Diabetes mellitus urine onderzoek,type 2 diabetes not responding to insulin,remedies for reducing sugar intake - PDF Review

A doenca e um conjunto de problemas em comum e pode acontecer por diversas situacoes, como a diabetes tipo I, tipo II, diabetes gestacional e diabetes associadas com outras doencas, como pancreatite alcoolica.
Na diabetes tipo I o pancreas nao produz insulina e acontece geralmente na infancia e adolescencia. Os pacientes que sofrem de diabetes tipo II, atinge pessoas apos os 40 anos de idade e nesse caso, as celulas sao resistentes com as aplicacoes de insulina. A diabetes gestacional, assim como diz o nome, acontece na gravidez e acontece por conta do aumento de peso exagerado das maes. Independente do tipo de diabete, a consequencia e uma so: a doenca consiste no aumento de acucar no sangue e deve ser tratado assim que diagnosticado, pois a patologia pode desencadear outras doencas. Se o paciente nao tratar com cuidado da diabetes, pode ter complicacoes como a diminuicao da circulacao do sangue, e com isso o paciente pode sofrer ataques cardiacos, perda da visao e tambem alguns problemas na pele, como feridas e ulceras. Ja na diabetes tipo II sao diversos os motivos que podem causar a doenca, mas destaca-se a acao da insulina e obesidade. Aos demais casos, lesao no pancreas e agressao ao organismo com o uso de alcool, drogas e medicamentos e alimentacao incorreta sao as causas da doenca. Os principais sintomas da doenca sao a fome exagerada, a visao do paciente passa por dificuldades, o sono pode acompanhar o paciente durante todo o dia, mesmo se a pessoa tiver uma noite de sono perfeita. Alguns pacientes apresentam aumento na quantidade da urina, nauseas e o paciente fica mais vulneravel e ter infeccoes, seja de qual tipo for.
E importante considerar todos os sintomas relatados pelo paciente, alem de exames laboratoriais, que e realizado por meio da glicemia no soro, que acontece apos o paciente ficar em jejum por ate doze horas.
Alguns pacientes devem realizar diariamente aplicacoes de insulina, que ajuda no controle do diabetes.
O paciente deve monitorar os niveis da glicose no sangue, realizando periodicamente teste da glicose no sangue. Alimentacao saudavel com a pratica de exercicio fisico regular sao bons aliados na prevencao da doenca. E importante estar atendo ao peso ideal, que varia de acordo com sexo e altura de casa pessoa, alem da idade.
Para gestantes, os cuidados comecam no pre-natal e na alimentacao saudavel em quantidade adequada, pois muitas gravidas aproveitam da qualidade de gestante para abusar na alimentacao, com isso, ganhe-se peso excessivo e prejudica a saude. Pessoas que sao fumantes tambem correm mais risco de desenvolver a doenca, por isso, manter-se longe do tabagismo e outra forma de prevenir a doenca. O controle de uma alimentacao saudavel nao significa o paciente abolir doces e acucar da alimentacao, basta apenas ter controle de tudo que se come e na quantidade em que se ingere. Exames regulares e o controle de hipertensao tambem sao aliados para uma diagnostico precoce. Auto-suggest helps you quickly narrow down your search results by suggesting possible matches as you type.
It turns out that the A1C, fasting plasma glucose, and the oral glucose tolerance test each catch slightly different groups of people, but any one of them is sufficient for diagnosis, regardless of what the others may indicate.
The discovery of insulin in 1921 was one the great achievements of 20th century medicine, it became available for clinical use 2 years later2. Since the advent of insulin and intravenous fluid replacement therapy, the morbidity and mortality from coma in patients with diabetes mellitus (DM) has been significantly reduced .
Further action should be taken after assessing the patient in the context of the table given below4,5. An additional new category Impaired Fasting Glycaemia( IFG) has been added, although its range is quite narrow it does highlight that some subjects have non-diabetic fasting values which are above the absolutely normal so they may need to be monitored, but the full significance of this group needs further evaluation.
If subsequently the patient falls into the Impaired The patient should have been on a normal diet for at least the last three days.
In these patients a blood glucose series over a 24hr period during a normal day gives the most information.
Alternatively, it can be performed when the patient is in hospital but reasonablely active. In these subjects the fasting blood glucose fairly accurately represents the mean blood glucose concentration for theprevious 24 hrs. 1.    Clinitest tablets- containing Benedict’s reagent (detect not only glucose but all reducing agents - false positive. Despite increasing understanding of the pathogenesis and therapy of diabetes mellitus, the most important question concerning the relationship between the degree of metabolic control and the occurrence of long -term complications of diabetes was hampered by lack of satisfactory methods. Since the advent of glycosylated haemoglobin the monitoring of metabolic control has been considerably aided 8-10.
These minor haemoglobins exhibit a faster chromatographic separation than the main band of haemoglobin A and are collectively referred to as "fast haemoglobin” or HbAI or “glycosylated haemoglobin”. HbA1c is a term reserved for the HbA, which has a glucose molecule, attached to the N-terminus by a ketamine linkage (glycosylation). Studies indicate that HbA1c is formed slowly and continuously throughout the life span of the erythrocyte furthermore it is formed non-enzymatically and essentially irreversibly. 1.   A single determination can substitute for several glucose determinations made at different time intervals.
