Diabetic Peripheral Neuropathy Essay

Diabetic Peripheral Neuropathy Essay
Diabetic Peripheral Neuropathy (DPN) is one of the most common microvascular complications in
diabetes and can result in foot ulceration, ampuation and an impaired quality of life(Carrington AL,
et al 2002,Boulton AJ,et al 2004). The reported prevalence of diabetic peripheral neuropathy ranges
from 16% to as high as 66%2 and its prevelance is believed to increase with the duration of diabetes
and poor glucose control.(Boulton AJ.et al 2000) It's accounts for 50–75% of non–traumatic
amputations in diabetic patients.(Holzer SE, et al 1998, Boulton AJM, 1998,Malay DS, et al 2006)
DPN has been defined as "the presence of symptoms and/or signs of peripheral nerve dysfunction in
people with diabetes after the exclusion of other causes" ... Show more content on Helpwriting.net
...
Assessment and diagnosis
The early diagnosis of neuropathy is crucial to stop progression to advanced stages, and further
complications. (Toopchizadeh V., et al.2016) Early intervention can protect diabetic patients from a
risk of foot ulcers and amputation, improve the quality of life (Vlckova–Moravcova E, et al
2008.Van Schie CH. 2008, Ismail K, et al 2007) and mitigate the socioeconomic consequences of
diabetic foot disease. (Davis WA,et al 2006,Lavery LA,et al 2007,Gordois A,et al 2003 )
The diagnosis of DPN is primarily clinical, based on clinical suspicion and confirmatory
examination findings from the history and examination, followed by the exclusion of other potential
causes.(Vinik A, et al 2013) Importantly, in any patients with neuropathy and specifically patients
with a severe form,it is essential to rule out any other causes apart from diabetes such as ,drug
induced neuropathy (e.g. isoniazid) , alcohol abuse, nutritional deficiency like vitamin B12
deficiency(Wile DJ,et al 2010),vasculitis , inherited neuropathies, and renal disease (Freeman
R.2009) The clinical presentation of DPN vary markedly from one patient to another depending on
the type of sensory fibers involved. About 50% of patients is symptomatic, commonly present with a
burning
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A Short Note On Diabetic Retinopathy ( Dr ) Is The Most...
Diabetic retinopathy (DR) is the most common cause of vision loss in working aged individuals in
developed countries. Diabetic macular edema (DME) is the main cause of decreased vision in
diabetic retinopathy [1]. It was shown that the 10–year cumulative incidence of diabetic macular
edema was 20.1% in type 1 diabetes and 25.4% in patients with type 2 diabetes treated with insulin
[2]. The management of DME includes strict glycemic and blood pressure control [3–5]. Argon laser
treatment for clinically significant macular edema (CSME) has been the mainstay treatment
according to the Early Treatment Diabetic Retinopathy Study (ETDRS) study that demonstrated a
50% reduction in moderate visual loss following focal laser photocoagulation [6,7].
The conventional Argon laser treatment is associated with heat to the surrounding tissues such as the
neurosensory retina and the choroid leading to collateral thermal damage. The greyish endpoint of a
laser burn means that the temperature is high enough to change the transparency of the retina [8].
Possible side effects of conventional macular laser photocoagulation include visual loss due to
accidental foveal photocoagulation, pre– and sub–retinal fibrosis, choroidal neovascularization,
visual field scotomas, decreased color vision and progressive expansion of the laser scars into the
fovea [9–12].
Conventional laser photocoagulation produces a continuous wave laser output. On the other hand
subthreshold micropulse laser treatment

Diabetic Patterns
In some studies, such as Rakhshandehroo and colleagues integrated training programs, will improve
significantly knowledge, attitude and performance in diabetic patients and may improve their
metabolic control.[11] ( Rakhshandero et al., 2008). Sung and Kim study in south Korea showed
combination of educational intervention with telephone counseling and follow–up lead to blood
glucose control and improvement of self– management or self– care of diabetic patients.[12] (Song
& Kim,2009) These findings confirm results of our study.
Overall, the findings suggested that the telenursing intervention improved metabolic parameters ( )
level and adherence to diabetic medication taking, physical exercise, dietary recommendation and
foot care. ... Show more content on Helpwriting.net ...
Regarding the barriers of non–adherence, (Table 5). The commonest reasons reported by
respondents for non–adherence to medication taking were forgetting their medication (86.7%)in
control group followed by complexity of therapy 76.7% in both group . This finding is in
accordance with that Bernardino et al. (2006), who found that, hypertensive patients may fail to take
their medication due to forgetting, followed by complexity therapy. At the end of the study after
educational intervention and 12–week follow–up, improvements in metabolic parameters and diet,
exercise, and drug therapy compliance could be the result of increased disease awareness, lifestyle
modifications, and regular follow–up. We think that educational program in combination with
telephone follow–up contributes to this awareness and improvements.. In the present study, barriers
of compliance to follow up were markedly due to difficult transportation 76.7% in both groups This
finding goes in accordance with that of Finnerty, Mattie and Finnerty (2003), who reported that the
causes of poor compliance to follow up clinic were Difficult transportation, long waiting time,
overcrowded clinics and inconvenient place for waiting was considered another barrier of
compliance. Another barrier of compliance to diabetic diet was the family could not serve special
food representing 80% of control group and 26.7% in study. this might be due to the beneficial role
of health education to patients and their families about the importance of social support in diabetic
treatment treatment. This finding was in accordance with that reported by Korhonen et al.

Chronic Diabetic
Chronic wounds are prevalent throughout the world, with limited effective methods of treatment.
Wounds associated with diabetes are difficult to heal and often stay unhealed leading to higher
morbidity and mortality in the diabetic population [1,2]. A major hurdle to the successful healing of
chronic diabetic wounds is the presence of biofilm–mediated infections [3–5]. Biofilms are a
structured community of microorganisms growing on a living or non–living surface and enclosed in
a self–produced matrix of extracellular polymeric substances [6,7]. The matrix provides enormous
protection to the biofilm against hostile environmental conditions, such as host immunological
system and antimicrobial agents [8–11]. The polymicrobial nature of diabetic ... Show more content
on Helpwriting.net ...
Nanoparticles encapsulated photosensitizers offer several distinct advantages over free
photosensitizing molecules, which include high drug loading, increased accumulation of the
photosensitizer in the target cells, and inhibiting the target cell's ability to pump out the
photosensitizers [31]. Further, incorporation in the nanoparticles can protect photosensitizers from
inactivation in biological environments [32]. In this study, the nanoparticles are formulated using
anionic surfactant docusate sodium (aerosol OT, AOT) and a naturally occurring polysaccharide
polymer sodium alginate. It has been reported that, besides improving the cellular uptake of
encapsulated photosensitizers, AOT–alginate nanoparticles significantly enhanced ROS yield of
photosensitizers [33]. The objective of the present study was to investigate the in vitro
photodynamic efficacy of MB and TB–loaded AOT–alginate nanoparticles against both planktonic
and biofilm phases of Pseudomonas aeruginosa, methicillin–resistant Staphylococcus aureus
(MRSA), and their mixed culture. In addition, the in vitro photobactericidal efficacy of
nanoparticles encapsulated dyes was compared with the respective free dyes. Our results
demonstrate that the AOT–alginate nanoparticles did not improve the in vitro photodynamic efficacy
of the encapsulated dyes under experimental conditions.

