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Edema and Diabetes

Diabetes Mellitus is another medical condition that can produce edema. As referenced in other articles, this edema is different from and should not be confused with lymphedema.

For reference and information, listed are several articles relating to diabetes and the various edemas associated with it.

Related Terms:  Type I Diabetes, Type II Diabetes, Edema, Lymphedema, Insulin, Glucose, Hyperglycemia, Juvenile Diabetes, Cardiovascular Disease, Neuropathy, Nephropathy, Insulin-dependent Diabetes Mellitus, IFG, Impaired Fasting Gluscose, HDL, Polycystic Ovarian Syndrome, Adult On-set Diabetes, Retinopathy, Diabetic Ketoacidosis, Hypoglycemia, Low Blood Sugar, Hypoglycemic Coma, Microvascular Disease, Peripheral Vasascular Disease, Diabetic foot problems, Non-insulin Dependent Diabetes Mellitus, Insulin Resistance, Fasting Plasma Glucose Test, FPG, Oral Glucose Tolerance Test, OGTT,  Random Plasma Glucose Test, RPGT, Pre-diabetes, Focal Macular Edema, Diffuse Macular Edema, Edema, Lymphedema

Discussion:

Diabetes is a condition that afflicts an estimated 18 million Americans which is a staggering 6.3% of the population. It is also one of the fastest growing medical conditions in the country, increasing rapidly in conjunction with the ever increasing amount of obesity.  In diabetes either the pancreas is unable to produce enough insulin or the cells in the muscle, liver, and fat do not efficiently use insulin.  Insulin is a hormone that enables the body to convert blood glucose (sugar), starches and other foods into energy. If the body is not able to produce this insulin, than glucose levels continue to rise in the blood (hyperglycemia) while at the same time the body cells are starved for energy.

Pre-Diabetes:

An estimated 40 million Americans have a condition known as pre-diabetes.  It is a condition where there is a consistent high level of glucose in the blood, yet is not high enough to be clinically diagnosed as full blown diabetes.  This elevated level will in many eventually lead to the condition itself.  Learning and checking glucose levels and changing life-style habit early can often prevent or delay the onset of diabetes.

Types of Diabetes:

Type I Diabetes is usually found or diagnosed in children and young adults. This was previously known as juvenile diabetes, or insulin-dependent diabetes mellitus.  In this type of diabetes the beta cells of the pancreas no longer make enough insulin because they have been destroyed by the body's immune system.

The exact cause of Type I Diabetes in unknown and accounts for approximately 3% of all new diagnosed cases per year.

In addition to general complications, Type I Diabetes may also have diabetic ketoacidosisIf insulin is not available for body fuel, then body fat is used instead. The by-product of this process is the production of ketones.  Ketones will eventually build up and become quite high in the urine.  The blood will become increasingly acidic (ketoacidosis).  Symptoms of ketoacidosis include increased thirst and urination, nausea, deep and rapid breathing, abdominal pain, sweet-smelling breath and loss of consciousness.  If this occurs immediate attention of a healthcare provider or emergency room services are required.

Another complication in Type I Diabetes may be hypoglycemiaWhen the balance between insulin, food intake and exercise is disturbed low blood glucose can occur, this is referred to as hypoglycemia. 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.

Symptoms of hypoglycemia include trembling, weakness, drowsiness, headache, confusion, dizziness, double vision, lack of coordination, convulsions and even unconsciousness can occur.   If these symptoms present, immediately go to the emergency room or call you local emergency number.

Type II Diabetes is the most commonly found type of diabetes.  This is referred to also as adult-onset diabetes or non-insulin dependent diabetes mellitus.   This form of diabetes is a chronic life-long condition.

A distinguishing feature of Type II Diabetes is insulin resistance. Fat and muscle cells are unable to absorb insulin that is produced by the pancreas. This in turn causes hyperglycemia which is an excess of insulin.  The cells respond in kind by becoming even more resistant creating a constant level of high glucose and high insulin.

Another feature of Type II Diabetes is that it may have no symptoms or warning signs.  Since family history and genetics play an important role in this form of diabetes, it is advisable to have your blood levels tested regularly.

Gestational Diabetes is the third form of this condition. This affects about 4% of all pregnant women and involve those who have high blood sugar during pregnancy and generally will present between the 24th and 28th week..  Gestational diabetes begins when your body is not able to produce the needed amount of insulin for pregnancy. This in turn leads to a build up of glucose in the body leading to hyperglycemia.

This condition is also referred to as carbohydrate intolerance and or glucose intolerance.

It is important for this condition to be treated readily, not only for the health of the mother, but because of the possible damage to the baby as well.  It causes increased perinatal complications including birth trauma, hypoglycemia and jaundice and may predispose the baby to develop diabetes later on in life.

Gestational diabetes will usually go away after delivery, but it can also make the mother more prone to develop Type II Diabetes.

Symptoms:

Symptoms for diabetes include excessive thirst, frequent urination, weight loss, blurred vision, increased hunger, frequent skin, bladder or gum infections; irritability, tingling or numbness in the hands or feet, slow to heal wounds, extreme unexplained fatigue. If you experience this combination of symptoms, it diabetes screening would be in order.

Who is at Risk:

People who are forty-five or older, overweight or obese individuals, thsoe who have previously been diagnosed with IFG (impaired fasting glucose), have a family history of diabetes, members of certain ethnic groups (including Asian-American, African American, Hispanic American and Native American), have had gestational diabetes,  elevated blood pressure, an HDL cholesterol level (good cholesterol) of 35 mg/dl or lower and/or a triglyceride of  250 mg/dl or higher, have polycystic ovarian syndrome, those who have a family history of cardiovascular disease.

Complications:

Complications associated with diabetes include heart disease  (cardiovascular disease), nerve damage (neuropathy), kidney damage (nephropathy), blindness (retinopathy), infections that may cause amputation of limbs, microvascular disease, peripheral vascular disease, diabetic foot problems, skin and mucus membrane problems.

Diagnosis:

Diabetes can be diagnosed using three simply blood tests.

The fasting plasma glucose (FPG) test measure blood glucose after fasting for a minimum of eights hours before the test.  Blood levels of 99 and below are normal.  Levels from 100 to 125 indicate pre-diabetes and levels of 126 indicates diabetes.

An oral glucose tolerance test (OGTT) shows blood glucose levels after eight hours of fasting and after two hours of drinking a glucose containing beverage. Blood levels after two hours of ingesting glucose of  139 or below is normal. Levels of 140 to 199 indicate pre-diabetes and levels of 200 and above indicate diabetes.

The random plasma glucose test reveals your blood glucose levels without regard to when you ate or drank last. Test result levels of 200 mg/dl in conjunction with other listed symptoms can indicate a diagnosis of diabetes.

Treatment and Management:

Diet, lifestyle, exercise and weight control are all critical factors in the successful management of diabetes. 

Medications will also be used to control diabetes.  All Type I diabetes will need to take insulin.

If you have Type II diabetes your body actually does make sufficient insulin, the probem arises because of the body's inability to metabolize it. After a few years however, your body may no longer be able to produce enough insulin and you may be  required to begin insulin administration.  There are also a number of oral medications available for Type II that help control glucose levels.  These include: (1)

Other treatments and medications used will be focused on the control of complications related to diabetes and the specifics will be strictly based upon the individual patient requirements and needs.

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Edema and Diabetes

There are three main types of edema associated with diabetes.  The causes of diabetic edema include cardiovascular disease and complications; Nephrotic Syndrome or acute renal failure; renal artery stenosis; acute liver failure, cirrhosis, chronic hepatitis; drugs used to treat diabetes and finally a mixture of other factors involving  protein losing enteropathy, thiamine deficiency, simple premenstrual fluid retention, pregnancy  and acute anaphylaxis.

Macular edema, is the swelling of the macular, an area near the center of the retina.  This area is responsible for fine or reading vision. This area is also involved in color perception and daytime vision.  Diabetic Retinopathy caused macular edema is a complication of diabetes.

It begins from the leaking of fluids from blood vessels in the macula.  The vision loss can progress causing eventual legal blindness.  There are two types of macular edemaThe first is called focal macular edema.   This edema is caused by vascular abnormalities, primarily micro aneurysms which cause the leakage.  Focal laser treatment (used to seal microaneursms) is used  treatment for this type of macular edema.  The second form of  is called diffuse macular edema and is caused by dilated retinal capillaries.  Grid laser treatment is used for this type and is applied to areas of retinal thickening in which there is diffuse leakage.  Again the focus is to seal leakages.

