Potassium Bicarbonate and Phosphate
Even though the body is potassium depleted, with a typical deficit of around 5 mmol kg, initial potassium values are usually normal or elevated. Insulin therapy, rehydration and correction of acidosis all cause a decrease in serum potassium and 20-30 mmol potassium h may be administered once potassium levels are below 5.0 mmol L, provided renal function is intact. Subsequent potassium administration is guided by frequent concentration measurements adjuvant oral administration may be used in...
Developing Positive Thinking
Studies have shown fairly conclusively that if you start with a positive frame of mind, your body can work with you and not against you. Even when things go wrong, if you're optimistic, you can pick yourself up and move forward. If you're pessimistic, you can become depressed and believe that nothing will help you. That kind of attitude is not conducive to good control of your blood glucose and avoidance of complications. I have a patient who came to me to improve his glucose control just after...
Tuna Dijon Brochettes
Tuna isn't just for salad anymore. Fresh tuna has a beautiful ruby red color, a firm texture, and a meaty flavor. It goes well with spicy sauces and spices, like Dijon mustard. With sweet pineapple and mild veggies, you get a full flavor experience. Special tools 2 metal skewers, 8 inches long 8 ounces tuna, fresh, cut into 6 equal chunks 1 tablespoon Dijon mustard 4 mushrooms 4 squares red pepper, 1 inch each 4 slices zucchini, -inch thick 4 chunks fresh, peeled pineapple, 1 inch each 4 medium...
Emphatic Exercising
As evidenced in a survey article, the fortunate folks who have received medals from the Joslin Diabetes Center for having lived with diabetes on insulin for 50 years or more have several things in common see Chapter 17 for the full story . One is that they exercise more than most other people at their age. The authors conclude that exercise may be an important protective factor. You can say that again The T1DM patients in my practice with the lowest hemoglobin A1c, the least need for insulin,...
The Weiss Concept Management of Diabetes Based on Maternal Glucose Combined
Taking into account all these uncertainties, Weiss had already begun, in the eighties, to implement the first fetal-based strategy of GDM management to target women who would benefit from intensive treatment. Tight glucose control with intensified insulin therapy was limited to pregnancies with fetal hyperinsulinism diagnosed by determination of amniotic fluid insulin 21 , which reflects urinary excretion of fetal insulin 22 . On the basis of his data it was found that only about 20 of the...
Advances In Diabetic Foot Care
The diabetic foot has become a major area of interest, and insight has been gained into the reasons why diabetic feet go wrong and the ways in which patients can be helped. Of all the complications of diabetes, the diabetic foot is probably the easiest to prevent and treat. The groundswell of interest in the diabetic foot surged in the 1980s, and developments in foot care included the setting up of multidisciplinary diabetic foot clinics Fig. 6 and the pioneering educational work of Jean...
Type Diabetes Mellitus in Youth The Complete Picture to Date
Neslihan Gungor, MD, Tamara Hannon, MD, Ingrid Libman, MD, PhD, Fida Bacha, MD, Silva Arslanian, MD Division of Pediatric Endocrinology, Metabolism, and Diabetes Mellitus, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA Type 2 diabetes mellitus T2DM historically was considered a disease of adults, with autoimmune type 1 diabetes mellitus T1DM accounting for almost all cases of pediatric diabetes. T2DM was recognized as a disease of the pediatric age group by the...
Zucchini Basil Muffins 1
2 eggs 3 4 c. milk 2 3 c. oil 2 c. flour Sugar substitute to 1 4 c. sugar 1 tbsp. baking powder 2 c. shredded zucchini 2 tbsp. minced basil Beat eggs in bowl. Stir in milk and oil. Combine flour, sugar, baking powder and salt. Mix dry ingredients into egg mixture just until flour is moistened. Batter should not be completely smooth. Gently mix in zucchini and basil. Fill greased muffin caps about 3 4 full. Sprinkle with cheese. Bake at 425 degrees for 20-25 minutes. Remove from pan. makes 10-18...
