diabetes a synopsis by aneek gupta

Islets of Langerhans - microstructure

After digestion, glucose passes into the bloodstream, where it is used by cells for growth andenergy. For glucose to get into cells, insulin must be present. Insulin is a hormone producedby the pancreas, a large gland behind the stomach.

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

Type 1diabetes

Type 1 diabetes is an autoimmune disease. An autoimmune disease resultswhen the body’s system for fighting infection (the immune system) turnsagainst a part of the body. In diabetes, the immune system attacks anddestroys the insulin-producing beta cells in the pancreas. The pancreas thenproduces little or no insulin. A person who has type 1 diabetes must take insulindaily to live.

Type 2diabetes

The most common form of diabetes is type 2 diabetes. About 90 to 95 percentof people with diabetes have type 2. This form of diabetes is most oftenassociated with older age, obesity, family history of diabetes, previous history ofgestational diabetes, physical inactivity, and certain ethnicities. About 80percent of people with type 2 diabetes are overweight.When type 2 diabetes is diagnosed, the pancreas is usually producing enoughinsulin, but for unknown reasons the body cannot use the insulin effectively, acondition called insulin resistance. After several years, insulin productiondecreases. The result is the same as for type 1 diabetes—glucose builds up inthe 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

Diabetes is a disorder of metabolism—the way our bodies use digested food for growth andenergy. 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.

anee

k

2-Hour Plasma GlucoseResult (mg/dL) Diagnosis

139 and below Normal

140 to 199Pre-diabetes

(impaired glucosetolerance)

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

Plasma Glucose Result(mg/dL) Diagnosis

99 and below Normal

100 to 125 Pre-diabetes(impaired fasting glucose)

126 and above Diabetes*

*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.govan

eek

Source: National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health.diabetes.niddk.nih.gov an

eek

Source: National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health.diabetes.niddk.nih.govan

eek

Source: National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases,National Institute of Health. diabetes.niddk.nih.gov

What does insulin do?After you eat, the food is brokendown into glucose, the simple sugarthat is the main source of energy forthe body's cells. But your cells cannotuse glucose without insulin, ahormone produced by the pancreas.Insulin helps the cells take in glucoseand convert it to energy. When thepancreas does not make enoughinsulin or the body is unable to usethe insulin that is present, the cellscannot use glucose. Excess glucosebuilds up in the bloodstream, settingthe stage for diabetes.

If you have insulin resistance, your muscle, fat, and liver cells do not use insulin properly. The pancreastries to keep up with the demand for insulin by producing more. Eventually, the pancreas cannot keepup with the body's need for insulin, and excess glucose builds up in the bloodstream. Many people withinsulin resistance have high levels of blood glucose and high levels of insulin circulating in their blood atthe 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 glucosetolerance ( IGT), depending on the test used to diagnose it.

If you have pre-diabetes, you have a higher risk of developing type 2 diabetes, formerly calledadult-onset diabetes or noninsulin -dependent diabetes. People with pre-diabetes also have a higher riskof 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 energyIf 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 insulinresistance.Insulin resistance plays a role in the development of cardiovascular disease, which damages the heartand blood vessels.Controlling blood pressure and LDL cholesterol and not smoking can also help prevent cardiovascularproblems.The Diabetes Prevention Program confirmed that exercise and a low-calorie, low-fat diet are the bestways to prevent type 2 diabetes.

Insulin resistance is a silent condition that increases the chances of developing diabetesand heart disease.


Duodenum

Small intestine

Commonbile duct

Pancreaticduct

Head ofpancreas

Body ofpancreas

Tail ofpancreas

anee

k

Source: National Center for Chronic Disease Prevention and Health Promotion . www.cdc.gov

StrokePeople with diabetes are 2 to 4 timesmore likely to suffer a stroke thanpeople without diabetes.Eyes

High blood sugars cancause blurred vision,and poorly-controlleddiabetes can lead toblindness.

NervesHigh blood sugarscan damage nervesin any part of thebody.

TeethHigh blood sugars can cause gumdisease (periodontal disease) andgum disease can cause high bloodsugars.HeartDiabetes, especially in people withhigh blood pressure and highcholesterol, causes heart disease.Heart disease is the #1 killer ofpeople with diabetes.

