FitSugar

Does Cold Water Quench Your Thirst Better?

FitSugar — Tue, 28 Oct 2008 05:00:46 -0700

I've heard some people claim that hot water actually quenches your thirst better than cold water, but that seems counterintuitive. Cold water certainly feels more refreshing, but really, isn't water just water regardless of the temperature? Take your best guess below and tell me what you think the truth is.

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Thirst - excessive

admin — Thu, 04 Sep 2008 19:04:59 -0700

Overview

Definition
Alternative Names
Considerations
Common Causes
Home Care
Call your health care provider if
What to expect at your health care provider's office

Illustrations

Insulin production and diabetes

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Excessive thirst is an abnormal feeling of always needing to drink fluids.

Alternative Names

Increased thirst; Polydipsia; Excessive thirst

Considerations

Drinking lots of water is usually healthy. However, the urge to drink too much beyond a certain limit may be the result of an underlying disease, either physical or emotional. Excessive thirst may be a symptom of high blood sugar (hyperglycemia), and can be an important clue in detecting diabetes.

Excessive thirst is a fairly common symptom. It is often the reaction to fluid loss during exercise, or to eating salty foods.

Common Causes

A recent salty or spicy meal
Bleeding enough to cause a significant decrease in blood volume
Diabetes
Diabetes insipidus
Drugs such as anticholinergics, demeclocycline, diuretics, phenothiazines
Excessive loss of water and salt (possibly due to not drinking enough water, profuse sweating, diarrhea, or vomiting)
Loss of body fluids from the bloodstream into the tissues due to:
- Conditions such as severe infections (sepsis) or burns
- Heart, liver, or kidney failure
Psychogenic polydipsia, the result of a mental disorder, is a condition causes a person to drink too much

Home Care

Because thirst is usually the body's signal to replace water loss, it is usually appropriate to drink plenty of liquids.

A very strong, constant urge to drink may be a sign of a psychological problem, which may mean psychological help is needed.

For thirst caused by diabetes, follow the prescribed treatment to properly control blood sugar levels.

Call your health care provider if

Excessive thirst is persistent and unexplained
Thirst is accompanied by other unexplained symptoms, such as blurry vision and fatigue
You are passing more than 5 quarts of urine per day

What to expect at your health care provider's office

The health care provider will get your medical history and perform a physical examination.

Medical history questions may include the following:

How long have you been aware of having increased thirst?
Is it consistent during the day?
Is it worse during the day?
Did it develop suddenly or slowly?
Are you eating more salty or spicy foods?
How much salt do you have each day?
Did you change your diet?
Have you noticed an increased appetite?
Have you noticed an unintentional weight gain?
Have you noticed an unintentional weight loss?
Has your activity level recently increased?
What other symptoms are happening at the same time?
Have you recently suffered a burn or other injury?
Are you urinating more or less frequently than usual?
Are you producing more or less urine than usual?
Have you noticed any bleeding?
Are you sweating more than usual?
Is there any swelling in your body?
Do you have a fever?

A psychological evaluation may be recommended if compulsive thirst of psychological origin is suspected. Fluid intake and output will be closely watched.

Diagnostic tests that may be performed include the following:

Review Date: 1/18/2007

Reviewed By: Benjamin W. Van Voorhees, MD, MPH, Assistant Professor of Medicine and Pediatrics, The University of Chicago, Chicago, IL. Review provided by VeriMed Healthcare Network.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

A.D.A.M. Copyright

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

adam.com

Source Doc: 1_003085

Thirst - absent

admin — Thu, 04 Sep 2008 19:05:00 -0700

Overview

Definition
Alternative Names
Considerations
Common Causes
Home Care
Call your health care provider if
What to expect at your health care provider's office

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Absence of thirst is a lack of the urge to drink fluids.

Alternative Names

Adipsia; Lack of thirst; Absence of thirst

Considerations

Not being thirsty at various times during the day is normal, if the body does not need fluid replacement. However, a quick change in the need for fluids should prompt a visit to your doctor.

Common Causes

Hypothalamic injury or tumor
Head injury
Stroke
Bronchial tumor that causes SIADH
Cirrhosis

Home Care

Follow your health care provider's recommendations. Drink enough fluids, even if you do not feel thirsty (6 - 8 glasses each day may be advised).

Call your health care provider if

Call for an appointment with your health care provider if you notice any abnormal lack of thirst.

What to expect at your health care provider's office

The health care provider will obtain your medical history and will perform a physical examination.

Medical history questions may include the following:

When did you first notice this problem?
Did the absence of thirst develop suddenly or slowly?
Is the thirst decreased or totally absent?
Is drinking fluids possible?
Did the loss of thirst follow a head injury?
What other symptoms do you have?
Do you have abdominal pain?
Do you have headaches?
Do you have difficulty swallowing?
Do you suddenly dislike drinking fluids?
Do you have difficulty breathing?
Do you have a cough?
Do you have any changes in appetite?
Do you urinate less than usual?
Do you have any changes in skin color?
What medications are you taking?

The physical examination may include a detailed nervous system examination if a head injury or problem with the hypothalamus is suspected. Diagnostic tests will vary depending on the history and physical examination findings.

Necessary fluids may be given through a vein (IV).

A.D.A.M. Copyright

adam.com

Source Doc: 1_003086

Summer Beverage Breakdown: Alcoholic Edition

FitSugar — Tue, 14 Jul 2009 10:00:16 -0700

When it's sunny and warm and you're craving a crisp, cold beverage, sometimes an iced coffee or fresh-squeezed tangerine juice just doesn't satisfy your thirst. Sometimes, you're in the mood for something with a little kick.

To see a breakdown of your favorite Summer alcoholic beverages keep reading

Diabetes

admin — Wed, 03 Sep 2008 17:55:12 -0700

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Diabetes is a life-long disease marked by high levels of sugar in the blood.

Causes, incidence, and risk factors

Diabetes can be caused by too little insulin (a hormone produced by the pancreas to control blood sugar), resistance to insulin, or both.

To understand diabetes, it is important to first understand the normal process of food metabolism. Several things happen when food is digested:

A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body.
An organ called the pancreas makes insulin. The role of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be used as fuel.

People with diabetes have high blood sugar. This is because their pancreas does not make enough insulin or their muscle, fat, and liver cells do not respond to insulin normally, or both.

There are three major types of diabetes:

Type 1 diabetes is usually diagnosed in childhood. The body makes little or no insulin, and daily injections of insulin are needed to sustain life.
Type 2 diabetes is far more common than type 1 and makes up most of all cases of diabetes. It usually occurs in adulthood. The pancreas does not make enough insulin to keep blood glucose levels normal, often because the body does not respond well to the insulin. Many people with type 2 diabetes do not know they have it, although it is a serious condition. Type 2 diabetes is becoming more common due to the growing number of older Americans, increasing obesity, and failure to exercise.
Gestational diabetes is high blood glucose that develops at any time during pregnancy in a woman who does not have diabetes.

Diabetes affects more than 20 million Americans. About 54 million Americans have prediabetes. There are many risk factors for diabetes, including:

A parent, brother, or sister with diabetes
Obesity
Age greater than 45 years
Some ethnic groups (particularly African Americans, Native Americans, Asians, Pacific Islanders, and Hispanic Americans)
Gestational diabetes or delivering a baby weighing more than 9 pounds
High blood pressure
High blood levels of triglycerides (a type of fat molecule)
High blood cholesterol level
Not getting enough exercise

The American Diabetes Association recommends that all adults over age 45 be screened for diabetes at least every 3 years. A person at high risk should be screened more often.

Symptoms

High blood levels of glucose can cause several problems, including frequent urination, excessive thirst, hunger, fatigue, weight loss, and blurry vision. However, because type 2 diabetes develops slowly, some people with high blood sugar experience no symptoms at all.

Symptoms of type 1 diabetes:

Increased thirst
Increased urination
Weight loss in spite of increased appetite
Fatigue
Nausea
Vomiting

Patients with type 1 diabetes usually develop symptoms over a short period of time, and the condition is often diagnosed in an emergency setting.