Diabetic Retinopathy Research Paper
Diabetic Retinopathy
Alexandra "Alex" Erlewine, SMAAlaska Career College
Etiology:
By 2025, it is estimated that 380 million individuals will be diagnosed with diabetes. With that being
said, 4 million of them will lose their sight. Diabetic Retinopathy (DR) is the leading cause of
blindness in patients ranging from age 20 to age 74. Development and progression of this disease is
closely associated with blood pressure, blood glucose, the type and duration of diabetes, and
possibly lipids. Although it has been found true that chronic hyperglycemia causes the development
and progression of diabetic retinopathy, the mechanism of how the damage is caused is unclear. To
further look into the complexity of DR, the disease can be classified as non–proliferative diabetic
retinopathy (NPDR), which is ... Show more content on Helpwriting.net ...
During the exam, the doctors will be looking for abnormal blood vessels, swelling, blood or fatty
deposits in the retina, growth of new blood vessels, vitreous hemorrhage, retinal detachment, and
abnormalities of the optic nerve (Staff, 2015). Some of the treatment options available for DR
include injections, photocoagulation , and a vitrectomy. Injection treatment involves medications,
which include steroids and anti–vascular endothelial growth factor, being injected into the back of
the eye to stop growth of new blood vessels and to attempt to slow down swelling and bleeding.
This form of treatment may possibly restore some lost vision and prevents bleeding inside the eye.
Photocoagulation is used to stop bleeding and slow swelling. An approach by laser treatment may
slow progression of DR and prevent loss of vision. For individuals who had had diabetes for less
than 20 years, a vitrectomy may protect vision in some people. This surgical procedure removed
blood or scar tissue formed in the eye by

A Brief Note On Patients With Diabetic Lower Leg Ulcers...
Wounds related to Diabetic Neuropathy Patients with diabetic neuropathy generally ended up with
wounds, since they have reduced ability to feel pain and temperature. The problem that the guideline
addresses is "patients with lower–extremity neuropathic disease (LEND) with or at risk for wounds"
(National Guideline Clearinghouse, 2012, para. 1). The purpose of the guideline is to "support
clinical practice by providing consistent, research–based information with the goal of improved
cost–effective patient outcomes as well as to stimulate increased wound research" (National
Guideline Clearinghouse, 2012, para. 9). This paper will present a summary of the quantitative and
the qualitative article, gaps between guideline and practice; also, ... Show more content on
Helpwriting.net ...
In the final analysis, the APC treatment was concluded that it is a safe medication for leg ulcers, and
provides evidences for larger clinical trial. "Overall, the results show that APC treatment of lower
leg ulcers in patients with diabetes improves wound healing, with a subsequent improvement in
patient quality of life and no deleterious effect on patient safety" (Kaley et al., 2013, p.5).
Qualitative Article Living with leg ulceration: a synthesis of qualitative research is a study that
analyzes twelve research studies about patients' experience of living with a leg ulcer. The authors
used a method called Qualitative Assessment and Review Instrument (QARI). "This tool is designed
to assist researchers to manage, appraise, analyze and synthesize textual data and provides a
structure for the synthesis" (Briggs & Flemming, 2007, p.320). Additionally, they used different
database to gather the records and ended up with twelve studies that met the criteria. In summary,
the topic that was most mentioned, with the most volume of data, was physical effects like pain,
odor, itch, leakage and infection. Also, the least mentioned was psychological impact (Briggs &
Flemming, 2007). Even though psychological impact was the least theme mentioned, that does not
mean that it is not as important. Reasons could be that physical effects overwhelmed the
psychological ones.
The authors described the problem as the leg ulcer journey. It explains as two routes,

Adherence Of Non Adherence Among Diabetic Population And...
Rozenfeld et all 2008 in his article evaluated the adherence to oral hypoglycemic agents (OHAs) in
diabetic patients. In his retrospective study, he conducted a research in a medical center where he
found the relation between the glycosylated hemoglobin and adherence. In his study, 80% of the
participants were adherent to the therapy showing inverse relationship with HbA1C level. As the
level of adherence increases in patients the HbA1C would decrease below 7% proving its adherence.
Most of the patients were using metformin (46%). According to him, if the efforts would done to
pay attention to each patient than adherence and glycemic control could be increased and it would
move towards the better health of the patient . Yang et all 2009 predicted the medication non–
adherence among diabetic patients with oral anti–diabetic medication and other drugs patients were
taking along with their anti–diabetic therapy. Basic objective behind his study was to analyze and
study the reasons and prevalence of non–adherence in diabetic population and the basic
demographic factors responsible for it. He performed a retrospective cohort study in various states
of the USA (Alabama, California, Florida, Mississippi, New York, and Ohio). According to the data
collected, mean age of patients was 71 years, 59% of the population were female, estimated non–
adherence was calculated to be 35% and co–morbidities present were CVD. In his study, he also
focused on interventions developed to improve

Evaluation Of A Person With An Acute Diabetic Foot Problem
Student Number: 0962380
Diabetes and the Foot
PC903
Module for MSc in Diabetes
Submitted: July 2015
Assignment Option 1
Evaluate care for a person with an acute or chronic diabetic foot problem, detail clinical presentation
and discuss assessment, diagnosis, classification and treatment choices. Assess the need for medical
and/or pharmacological management, justify your decisions using current guidelines,
recommendations and literature. Further consider the role of the multidisciplinary foot team and
discuss referral at the most appropriate stage of each intervention.
Word count: 3920
Introduction 3
Methodology 3
The case 3
Background 5
Assessment and Diagnosis 6
Osteomyelitis 9
Classification of diabetic foot ulcers 11 ... Show more content on Helpwriting.net ...
The literature will be found from search engines such as medline, Embase, Google scholar and the
reading list supplied. I will also be looking at the current NICE guidelines and other government
guidelines. The findings will be discussed and critically evaluated.
The case
Joseph MacAdie (names have been changed to protect patient confidentiality) is an 87 year old
gentleman who first presented in Accident and Emergency following a review from the community
occupational therapist and district nurse as he was complaining of a painful left knee and decreased
mobility. During the assessment the district nurse checked Mr MacAdie's blood glucose as he had a

known history of type 2 diabetes and his blood glucose was found to be 22.0 mmol/l. Due to this
elevated blood glucose Mr MacAdie was advised to attend A&E. It was during this admission that
following assessment Mr MacAdie was found to have an infected left great toe paronychia with left
foot swelling and erythema. An X–ray of the foot was taken, which showed potential osteomylitis,
and it was planned for this to be reviewed in the Endocrine department radiology meeting.
Mr MacAdie was reviewed by the Endocrine team and received antibiotics to treat the infection
consisting of a stat dose of 2g IV Ceftriaxone and he was discharged with oral Co–amoxiclav
265mg tds to continue until he was followed up at the diabetic foot clinic. To lower his

Diabetic Retinopathy Essay
Abstract – Diabetic retinopathy is a complication of diabetes that is caused by changes in the blood
vessels of the retina. The symptoms can blur or distort the patient's vision and are a main cause of
blindness. The main idea behind this work is the detection of the exudates on the real time fundus
images of the patients. The methodology used for the work is based on the basic if–else condition
for the detection of the exudates. The current detection process is carried out using MATLAB
software. Keywords – Diabetic Retinopathy, Exudates, if–else condition, MATLAB I. Introduction
Medical image analysis is an area of research that is currently interesting a lot of scientists and
physicians. The study of digital images with the ... Show more content on Helpwriting.net ...
Recent Work Salvatelliet et.al.[ii] have tested several correction techniques, their aim was to
establish a qualitative assessment of the adequacy of different methods for pre–processing stages in
a DR diagnosis system. The best results were obtained for the colour model using RGB for image
analysis and hue saturation intensity (HSI) for actual processing of images. A method to identify DR
using digital signal processing and image processing techniques has been proposed by Iqbal et.al.
[iii]. The methods used by them includes colour space conversion, zero padding of image edges,
median filtering and histogram equalization with overlap mean for the image pre–processing stage.
Nayomi et.al.[iv] propose a technique based morphological image processing and fuzzy logic to
detect hard exudates from DR retinal images. At the initial stage, the exudates were identified using
mathematical morphology which includes the elimination of optic disc. III. Material and
Methodology The current work includes the detection of the various area of interest in the retinal
images of the patients suffering from Diabetic Retinopathy. The detection is based on the basic if–
else condition. MATLAB 2013 is been used for accomplishment of the