Pulmonary edema may also be experienced as a complication. This can come about due to accompanying cardiovascular disease or may even be caused by diabetic drugs  as reported in the September 2001 issue of the Mayo Clinic Proceedings.  Treatment for this edema involves insertion of a "catheter" to drain the fluids.

Foot and leg edema may be experienced from either venous insufficiency, cardiovascular disease, cardiomyopathy, liver conditions, or kidney complications.  Foot and leg edema may also increase the already high risk of non-healing wounds for the diabetic patient.  Treatment of this edema may include diuretics and manual decongestive therapy which moves fluids out of affected areas to where the body can eliminate them.  Subsequent to drugs and decongestive therapy compression garments or hosiery may be proscribed as well.  It is important to remember that the edema resulting as a complication of diabetes is not the same as lymphedema.

Swelling from lymphedema is a direct result of malformation of the lymph system (congenital and hereditary, or primary lymphedema) or damage, injury, trauma or destruction to the lymph system from infections, lymph node removal, radiation treatments to mention only a few causes. Treatment for lymphedema includes manual decongestive therapy, no diuretics, use of compression garments and compression bandagesSurgical management and compression pump therapy may also be used.

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Lymphedema and Diabetes

You can have both lymphedema and diabetes.  If you have both the swelling from lymphedema will be complicated by edema from the diabetes.  Because of the immunocompromised state of a lymphedema limb serious infections such as cellulitis, lymphangitis and lymphadenitis are constant threats.  Your risk of infection will double when diabetes is added to this mixture.  Finally in both conditions patients face a heightened risk of non-healing wounds.  It is thus critical that lymphedema patients who also have diabetes to do all they can to lower their risk of complications from diabetes.  Learn the causative risk factors for diabetes and develop a life-style that will help decrease the problems associated with this condition.

Limiting Risk Factors for Diabetes and Diabetic Complications:

Weight:  Lymphedema does not cause obesity or morbid obesity.  But, both can cause lymphedema and can not only contribute to being diagnosed with diabetes, but can  add serious complications to it.  Its plain and simple - loose that weight!

Diet:  Unhealthy diets rich in fats, sugars, cholesterols complicates lymphedema and helps contribute to cardiovascular disease which complicates diabetes..  Limit (I would even say drastically) your consumption of those types of foods.  Diet is also important in preventing high blood pressure which is another causative factor of vascular disease..

Smoking:  While smoking has nothing to do with lymphedema, it is an important contributing factor in congestive heart failure, pleural disease such as COPD  (not to mention cancers and other conditions).

Alcohol:  Excessive use of alcohol complicates lymphedema and is an important contributor to liver diseases which can cause diabetic edema.  Limit your consumption!!

Exercise:  The human body was not designed to be a couch potato.  Proper and consistent exercise is one key to remaining healthy. Lymph fluid pumps through your body by muscular action.  Exercise will help lymphedema and will help prevent diabetic complications.

Just because you have lymphedema does not mean you need to quit either life nor activities. Many lymphedema patients complain the pain is one factor that stops them from many activities. Trust me, with severe stage three hereditary lymphedema and with two lymphomas, I know full well the affects of pain on your body, mind and emotions.  But the fact is that you must keep going and must get exercise.

Caffeine:  Caffeine acts as a diuretic which is contraindicated for lymphedema patients.  it also is a stimulant causing the heart to work harder.  Limit your intake.

Salt:  Salt (sodium chloride) contributes to fluid retention (edema and lymphedema), contributes to hypertension and congestive heart failure, both of which can cause complications for the diabetic.  Maintaining a low salt intake is important in the control of both conditions and in maintaining health.

Sugar: Of course, it goes without saying that it is critical you control of sugar intake if you have diabetes, but it would be a good idea with lymphedema (or with over all health) to restrict sugar consumption anyway.  Remember, sugar is an empty calorie that does not build healthy tissues, build muscles, heal wounds, sores, or infections, generally has no protein content or any other nutritional value.  Save those calories for foods that help heal and maintain health.

Lymphedema and Diabetes

Comparison:

                   Diabetes                                                Lymphedema

Pain:             Yes, from complications                       Can be severe due to nerve compression

Swelling:     Yes, complication of                              Yes, can affect all or part of limb  

Infections:   Yes, from ulcerations                            Yes, typically cellulitis, see below

Fluids:           Hematolgic Fluids                                Protein rich lymphatic fluids

Skin:              From wounds, infections                     Discolorations, growths, hardening

Leg Ulcers:  Yes, hard to heal                                  Yes, also wounds from skin changes

Fibrosis:        No                                                         Yes, extending into subcutaneous tissues

Neuropathy: Yes                                                       Yes

Special Considerations for Patients with Lymphedema and Diabetes

Treatment: Should you have diabetes and lymphedema, it becomes even more important that you learn the proper treatment for both.  The gold standard protocol is manual lymphatic drainage  (also referred to as either Manual Decongestive Therapy,  Complex or Complete Decongestive Therapy).

Insulin injections:   These should not be given in limbs (arms) affected by lymphedema.  There are two basic reasons for this.  First, an injection is a skin break creating an entry foci for bacteria. Secondly, the excess fluid and fibrotic nature of the lymphedema limb will not only improperly dilute the insulin and can prevent its proper absorption into the body.  When giving an injection always swab the injection site with either alcohol or another astringent.

Testing Blood Glucose Levels:   These glucose tolerance tests are absolutely necessary with diabetes.  However, they should not be done on a lymphedema limb.  Again for two basic reasons.  First, the piercing is a skin break creating a possible entry point for bacteria.  Secondly, the excess fluid of the lymphedema limb in conjunction with the fluid composition may give a false or inaccurate reading.

Infections: Remember that In lymphedema, the effected limb is immunodeficient or immunocompromised so in both conditions, the patient is at an increased risk for infections.  Visual inspection of limbs is important. But, also learn the early warning signs of infections that at the very earliest signs antibiotic treatment can begin.  Also, with lymphedema patients it should be standard protocol to have an emergency bottle of antibiotics, prescribed by their physician on hand.

Early warnings signs of infections (cellulitis, lymphangitis) include all over body aching (much like the flu), excess and unexplained energy drain and or unexplained lethargy, susceptibility and sensitive to cold, increased urination, unusual sharp pain in the lymphedema limb, any sudden appearance of red spots, streaks, rash like areas or blotches. Besides cellulitis and  lymphangitis, the third significant infection we get is erysipelas.  You can get a overall rundown on bacterial infections by reading our page Infections Associated with Lymphedema and on fungal infections from our page Fungal Infections Associated with Lymphedema. You might also want to read our page Lymphedema Antibiotics, so that should you get an infection, you'll be informed on what antibiotics the doctors might use

It also would be wise to be under the care of an infectious disease doctor.  These are highly trained specialists who know how to recognize, treat and cure infections.

Skin care:  Proper skin care is essential for the lymphedema patient and becomes even more so when they also have diabetes.  In both situations the skin can be thin (stretched from edema and lymphedema), become excessively dry and begin to crack and or peel.  It is important to use a moisturizing lotion to keep the skin healthy, supple and moist.  Lotions should include nutrients like vitamin E, Aloe and zinc.  Vasoline as a petroleum based ointment clogs the pores and prevents the skin from breathing.  It should not be used.

Wounds and ulcerations: In both conditions patients suffer from wounds and ulcerations and in both are hard to heal and easy to become infected.  In either conditions wounds can quickly have uncontrolled infections that can lead to gangrene, amputation or death.  Any wound no matter how small must be treated quickly and efficiently.  Because the wounds are going to be difficult to heal, it may be necessary for the patient to seek treatment at a wound care clinic. For information on wound care see: How to Treat a Lymphedema Wound

Bandaging:  Even with diabetes, lymphedema patients will need to continue bandaging.  You will need to work with your therapist, in your particular situation to learn how to bandage.  I have horrible neuropathy in one area of my left leg, while hypersensitivity in other areas.  Learn to use the appropriate compression by sight and by how you wrap.  Your therapist can work with you in this area. See also: Compression Bandages for Lymphedema, Short Stretch Bandages are for Lymphedema, Compression Garments for Lymphedema, Lymphedema Sleeves, and Farrow Wrap.

