Ruchi Mathur, MD, FRCP(C) is an Attending Physician with the Division of Endocrinology, Diabetes and Metabolism and Associate Director of Clinical Research, Recruitment and Phenotyping with the Center for Androgen Related Disorders, Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Medical Author: Melissa Conrad St?ppler, MD
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR
About 41 million Americans between the ages of 40 and 74
have "pre-diabetes." Prediabetes is a condition that, as the name implies, can
be considered an early, potentially reversible, stage in the development of Type II diabetes.
Pre-diabetes is sometimes called
impaired glucose toleranceor Impaired Fasting Glucose (IGT/IFG). In pre-diabetes, a person's blood sugar(glucose) levels are
slightly higher than the normal range, but not high enough for a true diagnosis of diabetes.
People with pre-diabetes have a significant risk of developing full-blown
diabetes; in the Diabetes Prevention Program study, about 11% of
people with pre-diabetes developed Type II diabetes each year during the
three-year follow-up time of the study.
Doctors generally use one of two different blood tests to
diagnose diabetes and pre-diabetes. One is called the fasting plasma glucose test (FPG), in which
a person's blood glucoselevel is measured first thing in the morning before
breakfast. The normal fasting blood glucoselevel is below 100 mg/dl. A person
with pre-diabetes has a fasting blood glucose level between 100 and 125 mg/dl.
If the blood glucose level rises to 126 mg/dl or above, a person is considered
to have diabetes.
I'm pretty lucky in my office practice. I have friendly
patients who are usually already fairly well informed about their disease. They are also
generally willing to have discussions about therapies and options.
What I have noticed (much to my delight) is that there
are a growing number of patients coming to me for evaluation BEFORE they actually have
developed diabetes, wanting to know how to prevent it. Most of them have seen family
members with diabetes go through the process of diagnosis and management. As our
attitude towards disease changes, and we learn to focus on prevention, I have
more and more to discuss with these patients. Ultimately, I hope to see a
paradigm shift where our focus is primarily on prevention of chronic diseases
such as diabetes. For now, I hope this review provides some information to those
of you wanting to make healthy lifestyle changes, and that it encourages you to
open up a dialogue with your own doctor about diabetes prevention.
There are 2 major forms of diabetes - type 1 and type 2. This article focuses
specifically on type 2 diabetes. This form of diabetes is virtually a pandemic
in the United States. This article reviews the risk factors for developing type
2 diabetes and covers key points regarding predicting who is at risk for type 2
diabetes (and what they can do about it).
What is type 2 diabetes?
While diabetes is characterized by high blood sugar
values, type 2 diabetes is also associated with a condition known as
insulin
resistance. While there is an element of impaired insulin secretion from the beta cells of the pancreas
especially when toxic levels of glucose occur (when
blood sugars are constantly
very high), the major defect is the body's inability to respond properly to
insulin.
Eventually, the pancreas is working it's best to produce
more and more insulin, but the body tissues (for example, muscle and fat
cells) do not
respond and become insensitive to the insulin. At this point, overt diabetes
occurs as the body is no longer able to effectively use its insulin to maintain
normal blood sugar levels. Over time, these high levels of sugar result in the
complications we see all too often in patients with diabetes.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
A stroke results from impaired oxygen delivery to brain cells via the bloodstream. A stroke is also referred to as a CVA, or cerebrovascular incident. Symptoms of stroke include: sudden numbness or weakness of the face, arm or leg. Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, or loss of balance, and/or sudden severe headache with no known cause. A TIA, or transient ischemic attack is a short-lived temporary impairment of the brain caused by loss of blood supply. Stroke is a medical emergency.
Hypoglycemia is a syndrome caused by low blood sugar. Symptoms of hypoglycemia include palpitations, trembling, intense hunger, sweating, nervousness, and weakness. Consuming lifesavers, table sugar, soda, and juice are good treatment options for hypoglycemia.
Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use. Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.
Obesity is the state of being well above one's normal weight. A person has traditionally been
considered to be obese if they are more than 20 percent over their ideal weight.
That ideal weight must take into account the person's height, age, sex, and
build.
Heart disease (coronary artery disease) is caused by a buildup of cholesterol deposits in the coronary arteries. Risk factors for heart disease include smoking, high blood pressure, heredity, diabetes, peripheral artery disease, and obesity. Symptoms include chest pain and shortness of breath. There are a variety of tests used to diagnose coronary artery disease. Treatment includes life-style changes, medications, procedures, or surgery.
The main features of metabolic syndrome include insulin resistance, hypertension (high blood pressure), cholesterol abnormalities, and an increased risk for clotting. Patients are most often overweight or obese. Lifestyle modification such as the Mediterranean diet, exercise, and quitting smoking are the preferred treatment of metabolic syndrome.
The major goal in treating diabetes is controlling elevated blood sugar without causing abnormally low levels of blood sugar. Treatment for type 1 diabetes is with insulin, exercise, and a diabetic diet. Treatment for type 2 diabetes is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugar, oral medications are used. If oral medications are still insufficient, insulin medications are considered.