Diabetic Mother
Infant of Diabetic Mother
1. Define Infant of Diabetic Mother. IDM is a baby born to a mother with diabetes. Throughout her
pregnancy the baby's mother had high blood sugar (glucose) levels. Babies who are born to diabetic
mothers are more likely to be born by a C–Section delivery. Diabetic mothers must be monitored
closely.
2. Causes. A pregnant woman with high blood sugar levels can affect the infant after birth. These
infants are often larger than other babies. Their organs such as the liver, heart, and adrenal glands are
likely to be enlarged. Because of increased insulin levels in their blood, these infants may have
periods of low blood sugar (hypoglycemia) shortly after birth. There is an increased risk of birth
defects, miscarriages, or stillborn children. If the baby is large there is an increased risk for brachial
plexus injuries and other traumas during birth.
3. ... Show more content on Helpwriting.net ...
Signs and Symptoms include: Blue or Patchy skin color, rapid breathing, and rapid heart rate,
newborn jaundice, poor feeding, lethargy, weak cry, puffy face, reddish appearance, tremors or
shaking.
4. LABS to monitor. Before the birth an ultrasound is performed on the mother to determine the size
of the baby. A lung maturity test if the baby is going to be delivered more than one weak early. After
the birth the baby will be tested to show if the infant has low blood sugar and low blood calcium. An
echocardiogram will show if the infant has an abnormally large heart, which can occur with heart
failure. LAB testing will also be done to determine hypoglycemia and polycythemia. Glucose
testing will be done.
5. Treatments. Test will be run to check the blood sugar level for several days. They will continue
until the infant's blood sugar remains stable with normal feedings. Low blood sugar that persist is
treated with sugar and water given through a vein. High bilirubin levels are treated with
phototherapy. Rarely, the infant may need breathing support or an exchange

Patient Education Essay
According to Healthy People 2012 there are more then 800,000 new cases of diabetes each year,
with the numbers on the rise. With this in mind, Healthy People 2012 has identified diabetes as their
number five focus area. In order to reach their goal of improving the quality of life for people with
diabetes they have identified diabetes teaching as their number one objective. Furthermore, in order
to reduce the number of complications of diabetes, Healthy People 2012 has identified foot ulcers as
their ninth objective. Through patient education Healthy People 2012 hopes to reduce the number of
foot ulcers in people with diabetes, as diabetes is the number one cause of nontraumatic amputations
in the United States. In order to ... Show more content on Helpwriting.net ...
stated that he wears a size ten shoe however he does not own a pair of shoes in his size. With all
these factors involved it becomes obvious that J.L. is a diabetic patient in need of foot care teaching,
in order to prevent further complications. After identification of a patient teaching need the next step
in the teaching process is establishing a measurable goal. "Teaching goals are broad in scope and set
down what is expected as the final outcome of the teaching and learning process" (Wilkinson & Van
Leuven, 2007, p. 538). In order to achieve a high level of standard, teaching goals need to be
specific, measurable, attainable, realistic and timely. For our example, the teaching goal for J.L. and
his diabetic foot care is as follows: Client is able to state five things he can do to prevent diabetic
foot complications by the end of the teaching session implemented on Sunday January 24, 2012.
Specifically, the five items J.L. will identify are to monitor and manage his diabetes, inspect feet
daily, wash feet with warm water while drying between toes and apply moisturizing cream to feet
daily (not between toes), avoid walking barefoot or with unfitted shoes, and calling the doctor
should he notice any changes in his feet. In this case the level of prevention used, when
implementing the diabetic foot care teaching, is tertiary prevention. "This intervention begins once
the disease if obvious: the aim is to interrupt the course of the disease,

A Short Note On Diabetic Retinopathy ( Dr ) Is The...
Abstract– Diabetic Retinopathy (DR) is the deterioration of human eye as a result of increase in the
blood glucose level. Longer the patient has DR, higher the chance to develop purblind. The robust
detection of lesions in digital colour fundus images is an important step in the development of
automated screening system for diabetic retinopathy. In this work a novel method is introduced for
automatic detection of red lesions in the fundus image. A new set of shape features extracted from
the detected red lesion called the dynamic shape features that differentiate between the lesions and
vessel segments. The detected lesion candidates are classified using dynamic shape features based
on the medical values. The simulation analysis indicates that the proposed work is better than the
previous works in terms of accuracy, sensitivity, precision and specificity.
Keywords: Diabetic retinopathy, Fundus, Lesions, Dynamic shape features, Retina
Introduction
Diabetic Retinopathy (DR) affects the diabetic patients. Generally diabetics are of three types Type
I, II and III. The Type I diabetic is due to the genetic predisposition, Type II diabetic which usually
affects the adults. This is owing to over weight of children beyond their age limit and Type III is
seen only in pregnant women. The patients with Type I diabetics will only suffer from DR which
influence the retina. This leads the way to damage of retina and finally blindness.
DR is caused by red lesion which is composed of

Diabetic Exosom
DCM is still the leading cause of morbidity and mortality between diabetic patients. The complete
understanding of DCM pathophysiology and the role of exosomes in this pathologic disorder are
still being investigated. However, there has been emerging in vitro ex–vivo and in vivo experimental
data about different underlying mechanisms that might be helpful to answer important questions
raised in the study of DCM. Over the last decade, exosomes have been extensively studied as
microRNA–carriers which are pivotal for local tissue–specific and inter–systemic cells
communication. Of interest, miRNAs–enriched exosomes play an important role in development of
DCM based on accumulated evidences such as alteration of miRNAs profile in the diabetic heart, ...
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Clearly, exosomes are related to all aspects of DCM, including altered insulin signaling and glucose
metabolism, hypertrophy, apoptosis and fibrosis. In this context, the functional and expressional
phenotype of exosomes from different sort of cells contributing to the onset and propagation of
DCM to HF can be alternative therapeutic approach based on the possibility of using external
artificial exosomes that are able to counteract the molecular defects in DCM. Nonetheless, further
future studies will be needed to test the following hypotheses in order to elucidate the complete
molecular mechanisms underlying the development of DCM and the biological nature of exosomes:
First, could we be able to isolate normal exosomes from the blood of healthy subjects ?; Second,
could isolated normal exosomes reverse the phenotype and restore normal cardiac function in
patients diagnosed with DCM?; Third, could we be able to engineer host cells to overexpress
beneficial factors that are capable to be loaded and delivered via exosomes?;

Diabetic Microvascular : Leading Cause Blindness
Diabetic microvascular complications are the leading cause of blindness, end–stage renal diseases,
and other neuropathies due to hypoxia and ischemia in the retina, the kidney, and nerves. Thickening
of the capillary basement membrane result in decreased tissue perfusion. Many people with type 2
diabetes present with microvascular complications because of the long duration of asymptomatic
hyperglycemia that usually precedes diagnosis (Mccaine and Huther).
Diabetic retinopathy is the leading cause of blindness globally and in the U.S. adults younger than
age 60. It is more common in individual with type 2 diabetes compared to those with type 1 due to
long–standing hyperglycemia before diagnosis. Most people with diabetes eventually develops some
degree of retinopathy and they are more likely to develop cataracts and glaucoma. The prevalence
and severity of retinopathy are strongly related to individual's age, the duration of diabetes, and the
extent of glycemic control. Three stages of the retinopathy leads to vision loss; stage I – non–
proliferative is characterized by thickening of the retinal capillary basement membrane and
increased retinal capillary permeability, vein dilation, micro–aneurysm formation, and hemorrhages.
Stage II – pre–proliferative there is progression of retinal ischemia with areas of inadequate
perfusion that result in infarcts. Stage III – proliferative involves neovascularization (angiogenesis)
and fibrous tissue formation within