Exercise: This is an important part of not only lymphedema and diabetic management, but in over-all general health as well. There is some type of exercise just about anyone can do, regardless of their physical limitations.  It is simply a matter of finding what is best for you and being committed to a systematic exercise program. Our page Exercises for Lymphedema goes into detail on various exercise options and has enumerable links for various types of exercises.

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Type II Diabetes

Definition

A chronic  disease that results when the body's insulin does not work effectively. Insulin is a hormone released by the pancreas in response to increased levels of blood sugar (glucose) in the blood.

Alternative Names

Noninsulin-dependent diabetes mellitus; Diabetes - Type II

Causes, incidence, and risk factors

Diabetes mellitus, a life-long disease for which there is not yet a cure, is caused by a problem in the way the body makes or uses insulin. Insulin is necessary for glucose to move from the blood to the inside of the cells.

Unless glucose gets into cells, the body cannot use it for energy. Excess glucose remains in the blood, and is then removed by the kidneys. Symptoms of excessive thirst, frequent urination, hunger, fatigue, and weight loss develop.

There are several types of diabetes: type I diabetes, which requires total insulin replacement in order to live; type II diabetes, which is related to insulin resistance, obesity, high cholesterol, and high blood pressure; and gestational diabetes mellitus, which occurs during pregnancy. Diabetes affects up to 6% of the population in the U.S. and type II diabetes accounts for 90% of all cases.

A main component of type II diabetes is insulin resistance at the level of the fat and muscle cells. This means the insulin produced by the pancreas cannot connect with cells to let glucose inside and produce energy. This causes hyperglycemia (high blood glucose).

To compensate, the pancreas produces more insulin. The cells sense this flood of insulin and become more resistant, resulting in high glucose levels and often times high insulin levels.

A person with type II diabetes often does not require insulin injections. The primary treatment is exercise and diet. Type II diabetes usually occurs gradually. Some 75% to 80% of people with type II diabetes are obese at the time of diagnosis. However, the disease can also develop in lean people, especially the elderly.

Genetics play a large role in type II diabetes and family history is a risk factor. However, environmental factors (such as a low activity level and poor diet) can increase a person's risk for type II diabetes.

Other risk factors are as follows: race/ethnicity (African-Americans, Hispanic-Americans, Native Americans, Asian-Americans, Pacific Islanders); age greater than 45 years; previously identified impaired glucose tolerance; hypertension (high blood pressure); HDL cholesterol of less than 35 and/or triglyceride level of greater than 250; history of gestational diabetes mellitus or babies over nine pounds.

Symptoms

Symptoms of type II diabetes include:

Note: There may be no symptoms or symptoms may develop slowly.

Signs and tests

Type II diabetes is diagnosed when:

Treatment

At diagnosis, the goals of treatment are to eliminate symptoms of hyperglycemia, stabilize blood glucose, and restore normal body weight. The ongoing goals of treatment are to prolong life, relieve symptoms, and prevent long-term complications.

These goals are achieved through diabetes education, self-monitoring of blood glucose (SMBG), careful dietary management, weight control, regular physical activity  medication, proper foot care, and continuing care.

EDUCATION

Diabetes education is an important part of a treatment plan. Diabetes educators and health care providers can teach essential skills needed after initial diagnosis of the disease. Appropriate education teaches a person with diabetes how to incorporate diabetes management principles into daily life and reduce need for medical treatment.

Basic principles include:

Learning the basic principles of diabetes self-care and establishing a routine may take several months. Once the condition has been stabilized, in-depth diabetes education programs can help the diabetic learn more about the disease process, learn how to control and live with diabetes, and learn more about intermediate and long-term complications of the disease and how to minimize them. Annual review of diabetic education is recommended to help the diabetic stay current on new research and treatment.

SELF-TESTING

Blood sugar testing, or self-monitoring of blood glucose, is done by checking the glucose content of a small drop of blood. Regular testing tells the person with diabetes how well diet, medication, and exercise are working together to control diabetes.

The results of the test can be used to adjust meals, activity, or medications to keep blood sugar levels in an appropriate range. Testing provides valuable information for the health care provider and identifies high and low blood sugar levels before serious problems develop.

There is one method of testing blood glucose measurements at home. A glucometer is a small machine that provides an exact reading of blood glucose. A test strip is used to collect a small drop of blood, obtained by pricking the finger with a small, specially-designed needle.

The strip is then placed in the meter. Results are available in 30 to 45 seconds. A health care provider or diabetes educator will help set up an appropriate testing schedule.

Tests are usually done before meals and at bedtime. More frequent testing may be indicated during illness or stress. Accurate record keeping of test results will make the testing more useful for planning the care of the person with diabetes.

DIETARY MANAGEMENT AND WEIGHT CONTROL

Meal planning includes choosing healthy foods, eating the right amount of food, and eating meals at the right time. The American Diabetes Association (ADA) currently recommends that 50% to 60% of a person's diet should come from carbohydrates, 10% to 20% from lean sources of protein, and less than 30% from fats.

The exact breakdown of these percentages is different for each individual. The ADA no longer recommends a diet of 1,800 to 2,000 calories a day for all patients. A registered dietitian can be helpful in determining an individual's specific dietary needs.

In type II, weight management and a  well-balanced diet  are important. Some people with type II diabetes can discontinue medications after intentional weight loss, although the diabetes is still present. Consultation with a registered dietitian is an invaluable planning tool.

REGULAR PHYSICAL ACTIVITY

Regular exercise is important for everyone, but especially for people with diabetes. Regular exercise helps control the amount of glucose in the blood. It also helps burn excess calories and fat to achieve optimal weight.

Exercise improves overall health by improving blood flow and  blood pressure. It naturally decreases insulin resistance even without weight loss. Exercise also increases the body's energy level, lowers tension  , and improves a person's ability to handle stress . Everyone should obtain medical approval before starting an exercise program, but this is especially important if you have diabetes.

The following should be considered:

MEDICATION

When the person with type II diabetes cannot achieve normal or near-normal blood glucose levels with diet and exercise, medication is added to the treatment plan. A person with diabetes may require oral agents.

These medications are taken by mouth, to lower blood glucose levels. They do not contain insulin themselves, so they are not helpful for Type I diabetes. Some people may find they no longer need medication if they lose weight and increase activity, because when their ideal weight is reached their own insulin can control their blood sugar. Medications are usually not given in pregnancy . They include:

Insulin is also used in people with type II diabetes who have poor blood glucose control with oral hypoglycemic agents or bad reactions to oral hypoglycemic agents. Insulin must be injected under the skin using a syringe and cannot be taken orally.

Insulin preparations differ in how fast they start to work and how long they work. The health-care professional measures blood glucose to determine the appropriate type of insulin to use.

More than one type may be mixed together in an injection to achieve the best control of blood glucose. The injections are needed, in general, from one to four times a day. People requiring insulin injections are taught how to give themselves injections by their health care provider or a diabetes educator referred by their provider.

FOOT CARE

People with diabetes are prone to foot problems because of complications caused by damage to blood vessels and nerves and decreased ability to fight infection. Blood flow to the feet may become compromised and damage to the nerves may cause an injury to the foot to go unnoticed until infection develops. Death of skin and other tissue can occur. If left untreated, amputation of the affected foot may be necessary.

To prevent injury to the feet, diabetics should adopt a daily routine of checking and caring for the feet as follows:

CONTINUING CARE:

A person with type II diabetes should have a visit with a diabetes care provider every three months. A thorough three-month evaluation includes:

The following evaluations should be done annually, unless otherwise indicated:

Support Groups

The stress of illness can often be helped by joining a support group where members share common experiences and problems. 

Expectations (prognosis)

For many years, physicians thought that the long-term complications of diabetes were inevitable. We now know this does not have to be true for most people.

The United Kingdom Prospective Diabetes Study (UKPDS) was completed in 1997. It followed close to 4,000 people with type II diabetes for 10 years. The study monitored how tight control of blood glucose (meaning a HbA1c of 7%) and tight control of blood pressure (meaning a blood pressure of less than 144 over less than 82) could protect a person from the long-term complications of diabetes.

At the end of the 10 years, the study showed that those people with the best control of blood glucose and blood pressure had a 32% decreased risk of all diabetes-related deaths, a 44% decreased risk of stroke, a 56% decreased risk of heart failure, and a 37% decreased risk for micro-vascular (small blood vessel) complications.

