPN was inspired to change the way the health system treats chronic wounds after working in emergency rooms for a decade.

"I got tired of seeing people's toes and limbs being amputated knowing 85 per cent of them were preventable," Cesarin told CTV News Edmonton.

Cesarin opened Accelerated Cast Clinic and Limb Preservation in August 2019, bringing together a team of specialists and therapists to serve clients' needs and reducing the need for amputations.

Dale Hasenuik is one of those patients. He lives with Type 2 diabetes and was told he needed to have his foot amputated after a deep sore became infected.

After only four months of treatments at Accelerated, his ulcer closed.

"I'm grateful," Hasenuik said. "They've basically saved my foot. It would have been gone, there was no doubt."

According to Wounds Canada, there are 400 lower limb amputations in Alberta each year, costing the health care system up to $86 million.

About 320,000 Albertans have diabetes and as many as 25 per cent of them will develop a foot ulcer in their lifetime.

The services at the clinic are covered by most private insurance plans. Cesarin hopes to work with the government to have everything covered by Alberta Health.

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This Edmonton clinic is reducing the number of amputations due to diabetes - CTV News

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Chandigarh: Punjab announced its first death due to COVID-19 Thursday, taking the toll in India to four. The deceased was a 70-year-old man who had arrived at Delhi airport from Germany via Italy on 7 March, before proceeding to his home in Banga, in Nawanshahr district.

A known case of diabetes and hypertension,according to a state government press note, the man was being monitored for coronavirus symptoms by health officials. He died Wednesday morning of what seemed to be a heart attack, but was confirmed as coronavirus-positive late at night.

As many as 17 people who he had come in contact with him, including three health officials, have been quarantined following his death. His village too has been locked down for screening.

Also read: Modi govt COVID-19 advisory: Those above 65, below 10 must stay home, no concessional travel

Chandigarh, the union territory that serves as the capital of Punjab and Haryana, reported its first COVID-19 case Wednesday night when a 23-year-old resident of Sector 21 was found positive. She had arrived from London on 15 March, and is undergoing treatment at the government medical college in Sector 32.

Another coronavirus-positive patient from Punjab is undergoing treatment in Amritsar. He was hospitalised on arrival from Italy on 9 March. His condition is said to be stable.

Taking note of these cases, the Punjab government has launched a door-to-door awareness and surveillance campaign to assess if the virus has managed to find its way into the community. The campaign will involve health officials, police and village-level workers.

Punjab is the first Indian state to start a campaign to stem the coronavirus involving the entire population. Until now, like other states, Punjabs efforts were limited to checking and quarantining persons arriving from countries already affected by the virus.

Punjabs principal secretary for health, Anurag Aggarwal, told ThePrint that special teams will be covering villages and urban areas beginning this week.

Apart from generating awareness about the disease and how to prevent it, these teams have also been authorised to report to the headquarters in case any member of the family they visit is showing signs of a suspected infection. In such cases, another team of health officials will go and conduct the screening, he said.

The health teams have been grouped in accordance with the system followed during polio vaccination drives. In many districts, village-level police officials, anganwadi and Asha workers have also been made part of the teams.

The first COVID-19 death in the state has also prompted the group of ministers authorised by the CM to monitor the situation to suspend all private and government bus services in the state from Friday midnight.

The number of people allowed to gather has been reduced from 50 to 20, and health officials have been asked to start stamping quarantine time dates on the arms of suspected patients.

Briefing journalists following an emergent meeting Thursday morning, cabinet minister Brahm Mohindra, who heads the group of ministers, said the Punjab School Education Board would follow the decision taken by the CBSE to postpone all board examinations until 31 March, after which fresh dates will be announced.

CM Amarinder Singh has also urged the central government to allow private hospitals and labs to conduct tests in order to ensure access to all people. He said he would take up the issue with Prime Minister Narendra Modi Friday, during his proposed video conference with all CMs.

Amarinder also offered to allow the 20 million tonnes of food grains currently stored in Punjabs godowns to be distributed to the poor whose earnings were impacted due to the coronavirus outbreak, instead of letting them rot in the storage areas.

The CM also issued an appeal to gurudwaras and other religious places to limit gatherings.

The Golden Temple in Amritsar witnesses thousands of visitors each day, but has not shut its doors to devotees due to the COVID-19 outbreak. The Shiromani Gurudwara Prabandhak Committee that runs the Golden Temple has allowed people to visit the gurudwara, but only after thermal screening and three-stage sanitisation.

Also read: Donkey poop a COVID-19 hack? Kolkata police take down 600 social media posts for rumours

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Punjabs first coronavirus death is 70-year-old man with diabetes who travelled via Italy - ThePrint

Patients with underlying health conditions, including asthma and diabetes, have been instructed by the Government to take extreme measures to shield themselves from the coronavirus (Covid-19), starting this weekend.

Yesterday Prime Minister Boris Johnson said anyone over 70, pregnant women and people with certain underlying health conditions making them more vulnerable to serious Covid-19 complications, should isolate themselves for at least 12 weeks starting this weekend.

The Government has now published a list of the conditions affected, including severe illnesses such as patients undergoing cancer treatment, but also anyone who would normally be eligible for a free flu jab.

The specific at-risk patients are those with:

The Government also went on to list a group of patients who are at even greater risk, saying these will be contacted specially by the NHS with more stringent measures they should take. For now, they are told to'rigourously follow' social distancing advice.

The groups most at risk are:

At yesterday's daily coronavirus briefing, chief medical officer Professor Chris Whitty said they hope the 12 weeks will cover the peak of the virus outbreak in the UK, but could end up lasting longer.

Prime Minister Boris Johnson said people in at-risk group should shield themselves away from social contact, only leaving the house for exercise, during which they should keep their distance from others. If at all possible, they should have their essential items brought to them.

In the unprecedented message, all members of the public were urged to avoid non-essential contact with others in a bid to delay the spread of Covid-19 until the NHS is prepared.

Social distancing measures the public is urged to undertake include working from home where possible; avoiding large gatherings, including in public venues; only engaging in essential contact; and entire households staying at home for two weeks if just one member displays symptoms such as a continuous cough or high temperature.

Speaking in Parliament yesterday, health secretary Matt Hancock noted that these nationwide proposals are unprecedented in peacetime and urged people to look out for the vulnerable members of their community.

Source: UK Government

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Patients with asthma and diabetes told to enter three-month quarantine - Pulse

When doctors first discovered diabetes in the early 1900s, there were few options for treatment. It wasnt until the 1990s that people with Type 2 diabetes had oral medications like metformin still a mainstay of treatment for many people with diabetes.

Insulin, a necessary treatment for patients with Type 1 diabetes, remains one of the biggest medical discoveries to this day. Prior to its unearthing in the early 1920s, led primarily by Dr. Frederick Banting of Toronto, Canada, diabetes was a dreaded disease that led to certain death. A strict diet to minimize sugar intake, which sometimes caused death by starvation, was the most effective treatment, possibly buying patients a few more years to live.