LungsPeople with diabetes aremore likely to die withpneumonia or influenzathan people who do nothave diabetes.

StomachPoorly-controlled diabetes can causenerve damage to the stomach leadingto nausea, poor digestion, andbloating.

KidneysHigh blood sugars,especially if combinedwith high bloodpressure, can causekidney damage and leadto dialysis.

FeetDiabetes can damage both thenerves and the blood vessels to thefeet leading to numbness, burning“pins and needles” feeling, poorcirculation and possibly amputation.

Reproductive Healthand PregnancyDiabetes can alsocomplicate pregnancy.


anee

k

http://www.cdc.gov

Source: National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health. diabetes.niddk.nih.gov

Have about 1,200 to 1,600 calories aday if you are a

small woman who exercisessmall or medium-sized woman whowants to lose weightmedium-sized woman who does notexercise much

The diabetes food pyramid can help you make wise foodchoices. It divides foods into groups, based on what theycontain. Eat more from the groups at the bottom of thepyramid, and less from the groups at the top. Foods from thestarches, fruits, vegetables, and milk groups are highest incarbohydrate. 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 mealplan that fits the way you usually eat, your daily routine, andyour diabetes medicines. Then make your own plan.


large woman who wants to lose weightsmall man at a healthy weightmedium-sized man who does notexercise muchmedium-sized or large man who wantsto lose weight


medium-sized or large man whoexercises a lot or has a physically activejoblarge man at a healthy weightmedium-sized or large woman whoexercises a lot or has a physically activejob

Choose this many servings from these food groups to meet your calories a day:

LifeART Collection Images Copyright © 1989-2001 by Lippincott Williams & Wilkins, Baltimore, MDanee

k

Source: National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.diabetes.niddk.nih.gov

The kidneys act as filters to clean the blood. They get rid of wastes andsend along filtered fluid. The tiny filters in the kidneys are called glomeruli.When kidneys are healthy, the artery brings blood and wastes from thebloodstream into the kidneys. The glomeruli clean the blood. Then wastesand extra fluid go out into the urine through the ureter. Clean blood leavesthe kidneys and goes back into the bloodstream through the vein.

When the kidneys are working well, the tinyfilters in your kidneys, the glomeruli, keepprotein inside your body. You need theprotein to stay healthy.

High blood glucose and high blood pressuredamage the kidneys’ filters. When the kidneysare damaged, the protein leaks out of thekidneys into the urine. Damaged kidneys donot do a good job of cleaning out wastes andextra fluid. Wastes and fluid build up in yourblood instead of leaving the body in urine.

Kidney damage begins long before you noticeany symptoms. An early sign of kidneydamage is when your kidneys leak smallamounts of a protein called albumin into theurine. But the only way to know about thisleakage is to have your urine tested.

With more damage, the kidneys leak moreand more protein. This problem is calledproteinuria. More and more wastes build up inthe blood. This damage gets worse until thekidneys fail.

Diabetic nephropathy is the medical term forkidney problems caused by diabetes.Nephropathy affects both kidneys at the sametime.


k

Gestational diabetes is a type of diabetes, or high blood sugar, that only pregnant women get. In fact, the wordgestational means pregnant. If a woman gets high blood sugar when she’s pregnant, but she never had high blood sugarbefore, she has gestational diabetes. Nearly 200,000* pregnant women get the condition every year, making it one ofthe 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.

Source: National Institute of Child Health and Human Development, National Institutes of Health. www.nichd.nih.gov

Why do some women getgestational diabetes?

Usually, the body breaks downmuch of the food you eat intoa type of sugar, calledglucose. Because glucosemoves from the stomach intothe blood, some people usethe term blood sugar, insteadof glucose. Your body makes ahormone called insulin thatmoves glucose out of theblood and into the cells of thebody. In women withgestational diabetes, theglucose can’t get into thecells, so the amount ofglucose in the blood getshigher and higher. This iscalled high blood sugar ordiabetes.

What if I don’t get treated forgestational diabetes?