Relationship Between Depression And Cognitive Impairment
Certain symptoms of cognitive impairment psychomotor retardation, loss of affect, concentration, and memory difficulties are frequent among persons with depression and other mood disorders, and prevalence of both cognitive impairment and depression increases significantly with age 73 . People with depression have been shown to perform worse on tests of cognitive performance and neuropsychological measures than non-depressed persons 73 . Similar to the relationship between diabetes and...
Insulin Therapy in Type Diabetes
Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A. Type 2 diabetes mellitus is defined by hyperglycemia, which is the result of an inability of the pancreas to make enough insulin for an individual's insulin resistance. Once this relative deficiency in insulin develops, the ability to produce insulin is no longer balanced with the insulin resistance and hepatic glucose production, thus the sugar...
ORAL AGENT CLASSES Sulfonylureas
Sulfonylureas are indicated when hyperglycemia cannot be controlled with exercise, diet, and therapeutic lifestyle changes. They bind to a specific receptor on the pancreatic P-cells that enhances the effect on glucose lowering resulting from a closure of the potassium-dependent adenosine triphosphate K-ATP channel. Glimepiride Amaryl binds to a different protein than the other sulfonylureas, but on the same site as the potassium channel. The subsequent reduction in plasma glucose results in...
Macrovascular Complications Protecting Your Heart
Macrovascular complications are the complications involving the large blood vessels of the body, particularly the coronary arteries in the heart. In this section, I discuss how diabetes can lead to damage to the heart by causing blockage of these arteries. Heart disease and heart attacks are the major macrovascular complications found in people with T1DM. How does heart disease lead to a heart attack Coronary artery disease CAD , which is also known as atherosclerotic heart disease, is the...
Diabetic tissue damage
In most people's minds diabetes is sugar trouble. Yet most of the problems of diabetes arise, not from the ups and downs of the glucose concentration but from its many tissue complications. Diabetes is a chronic multisystem disorder of which one manifestation is hyperglycaemia. The tissue complications of diabetes are preventable and while we still have much to learn about the causes of diabetic tissue damage, we can at least work on reducing the damage due to factors we have identified....
fibrinolysis and arterial mural proteolysis
Results of recent work have highlighted the potential role of plasminogen activators and PAI-1 in the evolution of macroangiography in two compartments, blood in the arterial lumen as described above and in the arterial wall itself 125 . Intramural plasminogen activators and PAI-1 influence proteolytic activity of matrix metalloproteinases MMPs that are activated from zymogens by plasmin. Cell surface plasmin-dependent proteolytic activation of MMPs promotes migration of SMCs and macrophages...
Predicting Preeclampsia
As the only current treatment for preeclampsia is delivery, a good screening test would be helpful to identify women at risk, diagnose them early, and to provide them with appropriate management that might lead to improved maternal and perinatal outcomes. Women with known risk factors should be assessed early in pregnancy by a physician who is experienced in the management of preeclampsia. Both human and animal data described earlier in Circulating Angiogenic Factors suggest that ang-iogenic...
Anemia and Diabetic Nephropathy
George Jerums, mbbs, md, fracp, Richard MacIsaac, phd, md, fracp, Sianna Panagiotopoulos, phd, and Merlin Thomas, mb, chb, phd Erythropoietin and the Anemia of Diabetic Nephropathy Anemia as a Progression Promoter in Diabetic Nephropathy Anemia and Extra-Renal Microvascular Disease Epidemiology of Anemia in Diabetes Community and Clinic-Based Studies Anemia, Cardiac Failure, and Cardiovascular Outcomes in Renal Disease The Potential Utility of Anemia Correction in Patients With Diabetes...
Dietary Approaches
The gold standard in the dietary treatment of obese patients with type 2 diabetes is a balanced moderately energy-restricted diet. The energy deficit is between 500 and 800 kcal day. The most important single measure is the reduction in fat intake, particularly in saturated fatty acids. It is generally recommended to prefer a high-carbohydrate low-fat diet. As shown TABLE 5 Obesity Prevention and Treatment Flowchart 18.5-24.9 Normal weight BMI 18.5-24.9 plus risk factors s and or comorbidity...
