Diabetes – Type I

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Diabetes is a chronic disease that involves high levels of sugar in the blood.

How It Is Caused?

Insulin is a hormone that is produced by the pancreas for controlling blood sugar levels in the body. Diabetes can be caused as a result of very little production of insulin, resistance to insulin, or perhaps both.



In order to understand diabetes, it is also important to first understand the normal process in which food is broken down in the body and used as energy. There are a number of things that happen when food is digested:
  • First, a sugar known as glucose enters the bloodstream. This glucose is an important source of fuel for the body.
  • An organ known as the pancreas produces insulin. The role of insulin is to transfer glucose from the bloodstream into fat, muscle and liver cells, where it can be utilized as fuel.
People with diabetes suffer from high blood sugar because:
  • Their pancreas don’t produce sufficient insulin
  • Muscle, fat and liver cells don’t respond normally to insulin
  • Both of the above

Types of Diabetes
There are 3 main types of diabetes which include:
Type I Diabetes:
Type I diabetes is generally diagnosed in childhood. A lot of patients are diagnosed when they are older than 20 years of age. In this disease, the body produces little or no insulin at all. Hence, daily injections of insulin are required. The exact cause still remains unknown, but genetics, autoimmune problems and viruses may play a role.
Type II Diabetes:
Type II diabetes is a lot more common as compared to type I. It is responsible for most of the diabetes cases. It generally occurs in adulthood, but even younger people are increasingly being diagnosed with this chronic disorder. The pancreas does not produce sufficient insulin to keep the blood glucose levels normal. This is because the body does not respond appropriately to insulin. A lot of people with type II diabetes are not aware that they have it, even though it such a serious condition. Type II diabetes is becoming very common due to unhealthy lifestyles, lack of exercise and obesity.
Gestational Diabetes:
Gestational diabetes involves high blood glucose levels that develop at anytime during pregnancy, in women who don’t have diabetes. Women with gestational diabetes are at a higher risk of type II diabetes and cardiovascular disease at a later stage in life.
Diabetes affects over 20 million Americans. More than 40 million Americans have pre-diabetes (early type II diabetes).
There are several risk factors for type II diabetes. These include:
Heart disease

  • Age over 45 years of age
  • Obesity
  • A family history of diabetes (hereditary)
  • High level of blood cholesterol
  • Gestational diabetes or delivering a baby weighing over 9 pounds
  • Lack of exercise
  • Unhealthy lifestyles
  • Previously impaired glucose tolerance
  • Polycystic ovary disease (in women)
  • Some ethnic groups (especially African Americans, Asians, Native Americans, Hispanic Americans and Pacific Islanders)

Symptoms
High blood glucose levels can cause many problems. Some common symptoms include:

  • Blurred vision
  • Fatigue
  • Hunger
  • Excessive thirst
  • Frequent urination
  • Weight loss

However, since type II diabetes develops gradually, some people with high blood sugar may experience no symptoms at all.
Symptoms of Type I Diabetes

  • Increased thirst
  • Fatigue
  • Increased urination
  • Vomiting
  • Nausea
  • Rapid weight loss in spite of increased appetite

Usually, patients with type I diabetes develop symptoms over a short period of time. The disease is often diagnosed in an emergency setting.
Symptoms of Type II Diabetes

  • Fatigue
  • Increased appetite
  • Blurred vision
  • Increased urination
  • Increased thirst

Tests and Exams
A urine analysis might be used to detect ketones and glucose from the breakdown of fat. However, the urine test alone will not diagnose diabetes. The following blood tests will also be used to diagnose the disease:

Fasting Blood Glucose Levels: Diabetes is diagnosed if the reading is higher than 126 mg/dL on 2 occasions. Levels in between 100 and 126 mg/dL are considered as pre-diabetes or impaired fasting glucose. These levels are considered as risk factors for type II diabetes and related complications.

Random Blood Glucose Level (non-fasting): Diabetes is suspected if the reading is higher than 200 mg/dL and is accompanied by classic diabetes symptoms which include increased thirst, frequent urination, and fatigue. Random blood glucose test must be confirmed along with a fasting blood glucose test.