Most women with gestational diabetes havehealthy pregnancies and healthy babiesbecause they control their condition. Withouttreatment, these women are at risk for: highblood pressure, preeclampsia (a sudden,dangerous increase in blood pressure), andfetal death during the last 4 to 8 weeks ofpregnancy. These women may also have verylarge babies. Some women need surgery todeliver their bigger babies, which canincrease the risk of infection and prolongrecovery time.As babies, children whose mothers hadgestational diabetes are at higher risk forbreathing problems. As they get older, thesechildren are also at higher risk for obesity,abnormal glucose tolerance, and diabetes.These women and their children also have ahigher lifetime risk for type 2 diabetes. Itmay be possible to prevent type 2 diabetesthrough lifestyle changes. Talk to your healthcare provider about diabetes and risk fromgestational diabetes.


k

http://www.nichd.nih.gov

Source: National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases,National Institutes of Health. diabetes.niddk.nih.gov

High blood glucose levels before and duringpregnancy can:

worsen your long-term diabetes complications,such as vision problems, heart disease, andkidney diseaseincrease the chance of problems for your baby,such as being born too early, weighing too muchor too little, and having low blood glucose orother health problems at birthincrease the risk of your baby having birthdefectsincrease the risk of losing your baby throughmiscarriage or stillbirthHowever, research has shown that when womenwith diabetes keep blood glucose levels undercontrol before and during pregnancy, the risk ofbirth defects is about the same as in babies bornto women who don’t have diabetes.

However, research has shown that when womenwith diabetes keep blood glucose levels undercontrol before and during pregnancy, the risk ofbirth defects is about the same as in babies born towomen who don’t have diabetes.

Glucose in a pregnant woman’s blood passes through to the baby. If your bloodglucose level is too high during pregnancy, so is your baby’s glucose level beforebirth.

Glucose


anee

k


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 havegestational diabetes does not mean that you will have any change in delivery. Talk to your health care provider about ANYconcerns you have about labor or delivery.

Keeping your blood sugar level under control during labor anddelivery is vital to your own health and to your baby's health. Ifyou do not take insulin during your pregnancy, you probablywon't need it during labor or delivery. If you do take insulinduring your pregnancy, you may receive an insulin shot whenlabor begins, or you may get insulin through a thin, plastic tubein your arm that goes into your bloodstream during labor.

Gestational diabetes puts women at higher risk than womenwithout the condition for developing preeclampsia, late in theirpregnancies. Preeclampsia is a condition related to a suddenblood pressure increase; it can be a serious. (For moreinformation on preeclampsia, go to the Your health careprovider might also tell you to: Have your blood pressurechecked as indicated section of this booklet.) The only way tocure preeclampsia is to deliver the baby; but delivery may notbe 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 determinewhether early delivery is safe and needed. Your health careprovider will give you more information about early delivery,should it be necessary.

This is a type of surgery used to deliver the baby, instead ofnatural delivery through the vagina. Cesarean delivery is alsocalled a cesarean section, or "C" section. Simply havinggestational diabetes is not a reason to have a C section, but yourhealth care provider may have other reasons for choosing acesarean delivery, such as changes in your health or your baby'shealth during labor.an

eek



Most women who have gestational diabetes give birth to healthy babies, especially when they keep their blood sugar undercontrol, eat a healthy diet, get regular, moderate physical activity, and maintain a healthy weight. In some cases, though, thecondition 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 havegestational diabetes does not mean that these problems will occur.

anee

k


Anterior view of teeth and gumsafflicted with periodontitis.

Formation of plaque on the teeth

Tooth and gum problems can happen to anyone. A sticky film full ofgerms, called plaque, builds up on your teeth. High blood glucosehelps germs, also called bacteria, grow. Then you can get red, sore,and swollen gums that bleed when you brush your teeth.

People with diabetes can have tooth and gum problems more oftenif their blood glucose stays high. High blood glucose can make toothand gum problems worse. You can even lose your teeth.

Smoking makes it more likely for you to get a bad case of gumdisease, especially if you have diabetes and are age 45 or older.

Red, sore, and bleeding gums are the first sign of gum disease.These problems can lead to periodontitis. Periodontitis is aninfection in the gums and the bone that holds the teeth in place. Ifthe infection gets worse, your gums may pull away from your teeth,making your teeth look long.