Banting and one of his colleagues were awarded the Nobel Peace Prize for their discovery in 1923. That same year, drug manufacturer Eli Lilly started large-scale production of insulin, producing enough to supply all of North America.

Now, in addition to injected insulin, there are a number of oral medication classes to choose from, all with their own benefits and risks. Butdiet and exerciseare still an important part of both Type 1 and Type 2 diabetes treatment. Now, even special types of surgery can help people with both types of diabetes manage their blood sugar.

A doctor may recommend one type of treatment or a combination of the three.

When changes in diet and increased physical activity are not enough to control blood glucose levels, doctors will prescribe medications. These same medications, aside from insulin, are not used, however, to treat patients with Type 1 diabetes. Insulin is the only medication prescribed to treat Type 1 diabetes, and Type 1 patients are required to take the hormone replacement daily. However, there are several different types, or classes, of medications available to treat Type 2 diabetes. Each controls blood sugar in different ways. Some people may take more than one medication to more effectively control sugar levels.

Type 2 Diabetes Groups

There are many medications to treat Type 2 diabetes, and typically they are organized into groups that represent the condition that they target. These drugs are then organized into classes by mechanism of action.

A new class of diabetes medications calledsodium-glucose co-transporter 2 (SGLT2) inhibitorsrelease excess glucose in the body through urination. The FDA approved Invokana (canagliflozin), the first drug in the class, in 2013. Several others followed. But the agency has also released a number of warnings for serious side effects linked to these medications.

Popular Drugs in This Class Include:

Side Effects of SGLT2 Inhibitors May Include:

The FDA warned UTIs caused by SGLT2s can lead to other serious infections. The first is urosepsis, a serious systemic blood infection that can be fatal. The second is pyelonephritis, a serious kidney infection. Pyelonephritis may also lead to a blood infection. Both types of infection require hospitalization and antibiotics.

Additional FDA safety communications warned aboutkidney injuryand diabetic ketoacidosis, a condition that occurs when too many toxins build up in the blood. New studies also show these drugs may also cause acute pancreatitis, a condition caused by the swelling and inflammation of the pancreas the organ that produces insulin.

Biguanides are a class of drugs that work by making the body more sensitive to insulin. They also stop the liver from making glucose and releasing it into the blood. They may also make fat and muscle cells more insulin sensitive.

Currently, there is only one drug in this class available on the market: Glucophage (metformin). This is one of the most widely used Type 2 diabetes medications in the world. Since it has been around since the 1920s, its side effects are very well known. It became available in the U.S. in the 1990s. Many doctors are very comfortable prescribing it as a frontline medication or incombination with other medications.

In fact, most combination oral medications contain metformin. Newer drugs also test their effectiveness against metformin in clinical trials.

Metformin's Side Effects May Include:

TZDs work by decreasing blood glucose levels by making muscle, fat and liver cells more sensitive to insulin. The FDA approved many of these drugs in the 1990s. The two most popular drugs in this class areActosandAvandia. But these drugs were linked to serious side effects including bladder cancer and heart failure.

It has been one of the most popular drugs in the United States for treating Type 2 diabetes since 2007. It has only been on the market since 1999. The drug recently came under fire for causing an increased risk of congestive heart failure and its link to bladder cancer. The drugs maker, Takeda, paid $2.37 billion to settle thousands of lawsuits by people who claimed Actos caused their bladder cancer.

This drug comes from the same controversial class of drugs as Actos, and works in a similar way. Studies link it to an increased risk of heart failure. A number of countries in Europe stopped selling the drug and banned it. Although not banned in the United States, it can only be prescribed by a small group of doctors.

TDS side effects may include:

These drugs stimulate the pancreas to produce more insulin. There are several well-known Type 2 diabetes drugs that use sulfonylureas as their base. These include Glucotrol (glipizide), Diabeta (glyburide) and several others. TheFDA approvedthe first of these drugs in the 1980s.

These work to decrease blood glucose levels by stimulating insulin release by the beta cells in the pancreas. Pancreatic beta cells are the cells primarily responsible for releasing insulin.

Side effects of sulfonylureas include:

One of the issues with Type 2 diabetes is glucose entering the bloodstream faster than the body can process it. Slowing the digestive process of starches and sugars slows down the rate that glucose enters the bloodstream.

These drugs slow the digestion of sugar. Because these medications affect the digestive system, side effects of nausea and flatulence are common. Alpha-glucosidase inhibitors are the least effective medications for lowering blood sugar and are rarely used in the United States. Precose (acarbose) and Glyset (miglitol) belong to this class. Amylin analogues also have a modest effect on blood sugar, and are injected with a dosing pen. The only product available is called pramlintide.

These drugs keep the hormone incretin from being broken down, stimulating insulin production and slowing digestion. Popular brand names are Januvia, Onglyza and Tradjenta. Generic names are sitagliptin, saxagliptin and linagliptin. Side effects include: joint pain, pancreatitis, sore throat, swelling of hands or feet, nausea, hypoglycemia and diarrhea.

Everyone with Type 1 diabetes must take insulin every day. However, patients diagnosed with Type 2 diabetes sometimes need to take insulin as well, when oral medications taken along with diet and exercise, are no longer enough to control the disease on their own. Some reasons why people with Type 2 may need to start taking insulin, even if just temporarily, often involve other health conditions, injury, medication use or any other physiological change that can cause an individuals body to become unable to produce enough insulin.

These reasons might include:

Insulin is injected under the skin (called a subcutaneous injection) using a syringe, insulin pen or insulin pump. The abdomen is the preferred injection site due to a more consistent absorption of insulin occurring in this region. However, the location for injections should be rotated regularly to avoid a condition called lipodystrophy, or erosion of the fat beneath the skin. Other popular injection sites include the thigh and the arm.

Insulin is not available to be taken in an oral form because stomach acid destroys the hormone. However, there is an inhaled version of the drug sold under the brand name Afrezza. This is a powder that is breathed in just before a meal (rapid-acting).

Doses of insulin vary by patient. How much insulin a patient requires daily depends on several factors, including:

In patients with Type 2 diabetes, insulin may be stopped if temporary situations necessitating its use are resolved, or sometimes with weight loss, exercise or other lifestyle changes. Patients with Type 1 diabetes will never be able to stop taking insulin, although doses may be adjusted.

There are four different types of insulin that work differently for patients with diabetes rapid-acting, short-acting, intermediate-acting and long-acting. Rapid-acting and short-acting insulins are often used in combination with longer-acting insulins. Both rapid- and short-acting insulins are taken shortly before meals (usually about 30 minutes prior) to cover the rise in blood glucose levels that results from eating.

Intermediate- and long-acting insulins cover any elevations in blood glucose levels after the shorter acting insulins stop working. Intermediate-acting insulin is usually taken twice a day, while long-acting insulin is taken once or twice a day.

The following chart breaks down the different types of insulin and how they work.

Insulin is generally considered safe to take. It is even the preferred drug, over oral drugs, to control blood glucose levels during pregnancy and when breastfeeding. However, insulin is not without side effects. Hypoglycemia (low blood sugar) is the most common side effect experienced in patients taking insulin.