2.   It does not vary immediately after meals or exercise thus samples can be taken at any time during the day.
3.   Serial determinations may be used to evaluate the relationship of blood glucose control in diabetes with the development of complications. 4.   Useful in confirming home glucose monitoring particularly in children, where compliance may be poor. 1.   As HbAl levels in the blood depends on red cell turnover, values are reduced in the following onditions11,12. 2.   Erroneous results may result from high levels of HbF in conditions such as f3-Thalassaemia. 3.   High values are obtained in iron deficiency anaemia, may be due to increased glycosylation. 6.  Should not be used to diagnose hypoglycaemia although recurrent low values may indicate risk of hypoglycaemia. Glycosylation of other proteins also is determined by its contact with a given level of glucose e.g.
Glycosylation of collagen from diabetic foot scrapings has been estimated and found to correlate very well with the HbA 1 level in diabetic patients with peripheral vascula: disease and peripheral neuropathy. A significant number of diabetics (especially those diagnosed before the age of thirty) die from diabetic nephropathy .It is now well established that early changes in the diabetic kidney may be significantly reduced and even reversed by excellent diabetic control16 Proteinuria is the clinical hallmark of diabetic nephropathy.
Albustix is unable to detect this concentration of protein, but there are methods, which allow its measurement i.e. It would be quite reasonable to suggest that all diabetics should have their urine tested at least annually to determine whether they have microalburninuria. These may be divided into primary and secondary types, both being relevant to diabetes mellitus.
1.Chronic poor control can produce massive over-secretion of triglycerides from the liver, this results in increased levels of VLDL in the periphery and aggravates the diabetic state by causing insulin resistance and a raised level of chylomicrons (due to reduced activity of lipoprotein lipase). In addition it should be noted that HDL is low in diabetes mellitus and one should remember that in diabetics over the age of 50 years , the incidence of ischaernic heart disease is increased two or three fold. C-peptide is formed during the conversion of pro-insulin into insulin in the granules of the beta cells of the islets of Langerhans.
Since C-peptide is not appreciably broken down by passage through the liver it is an excellent measure of endogenous insulin secretion in the diabetic. Thus the estimation of C-peptide is used in the diabetic for assessment of beta cell reserve ,in other words to see if there is any residual function in patients with type I diabetes .lt has been shown that in early diabetics especially children higher C-peptide values are found in patients with the best diabetic control.
It is reasoned that the presence of insulin antibodies may exert a favourable effect on metabolic control in type 1 and type II diabetics on insulin.The insulin antibodies act as a reservoir and bind and release insulin according to the reversible equilibrium between free and bound pools of the hormone. The diagnosis is based on the clinical presentation of dehydration and acidosis as ketone bodies are only measured retrospectively. Patients usually present with history of thirst, polyuria, nausea and vomiting and on examination are dehydrated, with Kussmaul respiration.
On urine testing ketonuria and glycosuria are present and the diagnosis should be rapidly confirmed by blood glucose and blood gases.
It is most important to avoid both hypokalaemia and hyperkalaemia during treatment, as both have serious possibly fatal consequences as regards cardiac arrhythmias. Insulin is given in small and regular amounts, the objective being to achieve a circulating concentration that will inhibit hepatic glucose output, promote glucose utilization and therefore inhibit lipolysis, leading to a fall in hepatic ketogenesis and correction of acidosis.Rapid acting insulin is used and the subcutaneous route is avoided because of the danger of poor perfusion and absorption. The use of alkali is not without risk, although in theory acidosis may impair myocardial contractility and slow the glycolytic rate so partial correction using sodium bicarbonate may be carried out.
At presentation the levels of 2:3 diphosphoglycerate (DPG) are low, meaning that that the delivery of oxygen to the peripheral tissues is less effective. So the role of the laboratory in the management of diabetic ketoacidosis is of paramount importance, not only does careful monitoring help in the management and reduce the mortalility but at the time of diagnosis the laboratory contributes to the assessment of the severity by providing glucose, electrolytes acid-base data20. Management is similar to that for ketoacidosis involving rehydration, insulin and electrolytes so therefore the demands on the laboratory are also similar.It should be remembered that the mortality is higher than in ketoacidosis. Is rare in diabetics but they are not immune to lactic acidosis from hypovolaemic or septic shock. 16.Viberti GC, Pickup JC, Jarrett RJ, et al, Effect of control of bood glucose on urinary excretion of albumin and B2 Microglobulin in insulin-dependent diabetes. This journal is a member of and subscribes to the principles of the Committee on Publication Ethics. ABCD sponsors treatment for those in need regardless of gender, race or creed, helping them to reach their full potential, to live life with dignity and to take their rightful place in their community. ABCD works through local Palestinian partners, the Bethlehem Arab Society for Rehabilitation (BASR) based in Beit Jala, The Sheepfold in Beit Sahour and two UNWRA Refugee Camps in Jalazone and Nour Shams. Funding is constantly needed for new projects and to update and refurbish existing facilities.