Rhuna Shen Susan E Wiegers and Ruchira Glaser
Department of Medicine, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A Cardiovascular disease is a leading cause of death in the diabetic population, accounting for close to 80 of the mortality in diabetic patients in North America 1,2 . Patients with diabetes mellitus have both a significantly higher risk for, and a higher mortality from, coronary artery disease CAD . The diabetic patient has a two-to four-fold increase in the...
Species of Plants Reported to Be Used Traditionally to Treat Diabetes
Lauraceae Lauraceae Lauraceae Lauraceae Lauraceae Cinnamomum tamala T. Nees amp Eberm. Cinnamomum zeylanicum Europe Blume Laurus nobilis L. Persea americana Mill. Persea gratissima Gaertn. Phoebe wightii Meisn. Piper cubeba Bojer Piper longum Blume Piper nigrum L. Part Used Comments about Activity Leaf, bark Cinnamaldehyde isolated from bark inhibits aldose reductase Lee, 2002 Bark Extracts decrease blood glucose in alloxan-treated rats Kar et al., 2003 Bark Antinociceptive in vivo Atta and...
Because I had gestational diabetes I might get diabetes when Im older
This is true. Gestational diabetes is a temporary form of insulin resistance that usually reveals itself about halfway through the pregnancy. This is when the hormones of pregnancy normally create extra insulin resistance. Most women are able to overcome this extra resistance to insulin. However, for women with gestational diabetes, either their pancreas is not able to make the additional insulin that is needed or their body's cells become less efficient at taking up glucose from the blood....
The Relevance Of The Problem
Nephropathy is a major cause of illness and death of patients with type 2 diabetes mellitus DM , the excess being confined to proteinuric patients due to complications of end-stage renal disease ESRD and particularly due to cardiovascular events 1 . Diabetic nephropathy is the single most common cause of ESRD in the United States and more than one third of all patients enrolled in the Medicare ESRD program are actually diabetics 2 . It derives that costs of renal replacement therapy for...
Pressure index
The pressure index is widely criticized because, when the arteries are calcified, it may be artificially raised. However, we feel that it is very relevant to the investigation of the diabetic foot as long as the potential difficulties of its interpretation are understood. If the pressure index is 0.5 then it is truly low, and indicates severe ischaemia whether the arteries are calcified or not. Indeed, if the artery is calcified the true pressure index may be even lower and even more urgent...
Carl Erik Mogensen
Hypoglycaemia may be an important complication in the treatment of type 1 diabetes. When intravenous glucose is available, glucagon has no place in the treatment and certainly also many patients may be treated with glucose or sweet foods given orally. However, if the patients are not conscious or acting negatively, glucagon used intramuscularly or subcu-taneously is important in a dose of 1-2 mg 1-3 . Glucagon acts by activating the enzymes in hepatic cells that increase glycogenolysis and...
Bibliography
Alberti KGGM. Preventing insulin dependent diabetes mel-litus. Promising strategies but formidable hurdles still to clear. Br Med J 1993 307 1435-6 Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part I diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998 15 539-53 American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care 2000 23 381-9 Diabetes care...
Tgfp Superfamily And Signal Transduction
The TGF-P family encodes several secreted factors that regulate a wide variety of cellular processes. The members include TGF-P 1-3, activins, inhibins, BMPs, and growth and differentiation factors GDFs 16,17 . These secreted proteins bind to type-I and type-II receptors expressed on the cell surface Fig. 1 . There are seven type I, also termed activin receptor-like kinases Alk , and five type-II receptors, with specific ligand-binding specificity 16 . The receptors contain intracellular...