Symptoms of type 2 diabetes:

Increased thirst
Increased urination
Increased appetite
Fatigue
Blurred vision
Slow-healing infections
Impotence in men

Signs and tests

A urine analysis may be used to look for glucose and ketones from the breakdown of fat. However, a urine test alone does not diagnose diabetes. The following blood glucose tests are used to diagnose diabetes:

Fasting blood glucose level -- diabetes is diagnosed if higher than 126 mg/dL on two occasions. Levels between 100 and 126 mg/dl are referred to as impaired fasting glucose or pre-diabetes. These levels are considered to be risk factors for type 2 diabetes and its complications.
Random (non-fasting) blood glucose level -- diabetes is suspected if higher than 200 mg/dL and accompanied by the classic symptoms of increased thirst, urination, and fatigue. (This test must be confirmed with a fasting blood glucose test.)
Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours (This test is used more for type 2 diabetes.)

You should also ask your doctor how often to you need your hemoglobin A1c (HbA1c) level checked. The HbA1c is a measure of average blood glucose during the previous 2 to 3 months. It is a very helpful way to determine how well treatment is working.

Ketone testing is another test that is used in type 1 diabetes. Ketones are produced by the breakdown of fat and muscle, and they are harmful at high levels. The ketone test is done using a urine sample. High levels of blood ketones may result in a serious condition called ketoacidosis. Ketone testing is usually done at the following times:

When the blood sugar is higher than 240 mg/dL
During acute illness (for example, pneumonia, heart attack, or stroke)
When nausea or vomiting occur
During pregnancy

Treatment

There is no cure for diabetes. Treatment involves medicines, diet, and exercise to control blood sugar and prevent symptoms and complications.

LEARN THESE SKILLS

Basic diabetes management skills will help prevent the need for emergency care. These skills include:

How to recognize and treat low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia)
What to eat and when
How to take insulin or oral medication
How to test and record blood glucose
How to test urine for ketones (type 1 diabetes only)
How to adjust insulin or food intake when changing exercise and eating habits
How to handle sick days
Where to buy diabetes supplies and how to store them

After you learn the basics of diabetes care, learn how the disease can cause long-term health problems and the best ways to prevent these problems. People with diabetes need to review and update their knowledge, because new research and improved ways to treat diabetes are constantly being developed.

SELF-TESTING

If you have diabetes, your doctor may tell you to regularly check your blood sugar levels at home. There are a number of devices available, and they use only a drop of blood. Self-monitoring tells you how well diet, medication, and exercise are working together to control your diabetes and can help your doctor prevent complications.

The American Diabetes Association recommends that premeal blood sugar levels fall in the range of 80 to 120 mg/dL and bedtime blood levels fall in the range of 100 to 140 mg/dL. Your doctor may adjust this depending on your circumstances.

WHAT TO EAT

You should work closely with your health care provider to learn how much fat, protein, and carbohydrates you need in your diet. A registered dietician can be very helpful in planning dietary needs.

People with type 1 diabetes should eat at about the same times each day and try to be consistent with the types of food they choose. This helps to prevent blood sugars from becoming extremely high or low.

Persons with type 2 diabetes should follow a well-balanced and low-fat diet.

HOW TO TAKE MEDICATION

Medications to treat diabetes include insulin and glucose-lowering pills called oral hypoglycemic drugs.

Persons with type 1 diabetes cannot make their own insulin, so daily insulin injections are needed. Insulin does not come in pill form. Injections that are generally needed one to four times per day. Some people use an insulin pump, which is worn at all times and delivers a steady flow of insulin throughout the day. Other people may use a new type of inhaled insulin.

Insulin preparations differ in how quickly they start to work and how long they remain active. Sometimes different types of insulin are mixed together in a single injection. The types of insulin to use, the doses needed, and the number of daily injections are chosen by a health care professional trained to provide diabetes care.

People who need insulin are taught to give themselves injections by their health care providers or diabetes educators.

Unlike type 1 diabetes, type 2 diabetes may respond to treatment with exercise, diet, and medicines taken by mouth. There are several types of medicines used to lower blood glucose in type 2 diabetes. They fall into one of three groups:

Medications called oral sulfonylureas that increase insulin production by the pancreas.
Medications called thiazolidinediones that help increase the cell's sensitivity (responsiveness) to insulin.
Medications that delay absorption of glucose from the gut. These include acarbose and miglitol.

There are some injectable medicines used to lower blood sugar. They include exenatide and pramlintide.

Most persons with type 2 diabetes will need more than one medication for good blood sugar control within 3 years of starting their first medication. Different groups of medications may be combined or used with insulin.

Some people with type 2 diabetes find they no longer need medication if they lose weight and increase activity, because when their ideal weight is reached, their own insulin and a careful diet can control their blood glucose levels.

It is unknown if hypoglycemic medicines taken by mouth are safe for use in pregnancy. Women who have type 2 diabetes and take these medications may be switched to insulin during pregnancy and while breastfeeding.

Gestational diabetes is treated with insulin and changes in diet.

EXERCISE

Regular exercise is especially important for people with diabetes. It helps with blood sugar control, weight loss, and high blood pressure. People with diabetes who exercise are less likely to experience a heart attack or stroke than diabetics who do not exercise regularly. You should be evaluated by your physician before starting an exercise program.

Here are some exercise considerations:

Choose an enjoyable physical activity that is appropriate for your current fitness level.
Exercise every day, and at the same time of day, if possible.
Monitor blood glucose levels before and after exercise.
Carry food that contains a fast-acting carbohydrate in case you become hypoglycemic during or after exercise.
Carry a diabetes identification card and a mobile phone or change for a payphone in case of emergency.
Drink extra fluids that do not contain sugar before, during, and after exercise.

Changes in exercise intensity or duration may need changes in diet or medication dose to keep blood sugar levels from going too high or low.

FOOT CARE

People with diabetes are prone to foot problems because of the likelihood of damage to blood vessels and nerves and a decreased ability to fight infection. Problems with blood flow and damage to nerves may cause an injury to the foot to go unnoticed until infection develops. Death of skin and other tissue can occur.

If left untreated, the affected foot may need to be amputated. Diabetes is the most common condition leading to amputations.

To prevent injury to the feet, people with diabetes should adopt a daily routine of checking and caring for the feet as follows:

Check your feet every day, and report sores or changes and signs of infection.
Wash your feet every day with lukewarm water and mild soap, and dry them thoroughly.
Soften dry skin with lotion or petroleum jelly.
Protect feet with comfortable, well-fitting shoes.
Exercise daily to promote good circulation.
See a podiatrist for foot problems or to have corns or calluses removed.
Remove shoes and socks during a visit to your health care provider and remind him or her to examine your feet.
Stop smoking, which hinders blood flow to the feet.

Support Groups

For additional information, see diabetes resources.

Expectations (prognosis)

With good blood glucose and blood pressure control, many of the complications of diabetes can be prevented.

Studies have shown that strict control of blood sugar and blood pressure levels in persons with diabetes helps reduce the risk of kidney disease, eye disease, nervous system disease, heart attack, and stroke.

Complications

Emergency complications include diabetic hyperglycemic hyperosmolar coma.

Long-term complications include:

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if symptoms of ketoacidosis occur:

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

Go to the emergency room or call the local emergency number if symptoms of extremely low blood sugar (hypoglycemic coma or severe insulin reaction) occur:

Prevention

Maintaining an ideal body weight and an active lifestyle may prevent the onset of type 2 diabetes. Currently there is no way to prevent type 1 diabetes.

References

Standards of medical care in diabetes--2007. Diabetes Care. Jan 2007;30 Suppl 1:S4-S41.

Larsen PR, Kronberg HM, Schlomo M, et al. Williams Textbook of Endocrinology. 10th ed. St. Louis, Mo: WB Saunders; 2003:1427-1468, 1485-1504.

Armstrong C. ADA Releases Standards of Medical Care for Patients with Diabetes. Am Fam Physician. Sept 2006; 74(5); 871-874.

Caballero E. Prediabetes. J Clin Endocrinol Metab. Jan 2007; 92(1); 15A-16A.

Review Date: 2/8/2007

Reviewed By: Robert Hurd, MD, Professor of Endocrinology, Department of Biology, Xavier University, Cincinnati, OH. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Source Doc: 1_001214

Diabetes insipidus - central

admin — Wed, 03 Sep 2008 17:49:54 -0700

Illustrations

Endocrine glands

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Central diabetes insipidus is a rare condition that involves extreme thirst and excessive urination.

Alternative Names

Central diabetes insipidus

Causes, incidence, and risk factors

Central diabetes insipidus occurs when the body has too little of the hormone vasopressin.