Other Insulin Side Effects Might Include:

Healthy eating helps keep blood sugar down and is a critical part of managing both Type 1 and Type 2 diabetes, according to the National Institutes of Health. In fact, healthy eating is a part of a diabetic patients treatment plan, along with insulin for primarily Type 1 patients or another prescribed medication for patients with Type 2. Type 1 patients are also required to count carbohydrates and frequently monitor their blood sugar levels. Type 2 patients should be mindful of their blood sugar levels before and after eating as well.

The NIH recommends talking to a registered dietitian or nutritionist to develop an eating plan that works around eachindividuals lifestyle, weight, medicines and other health problems. The National Institute of Diabetes and Digestive and Kidney Diseases has tips for healthy eating.

These include:

Exercise is also beneficial for controlling blood glucose. Both Type 1 and Type 2 patients can benefit from exercising regularly and maintaining a healthy weight. A personal trainer or a diabetes expert can help you set meaningful goals. An exercise plan does not have to be strenuous to impart benefits.

In fact, new research in the journal Diabetologia shows that short 10-minute walks after meals can help lower blood sugar. Researchers at the University of Otago in New Zealand found these short walks after meals helped control blood glucose better than a single 30-minute walk by 12 percent.

Other 2016 research in Diabetologia by Dr. Bernard Duvivier of Maastricht University in the Netherlands found simply sitting less and by standing more and doing light walking may control blood sugar better than higher intensity exercise.

Exercise can cause blood sugar levels to drop, especially in diabetic patients taking insulin. Patients with diabetes should regularly monitor their blood sugar levels before, during and after physical activity to make sure they dont get too low.

Additionally, after administering insulin, strenuous activity can potentially speed up the bodys absorption of the hormone. Patients who plan to exercise following an insulin injection, should not inject themselves in an area that is most likely to be affected by the activity. For example, patients who plan to go running soon after the injection of insulin, should not inject the hormone into their thigh.

Bariatric surgery is growing in popularity as a treatment for Type 2 diabetes. There are a few methods of performing the surgery, but they all involve shrinking the size of the stomach or rerouting the path of food.

As with any surgery, there are risks, including:

The most familiar type of surgery is gastric bypass. It creates a small pouch at the top of the stomach about the size of a walnut. The surgeon then reconnects the small intestine to this new walnut-sized stomach.

One study published in 2011 in Diabetes Care showed the surgery is highly effective in very obese patients with Type 2 diabetes. A review of clinical literature showed diabetes death rates lowered by up to 90 percent after gastric-bypass surgery.

Overweight patients with poorly controlled Type 1 diabetes may make good candidates for surgery as well. Such operations may give Type 1 patients greater control over the disease not a cure.

They may experience a possible reduction in daily insulin doses, according to a review of cases from the Cleveland Clinic in Ohio.

One study conducted at Cleveland Clinic showed that 9 out of 10 morbidly obese patients with Type 1 who underwent a laparoscopic procedure, such as a gastric bypass, lost more than 60 percent of their body weight in more than three years time. These patients also saw improvements in all cardiovascular risk factors, such as hypertension (high blood pressure) and triglyceride levels (the most common type of fat found in the blood).

Other Pages Related to Diabetes

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Diabetes - Symptoms, Diagnosis, Treatments & Complications

Introduction

Diabetes is a metabolic disorder in which the body is unable to appropriately regulate the level of sugar, specificallyglucose, in the blood, either by poor sensitivity to the protein insulin, or due to inadequate production of insulin by thepancreas. Type 2 diabetes accounts for 90-95% of all diabetes cases. Diabetes itself is not a high-mortality condition(1.3 million deaths globally), but it is a major risk factor for other causes of death and has a high attributable burden ofdisability. Diabetes is also a major risk factor for cardiovascular disease, kidney disease and blindness.[1]

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Diabetes Mellitus primarily affects the Islets of Langerhans of the pancreas, where glucagon (from the alpha cells) and insulin (from the beta cells)are produced. Glucagon raises the blood glucose level, while insulin lowers it.In Type 1 DM (Insulin Dependent), the loss of function of the beta cells leads to an absolute insulin deficiency. In Type 2 DM(Non-insulin Dependent), the impaired production and secretion of insulin by the beta cells is concomitant with the impaired ability of the tissues to utilize insulin (termed insulin resistance). The resulting accumulation of glucose in the blood is further elevated by the greater synthesis of glucose in the liver, which releases it to the general circulation.

Diabetes Mellitus (both Type 1 and Type 2) is now a global epidemic. Usually correlated with being overweight and obese, a sedentary lifestyle and familial history are also beingconsidered as risk factors.

According to the research entitled "Global Prevalence of Diabetes" by Sarah Wild, MB, BCHIR, PhD, and associates[2], "the total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030. The prevalence of diabetes is higher in men than women, but there are more women with diabetes than men. The urban population in developing countries is projected to double between 2000 and 2030. The most important demographic change to diabetes prevalence across the world appears to be the increase in the proportion of people greater than 65 years of age."

Diabetes can be categorized as acquired or hereditary. The lack or decrease in exercise, elevatedstress levels, and unhealthy diet all predispose an individual to Type 2 Diabetes Mellitus even without a clear family history.

Considered an endocrine disorder, this could also occur in pregnant women during a gestational stage. Susan Y. Chu, PhD, MSPH, and associates[3], in their research entitled "Maternal Obesity and Risk of Gestational Diabetes Mellitus", concluded that "high maternal weight is associated with a substantially higher risk of GDM."

In general, Diabetes Mellitus is a chronic disorder characterized by hyperglycemia or hypoglycemia (or impaired glucose tolerance), with subsequent disruption of the metabolism of carbohydrates, fats and proteins. Over time, it results in serious small and large vessel vascular complications and neuropathies.

Classic triad of Diabetes Mellitus are polydipsia (increased thirst), polyphagia (increased appetite and ingestion), and polyuria (increased urination caused by osmotic diuresis).

Amidst the increased appetite and craving for food, persons with DM (usually Type 1) may still experience weight loss because of the improper fat metabolism and breakdown of fat stores.

Other striking features include the presence of glucose and ketone bodies in the urine. Fatigue with weakness, irritability, blurred vision, numbness or tingling sensations in the hands and feet are also present.

Fasting glucose level of greater than126 mg/dl on two separate occasions is considered positive.

The strictest procedure is according to the World Health Organization, which states that the diagnosis is positive if "venous plasma glucose concentrationis greater than 11.1 mmol/L 2 hours after a 75g glucose tolerance test."

The study by Pooja Bhati et al. suggests that biomarkers of inflammation and endothelial function are correlated with Cardiac Vagal Tone and global Heart Rate Variability (HRV), which indicate some pathophysiological link between subclinical inflammation, endothelial dysfunction and cardiac autonomic dysfunction in Type 2 Diabetes Mellitus[4].

For Type 1 (insulin dependent) Diabetes, intramuscular administration of insulin is needed. Dosage is always expressed in USPunits. Humalog is the fastest acting insulin, acting within 15 minutes. The PZI has the longest peak of 8-20 hours and has the longest total duration of 36 hours. On the other hand, the Lantus is the only one "without peak" and lasts for 24 hours.