If you have one or more of these problems, you may have toothand gum damage from diabetes:

red, sore, swollen gumsbleeding gumsgums pulling away from your teeth so your teeth look longloose or sensitive teethbad breatha bite that feels differentdentures—false teeth—that do not fit well



k

Vitreous gel

Iris

Pupil

Lens

Cornea

Retina

Macula

Optic nerve

Source: National Eye Institute, U.S. National Institute of Health. www.nei.nih.gov

Diabetic eye disease refers to a group of eye problems that people withdiabetes may face as a complication of diabetes. All can cause severevision loss or even blindness.

Diabetic eye disease may include:

DiabeticRetinopathy:damage to theblood vessels inthe retina.

Cataract:clouding of the eye's lens.Cataracts develop at anearlier age in people withdiabetes.

Glaucoma:increase in fluidpressure inside theeye that leads to opticnerve damage andloss of vision. Aperson with diabetesis nearly twice aslikely to get glaucomaas other adults.an

eek

http://www.nei.nih.gov


The lens lies behind the iris and the pupil (see diagram). It works much like acamera lens. It focuses light onto the retina at the back of the eye, where an imageis recorded. The lens also adjusts the eye's focus, letting us see things clearly bothup close and far away. The lens is made of mostly water and protein. The protein isarranged in a precise way that keeps the lens clear and lets light pass through it.

But as we age, some of the protein may clump together and start to cloud a smallarea of the lens. This is a cataract. Over time, the cataract may grow larger andcloud more of the lens, making it harder to see.

Researchers suspect that there are several causes of cataract, such as smoking anddiabetes. Or, it may be that the protein in the lens just changes from the wear andtear it takes over the years.

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 doctorinserts a tiny probe into the eye. This device emits ultrasound waves that softenand break up the lens so that it can be removed by suction. Most cataract surgerytoday is done by phacoemulsification, also called "small incision cataract surgery."

Extracapsular surgery. Your doctor makes a longer incision on the side of thecornea and removes the cloudy core of the lens in one piece. The rest of the lensis removed by suction.

Symptoms of Cataractincludes:

Cloudy or blurry vision.Colors seem faded.Glare.Poor night vision.Double vision or multipleimages in one eye.Frequent prescriptionchanges in youreyeglasses or contactlenses.


anee

k


In the front of the eye is a space called the anterior chamber. A clearfluid flows continuously in and out of the chamber and nourishesnearby tissues. The fluid leaves the chamber at the open angle wherethe cornea and iris meet. (See diagram.) When the fluid reaches theangle, it flows through a spongy meshwork, like a drain, and leavesthe eye.Sometimes, when the fluid reaches the angle, it passes too slowlythrough the meshwork drain. As the fluid builds up, the pressureinside the eye rises to a level that may damage the optic nerve. Whenthe optic nerve is damaged from increased pressure, open-angleglaucoma--and vision loss--may result. That's why controllingpressure inside the eye is important.

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 eyepressure. Lowering eye pressure at least 30 percent through medicines slows the disease in some people. Glaucoma may worsenin 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 bypart of the iris. People with this type of glaucoma have a sudden increase in eye pressure. Symptoms include severe pain andnausea, 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. Thesechildren usually have obvious symptoms, such as cloudy eyes, sensitivity to light, and excessive tearing. Conventional surgerytypically 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 aresometimes 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 severeform, called neovascular glaucoma, is linked to diabetes. Corticosteroid drugs used to treat eye inflammations and other diseasescan 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.govLifeART Collection Images Copyright © 1989-2001 by Lippincott Williams & Wilkins, Baltimore, MD

Fluid forms here

Fluid exits hereFluid exits here

Angle

Anterior chamber

Lens

IrisIris

Pupil

anee

k



Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. It iscaused 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 bloodvessels grow on the surface of the retina. The retina is the light-sensitive tissue at the back of the eye. A healthy retinais necessary for good vision.

Image of the retina afflictedwith proliferative diabeticretinopathy as seen throughan opthalmoscope.

If you have diabetic retinopathy, at first you may not noticechanges to your vision. But over time, diabetic retinopathy canget worse and cause vision loss. Diabetic retinopathy usuallyaffects both eyes.

How does diabetic retinopathy cause vision loss?

