Type 1 diabetes

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  • Overview
  • Symptoms
  • Treatment
  • Prevention
  • Alternative Names:

    Insulin-dependent diabetes mellitus; Juvenile onset diabetes; Diabetes – Type 1

    Treatment:

    At diagnosis, the immediate goals of treatment are to treat
    diabetic ketoacidosis
    (also called DKA) and high blood glucose levels. Because of the sudden onset and severity of symptoms in type 1 diabetes, treatment for newly diagnosed people may involve hospitalization.

    The long-term goals of treatment are to prolong life, reduce symptoms, and prevent diabetes-related complications such as blindness, kidney failure, and amputation of limbs.

    These goals are accomplished through education, insulin use, meal planning and
    weight control
    ,
    exercise
    , foot care, and careful self-testing of blood glucose levels.

    INSULIN

    Insulin lowers blood sugar by allowing it to leave the blood stream and enter cells. Everyone needs insulin. People with type I diabetes can’t make their own insulin, and they must take insulin every day.

    Insulin is injected under the skin using a syringe, or in some cases, an infusion pump delivers the insulin continuously. It is not available in an oral form.

    Insulin preparations differ in how fast they start to work and how long they last. The health care professional reviews blood glucose levels to determine the appropriate type of insulin the person should use. More than one type of insulin may be mixed together in an injection to achieve the best control of blood glucose.

    The injections are needed, in general, from 1 to 4 times a day. People are taught how to give insulin injections by their health care provider or a diabetes nurse educator. Initially, a child’s injections may be given by a parent or other adult. By age 14, most children can be expected (but should not be required) to give their own injections.

    DIET

    Meal planning for type 1 diabetes requires consistency to allow food and insulin to work together to regulate
    blood glucose levels
    . If meals and insulin are out of balance, extreme variations in blood glucose can occur.

    The American Diabetes Association and the American Dietetic Association has information for planning healthy, balanced meals. Consultation with a registered dietitian or nutrition counselor is an invaluable tool for meal planning and dietary control for diabetics.

    PHYSICAL ACTIVITY

    Regular exercise is especially important for the person with diabetes, as it helps control the amount of sugar in the blood and helps burn excess calories and fat to achieve optimal weight.

    Before people with diabetes begin any exercise program, they should obtain medical approval. Type 1 diabetics must take special precautions before, during and after participation in intense physical activity or exercise.

    SELF-TESTING

    Blood glucose monitoring
    is done by checking the glucose content of a small drop of blood. The testing is done on a regular basis and will inform the person with diabetes how well diet, medication, and exercise are working together to control diabetes.

    The results can be used to adjust meals, activity, or medications to keep
    blood-sugar levels
    within an appropriate range. It will provide valuable information for the health care provider to suggest changes to improve care and treatment. Testing will identify high and
    low blood-sugar
    levels before serious problems develop.

    FOOT CARE

    People with diabetes are prone to foot problems because of complications related to the illness. Diabetes causes damage to the blood vessels and nerves, which can result in a decreased ability to sense trauma or pressure on the foot. A foot injury could go unnoticed until severe infection develops.

    Additionally, diabetes alters the bodies immune system, decreasing the body’s ability to fight infection. Small infections can rapidly progress to death of the skin and other tissues, necessitating amputation of the affected limb.

    To prevent injury to the feet, diabetics should adopt a daily
    foot care
    routine.

    TREATING LOW BLOOD SUGAR

    Low blood sugar, known as hypoglycemia, can occur in diabetics when they use too much insulin, exercise too much, or have not eaten enough food. Hypoglycemia can develop quickly in people with diabetes. Symptoms of low blood sugar typically appear when the sugar level falls below 70. Watch for weakness, shaking, sweating, headache, nervousness, and hunger.

    If these symptoms occur and you have a blood sugar test kit available, do a blood sugar check. If the level is low, the person with diabetes should eat something with sugar: fruit juice, several teaspoons of sugar, a cup of skim milk, or regular soda. If you don’t have a test kit handy, sugar should be eaten anyway – it can’t hurt. Symptoms should subside within 15 minutes. If the symptoms don’t subside, more sugar should be eaten and the sugar level tested again.

    AFTER the symptoms subside, more substantial food can be eaten. Eat simple sugar FIRST to get the situation under control. Even if you or your child is hungry, “real” food should not be eaten until the sugar level comes up – real food won’t produce enough sugar and takes too long to digest.

    If you are a parent, relative, or friend of someone experiencing these symptoms, monitor the person closely. If symptoms become worse — confusion, seizures, or unconsciousness — give the person a shot of glucagon. If you don’t have glucagon, call 911 immediately.

