Diabetes   A Synopsis By Aneek Gupta
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Diabetes A Synopsis By Aneek Gupta

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Diabetes, disorder of metabolism, sugar in the blood, pancreas, Type 1 diabetes, type 2 diabetes, autoimmune disease, older age, obesity, family history, Plasma Glucose Result, Pre-diabetes,......

Diabetes, disorder of metabolism, sugar in the blood, pancreas, Type 1 diabetes, type 2 diabetes, autoimmune disease, older age, obesity, family history, Plasma Glucose Result, Pre-diabetes, impaired fasting glucose, impaired glucose tolerance, Excess glucose, adult-onset diabetes, noninsulin-dependent diabetes, excess weight, cardiovascular disease, insulin resistance, blood pressure, LDL cholesterol, blurred vision, pneumonia, influenza, kidney damage, complicate pregnancy, periodontal disease, damage nerves, numbness, glomeruli, Nephropathy, Gestational diabetes, preeclampsia, pregnancy, cesarean section, red, sore, swollen gums, bleeding gums, dentures, Cataract, Glaucoma, Diabetic Retinopathy, Phacoemulsification, phaco, Low-tension or normal-tension glaucoma, Angle-closure glaucoma, Congenital glaucoma, Secondary glaucomas, proliferative diabetic retinopathy, aneek, aneek gupta, blindness, Diabetic neuropathies, metabolic factors, neurovascular factors, autoimmune factors, inherited traits, lifestyle factors, Autonomic Neuropathy, Proximal Neuropathy, Lumbosacral Plexus Neuropathy, Femoral Neuropathy,
Diabetes A Synopsis By Aneek

Diabetic Amyotrophy, Focal Neuropathy, Peripheral Neuropathy, Distal Symmetric Neuropathy or Sensorimotor Neuropathy, Nerve damage, Poor blood flow, peripheral vascular disease, PVD, Gastroparesis, Pneumonia, cough, fever, chills, trouble breathing, COPD, Influenza

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  • 1. ee k Diabetes is a disorder of metabolism—the way our bodies use digested food for growth and energy. Most of the food we eat is broken down into glucose, the form of sugar in the blood. Glucose is the main source of fuel for the body. Islets of Langerhans - microstructure After digestion, glucose passes into the bloodstream, where it is used by cells for growth and energy. For glucose to get into cells, insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach. an When we eat, the pancreas automatically produces the right amount of insulin to move glucose from blood into our cells. In people with diabetes, however, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced. Glucose builds up in the blood, overflows into the urine, and passes out of the body in the urine. Thus, the body loses its main source of fuel even though the blood contains large amounts of glucose. Type 1 diabetes Type 1 diabetes is an autoimmune disease. An autoimmune disease results when the body’s system for fighting infection (the immune system) turns against a part of the body. In diabetes, the immune system attacks and destroys the insulin-producing beta cells in the pancreas. The pancreas then produces little or no insulin. A person who has type 1 diabetes must take insulin daily to live. Type 2 diabetes The most common form of diabetes is type 2 diabetes. About 90 to 95 percent of people with diabetes have type 2. This form of diabetes is most often associated with older age, obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and certain ethnicities. About 80 percent of people with type 2 diabetes are overweight. When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin, but for unknown reasons the body cannot use the insulin effectively, a condition called insulin resistance. After several years, insulin production decreases. The result is the same as for type 1 diabetes—glucose builds up in the blood and the body cannot make efficient use of its main source of fuel. LifeART Collection Images Copyright © 1989-2001 by Lippincott Williams & Wilkins, Baltimore, MD
  • 2. k Plasma Glucose Result (mg/dL) Diagnosis 99 and below Normal Pre-diabetes (impaired fasting glucose) 126 and above Diabetes* 2-Hour Plasma Glucose Result (mg/dL) Diagnosis 139 and below Normal 140 to 199 Pre-diabetes (impaired glucose tolerance) 200 and above Diabetes* When Plasma Glucose Result (mg/dL) Fasting 95 or higher At 1 hour 180 or higher At 2 hours 155 or higher At 3 hours 140 or higher an ee 100 to 125 *Confirmed by repeating the test on a different day. Source: National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health. diabetes.niddk.nih.gov
  • 3. k ee an Source: National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health. diabetes.niddk.nih.gov
