Type 2 diabetes is a complex disorder which is due to two main causes; insulin resistance and insulin deficiency.
Macrovascular disease can therefore lead to heart disease, stroke, or peripheral vascular disease. Does controlling your blood glucose levels reduce your risk of developing heart disease, peripheral vascular disease, or stroke i.e. The largest and longest study done looking at the relationship between glucose levels and complications in type 2 diabetes is called the UKPDS (United Kingdom Prospective Study).
The excess glucose in your blood stream will stick to the protein in your red blood cell, namely the haemoglobin. This “sweetened red blood cell” is called your haemoglobin A1c, glycated haemoglobin, or HbA1c.
The chart below shows how the HbA1c indicates what your average glucose has been over the last 2 to 3 months (National Glycohaemoglobin Standardization Program, 2010). In 1995, a group of researchers started to follow up 505 adults living with T2 diabetes for a period of 14 years.
We can see that there has been much research done with regard to preventing or reducing the risk of macrovascular disease and its complications in diabetes. American Diabetes Association (2012) ‘Standard of Medical care in Diabetes – 2012’, Diabetes Care, 35(1), pp. ACCORD Study Group (2008) ‘Effects of intensive glucose lowering in type 2 diabetes’,New England Journal of Medicine358, pp. Abdominal and pelvic CT scan showing duodenal compression (black arrow) by the abdominal aorta and the superior mesenteric artery. Superior mesenteric artery (SMA) syndrome is a rare, life-threatening gastrointestinal disorder characterized by a compression of the third portion of the duodenum by the abdominal aorta and the overlying superior mesenteric artery. SMA syndrome was first described in 1842 by Carl Freiherr von Rokitansky, currently estimated to impact only 0.013% of the American population. It is a distinct disease from Nutcracker syndrome, which is the entrapment of the left renal vein between the abdominal aorta and the SMA. SMA syndrome can be triggered by any condition involving the dramatic reduction of the mesenteric angle.
In mild or acute cases, conservative treatment should be attempted first, involving the reversal or removal of the precipitating factor with proper nutrition and replacement of fluid and electrolytes either by surgically-inserted jejunal feeding tube, nasogastric intubation, or peripherally inserted central catheter (PICC line) administering total parenteral nutrition (TPN).
Como padre, usted sabe que la vida esta llena de escenarios causa-efecto: Si no trabaja, no puede pagar las cuentas.
Pero cuando se trata de la salud de sus hijos, existen algunas consecuencias a largo plazo que quizas ni siquiera sepa que tiene que enfrentar. Fue descrito en 1988 y se le adjudico tal nombren porque muchas personas sufrieron infarto al corazon y presentaron problemas cardiovasculares sin que estuvieran alterados sus niveles de colesterol y la presion arterial.
Anos despues se establecio que son dos los pilares de este sindrome: la obesidad y la resistencia a la insulina. This journal is a member of and subscribes to the principles of the Committee on Publication Ethics. Glycated hemoglobin is a substance in red blood cells that is formed when blood sugar (glucose) attaches to hemoglobin. How the Test is Performed Blood is drawn from a vein, usually from the inside of the elbow or the back of the hand.
Insulin is secreted by your pancreas and controls your blood glucose (sugar) levels by allowing it to move from your bloodstream into your cells where it is used for energy. The aim of treating diabetes is to bring your blood glucose levels down to as close to normal as possible to prevent problems with your health. Long term complications may be either microvascular complications which involve the smallest blood vessels in your body or macrovascular complications which involve the large blood vessels in the body that supply blood to your heart, brain, and feet.
This study showed that for every 1% reduction in your HbA1c, your risk of complications is reduced significantly. There was another study done, called the ACCORD Study (Action to Control Cardiovascular Risk in Diabetes, 2008), which set out to do just that.
This will give you an indication of what your blood glucose average has been over the last 2 to 3 months. Once glucose sticks to haemoglobin it remains stuck there for the life of the red blood cell which has a life span of approximately 3 months. Below are the blood glucose levels that are recommended by the American Diabetes Association (2012). It has been proven that controlling your blood glucose as best as you can, will benefit you in the years to come. The syndrome is typically caused by a decreased angle of 6°–25° between the aorta and the SMA (compared to a normal range of 38°-56°) due to a lack of retroperitoneal fat. A Hayes maneuver (pressure applied below the umbilicus in cephalad and dorsal direction) elevates the root of the SMA, also easing the constriction. Patients predominantly have a history of chronic abdominal complaints, with intermittent exacerbations depending on the cause and grade of duodenal compression.


