Written By
share_e
on
Monday, March 12, 2012
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5:31 PM
Definition
Multiple myeloma is cancer of the plasma cells in bone marrow.
Symptoms
Bleeding problems
Bone or back pain
Increased susceptibility to infection
Symptoms of anemia (such as tiredness, shortness of breath, and fatigue)
Unexplained fractures
Causes & Risk Factors
Plasma cells help the body's immune system fight disease by producing substances called antibodies. In multiple myeloma, plasma cells grow out of control and form tumors in the bone marrow.
The excess growth of plasma cells interferes with the body's ability to make red blood cells, white blood cells, and platelets. This causes anemia, which makes a person more likely to get infections and have abnormal bleeding.
As the cancer cells grow in the bone marrow, they can cause pain and destruction of the bones. If the bones in the spine are affected, it can put pressure on the nerves, resulting in numbness or paralysis.
Multiple myeloma mainly affects older adults. A history of radiation therapy raises your risk for this type of cancer.
Tests & Diagnostics
Blood tests can help diagnose this disease. They may include:
Blood chemistry (CHEM 20) may show increased levels of calcium, total protein, and abnormal kidney function
Complete blood count (CBC) reveals low numbers of red and white blood cells and platelets
Serum protein electropheresis (SPEP)
Urine protein electrophoresis (UPEP) or Bence-Jones protein analysis
Quantitative immunoglobulins (nephelometry)
Bone x-rays show fractures or hollowed out areas of bone. If your doctor suspects this type of cancer, a bone marrow biopsy will be performed.
Treatments
The goal of treatment is to relieve symptoms.
People who have mild disease or a questionable diagnosis are usually carefully monitored without treatment. Some people have a slow-developing form of multiple myeloma that takes years to cause symptoms.
Treatment begins when the disease becomes worse or causes symptoms.
Chemotherapy and radiation therapy may be performed to relieve bone pain or treat a bone tumor.
Bone marrow transplantation in younger patients has been shown to increase disease-free and overall survival, but it has significant risks.
Medications for multiple myeloma include decadron, melophalan, thalidomide, lenalidomide (Revlimid), and bortezomib (Velcade). Bisphosphonates are used to prevent fractures.
People with multiple myeloma should drink plenty of fluids to prevent dehydration and help maintain proper kidney function. They should also be cautious when having x-ray tests that use contrast dye.
Chemotherapy and transplants rarely lead to a permanent cure.
Complications
Kidney failure is a frequent complication. Other complications may include:
Bone fractures
Increased chances for infection (especially pneumonia)
Paralysis from tumor or spinal cord compression
Prevention
There are no clearly-established risk factors for multiple myeloma and it is possible that a combination of factors interact to cause the disease. Thus, there is no method for preventing multiple myeloma.
Osteoarthritis (OA) is the most common joint disorder.
Symptoms
The symptoms of osteoarthritis include:
Deep aching joint pain that gets worse after exercise or putting weight on it, and is relieved by rest
Pain that is worse when you start activities after a period of no activity
Over time, pain is present even when you are at rest
Grating of the joint with motion
Increase in pain during humid or moist weather
Joint swelling
Limited movement
Muscle weakness around arthritic joints
Some people might not have symptoms.
Causes & Risk Factors
In osteoarthritis, the cushioning (cartilage) between the bones wears away in the joints. As osteoarthritis gets worse, the cartilage disappears and bone rubs on bone. Bony spurs or growths usually form around the joint. The ligaments and muscles around the joint loosen and become weaker.
Often, the cause of OA is unknown. It is mainly related to aging, but other factors can also lead to OA.
Osteoarthritis tends to run in families
Being overweight increases the risk
Fractures or other joint injuries can lead to osteoarthritis later in life
Long-term overuse at work or in sports can lead to osteoarthritis
Medical conditions that can lead to osteoarthritis include:
Bleeding disorders that cause bleeding in the joint, such as hemophilia
Disorders that block the blood supply near a joint, such as avascular necrosis
Other types of arthritis, such as chronic gout, pseudogout, or rheumatoid arthritis
The symptoms of osteoarthritis usually appear in middle age and almost everyone has them by age 70. Before age 55, the condition occurs equally in men and women. After age 55, it is more common in women.