Vasopressin normally limits the amount of urine the body produces. Normally, the hypothalamus gland in the brain makes vasopressin, and the pituitary gland stores the hormone. Without vasopressin, the kidneys do not work properly. The result is a rapid loss of water from the body in the form of dilute urine. A person with diabetes insipidus drinks large quantities of water, driven by extreme thirst, to make up for the water loss.

The reduced levels of vasopressin associated with central diabetes insipidus may be caused by damage to the hypothalamus or pituitary gland. This damage may be related to surgery, infection, inflammation, tumor, or injury to the head.

Sometimes the cause remains unknown. Very rarely, diabetes insipidus can be caused by a genetic defect.

Symptoms

Increased amount of urine production
Excessive thirst
Confusion and changes in consciousness (if the patient is unable to drink)

Signs and tests

A person with central diabetes insipidus produces more than 3 liters of urine a day. Urinalysis will show a low concentration of salt in the urine.

A water restriction test is used to look at how well the kidney works and how much urine is produced. This test is done during a hospital stay. Results are checked every hour. A blood test to check plasma sodium concentration is done every 2 hours. Serum sodium/salt concentration may be high if the condition is untreated.

An MRI of the head may show a problem in or near the pituitary gland.

Treatment

The cause of the underlying condition should be treated.

Vasopressin (desmopressin) will be given either as a nasal spray, tablets by mouth, or injections under the skin. This controls the urine output and fluid balance and prevents dehydration.

In mild cases, drinking more water may be all that is needed. If the thirst mechanism is not working (for example, if the hypothalamus is damaged), a prescription for a certain amount of water intake may also be needed (usually 2-2.5 L per day) to ensure proper hydration.

Expectations (prognosis)

The outcome depends on the underlying disorder. If treated, diabetes insipidus does not cause severe problems or result in early death.

Complications

Dehydration
Electrolyte imbalance
Confusion and changes in mental status may develop if the condition is not treated.

All patients with diabetes insipidus should wear a medic alert bracelet or necklace to alert care givers to this condition in an emergency situation.

Calling your health care provider

Call your health care provider if symptoms indicate diabetes insipidus may be present.

Prevention

Many of the cases may not be preventable. Prompt treatment of infections, tumors, and injuries may reduce risk.

References

Bringhurst FR, Demay MB, Kronenberg HM. Disorders of Mineral Metabolism. In: Kronenberg HM, Schlomo M, Polansky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. St. Louis, Mo: WB Saunders; 2008: chap. 27.

Robinson AG, Verbalis JG. Posterior Pituitary. In: Kronenberg HM, Schlomo M, Polansky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. St. Louis, Mo: WB Saunders; 2008: chap. 9.

Review Date: 7/28/2008

Reviewed By: Robert Cooper, MD, Endocinology Specialist and Chief of Medicine, Holyoke Medical Center, Assistant Professor of Medicine, Tufts University School of Medicine, Boston MA Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M. Copyright

adam.com

Source Doc: 1_000460

Diabetes

FitSugar — Wed, 08 Oct 2008 17:34:55 -0700

Overview

Signs and Symptoms
Causes
Risk Factors
Diagnosis
Preventive Care
Treatment Approach
Other Considerations
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

Diabetes is a chronic (long-term) condition marked by abnormally high levels of sugar (glucose) in the blood. People with diabetes either do not produce enough insulin -- a hormone that is needed to convert sugar, starches and other food into energy needed for daily life -- or cannot use the insulin that their bodies produce. As a result, glucose builds up in the bloodstream. If left untreated, diabetes can lead to blindness, kidney disease, nerve disease, heart disease, and stroke.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 20.8 million Americans have diabetes.

While an estimated 14.6 million have been diagnosed with diabetes (both type 1 and type 2), unfortunately, 6.2 million people (or nearly one-third) are unaware that they have type 2 diabetes.

Diabetes is widely recognized as one of the leading causes of death and disability in the United States. The Centers for Disease Control and Prevention (CDC) recognize diabetes as the 6th leading cause of death in the U.S.

There are two major types of diabetes:

Type 1 -- Also known as juvenile or insulin-dependent diabetes, type 1 diabetes occurs when the pancreas produces too little insulin to regulate blood sugar levels appropriately. It is usually diagnosed in childhood.
Type 2 -- This form of the disease is far more common than type 1 and makes up 90% or more of all cases of diabetes. It usually occurs in adulthood. It occurs when the pancreas does not make enough insulin to keep blood glucose levels normal. Many people with type 2 diabetes do not know they have it, although it is a serious condition. Type 2 diabetes is becoming more common due to the growing number of older Americans, increasing obesity, and failure to exercise.

Pre-diabetes occurs in those individuals with blood glucose levels that are higher than normal but not high enough for a diagnosis of diabetes. This condition raises the risk of developing type 2 diabetes, heart disease, and stroke. Pre-diabetes is also called impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), depending on the test used to diagnose it. Some individuals have both IFG and IGT. In IFG, glucose levels are a little high when it has been several hours after eating. In IGT, glucose levels are a little higher than normal right after eating. Pre-diabetes is becoming more common in the U.S., according to estimates provided by the U.S. Department of Health and Human Services (DHHS). Many individuals with pre-diabetes go on to develop type 2 diabetes within 10 years.

Gestational diabetes is high blood glucose that develops at any time during pregnancy in a person who does not have diabetes. Four percent of all pregnant women develop gestational diabetes. Although it usually disappears after delivery, the mother is at increased risk of developing type 2 diabetes later in life.

Diabetes may also be associated with genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses.

Signs and Symptoms

Type 1: Type 1 diabetes can occur at any age, but it usually starts in people younger than 30. Symptoms are usually severe and occur rapidly. They include:

Increased thirst
Increased urination
Weight loss despite increased appetite
Nausea
Vomiting
Abdominal pain
Fatigue
Absence of menstruation

Type 2: People with type 2 diabetes often have no symptoms, and their condition is detected only when a routine exam reveals high levels of glucose in their blood. Occasionally, however, a person with type 2 diabetes may experience symptoms listed below, which tend to appear slowly over time:

Numbness or burning sensation of the feet, ankles, and legs
Blurred or poor vision
Impotence
Fatigue
Poor wound healing

In some cases, symptoms may mimic type 1 diabetes and appear more abruptly:

Excessive urination and thirst
Yeast infections
Whole body itching
Coma -- in severe cases, high blood glucose may affect water distribution in brain cells, causing a state of deep unconsciousness, or coma.

Causes

Both type 1 and type 2 diabetes are caused by the absence, insufficient production, or lack of response by cells in the body to the hormone insulin. Insulin is a key regulator of the body's metabolism. After meals, food is digested in the stomach and intestines. Sugar (glucose) molecules are absorbed directly into the bloodstream, and blood glucose levels rise. Under normal circumstances, the rise in blood glucose levels signals specific cells in the pancreas -- called beta cells -- to secrete insulin into the bloodstream. Insulin, in turn, enables glucose to enter cells in the body that may be burned for energy or stored for future use.

In type 1 diabetes, the beta cells of the pancreas produce little or no insulin, the hormone that allows glucose to enter body cells. Once glucose enters a cell, it is used as fuel. Without adequate insulin, glucose builds up in the bloodstream instead of going into the cells. The body is unable to use this glucose for energy despite high levels in the bloodstream, leading to increased hunger.

In addition, the high levels of glucose in the blood cause the patient to urinate more, which leads to excessive thirst. Within 5 - 10 years after diagnosis, the insulin-producing beta cells of the pancreas are completely destroyed, and no more insulin is produced.

The exact cause of type 1 diabetes is not known. Type 1 diabetes accounts for 3% of all new cases of diabetes each year. There is 1 new case per every 7,000 children per year. New cases are less common among adults older than 20.

Type 2 diabetes usually develops in older, overweight individuals who become resistant to the effects of insulin over time. When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin but, for unknown reasons, the body cannot use the insulin effectively. This is called insulin resistance. This means that the insulin produced by your pancreas cannot connect with fat and muscle cells to let glucose inside and produce energy. This causes hyperglycemia (high blood glucose). To compensate, the pancreas produces more insulin. The cells sense this flood of insulin and become even more resistant, resulting in a vicious cycle of high glucose levels and often high insulin levels.

Inflammation has also been found to be common among those with type 2 diabetes. Inflammatory markers (chemicals in the body that lead to inflammation), such as interleukin-6 (Il-6) and C-reactive protein, have been found to be increased in those with type 2 diabetes.

Type 2 diabetes usually occurs gradually. Most people with type 2 diabetes are overweight at the time of diagnosis. However, the disease can also develop in lean people, especially the elderly.