The study also found that for every one percentage-point decrease in HbA1c, a person could decrease his risk for all complications by 25%. The UKPDS dramatically demonstrated that with good self-care skills, blood glucose control, and blood pressure control, many complications can be prevented.

Complications

Emergency complications include nonketotic hyperosmolar coma (see diabetic hyperglycemic hypersmolar coma ).

Long-term complications include:

Calling your health care provider

Call the health care provider if symptoms of insulin reaction are present:

This can rapidly progress to emergency conditions (such as convulsions, unconsciousness, or hypoglycemic coma).

Prevention

Maintaining ideal body weight weight management and an active lifestyle may prevent the onset of type II diabetes in people at risk for the disease

Last Reviewed: 5/1/2002 by Todd T. Brown, M.D., Division of Endocrinology and Metabolism, Johns Hopkins Hospital, Baltimore, MD. Review provided by VeriMed Healthcare Network.

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Gestational Diabetes

Gestational (jes-TAY-shun-ul) diabetes is diabetes that is found for the first time when a woman is pregnant. Out of every 100 pregnant women in the United States, three to eight get gestational diabetes. Diabetes means that your blood glucose (also called blood sugar) is too high. Your body uses glucose for energy. But too much glucose in your blood can be harmful. When you are pregnant, too much glucose is not good for your baby.

This booklet is for women with gestational diabetes. If you have type 1 or type 2 diabetes and are considering pregnancy, call the National Diabetes Information Clearinghouse at 1–800–860–8747 for more information and consult your health care team before you get pregnant.

What causes gestational diabetes?

Changing hormones and weight gain are part of a healthy pregnancy. But both changes make it hard for your body to keep up with its need for a hormone called insulin. When that happens, your body doesn't get the energy it needs from the food you eat.

What is my risk of gestational diabetes?

To learn your risk for gestational diabetes, check each item that applies to you. Talk with your doctor about your risk at your first prenatal visit.

(1) I have a parent, brother, or sister with diabetes (2) I am African American, American Indian, Asian American, Hispanic/Latino, or Pacific Islander. (3) I am 25 years old or older. (4) I am overweight. (5) I have had gestational diabetes before, or I have given birth to at least one baby weighing more than 9 pounds. (6) I have been told that I have "pre-diabetes," a condition in which blood glucose levels are higher than normal, but not yet high enough for a diagnosis of diabetes. Other names for it are "impaired glucose tolerance" and "impaired fasting glucose."

If you checked any of these risk factors, ask your health provider about them

When will I be checked for gestational diabetes?

Your doctor will decide when you need to be checked for diabetes depending on your risk factors.

How is gestational diabetes diagnosed?

Your health care team will check your blood glucose level. Depending on your risk and your test results, you may have one or more of the following tests.

Fasting blood glucose or random blood glucose test

Your doctor may check your blood glucose level using a test called a fasting blood glucose test. Before this test, your doctor will ask you to fast, which means having nothing to eat or drink except water for at least 8 hours. Or your doctor may check your blood glucose at any time during the day. This is called a random blood glucose test.

These tests can find gestational diabetes in some women, but other tests are needed to be sure diabetes is not missed.

Screening glucose challenge test

If you have this test, your health care provider will give you special instructions to follow. For at least 3 days before the test, you should eat normally. Then you will fast for at least 8 hours before the test.

The health care team will check your blood glucose level before the test. Then you will drink a sugary beverage. The staff will check your blood glucose levels 1 hour, 2 hours, and 3 hours later. If your levels are above normal at least twice during the test, you have gestational diabetes.

Above-normal results for the oral glucose tolerance test*
Fasting 95 or higher
At 1 hour 180 or higher
At 2 hours 155 or higher
At 3 hours 140 or higher
Note: Some labs use other numbers for this test.
*These numbers are for a test using a drink with 100 grams of glucose.

How will gestational diabetes affect my baby?

Untreated or uncontrolled gestational diabetes can mean problems for your baby, such as

If you have gestational diabetes, your health care team may recommend some extra tests to check on your baby, such as

Working closely with your health care team will help you give birth to a healthy baby.

Both you and your baby are at increased risk for type 2 diabetes for the rest of your lives.

How will gestational diabetes affect me?

Often, women with gestational diabetes have no symptoms. However, gestational diabetes may

The good news is your gestational diabetes will probably go away after your baby is born. However, you will be more likely to get type 2 diabetes later in your life. (See the information on how to lower your chances of getting type 2 diabetes.) You may also get gestational diabetes again if you get pregnant again.

Some women wonder whether breastfeeding is OK after they have had gestational diabetes. Breastfeeding is recommended for most babies, including those whose mothers had gestational diabetes.

Gestational diabetes is serious, even if you have no symptoms. Taking care of yourself helps keep your baby healthy.

How is gestational diabetes treated?

Treating gestational diabetes means taking steps to keep your blood glucose levels in a target range. You will learn how to control your blood glucose using

Meal Plan

You will talk with a dietitian or a diabetes educator who will design a meal plan to help you choose foods that are healthy for you and your baby. Using a meal plan will help keep your blood glucose in your target range. The plan will provide guidelines on which foods to eat, how much to eat, and when to eat. Choices, amounts, and timing are all important in keeping your blood glucose levels in your target range.

You may be advised to

For more about meal planning, call the National Diabetes Information Clearinghouse for a copy of What I need to know about Eating and Diabetes.

Physical Activity

Physical activity, such as walking and swimming, can help you reach your blood glucose targets. Talk with your health care team about the type of activity that is best for you. If you are already active, tell your health care team what you do.

Insulin

Some women with gestational diabetes need insulin, in addition to a meal plan and physical activity, to reach their blood glucose targets. If necessary, your health care team will show you how to give yourself insulin. Insulin is not harmful for your baby. It cannot move from your bloodstream to the baby's.

How will I know whether my blood glucose levels are on target?

Your health care team may ask you to use a small device called a blood glucose meter to check your levels on your own. You will learn

You may be asked to check your blood glucose: 

The following chart shows blood glucose targets for most women with gestational diabetes. Talk with your health care team about whether these targets are right for you.

Blood glucose targets for most women with gestational diabetes
On awakening not above 95
1 hour after a meal not above 140
2 hours after a meal not above 120

Each time you check your blood glucose, write down the results in a record book. Take the book with you when you visit your health care team. If your results are often out of range, your health care team will suggest ways you can reach your targets.

ll I need to do other tests on my own?

Your health care team may teach you how to test for ketones (KEE-tones) in your morning urine or in your blood. High levels of ketones are a sign that your body is using your body fat for energy instead of the food you eat. Using fat for energy is not recommended during pregnancy. Ketones may be harmful for your baby.

If your ketone levels are high, your health care providers may suggest that you change the type or amount of food you eat. Or you may need to change your meal times or snack times

Will I need to do other tests on my own?

Your health care team may teach you how to test for ketones (KEE-tones) in your morning urine or in your blood. High levels of ketones are a sign that your body is using your body fat for energy instead of the food you eat. Using fat for energy is not recommended during pregnancy. Ketones may be harmful for your baby.

If your ketone levels are high, your health care providers may suggest that you change the type or amount of food you eat. Or you may need to change your meal times or snack times.

After I have my baby, how can I find out whether my diabetes is gone?

You will probably have a blood glucose test 6 to 12 weeks after your baby is born to see whether you still have diabetes. For most women, gestational diabetes goes away after pregnancy. You are, however, at risk of having gestational diabetes during future pregnancies or getting type 2 diabetes later.

How can I prevent or delay getting type 2 diabetes later in life?

You can do a lot to prevent or delay type 2 diabetes.

Remind your health care team to check your blood glucose levels regularly. Women who have had gestational diabetes should continue to be tested for diabetes or pre-diabetes every 1 to 2 years. Diagnosing diabetes or pre-diabetes early can help prevent complications such as heart disease later.

Your child’s risk for type 2 diabetes may be lower if you breastfeed your baby and if your child maintains a healthy weight.

Where can I get more information?

Diabetes Teachers (nurses, dietitians, and other health professionals)
To find a diabetes teacher near you, call the American Association of Diabetes Educators toll-free at 1–800–TEAMUP4 (1–800–832–6874). Or go to www.diabeteseducator.org and click on "Find a Diabetes Educator."

Dietitians
To find a dietitian near you, call the American Dietetic Association's National Center for Nutrition and Dietetics at 1–800–877–1600. Or go to www.eatright.org and click on "Find a Nutrition Professional."