Insulin Resistance Vs Insulin Sensitivity When it comes to insulin and insulin sensitivity vs insulin resistance, you are always on a continuum of how insulin sensitive your are are and what tissues are most effective at absorbing glucose. This entry was posted in Misc, Nutrition and tagged carbohydrates, carbs, diabetes, insulin. We also offer free, instant access to over 1,500 related articles on your pet's health including preventive medicine, common and not so common diseases, and even informative case studies. The Dietary Guidelines for Americans recommend an average individual consume two cups of fruit and two and a half cups of vegetables every day. If you find yourself blaming your lack of fruit and vegetable consumption on lack of time, don’t be afraid to try canned or frozen fruits and vegetables. For those of you, who find little appeal to certain fruits and vegetables, don’t give up hope. Whether you grown your own, support local farmers, or buy from a grocer, take advantage of the diverse selection of seasonal fruits and vegetables and eat to a healthier life! The microvascular complications of diabetes encompass long term complications of diabetes affecting small blood vessels. Macrovascular complications of diabetes include coronary artery disease, stroke and peripheral vascular disease. In type 1 diabetic patients, 13% have retinopathy at 5 years and 90% have retinopathy after 10 to 15 years. Proliferative retinopathy develops due to ischemia and release of vasoactive substances, such as vascular endothelial growth factor (VEGF), which stimulates new blood vessel formation as a progression of non-proliferative retinopathy. Diabetic nephropathy results from increased glomerular capillary flow that in turn results in increased extracellular matrix production and endothelial damage.
The macrovascular complications of diabetes result from hyperglycemia, excess free fatty acid, and insulin resistance. Symptoms of retinopathy are minimal until advanced disease ensues with loss or blurring of vision.
Patients may present with focal neuropathies due either to mononeuritis or entrapment syndromes. Patients with coronary artery disease can present with stable angina pectoris, unstable angina pectoris, or myocardial infarction.
Peripheral vascular disease is recognized by exertional leg pain that can progress to rest pain and ischemic ulcers.
Careful questioning about symptoms of ischemic coronary disease is still one of the most important ways to screen. Various studies have considered the issue of screening for coronary heard disease (CHD).10,1119, 20-23 The guidelines and individual recommendations are not entirely concordant.
The AHA consensus group has provided a thoughtful approach to screening for CHD in patients with diabetes. According to these guidelines, risk assessment begins with a medical history, including special attention to symptoms of atherosclerotic disease, such as angina, claudication, or erectile dysfunction.
It is not yet clear exactly how noninvasive testing changes risk management strategies in diabetes, because DM is already considered a coronary heart disease (CHD) risk equivalent.
Careful attention to history of changes in exercise tolerance, atypical symptoms that suggest angina, or suggestive electrocardiographic abnormalities, are reasons for the clinician to consider stress testing. The diagnosis of neuropathy is based on finding focal (individual root) or diffuse (entire limb) involvement.
The diagnosis of coronary artery disease can be confirmed by several diagnostic and imaging studies. The diagnosis of a stroke is based on a patient developing symptoms as above and is confirmed by a CT scan or MRI. The diagnosis of peripheral arterial disease is diagnosed by determining the ankle brachial index (ABI). Guidelines for medical nutrition therapy11,24-28 have been established by the ADA and are summarized in (Figure 2). Modify nutrient intake and lifestyle as appropriate to prevent and treat obesity, dyslipidemia, cardiovascular disease, hypertension, and nephropathy. Address individual nutritional needs, taking into consideration personal and cultural preferences and lifestyle while respecting the individual's wishes and willingness.
Facilitate changes in eating and physical activity habits that reduce insulin resistance and improve metabolic status. Provide self-management education for treatment (and prevention) of hypoglycemia, acute illnesses, and exercise-related blood glucose problems.
Decrease risk by encouraging physical activity and promoting food choices that facilitate moderate weight loss or at least prevent weight gain.
Regular exercise is encouraged, but complications of diabetes need to be taken into account. The Diabetes Control and Complications Trial56 (DCCT) enrolled 1,441 people with type 1 diabetes.
The United Kingdom Prospective Diabetes Study59,60 evaluated 5,102 patients with type 2 diabetes. Blood pressure control has been shown to reduce the risk for both retinopathy and nephropathy. The Euclid Trial,63 which included 354 normotensive patients with type 1 diabetes aged 20 to 59 years, demonstrated that lisinopril treatment resulted in a 50% reduction in retinopathy progression, 73% reduction in 2-grade retinopathy progression, and an 82% reduction in development of proliferative retinopathy. Several studies have assessed the effects of blood pressure control on nephropathy in patients with type 1 and type 2 diabetes have been performed assessing effects.
A recent meta analysis65 involving multiple studies66-76 demonstrated that ACE inhibitors can delay progression to overt nephropathy by 62% in patients with type 1 diabetes with micro-albuminuria. Several studies87-90 have shown that in patients with type 2 diabetes, there is a slowing of progression of micro-albuminuria to overt nephropathy when angiotensin II receptor blockers are administered. The frequency of glucose monitoring for type 2 diabetics is not known but should be sufficient to facilitate achievement of the glucose goals. Patients with type 1 diabetes should have an initial dilated and comprehensive eye exam within 3 to 5 years of the onset of diabetes. Early nephropathy is associated with micro-albuminuria, hypertension, and possible elevation in creatinine. The Diabetes Control and Complications trial found some improvement in neuropathy with intensive diabetes control.
Guidelines for the management of dyslipidemia have been published by the National Cholesterol Education Program (NCEP) and by several expert panels since 1988.

Physicians should note that not all patients with diabetes have a 20% risk of a cardiac event over a 10-year period as determined by the UKPDS risk engine,39 so some discretion may be used with the guidelines.