  • 4. k ee an Source: National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health. diabetes.niddk.nih.gov
  • 5. Insulin resistance is a silent condition that increases the chances of developing diabetes and heart disease. What does insulin do? Common bile duct Pancreatic duct Tail of pancreas ee k Duodenum After you eat, the food is broken down into glucose, the simple sugar that is the main source of energy for the body's cells. But your cells cannot use glucose without insulin, a hormone produced by the pancreas. Insulin helps the cells take in glucose and convert it to energy. When the pancreas does not make enough insulin or the body is unable to use the insulin that is present, the cells cannot use glucose. Excess glucose builds up in the bloodstream, setting the stage for diabetes. Body of pancreas Head of pancreas Small intestine If you have insulin resistance, your muscle, fat, and liver cells do not use insulin properly. The pancreas tries to keep up with the demand for insulin by producing more. Eventually, the pancreas cannot keep up with the body's need for insulin, and excess glucose builds up in the bloodstream. Many people with insulin resistance have high levels of blood glucose and high levels of insulin circulating in their blood at the same time. People with blood glucose levels that are higher than normal but not yet in the diabetic range have “pre-diabetes.” Doctors sometimes call this condition impaired fasting glucose ( IFG) or impaired glucose tolerance ( IGT), depending on the test used to diagnose it. an If you have pre-diabetes, you have a higher risk of developing type 2 diabetes, formerly called adult-onset diabetes or noninsulin -dependent diabetes. People with pre-diabetes also have a higher risk of heart disease. Insulin resistance can also occur in people who have type 1 diabetes, especially if they are overweight. Points to Remember: Glucose is the simple sugar that is the main source of energy for the body's cells. Insulin helps cells take in blood glucose and convert it to energy If you have insulin resistance, your body's cells do not respond well to insulin. Insulin resistance is a stepping-stone to type 2 diabetes. Lack of exercise and excess weight contribute to insulin resistance. Engaging in moderate physical activity and maintaining proper weight can help prevent insulin resistance. Insulin resistance plays a role in the development of cardiovascular disease, which damages the heart and blood vessels. Controlling blood pressure and LDL cholesterol and not smoking can also help prevent cardiovascular problems. The Diabetes Prevention Program confirmed that exercise and a low-calorie, low-fat diet are the best ways to prevent type 2 diabetes. Source: National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health. diabetes.niddk.nih.gov LifeART Collection Images Copyright © 1989-2001 by Lippincott Williams & Wilkins, Baltimore, MD
  • 6. ee k Eyes High blood sugars can cause blurred vision, and poorly-controlled diabetes can lead to blindness. Stroke People with diabetes are 2 to 4 times more likely to suffer a stroke than people without diabetes. Lungs People with diabetes are more likely to die with pneumonia or influenza than people who do not have diabetes. an Kidneys High blood sugars, especially if combined with high blood pressure, can cause kidney damage and lead to dialysis. Nerves High blood sugars can damage nerves in any part of the body. Teeth High blood sugars can cause gum disease (periodontal disease) and gum disease can cause high blood sugars. Heart Diabetes, especially in people with high blood pressure and high cholesterol, causes heart disease. Heart disease is the #1 killer of people with diabetes. Stomach Poorly-controlled diabetes can cause nerve damage to the stomach leading to nausea, poor digestion, and bloating. Reproductive Health and Pregnancy Diabetes can also complicate pregnancy. Feet Diabetes can damage both the nerves and the blood vessels to the feet leading to numbness, burning “pins and needles” feeling, poor circulation and possibly amputation. Source: National Center for Chronic Disease Prevention and Health Promotion . www.cdc.gov LifeART Collection Images Copyright © 1989-2001 by Lippincott Williams & Wilkins, Baltimore, MD
