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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. Long-term complications of diabetes occur after years of having diabetes and sometimes people don't even have any noticeable symptoms. Diabetics have to be cautious of symptoms that gradually arise, no matter how vague, as it may be the first indication of a complication. The blood glucose levels need to be regulated all the time to ensure that there is an adequate supply of glucose for all cells.
This glucose regulation involves a combination of mechanisms, the most important of which is the action of the hormones insulin and glucagon. Diabetic foot is a broad term for many of the diabetes-related complications that affect the feet.
Change in the color of the legs – paleness, bluish tinge, dark red to purple and black patches. Therefore understanding the nature of the blood vessel and nerve damage in diabetes is necessary to understand why leg pain may be occurring. The damage to nerves due to the high blood glucose levels (diabetic neuropathy) has a host of effects. Please note that any information or feedback on this website is not intended to replace a consultation with a health care professional and will not constitute a medical diagnosis. Most people know that people with Diabetes are prone to foot and leg problems, such as Peripheral Artery Disease (PAD) and Peripheral Neuropathy. There are two overarching causes of diabetes mellitus simply called type 1 and type 2. What type of diabetes do I have?Insulin is a hormone which allows sugar to move from the blood into tissues to be used as energy.
The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. We serve the Houston Katy metro area and West University, River Oaks, Bellaire, Heights, Memorial, Jersey Village, Beaumont, Galveston, Clearlake, Midtown, Uptown, Sugarland, Pearland, Katy, Sugar Land, Conroe, and Kingwood, San Antonio, Austin, Louisiana, Oklahoma, Lufkin, Dallas, Missouri City, Lake Charles, Woodlands, Spring, Willis, Atascocita, El Campo, Richmond, Harwin, Fort Bend County, Montogmery, Huntsville, Bear Creek, Pasadena, Baytown, Clear Creek, League City, Webster, Stafford, Sagemont, Bridgeland, Cypress, La Porte, Ft.
Diabetes mellitus (DM) is specifically a group of metabolic disorders which is characterized by high blood sugar level for long period of time.It is one of the most commonly occurring disease around the world. Symptoms of type 1 and type 2 diabetes include high blood sugar level, frequent urination with urgency, ketoacidosis, increased thirst. New medications for diabetes treatment include invokana, jardiance, farxiga, Victoza, Bydureon, Tradjenta and Onglyza.All of them have different mechanism, side effects and dosage. Most common side effects of invokana are bladder pain, bloody or cloudy urine, burning, itching in vagina, nausea, vomiting and loss of appetite. Jardiance is available in tablet forms and price of each tablet is approximately $14-$14.50.
Farxiga causes heavy glycosuria (sometimes up to about 70 grams per day) which may increase in weight loss and tiredness.Other side effects include fever, chills, breathing problem, itching and pain. Arslan Malik is noted health blogger, public health activist, aspiring dreamer and avid reader.
Mouse insulinoma MIN6 cells stained with a fluorescent insulin antibody, revealing the polarized secretory macherinery of pancreatic beta cells.
Diagram of a feed-forward transcriptional network in pancreatic beta cells in which Pdx-1 controls the expression of the insulin gene as well as the expression of transcription factors.
A proposed multi-component loop in which Pdx-1 activates the expression of the transcription factor Pax6, and vice versa.
A diagram showing a gene regulatory network involving transcription factors and microRNA that functions to control pancreatic beta cell development and insulin release. 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 legs are one of the parts of the body that are commonly afflicted with diabetic complications and pain is sometimes the first symptom.
Insufficient glucose means that cells cannot produce the energy needed for life-sustaining processes. Insulin lowers the glucose levels when it rises too high and glucagon increases it when the levels drop too low.
It is also important to remember that diabetes can affect a host of other organs and systems in the body which may contribute to leg pain, like weakening of the immune system which increases the risk of infections.
Instead the leg pain may occur for the same reasons as it would occur in any other person, whether they are a diabetic or not. According to a survey which was recently conducted, approximately 382 million people have diabetes in which 90% cases belong to type 2 diabetes. You health care provider may have better idea which one is better for you depending upon your health condition and severity. According to clinical studies 100 mg once a day is recommended but dose may increased depending upon the tolerance. Empagliflozin also belongs to gliflozin class. Jardiance mechanism of action is almost like invokana with pharmacokinetic differences. With doctor in pharmacy, he has worked closely with various health organizations, multinational pharmaceuticals and community health programs.