Risk Factors

Type 1 diabetes

Family history of type 1 diabetes
Mother who had pre-eclampsia (a condition characterized by a sharp increase in
Blood pressure during the third trimester of pregnancy)
Family history of autoimmune diseases, including Hashimoto's thyroiditis, Graves disease, myasthenia gravis, Addison's disease, or pernicious anemia
Viral infections during infancy, including mumps, rubella, and coxsackie
Child of an older mother
Northern European or Mediterranean descent
Lack of breast-feeding and consumption of cow's milk during infancy (still controversial)

Type 2 diabetes

Family history of type 2 diabetes (one-quarter to one-third of all individuals with type 2 diabetes have a family history of the condition)
Age older than 45 years
Excess body fat, particularly around the waist
Sedentary lifestyle and high-fat, high-calorie diet
Abnormal levels of cholesterol or triglycerides in the blood
High blood pressure
History of gestational diabetes or polycystic ovary syndrome (a hormonal disorder that causes women to have irregular or no menstruation)
African-American, Hispanic American or Native American (particularly Pima tribe in Arizona) descent
Low birth weight or a mother's malnutrition in pregnancy (this may cause metabolic disturbances in a fetus that lead to diabetes later in the child's life)

Diagnosis

According to the American Diabetes Association, all pregnant women should be screened for gestational diabetes during their third trimester, People who are 45 years or older should have their blood glucose levels checked every 3 years. Those who have a high risk of developing diabetes (such as people with a family history of the disease) should be tested more often.

Different types of tests are used to diagnose diabetes: Random plasma glucose level, fasting plasma glucose level, and oral glucose tolerance test.

If the fasting glucose level is 100 - 125 mg/dL, the individual has a form of pre-diabetes called impaired fasting glucose (IFG), meaning that the individual is more likely to develop type 2 diabetes but does not have the condition yet. A level of 126 mg/dL or above, confirmed by repeating the test on another day, means that the individual has diabetes.

Other diagnostic tests for diabetes includes fructosamine testing and hemoglobin A1c. The American Diabetes Association (ADA) recommends A1c as the best test to find out if an individual's blood sugar is under control over time. The test should be performed every 3 months for insulin-treated patients, during treatment changes, or when blood glucose is elevated. For stable patients on oral agents, health care professionals recommended testing A1c at least twice per year. The ADA currently recommends an A1c goal of less than 7.0%. Studies have reported that there is a 10% decrease in relative risk of microvascular complications, such as diabetic nephropathy or diabetic neuropathy, for every 1% reduction in hemoglobin A1c.

People with diabetes must closely monitor their blood sugar and see their doctor regularly. Self-monitoring of blood glucose is done by checking the glucose content of a drop of blood. Regular testing tells you how well diet, medication, and exercise are working together to control your diabetes. Dieticians can also be an integral part of care.

Preventive Care

Type 1 diabetes

There is currently no proven way to prevent type 1 diabetes. However, research conducted in Finland suggests that adequate amounts of vitamin D, particularly in the first year of life, may decrease one's chances of developing type 1 diabetes within the first 30 years of life. In northern Finland (where the annual exposure to sunlight is very limited) researchers followed 10,000 infants for up to 30 years. Those given at least 2,000 IU of vitamin D per day (generally from cod liver oil) for the first year of life were significantly less likely to develop type 1 diabetes over a 30 years than infants who were given less than that. Other studies have confirmed that doses of 2,000 IU or higher of vitamin D may have a strong protective effect against type 1 diabetes. For this reason, caretakers of infants and children at increased risk for type 1 diabetes might wish to consider supplementation. Experts suggest supplementing these individuals at the high end of current U.S. recommendations for vitamin D, which is 200 - 1,000 IU.

Type 2 diabetes

Considerable evidence from population-based studies suggests that type 2 diabetes is highly preventable -- particularly through exercise and weight management. Individuals who are physically inactive or overweight are much more likely to develop type 2 diabetes. Similarly, people who move from a non-Westernized country to a Westernized country (such as the United States where more people are overweight and live sedentary lives), increase their risk for type 2 diabetes. Studies suggest that you do not need vigorous physical activity to lower your risk of diabetes; moderate, regular exercise such as walking for 30 minutes most days of the week, is enough. In general, lifestyle changes recommended to treat diabetes may help prevent the condition as well.

Treatment Approach

The goal of diabetes treatment is to achieve and maintain a healthy blood glucose levels. A major study called the Diabetes Control and Complications Trial (DCCT) found that people with diabetes who kept their blood glucose levels close to normal reduced their risk of developing major complications from the condition.

People with diabetes can use the following therapies to help manage their blood glucose levels and to prevent complications:

Lifestyle changes, such as a well-balanced diet and regular exercise
Medications, particularly insulin for individuals with type 1 diabetes and some people with type 2 diabetes
Supplements, including fiber and chromium
Relaxation techniques
Acupuncture for pain from nerve damage

Lifestyle

People with diabetes can improve significantly from lifestyle changes -- particularly diet and exercise. People with type 2 diabetes may even eliminate the need for medications when they make appropriate lifestyle changes.

Diet

The American Diabetes Association (ADA) recommends that people with diabetes consume a healthy, low-fat diet, rich in grains, fruits, and vegetables. A healthy diet typically includes 10 - 20% of daily calories from protein such as poultry, fish, dairy, and vegetable sources. People with diabetes who also have kidney disease should work with their health care providers to limit protein intake to 10% of daily calories. A low-fat diet typically includes 30% or less of daily calories from fat -- less than 10% from saturated fats and up to 10% from polyunsaturated fats (such as fats from fish).

Carbohydrates tend to have the greatest effect on blood glucose. The balance between the amount of carbohydrate eaten and the available insulin determines how much the blood glucose level goes up after meals or snacks. To help control blood glucose, people should watch how many carbohydrate servings they eat each day. Foods that contain a high amount of carbohydrates include grains, pasta, and rice; breads, crackers, and cereals; starchy vegetables, including potatoes, corn, peas, and winter squash; legumes such as beans, peas, and lentils; fruits and fruit juices; milk and yogurt; and sweets and desserts. Non-starchy vegetables, such as spinach, kale, broccoli, salad greens, and green beans, are very low in carbohydrates. Carbohydrate counting can ensure that the right amount of carbohydrate is eaten at each meal and snack. A dietician can help each person work out a dietary plan that is right for them.

In addition, weight loss should be part of the plan for those with type 2 diabetes. Moderate weight loss (achieved by reducing calories by 250 - 500 per day and exercising regularly) not only controls blood sugars but blood pressure and cholesterol as well. People with diabetes who eat healthy, well-balanced diets will not need to take extra vitamins or minerals to treat their condition.

Exercise

Exercise plays an important role in controlling diabetes because it lowers blood sugar and helps insulin work more efficiently in the body. Exercise also enhances cardiovascular fitness by improving blood flow and increasing the heart's pumping power, promoting weight loss, and lowering blood pressure. However, exercise has the most value when it’s done regularly -- at least three to four sessions per week for 30 - 60 minutes per session. As little as 20 minutes of walking, three times a week, has a proven beneficial effect. People with type 2 diabetes who exercise regularly have been shown to lose weight and gain better control over their blood pressure, thereby reducing their risk for cardiovascular disease (a major complication of diabetes). Studies have also shown that people with type 1 diabetes who regularly exercise reduce their need for insulin injections.

Despite the benefits of exercise, many people have difficulty sticking with an exercise program for a long period of time. Health care providers can help develop suitable routines as well as strategies that may improve adherence to such routines. Anyone with long-standing diabetes should have a thorough screening before starting an exercise program and receive careful monitoring from a physician.

Medications

Medications for diabetes must always be used in combination with lifestyle changes, particularly diet and exercise, to improve the symptoms of diabetes. Medications include insulin, oral sulfonylureas (like glimepiride, glyburide, and tolazamide), biguanides (Metformin), alpha-glucosidase inhibitors (such as acarbose), thiazolidinediones (such as rosiglitazone) and meglitinides (including repaglinide and nateglinide). A new agent in the fight against diabetes, exenatide (Byetta), is an injectable drug that reduces the level of sugar (glucose) in the blood. In clinical studies, exenatide-treated patients achieved lower blood glucose levels and experienced weight loss. Exenatide was approved by the U.S. Food and Drug Administration in May 2005.