  • 7. k ee The diabetes food pyramid can help you make wise food choices. It divides foods into groups, based on what they contain. Eat more from the groups at the bottom of the pyramid, and less from the groups at the top. Foods from the starches, fruits, vegetables, and milk groups are highest in carbohydrate. They affect your blood glucose levels the most. How much should I eat each day? Talk with your diabetes teacher about how to make a meal plan that fits the way you usually eat, your daily routine, and your diabetes medicines. Then make your own plan. Have about 1,600 to 2,000 calories a day if you are a large woman who wants to lose weight small man at a healthy weight medium-sized man who does not exercise much medium-sized or large man who wants to lose weight an Have about 1,200 to 1,600 calories a day if you are a small woman who exercises small or medium-sized woman who wants to lose weight medium-sized woman who does not exercise much Have about 2,000 to 2,400 calories a day if you are a medium-sized or large man who exercises a lot or has a physically active job large man at a healthy weight medium-sized or large woman who exercises a lot or has a physically active job Choose this many servings from these food groups to meet your calories a day: Source: National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health. diabetes.niddk.nih.gov LifeART Collection Images Copyright © 1989-2001 by Lippincott Williams & Wilkins, Baltimore, MD
  • 8. k When the kidneys are working well, the tiny filters in your kidneys, the glomeruli, keep protein inside your body. You need the protein to stay healthy. ee High blood glucose and high blood pressure damage the kidneys’ filters. When the kidneys are damaged, the protein leaks out of the kidneys into the urine. Damaged kidneys do not do a good job of cleaning out wastes and extra fluid. Wastes and fluid build up in your blood instead of leaving the body in urine. an Kidney damage begins long before you notice any symptoms. An early sign of kidney damage is when your kidneys leak small amounts of a protein called albumin into the urine. But the only way to know about this leakage is to have your urine tested. The kidneys act as filters to clean the blood. They get rid of wastes and send along filtered fluid. The tiny filters in the kidneys are called glomeruli. When kidneys are healthy, the artery brings blood and wastes from the bloodstream into the kidneys. The glomeruli clean the blood. Then wastes and extra fluid go out into the urine through the ureter. Clean blood leaves the kidneys and goes back into the bloodstream through the vein. With more damage, the kidneys leak more and more protein. This problem is called proteinuria. More and more wastes build up in the blood. This damage gets worse until the kidneys fail. Diabetic nephropathy is the medical term for kidney problems caused by diabetes. Nephropathy affects both kidneys at the same time. Source: National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. diabetes.niddk.nih.gov LifeART Collection Images Copyright © 1989-2001 by Lippincott Williams & Wilkins, Baltimore, MD
  • 9. What if I don’t get treated for gestational diabetes? ee Why do some women get gestational diabetes? k Gestational diabetes is a type of diabetes, or high blood sugar, that only pregnant women get. In fact, the word gestational means pregnant. If a woman gets high blood sugar when she’s pregnant, but she never had high blood sugar before, she has gestational diabetes. Nearly 200,000* pregnant women get the condition every year, making it one of the top health concerns related to pregnancy. If not treated, gestational diabetes can cause problems for mothers and babies. Some of these problems can be serious. an Usually, the body breaks down much of the food you eat into a type of sugar, called glucose. Because glucose moves from the stomach into the blood, some people use the term blood sugar, instead of glucose. Your body makes a hormone called insulin that moves glucose out of the blood and into the cells of the body. In women with gestational diabetes, the glucose can’t get into the cells, so the amount of glucose in the blood gets higher and higher. This is called high blood sugar or diabetes. Most women with gestational diabetes have healthy pregnancies and healthy babies because they control their condition. Without treatment, these women are at risk for: high blood pressure, preeclampsia (a sudden, dangerous increase in blood pressure), and fetal death during the last 4 to 8 weeks of pregnancy. These women may also have very large babies. Some women need surgery to deliver their bigger babies, which can increase the risk of infection and prolong recovery time. As babies, children whose mothers had gestational diabetes are at higher risk for breathing problems. As they get older, these children are also at higher risk for obesity, abnormal glucose tolerance, and diabetes. These women and their children also have a higher lifetime risk for type 2 diabetes. It may be possible to prevent type 2 diabetes through lifestyle changes. Talk to your health care provider about diabetes and risk from gestational diabetes. Source: National Institute of Child Health and Human Development, National Institutes of Health. www.nichd.nih.gov LifeART Collection Images Copyright © 1989-2001 by Lippincott Williams & Wilkins, Baltimore, MD
