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Screening for Gestational Diabetes MellitusThe American Diabetes Association recommends that pregnant women without known risk factors for diabetes get screened for gestational diabetes at 24 - 28 weeks of pregnancy. Type 2 DiabetesType 2 diabetes is the most common form of diabetes, accounting for 90 - 95% of cases. Gestational DiabetesGestational diabetes is a form of type 2 diabetes, usually temporary, that first appears during pregnancy. Nerve Disorders (Neuropathy)Diabetes reduces or distorts nerve function, causing a condition called neuropathy.
Retinopathy and Eye ComplicationsDiabetes accounts for thousands of new cases of blindness annually and is the leading cause of new cases of blindness in adults age 20 - 74.
The early and more common type of this disorder is called nonproliferative or background retinopathy. Mental Function and DementiaSome studies indicate that patients with type 2 diabetes, especially those who have severe instances of low blood sugar, face a higher than average risk of developing dementia. There have been a number of new developments in the treatment of type 2 diabetes, and a question often asked is whether some of the type 2 therapies might be beneficial for people with type 1 diabetes. The first thing to think about here is that there is nothing about having type 1 diabetes which inherently prevents one from having features of type 2.
Furthermore, many of the drugs used in treating type 2 diabetes work to lower the blood glucose level to some extent independent of insulin – and so we might wonder whether, regardless of the “type” of diabetes, they could have generally beneficial effect. Although GLP-1 itself cannot be given as a treatment because it is rapidly cleared from the circulation, there are long-acting forms of GLP-1, including exenatide (Byetta and Bydureon), liraglutide (Victoza), albiglutide (Tanzeum), and dulaglutide (Trulicity).
An even newer form of treatment is to give medicines which inhibit the kidneys’ reabsorption of glucose.
None of the “type 2” medicines will replace insulin for people with type 1 diabetes – and it would be very dangerous to try this, because of the risk of severely uncontrolled blood glucose if insulin levels fall too low. The Diabetes Media Foundation is a 501(c)(3) tax-exempt nonprofit media organization devoted to informing, educating, and generating community around living a healthy life with diabetes. Centers for Disease Control and Prevention’s (CDC) National Diabetes Fact Sheet, nearly 26 million American adults and children have diabetes. In type 2 diabetes, the body does not respond properly to insulin, a condition known as insulin resistance.
Diabetes can also cause problems with attention and memory.InfectionsRespiratory Infections.
Depression, in turn, may increase the risk for high blood sugar levels (hyperglycemia) and complications of diabetes.HypoglycemiaTight blood sugar (glucose) control increases the risk of low blood sugar (hypoglycemia). The earliest manifestation of kidney damage is microalbuminuria, in which tiny amounts of a protein called albumin are found in the urine. For example, several years ago, one of my patients with type 1 diabetes was having trouble with weight and with blood glucose control on a basal-bolus insulin combination.
If we think about it, the prevalence of type 2 is about one tenth among all adults, and about one quarter among those age 65 and older.
This is generally regarded as a basic treatment for type 2, and there have been a few studies of its use in type 1 diabetes going back a number of years. These medicines are increasingly being studied and used in type 2 diabetic people taking insulin, and in many studies are as effective as insulin itself. In a healthy adult, almost 200 grams of glucose go through the kidneys every day – and it all is reabsorbed.
After about four months, even though he was happy with having lost weight and with his level of control, he began to notice frequent hypoglycemic episodes, despite our reducing his insulin doses. And there is a counterargument, that there is no point taking an extra medication just to be able to use a bit less insulin. Bloomgarden is a clinician in private practice with an international reputation for writing and lecturing on diabetes, having authored more than 450 articles. About 79 million Americans aged 20 years and older have pre-diabetes, a condition that increases the risk for developing diabetes.Diabetes and CancerType 2 diabetes increases the risk for certain types of cancer, according to a consensus report from the American Diabetes Association and the American Cancer Society. New Drug WarningIn 2012, the Food and Drug Administration (FDA) warned that statin drugs, which are used to treat high cholesterol, may raise blood sugar levels and increase some people’s chances of developing type 2 diabetes. The disease process of type 2 diabetes involves:The first stage in type 2 diabetes is insulin resistance.