For Type 2 (non-insulin dependent) Diabetes, popular oral hypoglycemics include Metformin and Sulfonylureas. Insulin sensitizers such as Rosiglitazone and Pioglitazone are also prescribed.

Weight management, nutritional and diet counselling combined with physical therapy/exercise prescription completes the holistic treatment approach.

Therapeutic exercise programscomprise the major aspect of management. Patient education for proper foot care is an essential part of the physical therapy program for diabetic patients.

A sound, individually tailored exercise prescription is a cornerstone in the management of Diabetes Mellitus.

The goal is to address the beyond normal BMI score (25 and above) for overweight and obese patients. Numerous studies show that a regular exercise program for diabetics has a profound effect on the regulation of their blood glucose levels.

From the archives of the Journal of the American Medical Association (JAMA), a researchconducted by Daniel Umpierre, MSc and associates[5] entitled "Physical Activity Advice Only or Structured Exercise Training and Association With HbA1C Levels in Type 2 Diabetes, A Systematic Review and Meta-analysis", it was concluded that "structured exercise training that consists of aerobic exercise, resistance training, or both combined is associated with HbA1C reduction in patients with Type 2 diabetes. Structured exercise training of more than 150 minutes per week is associated with greater HbA1C declines than that of 150 minutes or less per week. Physical activity advice is associated with lower HbA1C, but only when combined with dietary advice."

Similarly, a randomized controlled trial by Timothy S. Church, MD, MPH, PhD and associates[6] which was entitled "Effects of Aerobic and Resistance Training on Hemoglobin A1C Levels in Patients With Type 2 Diabetes" made a conclusion that "among patients with Type 2 Diabetes Mellitus, a combination of aerobic and resistance training compared with the non-exercise control group improved HbA1C levels. This was not achieved by aerobic or resistance training alone."

Guidelines for a sound exercise program are as follows:

Diabetics are more prone to hypoglycemia than hyperglycemia during exercise. But physical therapists must be efficiently adept in distinguishing the differences in the signs and symptoms, including the dangerous Diabetic Ketoacidocis (DKA).

During Diabetic Ketoacidosis (DKA) the patient might experience abdominal pain, anorexia, nausea, vomiting or diarrhea. This occurs more in children. Patient will have confusion and dull mental state which can lead to coma. There is an increase in pulse rate, yet weak. There is an initial deep and rapid breathingwhich could lead to Kussmaul respiration. Cardinal sign is a fruity or acetone breath. Urine output is increased and the glucose level is extremely high (greater than 300 mg/dl). Ketones are high and pH is acidotic (less than 7.3).The skin is warm and dry.Onset is rapid, which is less than 24 hours.

While on hyperglycemia, thereare no gastrointestinal symptoms, usually occur in adults with underlying chronic disease andthe patientis also inadull, confused mental state. Skin is warm and dry, pulse and respiratory rateare high, ketone andpHlevelare normal, relatively high glucose level and the onset is slow (may take days).

On the other hand, hypoglycemia can occur with all ages. The patient may feel hungry with difficulty in concentration and coordinationwhich could eventually lead to coma. Skin is cold and clammy, there is profuse sweating, increased pulse rate, shallow respiration, considerably low glucose level,ketones and pH are normaland the onset is rapid.

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Diabetes - Physiopedia

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Flannick J, Florez JC. Type 2 diabetes: genetic data sharing to advance complex disease research. Nat Rev Genet. 2016 Sep;17(9):535-49. doi: 10.1038/nrg.2016.56. Epub 2016 Jul 11. Review.

Fuchsberger C, Flannick J, Teslovich TM, Mahajan A, Agarwala V, Gaulton KJ, Ma C, Fontanillas P, Moutsianas L, McCarthy DJ, Rivas MA, Perry JRB, Sim X, Blackwell TW, Robertson NR, Rayner NW, Cingolani P, Locke AE, Tajes JF, Highland HM, Dupuis J, Chines PS, Lindgren CM, Hartl C, Jackson AU, Chen H, Huyghe JR, van de Bunt M, Pearson RD, Kumar A, Mller-Nurasyid M, Grarup N, Stringham HM, Gamazon ER, Lee J, Chen Y, Scott RA, Below JE, Chen P, Huang J, Go MJ, Stitzel ML, Pasko D, Parker SCJ, Varga TV, Green T, Beer NL, Day-Williams AG, Ferreira T, Fingerlin T, Horikoshi M, Hu C, Huh I, Ikram MK, Kim BJ, Kim Y, Kim YJ, Kwon MS, Lee J, Lee S, Lin KH, Maxwell TJ, Nagai Y, Wang X, Welch RP, Yoon J, Zhang W, Barzilai N, Voight BF, Han BG, Jenkinson CP, Kuulasmaa T, Kuusisto J, Manning A, Ng MCY, Palmer ND, Balkau B, Stankov A, Abboud HE, Boeing H, Giedraitis V, Prabhakaran D, Gottesman O, Scott J, Carey J, Kwan P, Grant G, Smith JD, Neale BM, Purcell S, Butterworth AS, Howson JMM, Lee HM, Lu Y, Kwak SH, Zhao W, Danesh J, Lam VKL, Park KS, Saleheen D, So WY, Tam CHT, Afzal U, Aguilar D, Arya R, Aung T, Chan E, Navarro C, Cheng CY, Palli D, Correa A, Curran JE, Rybin D, Farook VS, Fowler SP, Freedman BI, Griswold M, Hale DE, Hicks PJ, Khor CC, Kumar S, Lehne B, Thuillier D, Lim WY, Liu J, van der Schouw YT, Loh M, Musani SK, Puppala S, Scott WR, Yengo L, Tan ST, Taylor HA Jr, Thameem F, Wilson G Sr, Wong TY, Njlstad PR, Levy JC, Mangino M, Bonnycastle LL, Schwarzmayr T, Fadista J, Surdulescu GL, Herder C, Groves CJ, Wieland T, Bork-Jensen J, Brandslund I, Christensen C, Koistinen HA, Doney ASF, Kinnunen L, Esko T, Farmer AJ, Hakaste L, Hodgkiss D, Kravic J, Lyssenko V, Hollensted M, Jrgensen ME, Jrgensen T, Ladenvall C, Justesen JM, Krjmki A, Kriebel J, Rathmann W, Lannfelt L, Lauritzen T, Narisu N, Linneberg A, Melander O, Milani L, Neville M, Orho-Melander M, Qi L, Qi Q, Roden M, Rolandsson O, Swift A, Rosengren AH, Stirrups K, Wood AR, Mihailov E, Blancher C, Carneiro MO, Maguire J, Poplin R, Shakir K, Fennell T, DePristo M, de Angelis MH, Deloukas P, Gjesing AP, Jun G, Nilsson P, Murphy J, Onofrio R, Thorand B, Hansen T, Meisinger C, Hu FB, Isomaa B, Karpe F, Liang L, Peters A, Huth C, O'Rahilly SP, Palmer CNA, Pedersen O, Rauramaa R, Tuomilehto J, Salomaa V, Watanabe RM, Syvnen AC, Bergman RN, Bharadwaj D, Bottinger EP, Cho YS, Chandak GR, Chan JCN, Chia KS, Daly MJ, Ebrahim SB, Langenberg C, Elliott P, Jablonski KA, Lehman DM, Jia W, Ma RCW, Pollin TI, Sandhu M, Tandon N, Froguel P, Barroso I, Teo YY, Zeggini E, Loos RJF, Small KS, Ried JS, DeFronzo RA, Grallert H, Glaser B, Metspalu A, Wareham NJ, Walker M, Banks E, Gieger C, Ingelsson E, Im HK, Illig T, Franks PW, Buck G, Trakalo J, Buck D, Prokopenko I, Mgi R, Lind L, Farjoun Y, Owen KR, Gloyn AL, Strauch K, Tuomi T, Kooner JS, Lee JY, Park T, Donnelly P, Morris AD, Hattersley AT, Bowden DW, Collins FS, Atzmon G, Chambers JC, Spector TD, Laakso M, Strom TM, Bell GI, Blangero J, Duggirala R, Tai ES, McVean G, Hanis CL, Wilson JG, Seielstad M, Frayling TM, Meigs JB, Cox NJ, Sladek R, Lander ES, Gabriel S, Burtt NP, Mohlke KL, Meitinger T, Groop L, Abecasis G, Florez JC, Scott LJ, Morris AP, Kang HM, Boehnke M, Altshuler D, McCarthy MI. The genetic architecture of type 2 diabetes. Nature. 2016 Aug 4;536(7614):41-47. doi: 10.1038/nature18642. Epub 2016 Jul 11.