Diagnosis may follow X-ray examination revealing duodenal dilation followed by abrupt constriction proximal to the overlying superior mesenteric artery, as well as a delay in transit of four to six hours through the gastroduodenal region. Symptoms typically improve after restoration of weight.[8] If conservative treatment fails, or if the case is severe or chronic, surgical intervention is required. Si ignora ese ruido que hace el automovil, podria terminar al costado de la ruta con problemas en el motor.
Si bien existe una predisposicion genetica es el estilo de vida lo que mas determina que se desarrolle este sindrome en especial la obesidad El sindrome metabolico describe un grupo de factores de riesgo que encamina a los ninos hacia enfermedades cardiacas y diabetes tipo 2. Despues de todo, la presion arterial alta y colesterol elevado son cosas de las cuales generalmente se quejan las personas mayores. Gracias al aumento de la epidemia de obesidad en los jovenes, los ninos y adolescentes estan sufriendo estas afecciones (y las estan sufriendo mas temprano que nunca). In type 2 diabetes your cells do not recognize this insulin so the movement of glucose between your bloodstream and cells is affected. This can be achieved through healthy eating, exercise and medication which may be in the form of tablets, insulin or a combination of both. For example, your risk of a heart attack is reduced by 14% and your risk of leg amputation by 37%.
The HbA1c (see explanation below of HbA1c or glycated haemolglobin) target was to get it under 6%! The blood glucose readings, especially those first thing in the morning (fasting) and 2 hours after a meal (postprandial) help to see whether your medication is at the right dose. During this period the researchers tried to see if blood glucose sugar levels that are measured 2 hours after a meal play a role in predicting macrovascular complications.
ADVANCE Collaborative Group (2008) ‘Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes’.
Suggested exams include abdominal and pelvic Computed Tomography (CT) scan and upper gastrointestinal series (UGI). The first operation for SMA syndrome, duodenojejunostomy, was proposed in 1907 by Bloodgood.[5] This open surgery involves the creation of an alternate route between the duodenum and the jejunum,[9] bypassing the compression caused by the abdominal aorta and the superior mesenteric artery. Algunos calculos indican que casi 1 de 10 adolescentes (y mas de un tercio de los adolescentes obesos) sufren sindrome metabolico. The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood. Next, the health care provider gently inserts a needle into the vein.
Patients in this study were monitored for a further 10 years and it was found that although they did not follow such strict advice after the study ended, the benefits were still noticeable years later. However the end results showed that getting your HbA1C too low predisposes a person to getting too many hypoglycaemic episodes i.e. It seems that the most useful measurement to predict heart disease is to check blood sugar levels 2 hours after a meal along with the your bi-annual HbA1c.
Ellos tienden a vivir en el presente y no piensan demasiado en las consecuencias a largo plazo.
Y en un estudio realizado en 375 alumnos de segundo y tercer grado, se descubrio que 5% padecia sindrome metabolico y 45% sufria uno o dos factores de riesgo de este. It is important to emphasize that the following diagnostic algorithm and discussion refers specifically to pain fulfilling all the above-mentioned characteristics for biliary-like pain, and especially if one or more of the additional features of the pain outlined below are present. This benefit is felt to be due to ongoing benefits from early good glucose control and is called “metabolic memory’” or “The Legacy Effect”. Por lo general, esto resulta bien porque usted esta alli para brindar apoyo y, si es necesario, proteccion. En nuestro continente, uno de cada 5 personas lo posee y a fines de esta decada puede subir a uno de cada cuatro Esto es algo que los padres deben saber, especialmente porque pueden tomar medidas para disminuir las posibilidades de que sus hijos padezcan el sindrome metabolico o los factores de riesgo que lo producen. This underlines the importance of discussing your glucose level targets with your diabetes health care provider. Vascular imaging studies of the abdomen, including computed tomography and contrast angiography, are often normal. Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding. In infants or young children, a sharp tool called a lancet may be used to puncture the skin and make it bleed. In the case of spinal cord injury, impaired abdominal sensation due to nerve damage makes the clinical picture even more obscure.
Abdominal pain consistently relieved by defecation or the passage of flatus, in the absence of alarm features, suggests a functional bowel disorder (1).
The blood collects into a small glass tube called a pipette, or onto a slide or test strip. Alarm features include unintentional weight loss, lymphadenopathy, abdominal mass, bleeding, and evidence of anemia.3. Afterward, there may be some throbbing. Why the Test is Performed Your doctor may order this test if you have diabetes.