These guidelines were developed based on findings from lipid-lowering trials that included diabetic patients and were confirmed by subsequent trials. Post-hoc analyses of diabetic patients who were included in lipid-lowering trials have supported the notion that these patients have comparable relative reductions (or perhaps greater absolute reductions) in the risk for CHD events than their nondiabetic counterparts. Blood pressure control has a greater effect on reducing the risk for stroke than it does for reducing the risk for MI. Intervention trials have shown a somewhat modest a relationship between glycemic control and CHD risk.
Two recent studies have suggested that patients with a BMI ≥ 35 may benefit from gastric bypass surgery as treatment for obesity and diabetes.
A patient with diabetes should be referred to an endocrinologist if targets for glycemic control cannot be achieved or if the patient is experiencing significant hypoglycemia. The watchword of the ADA several years ago was "diabetes is serious." Careful screening for complications, including retinopathy, nephropathy, and neuropathy clearly are associated with opportunities to reduce the risk for disease progression. Diabetes mellitus is a leading cause of blindness, end-stage renal disease, and nontraumatic lower extremity amputations. Glycemic control is associated with a reduced risk for the microvascular and neuropathic complications of diabetes mellitus. Treatment of CHD risk factors, especially dyslipidemia, is associated with a reduced risk for CHD. Early detection of microvascular and neuropathic complications and implementation of appropriate treatment strategies, such as laser therapy (retinopathy), use of ACE inhibitors and ARBs (nephropathy), and proper footwear (neuropathy), will reduce the risk for adverse outcomes from these complications. Grundy SM, Cleeman JI, Merz CN, et al: Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Vinik AI, Pittenger GL, McNitt P, Stansberry KB Diabetic Neuropathies: An overview of clinical aspects, pathogenesis, and treatment. Armstrong DG, Lavery LA, Vela SA, et al: Choosing a practical screening instrument to identify patients at risk for diabetic foot ulceration.
Franz MJ, Horton ES Sr, Bantle JP, et al: Nutrition principles for the management of diabetes and related complications. Franz MJ, Bantle JP, Beebe CA, et al: Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications.
Gannon MC, Nuttall FQ, Westphal SA, et al: Effects of dose of ingested glucose on plasma metabolite and hormone responses in type II diabetic subjects. UK Prospective Diabetes Study (UKPDS) Group: Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34).
Crepaldi G, Carta Q, Deferrari G, et al: Effects of lisinopril and nifedipine on the progression to overt albuminuria in IDDM patients with incident nephropathy and normal blood pressure.
Mathiesen ER, Hommel E, Giese J, Parving H-H: Efficacy of captopril in postponing nephropathy in normotensive insulin dependent diabetic patients with microalbuminuria. O'Hare P, Bilbous R, Mitchell T, et al, for the Ace-Inhibitor Trial to Lower Albuminuria in Normotensive Insulin-Dependent Subjects Study Group. Ahmad J, Siddiqui MA, Ahmad H: Effective postponement of diabetic nephropathy with enalapril in normotensive type 2 diabetic patients with microalbuminuria. Ruggenenti P, Mosconi L, Bianchi L, et al: Long-term treatment with either enalapril or nitrendipine stabilizes albuminuria and increases glomerular filtration rate in non-insulin-dependent diabetic patients. Velussi M, Brocco E, Frigato F, et al: Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Parving HH, Lehnert H, Brochner-Mortensen J, et al, and the Irbesartan in Patients With Type 2 Diabetes and Microalbuminuria Study Group.
Diabetic Retinopathy Study Research Group: Preliminary report on effects of photocoagulation therapy. Diabetic Retinopathy Study Research Group: Four risk factors for severe visual loss in diabetic retinopathy. Diabetic Retinopathy Study Research Group: Photocoagulation treatment of proliferative diabetic retinopathy. Grundy SM, Cleeman JI, Merz CN, et al: A summary of implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Yusuf S, Sleight P, Pogue J, et al: Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. Yusuf S, Teo KK, Pogue J, et al: Telmisartan, ramipril, or both in patients at high risk for vascular events.
Gerstein HC, Miller ME, Byington RP, et al: Effects of intensive glucose lowering in type 2 diabetes. Patel A, MacMahon S, Chalmers J, et al: Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. Migrone G, Panunzi S et al: Bariatric Surgery verses Conventional Medical Therapy for Type 2 Diabetes NEJM. Shauer PR, Kashyap SR et al: Bariatric Surgery verses Intensive Medical Management Therapy in Obses Patients with Diabetes NEJM. Com isso, o pancreas nao produz insulina, que interfere na queima do acucar e de outras substancias, como proteinas e gordura. No tipo I, a causa principal da doenca pode ser considerada por celulas pancreaticas detectadas no sangue.
Mas, na maioria dos casos consiste em mudar habitos alimentares para refeicoes mais saudaveis, alem da pratica de exercicios fisicos.
Em paralelo ao tratamento e necessario usar alguns medicamentos, que serao indicados pelo medico. Em paralelo aos cuidados com a diabetes, o paciente tambem deve se preocupar com a pressao sanguinea e com o nivel de colesterol. Pois se o paciente tem a doenca, a melhor forma e saber da existencia da doenca e ja comecar um processo de tratamento. If this is not done then it must be accepted that that a certain number of people will be missed6,7. Diagnosis may be made on the basis of fasting and 2 hour blood sample, with one hour sample taken to provide additional information. There are various methods of monitoring but glucose measurement in blood and for urine is most widely used. In addition fasting and random samples sometimes give no indication of the glycaemic fluctuations at home or at work.