Turner syndrome is an inherited chromosomal condition affecting women. Women with Turner syndrome do not have ovarian function, and features of the syndrome include webbed neck, lymphedema of the hands and feet, heart defects, kidney problems, and skeletal abnormalities. The X chromosome is related to Turner syndrome. Treatment focuses on the symptoms of the syndrome.
Preeclampsia is related to increased blood pressure and protein in the mother's urine. Preeclampsia typically begins after the 20th week of pregnancy. When preeclampsia causes seizures, it is termed "eclampsia" and is the second leading cause of maternal death of in the US. Preeclampsia is the leading cause of fetal complications. Risk factors for preeclampsia include high blood pressure, obesity, multiple births, and women with preexisting medical conditions such as diabetes, kidney disease, rheumatoid arthritis, lupus, or scleroderma. Pregnancy planning and lifestyle changes may reduce the risk of preeclampsia during pregnancy.
Renal artery stenosis is a narrowing of the diameter of the renal arteries. When the renal arteries narrow, the result is restricted blood flow to the kidneys, which may lead to impaired kidney function and high blood pressure (referred to as renovascular hypertension (RVHT). Renal artery stenosis can occur in one or both kidneys. The primary cause of renal artery stenosis is atherosclerosis. Risk factors for renal artery stenosis include high blood pressure, high cholesterol levels, age, cigarette smoking, and diabetes. Symptoms of renal artery stenosis include high blood pressure that does not respond to treatment, severe high blood pressure in individuals younger than 30 or greater than 50 years of age. Renal artery stenosis is diagnosed with imaging and functional tests. Treatment for renal artery stenosis include medication or surgery.
A diabetic diet, or diabetes diet helps keep blood glucose levels in the target range for patients. Exercise and medication may also help stabilize blood glucose levels. Keeping track of when you take your diabetic medicine, keeping track of food choices, eating the proper amount of fruits, vegetables, carbohydrates, and fats will also help maintain proper blood glucose levels.
Prader-Willi syndrome is a condition characterized by severe floppiness (hypotonia), poor growth, delayed development, and poor feeding problems in early infancy later followed in infancy by excessive eating that may lead to extreme obesity. The genitals in both females and males are underdeveloped and most are infertile. Prader-Willi syndrome is related to chromosome 15.
Diabetes-related foot problems can affect your health with two problems: diabetic neuropathy, where diabetes affects the nerves, and peripheral vascular disease, where diabetes affects the flow of blood. Common foot problems for people with diabetes include athlete's foot, fungal infection of nails, calluses, corns, blisters, bunions, dry skin, foot ulcers, hammertoes, ingrown toenails, and plantar warts.
In the United States diabetes is the most common cause of kidney failure. High blood pressure and high levels of blood glucose increase the risk that a person with diabetes will eventually progress to kidney failure. Kidney disease in people with diabetes develops over the course of many years. albumin and eGFR are two key markers for kidney disease in people with diabetes. Controlling high blood pressure, blood pressure medications, a moderate protein diet, and compliant management of blood glucose can slow the progression of kidney disease. For those patients who's kidneys eventually fail, dialysis or kidney transplantation is the only option.
Cholesterol occurs naturally in the body. High blood cholesterol levels increase a person's risk of developing heart disease, heart attacks, strokes, TIAs, and more. In addition to medication (fibrates, statins, bile acid sequestrants, and niacin), lifestyle changes can be made to lower blood cholesterol levels
Managing your diabetes is important. The goal of diabetic therapy is to control blood glucose levels and prevent the complications of diabetes. Information about exercise, diet diet, and medication will help you manage your diabetes better. Blood glucose reagent strips, blood glucose meters, urine glucose tests, tests for urinary ketones, continuous glucose sensors, and Hemoglobin A1C testing information is also provided in this article.
The importance of a healthy lifestyle in disease prevention is widely understood and most people know that lifestyle changes and choices can be critical to good health. Yet, few practice healthy behaviors that constitute healthy living.
Stroke is the third leading killer in the United States. Some of the warning signs of stroke include sudden confusion, trouble seeing with one or both eyes, dizziness, loss of balance, and more. Stroke prevention and reatable risk factors for stroke include lowering high blood pressure, quit smoking, heart disease, diabetes control and prevention.
Disease prevention in women includes screening tests that are a basic part of prevention medicine. All screening tests
are commonly available through your general doctor. Some specialized tests may be available elsewhere.
Taking care of a disease such as diabetes is a life-long process. Learn how to care for yourself or loved one with diabetes in situations such as illness, work, school, travel, or a natural disaster.
Obesity means having excess body fat. For adults 35 and older, having a BMI greater
than 30 is considered obese.
Obesity is not just a cosmetic consideration. It is a chronic medical
disease that can lead to diabetes, high blood pressure,
heart disease,
gallstones, and other chronic illnesses.
Obesity is difficult to treat and has a high relapse rate. Greater than
95% of those who lose weight regain the weight within five years.
Even though medications and diets can help, the treatment of obesity
cannot be a short-term "fix" but has to be a life-long commitment to
proper diet habits, increased physical activity, and regular
exercise.
The goal of treatment should be to achieve and maintain a "healthier
weight," not necessarily an ideal weight.
Even a modest weight loss of 5%-10% of initial weight and the long-term
maintenance of that weight loss can bring significant health benefits ...