    You should have some glucagon stored for emergencies. Make sure everyone in your home, as well as babysitters and caregivers, knows how to use it. Periodically remind everyone how to use it, and check the expiration date.

    Don’t panic. Glucagon works very fast — usually within 15 minutes. While you are waiting for the person to revive, keep him on his side to prevent choking. If the person is not better in 15 minutes, call 911.

    TREATING HIGH KETONES

    When there is not enough insulin to move glucose into cells, glucose can build up in the blood. The body then looks for other forms of energy and uses fat as a fuel source. As fats are broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous to body tissue. This condition is known as ketoacidosis.

    You can check for ketones using a simple urine test available at pharmacies. This test should be performed every 4-6 hours anytime a person with diabetes is registering blood sugar above 240; sick; unusually thirsty or has a dry mouth; urinating frequently; or vomited

    The warning signs that ketoacidosis is getting serious might include flushed face, dry skin and mouth, nausea or vomiting, stomach pain, deep, rapid breathing, or fruity breath odor.

    If these symptoms occur, call the doctor or go to the emergency room right away. If left untreated, this condition will lead to coma and even death.

    MONITORING

    • Visit your physician and/or diabetes educator at least 4 times a year.
    • Have your
      glycosylated hemoglobin
      (HbA1c) measured 2-4 times a year to evaluate your overall glucose control. (Ask your doctor how often you should be tested.)
    • Have your
      cholesterol
      and
      triglyceride levels
      and kidney function evaluated yearly.
    • Visit your ophthalmologist (preferably one that specializes in diabetic retinopathy) at least once a year, more frequently if signs of diabetic retinopathy develop.
    • Every 6 months have a thorough dental cleaning and examination. Inform your dentist and hygienist that you have diabetes.
    • Monitor your feet every day for early signs of injury or infection. Make sure your health care provider inspects your feet at each visit.
    • Stay up-to-date with all of your vaccinations (including pneumococcal), and get a flu shot every year in the fall.

    EDUCATION

    You are the most important person in managing your diabetes.
    Diabetes education
    is a crucial part of the treatment plan. Diabetes education basically involves learning how to live with your diabetes.

    Knowledge of disease management is imperative to avoid developing short-term complications such as
    hypoglycemia
    and
    hyperglycemia
    and to delay or slow the onset of long-term complications of the disease such as
    diabetic retinopathy
    (eye disease) or
    nephropathy
    (kidney disease).

    You should be knowledgeable about the basic principles of diabetes management. Basic “survival skills” include:

    • how to recognize and treat low blood sugar(hypoglycemia)
    • how to recognize and treat high blood sugar (hyperglycemia)
    • diabetes meal planning
    • how to administer insulin
    • how to
      monitor blood glucose
      and
      urine ketones
    • how to adjust insulin and/or food intake during exercise
    • how to handle sick days
    • where to buy diabetic supplies and how to store them

    Support Groups:

    For additional information and resources, see
    diabetes support group
    .

    Expectations (prognosis):

    The outcome for people with diabetes varies. Recent studies show that tight control of blood glucose can prevent or delay the progression of eye disease, kidney disease and nervous system disease that is caused by diabetes. However, complications may occur even when good diabetes control is achieved with insulin and diet.

    Complications:

    EMERGENCY COMPLICATIONS:

    • DIABETIC KETOACIDOSIS

      In a person with type 1 diabetes, the body will use fat as a fuel if insulin is not present. The by-products of fat metabolism are ketones. Ketones build up in the blood and “spill” over into the urine.

      A condition called ketoacidosis develops when the blood is made acidic by the ketones.

    • HYPOGLYCEMIA

      Hypoglycemia (low blood glucose) occurs when the balance between insulin, food intake, and exercise is disturbed. Symptoms of mild hypoglycemia include hunger, nervousness, and fast heart rate. More serious hypoglycemia can lead to confusion and even loss of consciousness. Loss of consciousness due to low blood sugar is called hypoglycemic coma.

    LONG-TERM COMPLICATIONS:

    People who have had diabetes for several years are likely to develop long-term complications, which can be minimized but not entirely eliminated by proper diabetic management:

    • VASCULAR DISEASE

      By age 55, about 35% of men and women with type 1 diabetes have died from a heart attack compared to 8% of nondiabetic men and 4% of nondiabetic women.

      People with type 1 diabetes are also at higher risk to develop blockages in the major arteries of the legs than nondiabetics. Lower the risk of vascular disease by aggressively treating cholesterol and blood pressure, exercising regularly, and avoiding or quitting tobacco products.