Oral Glucose Tolerance Test: Diabetes is diagnosed if the level of glucose in the blood is higher than 200 mg/dL after two hours. This test is mostly used for type II diabetes.

Patients with diabetes must have their hemoglobin A1c (HbA1c) level checked every 3 to 6 months. HbA1c is the measure of average blood glucose levels during the previous 2 to 3 months. It is an extremely helpful way to confirm how well the treatment is working.

DETAILS


SELF-TESTING

In case you have diabetes, the healthcare professional may advise you to check your blood sugar levels regularly at home. A number of devices are available for testing your blood sugar levels at home, and they require just one drop of blood. Self-monitoring will tell you how well the medication, diet and exercise are working together in order to control your diabetes. It will also help your physician prevent further complications.
The American Diabetes Association suggests keeping blood glucose levels within the range of:

  • Before meals: 80 – 120 mg/dL
  • At bedtime: 100 – 140 mg/dL

Your medical practitioner might adjust this depending upon your circumstances.

WHAT YOU CAN EAT

  • You must work closely with your healthcare professional to learn how much protein, fat, and carbohydrates you require in your diet. A registered dietician is the best person to help you plan your dietary needs.
  • Patients with type I diabetes must eat around the same time every day, and be consistent with the type of foods they choose to eat. This will help to prevent the blood sugar levels from becoming too high or too low.
  • Patients with type II diabetes must ensure to follow a well-balanced as well as low-fat diet.

HOW TO TAKE YOUR MEDICATION
Medication to treat diabetes includes the use of insulin and glucose-lowering pills known as oral hypoglycemic drugs.

Patients with type I diabetes cannot produce insulin on their own. They require daily insulin injections. Insulin is not available in the form of pills. Hence, injections are generally required 1 to 4 times a day. Some patients even use an insulin pump. This pump is worn at all times and delivers a steady flow of insulin all through the day. Other patients may use inhaled insulin.

Unlike type I diabetes, type II diabetes might respond to treatment with diet, exercise and oral medication. There are many types of medicines that are used to lower blood sugar levels in type II diabetes.

Medications can be switched to insulin during pregnancy and breastfeeding.

Gestational diabetes can be treated with healthy changes in diet and regular exercise.

EXERCISE
Regular exercise is very important for people suffering with diabetes. Exercise helps with controlling blood sugar, high blood pressure and weight loss. People with diabetes who exercise regularly are less likely to experience a stroke or heart attack as compared to those who don’t exercise regularly. Here are some exercise considerations:

Confirm with your nurse or doctor whether you have the right footwear.

Always check with your healthcare professional before starting any new exercise routine.

Exercise daily, at the same time of day if possible.

Choose a physical activity that you enjoy and that is appropriate for your present fitness level.

Monitor your blood glucose level before and after exercising.

Carry food which contains a fast-acting carbohydrate in case you become hypoglycemic after or during exercise.

Drink plenty of fluids that don’t contain sugar before, during as well as after exercising.

Carry a diabetes identification card and cell phone in case of an emergency.

You might need to change your medication dosage or diet if you change the intensity or duration of your exercise to keep blood glucose levels from going too high or too low.

FOOT CARE
Patients with diabetes are more vulnerable to having foot problems. Diabetes damages the nerves and blood vessels, and reduces the body’s ability to combat infections. You might not notice a foot injury until an infection has developed. Death of skin as well as other tissues can also occur.

When left untreated, the affected foot might even need amputation. Diabetes is one the most common conditions that lead to amputations.

In order to prevent foot injury, daily foot care is very important.