McCarthy MI. Genomics, type 2 diabetes, and obesity. N Engl J Med. 2010 Dec 9;363(24):2339-50. doi: 10.1056/NEJMra0906948. Review.

Mohlke KL, Boehnke M. Recent advances in understanding the genetic architecture of type 2 diabetes. Hum Mol Genet. 2015 Oct 15;24(R1):R85-92. doi: 10.1093/hmg/ddv264. Epub 2015 Jul 9. Review.

Morris AP, Voight BF, Teslovich TM, Ferreira T, Segr AV, Steinthorsdottir V, Strawbridge RJ, Khan H, Grallert H, Mahajan A, Prokopenko I, Kang HM, Dina C, Esko T, Fraser RM, Kanoni S, Kumar A, Lagou V, Langenberg C, Luan J, Lindgren CM, Mller-Nurasyid M, Pechlivanis S, Rayner NW, Scott LJ, Wiltshire S, Yengo L, Kinnunen L, Rossin EJ, Raychaudhuri S, Johnson AD, Dimas AS, Loos RJ, Vedantam S, Chen H, Florez JC, Fox C, Liu CT, Rybin D, Couper DJ, Kao WH, Li M, Cornelis MC, Kraft P, Sun Q, van Dam RM, Stringham HM, Chines PS, Fischer K, Fontanillas P, Holmen OL, Hunt SE, Jackson AU, Kong A, Lawrence R, Meyer J, Perry JR, Platou CG, Potter S, Rehnberg E, Robertson N, Sivapalaratnam S, Stankov A, Stirrups K, Thorleifsson G, Tikkanen E, Wood AR, Almgren P, Atalay M, Benediktsson R, Bonnycastle LL, Burtt N, Carey J, Charpentier G, Crenshaw AT, Doney AS, Dorkhan M, Edkins S, Emilsson V, Eury E, Forsen T, Gertow K, Gigante B, Grant GB, Groves CJ, Guiducci C, Herder C, Hreidarsson AB, Hui J, James A, Jonsson A, Rathmann W, Klopp N, Kravic J, Krjutkov K, Langford C, Leander K, Lindholm E, Lobbens S, Mnnist S, Mirza G, Mhleisen TW, Musk B, Parkin M, Rallidis L, Saramies J, Sennblad B, Shah S, Sigursson G, Silveira A, Steinbach G, Thorand B, Trakalo J, Veglia F, Wennauer R, Winckler W, Zabaneh D, Campbell H, van Duijn C, Uitterlinden AG, Hofman A, Sijbrands E, Abecasis GR, Owen KR, Zeggini E, Trip MD, Forouhi NG, Syvnen AC, Eriksson JG, Peltonen L, Nthen MM, Balkau B, Palmer CN, Lyssenko V, Tuomi T, Isomaa B, Hunter DJ, Qi L; Wellcome Trust Case Control Consortium; Meta-Analyses of Glucose and Insulin-related traits Consortium (MAGIC) Investigators; Genetic Investigation of ANthropometric Traits (GIANT) Consortium; Asian Genetic Epidemiology NetworkType 2 Diabetes (AGEN-T2D) Consortium; South Asian Type 2 Diabetes (SAT2D) Consortium, Shuldiner AR, Roden M, Barroso I, Wilsgaard T, Beilby J, Hovingh K, Price JF, Wilson JF, Rauramaa R, Lakka TA, Lind L, Dedoussis G, Njlstad I, Pedersen NL, Khaw KT, Wareham NJ, Keinanen-Kiukaanniemi SM, Saaristo TE, Korpi-Hyvlti E, Saltevo J, Laakso M, Kuusisto J, Metspalu A, Collins FS, Mohlke KL, Bergman RN, Tuomilehto J, Boehm BO, Gieger C, Hveem K, Cauchi S, Froguel P, Baldassarre D, Tremoli E, Humphries SE, Saleheen D, Danesh J, Ingelsson E, Ripatti S, Salomaa V, Erbel R, Jckel KH, Moebus S, Peters A, Illig T, de Faire U, Hamsten A, Morris AD, Donnelly PJ, Frayling TM, Hattersley AT, Boerwinkle E, Melander O, Kathiresan S, Nilsson PM, Deloukas P, Thorsteinsdottir U, Groop LC, Stefansson K, Hu F, Pankow JS, Dupuis J, Meigs JB, Altshuler D, Boehnke M, McCarthy MI; DIAbetes Genetics Replication And Meta-analysis (DIAGRAM) Consortium. Large-scale association analysis provides insights into the genetic architecture and pathophysiology of type 2 diabetes. Nat Genet. 2012 Sep;44(9):981-90. doi: 10.1038/ng.2383. Epub 2012 Aug 12.

Pal A, McCarthy MI. The genetics of type 2 diabetes and its clinical relevance. Clin Genet. 2013 Apr;83(4):297-306. doi: 10.1111/cge.12055. Epub 2012 Dec 4. Review.

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Type 2 diabetes - Genetics Home Reference - NIH

Most pediatric patients with diabetes have type 1 diabetes mellitus (T1DM) and a lifetime dependence on exogenous insulin. Diabetes mellitus (DM) is a chronic metabolic disorder caused by an absolute or relative deficiency of insulin, an anabolic hormone. Insulin is produced by the beta cells of the islets of Langerhans located in the pancreas, and the absence, destruction, or other loss of these cells results in type 1 diabetes (insulin-dependent diabetes mellitus [IDDM]). A possible mechanism for the development of type 1 diabetes is shown in the image below. (See Etiology.)