Tests & Diagnostics
A physical exam can show:
Joint movement may cause a cracking (grating) sound
Joint swelling (bones around the joints may feel larger than normal)
Limited range of motion
Tenderness when the joint is pressed
Normal movement is often painful
No blood tests are helpful in diagnosing osteoarthritis.
An x-ray of affected joints will show a loss of the joint space. In advanced cases, there will be a wearing down of the ends of the bone and bone spurs.
Treatments
The goals of treatment are to:
Increase the strength of the joints
Maintain or improve joint movement
Reduce the disabling effects of the disease
Relieve pain
The treatment depends on which joints are involved.
MEDICATIONS
Over-the-counter pain relievers can help with symptoms. Most doctors recommend acetaminophen (Tylenol) first, because it has fewer side effects than other drugs.
If your pain continues, your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs help relieve pain and swelling. Types of NSAIDs include aspirin, ibuprofen, and naproxen.
However, long-term use of NSAIDs can cause stomach problems, such as ulcers and bleeding. These drugs may also increase the risk for heart attacks and strokes.
The prescription drug, Celebrex (a COX-2 inhibitor) may work as well as other NSAIDs. Because of a risk for heart attacks and stroke, it is given only at the lowest possible dose for the shortest possible period of time.
Corticosteroids injected right into the joint can also be used to reduce swelling and pain. However, relief only lasts for a short time.
Many people use over-the-counter remedies such as glucosamine and chondroitinsulfate. There is some evidence that these supplements can help control pain, although they do not seem to grow new cartilage. Some doctors recommend a trial period of 3 months to see whether glucosamine and chondroitin work.
Capsaicin (Zostrix) skin cream may help relieve pain. You may feel a warm, stinging sensation when you first apply the cream. This sensation goes away after a few days of use. Pain relief usually begins within 1 - 2 weeks.
Artificial joint fluid (Synvisc, Hyalgan) can be injected into the knee. It may relieve pain for 3 - 6 months.
LIFESTYLE CHANGES
Exercise helps maintain joint and overall movement. Ask your health care provider to recommend an appropriate home exercise routine. Water exercises, such as swimming, are especially helpful.
Other lifestyle recommendations include:
Applying heat and cold
Eating a healthy, balanced diet
Getting rest
Losing weight if you are overweight
Protecting the joints
People whose work is causing stress in certain joints should find ways to reduce trauma. You may need to adjust the work area or change work tasks.
PHYSICAL THERAPY
Physical therapy can help improve muscle strength and the motion at stiff joints. Therapists have many techniques for treating osteoarthritis. If therapy does not make you feel better after 3 - 6 weeks, then it likely will not work at all.
BRACES
Splints and braces can sometimes support weakened joints. Some prevent the joint from moving; others allow some movement. You should use a brace only when your doctor or therapist recommends one. Using a brace the wrong way can cause joint damage, stiffness, and pain.
SURGERY
Severe cases of osteoarthritis might need surgery to replace or repair damaged joints. Surgical options include:
Arthroscopic surgery to trim torn and damaged cartilage
Changing the alignment of a bone to relieve stress on the bone or joint (osteotomy)
Surgical fusion of bones, usually in the spine (arthrodesis)
Total or partial replacement of the damaged joint with an artificial joint (knee arthroplasty, hip arthroplasty)
Drugs
Patients with mild OA may be treated only with pain relievers such as acetaminophen (i.e., Tylenol). Most patients with OA, however, are given nonsteroidal anti-inflammatory drugs (NSAIDs). These include compounds such as ibuprofen (e.g., Motrin, Advil), ketoprofen (e.g., Orudis), and naproxen (e.g. Naprosyn). NSAIDs have the advantage of relieving slight inflammation as well as pain. Patients taking NSAIDS, however, may experience side effects, including stomach ulcers, sensitivity to sun exposure, kidney disturbances, and nervousness/anxiety or depression. Topical capsaicin cream (e.g., AthriCare) may provide relief when applied to affected areas.