Diabetic Teenager
For a 17–year–old, type I diabetic who is active in cross country, track, and swim team, compliance
in taking insulin per meal or snack and ensuring adequate dosing in conjunction with an active
lifestyle can be very challenging. While in high school, many teenagers may also indulge in
unhealthy meal and snack choices, which for a diabetic teenager may decrease diabetic management
and medication compliance (Datar & Nicosia, 2012). Additionally, the need to eat a proper meal at
an appropriate time with insulin administration to fuel an athlete's demanding physical needs may
also be a hindrance.
Thus, an insulin pump can be very beneficial for several reasons. It can deliver insulin more
precisely than injections, decrease swings in glucose levels, allow flexibility in the time and content
of food consumption, reduce hypoglycemic episodes, and allow exercise without having to consume
large amounts of carbohydrates (ADA, 2013). ... Show more content on Helpwriting.net ...
The first would be to make diet and exercise changes. More vegetables, lean meats, and fruits and
grains in moderation with at least 150 minutes per week of moderate exercise is important to
decrease weight (AAFP, 2009). Also, while in college it's important to get plenty of sleep, walk or
participate in any form of exercise in between study breaks, and manage stress to help decrease
weight gain and promote a healthier lifestyle. Additionally, Metformin may also be considered in
conjunction with diet and exercise

Diabetic Retinopathy is treatable if caught in time, but if it is not diagnosed it can lead to blindness.
Diabetics should have regular eye exams to prevent serious eye diseases, such as cataracts,
glaucoma, and macular degeneration.
Hypoglycemia is when a diabetic's blood glucose is too low. This can happen because of one's diet,
over exercising, or consuming alcoholic beverages. A diabetic with this condition may be sweaty,
confused, or have difficulty speaking. This condition is incorrectly referred to as "insulin shock"
(Nuzum and Merz, 2009). This condition could also happen if the person is sleeping. The person
may suddenly wake up and be sweating, confused, or be very weak. When this happens, the person
should drink about four ... Show more content on Helpwriting.net ...
The new focus is on "making the healthy choice, the easy choice" (Jost, 2001). Eliminating oils in
processed food may help to lessen the obesity level. Many American's are starting to realize that
fresh, lean, sugar free foods are better for their health. Using less salt and eliminating the salt shaker
on the table will help to prevent many medical ailments. According, to the article written by Nugun
and Merz they state patients with dyslipidemia typically have made poor lifestyle choices related to
diet and exercise (Complications of Diabetes and Associated Disorders, Center for Disease Control
[CDC],

A Brief Note On Diabetic Retinopathy ( Dr ) Is A Common...
Diabetic retinopathy (DR) is a common microvascular complication of diabetes1. The presentation
of DR is a visual indication of longstanding diabetes and is a significant cause of vision impairment.
In 2015, it was estimated there were 415 million sufferers worldwide (1 in 11), increasing to 642
million (1 in 10)2 by 2040. Of those suffering diabetes, DR impacts approximately 4.2 million
people, and this number is predicted to rise to 16 million by 20502. The prevalence of DR does not
mirror that of diabetes, as there is a combination of causation factors. A review by Cai and Boulton
(3) proposed that one of the initiating factors of DR is hyperglycaemia. This is supported by
Hammes et al (4) who emphasise the impact of ... Show more content on Helpwriting.net ...
The disease has a predictable progression, advancing from the initial non–proliferative DR (NPDR),
which can be asymptomatic, to the end–stage proliferative type (PDR). The rate and onset of
progression is variable, as it is affected by blood pressure and blood sugar levels1. The features of
NPDR include: microaneurysms, haemorrhages and exudation. Additionally PDR involves
neovascularisation, resulting in vision loss. Diabetic macular oedema (DME) is also a cause of
vision loss. Thickening of the retina at the macula can occur at any stage of DR, leading to blurred
or distorted central vision1.
This report outlines a case of PDR, unmanaged for several years. It is interesting to note the impact
of well–controlled blood pressure on the progression of the PDR.
CASE REPORT:
A 74–year–old Caucasian female presented to the Queensland University of Technology optometry
clinic as a new patient, following self–referral. She presented with a complaint of 'blank areas when
reading', of approximately 4 months duration. Past ocular history included bilateral cataract removal
10 years ago (by an overseas ophthalmologist). She was diagnosed with non–insulin dependent
diabetes mellitus (Type 2) 30 years ago and reported unstable management with metformin. Current
blood pressure is 144/82mmHg, showing good control of her hypertension

A Brief Note On Diabetic Peripheral Neuropathy ( Dnp )
Diabetic Foot Problems Diabetic peripheral neuropathy (DNP), also know as Neuropathy nerve
damage. "Diabetes can impair blood flow to your feet and cause nerve damage" (Castro 180). High
blood sugar can injure nerve fibers throughout your body, but diabetic neuropathy most often
damages nerves in legs and feet. " Enigmatically, recent reports have described that long–term tight
glycemic control may be major risk factor for the development of diabetic neuropathy" (Zhang, et
al. 1). Diabetic neuropathy can also affects the eyes, retinopathy, increasing the risk for glaucoma
and blindness. Physicians recommend eye exams every six months to one year. The eyes must be
checked often as vision can deteriorate quickly in patients with diabetes. A person with diabetes may
not be aware of a wound or injury to their foot due to a decreased sensation in their feet, a condition
called diabetic neuropathy. Therefore, great care must be taken to inspect the feet everyday.
Neuropathy is a chronic condition, which will get worst over the time. Been diagnosed with
neuropathy can change a patients life; this can turn into a chronic disease that will be treated with
adequate medication, maintaining low blood sugars, doing self–examinations of the feet to prevent
any further complications and visiting the physician as directed to do routine check ups.
"Diabetic neuropathy begins as a generalized asymptomatic dysfunction of sensorimotor or
autonomic peripheral nerve fibers and is by far the

Diabetic To Eat
Diabetic is one of the commonest metabolic disorder in the grown and growing countries. As it is a
kind of disease which affects the glucose maintenance system in our blood, diet plays a major in it's
management. As a diabetic, it is ultimately important for you to have a list of foods for diabetic to
eat. There are some things that can work against your diabetes and make you extremely ill and there
are some things that you should be including in your diet that you may not have been aware of.
Because we know just how difficult it can be to determine what foods you should or should not eat,
we have devised this article, complete with a list of foods for diabetic to eat to help you out. Before
we get into what you should eat, let's have a look at some of the things you should not eat. You want
to make sure you avoid or ... Show more content on Helpwriting.net ...
The less you have of either of these items, the better off you will be. It is also suggested that you
limit your intake of alcohol. Drinking heavily could lead to a greater heart disease risk, as well as
liver damage. With that being said, here is a list of foods for diabetic to eat: * Make sure you include
starches – While white breads can be bad for your diabetes, you still want to make sure that you
include plenty of starches in your diet. This should be vegetables, pasta, cereal, grains, and breads. *
Vegetables – Vegetables are important to any diet, diabetic or otherwise. These provide a great
source of fiber, minerals, and vitamins. Particularly good vegetables for your diet include cabbage,
spinach, broccoli, green beans, carrots, tomatoes, and peppers. * Fruits also provide you with fiber,
minerals, and vitamins. They are also a source for carbohydrates, but should be taken in moderation.
Depending on your calorie count, you should include two to four servings of fruits such as apples,
bananas, mango, fruit juice, oranges, raisins, and grapefruit each