After delivery, blood sugar (glucose) levels generally return to normal, although some women develop type 2 diabetes within 15 years.Because glucose crosses the placenta, a pregnant woman with diabetes can pass high levels of blood glucose to the fetus. People with diabetes are also at higher risk for developing cataracts and certain types of glaucoma, such as primary-open angle glaucoma (POAG).
People with diabetes face a higher risk for influenza and its complications, including pneumonia. Microalbuminuria typically shows up in patients with type 2 diabetes who have high blood pressure.The American Diabetes Association recommends that people with diabetes receive an annual microalbuminuria urine test. Features of insulin resistance – what has been called “metabolic syndrome” – are even more common. In diabetes, with the higher blood glucose levels the transporter proteins that do this are even more active, so that more glucose can be reabsorbed. As many people with type 1 diabetes are able to produce some insulin, if we can make this work more effectively it seems likely that a person’s own insulin would have desirable effects in lowering glucose levels.
He is Clinical Professor at the Icahn School of Medicine at Mount Sinai, and is Editor of the Journal of Diabetes. That is because, in diabetes type 1, the immune systems destroy insulin-producing cells located in the pancreas. Although insulin can attach normally to receptors on liver and muscle cells, certain mechanisms prevent insulin from moving glucose (blood sugar) into these cells where it can be used. This can cause excessive fetal weight gain, which can cause delivery complications as well as increased risk of breathing problems. It is a common complication for nearly half of people who have lived with type 1 or type 2 diabetes for more than 25 years.
If these processes affect the central portion of the retina, swelling may occur, causing reduced or blurred vision.If the capillaries become blocked and blood flow is cut off, soft, "woolly" areas may develop in the retina's nerve layer. Everyone with diabetes should have annual influenza vaccinations and a vaccination against pneumococcal pneumonia.Urinary Tract Infections. Then we added exenatide (Byetta) before breakfast and dinner, and he started to get much better control, lost some weight, and felt much better.
In the liver and in skeletal muscle, metformin has actions similar to those of insulin, and it appears to work in the gastrointestinal tract as well to increase production of a hormone called glucagon-like peptide-1 (GLP-1). The new medicines block much of this activity, and people with type 2 diabetes taking canagliflozin (Invokana), dapagliflozin (Farxiga), empagliflozin (Jardiance), and others in development tend to lose weight (the increased urine glucose could account for a 200 calorie per day energy deficit) and have lower blood pressure, as well as having a substantial reduction in blood glucose levels. Insulin-producing cells in question are beta cells.In normal conditions, the immune system will attack and fortify the body from bacteria and viral substances or who infiltrate into the body. Certain medications used for treating type 2 diabetes may possibly increase the risk for some types of cancers. However, for most people with diabetes the benefits of statin drugs still outweigh the risks.
Most patients with type 2 diabetes produce variable, even normal or high, amounts of insulin.
Children born to women who have gestational diabetes have an increased risk of developing obesity and type 2 diabetes. The most serious consequences of neuropathy occur in the legs and feet and pose a risk for ulcers and, in unusually severe cases, amputation.
Women with diabetes face a significantly higher risk for urinary tract infections, which are likely to be more complicated and difficult to treat than in the general population.Hepatitis.
Hypoglycemia may also be caused by insufficient intake of food, or excess exercise or alcohol. In fact, the EURODIAB study, which followed more than 3000 people with type 1 diabetes, and the DCCT study of intensive control of more than 1000 people with type 1 diabetes, both found that features of type 2 diabetes and of metabolic syndrome such as weight gain, elevated triglycerides, and elevated blood pressure all track together. He has continued to maintain his lower weight and excellent control for the past five years. A reasonable approach will be to carefully do studies of all these medicines in people with type 1 diabetes – and to individualize, individualize, individualize.