Upper gastrointestinal (GI) endoscopy is the primary tool for diagnosing mucosal disease of the esophagus, stomach, and duodenum.


It is also usually undertaken for completeness even when the pain is not relieved by acid suppression, but ultrasound (US) scanning should take precedence. However, you and your health care provider must decide what is a normal HbA1c level for you. Normal ranges may vary slightly among different laboratories.
Talk to your doctor about the meaning of your specific test results. What Abnormal Results Mean Abnormal results mean that your blood glucose levels have been above normal over a period of weeks to months. Abdominal US scan and relevant blood tests should be performed initially when gallbladder disease is suspected. If your HbA1c is above 7%, it means that your diabetes control may not be as good as it should be. High values mean you are at greater risk of diabetes complications. If you can bring your level down, you decrease your chances of long-term complications. Ask your doctor how often you should have your HbA1c tested. Usually, doctors recommend testing every 3 or 6 months. Risks Veins and arteries vary in size from one patient to another and from one side of the body to the other.
In many circumstances, abdominal computed tomography (CT) scanning will be chosen to provide a broader survey for abdominal pathology.
Good-quality CT scans can detect most cases of active and chronic pancreatitis and pancreatic tumors, as well as intra- and retro-peritoneal masses. Endoscopic US (EUS) is the most sensitive test for small gallstones, bile duct stones, and pancreatic disease, but it is not universally available, is operator dependent, and is also somewhat invasive.
Magnetic resonance (MR) scanning with MR cholangiopancreatography (MRCP) provides good images of the abdominal organs, and both biliary and pancreatic ductal systems (especially with secretin infusion). It has provided an excellent risk-free alternative to ERCP, which should be reserved for treatment of conditions detected by noninvasive means. The extent to which these scans are used in a particular case should depend on the clinician's level of suspicion for different sources of the pain.
For instance, a broader search may be appropriate in a patient aged 65 years (especially someone who is losing weight) than would be reasonable in a fit 30-year-old patient. Gallbladder bile can be sampled for cholesterol crystals with duodenal aspiration after cholecystokinin (CCK) stimulation. However, this test is cumbersome, requires small bowel intubation, is not well standardized, and has been largely superseded by EUS.13. Dynamic DISIDA gallbladder scanning (with CCK provocation) can be used to assess gallbladder dysfunction, and is appropriate when suspicion is high and scans are negative.
However, this test is not standardized and may be conducted differently in different institutions.
Moreover, low ejection fraction can occur in other conditions (such as diabetes, obesity, celiac disease, and with certain medications, such as narcotic and anticholinergic agents); therefore, the result must be interpreted in context, and with caution. Reproduction of pain on injection of CCK has been considered to indicate a gallbladder disorder, but this is not a good predictor of a good surgical outcome. Patients with comprehensive negative investigations, including DISIDA scanning, should be reassessed carefully, especially for other functional GI disorders. In a few cases, cholecystectomy can still be considered, if the pain is typical and disabling, and especially if there are other pointers, such as a strong family history of gallbladder disease, or transient disturbances of liver enzymes. In this context, the diagnosis of functional gallbladder disorder is suggested by abnormal isotope scanning of the gallbladder.
Supportive criteria are associated nausea and vomiting, pain radiating to the back and/or subscapular region, and pain awakening the patient from sleep. However, it is important to note that an abnormal test does not exclude another overlapping functional GI disorder as being the cause of the patient's symptoms.
For this reason, it is appropriate to give a therapeutic trial of medication and to only consider further more invasive treatments on a case-by-case basis. Thus, if not previously undertaken, an adequate therapeutic trial with an antispasmodic agent, a psychotropic agent, or other appropriate agents should be undertaken before consideration of cholecystectomy. As indicated above, however, clinical studies evaluating the role of cholecystectomy in symptomatic patients without gallstones but with positive dynamic biliary imaging have provided variable results. One systematic review and meta-analysis found that patients with suspected functional biliary pain with decreased gallbladder ejection fraction did not have a better symptomatic outcome after cholecystectomy than those with normal ejection fraction (7). A recent systematic review, however, addressed a different question, concluding that patients with biliary-like pain without gallstones but with a decreased gallbladder ejection fraction are more likely to experience symptom relief after cholecystectomy than those treated medically (8). It is clear that further prospective randomized clinical studies are required to determine definitively the role of dynamic isotope biliary scanning in the investigation and management of acalculous biliary-like pain.18.
The diagnosis of a functional gallbladder disorder is confirmed by the relief of pain after cholecystectomy, for a period longer than 12 months.18,19.



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