    • MICROVASCULAR DISEASE

      Microvascular (small vessel) changes occur in capillaries of every organ of the body. There is a thickening of the wall of the small blood vessels. These changes are responsible for many of the diabetes complications.

    • EYE COMPLICATIONS

      Changes in the small blood vessels of the retina (also known as
      diabetic retinopathy
      ) predispose the diabetic to several eye disorders. After 15 years of diabetes, 80% of diabetics will have some diabetic retinopathy.

      If bleeding and scarring has developed, a
      retinal detachment
      may occur, causing blindness. Vascular changes in the
      iris
      may cause obstruction of the flow of ocular fluid and cause
      glaucoma
      . Diabetics are also more likely than nondiabetics to develop
      cataracts
      .

    • DIABETIC NEPHROPATHY (kidney disease)

      Kidney abnormalities may be noted early in the disease. Poorly controlled diabetes may accelerate the development of
      kidney failure
      .
      Urinary tract infections
      in diabetics tend to be more severe and may result in
      kidney damage
      .

      Diabetics are more vulnerable to kidney damage from high blood pressure than nondiabetics.

    • DIABETIC NEUROPATHY(nerve damage)

      People with diabetes may develop temporary or permanent damage to nerve tissue.
      Diabetic neuropathy
      is more likely to develop if blood glucose is poorly controlled. Some diabetics will not develop neuropathy, while others may develop this condition relatively early.

      On average, symptoms such as numbness and tingling occur 10 to 20 years after diabetes has been diagnosed.

    • DIABETIC FOOT PROBLEMS

      The feet of people with diabetes are very susceptible to infection and injury. Many diabetes-related hospital admissions are for foot problems, and a significant number of non-accident-related leg amputations are performed on diabetics.

      Several foot problems are common in people with diabetes, including skin changes (loss of hair; loss of ability to sweat; and dry, cracked skin),
      arterial insufficiency
      (impaired blood supply to feet), neuropathy, and specific foot deformities (
      hallux valgus
      , bunion, hammertoe, and calluses).

    • SKIN AND MUCUS MEMBRANE PROBLEMS

      People with diabetes are more likely than nondiabetics to develop infections. Hyperglycemia (high blood sugar) predisposes diabetics to fungal infections of the skin, nails, and female genital tract and to urinary tract infection.

    Calling your health care provider:

    Medical follow-up for a person newly diagnosed with type 1 diabetes should probably occur weekly until good control of blood glucose is achieved. The health care provider will want to review results of home glucose monitoring and urine testing, and a diary of meals, snacks, and insulin injections.

    As the disease becomes more stable, follow-up visits will be less frequent. Periodic evaluation is very important for the evaluation of long-term complications associated with diabetes.

    Call your health care provider or go to the emergency room if symptoms of ketoacidosis are present:

    • increased thirst and urination
    • nausea
    • deep and rapid breathing
    • abdominal pain
    • sweet-smelling breath
    • loss of consciousness
      (This may occur in insulin dependent diabetics when a dose of insulin is missed, or if illness or infection is present.)

    Go to the emergency room or call the local emergency number (such as 911) if symptoms of severe hypoglycemia or insulin reaction are present:

    • trembling
    • weakness
    • drowsiness
    • headache
    • confusion
    • dizziness
    • double vision
    • lack of coordination
    • convulsions
      or
      unconsciousness

    Early signs of hypoglycemia may be treated at home by eating sugar or candy or injecting
    glucagon
    . If the signs of hypoglycemia are not relieved by the above action or if blood glucose levels remain below 60 mg/dL go to the emergency room.

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    ► Gilbert’s syndrome

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    Gilbert’s syndrome

    Definition:
    A multifactorial inherited disorder that affects the way bilirubin is processed by the liver and causes jaundice.
    Alternative Names:
    Icterus intermittens juvenilis; Low-grade chronic hyperbilirubinemia; Familial non-hemolytic – non-obstructive jaundice; Constitutional liver dysfunction; Unconjugated benign bilirubinemia
    Causes, incidence, and risk factors:
    Gilbert’s disease is common, affecting up to 10% of some Caucasian populations. The most significant symptom of this condition is jaundice. Affected individuals usually have no jaundice. However, jaundice appears under conditions of exertion, stress, fasting, and infections. The condition is usually benign.
    Review Date: 12/3/2001
    Reviewed By: Andrew J. Muir, M.D. M.H.S., Division of Gastroenterology, Duke University Medical Center, Durham, NC. Review provided by VeriMed Healthcare Network.
    .
    The information provided herein should not be used during any medical emergency or for the
    diagnosis or treatment of any
    medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions.
    Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute
    endorsements of those other sites. Copyright 2002 A.D.A.M., Inc.
    Any duplication or distribution of the information contained herein is strictly prohibited.