Etiology
Over the past 30 years, the ability to predict the development of T1D has improved dramatically with the combined use of genetic, autoantibody, and metabolic markers. The most often cited model of the natural history of T1D suggests that genetically susceptible individuals with a fixed number of beta cells are exposed to a putative environmental trigger that induces beta cell autoimmunity 11 . The development of islet reactive autoantibodies is a marker of ongoing autoimmune disease, but it is...
w Essential Fatty Acids
w-3 fatty acids are a group of polyunsaturated fatty acids including a-linolenic acid, eicosapentaenoic acid EPA , and docosahexaenoic acid DHA that come from food sources or dietary supplements. Food sources include fish and fish oils including salmon, rainbow trout, mackerel, krill, anchovy, and sardines , flaxseed oil, berries such as lingonberry and black raspberry , walnuts, and wheat germ. However, w-3 sources that are not from fish require conversion in the body and are therefore not a...
Aldose Reductase And Diabetic Nephropathy
Aldose reductase is a key enzyme of the polyol pathway, involved in the metabolism of glucose and the NADPH-dependent reduction of a broad range of carbonyl compounds. In particular, the downstream accumulation of sorbitol and activation of the hexose kinase pathway have been implicated in the pathogenesis of a number of diabetic complications, including nephropathy.86,87 Recent studies have shown that polymorphisms in the aldose reductase gene may be associated with susceptibility to...
Diabetic Glomerulosclerosis
DN is the most common cause of progression of CKD to ESRD 1 , as well as morbidity and mortality in patients with DM. DN is characterized early by glomerular hemodynamic abnormalities that will eventually lead to glomerular hyperfiltration and then to glomerular structural changes see Fig. 2 5-8 . These changes progress to MAU and an eventual CKD and CVD if preventative measures are not taken. Renal morphological changes in the initial stages involve hyperfiltration that is evidenced by...
Contributors
Joseph P. Bast, md Department of Medicine, Loyola University Stritch School of Medicine, Chicago, IL Geoffrey Boner, mbbcii Department of Internal Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel and Danielle Alberti Memorial Centre for Diabetes Complications, Vascular Division, Wynn Domain, Baker Medical Research Institute, Melbourne, Australia Erwin Bottinger, md Division of Nephrology, Department of Medicine, Mount Sinai School of Medicine, Dorrace Hamilton...
PREDIABETES AND COGNITION Prediabetic Stages
The progression from normal glucose tolerance to type 2 diabetes is a gradual process which generally proceeds unnoticed. In most cases, the very first changes in insulin and glucose metabolism already occur years before type 2 diabetes is actually diagnosed. Essential to type 2 diabetes is the reduction of insulin sensitivity in the tissue, referred to as insulin resistance 35 see Chapter 2 . Insulin resistance results in a compensatory increase in insulin secretion of the pancreas and...
George Jerums mbbs md Sianna Panagiotopoulos phd and Richard MacIsaac phd md
Podocyte Ultrastructure in Type 1 Diabetes Podocyte Ultrastructure in Type 2 Diabetes Podocyte and Nephrin Expression in Experimental Diabetes Nephrin Expression in Human Diabetes Alterations of Podocyte Function in Diabetes Podocyte Density in Diabetic Nephropathy Interaction of Proteins and Other Plasma Factors With Podocytes and Tubules in Diabetic Nephropathy Summary References
Second Edition
Diabetes and Cardiovascular Disease, Second Edition, edited by Michael T. Johnstone, md, cm, frcp c and Aristidis Veves, md, dsc, 2005 Cardiovascular Disease in the Elderly, edited by Gary Gerstenblith, md, 2005 Platelet Function Assessment, Diagnosis, and Treatment, edited by Martin Quinn, mb bch bao, phd and Desmond Fitzgerald, md, frcpi, 2005 Angiogenesis and Direct Myocardial Revascularization, edited by Roger J. Laham, md and Donald S. Baim, md, 2005 Interventional Cardiology percutaneous...