Health Information
To learn more about pregnancy, contact the National Institute of Child Health and Human Development (NICHD), part of the National Institutes of Health. Call NICHD toll-free at 1–800–370–2943. Or go to www.nichd.nih.gov.

For more information about diabetes, contact the National Diabetes Information Clearinghouse (NDIC) for free copies of these publications or read them online:

Managing Diabetes
What I need to know about Diabetes Medicines
What I need to know about Eating and Diabetes
What I need to know about Physical Activity and Diabetes
Your Guide to Diabetes: Type 1 and Type 2

Preventing Type 2 Diabetes
Am I at Risk for Type 2 Diabetes?
Small Steps. Big Rewards. Your GAME PLAN for Preventing Type 2 Diabetes

Acknowledgments

The NDIC would like to thank the following individuals who provided editorial guidance or facilitated field-testing of this publication.

Boyd E. Metzger, M.D. - Northwestern University - Evanston, IL

Susan A. Biastre, R.D - Women & Infants' Hospital - Providence, RI

Beverly Gardner, R.D., L.D.N., C.D.E. - Outpatient Nutrition & Diabetes Education Center - Durham Regional Hospital
Durham, NC

National Diabetes Information Clearinghouse (NDIC)

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Clinical Studies and Abstracts:

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Association between Diabetes Mellitus and Hypertension with Anthropometric Indicators in Older Adults: Results of the Mexican Health Survey, 2000.

J Nutr Health Aging. 2008

Sanchez Viveros S, Barquera S, Medina Solis CE, Velazquez Alva MC, Valdez R.

S Barquera, Head of the Chronic Diseases and Diet Department - Nutrition and Health Research Center, Instituto Nacional de Salud Publica, Av. Universidad No. 655. Col. Sta. Ma. Ahuacatitlan, Cuernavaca, Mor. – Mexico. CP. 62508, Tel. +777 329-3017 Fax +777 311-2219, sbarquera@insp.mx.

Objective: To determine the association between anthropometric indicators of adiposity with type 2 diabetes mellitus (T2DM) and hypertension (HTN) in older adults. Design: Cross-sectional study of participants of the Mexican Health Survey 2000 (MHS). Setting: Mexico, subjects recruited from the general community. 

Participants: The analytic sample included 7,322 adults who were >/= 60 years of age at the time of the survey. T2DM data were available on 6,994 individuals, who represent 95.5% of the original sample; data on HTN was available on 6,268 subjects, which accounted for 86.5% of the original sample. 

Measurements: Type 2 diabetes mellitus and hypertension, as well as anthropometric indicators including body mass index (BMI), waist circumference (WC), and conicity index (CI). Results: The prevalence of T2DM and HTN in this age group was 34.3% and 73.9%, respectively. After adjusting for other variables, the association between high WC and T2DM (OR=1.59 95%CI=1.26-2.01, P < 0.001) was stronger than the association with overweight (OR=1.26, 95%CI= 1.01-1.58, P=0.04) and obesity (OR=1.38, 95%CI= 1.08-1.79, P < 0.01) using BMI, and slightly higher than tertile 2 of the CI (OR=1.49, 95%CI=1.20-1.88, P < 0.01), while tertile 3 showed a stronger association with T2DM (OR=1.60, 95%CI=1.22-2.08, P < 0.001). However, the association between obesity and HTN measured by BMI (OR=1.98, 95%CI=1.48-2.65, P < 0.001) was stronger than what was observed with overweight (OR=1.42, 95%CI 1.13-1.77, P < 0.01), with high WC (OR=1.62, 95%CI=1.25-2.10, P < 0.001) and tertiles 2 and 3 of the CI (OR=1.23, 95%CI=0.99-1.55, P= 0.09); (OR=1.53, 95%CI= 1.16-2.03, P < 0.01) respectively.

Conclusions: BMI and abdominal obesity are significantly and independently associated with an increase in the prevalence of T2DM and HTN among older Mexican adults.

PMID: 18443716 [PubMed - as supplied by publisher]

.........................................................................................................

Ocular blood flow in diabetes and age-related macular degeneration.

Can J Ophthalmol. 2008 Jun

Pemp B, Schmetterer L.

ABSTRACT * RESUMEThe 2 leading causes of blindness in adults in the industrialized nations, diabetic retinopathy and age-related macular degeneration, have been investigated thoroughly with respect to their pathogenesis. In recent years, it has been discovered that dysfunctional ocular microcirculation appears to play a part in the development of both diseases. In diabetic retinopathy, it has been shown that the disease is associated with early retinal vascular dysregulation. In the later states of the disease, retinal tissue hypoxia is a major trigger of sight-threatening neovascularization. In age-related macular degeneration, there is increasing evidence that reduced blood flow in the choroid is associated with the development and progression of the disease. Knowledge of the pathophysiological vascular states underlying these diseases is essential for the assessment and development of future therapies.

CJO JCO (PubMed)

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FOXC2 is a winged helix gene that counteracts obesity, hypertriglyceridemia, and diet-induced insulin resistance

Cederberg A, Gronning LM, Ahren B, Tasken K, Carlsson P, Enerback S.

Medical Genetics, Department of Medical Biochemistry, Goteborg University, Box 440, SE-405 30, Goteborg, Sweden.

Obesity, hyperlipidemia, and insulin resistance are common forerunners of type 2 diabetes mellitus. We have identified the human winged helix/forkhead transcription factor gene FOXC2 as a key regulator of adipocyte metabolism. Increased FOXC2 expression, in adipocytes, has a pleiotropic effect on gene expression, which leads to a lean and insulin sensitive phenotype. FOXC2 affects adipocyte metabolism by increasing the sensitivity of the beta-adrenergic-cAMP-protein kinase A (PKA) signaling pathway through alteration of adipocyte PKA holoenzyme composition. Increased FOXC2 levels, induced by high fat diet, seem to counteract most of the symptoms associated with obesity, including hypertriglyceridemia and diet-induced insulin resistance--a likely consequence hereof would be protection against type 2 diabetes.

PMID: 11551504 [PubMed - indexed for MEDLINE]

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Expression of FOXC2 in Adipose and Muscle and its Association with Whole-Body Insulin Sensitivity

Gina B. Di Gregorio1*, Rickard Westergren2, Sven Enerback2, Tong Lu1, and Philip A. Kern1

1 The Central Arkansas Veterans Healthcare System, Department of Medicine, Division of Endocrinology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
2 Medical Genetics, Department of Medical Biochemistry, Goteborg University, Goteborg, Sweden

* To whom correspondence should be addressed. E-mail: Digregorioginab@uams.edu.

FOXC2 is a winged helix/forkhead transcription factor involved in PKA signaling. Overexpression of FOXC2 in the adipose tissue of transgenic mice protected against diet-induced obesity and insulin resistance. We examined the expression of FOXC2 in fat and muscle of non-diabetic humans with varying obesity and insulin sensitivity. There was no relation between BMI and FOXC2 mRNA in either adipose or muscle. There was a strong inverse relation between adipose FOXC2 mRNA and insulin sensitivity, using the frequently sampled IV glucose tolerance test (r=-0.78, P<0.001). However, there was no relationship between muscle FOXC2 and any measure of insulin sensitivity. To separate insulin resistance from obesity, we examined FOXC2 expression in pairs of subjects who were matched for BMI, but who were discordant for SI. When compared to the insulin sensitive subjects, the insulin resistant subjects had 3-fold higher levels of adipose FOXC2 mRNA (p=0.03). In contrast, muscle FOXC2 mRNA expression was no different between insulin resistant and insulin sensitive subjects. There was no association of adipose or muscle FOXC2 mRNA with either circulating or adipose-secreted TNF{alpha}, IL6, leptin, adiponectin, or non-esterified fatty acids. Thus, adipose FOXC2 is more highly expressed in insulin resistant subjects, and this effect is independent of obesity. This association between FOXC2 and insulin resistance may be related to the role of FOXC2 in PKA signaling.

Ajpendo

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Diabetes and the risk of non-Hodgkin's lymphoma and multiple myeloma in the European Prospective Investigation into Cancer and Nutrition.