  • 10. ee k High blood glucose levels before and during pregnancy can: worsen your long-term diabetes complications, such as vision problems, heart disease, and kidney disease increase the chance of problems for your baby, such as being born too early, weighing too much or too little, and having low blood glucose or other health problems at birth increase the risk of your baby having birth defects increase the risk of losing your baby through miscarriage or stillbirth However, research has shown that when women with diabetes keep blood glucose levels under control before and during pregnancy, the risk of birth defects is about the same as in babies born to women who don’t have diabetes. an However, research has shown that when women with diabetes keep blood glucose levels under control before and during pregnancy, the risk of birth defects is about the same as in babies born to women who don’t have diabetes. Glucose Glucose in a pregnant woman’s blood passes through to the baby. If your blood glucose level is too high during pregnancy, so is your baby’s glucose level before birth. Source: National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. diabetes.niddk.nih.gov LifeART Collection Images Copyright © 1989-2001 by Lippincott Williams & Wilkins, Baltimore, MD
  • 11. k ee Most women with gestational diabetes can make it to their due dates safely and begin labor naturally. In some cases, though, gestational diabetes could change the way you feel or how your baby is delivered. Again, keep in mind that just because you have gestational diabetes does not mean that you will have any change in delivery. Talk to your health care provider about ANY concerns you have about labor or delivery. an Keeping your blood sugar level under control during labor and delivery is vital to your own health and to your baby's health. If you do not take insulin during your pregnancy, you probably won't need it during labor or delivery. If you do take insulin during your pregnancy, you may receive an insulin shot when labor begins, or you may get insulin through a thin, plastic tube in your arm that goes into your bloodstream during labor. Gestational diabetes puts women at higher risk than women without the condition for developing preeclampsia, late in their pregnancies. Preeclampsia is a condition related to a sudden blood pressure increase; it can be a serious. (For more information on preeclampsia, go to the Your health care provider might also tell you to: Have your blood pressure checked as indicated section of this booklet.) The only way to cure preeclampsia is to deliver the baby; but delivery may not be the best option for your health or for the health of the baby. Your health care provider will keep you under close watch, possibly at the hospital, and will run multiple tests to determine whether early delivery is safe and needed. Your health care provider will give you more information about early delivery, should it be necessary. This is a type of surgery used to deliver the baby, instead of natural delivery through the vagina. Cesarean delivery is also called a cesarean section, or "C" section. Simply having gestational diabetes is not a reason to have a C section, but your health care provider may have other reasons for choosing a cesarean delivery, such as changes in your health or your baby's health during labor. Source: National Institute of Child Health and Human Development, National Institutes of Health. www.nichd.nih.gov
  • 12. k an ee Most women who have gestational diabetes give birth to healthy babies, especially when they keep their blood sugar under control, eat a healthy diet, get regular, moderate physical activity, and maintain a healthy weight. In some cases, though, the condition can affect the pregnancy. Keeping glucose levels under control may prevent certain problems related to gestational diabetes. Below are some conditions that can result from your having gestational diabetes. Keep in mind that just because you have gestational diabetes does not mean that these problems will occur. Source: National Institute of Child Health and Human Development, National Institutes of Health. www.nichd.nih.gov