However, in diabetes type 1, with no definite reason, the immune system attacks the pancreas and destroys the beta cells and causes inhibition of the production of the hormone insulin.Diabetes type 1 occurs when the body lacks insulin, so the glucose (blood sugar) rises above normal. In the beginning, this amount is usually enough to overcome such resistance.Over time, the pancreas becomes unable to produce enough insulin to overcome resistance. In addition to endangering the fetus, gestational diabetes can also cause serious health risks for the mother, such as preeclampsia, a condition that involves high blood pressure during pregnancy.CausesType 2 diabetes is caused by insulin resistance, in which the body does not properly use insulin. Peripheral neuropathy usually starts in the fingers and toes and moves up to the arms and legs (called a stocking-glove distribution). In this more severe condition, new abnormal blood vessels form and grow on the surface of the retina. Patients with diabetes are at increased risk for contracting the hepatitis B virus, which is transmitted through blood and other bodily fluids.
Usually the condition is manageable, but occasionally, it can be severe or even life threatening, particularly if the patient fails to recognize the symptoms, especially while continuing to take insulin or other hypoglycemic drugs.Mild hypoglycemia is common among people with type 2 diabetes, but severe episodes are rare, even among those taking insulin.
Insulin serves to absorb nutrients and sugars in the blood, and then circulate it to the various cells of the body to be used as an energy source.People with diabetes type 1 produce insulin only in very few or even none at all.


New Drug ApprovalsJuvisync is a two-in-one pill that combines the diabetes medication sitagliptin (Januvia) with the cholesterol drug simvastatin.Bydureon is a longer-lasting version of exenatide (Byetta) that requires injection only once a week.
In type 2 diabetes, the initial effect of this stage is usually an abnormal rise in blood sugar after a meal (called postprandial hyperglycemia).Eventually, the cycle of elevated glucose further damages beta cells, thereby drastically reducing insulin production and causing full-blown diabetes. Type 2 diabetes is thought to result from a combination of genetic factors along with lifestyle factors, such as obesity, poor diet, high alcohol intake, and being sedentary.Genetic mutations likely affect parts of the insulin gene and various other physiologic components involved in the regulation of blood sugar. Exposure to the virus can occur through sharing finger-stick devices or blood glucose monitors. Still, all patients who intensively control blood sugar (glucose) levels should be aware of warning symptoms.Hypoglycemia Symptoms. A doctor uses the results from a creatinine blood test to calculate the glomerular filtration rate (GFR). As a result, increasing blood glucose (hyperglycemia) and the body’s cells do not get enough energy intake.
Byetta is injected twice a day.Peginesatide (Omontys)  is a new erythropoiesis-stimulating drug approved specifically for patients with chronic kidney disease who are on dialysis. This is made evident by fasting hyperglycemia, in which glucose levels are high most of the time.Type 1 DiabetesIn type 1 diabetes, the pancreas does not produce insulin. Some rare types of diabetes are directly linked to genes.Diabetes Secondary to Other Conditions.
Major hemorrhage or retinal detachment can result, causing severe visual loss or blindness. Mild symptoms usually occur at moderately low and easily correctable levels of blood glucose. Conditions that damage or destroy the pancreas, such as pancreatitis (inflammation), pancreatic surgery, or certain industrial chemicals, can cause diabetes.