Some OA patients are treated with corticosteroids, which are injected directly into the joints to reduce inflammation. As of 2001, studies were being conducted regarding the use of hyaluronic acid, which is more commonly injected into the knee. Because the joint naturally contains some hyaluronic acid (for joint lubrication), the addition of extra hyaluronic acid can protect the joint, in some cases, for six months to one year.
Alternative Therapies
For more information and support, see arthritis resources.
Complications
Adverse reactions to drugs used for treatment
Decreased ability to perform everyday activities, such as personal hygiene, household chores, or cooking
A migraine is a common type of
headache that may occur with symptoms such as nausea, vomiting, or
sensitivity to light. In many people, a throbbing pain is felt only on
one side of the head.
Some people who get migraines have warning
symptoms, called an aura, before the actual headache begins. An aura is a
group of symptoms, usually vision disturbances, that serve as a warning
sign that a bad headache is coming. Most people, however, do not have
such warning signs.
Symptoms
Vision disturbances, or
aura, are considered a "warning sign" that a migraine is coming. The
aura occurs in both eyes and may involve any or all of the following:
A temporary blind spot
Blurred vision
Eye pain
Seeing stars or zigzag lines
Tunnel vision
Not every person with migraines has an aura. Those who do usually develop one about 10 - 15 minutes before the headache. However, it may occur just a few minutes to 24 hours beforehand.
Migraine
headaches can be dull or severe. The pain may be felt behind the eye or
in the back of the head and neck. For many patients, the headaches
start on the same side each time. The headaches usually:
Feel throbbing, pounding, or pulsating
Are worse on one side of the head
Start as a dull ache and get worse within minutes to hours
Last 6 to 48 hours
Other symptoms that may occur with the headache include:
Chills
Increased urination
Fatigue
Loss of appetite
Nausea and vomiting
Numbness, tingling, or weakness
Problems concentrating, trouble finding words
Sensitivity to light or sound
Sweating
Symptoms that may linger even after the migraine has gone away include:
Feeling mentally dull, like your thinking is not clear or sharp
Increased need for sleep
Neck pain
Causes & Risk Factors
A lot
of people get migraines -- about 11 out of 100. The headaches tend to
first appear between the ages of 10 and 46. Occasionally, migraines may
occur later in life in a person with no history of such headaches.
Migraines occur more often in women than men, and may run in families.
Women may have fewer migraines when they are pregnant. Most women with such headaches have fewer attacks during the last two trimesters of pregnancy.
A
migraine is caused by abnormal brain activity, which is triggered by
stress, certain foods, environmental factors, or something else.
However, the exact chain of events remains unclear.
Scientists
used to believe that migraines were due to changes in blood vessels
within the brain. Today, most medical experts believe the attack
actually begins in the brain itself, where it involves various nerve
pathways and chemicals. The changes affect blood flow in the brain and
surrounding tissues.
Migraine attacks may be triggered by:
Alcohol
Allergic reactions
Bright lights
Certain odors or perfumes
Changes in hormone levels (which can occur during a woman's menstrual cycle or with the use of birth control pills)
Changes in sleep patterns
Exercise
Loud noises
Missed meals
Physical or emotional stress
Smoking or exposure to smoke
Certain foods and preservatives in foods may trigger migraines in some people. Food-related triggers may include:
Any processed, fermented, pickled, or marinated foods
Baked goods
Chocolate
Dairy products
Foods containing monosodium glutamate (MSG)
Foods containing tyramine, which includes red wine, aged cheese, smoked fish, chicken livers, figs, and certain beans
Fruits (avocado, banana, citrus fruit)
Meats containing nitrates (bacon, hot dogs, salami, cured meats)
Nuts
Onions
Peanut butter
This list may not be all-inclusive. True migraine headaches are not a result of a brain tumor
or other serious medical problem. However, only an experienced health
care provider can determine whether your symptoms are due to a migraine
or another condition.