Haematologica. 2008 Apr 28

Aneire E. Khan on behalf of the European Prospective Investigation into Cancer and Nutrition (EPIC) Working Group

Correspondence: Aneire E. Khan, Department of Epidemiology and Public Health, Division of Epidemiology, Public Health and Primary Care, Imperial College London, St Mary’s Campus, Variety Wing, Norfolk Place, Paddington, London W2 1PG. E-mail: aneire.khan@imperial.ac.uk

ABSTRACT

Background: Non-Hodgkin’s lymphomas are a heterogeneous group of neoplasms arising from the lymphopoietic system including a wide range of subtypes of either B-cell or T-cell lymphomas. The few established risk factors for the development of these neoplasms include viral infections and immunological abnormalities, but their etiology remains largely unknown. Evidence suggests that certain medical conditions may be linked, through immunosuppression, to the risk of non-Hodgkin’s lymphoma. Multiple myeloma is a neoplasm of plasma cells that accounts for approximately 15% of lymphopoietic cancers. Increases in the incidence of non-Hodgkin’s lymphoma and multiple myeloma in the past implicate environmental factors as potential causal agents.

Design and Methods: In the European Prospective Investigation into Cancer and Nutrition (EPIC), 1,213 histologically confirmed incident cases of non-Hodgkin’s lymphoma and multiple myeloma (594 men; 619 women) were identified during a follow-up of 8.5 years. Cox proportional hazard models were used to explore the association between self-reported diabetes, diagnosed after 30 years of age, and the risk of non-Hodgkin’s lymphoma overall and multiple myeloma and various lymphoma subtypes.

Results: We found no association between a personal history of diabetes and the risk of non-Hodgkin’s lymphoma overall in men (HR: 1.28, 95% CI: 0.89–1.84), in women (HR: 0.71, 95% CI: 0.41–1.24), or in men and women combined (HR: 1.09, 95% CI: 0.80–1.47). Among the B-non-Hodgkin’s lymphoma subtypes, we observed a statistically significant increased risk of B-cell chronic lymphocytic leukemia (HR: 2.0, 95% CI: 1.04–3.86) in men, but not in women (HR: 1.07, 95% CI: 0.33–3.43).

Conclusions: This prospective study did not provide evidence for a role of self-reported diabetes in the etiology of non-Hodgkin’s lymphoma overall or multiple myeloma. We found an increased risk of B-cell chronic lymphocytic leukemia among men with diabetes, but not among women. We hypothesize that diabetes may not play a causal role in the etiology of B-cell chronic lymphocytic leukemia, though the underlying pathogenic mechanisms of both disorders may include shared genetic, host and/or environmental susceptibility factors.

Key words: non-Hodgkin’s lymphoma, diabetes, cohort study.

Haematologica

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Heritability of proliferative diabetic retinopathy.

Diabetes. 2008 Apr 28

Hietala K, Forsblom C, Summanen P, Groop PH; on behalf of the FinnDiane Study Group.

Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Finland (KH, CF, P-HG); Department of Ophthalmology, Helsinki University Central Hospital, Finland (KH, PS); Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Finland (CF, P-HG).

Objective: Diabetic nephropathy clusters in families suggesting that genetic factors play a role in its pathogenesis. We investigated whether similar clustering exists for proliferative retinopathy in families with two or more siblings with type 1 diabetes. 

Research design and methods: The FinnDiane Study has characterized 20% (4800 patients) of adults with type 1 diabetes in Finland. In 188 families there were at least two siblings with type 1 diabetes. Ophthalmic records were obtained for 369/396 (93%) and fundus photographs for 251/369 (68%) patients. Retinopathy was graded based on photographs and/or repeated ophthalmic examinations using the ETDRS-grading scale. 

Results: Mean age at onset of diabetes was 14.3 (+/-10.2) years and mean duration 25.9 (+/-11.8) years. Proliferative retinopathy was found in 115/369 patients (31%). The familial risk of proliferative retinopathy was estimated in 168/188 sibships, adjusted for HbA(1c), duration and mean blood pressure. Proliferative retinopathy in the probands (48/168) was associated with an increased risk (Odds Ratio [OR] 2.76 [95% CI 1.25- 6.11], P=0.01) of proliferative retinopathy in the siblings of probands (61/182). The heritability of proliferative retinopathy was h2=0.52 (+/- 0.31, P<0.05). 

Conclusions: We found a familial clustering of proliferative retinopathy in patients with type 1 diabetes. The observation cannot be accounted for by conventional risk factors, suggesting a genetic component in the pathogenesis of proliferative retinopathy in type 1 diabetes.

Diabetes

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Efficacy of berberine in patients with type 2 diabetes mellitus.

Metabolism. 2008 May

Yin J, Xing H, Ye J.

Department of Endocrinology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; 

Berberine has been shown to regulate glucose and lipid metabolism in vitro and in vivo. This pilot study was to determine the efficacy and safety of berberine in the treatment of type 2 diabetes mellitus patients. In study A, 36 adults with newly diagnosed type 2 diabetes mellitus were randomly assigned to treatment with berberine or metformin (0.5 g 3 times a day) in a 3-month trial. The hypoglycemic effect of berberine was similar to that of metformin. Significant decreases in hemoglobin A(1c) (from 9.5% +/- 0.5% to 7.5% +/- 0.4%, P < .01), fasting blood glucose (from 10.6 +/- 0.9 mmol/L to 6.9 +/- 0.5 mmol/L, P < .01), postprandial blood glucose (from 19.8 +/- 1.7 to 11.1 +/- 0.9 mmol/L, P < .01), and plasma triglycerides (from 1.13 +/- 0.13 to 0.89 +/- 0.03 mmol/L, P < .05) were observed in the berberine group. In study B, 48 adults with poorly controlled type 2 diabetes mellitus were treated supplemented with berberine in a 3-month trial. Berberine acted by lowering fasting blood glucose and postprandial blood glucose from 1 week to the end of the trial. Hemoglobin A(1c) decreased from 8.1% +/- 0.2% to 7.3% +/- 0.3% (P < .001). Fasting plasma insulin and homeostasis model assessment of insulin resistance index were reduced by 28.1% and 44.7% (P < .001), respectively. Total cholesterol and low-density lipoprotein cholesterol were decreased significantly as well. During the trial, 20 (34.5%) patients experienced transient gastrointestinal adverse effects. Functional liver or kidney damages were not observed for all patients. In conclusion, this pilot study indicates that berberine is a potent oral hypoglycemic agent with beneficial effects on lipid metabolism.

Metabolism Clinical and Experimental

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Effect of pitavastatin on type 2 diabetes mellitus nephropathy in KK-A(y)/Ta mice.

Metabolism. 2008 May

Masakazu Matsumoto, Mitsuo Tanimoto, Tomohito Gohda, Tatsuya Aoki, Maki Murakoshi, Kaori Yamada, Takahiko Yamazaki, Shigeru Kaneko, Satoshi Horikoshi, Yasuhiko Tomino

Abstract 

It is generally considered that 3-hydroxy-3-methylglutaryl–coenzyme A reductase inhibitors (statins) have renoprotective effects via a pathway independent of their cholesterol-lowering cascade. In the kidneys of diabetic nephropathy, monomeric endothelial nitric oxide synthase (eNOS) is thought to be overexpressed; and its dimerization is suppressed. In the present study, we investigated the expression of eNOS and oxidative stress in type 2 diabetes mellitus KK-Ay/Ta mice treated with pitavastatin, one of the statins. The KK-Ay/Ta mice were divided into 3 groups and given pitavastatin intraperitoneally starting at 8 weeks of age for 8 weeks: pitavastatin 3 mg/(kg d) (n = 5), pitavastatin 10 mg/(kg d) (n = 5), and a control group (n = 10). The urinary albumin-creatinine ratio (ACR), urinary 8-hydroxy-2'-deoxyguanosine, body weight, fasting blood glucose, hemoglobin A1c, total cholesterol, and triglyceride were measured; and the intraperitoneal glucose tolerance test was performed. The eNOS, nitrotyrosine, and p47 phox were evaluated by immunohistochemical analyses and/or Western blot analyses. Guanosine triphosphate cyclohydrolase 1 messenger RNA expression in the kidneys was evaluated using a real-time polymerase chain reaction assay. Pitavastatin improved the levels of urinary ACR and 8-hydroxy-2'-deoxyguanosine, intraperitoneal glucose tolerance test, and hemoglobin A1c. Protein levels of monomeric eNOS, nitrotyrosine, and p47 phox in the kidneys were decreased in the pitavastatin-treated groups. Guanosine triphosphate cyclohydrolase 1 messenger RNA expression was significantly increased in the pitavastatin groups. There were no significant changes in body weight, levels of fasting blood glucose, serum total cholesterol, triglyceride, and blood pressure among all groups. Pitavastatin improved urinary ACR apparently because of suppression of eNOS uncoupling and its antioxidant effect in the kidneys of KK-Ay/Ta mice.