Diabetic Cardiomyopathy
In 1972, diabetic cardiomyopathy (DCM) was first described by Rubler et al. based on postmortem
observations of the cardiac autopsy from diabetic patients who were suffering from heart failure
without other cardiovascular complications (Rubler et al. 1972). These observations were suggested
as specific impairment of the heart muscle itself (Rubler et al. 1972). DCM has a prevalence of 12%
in patients with type 2 diabetes (T2DM) (Kiencke et al. 2010), and been identified as a serious
complication of T2DM resulting from sustained toxic effects of hyperglycemia that leads to enhance
cardiac oxidative stress (Cai et al. 2001;Liu et al. 2014), inflammation (Westermann et al. 2007),
abnormal Ca2+ handling and mitochondrial function (Choi et al. 2002a;Duncan ... Show more
content on Helpwriting.net ...
2002), then, to the late stage which is presented with systolic dysfunction or heart failure (Boudina
et al. 2007;Boudina et al. 2010). The first stage of DCM is clinically asymptomatic, but the second
stage of DCM is characterized by diastolic dysfunction (including: ventricular hypertrophy and
stiffness, high end–diastolic pressure and volume) (Connelly et al. 2008;van et al. 2008) and cardiac
inter–cellular matrix remodeling (including: an accumulation of insoluble type VI collagen and a
deposition of fibrous tissue) (Khaidar et al. 1994;Spiro et al. 1993). Several mechanisms contribute
to ventricular stiffness in diabetic heart mainly due to sustained hyperglycemia that promotes
formation of advanced glycation end–products (AGEs) (Bodiga et al. 2014), all of which are cross–
linking with extracellular matrix proteins including collagen and elastin, leading to a change in the
histological properties and eventually impairing cardiac relaxation (Candido et al. 2003;Liu et al.
2003;Vasan et al. 2003). The prevalence of diastolic dysfunction is several times higher in patients
with T2DM than in age and sex–matched healthy populations (From et al. 2010;von and St John et
al. 2010). From a clinical standpoint, DCM is defined as the presence of left ventricular (LV)
dysfunction in diabetic subjects in the absence of

The New Class Of Anti Diabetic Drugs
Abstract
Glitazones are the new class of anti–diabetic drugs that are the first to be able to manage glycaemia
goals. Troglitazone was first approved for the market in 1997, but it was withdrawn from the market
by 2000. After the withdrawal of troglitazone, rosiglitazone and pioglitazone were introduced in
1999 as potentially safer alternatives. However, currently rosiglitazone is under black box warning
for increased risk of cardiovascular disease and pioglitazone is in a nutshell as the drug required
more investigation. In this review, the potential ability to predict the adverse drug reactions (ADRs)
are examined. If it is possible to predict ADRs, should it be done in the future.
Introduction
Millions of people worldwide are affected due to diabetes, 90% of them having type 2 diabetes
mellitus (non–insulin dependent). Since 1921, drug therapy has been improved minutely and in
1950s the antidiabetic sulphonamides and biguanides has been introduced. Therefore, the arrival of
"glitazone" or thiazolidinediones is an important event (14).
Thiazolidinediones are being developed for the treatment of type 2 diabetes mellitus and insulin
resistance. Thiazolidinediones binds and activate the peroxisome proliferator–activated receptor γ
(PPAR), a nuclear receptor that regulates the several genes which are involved in metabolism. The
PPAR γ controls lipid storage, insulin sensitization and adipocyte differentiation. Besides the
metabolic activities, thiazolidinediones also have

Diabetic Foot Care Device: A Case Study
The foot care device is basically a long handled sponge with a mirror attached. This particular piece
of adaptive equipment can help patients in the areas of occupation ADLs personal hygiene and
grooming and the IADL health management and maintenance. The device can help patients inspect
the bottoms of their feet or other hard to see areas on their body. This device can play a key role in
early detection of pressure ulcers and diabetic foot ulcers. The mirror on the equipment can help
address several client factors. Visual function is addressed with the mirror. Patients may not be able
to see the soles of their feet or other parts of their body very well by just using their eyes for skin
inspection. The client factor of skin and related ... Show more content on Helpwriting.net ...
Skin inspection is a very common thing that must be performed regularly with these diagnoses.
Inspection of the skin is extremely important as pressure sores and infections can occur very
quickly. Ideally skin should be inspected at least once a day. Patients will need to look for reddened
areas, scrapes, cuts, bruises or any kind of discoloration. Areas that need special attention are the
groin area, behind knees, the areas around the ankles and elbows, and posterior areas on the hips and
tailbone. The only way for your patient to know if their skin is healthy and intact is to look at it
regularly. In areas where sensation is decreased or impaired, skin inspection is a must and should
become a habit. Encourage the patient to plan it as a part of their regular routine. For example,
during a time when you are undressed anyway, like after a shower, before dressing in the morning or
after undressing in the evening. Also when working with some of these diagnosis or patients that are
in wheelchairs the therapist needs to educate the patient on position changes.
Pros of using the foot care device are that it can be used as a one handed device and it has a long
handle to help decrease trunk flexion. The device is fairly light weight, easy to maneuver, and can be
fit to accommodate your patient by adjusting measurements. I would say that the length of the
handle side can vary due to the size of your patient. This device could really benefit patients that do
not do their skin inspection daily. The device could make them become more compliant since it is
easier for them to check their

Diabetic Foot Problems
What are Diabetic Foot Problems and why do they occur? Foot problems are a big risk in diabetics
therefore diabetic patients must constantly monitor their feet or face severe consequences, including
amputation. With a diabetic foot, a wound as small as a blister from wearing a shoe that's too tight
can cause a lot of damage. Because diabetes decreases blood flow, injuries are slow to heal as new
blood often doesn't flow freely to the injury. When wounds do not heal in a timely fashion, they are
at risk for infection meaning that infections in the feet of diabetic patients spread quickly. If you
have diabetes, you should inspect your feet every day. Look for puncture wounds, bruises, pressure
areas, redness, warmth, blisters, ulcers, scratches,

Diabetic Absorbance
According to the experiment results the hypothesis was proven to be correct. The diabetics did
indeed have a higher absorbance level than the non–diabetics. It was made clear that the rate at
which a diabetic digests their meal is slower than a non–diabetic. It proves that fact that without
sugar, the body could not function properly because there would not be enough glucose in the body
to provide energy in order to make ATP. Without the main ingredient to make ATP the body would
die. This fact leads to the understanding as to why people with diabetes in third world countries are
dying because they cannot get the insulin needed in order to help their bodies make ATP and
function (Khunti).
As seen in figure one it is clear that it takes a diabetic longer to return to their pre–meal value
because it takes longer to break ... Show more content on Helpwriting.net ...
Also the diabetic would reach the maximum blood glucose level quicker because they could not
break down the glucose in the food as quick as the non–diabetic could. As seen in figure 1 it is clear
that a person with diabetics has almost double the absorbance level compared to the non–diabetics.
The data in figure 1 shows the absorbance over time for diabetics and non–diabetics. Looking
deeper into the meaning of why the absorbance is higher in the diabetic people it is known to be
because of the buildup of glucose in the bloodstream. This buildup leads to less glucose being able
to pass through and thus taking the diabetic longer to get back to the pre–meal value. The effects of
T2D can lead to this buildup and cause cardiovascular disorders, hypertension, and death. Diabetes
still not be taken lightly for this very reason. Unlike T2D patients type 1 diabetics(T1D) are at a
greater risk because their body does not produce insulin at all, thus making it harder to maintain and
regulate. T1D's are always having to check

