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Shachi says

Edema in Diabetic Nephropathy results from buildup of fluid. The kidneys are responsible for filtering bloodstream and removing excess water out of the body. Diabetic kidney disease with severely impaired kidney functions can cause accumulation of fluid in the body. In addition, reduction of blood plasma osmotic pressure due to loss of proteins will lead water to run into tissues, which will also aggravate swelling. The patients may experience swelling in eyelids, limbs, ankles, or short breath. The causes of edema are many. 1. It can be due to the damage of immune system,which leads to the increased permeability of systemic capillary wall causing the water in the plasma to seep into the interstitial space. 2. Hypoproteinemia- it will secrete more secondary aldosterone and antidiuretic hormone and renal tubule will reabsorb more water and sodium, which will cause edema. Along with aggravation of patients′ condition, more and more renal units will be damaged and glomerulosclerosis will occur at more glomeruli. Excessive loss of protein will lead to hypoproteinemia. Loss of protein from glomerular capillaries leads to decrease of plasma colloid osmotic pressure. Plasma colloid plays an important role in regulating the exchange of water inside and outside the blood vessels. So decrease of plasma colloid osmotic pressure will lead to water retention in tissue, which causes edema. So, Patients with Diabetic Nephropathy may need to restrict their dietary water consumption to relieve their edema. Diuretics may be prescribed to remove the excess fluid out of the body.
Edema in Diabetic Nephropathy results from buildup of fluid. The kidneys are responsible for filtering bloodstream and removing excess water out of the body. Diabetic kidney disease with severely impaired kidney functions can cause accumulation of fluid in the body. In addition, reduction of blood plasma osmotic pressure due to loss of proteins will lead water to run into tissues, which will... (Read More)
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Shachi says

Skin problems are common in people with diabetes. Blood glucose provides an excellent breeding ground for bacteria and fungi, and can reduce the body’s ability to heal itself. These factors put people with diabetes at greater risk for skin problems. In fact, as many as a third of people with diabetes will have a skin disorder related to their disease at some time in their lives. Fortunately, most skin conditions can be prevented and successfully treated if caught early. But if not cared for properly, a minor skin condition can turn into a serious problem with potentially severe consequences. Some of the problems listed below—such as bacterial infections, fungal infections and itching—are skin conditions that can affect anyone. However, people with diabetes are more prone to getting these conditions, which can lead to serious complications. Some of the conditions listed—such as diabetic dermopathy, necrobiosis lipoidica diabeticorum and eruptive xanthomatosis—occur only in people with diabetes. (Remember, people with diabetes also can develop skin conditions that affect people who do not have diabetes.) Some common skin conditions include: Dry skin — If your blood glucose is high, your body loses fluid, causing your skin to become dry. This occurs because the body is turning the water into urine to remove excess glucose from the blood. Your skin also can get dry if the nerves, especially those in your legs and feet, do not get the message to sweat (because of diabetic neuropathy). Sweating helps keep your skin soft and moist. Dry skin can become red and sore, and can crack and peel. Germs can enter through the cracks in your skin and cause an infection. In addition, dry skin usually is itchy, and scratching can lead to breaks in the skin and infection. Acanthosis nigricans — This is a condition that results in the darkening and thickening of the skin. Often, areas of tan or brown skin, sometimes slightly raised, appear on the sides of the neck, the armpits, and groin. Occasionally, these darkened areas may appear on the hands, elbows, and knees. Acanthosis nigricans usually strikes people who are very overweight. There is no cure for acanthosis nigricans, but losing weight may improve the condition. Acanthosis nigricans usually precedes diabetes. Atherosclerosis — Atherosclerosis is the narrowing of blood vessels from a thickening of the vessel walls. While atherosclerosis most often is associated with blood vessels in or near the heart, it can affect blood vessels throughout the body, including those that supply the skin. When the blood vessels supplying the skin become narrow, changes occur due to a lack of oxygen. Loss of hair, thinning and shiny skin, thickened and discolored toenails, and cold skin are symptoms of atherosclerosis. Because blood carries the white blood cells that help fight infection, legs and feet affected by atherosclerosis heal slowly when they are injured. Bullosis diabeticorum (diabetic blisters) — In rare cases, people with diabetes develop blisters that resemble burn blisters. These blisters—called bullosis diabeticorum—can occur on the fingers, hands, toes, feet, legs, or forearms. Diabetic blisters usually are painless and heal