Regenerative Tissue Therapy (cells)

Mentioned below is an outline for the eligibility, inclusion as well as exclusion criteria. But, it is also important that any exceptions to these guidelines are properly considered, and the final decision for selection of the prescribed Regenerative Tissue Therapy (cells) would depend solely upon the project director, on a case to case basis.
On the basis of preference, we recommend umbilical cord as well as cord blood derived Regenerative Tissue Therapy (cells) in comparison to autologous Regenerative Tissue Therapy (cells) that have been derived from sources, such as skin, bone marrow, liver, peripheral blood, adipose tissue, cornea (limbus), small intestine, etc. However, this decision is only taken after a comprehensive study of the medical history of a patient. The selection of Regenerative Tissue Therapy (cells), their dosage, source as well as exact mode of administration is decided on case to case basis.
Before the therapy, administration of GM-CSF is recommended to mobilize the patient’s autologous Regenerative Tissue Therapy (cells) from his/her bone marrow and make them to act synergistically with the new transfused cells.
The project director will also recommend relevant supportive therapies which include:

Hyperbaric Oxygen Therapy
This therapy is performed by administrating hyperbaric Oxygen in specialized Hyperbaric Oxygen chambers. Hyperbaric Oxygen therapy is used for the following:

  • To treat De-compression sickness or air embolism.
  • Increase partial pressure of oxygen in the damaged tissues in the body.
  • Improve the oxygen carrying capacity of the blood.

Chelation Therapy

This therapy is used for the removal of toxic heavy metals including lead, mercury, iron (including cases of Thalassemia), plutonium, uranium arsenic and other types of toxic metal poisoning. Chelating agent can either be administered orally, intravenously or intramuscularly, based upon the agent as well as type of poisoning.
There are a number of chelating agents and each has different affinities for different metals. Some of the common chelating agents comprise:

  • Alpha lipoic acid
  • Aminophenoxyethane-tetraacetic acid
  • Deferiprone
  • Deferasirox
  • Diethylene triamine pentaacetic acid
  • Deferoxamine
  • Dimercaprol
  • Dimercaptosuccinic acid
  • Dimercapto-propane sulfonate
  • D-penicillamine
  • Ethylenediamine tetraacetic acid (calcium disodium versante)
  • Ethylene glycol tetraacetic acid

The project director advises the use of both Hyperbaric oxygen and Chelation therapy before the Regenerative Tissue Therapy (cells). The key reason behind this recommendation is to ensure that the infused Regenerative Tissue Therapy (cells) are better accepted and engrafted into the damaged tissues or organs, and swiftly begin its repair. In this way, the benefits of Regenerative Tissue Therapy (cells) can be optimized. However, this will be determined on a case to case basis.

Eligibility Criteria

  • Age Eligible for Study: 20 years or older
  • Gender Eligible for Study: Both
  • Accepts Healthy Volunteers: No

Criteria for Inclusion

    • Clinical diagnosis of ischemic cardiomyopathy

Ischemic cardiomyopathy with old myocardial infarction because of coronary artery atherosclerotic disease

  • LV Dysfunction: Ejection fraction (EF) 15%, and 35%, assessed through echocardiography
  • Age: 20 – 80 years of age
  • Refractory Heart Failure: AHA/ACC heart failure Stage D
  • An indication for CABG: Myocardial ischemia according to major coronary artery stenosis (greater than 75%)
  • Heart Failure Symptoms: NYHA Class III or IV
  • Viability in the infarct area measured by cardiac delayed hyperenhancement MRI (magnetic resonance imaging)

Infarct area affecting greater than 2 contiguous LV segments in a 18-segment model

Number of segments which transmural extent of hyperenhancement more than 51% is less than one.

Ex1. No correlation with graft number.

Ex2. Infarct area without or with bypass graft.

Ex3. In case of multiple myocardial infarction, indication for larger in infarct volume.

Written consent

Criteria for Exclusion

Onset of unstable angina or myocardial infarction within 28 days prior to study entry

Uncontrollable diabetes mellitus (HbA1c>8.0)

An indication for mitral valve repair or surgical ventricular reconstruction

Chronic hemodialysis

Contraindication for endomyocardial biopsy

Liver Cirrhosis (ICGR 15 greater than 30%)

Evidence of malignant disease within three years prior to study entry

Maximum diameter of Aortic aneurysm greater than 5.5 cm. (including dissecting aneurysm)

Cardiogenic shock

Any active infections (including cytomegalovirus infection)

Alcohol or drug dependency

Positive for HIV antigen

Active bleeding state (gastric ulcer, cerebral bleeding, etc.)