Type 2 diabetes mellitus (noninsulin-dependent diabetes mellitus [NIDDM]) is a heterogeneous disorder. Most patients with type 2 diabetes mellitus have insulin resistance, and their beta cells lack the ability to overcome this resistance. [6] Although this form of diabetes was previously uncommon in children, in some countries, 20% or more of new patients with diabetes in childhood and adolescence have type 2 diabetes mellitus, a change associated with increased rates of obesity. Other patients may have inherited disorders of insulin release, leading to maturity onset diabetes of the young (MODY) or congenital diabetes. [7, 8, 9] This topic addresses only type 1 diabetes mellitus. (See Etiology and Epidemiology.)

Hypoglycemia is probably the most disliked and feared complication of diabetes, from the point of view of the child and the family. Children hate the symptoms of a hypoglycemic episode and the loss of personal control it may cause. (See Pathophysiology and Clinical.) [10]

Manage mild hypoglycemia by giving rapidly absorbed oral carbohydrate or glucose; for a comatose patient, administer an intramuscular injection of the hormone glucagon, which stimulates the release of liver glycogen and releases glucose into the circulation. Where appropriate, an alternative therapy is intravenous glucose (preferably no more than a 10% glucose solution). All treatments for hypoglycemia provide recovery in approximately 10 minutes. (See Treatment.)

Occasionally, a child with hypoglycemic coma may not recover within 10 minutes, despite appropriate therapy. Under no circumstances should further treatment be given, especially intravenous glucose, until the blood glucose level is checked and still found to be subnormal. Overtreatment of hypoglycemia can lead to cerebral edema and death. If coma persists, seek other causes.

Hypoglycemia was a particular concern in children younger than 4 years because the condition was thought to lead to possible intellectual impairment later in life. Persistent hyperglycemia is now believed to be more damaging.

In an otherwise healthy individual, blood glucose levels usually do not rise above 180 mg/dL (9 mmol/L). In a child with diabetes, blood sugar levels rise if insulin is insufficient for a given glucose load. The renal threshold for glucose reabsorption is exceeded when blood glucose levels exceed 180 mg/dL (10 mmol/L), causing glycosuria with the typical symptoms of polyuria and polydipsia. (See Pathophysiology, Clinical, and Treatment.)

All children with diabetes experience episodes of hyperglycemia, but persistent hyperglycemia in very young children (age < 4 y) may lead to later intellectual impairment. [11, 12]

Diabetic ketoacidosis (DKA) is much less common than hypoglycemia but is potentially far more serious, creating a life-threatening medical emergency. [13] Ketosis usually does not occur when insulin is present. In the absence of insulin, however, severe hyperglycemia, dehydration, and ketone production contribute to the development of DKA. The most serious complication of DKA is the development of cerebral edema, which increases the risk of death and long-term morbidity. Very young children at the time of first diagnosis are most likely to develop cerebral edema.

DKA usually follows increasing hyperglycemia and symptoms of osmotic diuresis. Users of insulin pumps, by virtue of absent reservoirs of subcutaneous insulin, may present with ketosis and more normal blood glucose levels. They are more likely to present with nausea, vomiting, and abdominal pain, symptoms similar to food poisoning. DKA may manifest as respiratory distress.

If children persistently inject their insulin into the same area, subcutaneous tissue swelling may develop, causing unsightly lumps and adversely affecting insulin absorption. Rotating the injection sites resolves the condition.

Fat atrophy can also occur, possibly in association with insulin antibodies. This condition is much less common but is more disfiguring.

The most common cause of acquired blindness in many developed nations, diabetic retinopathy is rare in the prepubertal child or within 5 years of onset of diabetes. The prevalence and severity of retinopathy increase with age and are greatest in patients whose diabetic control is poor. [14] Prevalence rates seem to be declining, yet an estimated 80% of people with type 1 diabetes mellitus develop retinopathy. [15]

The exact mechanism of diabetic nephropathy is unknown. Peak incidence is in postadolescents, 10-15 years after diagnosis, and it may occur in as many as 30% of people with type 1 diabetes mellitus. [16]

In a patient with nephropathy, the albumin excretion rate (AER) increases until frank proteinuria develops, and this may progress to renal failure. Blood pressure rises with increased AER, and hypertension accelerates the progression to renal failure. Having diabetic nephropathy also increases the risk of significant diabetic retinopathy.

Progression may be delayed or halted by improved diabetes control, administration of angiotensin-converting enzyme inhibitors (ACE inhibitors), and aggressive blood pressure control. Regular urine screening for microalbuminuria provides opportunities for early identification and treatment to prevent renal failure.

A child younger than 15 years with persistent proteinuria may have a nondiabetic cause and should be referred to a pediatric nephrologist for further assessment.

The peripheral and autonomic nerves are affected in type 1 diabetes mellitus. [17] Hyperglycemic effects on axons and microvascular changes in endoneural capillaries are amongst the proposed mechanisms. (In adults, peripheral neuropathy usually occurs as a distal sensory loss.)

Autonomic changes involving cardiovascular control (eg, heart rate, postural responses) have been described in as many as 40% of children with diabetes. Cardiovascular control changes become more likely with increasing duration and worsening control. [18] In a study by 253 patients with type 1 diabetes (mean age at baseline 14.4 y), Cho et al reported that the prevalence of cardiac autonomic dysfunction increases in association with higher body mass index and central adiposity. [19]

Gastroparesis is another complication, and it which may be caused by autonomic dysfunction. Gastric emptying is significantly delayed, leading to problems of bloating and unpredictable excursions of blood glucose levels.

Although this complication is not seen in pediatric patients, it is a significant cause of morbidity and premature mortality in adults with diabetes. People with type 1 diabetes mellitus have twice the risk of fatal myocardial infarction (MI) and stroke that people unaffected with diabetes do; in women, the MI risk is 4 times greater. People with type 1 diabetes mellitus also have 4 times greater risk for atherosclerosis.

The combination of peripheral vascular disease and peripheral neuropathy can cause serious foot pathology. Smoking, hypertension, hyperlipidemia, and poor diabetic control greatly increase the risk of vascular disease. Smoking, in particular, may increase the risk of myocardial infarction by a factor of 10.

Hypothyroidism affects 2-5% of children with diabetes. [20] Hyperthyroidism affects 1% of children with diabetes; the condition is usually discovered at the time of diabetes diagnosis.

Although Addison disease is uncommon, affecting less than 1% of children with diabetes, it is a life-threatening condition that is easily missed. Addison disease may reduce the insulin requirement and increase the frequency of hypoglycemia. (These effects may also be the result of unrecognized hypothyroidism.)

Celiac disease, associated with an abnormal sensitivity to gluten in wheat products, is probably a form of autoimmune disease and may occur in as many as 5% of children with type 1 diabetes mellitus. [21]

Necrobiosis lipoidica is probably another form of autoimmune disease. This condition is usually, but not exclusively, found in patients with type 1 diabetes. Necrobiosis lipoidica affects 1-2% of children and may be more common in children with poor diabetic control.