  • 13. k Tooth and gum problems can happen to anyone. A sticky film full of germs, called plaque, builds up on your teeth. High blood glucose helps germs, also called bacteria, grow. Then you can get red, sore, and swollen gums that bleed when you brush your teeth. ee People with diabetes can have tooth and gum problems more often if their blood glucose stays high. High blood glucose can make tooth and gum problems worse. You can even lose your teeth. Smoking makes it more likely for you to get a bad case of gum disease, especially if you have diabetes and are age 45 or older. Formation of plaque on the teeth Red, sore, and bleeding gums are the first sign of gum disease. These problems can lead to periodontitis. Periodontitis is an infection in the gums and the bone that holds the teeth in place. If the infection gets worse, your gums may pull away from your teeth, making your teeth look long. an If you have one or more of these problems, you may have tooth and gum damage from diabetes: red, sore, swollen gums bleeding gums gums pulling away from your teeth so your teeth look long loose or sensitive teeth bad breath a bite that feels different dentures—false teeth—that do not fit well Anterior view of teeth and gums afflicted with periodontitis. Source: National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. diabetes.niddk.nih.gov LifeART Collection Images Copyright © 1989-2001 by Lippincott Williams & Wilkins, Baltimore, MD
  • 14. ee k Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of diabetes. All can cause severe vision loss or even blindness. Diabetic eye disease may include: Cornea Pupil Lens Iris Cataract: clouding of the eye's lens. Cataracts develop at an earlier age in people with diabetes. Vitreous gel Macula an Retina Optic nerve Diabetic Retinopathy: damage to the blood vessels in the retina. Glaucoma: increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision. A person with diabetes is nearly twice as likely to get glaucoma as other adults. Source: National Eye Institute, U.S. National Institute of Health. www.nei.nih.gov
  • 15. The lens lies behind the iris and the pupil (see diagram). It works much like a camera lens. It focuses light onto the retina at the back of the eye, where an image is recorded. The lens also adjusts the eye's focus, letting us see things clearly both up close and far away. The lens is made of mostly water and protein. The protein is arranged in a precise way that keeps the lens clear and lets light pass through it. ee k But as we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract. Over time, the cataract may grow larger and cloud more of the lens, making it harder to see. Researchers suspect that there are several causes of cataract, such as smoking and diabetes. Or, it may be that the protein in the lens just changes from the wear and tear it takes over the years. an Symptoms of Cataract includes: Cloudy or blurry vision. Colors seem faded. Glare. Poor night vision. Double vision or multiple images in one eye. Frequent prescription changes in your eyeglasses or contact lenses. Types of cataract surgery: Phacoemulsification, or phaco. A small incision is made on the side of the cornea, the clear, dome-shaped surface that covers the front of the eye. Your doctor inserts a tiny probe into the eye. This device emits ultrasound waves that soften and break up the lens so that it can be removed by suction. Most cataract surgery today is done by phacoemulsification, also called "small incision cataract surgery." Extracapsular surgery. Your doctor makes a longer incision on the side of the cornea and removes the cloudy core of the lens in one piece. The rest of the lens is removed by suction. Source: National Eye Institute, U.S. National Institute of Health. www.nei.nih.gov LifeART Collection Images Copyright © 1989-2001 by Lippincott Williams & Wilkins, Baltimore, MD
  • 16. k Anterior chamber Pupil Fluid exits here ee Fluid exits here In the front of the eye is a space called the anterior chamber. A clear fluid flows continuously in and out of the chamber and nourishes nearby tissues. The fluid leaves the chamber at the open angle where the cornea and iris meet. (See diagram.) When the fluid reaches the angle, it flows through a spongy meshwork, like a drain, and leaves the eye. Sometimes, when the fluid reaches the angle, it passes too slowly through the meshwork drain. As the fluid builds up, the pressure inside the eye rises to a level that may damage the optic nerve. When the optic nerve is damaged from increased pressure, open-angle glaucoma--and vision loss--may result. That's why controlling pressure inside the eye is important. Iris Iris