Gelatin allergy

Chromosomal abnormality

An indication for LV aneurysmectomy. Patients with over two segments of dyskinesis area
Contra-indication for endomyocardial biopsy
End-stage or uncontrollable congestive heart failure without continuous infusion of catecholamine
Cardiogenic shock
Complete or mobitz type AV block
Screening of gelatin allergy is required for all patients through gelatin patch test and gelatin-IgE.

AIM

Regenerative Tissue Therapy (cells) offers tremendous promise for treating a number of diseases and disorders including both diabetes type I and type II, due to following benefits:
Regenerative Tissue Therapy (cells) can be coaxed to produce insulin-producing cells that could be used in islet transplantation through cloning.
They can be used to prevent diabetes and related complications (including complications caused during pregnancy).
They are able to repair the tissue damage that is caused due to diabetes over a period of time.
Researchers are even considering Regenerative Tissue Therapy (cells) in relation to body fat, in order to limit the accumulation of bad fats and in turn prevent resistance to insulin.
The long term goal of treatment is to:
Reduce symptoms
Prolong life
Prevent related complications such as heart disease, blindness, kidney failure as well as amputation of limbs
Criteria for Selection
Type I or Type II Diabetes
Patients with uncontrolled blood sugar levels.
Patients with complications caused due to Diabetes.

How It Works

Basic Overview
There are some fundamental principles which need to be followed before Regenerative Tissue Therapy (cells) infusion (especially in the case of frozen Regenerative Tissue Therapy (cells)).

Firstly, the frozen Regenerative Tissue Therapy (cells) need to be thawed in warm water at 37 degrees C, through constant agitation.

While thawing, it is very important to ensure that the Regenerative Tissue Therapy (cells) are not exposed to bright light.

The fragile Regenerative Tissue Therapy (cells) then need to be collected in a syringe using a wide bore needle, which should be covered with a tape to prevent exposure to direct light and prevent damage to the cells.

The infusion must be administered over a period of 3 to 5 minutes in dim light, using a 23 gauge needle.

Following transfusion, look out for any immediate reactions.

Dose and Mode of Administration of Regenerative Tissue Therapy (cells):

The dosage of Regenerative Tissue Therapy (cells) can vary on a case to case basis and range in between 30 to 100 million Regenerative Tissue Therapy (cells) in order to generate apt results. In order to produce a positive response a dose as low as one million Regenerative Tissue Therapy (cells) can be enough.

We advocate intravenous mode of administration in most cases. However, in special cases or specific disorders, we even recommend subcutaneous, intramusclular, sub-dural, intrathecal, intra-arterial, sub-arachnoid, intraocular and even direct on-site delivery of Regenerative Tissue Therapy (cells) on the exact site of injury, either via direct implantation (injection) or by using special interventional techniques.

The end decision on the dose of Regenerative Tissue Therapy (cells) as well as mode of administration is best taken after through deliberation of the patient’s medical history, extent of concerned ailment, and depending cause. This decision is taken on a case to case basis.

Treatment Details

Allogenic Umbilical Cord Derived Regenerative Tissue Therapy (cells):

It is important that every dose of umbilical Regenerative Tissue Therapy (cells) is preceded by GM-CSF, one day prior to the infusion. This should be done in a dosage of 5 microgram / kg of body weight in adults and 2.5 microgram / kg of body weight in children.

Mode of Administering GM-CSF:

Injection under the skin (subcutaneous)

Infusion into the vein (intravenous)

Side Effects of GM-CSF

Important points to consider with regards to GM-CSF side effects:

Most patients do not experience all of the listed side effects.

The side effects are mostly reversible and will subside after the treatment is complete.

The side effects are most often predictable with regards to their onset as well as duration.

There is no connection between severity of the side effects and the effectiveness of the medication.

There are a number of options available to help reduce or prevent the occurrence of side effects.