Metabolism Clinical and Experimental

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Associations:

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American Diabetes Association

http://www.diabetes.org/home.jsp

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Canadian Diabetes Association

http://www.diabetes.ca/

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Diabetes UK

http://www.diabetes.org.uk/

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External Links:

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Diabetes.com

http://www.diabetes.com/

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Diabetes Public Health Resource

http://www.cdc.gov/diabetes/

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Diabetes - CDC

http://www.cdc.gov/doc.do/id/0900f3ec802723eb

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Macular Edema in Diabetes

http://emedicine.medscape.com/article/1224138-overview

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Diabetes and lymphedema

http://juvenation.org/juvenation_forums/general/f/120/t/10614.aspx

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Edema / Diabetes

http://www.diabetesselfmanagement.com/Articles/Diabetes-Definitions/edema/

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Diabetic Retinopathy

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002192/

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Diabetes, Heart Disease, and Stroke

http://diabetes.niddk.nih.gov/dm/pubs/stroke/

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FOXC2 mRNA expression and a 5' Untranslated region polymorphism of the gene are associated with insulin resistance

Diabetes,  Dec, 2002  by Martin Ridderstrale,  Emma Carlsson,  Mia Klannemark,  Anna Cederberg,  Christina Kosters,  Hans Tornqvist,  Heidi Storgaard,  Allan Vaag,  Sven Enerback,  Leif Groop

http://www.findarticles.com/p/articles/mi_m0922/is_12_51/ai_95572119

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Diabetes - Medline Plus

http://www.nlm.nih.gov/medlineplus/diabetes.html

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Diabetes - Condition Guide

http://www.mercksource.com/portal/site/mercksource/zQzmenuItemzEzConditionPagezAzconditionzEzDiabeteszAzrmmbrMezEzfalse
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Medicines for People with Diabetes (1)

National Diabetes Information Clearinghouse

http://diabetes.niddk.nih.gov/dm/pubs/medicines_ez/index.htm/

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Diabetes Dictionary: E

http://www.childrenwithdiabetes.com/dictionary/e.htm


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Diabetes Complications

http://www.diabetesnet.com/diabetes_complications/index.php


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Diabetec Complications - A Directory

http://www.findarticles.com/cf_dls/PI/search.jhtml?isp=FA&key=%2BDiabetes  


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Risk factors for cerebral edema in children with diabetic ketoacidosis

http://www.cps.ca/english/surveillance/cpsp/Studies/NT1DM.htm

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Recognition and Treatment of Cerebral Edema Complicating Diabetic Ketoacidosis

CPSP resource article published September 2000


http://www.cps.ca/english/CPSP/Resources/Rcerebraledema.htm

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Macular edema

http://www.emedicine.com/oph/topic400.htm

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Monocyte Attachment and Migration through Collagen IV in Diabetes Mellitus.

Mol Cells. 2008 Apr

PubMed

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Diabetes Reduces Aortic Endothelial Gap Junctions in ApoE-deficient Mice: Simvastatin Exacerbates the Reduction.

J Histochem Cytochem. 2008 Apr 28

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2443608/

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Cost-effectiveness of Intensified versus conventional multifactorial intervention in type 2 diabetes: Results and projections from the steno-2 study.

Diabetes Care. 2008 Apr 28

Diabetes Care

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The risks of non-traumatic lower extremity amputations in patients with type 1 diabetes - a population-based cohort study in Sweden.

Diabetes Care. 2008 Apr 28

Diabetes Care

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Preventing Lef Ventricular Hypertropy by Ace Inhibition in Hypertensive Patients with Type 2 Diabetes: A Prespecified Analysis of the Benedict Trial

Diabetes Care. 2008 Apr

Diabetes Care

..............................................

Efficacy of berberine in patients with type 2 diabetes mellitus.

Metabolism. 2008 May

Metabolism Clinical and Experimental

..............................................

Cardiovascular risk profile and morbidity in subjects affected by type 2 diabetes mellitus with and without diabetic foot.

Metabolism. 2008 May

Metabolism Clinical and Experimental

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ICD 10 and ICD 9 Codes

ICD 10 

Insulin-dependent diabetes mellitus
[See before E10 for subdivisions ]
Includes: diabetes (mellitus):
· brittle
· juvenile-onset
· ketosis-prone
· type I
Excludes: diabetes mellitus (in):
· malnutrition-related ( E12.- )
· neonatal ( P70.2 )
· pregnancy, childbirth and the puerperium ( O24.- )
glycosuria:
· NOS ( R81 )
· renal ( E74.8 )
impaired glucose tolerance ( R73.0 )
postsurgical hypoinsulinaemia ( E89.1 )
E11 Non-insulin-dependent diabetes mellitus
[See before E10 for subdivisions ]
Includes: diabetes (mellitus)(nonobese)(obese):
· adult-onset
· maturity-onset
· nonketotic
· stable
· type II
non-insulin-dependent diabetes of the young
Diabetes mellitus in pregnancy
Includes: in childbirth and the puerperium
O24.0 Pre-existing diabetes mellitus, insulin-dependent
O24.1 Pre-existing diabetes mellitus, non-insulin-dependent
O24.2 Pre-existing malnutrition-related diabetes mellitus
O24.3 Pre-existing diabetes mellitus, unspecified
O24.4 Diabetes mellitus arising in pregnancy
Gestational diabetes mellitus NOS
O24.9 Diabetes mellitus in pregnancy, unspecified

ICD 9

ICD-9-CM Diagnosis 250

Diabetes mellitus

  • (dye-a-BEE-teez) A disease in which the body does not properly control the amount of sugar in the blood. As a result, the level of sugar in the blood is too high. This disease occurs when the body does not produce enough insulin or does not use it properly.
  • A heterogeneous group of disorders characterized by HYPERGLYCEMIA and GLUCOSE INTOLERANCE.
  • Type 2 diabetes, characterized by target-tissue resistance to insulin, is epidemic in industrialized societies and is strongly associated with obesity; however, the mechanism by which increased adiposity causes insulin resistance is unclear. Adipocytes secrete a unique signalling molecule, which was named resistin (for resistance to insulin). Circulating resistin levels are decreased by the anti-diabetic drug rosiglitazone, and increased in diet-induced and genetic forms of obesity. Administration of anti-resistin antibody improves blood sugar and insulin action in mice with diet-induced obesity. Moreover, treatment of normal mice with recombinant resistin impairs glucose tolerance and insulin action. Insulin-stimulated glucose uptake by adipocytes is enhanced by neutralization of resistin and is reduced by resistin treatment. Resistin is thus a hormone that potentially links obesity to diabetes.
  • 250 is a non-specific code that cannot be used to specify a diagnosis

ICD-9-CM Diagnosis 250.0

Diabetes mellitus without mention of complication

  • (dye-a-BEE-teez) A disease in which the body does not properly control the amount of sugar in the blood. As a result, the level of sugar in the blood is too high. This disease occurs when the body does not produce enough insulin or does not use it properly.
  • A heterogeneous group of disorders characterized by HYPERGLYCEMIA and GLUCOSE INTOLERANCE.
  • Type 2 diabetes, characterized by target-tissue resistance to insulin, is epidemic in industrialized societies and is strongly associated with obesity; however, the mechanism by which increased adiposity causes insulin resistance is unclear. Adipocytes secrete a unique signalling molecule, which was named resistin (for resistance to insulin). Circulating resistin levels are decreased by the anti-diabetic drug rosiglitazone, and increased in diet-induced and genetic forms of obesity. Administration of anti-resistin antibody improves blood sugar and insulin action in mice with diet-induced obesity. Moreover, treatment of normal mice with recombinant resistin impairs glucose tolerance and insulin action. Insulin-stimulated glucose uptake by adipocytes is enhanced by neutralization of resistin and is reduced by resistin treatment. Resistin is thus a hormone that potentially links obesity to diabetes.
  • 250.0 is a non-specific code that cannot be used to specify a diagnosis
  • 250.0 contains 6 index entries

ICD-9-CM Diagnosis 250.00

  Diabetes mellitus without complication type ii or unspecified type not stated as uncontrolled
  • 250.00 is a specific code that can be used to specify a diagnosis