1. Briefly define the following parts of the eye and their role in vision:
A. Optic Nerve: each of the second pair of cranial nerves, transmitting impulses
to the brain from the retina at the back of the eye.
It is where energy is converted into electrical energy so it can travel to the brain and trigger
responses. The optic nerve is a continuation of rods and cones which make up the retina.
However, at its head, there is a blind spot because there are no photoreceptors in this part of
the optic nerve. This blind spot does not cause problems for people when seeing.
B. Macula: an oval yellowish(means that it absorbs blue and violet light which would
harm the retina thus acting as a protector/ sunblock for the retina.
)area ... Show more content on Helpwriting.net ...
However, even patients with controlled diabetes can develop diabetic retinopathy.
It is important for diabetic patients to be examined yearly because there are no
symptoms of diabetic retinopathy so early detection and treatment can help reduce the
risk of permanent vision loss. two forms of diabetic retinopathy:
Nonproliferative: this is where exisiting blood vessels in the retina completely deteriorate. These
deteriorated blood vessels can become blocked or develop into aneurysms. Then fats, fluids,
and proteins leak out of the abnormal blood vessels. The fluids then collect in the retina and
cause the macula to swell, this is called edema. Edema impairs the vision responsible for

seeing fine detail and reading.
Proliferative: This is where new blood vessels grow on the surface of the retina which cause
small hemorrhages and bleeding. This causes scar formation which allows the clear gel of the
vitreous to adhere to the retina. This puts pressure on the shape of the vitreous causing it to
change its shape and tear the retina causing retinal detachment. It can treated can be treated
three ways:
Photcoagulation: A focal is used to burn the areas of the retina where the abnormal

A Brief Note On Diabetic Kidney Disease ( Dkd )
Diabetic Kidney Disease Diabetic kidney disease (DKD) is defined kidney disease attributed to
diabetes (versus chronic kidney disease, which may be due to numerous etiologies including
diabetes). ADA recommends screening for nephropathy 5 years after diagnosis for type 1 diabetes
and at diagnosis for type 2 diabetes. Screening includes urine albumin excretion (albumin/gr
creatinine). ADA no longer uses the terms "micro (< 30 ug/mg Cr) and macroalbuminuria (> ug/mg
Cr)", but defines albuminuria as a continuum. The term "microalbuminuria" implies less serious
disease, which is not true. Glomerular filtration rate (GFR) is used to assess kidney function. Since
it is difficult to measure GFR directly, the secretion of an endogenous filtration marker (e.g. serum
creatinine) is used to estimated GFR (eGFR). eGFR depends on age, gender, weight and ethnicity.
Younger people have higher eGFR due to more muscle mass and average creatinine generation rate
(ref NKF FAQ GFR). Since nephropathy is linked with hypertension, providers should closely
monitor blood pressure (ref). Diabetic kidney disease may be preventable, so it is important for
pediatric health care professionals to understand screening, risk factors, prevention, and treatment
options. Overt diabetic kidney disease remains uncommon in youth. Although one retrospective
study in type 1 diabetes subjects found that end–stage renal disease occurred in 2.9% of its
population, with a significant association

Diabetic Ketoacidosis : An Acute Complication Of...
Diabetic Ketoacidosis
Background
Diabetic Ketoacidosis (DKA) is an acute complication of uncontrolled glucose levels characterized
by reduced levels of insulin and presence of ketones. It is a medical emergency and results can be
detrimental if left untreated. DKA is commonly seen in patients with type 1 diabetes mellitus (type 1
DM). However, critically ill patients with type 2 diabetes mellitus (type 2 DM) such as trauma,
surgery or infection, are also at risk for DKA (Ignatavicius & Workman, 2013). Patients with type 1
DM are predisposed to DKA if their underlying conditions are not diagnosed early and in some
cases, they may experience similar signs and symptoms without actually developing DKA.
Comorbidities involving parts of ... Show more content on Helpwriting.net ...
Likewise, patients with type 2 DM are resistant to/lack the insulin hormone (Sole et al. 2013). There
is also the free activity of lipase, an enzyme responsible for the breakdown of triglycerides into fatty
acids and glycerol. This enzyme is founding adipose cells due to clustering and increased production
of fatty acids leading to an output of ketone from the liver (Grossman & Porth, 2014). As ketone
levels rise, so does bicarbonate levels leading to metabolic acidosis which is characterized by rapid
breathing otherwise known as Kussmaul respirations, a fruity breath, and in some cases increase in
lactic acid (Sole et al. 2013).
In addition to the disorders in the metabolism, patients with DKA experience a condition known as
Hyperglycemia–Induced Osmotic Diuresis characterized by the intracellular and extracellular shift
of increased glucose levels in the blood, and leads to electrolyte imbalance, increased serum
osmolality, and dehydration. Affected electrolytes include sodium, potassium, magnesium, calcium,
and phosphorus. Hypokalemia occurs as a result of absorption of potassium from cell to skeletal
muscle (Gosmanov, Gosmanova, & Dillard–Cannon 2014). These changes may cause a false
elevation of serum potassium levels (Sole et al. 2013).
Furthermore, dehydration becomes worse as the body tries to compensate for fluid shifts from the
intracellular to the intravascular spaces leading to a decrease in glomerular filtration rate, decreased

Thesis Statement For Diabetic Foot Ulcer
DIABETIC FOOT ULCER 3
Research question: What are the contributing factors in developing a diabetic foot ulcer in Type 2
diabetics in the community?
An estimated 16 million Americans are known to have diabetes and a substantial amount more are at
risk for developing this disease. In Americans, approximately 3–6% of the population has diabetes
(AADE, 2014). As you age, Type 2 diabetes begins to rise affecting how your body metabolizes
glucose. With Type 2 diabetes, glucose continues to build and lead to high blood sugar causing a
variety of symptoms contributing to the development of a diabetic foot ulcer. According to the
American Podiatric Medical Association, Diabetes is the leading cause of non–traumatic lower ...
Show more content on Helpwriting.net ...
They have diminished inflammatory response even when extreme soft tissue and bone infection are
present. Identification of foot infections in the patient with diabetes mellitus requires vigilance
because the signs of infection may not be present ( Baranoski and Ayello, 2003,p.327). The most
common bacteria found in non–limb threatening infection are Staphylococcus and Streptococcus.
These infections should be treated with oral antibiotics. If the limb is threatened with the infection,
parenteral antibiotics and surgical debridement of necrotic tissue needs to be executed. Most limb
threatening infections are polymicrobial. Staphylococcus aureus, group B atreptococci,
Enterococcus, and facultative Gram–negative bacilli are the major pathogens involved in these types
of

Diabetic Neuropathy
Diabetic neuropathy is a nerve disorders caused by diabetes. Symptoms include pain, tingling, or
numbness, loss of feeling in hands, arms, feet, and legs. Nerve problems can occur in every organ
system. Diabetic neuropathies appears more common in people who have problems controlling their
blood glucose, those with high levels of blood fat, high blood pressure and obese (Porth, 2015).
Metabolic factors include high blood glucose, abnormal blood fat levels, and low insulin levels.
Neurovascular factors are associated to damage to the blood vessels that carry oxygen and nutrients
to nerves (Porth, 2015). Autoimmune factors that cause inflammation in nerves. Mechanical injury
to nerves, for example, carpal tunnel syndrome (Porth, 2015). Inherited ... Show more content on
Helpwriting.net ...
It affects the nerves that control the heart, regulate blood pressure, and control blood glucose levels
(Callaghan, 2012). Autonomic neuropathy interferes with the body's ability to adjust blood pressure
and heart rate, resulting in blood pressure to drop sharply after sitting or standing, causing light–
headed or even to fainting. Damage to the nerves that control heart rate can mean that the heart rate
stays high, instead of rising and falling in response to normal body functions and physical activity.
Nerve damage to the digestive system commonly causes constipation, causing the stomach to empty
too slowly (Callaghan, 2012). This can lead to persistent nausea and vomiting, bloating, and loss of
appetite, making blood glucose levels fluctuate widely, due to abnormal food digestion. Nerve
damage to the esophagus makes swallowing difficult, while nerve damage to the bowels can cause
constipation alternating with frequent, uncontrolled diarrhea (Callaghan, 2012). Autonomic
neuropathy often affects the control of urination, which can prevent the bladder from emptying
completely, allowing bacteria to grow in the bladder and kidneys and causing urinary tract
infections. Urinary incontinence may result due to not being able to sense when the bladder is full or
control the muscles that release urine. It can also gradually decrease sexual response in both