Commonly Noted Side Effects of GM-CSF

After the initial dose of GM-CSF, patients may experience side effects, such as low blood pressure, flushing, rapid heart rate or lightheadedness. This is known as “first-dose effect,” and normally does not reoccur with future doses.

Diarrhea

Weakness

Fatigue

Local reactions on the injection site which include redness, swelling and tenderness.

Less Common Side Effects

Mild flu-like syndrome including fever, generalized pains and aches, fatigue, headache, and weakness.

Swelling on hands and feet

Points to note in case Regenerative Tissue Therapy (cells) are obtained from the umbilical cord lining and cord blood:

The CD 34+ cells mentioned in the present discussion are cells which are similar to hematopoetic cells that carry CD 34+ markers and are derived from the cord blood after isolation using magnetic beads or cell sorting techniques.

The Mesenchymal Regenerative Tissue Therapy (cells) mentioned in the present discussion are cells similar to total nucleated cells which are obtained from the cord lining, derived subsequent to the exhaustive processing.

Regenerative Tissue Therapy (cells) Dosage

Around 32 – 80 million Mesenchymal Regenerative Tissue Therapy (cells) plus 10 – 40 million CD 34 + cells over a one year period.

Duration: 8 – 20 million Mesenchymal Regenerative Tissue Therapy (cells) plus 2.5 to 10 million CD 34+ cells over a 3 month period, concurrently with GM-CSF a day prior to the Regenerative Tissue Therapy (cells).

Total dose of Regenerative Tissue Therapy (cells) required is around 100 – 200 million to produce sufficiently favorable results.

Mode of Administration of Regenerative Tissue Therapy (cells): Intravenous

Possible Side Effects of the Regenerative Tissue Therapy (cells):

Headaches

Mild Fever

Skin Rash

Quality Check:

The Regenerative Tissue Therapy (cells) are quality checked for the following, under the GLP and GMP standards:

Bacterial contamination

Endotoxin content

HIV I AND II by ELIZA and PCR

HbsAG by ELIZA and PCR

HCV by ELIZA and PCR

CMV

Autologous Bone Marrow Derived Regenerative Tissue Therapy (cells)

About 150 to 200 ml of bone marrow is collected in a specifically designed blood bag using aseptic precautions. This procedure is performed under general anesthesia in an operation theatre.

After this, the Regenerative Tissue Therapy (cells) are processed and isolated under the GLP and GMP standards.

The final volume of approximately 5 to 10 ml is administered intravenously within 6 – 8 hours from the time of collection.

As it is not possible to test these Regenerative Tissue Therapy (cells) for bacterial contamination, an antibiotic cover is essential before infusion.

Mode of Administration of Regenerative Tissue Therapy (cells): Intravenous

Autologous Regenerative Tissue Therapy (cells) Procured from Adipose Tissue

Using liposuction, around 150 to 200 ml adipose tissue is obtained in a specifically designed blood. This is done by a plastic surgeon in an OT, under general anesthesia.

These Regenerative Tissue Therapy (cells) are then processed and isolated using the GLP and GMP standards.

Following this, a final volume of 5 to 10 ml is administered intravenously within 6 to 8 hours from time of collection.

The Regenerative Tissue Therapy (cells) cannot be tested for bacterial contamination and therefore, an antibiotic cover is necessary before infusion.

Mode of Administration: Intravenous

Autologous Regenerative Tissue Therapy (cells) Obtained from Peripheral Blood

The Regenerative Tissue Therapy (cells) are derived through a procedure known as “apheresis”.

The procedure is performed in an ambient room with the help of a well programmed cell separator (Hemonitics or Kobe Spectra) which provides the required Regenerative Tissue Therapy (cells). Approximately 200 to 250 ml Regenerative Tissue Therapy (cells) are derived from the blood stream in a specially designed blood bag.

Prior infusion of GM-CSF guarantees maximum mobilization of necessary Regenerative Tissue Therapy (cells) from the bone marrow. This is done in a dose of 5 microgram / kg body weight in an adult and 2.5 microgram / kg body weight in children.

Mode of Administration: Intravenous.