Lens Angle Fluid forms here an Open-angle glaucoma is the most common form. Some people have other types of the disease. Low-tension or normal-tension glaucoma. Optic nerve damage and narrowed side vision occur in people with normal eye pressure. Lowering eye pressure at least 30 percent through medicines slows the disease in some people. Glaucoma may worsen in others despite low pressures. Angle-closure glaucoma. The fluid at the front of the eye cannot reach the angle and leave the eye. The angle gets blocked by part of the iris. People with this type of glaucoma have a sudden increase in eye pressure. Symptoms include severe pain and nausea, as well as redness of the eye and blurred vision. If you have these symptoms, you need to seek treatment immediately. Congenital glaucoma. Children are born with a defect in the angle of the eye that slows the normal drainage of fluid. These children usually have obvious symptoms, such as cloudy eyes, sensitivity to light, and excessive tearing. Conventional surgery typically is the suggested treatment, because medicines may have unknown effects in infants and be difficult to administer. Surgery is safe and effective. If surgery is done promptly, these children usually have an excellent chance of having good vision. Secondary glaucomas. These can develop as complications of other medical conditions. These types of glaucomas are sometimes associated with eye surgery or advanced cataracts, eye injuries, certain eye tumors, or uveitis (eye inflammation). Pigmentary glaucoma occurs when pigment from the iris flakes off and blocks the meshwork, slowing fluid drainage. A severe form, called neovascular glaucoma, is linked to diabetes. Corticosteroid drugs used to treat eye inflammations and other diseases can trigger glaucoma in some people. Treatment includes medicines, laser surgery, or conventional surgery. Source: National Eye Institute, U.S. National Institute of Health. www.nei.nih.gov LifeART Collection Images Copyright © 1989-2001 by Lippincott Williams & Wilkins, Baltimore, MD
  • 17. k Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina. In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. The retina is the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision. ee If you have diabetic retinopathy, at first you may not notice changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes. How does diabetic retinopathy cause vision loss? Blood vessels damaged from diabetic retinopathy can cause vision loss in two ways: an Fragile, abnormal blood vessels can develop and leak blood into the center of the eye, blurring vision. This is proliferative retinopathy and is the fourth and most advanced stage of the disease. Fluid can leak into the center of the macula, the part of the eye where sharp, straight-ahead vision occurs. The fluid makes the macula swell, blurring vision. This condition is called macular edema. It can occur at any stage of diabetic retinopathy, although it is more likely to occur as the disease progresses. About half of the people with proliferative retinopathy also have macular edema. Image of the retina afflicted with proliferative diabetic retinopathy as seen through an opthalmoscope. Source: National Eye Institute, U.S. National Institute of Health. www.nei.nih.gov LifeART Collection Images Copyright © 1989-2001 by Lippincott Williams & Wilkins, Baltimore, MD
  • 18. an ee k Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina. Source: National Eye Institute, U.S. National Institute of Health. www.nei.nih.gov
  • 19. k ee Diabetic neuropathies are a family of nerve disorders caused by diabetes. People with diabetes can, over time, develop nerve damage throughout the body. Some people with nerve damage have no symptoms. Others may have symptoms such as pain, tingling, or numbness—loss of feeling—in the hands, arms, feet, and legs. Nerve problems can occur in every organ system, including the digestive tract, heart, and sex organs. About 60 to 70 percent of people with diabetes have some form of neuropathy. People with diabetes can develop nerve problems at any time, but risk rises with age and longer duration of diabetes. The highest rates of neuropathy are among people who have had diabetes for at least 25 years. Diabetic neuropathies also appear to be more common in people who have problems controlling their blood glucose, also called blood sugar, as well as those with high levels of blood fat and blood pressure and those who are overweight. an The causes are probably different for different types of diabetic neuropathy. Researchers are studying how prolonged exposure to high blood