Patients with diabetes should be aware of other warning signs of a heart attack, including sudden fatigue, sweating, shortness of breath, nausea, and vomiting.Rapid heart ratesLightheadedness when standing up (orthostatic hypotension)Heart disease risk factors may increase the likelihood of developing neuropathy. The American Diabetes Association recommends that patients with type 2 diabetes get an initial comprehensive eye exam by an ophthalmologist or optometrist shortly after they are diagnosed with diabetes, and once a year thereafter. High levels of sugar in the blood will increase the frequency of urination in response to lowering blood sugar. Similar anemia drugs require more frequent injections.New Vaccination RecommendationThe CDC now recommends that adults ages 19 - 59 years diagnosed with diabetes should receive vaccination to prevent hepatitis B. Certain genetic and hormonal disorders are associated with or increase the risk of diabetes.High doses of statin drugs, which are used to lower cholesterol levels, may increase some people’s chances of developing type 2 diabetes. Lowering triglycerides, losing weight, reducing blood pressure, and quitting smoking may help prevent the onset of neuropathy.Foot Ulcers and AmputationsAbout 15% of patients with diabetes have serious foot problems. When blood sugar is out with urine, the body will lose a lot of water, causing dehydration.Losing weight. Some types of drugs can also cause temporary diabetes including corticosteroids, beta blockers, and phenytoin.Risk FactorsNearly 26 million American children and adults have diabetes. Ketones are byproducts of fat breakdown that build up in the blood and appear in the urine. In addition to a comprehensive eye exam, fundus photography may be used as a screening tool.
Unvaccinated patients with diabetes can become infected with hepatitis B through sharing fingerstick or blood glucose monitoring devices. Most amputations start with foot ulcers.Those most at risk are people with a long history of diabetes, and people with diabetes who are overweight or who smoke. Fundus photography uses a special type of camera to take images of the back of the eye.Screening for Neuropathy. Glucose is wasted with urine also contains many nutrients and calories needed the human body. In addition, 79 million American adults have pre-diabetes, a condition that increases the risk for developing diabetes. People who have the disease for more than 20 years and are insulin-dependent are at the highest risk. All patients should be screened for nerve damage (neuropathy), including a comprehensive foot exam.
Therefore, people with diabetes type 1 will also lose weight drastically.Damage to the body.
Type 2 diabetes used to mainly develop after the age of 40, but it is now increasing in younger people and children. Related conditions that put people at risk include peripheral neuropathy, peripheral artery disease, foot deformities, and a history of ulcers.Foot ulcers usually develop from infections, such as those resulting from blood vessel injury. Extreme stages of diabetic ketoacidosis can lead to coma and death.Until recently, DKA was a complication almost exclusively of type 1 diabetes.
Patients who lose sensation in their feet should have a foot exam every 3 - 6 months to check for ulcers or infections.Screening for Thyroid Abnormalities. Foot infections often develop from injuries, which can dramatically increase the risk for amputation.
Within 10 minutes after a meal, insulin rises to its peak level.Insulin enables glucose to enter cells in the body, particularly muscle and liver cells. However, in rare cases DKA can also occur in patients with type 2 diabetes, usually due to a serious infection or another severe illness.Hyperglycemic Hyperosmolar Nonketonic Syndrome (HHNS)Hyperglycemic hyperosmolar nonketonic syndrome (HHNS) is a serious complication of diabetes that involves a cycle of increasing blood sugar levels and dehydration, without ketones.
Patients should meet with a professional dietitian to plan an individualized diet within the general guidelines that takes into consideration their own health needs.Healthy eating habits along with good control of blood glucose are the basic goals, and several good dietary methods are available to meet them. Excess body fat appears to play a strong role in insulin resistance, but the way the fat is distributed is also significant.
Numbness from nerve damage, which is common in diabetes, compounds the danger since the patient may not be aware of injuries. General dietary guidelines for diabetes recommend:Carbohydrates should provide 45 - 65% of total daily calories. Weight concentrated around the abdomen and in the upper part of the body (apple-shaped) is associated with insulin resistance and diabetes, heart disease, high blood pressure, stroke, and unhealthy cholesterol levels. It is often triggered by a serious infection or another severe illness, or by medications that lower glucose tolerance or increase fluid loss (especially in people who are not drinking enough fluids).Symptoms of HHNS include high blood sugar levels, dry mouth, extreme thirst, dry skin, and high fever. The risk of developing diabetes type 1 be inherited through genetics.Also, several other supporting factors in the environment can lead to the development of this type of diabetes. Waist circumferences greater than 35 inches in women and 40 inches in men have been specifically associated with a greater risk for heart disease and diabetes.