Tests & Diagnostics
Your
doctor can diagnose this type of headache by asking questions about your
symptoms and family history of migraines, and by monitoring how you
respond to treatment. A complete physical exam will be done to make sure that your headaches are not due to muscle tension, sinus problems, or a more serious underlying brain disorder.
Tests are usually not needed if you have typical signs and symptoms of migraines. However, your doctor may order a brain MRI or CT scan to rule out other causes.
If you have a migraine with unusual symptoms such as weakness, memory problems, or loss of alertness, an EEG may be needed to rule out seizures. Rarely, a lumbar puncture (spinal tap) might be done.
reatments
There is no specific cure for migraine headaches. The goal is to prevent symptoms by avoiding or changing your triggers.
A good way to identify triggers is to keep a headache diary. Write down:
When your headaches occur
How severe they are
What you've eaten
How much sleep you had
Other symptoms
Other possible factors (women should note where they are in their menstrual cycle)
For
example, the diary may reveal that your headaches tend to occur more
often on days when you wake up earlier than usual. Changing your sleep
schedule may result in fewer migraine attacks.
When you do get migraine symptoms, try to treat them right away. The headache may be less severe. When migraine symptoms begin:
Drink water to avoid dehydration, especially if you have vomited
Rest in a quiet, darkened room
Place a cool cloth on your head
Many different medications are available for people with migraines. Medicines are used to:
Reduce the number of attacks
Stop the migraine once early symptoms occur
Treat the pain and other symptoms
REDUCING ATTACKS If
you have frequent migraines, your doctor may prescribe medicine to
reduce the number of attacks. Such medicine needs to be taken every day
in order to be effective. Such medications may include:
Antidepressants such as amitriptyline
Blood pressure medicines such as beta blockers (propanolol) or calcium channel blockers (verapamil)
Seizure medication such as valproic acid and topiramate
Serotonin reuptake inhibitors (SSRIs) such as venlafaxine
STOPPING AN ATTACK Other medicines are taken at the first sign of a migraine attack. Over-the-counter pain medications such as acetaminophen, ibuprofen, or aspirin
are often helpful, especially when your migraine is mild. (Be aware,
however, that overuse or misuse of such pain medications may result in
rebound headaches.) If these don't help, ask your doctor about
prescription medications.
Your doctor can select from several different types of medications, including:
These medications come in different forms. Patients who have nausea and vomiting with their migraines may be prescribed a nasal spray or injection instead of pills.
Some migraine medicines narrow your blood vessels and should not be used if you are at risk for heart attacks or have heart disease, unless otherwise instructed by your health care provider. Ergots should not be taken if you are pregnant or planning to become pregnant, because they can cause serious side effects to an unborn baby.
TREATING SYMPTOMS Other
medications are primarily given to treat the symptoms of migraine. Used
alone or in combinations, these drugs can reduce your pain, nausea, or
emotional distress. Medications in this group include:
If you wish to consider an alternative, feverfew is a popular herb
for migraines. Several studies, but not all, support using feverfew for
treating migraines. If you are interested in trying feverfew, make sure
your doctor approves. Also, know that herbal remedies sold in
drugstores and health food stores are not regulated. Work with a trained
herbalist when selecting herbs.
Complications
Migraine
headaches generally represent no significant threat to your overall
health. However, they can be a long-term (chronic) problem and may
interfere with your day-to-day life.