Nutrition and Dietary Supplements

Considerable research has been conducted on the relationship between diabetes and specific nutrients and dietary supplements. Dietary supplements may increase the effects of blood sugar lowering medications, including insulin. Whenever considering the use of supplements or making dietary changes, be sure to discuss these changes with your health care provider to ensure safety and appropriateness.

Supplements with Blood Sugar Lowering Effects

Chromium -- Found in a variety of foods and supplements, including liver, brewer's yeast, cheese, meats, fish, fruits, vegetables, and whole grains, chromium appears to enhance the body's sensitivity to insulin. Researchers believe that chromium helps insulin pull glucose from the bloodstream into the cells for energy. The benefit of chromium supplements for diabetes has been studied and debated for a number of years. While some studies show no beneficial effects of chromium use for people with diabetes, other studies have shown that chromium supplements may reduce blood glucose levels in individuals with type 2 diabetes and reduce the need for insulin in those with type 1 diabetes. Most Americans get at least 50 mcg of chromium in their diets each day. The National Research Council estimates that intakes of 50 - 200 mcg per day are safe and effective. Clinical studies showing improved blood sugar control for those with diabetes have used doses of chromium picolinate ranging from 200 - 1,000 mcg per day. However, until human studies of long-term safety are conducted with higher doses, it is best to use 200 mcg or less per day.

Magnesium -- Several clinical studies have demonstrated a strong association between low levels of magnesium in the blood and type 2 diabetes. However, researchers are still unclear about the cause and effect in that association. They are investigating whether low magnesium levels worsen blood sugar control in people with type 2 diabetes or whether diabetes causes magnesium deficiencies. Some experts believe that low magnesium levels worsen blood sugar control and that foods rich in magnesium (such as whole grains, green leafy vegetables, bananas, legumes, nuts, and seeds) or magnesium supplements may promote healthy blood glucose levels. At least one small study suggests that taking magnesium supplements may improve the action of insulin and decrease blood sugar levels, particularly in the elderly. People with severe heart disease or kidney disease should not take magnesium supplements. People with diabetes should discuss whether it’s safe and appropriate to take magnesium supplements with a health care provider.

Fiber -- Studies suggest that a high-fiber diet may help:

Prevent development of type 2 diabetes
Lower average glucose and insulin levels in people who already have type 2 diabetes
Improve cholesterol and triglyceride levels in those with diabetes

In a large-scale study of nurses in the United States, women who consumed the most whole grain foods in their diets were nearly 40% less likely to develop diabetes than women who consumed the least.

Studies have also shown that cholesterol levels improved in people with type 2 diabetes after they took supplements of a soluble fiber known as psyllium (Plantago psyllium).

Beta-glucan is a soluble fiber derived from the cell walls of algae, bacteria, fungi, yeast, and plants. It is commonly used for its cholesterol-lowering effects. There are several human trials supporting the use of beta-glucan for glycemic (blood sugar) control.

Vanadium -- Vanadium is an essential trace mineral present in the soil and in many foods. It appears to mimic the action of insulin and, in a number of human studies, vanadyl sulfate (a form of vanadium) has increased insulin sensitivity in those with type 2 diabetes. Animal studies and some small human studies also suggest that vanadium may lower blood glucose to normal levels (reducing the need for insulin) in people with diabetes. One preliminary clinical study found that people with diabetes using insulin who were given vanadium were able to lower their dose of insulin.

Antioxidants

Antioxidants such as beta-carotene and vitamin C are scavengers of free radicals -- unstable and potentially damaging molecules generated by normal chemical reactions in the body. Free radicals are unstable because they lack one electron. In an attempt to replace this missing electron, the free radical molecules react with neighboring molecules in a process called oxidation. Some clinical studies suggest that people with diabetes have elevated levels of free radicals and lower levels of antioxidants. Preliminary clinical studies show that the following antioxidants may improve symptoms of diabetes (by returning blood glucose levels to the normal range) and reduce the risk of associated complications:

Vitamin E
Selenium
Zinc

Two additional substances that show preliminary evidence to possibly help control blood sugar include:

Biotin (a B-complex vitamin) -- helpful for type 2 diabetes; brewer's yeast is a good source of biotin
Vitamin B6 -- helpful for both type 1 and type 2 diabetes

Supplements with Cardiovascular Effects

Because insulin resistance is often associated with cardiovascular disease, people with diabetes may benefit from nutrients that help manage elevated blood lipid levels, high blood pressure, or heart failure. Although the following supplements have been shown to improve cardiovascular health, there is some concern that they may raise blood glucose levels. People with diabetes interested in trying the following supplements should first consult with their health care providers:

Coenzyme Q10 (CoQ10)
Niacin
Omega-3 Fatty acids

Although clinical studies have not shown that either CoQ10 or omega-3 fatty acid supplements raise blood sugar levels, people with diabetes should discuss the safety and appropriateness of using these, or any supplements, with their doctor or pharmacist.

In addition, the following antioxidants have been shown to improve cholesterol levels in people with type 2 diabetes:

Beta-carotene
Vitamin C (1000 mg per day)
Vitamin E (800 IU per day)

Several clinical studies have also found that elevated manganese levels may help protect against LDL oxidation (a process that contributes to the development of plaque in the arteries).

Supplements that May Reduce Complications of Diabetes

More than one-third of all people with diabetes develop a painful condition known as diabetic neuropathy (nerve damage). Some researchers speculate that elevated levels of free radicals, which can cause damage to nerves and blood vessels, may cause this condition. Clinical studies suggest that the following antioxidant supplements may improve nerve communication in damaged areas and reduce the symptoms of diabetic neuropathy:

Alpha-lipoic acid
Gamma-linolenic acid [evening primrose oil (Oenothera biennis ) is a rich source]

Herbs

People have long used plant-based medicines in the treatment of diabetes. For instance, the plant extract guanidine, which lowers blood glucose, prompted the development and use of biguanides, a commonly used oral medication for diabetes. Other herbs may have a role in the management or prevention of diabetes. These include:

Bitter melon (Momordica charantia). Bitter melon has traditionally been used as a remedy for lowering blood glucose in patients with diabetes mellitus. Preliminary clinical studies have indicated that bitter melon may decrease serum glucose levels.
Fenugreek seeds (Trigonella foenum graecum). Fenugreek seeds, a spice found in many curry preparations, are high in fiber and have been shown to regulate glucose and improve lipid levels in both animals and humans. In two small studies of people with either type 1 or type 2 diabetes, fenugreek seed powder lowered blood glucose and improved levels of blood cholesterol and trigylcerides, among other beneficial effects.
Gymnema (Gymnema sylvestre). Preliminary human research reports that gymnema may be beneficial in patients with type 1 or type 2 diabetes when it is added to diabetes drugs being taken by mouth or to insulin. Gymnema may alter the ability to detect sweet tastes.
Cinnamon (Cinnamomum zeylanicum). In a clinical study of 60 people with type 2 diabetes, intake of 1, 3, or 6 grams of cinnamon per day reduced glucose, triglyceride, LDL cholesterol, and total cholesterol. Other clinical studies have found similar results. As a result, experts claim that cinnamon may play an important role in regulating blood sugar in people with diabetes.
American ginseng (Panax quinquefolium). Although both Asian (Panax ginseng) and American (Panax quinquefolium) appear to lower blood glucose levels, only American ginseng has been studied scientifically. Several clinical studies report a blood sugar lowering effect of American ginseng (Panax quinquefolium) in individuals with type 2 diabetes, both on fasting blood glucose and on postprandial glucose levels. One clinical study found that people with type 2 diabetes who take American ginseng before or together with a glucose meal experience a reduction in glucose levels after they consume the meal.

Acupuncture

Some researchers speculate that acupuncture may trigger the release of natural painkillers and reduce the debilitating symptoms of a complication of diabetes known as neuropathy (nerve damage). In one clinical study of people with diabetes suffering from chronic, painful neuropathy, acupuncture reduced pain and improved sleep in 77% of the participants and eliminated the need for pain medications in 32% of the participants. Given these findings, acupuncture may be a reasonable option for people with diabetes who have neuropathy and either find no symptom relief or develop side effects from conventional drug treatment.

Mind-Body Medicine

Stressful life events can worsen diabetes in several ways. For example, stress stimulates the nervous and endocrine systems in ways that increase blood glucose levels and disrupts healthful behaviors (increasing the chances that an individual may consume a high level of calories and limit his or her physical activity -- a pattern that leads to elevated blood glucose).