on their own. They often occur in people who have diabetic neuropathy. Bringing your blood glucose level under control is the treatment for this condition. Diabetic dermopathy — Diabetes can affect the small blood vessels of the body that supply the skin with blood. Changes to the blood vessels because of diabetes can cause a skin condition called diabetic dermopathy. Dermopathy appears as scaly patches that are light brown or red, often on the front of the legs. The patches do not hurt, blister or itch, and treatment generally is not necessary. The patches are sometimes called skin spots. Digital sclerosis — The word "digital" refers to your fingers and toes, and "sclerosis" means hardening. Digital sclerosis, therefore, is a condition in which the skin on your toes, fingers and hands become thick, waxy and tight. Stiffness of the finger joints also may occur. The treatment is to bring your blood glucose level under control. Lotions and moisturizers may help soften the skin. Eruptive xanthomatosis — Eruptive xanthomatosis can occur in some individuals when blood glucose levels are not well controlled and when triglycerides in the blood rise to extremely high levels. This condition appears as firm, yellow, pea-like bumps on the skin. The bumps—which are surrounded by red halos and are itchy—usually are found on the feet, arms, legs, buttocks and backs of the hands. Treatment for eruptive xanthomatosis consists of controlling your blood glucose level. Lipid-lowering drugs also may be needed. Itching — Itching skin, also called pruritus, can have many causes, such as a yeast infection, dry skin or poor blood flow. When itching is caused by poor blood flow, the lower legs and feet are most often affected. Using lotion can help to keep your skin soft and moist, and prevent itching due to dry skin. Necrobiosis lipoidica diabeticorum — Necrobiosis lipoidica diabeticorum (NLD) is caused by changes in the blood vessels and generally affects the lower legs. With NLD, the affected skin becomes raised, yellow and waxy in appearance, often with a purple border. Sometimes, NLD is itchy and painful. As long as the sores do not break open, treatment is not necessary. If the sores do break open, see your health care provider for treatment. Scleroderma diabeticorum — Like digital sclerosis, this condition causes a thickening of the skin; but scleroderma diabeticorum affects the skin on the back of the neck and upper back. This condition, which is rare, most often affects people with diabetes who are overweight. The treatment is to bring your blood glucose level under control. Lotions and moisturizers may help soften the skin. Keeping your diabetes under control is the most important factor in preventing the skin-related complications of diabetes. Follow your health care provider’s advice regarding nutrition, exercise, and medication. Keep your blood glucose level within the range recommended by your health care provider. Proper skin care also can help reduce your risk of skin-related problems.
Skin problems are common in people with diabetes. Blood glucose provides an excellent breeding ground for bacteria and fungi, and can reduce the body’s ability to heal itself. These factors put people with diabetes at greater risk for skin problems. In fact, as many as a third of people with diabetes will have a skin disorder related to their disease at some time in their lives. Fortunately,... (Read More)
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What is Diabetic Ketoacidosis?

Shachi says

DIABETIC KETOACIDOSIS (DKA) Diabetic ketoacidosis is an acute, life threatening metabolic acidosis which mostly complicates type 1 diabetes. Occasionally a patient with type 2 diabetes may develop DKA, especially if they have intercurrent illness or long duration of diabetes with complete depletion of insulin stores. When cells don't get the glucose they need for energy, body begins to burn fat which produces ketones. Ketones are acids that build up in the blood and appear in the urine when body doesn't have enough insulin. They are a warning sign that diabetes is out of control.High levels of ketones can poison the body and when the levels get too high, a person can develop diabetic ketoacidosis, or DKA. CAUSES: Diabetic ketoacidosis occurs when a person with diabetes becomes dehydrated. As the body produces a stress response, hormones (unopposed by insulin due to the insulin deficiency) begin to break down muscle, fat, and liver cells into glucose (sugar) and fatty acids for use as fuel. These hormones include glucagon, growth hormone, and adrenaline. These fatty acids are converted to ketones by a process called oxidation. The body consumes its own muscle, fat, and liver cells for fuel. In diabetic ketoacidosis, the body shifts from its normal fed metabolism (using carbohydrates for fuel) to a fasting state (using fat for fuel). The resulting increase in blood sugar occurs, because insulin is unavailable to transport sugar into cells for future use. As blood sugar levels rise, the kidneys cannot retain the extra sugar, which is dumped into the urine, thereby increasing urination and causing dehydration. Commonly, about 10% of total body fluids are lost as the patient slips into diabetic ketoacidosis. Significant loss of potassiumand other salts in the excessive