      The information contained in this web site is for educational
    purposes only and is not intended or implied to be a substitute for
    professional
    medical advice. Inclusion here does not imply any endorsement or
    recommendation by any hospital in the University of Maryland Medical
    System. Always seek the advice of your physician or other qualified
    medical provider for all medical problems prior to starting any new
    treatment.

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    “Too many people have been harmed to allow tonight’s vote to be the end”, the Wisconsin Republican said “In the coming weeks my committee will hold hearings to lay out the realities of our health care system, and I am committed to working with anyone who is serious about addressing these issues”. But they urged Senate leaders to take up an approach with both parties, rather than the Republican-only effort that characterized the various pushes to repeal or replace parts of the Affordable Care Act in recent weeks. If any change is to be made to U.S. healthcare law, Congress will have to begin the process of negotiating and writing a new bill again.

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    In the end, senators did not, as Lindsay Graham of SC said, want to vote for a “pig in a poke” simply for the exercise of passing something at the insistence of the president.

    McCain, who returned to the Senate this week as he deals with brain cancer, voted against it.

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    The early Friday morning vote came after a series of unsuccessful votes by Republicans this week to repeal Obamacare. Chris Coons, a Democrat from DE , had a feeling even earlier in the day that McCain may be on his side this time.

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    But the continued release of details, including Friday’s reveal by The Associated Press that a Russian-American lobbyist was also at the meeting, shows a White House that won’t recognize that it’s better to get all the details out at once.

    A former veteran of the Soviet army, who has always been part of a pro-Kremlin lobbying effort in Washington, said he also attended the June 2016 meeting between Donald Trump Jr. and a Russian lawyer.

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    “She’s been in touch with Chaika daily coordinating the Russian state attack against me”, Browder said in an interview with Business Insider on Friday.

    As for the identities of others who attended, there’s no indication or reason to believe that Trump Jr. remembered them a year after the fact. “This is an e-mail chain released by Donald Trump Jr. himself”. But in recent years, his lobbying work seemed to take on a singular focus: reversing the 2012 Magnitsky Act, a law passed by Barack Obama that infuriated Russia’s president, Vladimir Putin, and was created to punish Russia for the 2009 prison death of the Russian lawyer Sergei Magnitsky. “I just heard that a little while ago, but a little surprised to hear that”, Trump said in Paris.

    “Most people would’ve taken that meeting”, Trump said during a Thursday press conference in France, referring to the June 2016 confab.

    “This could be a good issue to expose how the D.N.C.is accepting bad money”, The AP quoted Akhmetshin recalling her saying.

    “They couldn’t wait for the meeting to end”, he added. Trump Jr.’s attorney did not respond to inquiries, nor did a spokesman for Kushner.

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    Caputo called the whole thing “collusion delusion”.

    The emails also show that Trump Jr. believed Veselnitskaya would “provide the Trump campaign with some official documents and information that would incriminate Hillary (Clinton) and her dealings with Russian Federation and would be very useful to your father”.

    He has said that as chairman of the House Foreign Affairs Subcommittee on Europe, Eurasia and Emerging Threats, he gathers information from a variety of sources and then weighs its accuracy.

    Trump’s campaign paid Parscale’s firm more than $90 million to advertise on social media, analyze data and perform other functions.

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    Enlarged prostate

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  • Overview
  • Symptoms
  • Treatment
  • Prevention
  • Alternative Names:

    BPH; Benign prostatic hypertrophy (hyperplasia); Prostate – enlarged

    Treatment:

    The choice of a treatment is based on the severity of your symptoms, the extent to which they affect your daily life, and the presence of any other medical conditions. Treatment options include “watchful waiting,” lifestyle changes, medication, or surgery.

    If you are over 60, you are more likely to have symptoms. But many men with an enlarged prostate have only minor symptoms. Self-care steps are often enough to make you feel better.

    If you have BPH, you should have a yearly exam to monitor the progression of your symptoms and determine if any changes in treatment are necessary.

    SELF-CARE

    For mild symptoms:

    • Urinate when you first get the urge. Also, go to the bathroom when you have the chance, even if you don’t feel a need to urinate.
    • Avoid alcohol and caffeine, especially after dinner.
    • Don’t drink a lot of fluid all at once. Spread out fluids throughout the day. Avoid drinking fluids within 2 hours of bedtime.
    • Try NOT to take over-the-counter cold and sinus medications that contain decongestants or antihistamines. These medications can increase BPH symptoms.
    • Keep warm and exercise regularly. Cold weather and lack of physical activity may worsen symptoms.
    • Learn and perform
      Kegel exercises
      (pelvic strengthening exercises).
    • Reduce stress. Nervousness and tension can lead to more frequent urination.