It makes sense, then, to consider stress management as part of the treatment and prevention of diabetes. Clinical studies have reported that people with diabetes who participate in biofeedback sessions (a technique that increases awareness and control of the body's response to stress) are more likely to reach target blood glucose levels than those who do not receive biofeedback. Although other studies have produced results that contradict this, researchers and clinicians agree that long-term stress is likely to worsen diabetes and that biofeedback, tai chi, yoga, and other forms of relaxation may help motivate people with diabetes to change their habits in order to manage their condition.

Other Considerations

Pregnancy

Women of child-bearing age who have diabetes should consult an endocrine specialist about the benefits of managing glucose levels before trying to conceive.

About 4% of all pregnant women in the United States are diagnosed with gestational diabetes. Risk factors for developing diabetes while pregnant include:

Modest weight gain prior to pregnancy (11 - 22 pounds or more)
Family history of diabetes
Tobacco use
African-American, Hispanic American, or Asian ancestry
Age older than 50 at conception

Normalizing glucose levels in women with gestational diabetes reduces their risk of complications, such as having an overweight baby, birth trauma, or the need for cesarean section. If the mother's glucose levels are uncontrolled, an infant can be stillborn or suffer from any number of complications, including defects of the brain or central nervous system, an abnormally large body or organs, heart or kidney abnormalities, asphyxia, respiratory distress, and congestive heart failure.

If dietary restrictions fail to improve glucose levels, a woman with gestational diabetes may need insulin. Women should not take oral diabetes medications during pregnancy. Women who develop gestational diabetes may experience the condition again in subsequent pregnancies. Gestational diabetes also increases the risk for developing type 2 diabetes.

Prognosis and Complications

People who maintain tight control over their blood glucose levels can prevent or delay the development of long-term complications from diabetes. Type 1 diabetes generally has more complications than type 2 diabetes.

Long-term complications of diabetes may include:

Heart disease and stroke
Vision loss and blindness
Kidney disease
Neuropathy (nerve damage)
Foot ulcers and infections
Skin problems, including bruising, dryness, itching, hair loss, warts, gangrene (tissue death), and skin ulcers

Supporting Research

Baker H. Nutrition in the elderly: nutritional aspects of chronic diseases. Geriatrics. 2007;62(9):21-5.

Batty GD, Kivimaki M, Smith GD, Marmot MG, Shipley MJ. Obesity and overweight in relation to mortality in men with and without type 2 diabetes/impaired glucose tolerance: the original Whitehall Study. Diabetes Care. 2007;30(9):2388-91.

Bo S, Ciccone G, Baldi C, et al., Effectiveness of a Lifestyle Intervention on Metabolic Syndrome. A Randomized Controlled Trial. J Gen Intern Med. 2007; [Epub ahead of print].

Bozkurt O, de Boer A, Grobbee DE, et al. Pharmacogenetics of glucose-lowering drug treatment: a systematic review. Mol Diagn Ther. 2007;11(5):291-302.

Casellini CM, Vinik AI. Clinical manifestations and current treatment options for diabetic neuropathies. Endocr Pract. 2007;13(5):550-66.

Diabetes Research in Children Network (DirecNet) Study Group, Buckingham B, Beck RW, Tamborlane WV, et al. Continuous glucose monitoring in children with type 1 diabetes. J Pediatr. 2007;151(4):388-93, 393.e1-2.

Herder C, Schneitler S, Rathmann W, et al. Low-Grade Inflammation, Obesity and Insulin Resistance in Adolescents. J Clin Endocrinol Metab. 2007; [Epub ahead of print].

Howes JB, Sullivan D, Lai N. The effects of dietary supplementation with isoflavones from red clover on the lipoprotein profiles of postmenopausal women with mild to moderate hypercholesterolemia. Atherosclerosis. 2000;152(1):143-147.

Hypponen E, Laara E, Reunanen A, Jarvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet. 2001;358(9292):1500-1503.

Kapoor R, Huang YS. Gamma linolenic acid: an antiinflammatory omega-6 fatty acid. Curr Pharm Biotechnol. 2006;7(6):531-4.

Khan A, Khattak K, Sadfar M, Anderson R, Khan M. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care. 2003;26:3215-3218.

Krauss RM, Eckel RH, Howard B, Appel LJ, Daniels SR, Deckelbaum RJ, et al. AHA Scientific Statement: AHA Dietary guidelines Revision 2000: A statement for healthcare professionals from the nutrition committee of the American Heart Association. Circulation. 2000;102(18):2284-2299.

Kris-Etherton P, Eckel RH, Howard BV, St. Jeor S, Bazzare TL. AHA Science Advisory: Lyon Diet Heart Study. Benefits of a Mediterranean-style, National Cholesterol Education Program/American Heart Association Step I Dietary Pattern on Cardiovascular Disease. Circulation. 2001;103:1823.

Kurowska EM, Spence JD, Jordan J, Wetmore S, Freeman DJ, Piche LA, Serratore P. HDL-cholesterol-raising effect of orange juice in subjects with hypercholesterolemia. Am J Clin Nutr. 2000;72(5):1095-1100.

Malnick SD, Somin M. The VALIDD study. Lancet. 2007;370(9591):931; author reply 931-2.

Marz W, Wieland H. HMG-CoA reducatse inhibition: anti-inflammatory effects beyond lipid lowering. Herz. 2000;25(6):117-25.

Mosdol A, Witte DR, Frost G, Marmot MG, Brunner EJ. Dietary glycemic index and glycemic load are associated with high-density-lipoprotein cholesterol at baseline but not with increased risk of diabetes in the Whitehall II study. Am J Clin Nutr. 2007;86(4):988-94.

National Cholesterol Education Program. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486-2497.

Nutrition Committee of the American Heart Association. AHA Dietary Guidelines. Revision 2000: A Statement for Healthcare Professionals. Circulation. 2000; 102:2284-2299.

Pedersen BK. IL-6 signalling in exercise and disease. Biochem Soc Trans. 2007;35(Pt 5):1295-7.

Peek ME, Cargill A, Huang ES. Diabetes health disparities: a systematic review of health care interventions. Med Care Res Rev. 2007;64(5 Suppl):101S-56S.

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Review Date:
12/7/2007
Reviewed By:
Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, NMD, private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

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Diabetes insipidus

admin — Wed, 03 Sep 2008 17:49:17 -0700

Overview

Definition
Causes, incidence, and risk factors
Symptoms
Signs and tests
Treatment
Expectations (prognosis)
Complications
Calling your health care provider

Illustrations

Endocrine glands

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Diabetes insipidus is a condition in which the kidneys are unable to conserve water.

Causes, incidence, and risk factors

Diabetes insipidus (DI) is an uncommon condition that occurs when the kidneys are unable to conserve water as they perform their function of filtering blood. The amount of water conserved is controlled by antidiuretic hormone (ADH), also called vasopressin.

ADH is a hormone produced in a region of the brain called the hypothalamus. It is then stored and released from the pituitary gland, a small gland at the base of the brain.

DI caused by a lack of ADH is called central diabetes insipidus. When DI is caused by a failure of the kidneys to respond to ADH, the condition is called nephrogenic diabetes insipidus.

Central diabetes insipidus is caused by damage to the hypothalamus or pituitary gland as a result of:

Head injury
Infection
Surgery
Tumor

Nephrogenic DI involves a defect in the parts of the kidneys that reabsorb water back into the bloodstream. It occurs less often than central DI. Nephrogenic DI may occur as an inherited disorder in which male children receive the abnormal gene that causes the disease from their mothers.

Nephrogenic DI may also be caused by:

Certain drugs (such as lithium, amphotericin B, and demeclocycline)
High levels of calcium in the body (hypercalcemia)
Kidney disease (such as polycystic kidney disease)

Symptoms

Excessive thirst
- May be intense or uncontrollable
- May involve a craving for ice water
Excessive urine volume

Signs and tests

Treatment

The cause of the underlying condition should be treated when possible.

Central diabetes insipidus may be controlled with vasopressin (desmopressin, DDAVP). You take vasopressin as either a nasal spray or tablets.

If nephrogenic DI is caused by medication (for example, lithium), stopping the medication may help restore normal kidney function. However, after many years of lithium use, the nephrogenic DI may be permanent.

Hereditary nephrogenic DI and lithium-induced nephrogenic DI are treated by drinking enough fluids to match urine output and with drugs that lower urine output. Drugs used to treat nephrogenic DI include:

Anti-inflammatory medication (indomethacin)
Diuretics (hydrochlorothiazide (HCTZ) and amiloride)

Expectations (prognosis)

The outcome depends on the underlying disorder. If treated, diabetes insipidus does not cause severe problems or reduce life expectancy.