Prevention
Understanding your
headache triggers can help you avoid foods and situations that cause
your migraines. Keep a headache diary to help identify the source or
trigger of your symptoms. Then modify your environment or habits to
avoid future headaches. Other tips for preventing migraines include:
Avoid smoking
Avoid alcohol
Avoid artificial sweeteners and other known food-related triggers
Written By
share_e
on
Sunday, March 11, 2012
|
10:17 PM
Gastroesophageal reflux disease (GERD) is a condition in which the
stomach contents (food or liquid) leak backwards from the stomach into
the esophagus (the tube from the mouth to the stomach). This action can
irritate the esophagus, causing heartburn and other symptoms.
Symptoms
More common symptoms are:
Feeling that food may be left trapped behind the breastbone
Heartburn or a burning pain in the chest (under the breastbone)
Increased by bending, stooping, lying down, or eating
More likely or worse at night
Relieved by antacids
Nausea after eating
Less common symptoms are:
Cough or wheezing
Difficulty swallowing
Hiccups
Hoarseness or change in voice
Regurgitation of food
Sore throat
Causes & Risk Factors
When
you eat, food passes from the throat to the stomach through the
esophagus (also called the food pipe or swallowing tube). Once food is
in the stomach, a ring of muscle fibers prevents food from moving
backward into the esophagus. These muscle fibers are called the lower
esophageal sphincter, or LES.
If this sphincter muscle doesn't
close well, food, liquid, and stomach acid can leak back into the
esophagus. This is called reflux or gastroesophageal reflux. This reflux
may cause symptoms, or can even damage the esophagus.
The risk factors for reflux include hiatal hernia
(a condition in which part of the stomach moves above the diaphragm,
which is the muscle that separates the chest and abdominal cavities), pregnancy, and scleroderma.
Obesity, cigarettes, and possibly alcohol also increase the chance of GERD.
Heartburn
and gastroesophageal reflux can be brought on or worsened by pregnancy
and many different medications. Such drugs include:
Anticholinergics (e.g., for seasickness)
Beta-blockers for high blood pressure or heart disease
Bronchodilators for asthma
Calcium channel blockers for high blood pressure
Dopamine-active drugs for Parkinson's disease
Progestin for abnormal menstrual bleeding or birth control
Sedatives for insomnia or anxiety
Tricyclic antidepressants
If
you suspect that one of your medications may be causing heartburn, talk
to your doctor. Never change or stop a medication you take regularly
without talking to your doctor.
Tests & Diagnostics
You may not need any tests if your symptoms are not severe.
If
your symptoms are severe or they come back after you have been treated,
one or more tests may help diagnose reflux or any complications:
Esophagogastroduodenoscopy
(EGD) is often used to identify the cause and examine the esophagus
(swallowing tube) for damage. The doctor inserts a thin tube with a
camera on the end through your mouth. The tube is then passed into your
esophagus, stomach, and small intestine.
Barium swallow
Continuous esophageal pH monitoring
Esophageal manometry
A positive stool occult blood test may diagnose bleeding from the irritation in the esophagus.
Treatments
To prevent heartburn, avoid foods and beverages that may trigger your symptoms. For many people, these include:
Alcohol
Caffeine
Carbonated beverages
Chocolate
Citrus fruits and juices
Tomatoes
Tomato sauces
Spicy or fatty foods
Full-fat dairy products
Peppermint
Spearmint
If other foods regularly give you heartburn, avoid those foods, too.
Also, try the following changes to your eating habits and lifestyle:
Avoid bending over or exercising just after eating
Avoid garments or belts that fit tightly around your waist
Do not lie down with a full stomach. For example, avoid eating within 2 -3 hours of bedtime.
Do not smoke.
Eat smaller meals.
Lose weight if you are overweight.
Reduce stress.
Sleep
with your head raised about 6 inches. Do this by tilting your entire
bed, or by using a wedge under your body, not just with normal pillows.
Over-the-counter
antacids may be used after meals and at bedtime, although they do not
last very long. Common side effects of antacids include diarrhea or
constipation.
Other over-the-counter and prescription drugs
can treat GERD. They work more slowly than antacids but give you longer
relief. Your doctor or nurse can tell you how to take these drugs.