The presentations have been transcribed and the transcriptions with PowerPoints are available online. 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. It is important to remember that if you develop complications of diabetes, early diagnosis and treatment is important to prevent the complications from getting worse. It is therefore important to understand why leg pain occurs in diabetics and how to differentiate pain due to a diabetic complication from leg pain that may also affect non-diabetics. High blood glucose levels can be detrimental since it can damage cells, nerves and blood vessels. With diabetes, the pancreas either cannot produce insulin or the cells in the body do not respond to insulin. The blood vessels and nerves in particular are easily damaged by high blood glucose levels. Muscle strain, injury and overuse are some of the reasons for leg pain that does not depend on diabetes.
Here there is narrowing of the arteries that carry oxygen and nutrient rich blood to the legs.
It affects regulation of blood flow through the legs which may already be complicated with peripheral arterial disease. This involves a combination of dietary and lifestyle measure as well as anti-diabetic medication and insulin if necessary. Any therapy should be directed at the underlying causes – restricted blood flow and nerve damage caused by elevated blood glucose levels. What causes both Type 1 and Type 2 Diabetes to damage the blood vessels and nerves in the feet? However, new medications for diabetes treatment are far more better than previously used anti-diabetes drugs.
Beside his professional practice, he has an avid interest in writing and teaching Physiology and Medicines. Characterization of pancreatic transcription factor Pdx-1 binding sites using promoter microarray and serial analysis of chromatin occupancy.
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. Therefore it is important that the body maintains the blood glucose levels within a narrow range. However, there can also be other leg symptoms which may or may not be related to the pain.  These symptoms can affect only one leg or may affect both legs. These effects are more pronounced in long term diabetes, especially in cases where the diabetes has been poorly managed. Along with the nerve damage discussed below, there is a greater risk of injuries and infections with poor wound healing and impaired immune response. Thirdly, the irritation of the nerves due to diabetes can also lead to neuralgia (nerve pain) even when there is peripheral arterial disease, ulcers or infections. Lifestyle changes, exercises and other therapies may also be helpful to restore blood flow to the area and control blood glucose levels which can ultimately reduce the pain. Long-term complications include retinopathy, kidney failure, cardiovascular diseases, leg ulcers, impaired wound healing, muscular weakness etc. Dapagliflozin inhibits sub-type 2 of the sodium-glucose transport proteins (SGLT2) which are responsible for at least 90% of the glucose re-absorption in the kidney. He covers variety of topics from Nutrition and Natural Care to Diseases, Treatments, Drug Interactions, Preventive Care and Clinical Research.
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.
Eventually some of the symptoms mentioned above, including leg pain, arises only when the legs are exerted like when running or climbing stairs. Infections may set in and become extensive without a person experiencing the early signs and symptoms like pain when medical treatment would be the most effective. The FDA approved dapagliflozin on January 8, 2014 for glycemic control, along with diet and exercise, in adults with type 2 diabetes.
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 is a hormone that allows sugar to be moved out of the blood into tissues where is used as energy. 5.
Two offices, located in the Texas Medical Center and in Katy at the Methodist West Houston Professional building. 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.
Glucose levels in the blood should balance out because insulin has done its jobDiabetes is a disease characterized by the build-up of sugar in the blood.
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. In people without diabetes, sugar (or glucose) is able to move out of the blood and into the cells of the body where it can then be used for energy.
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.
This is made possible by a hormone called insulin which acts as a "key" allowing glucose into the cells to be used as energy. 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. 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. In both cases, glucose is “locked out” of the cells and therefore remains in the blood causing high blood sugar (hyperglycemia). The explanation behind this initial high blood sugar is what determines whether a patient is diagnosed with type 1 diabetes or type 2.
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. 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. 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. 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.
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. 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. 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. 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. 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. 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. 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. 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. 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.
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.
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. Such abnormalities produce complications over time in many organs and structures in the body.
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. People with diabetes are more likely than non-diabetics to have heart problems, and to die from heart complications. Diabetes affects the heart in many ways:Both type 1 and 2 diabetes speed the progression of atherosclerosis (hardening of the arteries).
With this condition, the tiny filters in the kidney (called glomeruli) become damaged and leak protein into the urine. 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).

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