Charcot foot or Charcot joint (medically referred to as neuropathic arthropathy) is a degenerative condition that affects the bones and joints in the feet. The syndrome consists of abdominal obesity, unhealthy cholesterol and triglyceride levels, high blood pressure, and insulin resistance.Polycystic Ovary Syndrome. Early changes appear similar to an infection, with the foot becoming swollen, red, and warm. In terms of sexual health, diabetes may cause decreased vaginal lubrication, which can lead to pain or discomfort during intercourse.Women with diabetes should also be aware that certain types of medication can affect their blood glucose levels. Patients at high risk for diabetes should try to get at least 14 grams of fiber in their diet each day. Polycystic ovary syndrome (PCOS) is a condition that affects about 6% of women and results in the ovarian production of high amounts of androgens (male hormones), particularly testosterone. Patients with diabetes should monitor their carbohydrate intake either through carbohydrate counting or meal planning exchange lists.Fats should provide 25 - 35% of daily calories. Women with PCOS are at higher risk for insulin resistance, and about half of PCOS patients also have diabetes.Depression. The bones may crack, splinter, and erode, and the joints may shift, change shape, and become unstable.
Long-term use (more than 2 years) of birth control pills may increase the risk of health complications. Severe clinical depression may modestly increase the risk for type 2 diabetes.Schizophrenia.
It typically develops in people who have neuropathy to the extent that they cannot feel sensation in the foot and are not aware of an existing injury. Thiazolidinedione drugs such as rosiglitazone (Avandia) and pioglitazone (Actos) can prompt renewed ovulation in premenstrual women who are not ovulating, and can weaken the effect of birth control pills.Diabetes and Pregnancy. This condition will cause minor scratches on the feet quickly turn into a serious injury and infection. While no definitive association has been established, research has suggested an increased background risk of diabetes among people with schizophrenia. Instead of resting an injured foot or seeking medical help, the patient often continues normal activity, causing further damage.
Both temporary diabetes that occurs during pregnancy (gestational diabetes) and pregnancy in a patient with existing diabetes can increase the risk for birth defects.
In severe cases, foot infection must be amputated in order to wound not continue to spread.Retinal damage.
In addition, many of the new generation of antipsychotic medications may elevate blood glucose levels. People with diabetes are prone to foot problems because the disease can cause damage to the blood vessels and nerves, which may result in decreased ability to sense trauma to the foot.


Studies indicate that high blood sugar levels (hyperglycemia) can affect the developing fetus during the critical first 6 weeks of organ development.
Limit trans-fats (hydrogenated fat found in snack foods, fried foods, commercially baked goods) to less than 1% of total calories.Protein should provide 12 - 20% of daily calories, although this may vary depending on a patient’s individual health requirements. Patients taking antipsychotic medications (such as clozapine, olanzapine, risperidone, aripiprazole, quetiapine fumarate, and ziprasidone) should receive a baseline blood glucose level test and be monitored for any increases during therapy.Gestational Diabetes Risk FactorsGestational diabetes is a type of diabetes that develops during the last trimester of pregnancy.
Therefore, it is important that women with pre-existing diabetes (both type 1 and type 2) who are planning on becoming pregnant strive to maintain good glucose control for 3 - 6 months before pregnancy. It is also important for women to closely monitor their blood sugar levels during pregnancy. Keeping glucose levels remain normal will reduces the risk of damage to the retina.Kidney damage. They should be screened for diabetes 6 - 12 weeks after giving birth and should be sure to have regular screenings at least every 3 years afterward.SymptomsType 2 diabetes usually begins gradually and progresses slowly. For women with type 2 diabetes who take insulin, pregnancy can affect their insulin dosing needs. Reducing sodium can lower blood pressure and decrease the risk of heart disease and heart failure.Weight ManagementBeing overweight is the number one risk factor for type 2 diabetes. Insulin dosing may also need to be adjusted during and following delivery.Diabetes and Menopause.