Autologous Regenerative Tissue Therapy (cells) Derived from Teeth, Liver, Cornea, Skin, Small Intestine, etc.

Using sophisticated techniques for their isolation, the Regenerative Tissue Therapy (cells) are derived from any of these organs. This procedure is performed in an operation theatre, under general anesthesia.

Using GLP and GMP standards, the Regenerative Tissue Therapy (cells) are then processed and isolated.

A final volume of about 5 to 10 ml is administered intravenously within 6 to 8 hours from time of collection.

The Regenerative Tissue Therapy (cells) cannot be tested for bacterial contamination. As a result, an antibiotic cover is necessary prior to the infusion.

Mode of Administration: Intravenous.

Follow Up

Every two months from the initial dose.

Allogenic/Autologous Therapy using Regenerative Tissue Therapy (cells) Obtained from the Placenta, Amniotic Sac and Amniotic Fluid

A variety of progenitor cell populations including trophoblastic, mesenchymal, hematopoietic and more primitive Regenerative Tissue Therapy (cells) can be isolated from the amniotic fluid and placenta. At least some of the placental as well as amniotic cells share a common origin, such as the inner cell mass of the morula. In fact, majority of the progenitor cells which can be isolated from these two sources share quite a lot of characteristics. The amniotic fluid and placenta contains multiple types of progenitor cell from the developing embryo, including bone, fat and muscle.

Amniotic Sac and Placenta:

Following harvesting of blood cells simultaneous from the UCB (umbilical cord), UPT (placenta tissue) and UPB (placenta blood) for their content of nucleated cells, results showed that the nuclear cells (NC) from the placenta blood and placenta tissue have three to four times more cells in comparison to only the umbilical cord blood. The cells from the Placental tissue and Placental Blood have more ability to survive as compared to cells from UCB (Cord Blood), over long-term cell culture conditions.

These cells that are stored in liquid nitrogen did not show a major loss of total nucleated cells and CD34 (+) cells. Furthermore, it was noticed that the UPB and UPT included more suppressor lymphocytes, which can prove important in the prevention of graft-versus-host disease. These types of implications state the importance of placental blood as well as tissue collection, and their processing simultaneously with umbilical cord blood for the transplantation of Regenerative Tissue Therapy (cells).

Amniotic Fluid

Regenerative Tissue Therapy (cells) from the amniotic fluid are used to differentiate into muscle, nerve, blood vessel, cartilage, adipose tissue, bone, etc. These cells offer an important resource for the repairing of cells, tissues or organs.

These Regenerative Tissue Therapy (cells), which are procured from the amniotic fluid, are referred to as AFS cells (Amniotic Fluid Derived Regenerative Tissue Therapy (cells)). There could be an intermediate stage between the embryonic and adult Regenerative Tissue Therapy (cells). These cells are capable of extensive self-renewal, a significant property of Regenerative Tissue Therapy (cells). Also, the cells can be used to generate a broad range of cells that can prove extremely valuable for the therapy.

AFS cells can be obtained from an abundant supply of amniotic fluid using the various procedures that examine cells for prenatal diagnosis of some genetic disorders. This procedure is called amniocentesis. Childbirth is also considered as a source of amniotic fluid. Chances of a perfect match are possible due to its primitive nature.

Benefits of AFS Cells:

They can be obtained very easily through amniocentesis.

Since they double every 36 hours, they can be grown in huge amounts to produce larger quantities of Regenerative Tissue Therapy (cells).

The specialized cells generated from Amniotic Fluid Derived Regenerative Tissue Therapy (cells) include all 3 types of cells, which exist in the developing mesoderm, embryo – ectoderm and endoderm. As a result, these Regenerative Tissue Therapy (cells) can differentiate into any tissue, organ or cell within the body.

There is no need for ‘Feeders’ or ‘Factors’ to guide these cells towards the intended cell line.

They don’t cause tumors and hence are preferred over embryonic Regenerative Tissue Therapy (cells).

Similar to embryonic Regenerative Tissue Therapy (cells), AFS cells can generate all types of adult cells.