Limited joint mobility (primarily affecting the hands and feet) is believed to be associated with poor diabetic control. [22]

Originally described in approximately 30% of patients with type 1 diabetes mellitus, limited joint mobility occurs in 50% of patients older than age 10 years who have had diabetes for longer than 5 years. The condition restricts joint extension, making it difficult to press the hands flat against each other. The skin of patients with severe joint involvement has a thickened and waxy appearance.

Limited joint mobility is associated with increased risks for diabetic retinopathy and nephropathy. Improved diabetes control over the past several years appears to have reduced the frequency of these additional complications by a factor of approximately 4. Patients have also markedly fewer severe joint mobility limitations.

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Pediatric Type 1 Diabetes Mellitus: Practice Essentials ...

Diabetes is a condition in which there is too much glucose (a type of sugar) in the blood. Over time, high blood glucose levels can damage the body's organs. Possible complications include damage to large (macrovascular) and small (microvascular) blood vessels, which can lead to heart attack, stroke, and problems with the kidneys, eyes, gums, feet and nerves.Reducing risk of diabetes complicationsThe good news is that the risk of most diabetes-related complications can be reduced by keeping blood pressure, blood glucose and cholesterol levels within recommended range. Also, being a healthy weight, eating healthily, reducing alcohol intake, and not smoking will help reduce your risk.

Regular check-ups and screening are important to pick up any problems early

Enjoy a variety of foods from each food group be sure to include foods high in fibre and low in fat, and reduce your salt intake. Its helpful to consult with a dietitian to review your current eating plan and provide a guide about food choices and food quantities.

It can be daunting trying to lose weight, so to get started set yourself a short-term achievable goal. Try thinking about the food you are eating, whether you really need it, if it's a healthy choice, and consider the portion size.

If you are unable to do physical activity such as walking, swimming or gym work, then consider water aerobics, chair exercises or strength resistance training with light weights.

Check with your doctor if you are not sure whether the exercise you are planning to do is suitable or if you have a medical condition that may prevent you from doing certain types of physical activity.

Smoking is the greatest single lifestyle risk factor for developing diabetes complications. Smoking can undo all the benefits gained by weight loss, healthy eating, good blood glucose and blood pressure control.

Smoking affects circulation by increasing heart rate and blood pressure, and by making small blood vessels narrower. Smoking also makes blood cells and blood vessel walls sticky, and allows dangerous fatty material to build up. This can lead to heart attack, stroke and other blood vessel disease.

People with diabetes who smoke have higher blood glucose levels and less control over their diabetes than non-smokers with diabetes.

You can help pick up problems early by having regular checks of your:

Keeping your blood glucose levels within the recommended range can help reduce your risk of long-term diabetes-related health problems. Speak to your doctor or diabetes educator if you are unsure of your recommended blood glucose levels.

Your doctor or diabetes nurse educator may advise you to check your blood glucose levels at home depending on your individual management plan. Regular measuring of your blood glucose levels gives you information about how medication, food, exercise, illness and stress affect your diabetes.

HbA1c is a measurement of how much glucose has attached to your red blood cells over a three-month period. It is a direct measurement of your risk of long-term diabetes-related health problems.

Its recommended that you measure your HbA1c levels at least every year, but they may need to be checked every three to six months. Both HbA1c and blood glucose monitoring are important ways to assess your diabetes management.

The goal for HbA1c for most people with diabetes is no more than 53 mmol/mol or seven per cent. However, recommended ranges can vary depending on the person, for example, with children, frail elderly people, pregnant women, or the type of diabetes and its management.

Have a cholesterol and triglyceride test at least once a year. Aim for total cholesterol less than 4.0 mmol/L and triglycerides less than 2.0 mmol/L.

There are a number of causes of high cholesterol, including your family history and your diet. Too much saturated fat in your diet can increase the LDL (bad) cholesterol in your blood and result in the build-up of plaque in your blood vessels.

Foods high in saturated fats include full-fat dairy products, fatty meats, pastries, biscuits, cakes, coconut cream or coconut milk, palm oil and fatty take-away foods.

The most common long-term diabetes-related health problems are:

Other parts of the body can also be affected by diabetes, including the digestive system, the skin, sexual organs, teeth and gums, and the immune system.

Cardiovascular disease includes blood vessel disease, heart attack and stroke. It is the leading cause of death in Australia.

The risk of cardiovascular disease is greater for people with diabetes, who often have increased cholesterol and blood pressure levels. Smoking, having a family history of cardiovascular disease and being inactive also increase your risk.

To reduce your risk and pick up any problems early:

Diabetes-related eye problems include:

While most people who have damage to the eyes have no symptoms in the earlier stages, there are certain symptoms that may occur and these need urgent review. If you have flashes of light, floaters, blots and dots or part of your vision missing, see your doctor immediately.

Everyone with diabetes should have a professional eye examination by an ophthalmologist or optometrist when they are first diagnosed, and then at least every two years after that (children usually start this screening five years after diagnosis or at puberty).

It is important that you inform the person checking your eyes that you have diabetes. If retinopathy or another abnormality is found, eye tests will be required every year, or more frequently if advised by your ophthalmologist.

People with diabetes are at risk of kidney disease(nephropathy) due to changes in the small blood vessels of the kidneys. Kidney disease is painless and does not cause symptoms until it is advanced.

Screening is very important. Kidney damage can be diagnosed early by checking for microalbumin (very small amounts of protein) in the urine at least once a year. Your doctor will also check your kidney function, including estimated glomerular filtration rate (e-GFR), with a blood test.

If problems are picked up early, nephropathy can be slowed or prevented with the right treatment. Medication called ACE inhibitors and angiotensin receptor antagonists help to protect the kidneys from further damage. These tablets can also be used to treat high blood pressure.

Nerve damage (neuropathy) is usually caused by high blood glucose levels, although similar nerve damage can also result from:

Damage can occur to the sensory (feeling) and motor (movement) nerves of the legs and feet, arms, hands, chest and stomach, and to the nerves that control the actions of body organs.

To help prevent nerve damage:

Better Health Channel has more information about diabetic neuropathy.

The feet of someone with diabetes are at risk of damage when the blood supply in both large and small blood vessels is reduced. Nerve damage (peripheral neuropathy) often results and problems to the structure of the foot can also occur for example, clawed toes.

Reduced blood supply and nerve function can delay healing, increase the risk of infection, reduce feeling in the feet, and lead to ulcers and structural foot problems.

Look after your feet by:

People with diabetes may experience very dry skin due to damage to the small blood vessels and nerves. A common problem for people with diabetes is very dry skin on the feet.

There are also other skin conditions related to diabetes. High blood glucose levels over time can affect the health of the skin. The skin acts as a barrier to protect our bodies from infection so it is important to keep the skin as healthy as possible. If the skin becomes dry, it can lead to cracks and possibly infections.

To reduce the risk of skin problems:

People with poorly managed diabetes are at increased risk of tooth decay and gum infections. This is because the small blood vessels that help nourish your teeth and gums can become damaged. (Dental and gum infections can also lead to high blood glucose levels.)