This risk will continue to increase over time, especially after suffering from diabetes for 15-25 years. The changes in estrogen and other hormonal levels that occur during perimenopause can cause major fluctuations in blood glucose levels. It can also help control or even stop progression of type 2 diabetes in people with the condition and reduce risk factors for heart disease. These complications can lead more serious conditions such as kidney failure or heart attack.
All lifestyle and medical efforts should be made to reduce the risk for these conditions.People with type 2 diabetes are also at risk for nerve damage (neuropathy) and abnormalities in both small and large blood vessels (vascular injuries) that occur as part of the diabetic disease process.
Women with diabetes also face an increased risk of premature menopause, which can lead to higher risk of heart disease.DiagnosisHealthy adults age 45 and older should get tested for diabetes every 3 years. Patients should lose weight if their body mass index (BMI) is 25 - 29 (overweight) or higher (obese).The American Diabetes Association recommends that patients aim for a small but consistent weight loss of ? - 1 pound per week. Share on: Twitter Facebook Google +Posts Related to Type 1 Diabetes Causes Symptoms Treatment4 Differences Between Diabetes Type 1 and Type 2Most people do not understand what the difference between diabetes type 1 and type 2.
Such abnormalities produce complications over time in many organs and structures in the body. Patients who have certain risk factors should ask their doctors about testing at an earlier age and more frequently. Most people think that diabetes is just one disease that occurs due to high sugar levels in the blood. Although these complications tend to be more serious in type 1 diabetes, they still are of concern in type 2 diabetes.Heart DiseaseThere is an association between high blood pressure (hypertension), unhealthy cholesterol levels, and diabetes.
ExerciseSedentary habits, especially watching TV, are associated with significantly higher risks for obesity and type 2 diabetes. People with diabetes are more likely than non-diabetics to have heart problems, and to die from heart complications.
People who have pre-diabetes have fasting blood glucose levels that are higher than normal, but not yet high enough to be classified as diabetes. Regular exercise, even of moderate intensity (such as brisk walking), improves insulin sensitivity and may play a role in preventing type 2 diabetes -- regardless of weight loss.Aerobic Exercise. This condition (prediabetes) almost always comes before a person has type 2 diabetes that more severe. Diabetes affects the heart in many ways:Both type 1 and 2 diabetes speed the progression of atherosclerosis (hardening of the arteries).
The heart-protective effects of aerobic exercise are also important, even if patients have no risk factors for heart disease other than diabetes itself.For improving blood sugar control, the American Diabetes Association recommends at least 150 minutes per week of moderate-intensity physical activity (50 - 70% of maximum heart rate) or at least 90 minutes per week of vigorous aerobic exercise (more than 70% of maximum heart rate). Exercise at least 3 days a week, and do not go more than 2 consecutive days without physical activity.Strength Training.
With this condition, the tiny filters in the kidney (called glomeruli) become damaged and leak protein into the urine. Strength training, which increases muscle and reduces fat, is also helpful for people with diabetes who are able to do this type of exercise.
Some doctors recommend it as a follow-up after FPG, if the latter test results are normal but the patient has symptoms or risk factors of diabetes. The American Diabetes Association recommends performing resistance exercise three times a week.
Urine tests showing microalbuminuria (small amounts of protein in the urine) are important markers for kidney damage.Diabetic nephropathy is the leading cause of end-stage renal disease (ESRD). Build up to three sets of 8 - 10 repetitions using weight that you cannot lift more than 8 - 10 times without developing fatigue. Be sure that your strength training targets all of the major muscle groups.Exercise Precautions. The following are precautions for all people with diabetes, both type 1 and type 2:Because people with diabetes are at higher than average risk for heart disease, they should always check with their doctors before undertaking vigorous exercise. For fastest results, regular moderate to high-intensity (not high-impact) exercises are best for people who are cleared by their doctors.
