Conclusion High-quality diabetes care involves a series of periodic conversations about self-management and about pharmacologic and nonpharmacologic treatments that fit with each patient’s goals (ie, shared decision making). Incorporating these conversations into regular practice provides FPs with opportunities to maximize likely benefits of treatments and decrease the risk of harms, to support patients in initiating and sustaining desired lifestyle changes, and to help patients cope with the burdens of diabetes and comorbid conditions.
Type 2 diabetes is a disorder characterized by abnormally high blood sugar levels. In this form of diabetes, the body stops using and making insulin properly. Insulin is a hormone produced in the pancreas that helps regulate blood sugar levels. Specifically, insulin controls how much glucose (a type of sugar) is passed from the blood into cells, where it is used as an energy source. When blood sugar levels are high (such as after a meal), the pancreas releases insulin to move the excess glucose into cells, which reduces the amount of glucose in the blood.
Hypoglycemia means abnormally low blood sugar (glucose). In patients with diabetes, the most common cause of low blood sugar is excessive use of insulin or other glucose-lowering medications, to lower the blood sugar level in diabetic patients in the presence of a delayed or absent meal. When low blood sugar levels occur because of too much insulin, it is called an insulin reaction. Sometimes, low blood sugar can be the result of an insufficient caloric intake or sudden excessive physical exertion.
Cons: Glucose Buddy does not sync with meters, continuous glucose monitors (CGMs), or pumps. Both Android and Apple users can access glucosebuddy.com, but only Apple users can sync their app with the website; Android users have to manually input their log on the web portal. There is no way to back up your data, so if you lose your phone and you haven’t manually entered logbook data on the website (or if your Apple device didn’t sync), you’ll have to start over. A built-in calorie tracker and food database is planned, but no release date has been set yet.
A 2018 study suggested that three types should be abandoned as too simplistic. It classified diabetes into five subgroups, with what is typically described as type 1 and autoimmune late-onset diabetes categorized as one group, whereas type 2 encompasses four categories. This is hoped to improve diabetes treatment by tailoring it more specifically to the subgroups.
Anything that makes life with type 1 diabetes or type 2 diabetes easier is a win, and research shows that using a diabetes app can improve your health. For example, a review published online in March 2018 in the journal Diabetes, Obesity and Metabolism combined the results of 16 trials of type 2 diabetes apps and found that, on average, using a diabetes app led to a drop in hemoglobin A1C of 0.57 percent.
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
Note: Income from other Charitable Activities in the audited financial statements has been included in special events fundraising. No government funding was reported on the charity's F2017 audited financial statements for either F2017 or F2016, although government funding was reported on its F2016 audited financial statements. Amortization has been removed from program, administrative and fundraising costs on a pro-rated basis.  https://www.diabetes.ca/newsroom/search-news/clothesline-lends-a-hand-to-help-goodwill-toronto
Providing care that is concordant with the latest guidelines requires repeated discussions featuring shared decision making with people with diabetes about opportunities to reduce the risk of diabetes complications, keep patients safe, and support self-management. For this reason, long-term and short-term risks must be balanced in a way that incorporates consideration of each person’s needs, preferences, and capabilities, along with the research evidence and clinician judgment. For example, glycemic targets will vary based on patient circumstances (Figure 2).8 The recommendations highlighted here presume that diabetes care is being provided in an ongoing, relationship-based primary care context, in which repeated consultations occur to routinely and iteratively set care goals and develop plans to achieve them. A revised acronym was developed as an aid to facilitate rapid assessment and action that incorporates the key messages presented here during these routine diabetes visits: ABCDES3 (Figure 3).8
Other technology devices, like physical activity trackers, are being integrated with some continuous glucose monitor (CGM) systems to help demonstrate how activity impacts blood glucose levels. In the fall of 2017, Fitbit partnered with Dexcom to bring CGM data to Fitbit Ionic. Some health-care programs, like UHC Medicare Advantage plans, are even providing piloting programs in which participants who use CGM technology, like Dexcom, are receiving Fitbit activity trackers.
The guideline states that targets for HbA1c levels and treatments should be individualized based on goals, preferences, and functional status, as described in Figure 2.8 Lower targets are appropriate when priority is placed on reducing the risk of microvascular outcomes and when the treatments used do not place the patient at risk of hypoglycemia. Higher targets are appropriate when reducing the risk of long-term complications is a lower priority. Diabetes Canada has an interactive tool to help tailor glycemic targets to optimize relevant outcomes while avoiding hypoglycemia (guidelines.diabetes.ca/bloodglucoselowering/a1ctarget).
Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to insulin properly. As the disease progresses, a lack of insulin may also develop. This form was previously referred to as "non insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes". The most common cause is a combination of excessive body weight and insufficient exercise.
Gestational diabetes mellitus (GDM) resembles type 2 DM in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 2–10% of all pregnancies and may improve or disappear after delivery. However, after pregnancy approximately 5–10% of women with GDM are found to have DM, most commonly type 2. GDM is fully treatable, but requires careful medical supervision throughout the pregnancy. Management may include dietary changes, blood glucose monitoring, and in some cases, insulin may be required.