Proton pump inhibitors (PPIs) are the most potent acid inhibitors: omeprazole (Prilosec), esomeprazole (Nexium), iansoprazole (Prevacid), rabeprazle (AcipHex), and pantoprazole (Protonix)
Anti-reflux operations (Nissen fundoplication
and others) may be an option for patients whose symptoms do not go away
with lifestyle changes and drugs. Heartburn and other symptoms should
improve after surgery, but you may still need to take drugs for your
heartburn. There are also new therapies for reflux that can be performed
through an endoscope (a flexible tube passed through the mouth into the stomach).
Complications
Barrett's esophagus (a change in the lining of the esophagus that can increase the risk of cancer)
Bronchospasm (irritation and spasm of the airways due to acid)
Chronic cough or hoarseness
Dental problems
Esophageal ulcer
Inflammation of the esophagus
Stricture (a narrowing of the esophagus due to scarring from the inflammation)
Prevention
Heartburn prevention techniques
Looking at the esophagus with an endoscope
and obtaining a sample of esophagus tissue for examination
(esophagoscopy with biopsy) may be recommended to diagnose Barrett's
esophagus.
Follow-up endoscopy to look for dysplasia or cancer is often advised.
Diabetes is a chronic (lifelong) disease marked by high levels of sugar in the blood.
Causes, incidence, and risk factors
Insulin
is a hormone produced by the pancreas to control blood sugar. Diabetes
can be caused by too little insulin, resistance to insulin, or both.
To
understand diabetes, it is important to first understand the normal
process by which food is broken down and used by the body for energy.
Several things happen when food is digested:
A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body.
An
organ called the pancreas makes insulin. The role of insulin is to move
glucose from the bloodstream into muscle, fat, and liver cells, where
it can be used as fuel.
People with diabetes have high blood sugar. This is because:
Their pancreas does not make enough insulin
Their muscle, fat, and liver cells do not respond to insulin normally
Both of the above
There are three major types of diabetes:
Type
1 diabetes is usually diagnosed in childhood. Many patients are
diagnosed when they are older than age 20. In this disease, the body
makes little or no insulin. Daily injections of insulin are needed. The
exact cause is unknown. Genetics, viruses, and autoimmune problems may play a role.
Type
2 diabetes is far more common than type 1. It makes up most of diabetes
cases. It usually occurs in adulthood, but young people are
increasingly being diagnosed with this disease. The pancreas does not
make enough insulin to keep blood glucose levels
normal, often because the body does not respond well to insulin. Many
people with type 2 diabetes do not know they have it, although it is a
serious condition. Type 2 diabetes is becoming more common due to
increasing obesity and failure to exercise.
Gestational diabetes is high blood glucose that develops at any time during pregnancy in a woman who does not have diabetes. Women who have gestational diabetes are at high risk of type 2 diabetes and cardiovascular disease later in life.
Diabetes affects more than 20 million Americans. Over 40 million Americans have prediabetes (early type 2 diabetes).
There are many risk factors for type 2 diabetes, including:
Age over 45 years
A parent, brother, or sister with diabetes
Gestational diabetes or delivering a baby weighing more than 9 pounds
Heart disease
High blood cholesterol level
Obesity
Not getting enough exercise
Polycystic ovary disease (in women)
Previous impaired glucose tolerance
Some ethnic groups (particularly African Americans, Native Americans, Asians, Pacific Islanders, and Hispanic Americans)
Symptoms
High blood levels of glucose can cause several problems, including:
Blurry vision
Excessive thirst
Fatigue
Frequent urination
Hunger
Weight loss
However, because type 2 diabetes develops slowly, some people with high blood sugar experience no symptoms at all.
Symptoms of type 1 diabetes:
Fatigue
Increased thirst
Increased urination
Nausea
Vomiting
Weight loss in spite of increased appetite
Patients
with type 1 diabetes usually develop symptoms over a short period of
time. The condition is often diagnosed in an emergency setting.