Not looking after your teeth and gums can cause the gums to become inflamed and loosen around your teeth. Poor oral care is also strongly linked with an increased risk of heart disease.

To reduce your risk of teeth and gum problems:

Living with and managing either type 1 or type 2 diabetes can lead to stress, anxiety and depression. This can affect your blood glucose levels and how you manage your diabetes in general. Over time, this can affect your health.

It is important to talk to your doctor if you are going through times of stress, depression or anxiety. Your doctor can refer you to a counsellor, psychologist or psychiatrist by providing a diabetes mental health plan. This is Medicare rebated.

Other help is available, including:

You can find more information about diabetes and mental health at Diabetes Victoria.

Diabetes, particularly type 2, has been linked with Alzheimer's disease and vascular dementia. Brain changes, resulting from reduced blood supply to the brain over time, appear to be associated with an increased risk for development of these conditions.

Your immune system helps to prevent and fight infection. High blood glucose levels slow down the white blood cells, which help fight infection. This makes it more difficult for the immune system to do its job.

Support your immune system and reduce your risk of infection by:

People with either type 1 or type 2 diabetes are at increased risk of thyroid disease. This includes both overactive and underactive thyroid. Thyroid disorders can affect general health and may affect blood glucose levels.

Thyroid function is assessed by a blood test. Talk to your doctor to see if you have had your thyroid function checked.

Reduced blood supply and nerve damage can affect sexual function. Erectile dysfunction (impotence) in men is the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. This is a common problem for men of all ages and is more common in men with diabetes.

Erectile dysfunction is not a disease, but a symptom of some other problem physical, psychological or a mixture of both. Most cases of erectile dysfunction are physical, such as nerve or blood vessel damage.

In women, sexual dysfunction is also reported, although there is a lack of research in this area. It is difficult to know whether this is directly related to hormonal changes such as menopause, or to diabetes.

It is important to seek help from your doctor, diabetes educator or organisations such as Andrology Australia.

Remember, you dont have to manage your diabetes on your own. There are health professionals available to help you.

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Diabetes - long-term effects - Better Health Channel

Chances are that you know someone with diabetes mellitus. It affects almost 10 percent of the population, and odds of having diabetes increase with age, with 1 in 4 people having diabetes after age 65. Diabetes mellitus, often referred to as sugar diabetes because of the inability to regulate blood sugar levels, results from the body not making enough insulin or not being able to use insulin properly.

Insulin is necessary to move sugar from the blood into cells to be used for energy. Without working insulin, blood sugar rises and damages the blood vessels and other body tissues leading to blindness, nerve disease, kidney failure, heart attacks and strokes.

What does this all have to do with vaccines? It turns out vaccines can play a major role in helping keep individuals with diabetes well.

Diabetes impairs the immune system and interferes with the ability of cells in the body to release chemicals that defend against germs. Additionally, the immune cells that gobble up bacteria or kill infected cells dont work as well. Researchers have found that some of these issues result from high sugar levels but others dont. Put another way, even a diabetic with excellent blood sugar control is still at increased risk of infection.

Besides the weakened immune system, diabetics have other problems leading to infection. Nerve damage keeps diabetics from sensing when they may become injured or develop pressure sores. Resulting cuts and ulcers heal slowly due to poor circulation. The open wounds provide easy entry for bacteria and fungi.

Bacteria grow faster in body tissues with elevated sugar levels and this may be the reason diabetics are at risk of infections of the lung (pneumonia), blood (septicemia), spinal cord and brain (meningitis) and urinary tract.

Serious complications are four times more likely to develop in diabetics with these infections compared to otherwise healthy individuals. The stress from fighting an infection can send a diabetics blood sugars spiraling dangerously out of control further complicating the course.

Given the additional difficulties, diabetics are much more likely to die than healthy individuals with similar infections. Vaccines, however, can provided needed protection.

Pneumovax, a pneumonia vaccine, is a must. Diabetics should receive it once younger than the age of 65 and again in the senior years. Due to diabetics increased risk of skin infections and the fact that tetanus bacteria are just about everywhere in the environment, a tetanus shot is essential every 10 years. A flu shot is needed every year as the flu strikes diabetics particularly hard. Diabetics are at increased risk of shingles and should receive Shingrix once they turn 50.

Diabetics have twice the risk of catching hepatitis B compared to healthy individuals. Many adults have never been vaccinated. Luckily, theres a new hepatitis B vaccine, Heplisav-B, which requires two shots instead of three and better stimulates the immune system.

Diabetics, who track their blood sugars, follow diet guidelines, take their prescribed medications and are vaccinated, have the best chance at a long, healthy life.

Vaccine Smarts is written by Sealy Institute for Vaccine Sciences faculty members Drs. Megan Berman, an associate professor of internal medicine, and Richard Rupp, a professor of pediatrics at the University of Texas Medical Branch. For questions about vaccines, email vaccine.smarts@utmb.edu.

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For those with diabetes, vaccines are a must - Galveston County Daily News

By Jessica Hamzelou

Fei Maohua/Xinhua News Agency/PA Images

People who have the new coronavirus are most likely to die if they are older or show signs of sepsis or blood clotting problems. Thats according to a study that followed a small group of people infected with the covid-19 virus from diagnosis to hospital discharge or death.

Early on in the outbreak, two hospitals in Wuhan, China, were designated to treat people infected with the coronavirus. Until 1 February, people who were diagnosed with the virus in other hospitals in the city were transferred to one of the two for care.

By 31 January, 191 adults had been treated for the virus and either discharged or died at the two hospitals. Bin Cao at the China-Japan Friendship Hospital and Capital Medical University in Beijing and his colleagues assessed these cases, looking for patterns in the characteristics of those who survived the virus and those who didnt.

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The average age of these individuals was 56, and 62 per cent were men. Around half of those treated had underlying medical conditions, most commonly diabetes and high blood pressure.

Of the 191 individuals, 137 were eventually discharged and 54 died. The average time from the onset of the illness to discharge from hospital was 22 days, the team say. Those who didnt survive the virus died an average of 18.5 days after symptoms began.

Death was more likely in people who already had diabetes or coronary heart disease. Older people were more likely to die, as were those showing signs of sepsis or blood clotting problems. Overall, more than half of those hospitalised with the virus developed sepsis.

Poorer outcomes in older people may be due, in part, to the age-related weakening of the immune system and increased inflammation that could promote viral replication and more prolonged responses to inflammation, causing lasting damage to the heart, brain and other organs, said study co-author Zhibo Liu at Jinyintan Hospital in Wuhan.

The team also found that people with covid-19 continue to shed the virus, and so might be able to infect others, for around 20 days, or until they die. The extended viral shedding noted in our study has important implications for guiding decisions around isolation precautions and antiviral treatment in patients with confirmed covid-19, said Cao.

Journal reference: The Lancet, DOI: 10.1016/ S0140-6736(20)30566-3

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Coronavirus: Risk of death rises with age, diabetes and heart disease - New Scientist News