urination is also common. PRESENTING FEATURES: The symptoms of DKA are due to metabolic acidosis and dehydration. The patient will also have symptoms of severe hyperglycemia SYMPTOMS • Polyuria, nocturia • Thirst • Weight loss • Malaise, lethargy • Visual disturbance • Abdominal pain • Anorexia • Nausea, vomiting • Breathlessness SIGNS • Dehydration, loss of skin turgor • Hypotension • Tachycardia • Hypothermia • Acetone odor in breath • Hyperventilation (Kussmaul’s breathing) • Drowsiness • Hyperreflexia, hypotonia • Acute abdomen/gastric dilation TESTS AND DIAGNOSIS: If doctor suspects diabetic ketoacidosis,he will do a physical exam and various blood tests. In some cases, additional tests may be needed to help the doctor determine what triggered the episode of diabetic ketoacidosis or what damage the ketoacidosis may have caused. Blood tests Blood tests used in the diagnosis of diabetic ketoacidosis will measure: • Blood sugar level: If there isn't enough insulin in body to allow sugar to enter cells, blood sugar level will rise (hyperglycemia). As body breaks down fat and protein for energy, blood sugar level will continue to rise. • Ketone level. When body breaks down fat and protein for energy, toxic acids known as ketones enter bloodstream. • Blood acidity. If have excess ketones in blood, blood will become acidic (acidosis). This can damage organs throughout body. Additional tests doctor also may order tests to identify underlying health problems that may have contributed to diabetic ketoacidosis and check for complications. Tests may include: • Blood electrolyte tests • Urinalysis • Chest X-ray DIABETIC KETOACIDOSIS MANAGEMENT Self-Care at Home Home care is generally directed toward preventing diabetic ketoacidosis and treating moderately to elevated high levels of blood sugar. If have type 1 diabetes, should monitor blood sugars as instructed by health care practitioner. Check these levels more often if feel ill, if you are fighting an infection, or if you have had a recent illness or injury. Be alert for signs of infection and keep yourself well hydrated by drinking sugar free fluids throughout the day. The goals of treatment: Improving Circulating Volume and Tissue perfusion Decreasing serum glucose and osmolarity Clearing blood and urine ketones Correcting electrolyte imbalances Identifying and treating the underlying cause FLUID AND ELECTROLYTES As it takes about 48-72 hours for DKA to develop, full replacement of the previous losses and correction of acid-base disturbances should be done with the same speed. Initially the fluid of choice is normal saline. 1 litre should be infused in the first 1 hour; The next 1 litre in the next 2 hours; 2 litres in the next 4 hours; 2 litres in the next 8 hours. i.e. about of saline should be monitored by BP, CVP, pulse an skin turgor. If the sodium levels are >150 mEg/I, half normal saline can be used. When the blood sugar levels reach around 250 mg/ld, the fluid should be changed to 5% dextrose saline drip (along with administration of insulin) to prevent hypoglycemia. Care should be taken not to infuse large amount of fluid too rapidly in elderly patients and especially those with pre-existing heart disease, congestive cardiac failure or renal failure. Insulin It is now well-accepted that a slow, steady infusion of insulin is ideal- often in adults after a bolus of 0.1-0.2units/kg body weight. If this is not possible an hourly small injection of short or rapid acting insulin is equally effective. The recommended insulin infusion dose is 0.1unit/kg/hour Potassium Potassium levels should be monitored regularly. Initially it may be low, normal or high. If it is low, start a potassium drip immediately with 40 meg of KCI per litre of fluid to begin with making sure that the urine output is adequate (>50 ml/hr). If the response is not adequate, adjust the dose of the KCI drip accordingly. If patient is taking oral feeds, oral potassium can be formula. Next Steps Follow-up In cases of mild dehydration with borderline diabetic ketoacidosis, may be treated and released from the emergency department providing that you are reliable and will promptly follow-up with your health care practitioner. Whether you are released to go home or monitored in the hospital, it is important that close monitoring of blood sugar and urinary ketone levels be continued. Elevated blood sugars should be controlled with extra insulin doses and drinking plenty of sugar-free fluids. Long-term care should include periodic follow-up with health care practitioner to achieve good control of blood sugars. Care includes screening for and treating the complications of diabetes by periodic blood tests of hemoglobin A1C, kidney function, and cholesterol, as well as an annual eye examination and regular inspection of the feet (for evidence of wounds or damage to nerves). PREVENTION • Educate patient about sick day rules • Advise not to omit insulin • Advise patients to do frequent blood sugar monitoring and tell them the targets • Advise patients to test urine for ketones during sick days • Advise patient to seed prompt treatment for fever or any other infection • Increase fluid intake during fever • Keep a vial of regular insulin at home • Advise patients to report to hospital or physician as early as possible if unable to eat or drowsy.