In obese young people, decreased β-cell function has recently been shown to predict deterioration of glucose tolerance (4,78). Additionally, the rate of decline in glucose tolerance in first-degree relatives of type 2 diabetic individuals is strongly related to the loss of β-cell function, whereas insulin sensitivity changes little (79). This observation mirrors those in populations with a high incidence of type 2 diabetes in which transition from hyperinsulinemic normal glucose tolerance to overt diabetes involves a large, rapid rise in glucose levels as a result of a relatively small further loss of acute β-cell competence (3). The Whitehall II study showed in a large population followed prospectively that people with diabetes exhibit a sudden rise in fasting glucose as β-cell function deteriorates (Fig. 5) (80). Hence, the ability of the pancreas to mount a normal, brisk insulin response to an increasing plasma glucose level is lost in the 2 years before the detection of diabetes, although fasting plasma glucose levels may have been at the upper limit of normal for several years. This was very different from the widely assumed linear rise in fasting plasma glucose level and gradual β-cell decompensation but is consistent with the time course of markers of increased liver fat before the onset of type 2 diabetes observed in other studies (81). Data from the West of Scotland Coronary Prevention Study demonstrated that plasma triacylglycerol and ALT levels were modestly elevated 2 years before the diagnosis of type 2 diabetes and that there was a steady rise in the level of this liver enzyme in the run-up to the time of diagnosis (75).
As of 2017, an estimated 425 million people had diabetes worldwide, with type 2 DM making up about 90% of the cases. This represents 8.8% of the adult population, with equal rates in both women and men. Trend suggests that rates will continue to rise. Diabetes at least doubles a person's risk of early death. In 2017, diabetes resulted in approximately 3.2 to 5.0 million deaths. The global economic cost of diabetes related health expenditure in 2017 was estimated at US$727 billion. In the United States, diabetes cost nearly US$245 billion in 2012.
Type 2 diabetes is the most common type of diabetes, accounting for 90 to 95 percent of all cases. In 2015, more than 23 million people in the United States had diagnosed diabetes and an additional 7 million people likely had undiagnosed diabetes. The prevalence of diabetes increases with age, and the disease currently affects more than 20 percent of Americans over age 65. It is the seventh leading cause of death in the United States.
Another diabetes-related sexual dysfunction symptom in men is reduced amounts of ejaculation, or retrograde ejaculation. Retrograde ejaculation is a condition in which the semen goes into the bladder, rather than out of the body through the urethra. Diabetes and damage to the blood vessels causes nerve damage to the muscles that control the bladder and urethra, which results in this problem.
^ Boussageon R, Supper I, Bejan-Angoulvant T, Kellou N, Cucherat M, Boissel JP, Kassai B, Moreau A, Gueyffier F, Cornu C (2012). Groop L, ed. "Reappraisal of metformin efficacy in the treatment of type 2 diabetes: a meta-analysis of randomised controlled trials". PLoS Medicine. 9 (4): e1001204. doi:10.1371/journal.pmed.1001204. PMC 3323508. PMID 22509138.
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For people with Type 1 diabetes, blood glucose monitoring and insulin administration is the standard of care. Patients need to check their blood sugar a number of times a day, then give themselves insulin to replace what would have been made in the pancreas. Treatment for Type 2 diabetes, however, doesn’t involve these critical calculations of insulin. It’s usually maintained with a pretty regular administration of the same drugs on a set schedule.
The earliest predictor of the development of type 2 diabetes is low insulin sensitivity in skeletal muscle, but it is important to recognize that this is not a distinct abnormality but rather part of the wide range expressed in the population. Those people in whom diabetes will develop simply have insulin sensitivity, mainly in the lowest population quartile (29). In prediabetic individuals, raised plasma insulin levels compensate and allow normal plasma glucose control. However, because the process of de novo lipogenesis is stimulated by higher insulin levels (38), the scene is set for hepatic fat accumulation. Excess fat deposition in the liver is present before the onset of classical type 2 diabetes (43,74–76), and in established type 2 diabetes, liver fat is supranormal (20). When ultrasound rather than magnetic resonance imaging is used, only more-severe degrees of steatosis are detected, and the prevalence of fatty liver is underestimated, with estimates of 70% of people with type 2 diabetes as having a fatty liver (76). Nonetheless, the prognostic power of merely the presence of a fatty liver is impressive of predicting the onset of type 2 diabetes. A large study of individuals with normal glucose tolerance at baseline showed a very low 8-year incidence of type 2 diabetes if fatty liver had been excluded at baseline, whereas if present, the hazard ratio for diabetes was 5.5 (range 3.6–8.5) (74). In support of this finding, a temporal progression from weight gain to raised liver enzyme levels and onward to hypertriglyceridemia and then glucose intolerance has been demonstrated (77).
With so many technologies in the marketplace, selecting the right app can be overwhelming. Remember that apps are tools designed to create accountability, track data and help users discover patterns and change behaviors. Trying several apps allows you to experiment with features to find the best fit for your lifestyle and needs. Focus on using app technologies that ease the burden of diabetes management instead of complicating it.