Complications

If thirst mechanisms are normal and you drink enough fluids, there are no significant effects on body fluid or salt balance.

Not drinking enough fluids can lead to the following complications:

Dehydration
- Dry skin
- Dry mucus membranes
- Fever
- Rapid heart rate
- Sunken appearance to eyes
- Sunken fontanelles (soft spot) in infants
- Unintentional weight loss
Electrolyte imbalance
- Fatigue, lethargy
- Headache
- Irritability
- Muscle pains

Calling your health care provider

Call your health care provider if you develop symptoms of diabetes insipidus.

If you have diabetes insipidus, contact your health care provider if frequent urination or extreme thirst return.

Review Date: 3/18/2008

Reviewed By: Elizabeth H. Holt, MD, PhD, Assistant Professor of Medicine, Section of Endocrinology and Metabolism, Yale University. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M. Copyright

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Source Doc: 1_000377

Type 1 diabetes

admin — Wed, 03 Sep 2008 17:48:40 -0700

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Type 1 diabetes is a chronic (lifelong) disease that occurs when the pancreas does not produce enough insulin to properly control blood sugar levels.

Alternative Names

Insulin-dependent diabetes; Juvenile onset diabetes; Diabetes - type 1

Causes, incidence, and risk factors

Diabetes is a lifelong disease for which there is not yet a cure. There are several forms of diabetes. Type 1 diabetes is often called juvenile or insulin-dependent diabetes. In this type of diabetes, cells of the pancreas produce little or no insulin, the hormone that allows glucose to enter body cells.

Without enough insulin, glucose builds up in the bloodstream instead of going into the cells. The body is unable to use this glucose for energy despite high levels in the bloodstream. This leads to increased hunger.

In addition, the high levels of glucose in the blood cause the patient to urinate more, which in turn causes excessive thirst. Within 5 to 10 years, the insulin-producing beta cells of the pancreas are completely destroyed and the body can not longer produce insulin.

Type 1 diabetes can occur at any age. Many patients, however, are diagnosed after age 20.

The exact cause is unknown. Genetics, viruses, and auto-immune problems may play a role.

Symptoms

Increased thirst
Increased urination
Weight loss despite increased appetite
Nausea
Vomiting
Abdominal pain
Fatigue
Absence of menstruation

Signs and tests

The following tests can be used to diagnose diabetes:

Urinalysis shows glucose and ketone bodies in the urine, but a blood test is required for diagnosis
Fasting blood glucose is 126 mg/dL or higher
Random (nonfasting) blood glucose exceeds 200 mg/dL (this must be confirmed with a fasting test)
Insulin test (low or undetectable level of insulin)
C-peptide test (low or undetectable level of the protein C-peptide, a by-product of insulin production)

Treatment

The immediate goals of treatment are to treat diabetic ketoacidosis and high blood glucose levels. Because of the sudden onset and severity of symptoms in type 1 diabetes, treatment for newly diagnosed people may involve hospitalization.

The long-term goals of treatment are to prolong life, reduce symptoms, and prevent diabetes-related complications such as blindness, kidney failure, and amputation of limbs.

These goals are accomplished through education, insulin use, meal planning and weight control, exercise, foot care, and careful self-testing of blood glucose levels.

INSULIN

Insulin lowers blood sugar by allowing it to leave the blood stream and enter cells. Everyone needs insulin. People with type 1 diabetes can't make their own insulin, and they must take insulin every day.

Insulin is injected under the skin or inhaled. In some cases, a pump delivers the insulin continuously. Insulin does not come in pill form.

Insulin preparations differ in how fast they start to work and how long they last. The health care professional reviews blood glucose levels to determine the appropriate type of insulin the person should use. More than one type of insulin may be mixed together in an injection to achieve the best control of blood glucose.

The injections are needed, in general, from one to four times a day. People are taught how to give insulin injections by their health care provider or a diabetes nurse educator. Initially, a child's injections may be given by a parent or other adult. By age 14, most children can be expected (but should not be required) to give their own injections.

DIET

Meal planning for type 1 diabetes requires consistency to allow food and insulin to work together to regulate blood glucose levels. If meals and insulin are out of balance, extreme variations in blood glucose can occur.

The American Diabetes Association and the American Dietetic Association has information for planning healthy, balanced meals. A consultation with a registered dietitian or nutrition counselor can be helpful.

PHYSICAL ACTIVITY

Regular exercise helps control the amount of sugar in the blood and helps burn excess calories and fat to achieve optimal weight.

Ask your health care provider before starting any exercise program. Those with Type 1 diabetes must take special precautions before, during, and after intense physical activity or exercise.

SELF-TESTING

Blood glucose monitoring is done by checking the glucose content of a small drop of blood. The testing is done on a regular basis and will inform the person with diabetes how well diet, medication, and exercise are working together to control diabetes.

The results can be used to adjust meals, activity, or medications to keep blood sugar levels within an appropriate range. It will provide valuable information for the health care provider to suggest changes to improve care and treatment. Testing will identify high and low blood sugar levels before serious problems develop.

FOOT CARE

Diabetes causes damage to the blood vessels and nerves, which can result in a decreased ability to feel injury to or pressure on the foot. A foot injury could go unnoticed until severe infection develops.

Additionally, diabetes affects the body's immune system, decreasing the body's ability to fight infection. Small infections can rapidly progress to death of the skin and other tissues. Amputation may be needed.

See: Daily foot care routine

TREATING LOW BLOOD SUGAR

Low blood sugar, known as hypoglycemia, can occur from too much insulin, too much exercise, or too little food. Hypoglycemia can develop quickly in people with diabetes. Symptoms typically appear when the blood sugar level falls below 70. Watch for weakness, shaking, sweating, headache, nervousness, and hunger.

If these symptoms occur and you have a blood sugar test kit available, do a blood sugar check. If the level is low, the person with diabetes should eat something with sugar: fruit juice, several teaspoons of sugar, a cup of skim milk, or regular soda. If you don't have a test kit handy, sugar should be eaten anyway - it can't hurt. Symptoms should go away within 15 minutes. If the symptoms don't go away, more sugar should be eaten and the sugar level tested again.

AFTER the symptoms go away, more substantial food can be eaten. Eat simple sugar first to get the situation under control. Even if you or your child is hungry, "real" food should not be eaten until the sugar level comes up - real food won't produce enough sugar and takes too long to digest.

If you are a parent, relative, or friend of someone experiencing these symptoms, monitor the person closely. If symptoms become worse -- confusion, seizures, or unconsciousness -- give the person a shot of glucagon. If you don't have glucagon, call 911 immediately.

You should have some glucagon stored for emergencies. Make sure everyone in your home, as well as babysitters and caregivers, knows how to use it. Periodically remind everyone how to use it, and check the expiration date.

Don't panic. Glucagon works very fast -- usually within 15 minutes. Lay the person on the side to prevent choking. If the person is not better in 15 minutes, call 911.

TREATING HIGH KETONES

When there is not enough insulin to move glucose into cells, glucose can build up in the blood. The body then looks for other forms of energy and uses fat as a fuel source. As fats are broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous. This condition is known as ketoacidosis.

You can check for ketones using a simple urine test available at pharmacies. This test should be done every 4-6 hours anytime a person with diabetes has a blood sugar above 240 or if they are sick, unusually thirsty, has a dry mouth, frequent urination, or vomiting.

The warning signs that ketoacidosis is getting serious might include flushed face, dry skin and mouth, nausea or vomiting, stomach pain, deep, rapid breathing, or fruity breath odor.

If these symptoms occur, call the doctor or go to the emergency room right away. If left untreated, this condition will lead to coma and even death.

MONITORING

Visit your health care provider or diabetes educator at least four times a year. Have your glycosylated hemoglobin (HbA1c) regularly checked. Cholesterol and triglyceride levels should be checked yearly, along with kidney function.

Visit your ophthalmologist (preferably one that specializes in diabetic retinopathy) at least once a year, or more frequently if signs of diabetic retinopathy develop.

See the dentist every 6 months for a thorough dental cleaning and exam. Make sure your dentist and hygienist know that you have diabetes.

Check your feet every day for early signs of injury or infection. Make sure your health care provider inspects your feet at each visit.

Stay up-to-date with all of your vaccinations and get a flu shot every year in the fall.