This may be done while the patient is at home using finger prick capillary blood glucose with reagent strips and a reflectance meter provided the meter has been calibrated and the patient is taught the correct procedure. In these patients the blood glucose measurement is an indispensable tool in spot checks for hypoglycaemia and hyperglycaemia.
In normal adults and children older than six months about 90% of the haemoglobin is HbA, which consists of a pair of, a and b polypeptide chains attached to the haem molecule.
The other minor haemoglobins either have an attachment of a sugar phosphate to the N-term inus of the beta-chain or they may be a further modification of HbA1c. Diphosphoglycerate (2,3,DPG) binds to the N-terminal valine of the beta chain of haemoglobin and this being the same site where glucose attaches to form HbAlc, there is a competition between glucose and 2,3 DPG. Albustix may detect this, in fact Albustix with routine testing can measure levels greater than 0.1 gIl of urine.
It should be noted that despite proteinuria, renal function can remain normal in these patients for several years.
In the primary hyperlipidaemias type II, IV and V, there is an associated carbohydrate intolerance but in the context of diabetes mellitus we are more concerned with the secondary hyperlipidaemias secondary to diabetes mellitus and these can divided into three categories17. Raised levels of VLDL are found in these patients which can persist even when the diabetes is adequately controlled.
Therefore fasting levels of triglycerides and cholesterol should be monitored in diabetics.
So it may useful to determine the level of insulin antibodies in some patients so that they may managed more efficiently. It should be noted here that while the usual presentation is with accompanying hyperglycaemia, diabetic ketoacidosis may present with only minor elevations of blood glucose.
Base line measurements of electrolyte concentrations arc essential as they determine the pattern of rehydration and electrolyte replacement.
Plasma sodium may be low, normal or high depending on the relative loss of water or sodium. The administration of phosphate raises the levels of 2:3 DPG, but careful monitoring of potassium levels is required.
Definition, diagnosis and classification of diabetes mellitus and its complications.Part 1.
Glucose tolerance test and glycosylated haemoglobin measurement for the diagnosis of diabetes mellitus- an assessment of the criteria of the WHO Expert Committee on Diabetes Mellitus.. We encourage you to read any of these popular articles below or search our extensive pet health library. With over 600 hospitals and 1,800 fully qualified, dedicated and compassionate veterinarians, we strive to give your pet the very best in medical care. Despite the known health benefits of consuming fruits and vegetables, Americans as a whole do not consume the recommended amounts each day. To learn more about the health benefits of fruits and vegetables, more ways to incorporate them into your diet, and local nutrition education programs available in Bosque County, contact your local Kate Whitney at the Extension Office at 254-435-2331. These classically have included retinopathy, nephropathy and neuropathy.Retinopathy is divided into 2 main categories. Early macrovascular disease is associated with atherosclerotic plaque in vessels supplying blood to the heart, brain, limbs, and other organs.
Approximately 25% of type 1 diabetics develop proliferative retinopathy after 15 years of diabetes.1 Type 2 diabetics taking insulin have a 40% prevalence of retinopathy at 5 years, while those on oral hypoglycemic agents have a 24% prevalence. Microaneurysms may form due to the release of vasoproliferative factors, weakness in the capillary wall, or increased intra-luminal pressures. These vessels erupt through the surface of the retina and grow on the posterior surface of the vitreous humor.
Diabetes is associated with dyslipidemia, hyperglycemia, and low insulin and growth factor abnormalities. These cause increased oxidative stress, protein kinase activation and activation of the receptor for advanced glycation end products (RAGE).
Signs of non-proliferative retinopathy include microaneurysms, venous loops, retinal hemorrhages, hard exudates, and soft exudates. More frequent follow-up examinations should be performed in those who have more advanced retinopathy. Sensitive assays to detect very low levels of albumin, or microalbuminuria, have been available for many years.10,11 The simplest screening measure is a spot urine test adjusted for the urine creatinine level. Patients who have difficulty examining their feet should seek assistance, especially if the patient has impaired vision. Whereas nearly every group suggests stress tests for patients with symptoms of CHD or electrocardiographic changes suggesting ischemia, recommendations on screening for asymptomatic disease are less consistent. Electrocardiographic changes showing left ventricular hypertrophy and ST-T changes suggest increased cardiovascular risk. Thus, noninvasive testing should be targeted as much as possible to detect patients who might have CHD that is amenable to surgical intervention.
In addition, dyslipidemia, obesity, and hypertension, albuminuria, and a family history of CHD may be reasons to consider stress testing in patients who do not have clinical symptoms of CHD. Findings can be asymmetric ( mononeuritis multiplex) or symmetric conforming to a distal-to-proximal gradient of involvement (most common).
A resting 12-lead ECG is not sensitive enough to identify disease in patients with stable angina.
CT angiography can be used to identify the location of vascular occlusion and assess for salvageable brain tissue. This is the ratio of the Doppler determined systolic ankle pressure over the systolic brachial pressure. The primary focus of these guidelines is targeted to improve outcomes including glycemic control, weight reduction (as appropriate), blood pressure control, and a favorable lipid profile. Low glycemic index foods consumed alone result in lower prandial glucose excursion than do high glycemic index foods.
Nutritional supplements are not necessary in patients who are otherwise consuming a well-balanced diet. Injury to patients with loss of sensation in their feet is a limitation for weight-bearing exercise.