Symptoms of type 2 diabetes:
Blurred vision
Fatigue
Increased appetite
Increased thirst
Increased urination
Signs and tests
A urine analysis may be used to look for glucose and ketones from the breakdown of fat. However, a urine test alone does not diagnose diabetes.
The following blood tests are used to diagnose diabetes:
Fasting blood glucose level
-- diabetes is diagnosed if higher than 126 mg/dL on two occasions.
Levels between 100 and 126 mg/dL are referred to as impaired fasting
glucose or prediabetes. These levels are considered to be risk factors
for type 2 diabetes and its complications.
Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours. (This test is used more for type 2 diabetes.)
Random (non-fasting) blood glucose level
-- diabetes is suspected if higher than 200 mg/dL and accompanied by
the classic diabetes symptoms of increased thirst, urination, and
fatigue. (This test must be confirmed with a fasting blood glucose test.)
Persons with diabetes need to have their hemoglobin A1c (HbA1c)
level checked every 3 - 6 months. The HbA1c is a measure of average
blood glucose during the previous 2 - 3 months. It is a very helpful way
to determine how well treatment is working.
Treatment
The immediate goals are to treat diabetic ketoacidosis
and high blood glucose levels. Because type 1 diabetes can start
suddenly and have severe symptoms, people who are newly diagnosed may
need to go to the hospital.
The long-term goals of treatment are to:
Prolong life
Reduce symptoms
Prevent diabetes-related complications such as blindness, heart disease, kidney failure, and amputation of limbs
These goals are accomplished through:
Blood pressure and cholesterol control
Careful self testing of blood glucose levels
Education
Exercise
Foot care
Meal planning and weight control
Medication or insulin use
There is no cure for diabetes. Treatment involves medicines, diet, and exercise to control blood sugar and prevent symptoms.
LEARN THESE SKILLS
Basic diabetes management skills will help prevent the need for emergency care. These skills include:
How to recognize and treat low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia)
What to eat and when
How to take insulin or oral medication
How to test and record blood glucose
How to test urine for ketones (type 1 diabetes only)
How to adjust insulin or food intake when changing exercise and eating habits
How to handle sick days
Where to buy diabetes supplies and how to store them
After
you learn the basics of diabetes care, learn how the disease can cause
long-term health problems and the best ways to prevent these problems.
Review and update your knowledge, because new research and improved ways
to treat diabetes are constantly being developed.
SELF-TESTING
If you have diabetes, your doctor may tell you to regularly check your blood sugar levels
at home. There are a number of devices available, and they use only a
drop of blood. Self-monitoring tells you how well diet, medication, and
exercise are working together to control your diabetes. It can help your
doctor prevent complications.
The American Diabetes Association recommends keeping blood sugar levels in the range of:
80 - 120 mg/dL before meals
100 - 140 mg/dL at bedtime
Your doctor may adjust this depending on your circumstances.
WHAT TO EAT
You
should work closely with your health care provider to learn how much
fat, protein, and carbohydrates you need in your diet. A registered
dietician can help you plan your dietary needs.
People with type 1
diabetes should eat at about the same times each day and try to be
consistent with the types of food they choose. This helps to prevent
blood sugar from becoming extremely high or low.
People with type 2 diabetes should follow a well-balanced and low-fat diet.
HOW TO TAKE MEDICATION
Medications to treat diabetes include insulin and glucose-lowering pills called oral hypoglycemic drugs.
People
with type 1 diabetes cannot make their own insulin. They need daily
insulin injections. Insulin does not come in pill form. Injections are
generally needed one to four times per day. Some people use an insulin
pump. It is worn at all times and delivers a steady flow of insulin
throughout the day. Other people may use inhaled insulin. See also: Type 1 diabetes
Unlike
type 1 diabetes, type 2 diabetes may respond to treatment with
exercise, diet, and medicines taken by mouth. There are several types of
medicines used to lower blood glucose in type 2 diabetes. See also: Type 2 diabetes
Medications may be switched to insulin during pregnancy and while breastfeeding.