The results are given in percentages and indicate a person’s average blood glucose levels over the past 2 - 3 months.
For people who have been sedentary or have other medical problems, lower-intensity exercises are recommended.Strenuous strength training or high-impact exercise is not recommended for people with uncontrolled diabetes. 6.5% or higherA1C tests are also used to help patients with diabetes monitor how well they are keeping their blood glucose levels under control. For patients with diabetes, A1C is measured periodically every 2 - 3 months, or at least twice a year. Patients who use blood pressure medication should talk to their doctors about how to balance medications and exercise.
While fingerprick self-testing provides information on blood glucose for that day, the A1C test shows how well blood sugar has been controlled over the period of several months.
Patients with high blood pressure should also aim to breathe as normally as possible during exercise. Holding the breath can increase blood pressure, especially during strength training.Warning on Dietary SupplementsVarious fraudulent products are often sold on the Internet as “cures” or treatments for diabetes. Your doctor may adjust this goal depending on your individual health profile.The American Diabetes Association recommends that results from the A1C test be used as to calculate estimated Average Glucose (eAG).
The FDA warns patients with diabetes not to be duped by bogus and unproven remedies.TreatmentManagement of Pre-DiabetesTreatment of pre-diabetes is very important. Research shows that lifestyle and medical interventions can help prevent, or at least delay, the progression to diabetes, as well as lower their risk for heart disease.The most important lifestyle treatment for people with pre-diabetes is to lose weight through diet and regular exercise. Even a modest weight loss of 10 - 15 pounds can significantly reduce the risk of progressing to diabetes.Patients should have an exercise goal of 30 - 60 minutes, at least 5 days a week, and follow a low-fat, high-fiber diet. Quitting smoking is also essential.It is also important to have your doctor check your cholesterol and blood pressure levels on a regular basis. Pregnant women without known risk factors for diabetes should be screened for gestational diabetes at 24 - 28 weeks of pregnancy using the OGTT.
Your doctor should also check your fasting blood glucose and microalbuminuria levels every year, and your hemoglobin A1C and lipids every 6 months.In addition to lifestyle measures, the insulin-regulating drug metformin (Glucophage, generic) may be recommended for patients who may be at very high risk for developing diabetes. Pregnant women with risk factors for diabetes should be screened for type 2 diabetes at the first prenatal visit.Screening Tests for ComplicationsScreening for Heart Disease. All patients with diabetes should be tested for high blood pressure (hypertension) and unhealthy cholesterol and lipid levels and given an electrocardiogram. The electrocardiogram (ECG or EKG) is used extensively in the diagnosis of heart disease, from congenital heart disease in infants to myocardial infarction and myocarditis in adults. Daily aspirin is not recommended for patients with diabetes who are younger than these ages and who do not have cardiovascular risk factors. Treating children with type 2 diabetes depends on the severity of the condition at diagnosis. Formerly, only insulin was approved for treating children with diabetes.The American Diabetes Association does not recommend tight blood glucose control for children because glucose is necessary for brain development. Elderly people should not generally be placed on tight control as low blood sugar can increase the risk of stroke or heart attack.Treatment of ComplicationsHigh Blood Pressure and Heart DiseaseAll patients with diabetes and high blood pressure should make lifestyle changes.
These include losing weight (when needed), following the Dietary Approaches to Stop Hypertension (DASH) diet, quitting smoking, limiting alcohol, and limiting salt to no more than 1,500 mg of sodium per day.Reducing Blood Pressure. However, patients with diabetes and high blood pressure need an individualized approach to drug treatment, based on their particular health profile. The most beneficial fall into the following categories:Diuretics rid the body of extra sodium (salt) and water.



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