The 2 main approaches to preventing retinopathy and nephropathy are intensive glycemic control and aggressive control of hypertension. The intensive treatment was either given with insulin pumps or multiple daily injections (3 or more injections per day.) The insulin dosage was guided by self-monitoring of blood sugar 3 or 4 times per day. Two-step progression of retinopathy decreased by 69%, nephropathy progression decreased by 70%, and nerve conduction velocities improved. Patients were treated with sulphonylureas or insulin in 1 study and another group was compared to these groups using metformin in a second study.
In hypertensive patients with micro-albuminuria or albuminuria, ACE inhibitors or angiotensin II receptor blockers should be strongly considered.
The largest blood pressure trials in diabetic patients have demonstrated favorable effects on reduction in CVD. ASA should be used in combination with clopidogrel for up to 1 year in these patients following acute coronary syndrome. This was expected, because the trial included a population at low risk for CHD at randomization.
Mingrone et al116 found that in patients aged 30 to 60 years, with BMI ≥35, 95% of patients treated with biliopancreatic diversion, and 75% of those treated with gastric bypass, had remission of diabetes. Aggressive interventions with glycemic control, as well as management of lipids and blood pressure, seem to have favorable effects on many complications of diabetes. The relationship of glycemic exposure (HbA1c) to the risk of development and progression of retinopathy in the Diabetes Control and Complications Trial.
Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy.
Incidence and prevalence of clinical peripheral vascular disease in a population-based cohort of diabetic patients.
The American Association of Clinical Endocrinologists medical guidelines for clinical practice for developing a comprehensive care plan. Diabetes guidelines: A summary and comparison of the recommendations of the American Diabetes Association, Veterans Health Administration, and American Association of Clinical Endocrinologists. Sustained effect of intensive treatment of type 1 diabetes mellitus on development and progression of diabetic nephropathy: The Epidemiology of Diabetes Interventions and Complications (EDIC) study. Relationship of hyperglycemia to the long-term incidence and progression of diabetic retinopathy. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.
Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33).
Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39.
Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38.
Effect of lisinopril on progression of retinopathy in normotensive people with type 1 diabetes. Early aggressive antihypertensive treatment reduces rate of decline in kidney function in diabetic nephropathy.
Should all patients with type 1 diabetes mellitus and microalbuminuria receive angiotensin-converting enzyme inhibitors? Randomised placebo-controlled trial of lisinopril in normotensive patients with insulin-dependent diabetes and normoalbuminuria or microalbuminuria.
Comparison of reduction in microalbuminuria by enalapril and hydrochlorothiazide in normotensive patients with insulin dependent diabetes.

The beneficial effect of angiotensin-converting enzyme inhibition with captopril on diabetic nephropathy in normotensive IDDM patients with microalbuminuria. Prevention of diabetic nephropathy with enalapril in normotensive diabetics with microalbuminuria. Randomised controlled trial of long term efficacy of captopril in preservation of kidney function in normotensive patients with insulin dependent diabetes and microalbuminuria. Placebo-controlled trial of lisinopril in normotensive diabetic patients with incipient nephropathy.
Low-dose ramipril reduces microalbuminuria in type 1 diabetic patients without hypertension: results of a randomized controlled trial. Effect of captopril on progression to clinical proteinuria in patients with insulin-dependent diabetes mellitus and microalbuminuria.
Long-term renoprotective effect of angiotensin-converting enzyme inhibition in non-insulin-dependent diabetes mellitus. Long-term stabilizing effect of antiogensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type 2 diabetic patients. Greater reduction of urinary albumin excretion in hypertensive type II diabetic patients with incipient nephropathy by lisinopril than by nifedipine.
Use of enalapril to attenuate decline in renal function in normotensive, normoalbuminuria patients with type 2 diabetes mellitus.
Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes.
The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. The need for a large-scale trial of fibrate therapy in diabetes: The rationale and design of the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. Vale lembrar que nao existe um tratamento padrao, que sirva para todos os tipos de paciente. There is also no justification for proceeding with the glucose tolerance test when the fasting blood glucose is raised. Consequently in the presence of increased concentrations of HbAlc, there is less 2,3 DPO bound to the molecule and there will be diminished delivery of oxygen to the tissues. Thus the measuring of urinary albumin at such low levels allows the clinician to identify those patients at risk of developing diabetic nephropathy. The C-peptide remains in the beta granules alongside the insulin molecule from which it is released into the circulation simultaneously, molecule per molecule, whenever insulin secretion is stimulated. In children, urinary C-peptide can be used to determine the beta cell reserve in preference to plasma levels. Sometimes the serum may be grossly lipaernic at presentation leading to pseudohyponatraemia with the common measuring methods, therefore plasma sodium may rise rapidly with rehydration and clearance of lipaemia with insulin. Not good toward boarding, grooming, prescription and non-prescription medication, and retail items. Another great benefit of summer is the abundance of fresh delicious, fruits and vegetables available. The classification of neuropathy includes focal, diffuse, sensory, motor and autonomic neuropathy. Late stages of macrovascular disease involve complete obstruction of these vessels which can include myocardial infarction (MI), stroke, claudication, and gangrene.
Signs include depression or loss of ankle jerks and vibratory sensation, with hyperalgesia and calf pain in some patients.
A rare but severe form of diabetic neuropathy is diabetic amyotrophy, which begins with pain followed by severe weakness and spreads from unilateral to bilateral.
Patients with cerebral vascular disease can present with a sudden onset of a focal neurologic deficit such as facial droop, hemiparesis, or isolated weakness of an arm or leg. Handheld ophthalmoscopy in the office may be able to detect diabetic retinopathy but offers limited view of the retina and difficulty detecting diabetic macular edema.