glucose causes nerve damage. Nerve damage is likely due to a combination of factors: metabolic factors, such as high blood glucose, long duration of diabetes, abnormal blood fat levels, and possibly low levels of insulin neurovascular factors, leading to damage to the blood vessels that carry oxygen and nutrients to nerves autoimmune factors that cause inflammation in nerves mechanical injury to nerves, such as carpal tunnel syndrome inherited traits that increase susceptibility to nerve disease lifestyle factors, such as smoking or alcohol use Source: National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. diabetes.niddk.nih.gov LifeART Collection Images Copyright © 1989-2001 by Lippincott Williams & Wilkins, Baltimore, MD
  • 20. k Focal Neuropathy Autonomic Neuropathy appears suddenly and affects specific nerves, most often in the head, torso, or leg. Focal neuropathy may cause inability to focus the eye double vision aching behind one eye paralysis on one side of the face, called Bell’s palsy severe pain in the lower back or pelvis pain in the front of a thigh pain in the chest, stomach, or side pain on the outside of the shin or inside of the foot chest or abdominal pain that is sometimes mistaken for heart disease, a heart attack, or appendicitis ee affects the nerves that control the heart, regulate blood pressure, and control blood glucose levels. Autonomic neuropathy also affects other internal organs, causing problems with digestion, respiratory function, urination, sexual response, and vision. In addition, the system that restores blood glucose levels to normal after a hypoglycemic episode may be affected, resulting in loss of the warning symptoms of hypoglycemia. Proximal Neuropathy Peripheral Neuropathy an (Lumbosacral Plexus Neuropathy, Femoral Neuropathy, or Diabetic Amyotrophy ) starts with pain in the thighs, hips, buttocks, or legs, usually on one side of the body. This type of neuropathy is more common in those with type 2 diabetes and in older adults with diabetes. Proximal neuropathy causes weakness in the legs and the inability to go from a sitting to a standing position without help. Treatment for weakness or pain is usually needed. The length of the recovery period varies, depending on the type of nerve damage. (Distal Symmetric Neuropathy or Sensorimotor Neuropathy) is nerve damage in the arms and legs. Symptoms of peripheral neuropathy may include: numbness or insensitivity to pain or temperature a tingling, burning, or prickling sensation sharp pains or cramps extreme sensitivity to touch, even light touch loss of balance and coordination Source: National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. diabetes.niddk.nih.gov LifeART Collection Images Copyright © 1989-2001 by Lippincott Williams & Wilkins, Baltimore, MD
  • 21. an ee k Diabetic neuropathy can be classified as peripheral, autonomic, proximal, or focal. Each affects different parts of the body in various ways. Source: National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. diabetes.niddk.nih.gov
  • 22. k Too much glucose in the blood for a long time can cause diabetes problems. This high blood glucose, also called blood sugar, can damage many parts of the body. ee Saphenous nerve High blood glucose from diabetes causes two problems that can hurt your feet: Nerve damage: One problem is damage to nerves in your legs and feet. With damaged nerves, you might not feel pain, heat, or cold in your legs and feet. A sore or cut on your foot may get worse because you do not know it is there. This lack of feeling is caused by nerve damage, also called diabetic neuropathy. Nerve damage can lead to a sore or an infection. an Poor blood flow: The second problem happens when not enough blood flows to your legs and feet. Poor blood flow makes it hard for a sore or infection to heal. This problem is called peripheral vascular disease, also called PVD. Smoking when you have diabetes makes blood flow problems much worse. Principal nerve Tibial nerve Deep fibular nerve Superficial fibular nerve Medial plantar nerve Lateral plantar nerve Nerves of Leg Source: National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. diabetes.niddk.nih.gov LifeART Collection Images Copyright © 1989-2001 by Lippincott Williams & Wilkins, Baltimore, MD