Diabetic Neuropathy
Diabetic neuropathy is defined as damage to nerves caused by diabetes. Nerve damage in the arms,
legs, hands and feet caused by diabetes is referred to as diabetic peripheral neuropathy. While some
patients may have extremely painful symptoms, others may be asymptomatic. If there is damage to
the peripheral nerves, one might not be able to feel normally in their arms, hands, legs, and feet. In
some cases, these parts may feel numb. Some may also have a needles and pins, or burning
sensation. These symptoms are often worsened at night and can interfere with sleep. "Painful
diabetic neuropathy symptoms exhibit a symmetrical 'stocking and gloves' distribution and are often
associated with nocturnal exacerbation (Aslam, Singh, & Rajbhandari, 2014, ... Show more content
on Helpwriting.net ...
One such test is performed using calibrated, sterile, disposable needle . "A constant force is applied
perpendicularly on the skin of the foot until the calibrated mark is reached. A record is made as to
whether the patient responded to any sensation felt in the foot (Nather et al., 2011, para.

Diabetic Keetoacidosis
Diabetic ketoacidosis is an event which occurs when there is not enough insulin in the body to
utilize sufficient amount of glucose needed to provide cells with energy; body then starts to use fatty
acids as a fuel, which are converted to ketones in the liver. In healthy people who do not have
diabetes, ketone bodies are produced in normal quantities and then successfully used by tissues as
energy supply. This state is known as dietary ketosis and it is completely normal and may even
provide health benefits. But in those who have diabetes, ketones are produced in enormous
quantities and aren't used in full by cells, so they start to build up in the blood. Acids 3–
hydroxybutyric acid and acetoacetic acid are produced rapidly causing decrease in buffering
capacity of the blood and eventually depleting buffering systems (Manninen, 2004). 3–
hydroxybutyric acid Figure 1. 3–hydroxybutyric acid. acetoacetic acid Figure 2. Acetoacetic acid.
This only occurs in people who have diabetes and ... Show more content on Helpwriting.net ...
This is being done to provide the most comfortable conditions for a variety of biochemical reactions
going on in these fluids, because "in order for a particular reaction to occur or to occur at an
appropriate rate, the pH of the reaction medium must be controlled" (Biological buffers, n.d.).
Human blood pH levels are kept in the narrow range from 7.35 to 7.45 to ensure that physiological
processes go smoothly. When some acid is being added to the blood so that there are a lot of
hydrogen ions available, then blood buffering systems start to work to maintain the pH level.
Bicarbonate buffering system plays major role in regulating blood pH. In bicarbonate buffering
system carbonic acid serves as hydrogen ion donor; when some base is added to blood plasma,
carbonic acid dissolves into hydrogen cation and bicarbonate anion. When some acid is added to
blood, bicarbonates take up hydrogen ions to become carbonic

Diabetic Children
Diabetes is one of the top health disorders that affect millions of Americans today. Sadly, children
are not the exception. Parents with children that have diabetes are acutely aware of the many
challenges and risks that occur from the illness. Symptoms of the disease include hyperglycemia,
abnormal high levels of blood sugar, and hypoglycemia, low levels of blood sugar as a result from
too much insulin released into the bloodstream. Because fluctuations in blood sugar levels are
unpredictable, parents must be vigilant about testing the child's blood glucose level and
administering medication as needed.
Besides rigorous glucose testing and the administering of medication, another major challenge for
parents with diabetic children is dietary. ... Show more content on Helpwriting.net ...
Parents are expected to frequently monitor their children's blood sugar level, and to take medication
as prescribed by the child's physician. Additional cost may arise from supplemental supplies, doctor
visits, or even hospital stays. Be that as it may, parents whose children receive a proper diagnosis
and routine medical care by an endocrinologist; a specialist in the study of the endocrine glands, are
most likely able to live full and active lives.
Although diabetes is a serious disease that can be time consuming, and stressful to the parents and
child, it is important for parents to try to have a positive outlook about their child's medical
condition. Children can be keenly aware if their parent remains stressed for a period of time.
Therefore, it is perhaps to the family's advantage if there is a reliable support system into place, such
as close friends or extended family members.
All things considered, it follows that my job as a parent of a diabetic child would be to ensure that
my child has regular doctors' visits, give or is given medication in a timely manner, acquire needed
medical equipment and supplies, gets regular exercise, adhere to the dietary guidelines set–forth by
my child's nutritionist, and receive emotional support as deemed necessary for myself, as well as my

Diabetic Misconceptions
Indeed, American consume a very high amount of flour and sugar daily because almost every food
contained sugar and flour. Although I know it is the misconception of diabetic, I still view diabetic
as one of the adult's disease when I heard the word diabetic. Somehow, I do not expect that
teenagers would suffer from it. I agree with Dr. Mark Hyman that most of us do not know how to
feed our brain due to the lack of education. Obviously, I am the first generation who go to the
college in my family and I have never thought about how my diet affect my brain. Moreover, I do
not realize that sugar can contribute to depression. I also have no idea how to feed my brain with
healthy foods until I saw the video of "How to Eat Right for Your Brain" by

Diabetics
Elosegui 1 Jonathan Elosegui Paola Brown English 102 10 March 2008 Puerto Rico walks away
from commonwealth. I will not pledge allegiance to the flag of the United States of America and to
the republic for which it stands. This must be the words of thousands of Puerto Ricans living in the
island today wishing that their small island would once and for all become free from the
colonization of the United States. Puerto Rico has been living under U.S. domination for the past 92
years and it's considered the last nation in Latin America that is still living in colonization. Puerto
Ricans want to be free and should be allowed to be free; to have the opportunity to vote for the
president who sends its young people to war, to have their own ... Show more content on
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However, as a person born in Puerto Rico I have enjoyed many of the benefits that being a
commonwealth has provided in my life. One of the most important benefits is the right to American
citizenship upon birth. All Puerto Ricans who are born in the island are American citizens and are
free to enter the mainland U.S. If Puerto Rico remains a commonwealth this is a benefit that future
generations will continue to enjoy. Another benefit the island enjoys is the aid provided by the
United States and the tax exemption the island receives; Puerto Rico is exempt from paying federal
taxes. Many supporters of the commonwealth status clearly point out the help the island receives
and how life would be if Puerto Rico did not receive the strong financial support from the United
Sates and research provided in the CQ Researcher article, Puerto Rico: The Struggle Over Status
points out that "Puerto Rico receives generous tax benefits and more than $6 billion a year from the
U.S government" clearly something that the island will not receive if it became independent. All of
these benefits the island receives still do not amount to independency and the benefit to govern
itself. As an independent nation Puerto Rico would open its trading market with various countries
around the world expanding the economy and not having to depend on the help the Unites Sates
provides. American