The use of a mirror, such as a magnifying shaving mirror, can help the patient see the bottoms of his or her feet (see elsewhere in this section, "Prevention and Treatment of Leg and Foot Ulcers in Diabetes Mellitus").
Consequently, clinicians must ask about reduced exercise tolerance, dyspnea, or exercise-induced nausea. The ongoing DIAD study, which is designed to determine risk factors associated with clinically silent myocardial disease using stress tests with cardiac imaging, has suggested that the presence of neuropathy may be one of the most important predictors of cardiovascular risk. Whereas noninvasive screening in asymptomatic patients might detect disease amenable to percutaneous intervention or coronary artery bypass grafting, the cost-effectiveness and determination of how much such screening affects long-term outcomes are still uncertain. This approach is most consistent with the AACE guidelines and should select patients at highest risk for CHD.
Because the average daily albumin excretion rate varies in normals and diabetics by 40%, it is recommended that 3 urine collections over several weeks be taken before this diagnosis is made.
Electrodiagnostic studies can confirm peripheral nerve disease and define the pattern of disease. Cardiovascular stress testing can be assessed with ECG assessment during exercise, dobutamine, dipyridamole, or adenosine. There is clear evidence that excess saturated fat in the diet has a detrimental effect on lipid profiles, and therefore restriction of saturated fat is recommended. However, in the context of a mixed meal, differences between low and high glycemic index foods are attenuated.
Many recommendations for weight management propose restriction of calories based on the degree of obesity and propose 30 to 45 minutes of exercise 3 to 5 days a week. Because of risk of CHD in patients with diabetes, appropriate screening for CHD should be performed before patients engage in an exercise program.10,11,19,48-50 Benefits of exercise include weight control and improved glycemic control, often due to reduced insulin resistance. Intensive glycemic control has been the most effective approach to preventing neuropathic complications of diabetes.
The study subjects maintained an average HbA1C of 7.9% in the conventional treatment group compared to 7% in the intensive treatment group. There were 1,148 patients with type 2 diabetes and coexisting hypertension that were studied.
No studies in type 1 patients have shown that starting ACE inhibitors when the albumin excretion rate is normal delays the development of micro-albuminuria. Both Type 1 and Type 2 diabetics should have subsequent eye exams annually, which should be performed by an ophthalmologist or optometrist knowledgeable and experienced in diagnosing retinopathy.
The guidelines are generally consistent in recommending aggressive lipid-lowering management in diabetes, which is considered a coronary risk equivalent.
This trial was confounded by very high levels of statin drop-in, especially in the placebo arm. Schauer et al117 found that 42% of obese patients with gastric bypass, 37% obese patients with sleeve gastrectomy, and 12% of medically managed patients achieved HbA1c ≤6% at 1 year. Patients who develop complications should be referred to an endocrinologist to see if glycemic control can be improved, or simply to treat the complications. Design, implementation, and preliminary results of a long-term follow-up of the Diabetes Control and Complications Trial cohort.
Diabetic nephropathy is a major clinical problem and renal failure is reported to be the cause of death in over 20% of type 1 diabetics3. This solution should be drunk slowly, the solution should not be too concentrated as excessive hyperosmolality may lead to vomiting and even without vomiting to poor absorption). When renal function does start to decline, it does so progressively, without remission and the rate of progression of nephropathy is best followed by serum creatinine concentrations. Plasma potassium levels will fall with rehydration and this action is more pronounced if alkali is used ,also insulin adminstration will cause the cells to take up potassium so increasing the possibility of hypokalaemia. When you shop for frozen vegetables, choose those without sauces which can add unwanted salt, fat, and calories.
Vascular permeability in the macula can lead to macular edema and can threaten central vision.
First, decreased nitric oxide, increased endothelin, and increased angiotensin II cause vasoconstriction that results in hypertension and vascular smooth muscle cell growth. Dizziness, slurred speech, gait difficulties, and visual loss can also be presenting symptoms. In the absence of robust evidence, as noted by the AHA, physicians still need to make decisions about patients who might have silent myocardial disease. Autonomic neuropathy is diagnosed in patients with gastroparesis or orthostatic hypotension.
The data supporting absolute restriction of carbohydrates are not robust, so the ADA guidelines allow flexibility in intake of carbohydrates and nonsaturated fat. The amount29-31 and source31,32 of carbohydrates are important determinants of postprandial glucose levels. Exercise is an important component of any regimen for weight reduction and glycemic control. There was a 27% risk reduction for retinal photo coagulation at 12 years, 33% risk reduction at 12 years for micro-albuminuria, and 74% risk reduction for doubling of creatinine at 12 years. Blood sugar testing in type 1 diabetics or pregnant women with diabetes is recommended at least 3 times a day. If patients develop a cough, angioreceptor blockers have shown similar efficacy at decreasing micro-albuminuria, lowering blood pressure, and preventing worsening renal function.
Increasing doses of tricyclic antidepressants, gabapentin, phenytoin, carbamazepine, and benzodiazepines have been used with varying degrees of success. The ACCORD trial did not find that fenofibrate decreased cardiac events in the entire population but did so in those with high triglycerides and low HDL cholesterol. These screening and intervention strategies are supported by robust observational and intervention trial data and, in turn, are endorsed by the various organizations that have written disease management guidelines.