ICD-9-CM Diagnosis 250.01

 Diabetes mellitus without complication type i not stated as uncontrolled
  • 250.01 is a specific code that can be used to specify a diagnosis

ICD-9-CM Diagnosis 250.02

Diabetes mellitus without complication type ii or unspecified type uncontrolled

  • 250.02 is a specific code that can be used to specify a diagnosis

ICD-9-CM Diagnosis 250.03

Diabetes mellitus without complication type i uncontrolled

  • 250.03 is a specific code that can be used to specify a diagnosis

ICD-9-CM Diagnosis 250.10

Diabetes mellitus with ketoacidosis type ii or unspecified type not stated as uncontrolled

  • 250.10 is a specific code that can be used to specify a diagnosis

ICD-9-CM Diagnosis 250.11

Diabetes mellitus with ketoacidosis type i not stated as uncontrolled

  • 250.11 is a specific code that can be used to specify a diagnosis

ICD-9-CM Diagnosis 250.12

Diabetes mellitus with ketoacidosis type ii or unspecified type uncontrolled
  • 250.12 is a specific code that can be used to specify a diagnosis

2008 ICD-9-CM Diagnosis 648.8 Gestational Diabetes

Abnormal glucose tolerance of mother complicating pregnancy childbirth or the puerperium

  • 648.8 is a non-specific code that cannot be used to specify a diagnosis
  • 648.8 contains 10 index entries
  • View the ICD-9-CM Volume 1 648.* hierarchy

Use additional code, if applicable, for associated long-term (current) insulin use V58.67

==================

See also:

Edema 

http://www.lymphedemapeople.com/wiki/doku.php?id=edema

Edema and Chronic Venous Insufficiency

http://www.lymphedemapeople.com/thesite/edema_chronic_venous_insufficiency.htm

Edema and Deep Venous Thrombosis

http://www.lymphedemapeople.com/thesite/lymphedema_deep_venous_thrombosis.htm

Edema and Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome

http://www.lymphedemapeople.com/thesite/edema_and_reflex_sympathetic_dystrophy.htm

Edema and Venous Pooling

http://www.lymphedemapeople.com/thesite/edema_and_venous_pooling.htm

Angioedema

http://www.lymphedemapeople.com/wiki/doku.php?id=angioedema

Edema of the Neck

http://www.lymphedemapeople.com/thesite/lymphedema_of_the_neck.htm

Edema and Nephrotic Syndrome

http://www.lymphedemapeople.com/thesite/edema_nephrotic_syndrome.htm

Edema of the Face

http://www.lymphedemapeople.com/thesite/edema_of_the_face.htm

Thrombophlebitis

http://www.lymphedemapeople.com/wiki/doku.php?id=thrombophlebitis

Edema and Diabetes

http://www.lymphedemapeople.com/thesite/lymphedema_and_diabetes.htm

===========================

For information about Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema\

For Information about Lymphedema Complications

http://www.lymphedemapeople.com/wiki/doku.php?id=complications_of_lymphedema

For Lymphedema Personal Stories

http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=3

For information about How to Treat a Lymphedema Wound

http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound

For information about Lymphedema Treatment 

http://www.lymphedemapeople.com/wiki/doku.php?id=treatment

For information about Exercises for Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema

For information on Infections Associated with Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema

For information on Lymphedema in Children

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children

Lymphedema Glossary

http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing

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Lymphedema People - Support Groups

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Children with Lymphedema

The time has come for families, parents, caregivers to have a support group of their own. Support group for parents, families and caregivers of chilren with lymphedema. Sharing information on coping, diagnosis, treatment and prognosis. Sponsored by Lymphedema People.

http://health.groups.yahoo.com/group/childrenwithlymphedema/

Subscribe: childrenwithlymphedema-subscribe@yahoogroups.com

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Lipedema Lipodema Lipoedema

No matter how you spell it, this is another very little understood and totally frustrating conditions out there. This will be a support group for those suffering with lipedema/lipodema. A place for information, sharing experiences, exploring treatment options and coping.

Come join, be a part of the family!

http://health.groups.yahoo.com/group/lipedema_lipodema_lipoedema/?yguid=209645515

Subscribe: lipedema_lipodema_lipoedema-subscribe@yahoogroups.com

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MEN WITH LYMPHEDEMA

If you are a man with lymphedema; a man with a loved one with lymphedema who you are trying to help and understand come join us and discover what it is to be the master instead of the sufferer of lymphedema.

http://health.groups.yahoo.com/group/menwithlymphedema/

Subscribe: menwithlymphedema-subscribe@yahoogroups.com

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All About Lymphangiectasia

Support group for parents, patients, children who suffer from all forms of lymphangiectasia. This condition is caused by dilation of the lymphatics. It can affect the intestinal tract, lungs and other critical body areas.

http://health.groups.yahoo.com/group/allaboutlymphangiectasia/

Subscribe: allaboutlymphangiectasia-subscribe@yahoogroups.com

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Lymphatic Disorders Support Group @ Yahoo Groups

While we have a number of support groups for lymphedema... there is nothing out there for other lymphatic disorders. Because we have one of the most comprehensive information sites on all lymphatic disorders, I thought perhaps, it is time that one be offered.

DISCRIPTION

Information and support for rare and unusual disorders affecting the lymph system. Includes lymphangiomas, lymphatic malformations, telangiectasia, hennekam's syndrome, distichiasis, Figueroa
syndrome, ptosis syndrome, plus many more. Extensive database of information available through sister site Lymphedema People.

http://health.groups.yahoo.com/group/lymphaticdisorders/

Subscribe: lymphaticdisorders-subscribe@yahoogroups.com

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All About Lymphedema

For our Google fans, we have just created this online support group in Google Groups:

Homepage: http://groups-beta.google.com/group/All-About-Lymphedema

Group email: All-About-Lymphedema@googlegroups.com

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Lymphedema Friends

http://groups.aol.com/lymphedemafriend

If you an AOL fan and looking for a support group in AOL Groups, come and join us there.

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Lymphedema People New Wiki Pages

Have you seen our new “Wiki” pages yet?  Listed below are just a sample of the more than 140 pages now listed in our Wiki section. We are also working on hundred more.  Come and take a stroll! 

Lymphedema Glossary 

http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing 

Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema 

Arm Lymphedema  

http://www.lymphedemapeople.com/wiki/doku.php?id=arm_lymphedema 

Leg Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=leg_lymphedema 

Acute Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=acute_lymphedema 

The Lymphedema Diet 

http://www.lymphedemapeople.com/wiki/doku.php?id=the_lymphedema_diet 

Exercises for Lymphedema  

http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema 

Diuretics are not for Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=diuretics_are_not_for_lymphedema 

Lymphedema People Online Support Groups 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_people_online_support_groups 

Lipedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=lipedema 

Treatment 

http://www.lymphedemapeople.com/wiki/doku.php?id=treatment 

Lymphedema and Pain Management 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_pain_management 

Manual Lymphatic Drainage (MLD) and Complex Decongestive Therapy (CDT)

http://www.lymphedemapeople.com/wiki/doku.php?id=manual_lymphatic_drainage_mld_complex_decongestive_therapy_cdt 

Infections Associated with Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema 

How to Treat a Lymphedema Wound 

http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound 

Fungal Infections Associated with Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=fungal_infections_associated_with_lymphedema 

Lymphedema in Children 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children 

Lymphoscintigraphy 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphoscintigraphy 

Magnetic Resonance Imaging 

http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging 

Extraperitoneal para-aortic lymph node dissection (EPLND) 

http://www.lymphedemapeople.com/wiki/doku.php?id=extraperitoneal_para-aortic_lymph_node_dissection_eplnd 

Axillary node biopsy 

http://www.lymphedemapeople.com/wiki/doku.php?id=axillary_node_biopsy

Sentinel Node Biopsy 

http://www.lymphedemapeople.com/wiki/doku.php?id=sentinel_node_biopsy

 Small Needle Biopsy - Fine Needle Aspiration 

http://www.lymphedemapeople.com/wiki/doku.php?id=small_needle_biopsy 

Magnetic Resonance Imaging 

http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging 

Lymphedema Gene FOXC2

 http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_foxc2

 Lymphedema Gene VEGFC

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_vegfc

 Lymphedema Gene SOX18

 http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_sox18

 Lymphedema and Pregnancy

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_pregnancy

Home page: Lymphedema People

http://www.lymphedemapeople.com

Page Updated: Nov. 24, 2011