DIABETIC KETOACIDOSIS (DKA) Diabetic ketoacidosis is an acute, life threatening metabolic acidosis which mostly complicates type 1 diabetes. Occasionally a patient with type 2 diabetes may develop DKA, especially if they have intercurrent illness or long duration of diabetes with complete depletion of insulin stores. When cells don't get the glucose they need for energy, body begins to burn fat... (Read More)
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Shachi says

It is not uncommon to find sugar cravings among diabetic patients.We are here to combat them and suggest methods to have sugary foods, keeping your health in check. First and foremost, you must remember to carefully plan your diet and curb your cravings. Apart from small intakes of fresh fruits, you could add to your diet 'low calorie sweetners'. Sometimes they are also referred to as artificial sweeteners, sugar substitutes or non-nutritive sweeteners.They can be used to sweeten food and drinks for less calories and carbohydrate when they replace sugar. Since the sweetening power of the low calorie sweeteners is 100 times more intense than regular sugar, only a small amount is needed when you use sugar substitutes. With the exception of aspartame,all of the sweeteners listed below cannot be broken down by the body. They pass through our systems without being digested, so they provide no extra calories. Though many foods containing low-calorie sweeteners do provide some calories and carbohydrate from other ingredients. That means foods that carry claims like "sugar-free," "reduced sugar" or "no sugar added" are not necessarily carbohdyrate-free or lower in carbohydrate than the original version of the food. It is important to always check the nutrition facts panel, even for foods that carry these claims. There are six artificial sweeteners that have been tested and approved by the U.S. Food and Drug Administration (FDA). When certain materials are generally recognized as safe by the FDA, it means that experts have agreed that it is safe for use by the public in appropriate amounts. The sweteners are used to make diet drinks, baked goods, frozen desserts, candy, light yogurt and chewing gum. You can buy them to use as table top sweeteners and add them to coffee, tea, or sprinkle them on top of fruits. Some are also available in "granular" versions which can be used in cooking and baking. The 6 sweeteners are: • acesulfame potassium (also called acesulfame K) • aspartame • saccharin • sucralose • neotame • advantame Stevia, a highly purified product comes from the stevia plant and is several hundred times sweeter than sugar. According to the U.S. Food and Drug Administration (FDA),it is generally recognized as safe as a food additive and table top sweetener. The chart below lists the brand names seen in stores for low-calorie sweeteners: Sweetener Name Brand Names Found in Stores Acesulfame Potassium Sunett Sweet One Aspartame Nutrasweet Equal Neotame N/A Saccharin Sweet 'N Low Sweet Twin Sugar Twin Sucralose Splenda Stevia/Rebaudioside A A Sweet Leaf Sun Crystals Steviva Truvia PureVia
It is not uncommon to find sugar cravings among diabetic patients.We are here to combat them and suggest methods to have sugary foods, keeping your health in check. First and foremost, you must remember to carefully plan your diet and curb your cravings. Apart from small intakes of fresh fruits, you could add to your diet 'low calorie sweetners'. Sometimes they are also referred to as... (Read More)
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Shachi says

"Hypoglycemia, commonly referred to as ""low blood sugar,"" occurs when the amount of glucose in the blood falls below normal levels. Glucose is an important source of energy for the body. When your blood sugar level is too low, your brain cells and muscles do not have enough energy to function properly. Hypoglycemia can occur as a consequence of diabetes or as a reaction to a specific food eaten, or when you don't eat enough. It can usually be treated quickly by eating a small amount of food containing glucose as soon as possible. Left untreated, hypoglycemia can cause confusion, headaches and fainting and, in more severe cases, seizures, coma, and even death. You should eat three full meals and have three small snacks throughout the day so that you are eating regularly and consistently. Make sure to time the meals and snacks so that the gaps between them are evenly spaced out; if you miss a snack or eat later than usual, this can cause your blood sugar to get lower. Any meal should never be more than four hours a day. All these tips become even more critical if you are on medicine! Complex carbohydrates should comprise 40 to 60% of your daily diet and good sources include brown rice, beans, and whole grain bread as well as vegetables such as kale, cabbage, and broccoli. Limit refined carbohydrates like white bread, pastries, syrups, and candy. Good choices for fruit include oranges, peaches, grapes, blueberries, strawberries, and watermelon, among others; these will not only round out your meal but also provide valuable phytonutrients. Fresh fruit is a great source of natural sugar, which can spike your blood sugar and prevent hypoglycemia. A good rule of thumb is that your plate should be two-thirds full of vegetables and fruits. Avoid beverages and foods that contain significant levels of caffeine, including coffee, tea and some types of sodas. Caffeine can cause the same symptoms as hypoglycemia, which may make you feel even worse. At the first sign of hypoglycemia symptoms, promptly ingest a quick snack. Go for whatever you have on hand or is available the quickest. Symptoms should dissipate within 10 to 15 minutes after consumption; re-test your blood sugar after 15 minutes to make sure it's back up to 70 mg/dL or higher. quick-fix food options include: 1/2 cup of fruit juice (orange, apple, grape, etc.) 1/2 cup of regular soda (not diet) 1 cup of milk1 tbsp of honey or sugar."
"Hypoglycemia, commonly referred to as ""low blood sugar,"" occurs when the amount of glucose in the blood falls below normal levels. Glucose is an important source of energy for the body. When your blood sugar level is too low, your brain cells and muscles do not have enough energy to function properly. Hypoglycemia can occur as a consequence of diabetes or as a reaction to a specific food... (Read More)
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