He has 8 siblings and a huge extended family, and no one has ever had diabetes (not even Type 2), cancer, etc. Challenges are part of life's lessons, to teach us to grow in all aspects, and to learn what we need to learn, to make it in this world. Both of these solutions should be used knowing that they carry the risk of haemolysis if used in excess. Obliteration of retinal capillaries can lead to intraretinal microvascular abnormalities (IRMAs). Trauma and nerve entrapment can lead to structural nerve damage including segmental demyelination, axonal atrophy and loss, and progressive demyelination. Second, decreased nitric oxide, activated nuclear factor-KB (NFKB), increased angiotensin II, and activation of activated protein-1 cause increased inflammation. It is easier to detect with binocular vision and, in difficult cases, IV fluorescein angiography and confocal microscopy are used. Serum creatinine determinations should be performed at least annually in patients with albuminuria; when estimated glomerular filtration rate (GFR) values are declining, more-specific measures of GFR (most commonly, creatinine clearance) should be used.
Alternatively nuclear stress testing with thallium 201 or technetium 99m in association with dipyridamole or adenosine can be used.
Risk reduction was 70% for clinically important sustained retinopathy, 56% for laser photo coagulation, 60% for sustained micro-albuminuria, 54% for clinical grade nephropathy, and 64% for clinical neuropathy. Some calcium channel blockers (diltiazem and verapamil) have been shown to decrease microalbuminuria and may be added to the above medications if necessary.
If he isn't showing any signs of being T1, I wouldn't be too concerned about it, especially with what his A1c is currently. If you’re grilling steaks, marinate fresh bell peppers, onion, and squash and throw them on the grill as well. This results in the release of chemokines, and cytokines, and expression of cellular adhesion molecules. Technology is available for screening with fundus photographs obtained in the physician's office and then read by an experienced reader.
If revascularization is being considered other tests including duplex ultrasonography, MR angiography, and CT angiography can be used to determine specific sites of surgical intervention.
There were no differences among the 3 arms.109 The beneficial effects could not be entirely attributed to blood pressure reduction in these trials. Third, decreased nitric oxide, increased tissue factor, increased plasminogen activator inhibitor-1, and decreased prostacyclin result in thrombosis, hypercoagulation, platelet activation, and decreased fibrinolysis. However, these methods are not yet sufficiently standardized to be used as routine screening tools. Carbohydrate content (total grams) alone explained 68% of the variation in glycemic load, and the glycemic index of the food explained 49%. Retinopathic events including proliferative retinopathy, macular edema, and need for laser therapy were 74%, 77%, and 77% lower in the intensively treated group.
If renal failure develops, treatment with dialysis or kidney transplant should be considered. The best way is by cystocentesis, which involves passing a sterile needle through the abdominal wall into a full bladder and withdrawing a sample of urine directly into a sterile syringe.
When total carbohydrate and glycemic index were both included in the regression analysis, the glycemic index accounted for 32% of the variation. If he is noticing that he gets very sleepy after eating, that is a red flag.I went through this period for months and the doctor recognized the symptoms and kept cheking my fasting glucose and it was always normal. The advantage of this method is that the urine is not contaminated by miscellaneous debris from the lower urinary passage that can interfere with the interpretation of the urinalysis.
A very thin sterile catheter is passed up the urinary passage into the bladder and then urine is withdrawn from the bladder directly into a sterile syringe. Be sure to smile at a stranger when out and about, that may be the only smile they get that day. The last and simplest way to collect urine is by mid-stream "clean catch" or "free flow", in which urine is collected into a sterile container as the pet urinates. The disadvantage is that it can be difficult to collect a mid-stream sample from most pets, and the urine is more easily contaminated by miscellaneous debris.
T1's and T2's cross post on these forums, and it is imperative that we all know which type one is. Type 1 and Type 2 are two totally absolute different diseases with different causes, thus making self-management very different. Urine that is dark yellow suggests the pet is dehydrated, while very pale yellow or clear urine indicates the pet is not concentrating urine well and may have kidney disease or another disease that interferes with urine concentration. If the urine is any color other than yellow (for example orange, red, or black), it is likely that pigments are present in the urine, which may signal a serious underlying disease. However, if the pet is continuously passing dilute urine, it may indicate underlying disease and your veterinarian may want to investigate this further. A common first step is to check the specific gravity of a first morning urine sample, since the first urine of the day is often the most concentrated. If the specific gravity of this sample is within acceptable limits, then there may be less cause for concern. The urine pH can be influenced by the pet's diet, but it is often a reflection of the pet's metabolic state, and it can also be an indicator of infection and underlying disease. For example, a pet that always has highly acidic urine may develop calcium oxalate stones; on the other hand, a pet that always has highly alkaline urine is more susceptible to bladder infections, and may develop struvite stones. Each test pad measures a different chemical component of the urine and changes color to indicate the amount of that substance in the urine. The dipstick is dipped into the urine and after a specified time interval, the color in the test pads is compared to a chart that translates the intensity of the color to an actual measurement. In some diseases, abnormally high levels of bilirubin may build up in the blood, and will subsequently be filtered out by the kidney, resulting in increased  quantities of bilirubin in the urine. The presence of bilirubin in the urine is often associated with liver disease or conditions involving red blood cell destruction (hemolysis). Therefore, examination of the urinary sediment should be included with every complete urinalysis.

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Comments to Diabetes mellitus urine onderzoek

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