EDUCATION

You are the most important person in managing your diabetes. Diabetes education involves learning how to live with your diabetes and helps prevent complications. You should know the basic steps to diabetes management:

How to recognize and treat low blood sugar (hypoglycemia)
How to recognize and treat high blood sugar (hyperglycemia)
Diabetes meal planning
How to give insulin
How to monitor blood glucose and urine ketones
How to adjust insulin and food intake during exercise
How to handle sick days
Where to buy diabetes supplies and how to store them

Support Groups

For additional information and resources, see diabetes support group.

Expectations (prognosis)

The outcome for people with diabetes varies. Studies show that tight control of blood glucose can prevent or delay complications to the eyes, kidneys, and nervous system. However, complications may occur even in those with good diabetes control.

Complications

Emergency complications include:

Ketoacidosis
Hypoglycemia

Long-term complications include:

Vascular disease, including blocked arteries and heart attacks -- risk can be reduced by treating high cholesterol and blood pressure, exercising regularly, and avoiding or quitting tobacco products
Eye problems, including diabetic retinopathy , retinal detachment, glaucoma, and cataracts
Kidney disease (diabetic nephropathy)
Nerve damage (diabetic neuropathy)
Foot problems, including skin changes, arterial insufficiency, neuropathy, and specific foot deformities (hallux valgus, bunion, hammertoe, and calluses)
Infections of the skin, female genital tract, and urinary tract

Calling your health care provider

If you are newly diagnosed with type 1 diabetes, you should probably have medical follow-up weekly until you have good control of blood glucose. Your health care provider will review results of home glucose monitoring and urine testing, and a diary of meals, snacks, and insulin injections.

As the disease becomes more stable, follow-up visits will be less frequent. Periodic visits to your health care provider is very important for monitoring potential long-term complications associated with diabetes.

Call your health care provider or go to the emergency room if you have symptoms ketoacidosis:

Increased thirst and urination
Nausea
Deep and rapid breathing
Abdominal pain
Sweet-smelling breath
Loss of consciousness (This may occur in insulin dependent diabetics who miss a dose of insulin, or if they are sick or have an infection.)

Go to the emergency room or call 911 if you have symptoms of severe hypoglycemia or insulin reaction:

You can treat early signs of hypoglycemia at home by eating sugar or candy or taking glucose tablets. If your signs of hypoglycemia are still not relieved or if your blood glucose levels remain below 60 mg/dL, go to the emergency room.

References

Standards of medical care in diabetes--2007. Diabetes Care. Jan 2007;30 Suppl 1:S4-S41.

Larsen PR, Kronberg HM, Schlomo M, et al. Williams Textbook of Endocrinology. 10th ed. St. Louis, Mo: WB Saunders; 2003:1427-1468, 1485-1504.

Armstrong C. ADA Releases Standards of Medical Care for Patients with Diabetes. Am Fam Physician. Sept 2006; 74(5); 871-874.

Review Date: 11/28/2007

Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc. Previously reviewed by Robert Hurd, MD, Professor of Endocrinology, Department of Biology, Xavier University, Cincinnati, OH. Review provided by VeriMed Healthcare Network (2/8/2007).

A.D.A.M. Copyright

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Source Doc: 1_000305

Snake bites

admin — Wed, 03 Sep 2008 17:46:41 -0700

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Snake bites occur when a snake bites the skin, and are medical emergencies if the snake is poisonous.

Alternative Names

Bites - snakes

Considerations

Snake bites can be deadly if not treated quickly. Children are at higher risk for death or serious complications due to snake bites because of their smaller body size.

The right antivenom can save a person's life. Getting to an emergency room as quickly as possible is very important. If properly treated, many snake bites will not have serious effects.

Causes

Poisonous snake bites include bites by any of the following:

Cobra
Copperhead
Coral snake
Cottonmouth (water moccasin)
Rattlesnake
Various snakes found at zoos

All snakes will bite when threatened or surprised, but most will usually avoid people if possible and only bite as a last resort.

Snakes found in and near water are often mistaken as being poisonous. Most species of snake are harmless and many bites are not life-threatening, but unless you are absolutely sure that you know the species, treat it seriously.

Symptoms

Symptoms depend on the type of snake, but may include:

Bleeding from wound
Blurred vision
Burning of the skin
Convulsions
Diarrhea
Dizziness
Excessive sweating
Fainting
Fang marks in the skin
Fever
Increased thirst
Loss of muscle coordination
Nausea and vomiting
Numbness and tingling
Rapid pulse
Tissue death
Severe pain
Skin discoloration
Swelling at the site of the bite
Weakness

Rattlesnake bites are painful when they occur. Symptoms usually begin right away and may include:

Bleeding
Breathing difficulty
Blurred vision
Eyelid drooping
Low blood pressure
Nausea and vomiting
Numbness
Pain at site of bite
Paralysis
Rapid pulse
Skin color changes
Swelling
Tingling
Tissue damage
Thirst
Tiredness
Weakness
Weak pulse

Cottonmouth and copperhead bites are painful right when they occur. Symptoms, which usually begin right away, may include:

Bleeding
Breathing difficulty
Low blood pressure
Nausea and vomiting
Numbness and tingling
Pain at site of bite
Shock
Skin color changes
Swelling
Thirst
Tiredness
Tissue damage
Weakness
Weak pulse

Coral snake bites may be painless at first. Major symptoms may not develop for hours. DO NOT make the mistake of thinking you will be fine if the bite area looks good and you are not in a lot of pain. Untreated coral snake bites can be deadly. Symptoms may include:

Blurred vision
Breathing difficulty
Convulsions
Drowsiness
Eyelid drooping
Headache
Low blood pressure
Mouth watering (excessive salivation)
Nausea and vomiting
Numbness
Pain and swelling at site of bite
Paralysis
Shock
Slurred speech
Swallowing difficulty
Swelling of tongue and throat
Weakness
Skin color changes
Skin tissue damage
Stomach or abdominal pain
Weak pulse

First Aid

1. Keep the person calm, reassuring them that bites can be effectively treated in an emergency room. Restrict movement, and keep the affected area below heart level to reduce the flow of venom.

2. If you have a pump suction device (such as that made by Sawyer), follow the manufacturer's directions.

3. Remove any rings or constricting items because the affected area may swell. Create a loose splint to help restrict movement of the area.

4. If the area of the bite begins to swell and change color, the snake was probably poisonous.

5. Monitor the person's vital signs -- temperature, pulse, rate of breathing, and blood pressure -- if possible. If there are signs of shock (such as paleness), lay the person flat, raise the feet about a foot, and cover the person with a blanket.

6. Get medical help right away.

7. Bring in the dead snake only if this can be done safely. Do not waste time hunting for the snake, and do not risk another bite if it is not easy to kill the snake. Be careful of the head when transporting it -- a snake can actually bite for up to an hour after it's dead (from a reflex).

Do Not

DO NOT allow the person to become over-exerted. If necessary, carry the person to safety.
DO NOT apply a tourniquet.
DO NOT apply cold compresses to a snake bite.
DO NOT cut into a snake bite with a knife or razor.
DO NOT try to suck out the venom by mouth.
DO NOT give the person stimulants or pain medications unless a doctor tells you to do so.
DO NOT give the person anything by mouth.
DO NOT raise the site of the bite above the level of the person's heart.

Call immediately for emergency medical assistance if

Call for medical help if someone has been bitten by a snake. If possible, call ahead to the emergency room so that antivenom can be ready when the person arrives.

You may also call the National Poison Control Center (1-800-222-1222). The center can be called from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

See: Poison control center - emergency number

Prevention

Avoid areas where snakes may be hiding, such as under rocks and logs.
Even though most snakes are not poisonous, avoid picking up or playing with any snake unless you have been properly trained.
If you hike often, consider buying a snake bite kit (available from hiking supply stores). Do not use older snake bite kits, such as those containing razor blades and suction bulbs.
Don't provoke a snake. That is when many serious snake bites occur.
Tap ahead of you with a walking stick before entering an area where you can't see your feet. Snakes will try to avoid you if given enough warning.
When hiking in an area known to have snakes, wear long pants and boots if possible.

References

Tintinalli JE, Kelen GD, Stapcynski JS, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw Hill; 2004.

Review Date: 2/27/2008

Reviewed By: Stephen C. Acosta, MD, Department of Emergency Medicine, Portland VA Medical Center, Portland, OR. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M. Copyright

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Source Doc: 1_000031