Fluid and Electrolyte Losses
Fluid and electrolyte abnormalities are virtually universal in patients with DKA, and, if unrecognized or mismanaged, contribute significantly to the morbidity and mortality of DKA 1-6 . Fluid and electrolyte losses in DKA vary so that the extent of these losses is unpredictable in any given patient. However, estimates of losses that form the basis of the initial management of DKA have been formulated see Table 2 . It is emphasized that these recommendations are only guidelines, that each...
Fatty Acids As Insulin Secretagogues
Fatty acids trigger secretion of insulin in a glucose-dependent manner 3,44 . Fatty acids serve as an important endogenous fuel of islet tissue incubated with low glucose or in the absence of glucose. The possibility has been considered that a high level of fatty acids may inhibit the glucokinase glucose sensor because acyl-CoA, the first metabolite in fatty acid catabolism, is a very potent inhibitor of this enzyme 3 . However, this inhibition is competitive with glucose and is therefore...
Risk factors of youth type diabetes mellitus
The risk factors for youth T2DM are discussed under the following four broad categories 1 genetics, 2 environment, 3 ethnicity, and 4 insulin resistance phenotype. Genetics family history of type 2 diabetes mellitus The cause of T2DM is heterogeneous, including social, behavioral, and environmental risk factors in addition to a strong hereditary component 42,56 . Although few susceptibility genes have been identified thus far 57 , the genetic component of T2DM is evidenced by the strong...
Farhad Amiri Karim Benkirane and Ernesto L Schiffrin
MAPK Signaling in Vascular ERK1 and ERK2 Signaling, Effects of PPAR-y, and Vascular Remodeling 199 p38 Signaling in Vascular Role of JNK Signaling in Vascular PI3K Signaling Pathway and Vascular Role of Akt PKB Signaling Pathway in Vascular ROS and Vascular Vascular Inflammation and Dual PPAR In both hypertension and diabetes mellitus significant changes that occur in the vasculature affect both large and small arteries and lead to cardiovascular events such as myocardial infarction, stroke,...
Gluconeogenesis 1
Fructose 1,6 bisphosphatase Fructose 2,6 bisphosphate - 6 phosphfructo-2-kinase fructose-2,6-bisphosphatase Fructose2,6bisphosphat l glucagon insulin
PolyADPRibose Polymerase Regulates Gene Expression and Mononuclear Cell
Using pharmacological inhibitors of PARP, it has been demonstrated as briefly mentioned earlier that the activity of PARP is required for the expression of the MHC class II gene, DNA methyltransferase gene, protein kinase C PKC , collagenase, ICAM-1, and iNOS 10-14 . An oligonucleotide microarray analysis identified multiple genes that appear to be under the control of PARP-1 in resting cells 14 and even more genes are affected under conditions of immunostimulation 30 . A distinct mode of...
Bardetbiedl Syndrome
Bardet-Biedl syndrome BBS is an autosomal recessive condition characterized by rod-cone dystrophy atypical retinitis pigmentosa , postaxial polydactyly, central obesity, mental retardation, hypogonadism, and renal dysfunction. Other features, not always present, include hepatic fibrosis, diabetes mellitus, reproductive abnormalities, endocrinological disturbances, short stature, developmental delay, and speech deficits. BBS is distinguished from the much rarer Laurence-Moon syndrome, in which...
What if there is a vitreous hemorrhage but no obvious neo
Although knowing when to intervene earlier is important, it is also good to know when to hold off. Such a situation may occur when you are faced with a patient who has a vitreous hemorrhage but no evidence of neovascularization. The DRS showed that a vitreous hemorrhage alone is generally not an indication for PRP, but this is true only if you are certain there is no neovascularization. If there is a localized preretinal hemorrhage that blocks the view of a section of the retina, or a dense...
Glomerular filtration barrier charge and size selectivity
Techniques that explore charge and size selectivity of the glomerular filtration barrier in vivo rely on examining the differential clearance of circulating proteins of varying charges and sizes or of neutral molecules of differing sizes. The clearance of albumin Stokes-Einstein radius 36 A, isoelectric point 4-5 is compared to that of IgG radius 55 A, isoelectric point 4-10 as an index of size selectivity, while the clearance of the most anionic species of albumin glycated albumin or IgG IgG4...