Blood vessels damaged from diabetic retinopathy can causevision loss in two ways:

Fragile, abnormal blood vessels can develop and leak bloodinto the center of the eye, blurring vision. This is proliferativeretinopathy and is the fourth and most advanced stage of thedisease.

Fluid can leak into the center of the macula, the part of theeye where sharp, straight-ahead vision occurs. The fluidmakes the macula swell, blurring vision. This condition iscalled macular edema. It can occur at any stage of diabeticretinopathy, although it is more likely to occur as the diseaseprogresses. About half of the people with proliferativeretinopathy also have macular edema.


k



Diabetic retinopathy is the most common diabetic eye disease and aleading cause of blindness in American adults. It is caused by changes inthe blood vessels of the retina.

anee

k



Diabetic neuropathies are a family of nerve disorders caused by diabetes.People with diabetes can, over time, develop nerve damage throughout thebody. Some people with nerve damage have no symptoms. Others may havesymptoms 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 ofneuropathy. People with diabetes can develop nerve problems at any time,but risk rises with age and longer duration of diabetes. The highest rates ofneuropathy are among people who have had diabetes for at least 25 years.Diabetic neuropathies also appear to be more common in people who haveproblems controlling their blood glucose, also called blood sugar, as well asthose with high levels of blood fat and blood pressure and those who areoverweight.

The causes are probably different for different types of diabetic neuropathy.Researchers are studying how prolonged exposure to high blood glucosecauses nerve damage. Nerve damage is likely due to a combination offactors:

metabolic factors, such as high blood glucose, long duration of diabetes,abnormal blood fat levels, and possibly low levels of insulinneurovascular factors, leading to damage to the blood vessels that carryoxygen and nutrients to nervesautoimmune factors that cause inflammation in nervesmechanical injury to nerves, such as carpal tunnel syndromeinherited traits that increase susceptibility to nerve diseaselifestyle factors, such as smoking or alcohol use


k


Peripheral Neuropathy(Distal Symmetric Neuropathy or SensorimotorNeuropathy) is nerve damage in the arms andlegs. Symptoms of peripheral neuropathy mayinclude:

numbness or insensitivity to pain ortemperaturea tingling, burning, or prickling sensationsharp pains or crampsextreme sensitivity to touch, even light touchloss of balance and coordination

Autonomic Neuropathyaffects the nerves that control the heart,regulate blood pressure, and control bloodglucose levels. Autonomic neuropathy alsoaffects other internal organs, causingproblems with digestion, respiratory function,urination, sexual response, and vision. Inaddition, the system that restores bloodglucose levels to normal after a hypoglycemicepisode may be affected, resulting in loss ofthe warning symptoms of hypoglycemia.

Focal Neuropathyappears suddenly and affects specific nerves,most often in the head, torso, or leg. Focalneuropathy may cause

inability to focus the eyedouble visionaching behind one eyeparalysis on one side of the face, called Bell’spalsysevere pain in the lower back or pelvispain in the front of a thighpain in the chest, stomach, or sidepain on the outside of the shin or inside of thefootchest or abdominal pain that is sometimesmistaken for heart disease, a heart attack, orappendicitis

Proximal Neuropathy(Lumbosacral Plexus Neuropathy,Femoral Neuropathy, or DiabeticAmyotrophy ) starts with pain in thethighs, hips, buttocks, or legs, usuallyon one side of the body. This type ofneuropathy is more common in thosewith type 2 diabetes and in older adultswith diabetes. Proximal neuropathycauses weakness in the legs and theinability to go from a sitting to astanding position without help.Treatment for weakness or pain isusually needed. The length of therecovery period varies, depending onthe type of nerve damage.


k

Diabetic neuropathy can be classified as peripheral, autonomic, proximal, or focal. Each affects different parts of the bodyin various ways.

Source: National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases,National Institutes of Health. diabetes.niddk.nih.govan

eek

Too much glucose in the blood for a long time cancause diabetes problems. This high blood glucose,also called blood sugar, can damage many parts ofthe body.

High blood glucose from diabetes causes twoproblems that can hurt your feet:

Nerve damage:One problem is damage to nerves in your legs andfeet. With damaged nerves, you might not feel pain,heat, or cold in your legs and feet. A sore or cut onyour foot may get worse because you do not know itis there. This lack of feeling is caused by nervedamage, also called diabetic neuropathy. Nervedamage can lead to a sore or an infection.