    Saw palmetto may ease prostate symptoms. Look for fat-soluble saw palmetto extract with 85-95% fatty acids and sterols.

    Sit in an aisle seat at the theatre or on an airplane. This won’t reduce your symptoms, but it may relieve your anxiety about having to urinate often or suddenly.

    If these measures are not enough to ease your symptoms, talk to your doctor, who may consider medications or surgery.

    MEDICATIONS

    • Finasteride lowers levels of hormones produced by the prostate, reduces the size of the prostate gland, increases urine flow rate, and decreases symptoms of BPH. It may take 3 to 6 months before you notice a significant improvement in your symptoms. Potential side effects related to use of finasteride include decreased sex drive and
      impotence
      .
    • Alpha 1-Blockers (like doxazosin, prazosin, tamsulosin, and terazosin) are a class of medications also used to treat
      high blood pressure
      . These medications relax the muscles of the bladder neck, allowing easier urination. Two thirds of the people treated with alpha 1-blocker medications report an improvement in symptoms.
    • Antibiotics may be prescribed to treat
      chronic prostatitis
      (inflammation of the prostate), which may accompany BPH. Some men note relief of their BPH symptoms after a course of antibiotics.

    SURGERY

    Prostate surgery may be recommended if you have:

    • Incontinence
    • Recurrent
      blood in the urine
    • Urinary retention
    • Recurrent
      urinary tract infections

    The choice of a specific surgical procedure is usually based on the severity of your symptoms and the size and shape of your prostate gland.


    • TURP:

      Transurethral resection of the prostate (TURP) is the most common surgical treatment for BPH. The TURP is performed by inserting a scope through the penis and removing the prostate piece by piece.

    • TUIP:

      Transurethral incision of the prostate (TUIP) is similar to TURP, but is usually performed in men who have a relatively small prostate. This procedure is usually performed as an outpatient without need for a hospital stay. Like the TURP, a scope is inserted through the penis until the prostate is reached. Then, rather than removal of the prostate, a small incision is made in the prostatic tissue to enlarge the opening of the urethra and bladder outlet.

    • Open Prostatectomy:

      An open prostatectomy is usually performed using general or spinal anesthesia. An incision is made through the abdomen or perineal area (i.e., through the pelvic floor, including the region from the scrotum to the anus). Then, the prostate is removed. This is a lengthy procedure, and it usually requires a hospital stay of 5 to 10 days.

    The majority of men who have prostate surgery have improvement in urine flow rates and symptoms. Possible complications include impotence, urinary incontinence, retrograde ejaculation (semen flowing back into the bladder rather than out the penis), infertility, and
    urethral stricture
    (narrowing). Rates of these complications vary, depending on the surgical procedure that you and your doctor decide is best.

    Various other procedures are available, such as those that destroy prostate tissue with heat generated by microwaves or lasers. Photoselective Vaporization of the Prostate (PVP), one of the newer laser technologies, is typically done as an outpatient procedure. The patient goes home on the same day. However, there is no long-term data for this procedure. Another form of treatment is prostatic
    stents
    .

    For more information, see
    prostate surgery
    .

    Support Groups:

    Several national groups provide information on BPH. See
    BPH support groups
    .

    Expectations (prognosis):

    Studies show that of the men who receive no treatment for BPH, as many as 31 to 55% actually show an improvement, and only 1 to 5% ever develop complications.

    Complications:

    Men who have had long-standing BPH with a gradual increase in symptoms may develop:

    • Sudden inability to urinate
    • Urinary tract infections
    • Urinary stones
    • Damage to the kidneys
    • Blood in the urine

    Even after surgical treatment, a recurrence of BPH may develop over time.

    Calling your health care provider:

    Call your doctor right away if you have:

    • Less urine than usual.
    • Fever or chills.
    • Back, side, or abdominal pain.
    • Blood or pus in your urine.

    Also call your doctor if:

    • Your bladder does not feel completely empty after you urinate.
    • You take medications that may cause urinary problems, like diuretics, antihistamines, antidepressants, or sedatives. DO NOT stop or adjust your medications on your own without talking to your doctor.
    • You have taken self-care measures for 2 months without relief.

    References:

    National Kidney and Urologic Diseases Information Clearinghouse. Prostate Enlargement: Benign Prostatic Hyperplasia. Available at:
    http://kidney.niddk.nih.gov/kudiseases/pubs/prostateenlargement/
    . Accessed May 18, 2005.

    Male reproductive anatomy

    Male reproductive anatomy