How Obesity Causes Diabetes Not a Tall Tale
The epidemic of obesity-associated diabetes is a major crisis in modern societies, in which food is plentiful and exercise is optional. The biological basis of this problem has been explored from evolutionary and mechanistic perspectives. Evolutionary theories, focusing on the potential survival advantages of thrifty genes that are now maladaptive, are of great interest but are inherently speculative and difficult to prove. Mechanistic studies have revealed numerous fat-derived molecules and a...
Bentover rowing
To do bent-over rowing, follow these instructions and see Figure 9-5 1. Hold a dumbbell in each hand, arms hanging down, with your legs straight and back parallel to the floor. 2. Raise the dumbbells to your chest. 3. Lower the dumbbells back toward the floor. To do good mornings, follow these instructions and refer to Figure 9-6 1. Hold the ends of one dumbbell above your head, arms straight. 2. Lower the dumbbell forward as you bend forward so that your back is parallel to the floor. 3. Stand...
Recent Advances in Imaging of Insulinoma and pCell Hyperplasia
Current imaging techniques for the detection of insulinomas in patients with hyperin-sulinemic hypoglycemia include endosonography, which is considered the most sensitive imaging technique, followed by MRI or CT. Somatostatin receptor scintigraphy SRS is a valuable imaging technique in most neuroendocrine tumors of the gastrointestinal tract. In the case of benign insulinomas, however, its value is limited due to the fact that many insulinomas do not express the somatostatin receptor subtypes...
Hunt P. 1995 Dietary Counselling Theory Into Practice. J Inst Health Educ 33 4-8
1. Davidson C, Kowalska AZ, Nutman PN, Pearson GC. Dietitian-patient communication a critical appraisal and approach to training. Human Nutr Appl Nutr 1987 41A 381-389. 2. Vickery CE, Hodges PAM. Counselling strategies for dietary management expanded possibilities for effecting behaviour change. J Am Diet Assoc 1986 86 924-928. 3. Rollnick S. Behaviour change in practice targeting individuals. Int J Obes 1996 20 Suppl 1 S22-S26. 4. Coles C. Diabetes education theories of practice. Pract...
summary and conclusions
There are many differences between the sexes in the susceptibility and development of chronic metabolic diseases and CvDs. Fundamental differences between males and females primarily involve hormones, which define the secondary sex characteristics at puberty, regulate fertility, metabolism, and behavior, and play an important role in regulating many functions of different nonreproductive tissues. Changes in the androgen balance have been found to be associated with a series of chronic metabolic...
Intracavernosal Injection Therapy
Intracavernosal therapy requires some specialist knowledge and the ability to treat priapism should it occur. Many specialists used to regard this as the standard treatment and use it for both diagnostic and therapeutic reasons although its role as first-line therapy has been replaced by less invasive treatment modalities. Patients need to be taught how to perform self-injection and the dose needs to be chosen carefully to avoid prolonged erections or priapism. Some patients find it helpful to...
Management 1
Stage 2 feet require multidisciplinary care. The following components of multidisciplinary care are important at stage 2 Wound control and microbiological control are not needed as the feet have intact skin. To maintain mechanical control, deformity must be accommodated by footwear and callus, dry skin and fissures treated. Common non-diabetic foot problems, already described in stage 1, will also occur in stage 2 feet and need management as described in Chapter 2. Deformities in the...
Foot Problems in Diabetes
Jonathan E. Shaw, Andrew J.M. Boulton Department of Medicine, Manchester Royal Infirmary, Manchester, UK The diabetic foot can present with a variety of problems, but the most important clinically are ulceration, amputation and Charcot neuroarthropathy. These will be the focus of this chapter. Many diabetic complications have a great impact on the foot and it is therefore not surprising that diabetic foot problems account for more hospital inpatient days than any other diabetic problems....