Gestational diabetes may be treated with exercise and changes in diet.
EXERCISE
Regular exercise is especially important for people with diabetes. It helps with blood sugar control, weight loss, and high blood pressure. People with diabetes who exercise are less likely to experience a heart attack or stroke than those who do not exercise regularly.
Here are some exercise considerations:
Always check with your doctor before starting a new exercise program.
Ask your doctor or nurse if you have the right footwear.
Choose an enjoyable physical activity that is appropriate for your current fitness level.
Exercise every day, and at the same time of day, if possible.
Monitor blood glucose levels before and after exercise.
Carry food that contains a fast-acting carbohydrate in case you become hypoglycemic during or after exercise.
Carry a diabetes identification card and a cell phone in case of emergency.
Drink extra fluids that do not contain sugar before, during, and after exercise.
You may need to change your diet or medication dose if you change your exercise intensity or duration to keep blood sugar levels from going too high or low.
FOOT CARE
People with diabetes are more likely to have foot problems. Diabetes can damage blood vessels and nerves and decrease the body's ability to fight infection. You may not notice a foot injury until an infection develops. Death of skin and other tissue can occur.
If left untreated, the affected foot may need to be amputated. Diabetes is the most common condition leading to amputations.
To prevent injury to the feet, check and care for your feet every day.
Expectations (prognosis)
With good blood glucose and blood pressure control, many of the complications of diabetes can be prevented.
Studies have shown that strict control of blood sugar, cholesterol, and blood pressure levels in persons with diabetes helps reduce the risk of kidney disease, eye disease, nervous system disease, heart attack, and stroke.
Complications
Emergency complications include:
Diabetic hyperglycemic hyperosmolar coma
Diabetic ketoacidosis
Long-term complications include:
Atherosclerosis
Coronary artery disease
Diabetic nephropathy
Diabetic neuropathy
Diabetic retinopathy
Erection problems
Hyperlipidemia
Hypertension
Infections of the skin, female urinary tract, and urinary tract
Peripheral vascular disease
Stroke
Calling your health care provider
Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of ketoacidosis:
Abdominal pain
Deep and rapid breathing
Increased thirst and urination
Loss of consciousness
Nausea
Sweet-smelling breath
Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of extremely low blood sugar (hypoglycemic coma or severe insulin reaction):
Confusion
Convulsions or unconsciousness
Dizziness
Double vision
Drowsiness
Headache
Lack of coordination
Weakness
Prevention
Maintaining an ideal body weight and an active lifestyle may prevent type 2 diabetes.
Currently there is no way to prevent type 1 diabetes.
There is no effective screening test for type 1 diabetes in people who don't have symptoms.
Screening for type 2 diabetes and people with no symptoms is recommended for:
Overweight children who have other risk factors for diabetes starting at age 10 and repeating every 2 years
Overweight adults (BMI greater than 25) who have other risk factors
Adults over 45, repeated every 3 years
To
prevent complications of diabetes, visit your health care provider or
diabetes educator at least four times a year. Talk about any problems
you are having.
Regularly have the following tests:
Have your blood pressure checked every year (blood pressure goals should be 130/80 mm/Hg or lower).
Have your glycosylated hemoglobin (HbA1c) checked every 6 months if your diabetes is well controlled, otherwise every 3 months.
Have your cholesterol and triglyceride levels checked yearly (aim for LDL levels below 100 mg/dL).
Get yearly tests to make sure your kidneys are working well (microalbuminuria and serum creatinine).
Visit your ophthalmologist (preferably one who specializes in diabetic retinopathy) at least once a year, or more often if you have signs of diabetic retinopathy.
See
the dentist every 6 months for a thorough dental cleaning and exam.
Make sure your dentist and hygienist know that you have diabetes.
Make sure your health care provider inspects your feet at each visit.
Stay up-to-date with all of your vaccinations and get a flu shot every year in the fall.