Poor blood flow:The second problem happens when not enoughblood flows to your legs and feet. Poor blood flowmakes it hard for a sore or infection to heal. Thisproblem is called peripheral vascular disease, alsocalled PVD. Smoking when you have diabetes makesblood flow problems much worse.


Nerves of Leg


Principal nerve

Saphenous nerve

Tibial nerve

Medial plantar nerve

Lateral plantar nerve

Deep fibular nerve

Superficialfibular nerve

anee

k

Gastroparesis, also calleddelayed gastric emptying, isa disorder in which thestomach takes too long toempty its contents. Normally,the stomach contracts tomove food down into thesmall intestine for digestion.The vagus nerve controls themovement of food from thestomach through thedigestive tract. Gastroparesisoccurs when the vagus nerveis damaged and the musclesof the stomach and intestinesdo not work normally. Foodthen moves slowly or stopsmoving through the digestivetract

What are the complications ofgastroparesis?

If food lingers too long in the stomach, it can cause bacterial overgrowth from thefermentation of food. Also, the food can harden into solid masses called bezoars thatmay cause nausea, vomiting, and obstruction in the stomach. Bezoars can bedangerous 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 andis absorbed, blood glucose levels rise. Sincegastroparesis makes stomach emptyingunpredictable, 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

Esophagus

Stomach

Small Intestine

anee

k

Source: National Heart and Lung and Blood Institute, National Institutes of Health. www.nhlbi.nih.gov

Pneumonia is an infection in oneor both of the lungs. Many smallgerms, such as bacteria, viruses,and fungi, can cause pneumonia.

The infection causes your lungs’air sacs, called alveoli, to becomeinflamed. The air sacs may fill upwith fluid or pus, causingsymptoms such as a cough, fever,chills, and trouble breathing.

Pneumonia and its symptoms can vary from mild to severe. Many factorsaffect how serious pneumonia is, such as the type of germ causing theinfection 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, orCOPD (chronic obstructive pulmonary disease).People who have weak immune systems as a result of diseases or otherfactors. These may include HIV/AIDS, chemotherapy (a treatment forcancer), or an organ or bone marrow transplant.

Deoxygenated bloodfrom the heart

Bronchioles

Oxygenated blood to the heart

Alveoli - site of gas exchange


anee

k

http://www.nhlbi.nih.gov

Source: National Heart and Lung and Blood Institute, National Institutes of Health. www.nhlbi.nih.gov

Pneumonia is named for the way in which a person gets the infection or for the germ that causes it.

anee

k

http://www.nhlbi.nih.gov

Source: Center for Disease Control; and Prevention. www.cdc.gov

The pneumococcal shot protects you from getting a serious infection in your blood or brain that cancause dangerous health problems, hospitalization or death.

anee

k

http://www.cdc.gov

Influenza (the flu) is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and attimes can lead to death. The best way to prevent the flu is by getting a flu vaccination each year. Every year in the UnitedStates, on average 5% to 20% of the population gets the flu; more than 200,000 people are hospitalized from flucomplications, and; about 36,000 people die from flu. Some people, such as older people, young children, and people withcertain 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 eachyear. There are two types of vaccines:

The "flu shot" – an inactivated vaccine (containing killed virus) that isgiven with a needle. The flu shot is approved for use in people 6months of age and older, including healthy people and people withchronic medical conditions.The nasal-spray flu vaccine – a vaccine made with live, weakened fluviruses that do not cause the flu (sometimes called LAIV for “LiveAttenuated Influenza Vaccine”). LAIV is approved for use in healthy*people 2-49 years of age who are not pregnant.

Some people should not be vaccinated without first consulting aphysician. They include:

People who have a severe allergy to chicken eggs.People who have had a severe reaction to an influenza vaccination inthe past.People who developed Guillain-Barré syndrome (GBS) within 6 weeksof getting an influenza vaccine previously.Children less than 6 months of age (influenza vaccine is not approvedfor use in this age group).People who have a moderate or severe illness with a fever should waitto 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


k

http://www.cdc.gov

diabetes a synopsis by aneek gupta

Health & Medicine