  • 23. ee k Esophagus Gastroparesis, also called delayed gastric emptying, is a disorder in which the stomach takes too long to empty its contents. Normally, the stomach contracts to move food down into the small intestine for digestion. The vagus nerve controls the movement of food from the stomach through the digestive tract. Gastroparesis occurs when the vagus nerve is damaged and the muscles of the stomach and intestines do not work normally. Food then moves slowly or stops moving through the digestive tract Stomach an Small Intestine What are the complications ofgastroparesis? If food lingers too long in the stomach, it can cause bacterial overgrowth from the fermentation of food. Also, the food can harden into solid masses called bezoars that may cause nausea, vomiting, and obstruction in the stomach. Bezoars can be dangerous if they block the passage of food into the small intestine. Gastroparesis can make diabetes worse by making blood glucose control more difficult. When food that has been delayed in the stomach finally enters the small intestine and is absorbed, blood glucose levels rise. Sincegastroparesis makes stomach emptying unpredictable, a person’s blood glucose levels can be erratic and difficult to control. Source: National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. diabetes.niddk.nih.gov
  • 24. Pneumonia is an infection in one or both of the lungs. Many small germs, such as bacteria, viruses, and fungi, can cause pneumonia. Bronchioles Oxygenated blood to the heart Deoxygenated blood from the heart ee k The infection causes your lungs’ air sacs, called alveoli, to become inflamed. The air sacs may fill up with fluid or pus, causing symptoms such as a cough, fever, chills, and trouble breathing. an Alveoli - site of gas exchange Pneumonia and its symptoms can vary from mild to severe. Many factors affect how serious pneumonia is, such as the type of germ causing the infection and your age and overall health. Pneumonia tends to be more serious for: Infants and young children. Older adults (people 65 years or older). People who have other health problems like heart failure, diabetes, or COPD (chronic obstructive pulmonary disease). People who have weak immune systems as a result of diseases or other factors. These may include HIV/AIDS, chemotherapy (a treatment for cancer), or an organ or bone marrow transplant. Source: National Heart and Lung and Blood Institute, National Institutes of Health. www.nhlbi.nih.gov LifeART Collection Images Copyright © 1989-2001 by Lippincott Williams & Wilkins, Baltimore, MD
  • 25. k an ee Pneumonia is named for the way in which a person gets the infection or for the germ that causes it. Source: National Heart and Lung and Blood Institute, National Institutes of Health. www.nhlbi.nih.gov
  • 26. k an ee The pneumococcal shot protects you from getting a serious infection in your blood or brain that can cause dangerous health problems, hospitalization or death. Source: Center for Disease Control; and Prevention. www.cdc.gov
  • 27. k ee Influenza (the flu) is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death. The best way to prevent the flu is by getting a flu vaccination each year. Every year in the United States, on average 5% to 20% of the population gets the flu; more than 200,000 people are hospitalized from flu complications, and; about 36,000 people die from flu. Some people, such as older people, young children, and people with certain health conditions (such as asthma, diabetes, or heart disease), are at high risk for serious flu complications. The single best way to prevent the flu is to get a flu vaccination each year. There are two types of vaccines: The "flu shot" – an inactivated vaccine (containing killed virus) that is given with a needle. The flu shot is approved for use in people 6 months of age and older, including healthy people and people with chronic medical conditions. The nasal-spray flu vaccine – a vaccine made with live, weakened flu viruses that do not cause the flu (sometimes called LAIV for “Live Attenuated Influenza Vaccine”). LAIV is approved for use in healthy* people 2-49 years of age who are not pregnant. an Some people should not be vaccinated without first consulting a physician. They include: People who have a severe allergy to chicken eggs. People who have had a severe reaction to an influenza vaccination in the past. People who developed Guillain-Barré syndrome (GBS) within 6 weeks of getting an influenza vaccine previously. Children less than 6 months of age (influenza vaccine is not approved for use in this age group). People who have a moderate or severe illness with a fever should wait to get vaccinated until their symptoms lessen. If you have questions about whether you should get a flu vaccine, consult your health-care provider. Source: Centers for Disease Control and Prevention. www.cdc.gov LifeART Collection Images Copyright © 1989-2001 by Lippincott Williams & Wilkins, Baltimore, MD