The project director also recommends the use of Regenerative Tissue Therapy (cells) derived from the placenta, amniotic sac or amniotic fluid. These Regenerative Tissue Therapy (cells) are cautiously isolated, processed and cultured in a clean room, using GLP and GMP standards. The cells can be utilized for both allogenic and autologous use, similar to cells that have been isolated from the cord blood and cord tissue.

Sometimes, this is done concurrently with hyperbaric oxygen and/or Chelation therapy, after a prior administration of GM- CSF. The selection of Regenerative Tissue Therapy (cells), dose, source, mode of administration and any accompanying concurrent therapy can differ on a case to case basis.

Mode of Administration of Regenerative Tissue Therapy (cells): Intravenous

Possible Side Effects of Amniotic Regenerative Tissue Therapy (cells):

Headache

Mild Fever

Rash

Quality Check:

The Regenerative Tissue Therapy (cells) are quality checked for the following, using the GLP and GMP standards:

Endotoxin content

HCV by ELIZA and PCR

HIV I AND II by ELIZA and PCR

HbsAG by ELIZA and PCR

Bacterial contamination

CMV

Support Groups

For more information, check diabetes resources.

Outlook (Prognosis)

With good blood sugar and blood pressure control, a number of complications caused by diabetes can be prevented.

Studies reveal that strict control of blood sugar, blood pressure levels and cholesterol in patients with diabetes helps lower the risk of eye disease, kidney disease, nervous system disease, stroke and heart attack.

Possible Complications Caused Due to Diabetes

Emergency complications comprise:

Diabetic ketoacidosis

Diabetic hyperglycemic hyperosmolar coma

Atherosclerosis

Coronary artery disease

Long-term complications include:

Hypertension

Diabetic neuropathy

Diabetic nephropathy

Diabetic retinopathy

Hyperlipidemia

Erection problems

Infections of the skin and urinary tract

Stroke

Peripheral vascular disease

When to Contact a Medical Practitioner

Contact the local emergency number like 911 or go to the emergency room if you experience symptoms of ketoacidosis such as:

  • Nausea
  • Abdominal pain
  • Increased thirst and urination
  • Deep and rapid breathing
  • Sweet-smelling breath
  • Loss of consciousness

Call the local emergency number if you experience symptoms of extremely low blood sugar (severe insulin reaction or hypoglycemic coma) such as:

  • Convulsions or unconsciousness
  • Confusion
  • Dizziness
  • Double vision
  • Headache
  • Drowsiness
  • Weakness
  • Lack of coordination

Prevention

Maintaining an active lifestyle and ideal body weight can help prevent the onset of type II diabetes.

At present there is no way to prevent type I diabetes.

There is no effective screening test for type I diabetes in patients who don’t experience symptoms.

Screening for type II diabetes and patients with no symptoms is recommended for:

Adults over 45 years of age, repeated every three years

Overweight children with other risk factors for diabetes starting at the age of 10 and repeating every two years

Overweight adults with other risk factors and BMI greater than 25

In order to prevent the complications related to diabetes, visit your medical practitioner or diabetes educator at least 4 times a year. Speak to him/her about any problems that you are facing.

Have the Following Tests Conducted Regularly

Get your blood pressure checked every year. Ideal blood pressure goals must be 130/80 mm/Hg or lower.

Have your triglyceride and cholesterol levels checked every year. Ideal aim for LDL levels should be below 100 mg/dL.

If your diabetes is well controlled, get your glycosylated hemoglobin (HbA1c) checked every six months, or else every 3 months.

Get yearly tests done to make sure that your kidneys are functioning well (serum creatinine and microalbuminuria).

Visit your ophthalmologist at least once a year or more often if you experience symptoms of diabetic retinopathy. The ophthalmologist should preferably be someone who specializes in diabetic retinopathy.

Visit the dentist every six months for a thorough dental checkup. Make sure that your dentist and hygienist knows that you have diabetes.

Make sure that your medical practitioner inspects your feet during every visit.

Be up-to-date with all of your vaccinations and get a flu shot every year during fall.

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