Diabetic Nephropathy
Diabetic Nephropathy or Diabetic Kidney Disease is a syndrome that has been generally defined as
disease in which there is increased protein excretion in urine. It is commonly characterized by the
presence of pathological quantities of albumin in urine that is excreted from the patient's body,
diabetic glomerular lesions, and loss of glomerular filtration rate (GFR) in diabetics. It can be
categorized into stages: microalbuminuria and macroalbuminuria. The early stage is usually
characterized by a small increase in urinary albumin excretion (UAE), and it is also called
microalbuminuria or incipient Diabetic nephropathy while a more advanced disease that is
characterized by the presence of proteinuria is called macroalbuminuria or overt Diabetic ... Show
more content on Helpwriting.net ...
It is often associated with cardiovascular diseases which cause an increase in the mortality of
diabetic patients. According to Duran–Salgado & Rubio–Guerra (2014), Diabetic nephropathy
occurs in nearly about one–third of patients that have type 1 Diabetes mellitus and around 25% of
patients that have type 2 Diabetes mellitus. Diabetic nephropathy is usually characterized by
glomerular hypertrophy, thickness of the basement, tubular and glomerular membranes and
accumulation of extracellular matrix in these membranes that causes the tubulointerstitial and
glomerular fibrosis and sclerosis. The two main risk factors for diabetic nephropathy are
hyperglycemia and arterial hypertension, but the genetic susceptibility in both type 1 and type 2
diabetes is of great importance. Other risk factors included are smoking, dyslipidemia, proteinuria,
glomerular hyperfiltration and dietary factors. Zelmanovitz et al. (2009) reported in their study that
the prevalence of Diabetic nephropathy varies according to ethnicity as the results indicate that it is
higher or more common in African–Americans, Asians and Native–Americans than in

Oral Anti Diabetic Agents Are Used As Pharmacotherapy Options
Introduction:
Oral anti diabetic agents are used as pharmacotherapy options mainly for type 2 diabetes patients or
as an adjuvant therapy for type 1 diabetes patients, who need an oral agent along with insulin/insulin
analogues for better glycemic control. There are a wide variety of oral anti diabetic drug classes that
are available. The choice of pharmacotherapy is patient specific and usually a stepped therapy
approach is applied and titrated as per individual patient requirements. The article here is a detailed
overview of the different classes of these oral agents, their pharmacology, comparative efficacy,
efficacy results from clinical trials, general recommendations etc.
The different classes of oral anti diabetics starting from traditional therapy to the latest
developments are as follows :
 BIGUANIDES [METFORMIN]
 SULFONYLUREAS
a. FIRST GENERATION SULFONYLUREAS.
b. SECOND GENERATION SULFONYLUREAS.
 MEGLITINIDES
 THIAZOLIDINEDIONES
 DPP–4 INHIBITORS
 ALPHA–GLUCOSIDASE INHIBITORS
 SGL2 INHIBITORS (NEWEST CLASS OF DRUGS) CLASS I: BIGUANIDES [METFORMIN]
According to the ADA (American Diabetes Association) 2013 guidelines, metformin is considered
as first line therapy for initiation of treatment in a type 2 diabetes patient when lifestyle
modifications, diet and exercise fail to achieve glycemic control.
Mechanism of action: Metformin decreases hepatic glucose production thereby decreasing intestinal
absorption of

Diabetic Foot Analysis
7 Tips to Care for Your Diabetic Feet
Your diabetic foot problems could land you in the hospital.
There are two serious complications that affect those who suffer from diabetes, poor circulation and
nerve damage. A simple blister or cut on the foot can quickly progress to a serious infection due to
the numbness and lack of feeling that results from nerve damage and poor blood flow. Neuropathy,
which is chronic nerve damage caused by the disease, can produce cracked, dry skin which provides
an opening for bacteria to enter and cause infection.
Foot infections caused by diabetes can range from a doctor's visit for antibiotics if caught early
enough, to undergoing an amputation of a toe or foot. For people who suffer from diabetes, a
vigilant daily inspection is crucial to the overall health and wellbeing of your feet.
Daily Diabetic ... Show more content on Helpwriting.net ...
This can cause a serious foot infection. Always wear shoes or some form of protective foot covering
to reduce the risk of a foot injury.
Keep your feet clean and dry – Wash your feet every day with warm water and a mild soap making
sure to first test the water temperature with your hand. Do not soak your feet and when drying them,
don't rub, but pat each foot with a towel. Also, make sure to be careful while drying between your
toes.
Moisturize dry, cracked feet – Use a good, thick lotion to keep the skin of your feet soft and
moisturized as this prevents cracking and decreases the risk of infection. Don't put lotion between
the toes.
Trim toe nails straight across – Don't cut the corners or down the sides of the toe nail. Use an emery
board or nail file to shape toe nails and if you find an ingrown toenail, make an appointment to see a
podiatrist. Proper medical care is important in preventing infections for those with

Diabetic Retinopathy Research Paper
Diabetic retinopathy is a leading cause of adult vision loss world–wide that offers a significant
diagnostic challenge. The prevalence of DR increases with duration of diabetes [31]. DR is difficult
to prevent and treat. Biochemical mechanisms, such as hyperglycemia, are proposed as possible
pathogenic factors in DR, while retinal vasodilation and retinal hyperperfusion, related to hypoxia
and the release of nitric oxide, may be key initiating factors in early DR developments [32–35].
Hyperperfusion, is associated with impaired vascular autoregulation, which may lead to increased
epithelial wall tension and permeability, and subsequent leakage and microaneurysm development
[36]. Disturbances are detected in many aspects of ocular circulation ... Show more content on
Helpwriting.net ...
Human grading is a naturally subjective task, because a human grader performance is influenced by
several factors such as exhaustion. Therefore, automated analyses of the images are fundamental to
bring objectivity, and repeatability, to the task of identifying patients that need referral for medical
appointments with retinal specialists. This automated solution decreases the human burden for
grading, which is especially expensive as most of the patients do not need referral for further
treatment, and permits for more critical patients to be given eye care priority. It also increases the
clinician productivity in a regular population screening setting facilitating the rapid translation to
daily use. Earlier studies have demonstrated that automated algorithms in DR detection are reliable
[54, 55]. However, there is still lack of prove and standardization to facilitate the generalization of
the use of these algorithms for images obtained with different imaging modalities and also from
different populations. A more detailed review on retinal imaging techniques and quantitative
approaches to retinal image analysis in DR can be found in the works of Abramoff and colleagues
[56].
The latest advancements in optical imaging, technology miniaturization and automation has
accelerated the development of portable DR screening devices and provided advantages for the
development of point–of–care

Many people with type 1 and type 2 diabetes eventually struggle with vision problems, and when
they do they turn to the professional healthcare team at Tri–State Eye in Middletown, NY, and
Milford, PA. Their team of eye doctors offers specialized treatments to alleviate diabetic retinopathy
and minimize the risk of blindness in people with diabetes. Here, they explain more about what
diabetic retinopathy is and how it can affect you or your loved ones.
Tri–State Eye's Diabetic Retinopathy FAQ Guide
Why Does Diabetes Affect Vision?
The reason people with diabetes often have eye problems is because high blood sugar levels can
damage the blood vessels in the retina–this is the main cause of diabetic retinopathy. Since many
diabetics have high ... Show more content on Helpwriting.net ...
NPDR is the early stage of diabetic retinopathy. At this point, the blood vessels behind the retina
have already started leaking blood or fluid, but the person may not actually notice any vision
problems yet. Eventually people with NPDR can develop macular edema or macular ischemia and
experience severe vision loss.
What Is Proliferative Diabetic Retinopathy?
PDR causes new blood vessels to form over the retina and optic nerve. Unfortunately, the resulting
blood vessels are usually accompanied by scar tissue. PDR can result in retina detachment, vitreous
hemorrhage, traction retinal detachment, and neovascular glaucoma.
How Is Diabetic Retinopathy Diagnosed?
An eye doctor who specializes in diabetic eye problems can perform an eye exam to see if you have
any signs of diabetic retinopathy. By dilating your pupils and performing a fluorescein angiography
test they should be able to tell you definitively if you have diabetic retinopathy or not.
If you have diabetes you should get tested regularly, and if you are diagnosed with diabetic
retinopathy you should be aware that there are treatment options available. To find out more about
treating diabetic retinopathy call Middletown Tri–State Eye at (845) 703–2020 or visit them online

Diabetic Peripheral Neuropathy Essay

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