Diabetes and high blood pressure are often found together. You can decrease your risk of high blood pressure by increasing physical activity, reducing salt and fat in your diet, limiting alcohol consumption, avoiding tobacco use, reducing stress, and maintaining a healthy body weight. Many people with undiagnosed type 2 diabetes have high blood pressure. Good control of blood pressure can substantially reduce your risk of developing complications.
Diabetes Canada has created several interactive clinical decision support tools to help reduce some of the barriers to implementing these recommendations, including an interactive tool to consider pharmacotherapy options for glycemic control that compares the relative advantages or limitations of different agents (guidelines.diabetes.ca/bloodglucoselowering/pharmacologyt2), an interactive tool for selecting agents for vascular protection (guidelines.diabetes.ca/vascularprotection/riskassessment), and a prescription for cardiovascular protection (guidelines.diabetes.ca/docs/resources/prescription-for-cardiovascular-protection-with-diabetes.pdf). People with diabetes also require routine monitoring (and relevant action) for neuropathy, nephropathy, and retinopathy, which can be facilitated with a flow sheet (guidelines.diabetes.ca/docs/cpg/Appendix-3.pdf).8
Best of them all I was diagnosed LADA a year ago. Downloaded a bunch of apps and used them all for a month. This one’s easily the winner. Extremely comprehensive, a complete set of features and enough customization to track carb intake; initial no pill and no insulin treatment; then medication only treatment; then long lasting insulin treatment. And I know it’s future proof for when I start the short term insulin and then the pump. Thank you!
The classic symptoms of diabetes are polyuria (frequent urination), polydipsia (increased thirst), polyphagia (increased hunger), and weight loss.[23] Other symptoms that are commonly present at diagnosis include a history of blurred vision, itchiness, peripheral neuropathy, recurrent vaginal infections, and fatigue.[13] Many people, however, have no symptoms during the first few years and are diagnosed on routine testing.[13] A small number of people with type 2 diabetes mellitus can develop a hyperosmolar hyperglycemic state (a condition of very high blood sugar associated with a decreased level of consciousness and low blood pressure).[13]
Two new high-priority recommendations in the 2018 guidelines involve preventing hypoglycemia. First, all people with diabetes who take agents that can cause hypoglycemia (ie, insulin or insulin secretagogues) should be counseled on safe driving (ie, having sugar on-hand to prevent lows). A new chapter in the 2018 guidelines (guidelines.diabetes.ca/cpg/chapter21) describes how to assess and manage private and commercial drivers, especially those who take insulin or insulin secretagogues.8 Diabetes Canada has handouts to support conversations regarding safe driving, and the guidelines feature a sample diabetes and driving educational resource to fill out with people who have diabetes (guidelines.diabetes.ca/docs/patient-resources/drive-safe-with-diabetes.pdf). Second, the guidelines recommend that medications that pose less risk of hypoglycemia should be used preferentially, especially in the elderly (ie, metformin or dipeptidyl peptidase 4 inhibitors in preference to insulin or insulin secretagogues). Likewise, risks of hypotension should be considered when managing blood pressure. As noted in the previous guideline, recommendations emphasize the safe use of medications when people with diabetes are unwell and when they are at risk of hypovolemia. Euglycemic ketoacidosis is a particular risk with sodium glucose transporter 2 inhibitors, and these should be held on sick days (ie, when patients are at risk of dehydration).17 The Diabetes Canada guidelines have an appendix to support sick-day planning (guidelines.diabetes.ca/docs/cpg/Appendix-8.pdf) and an appendix for therapeutic considerations for renal impairment (guidelines.diabetes.ca/docs/cpg/Appendix-7.pdf).8 The website also features patient resources for primary care physicians to use with their patients for sick-day management (guidelines.diabetes.ca/docs/patient-resources/stay-safe-when-you-have-diabetes-and-sick-or-at-risk-of-dehydration.pdf), as well as for hypoglycemia identification, treatment, and prevention (guidelines.diabetes.ca/docs/patient-resources/hypoglycemialow-blood-sugar-in-adults.pdf).
Diabetes in Check, from the recently-IPO'd Everyday Health is a type 2 diabetes management app that features a wide range of tools. It includes diabetes coaching designed by a certified diabetes educator, trackers for blood glucose and medication, reminders, and tools for healthy eating, including a food tracker with a barcode scanner and a recipe database. For a $3.99 subscription, users can get daily personalized food recommendations.
The WHO estimates that diabetes mellitus resulted in 1.5 million deaths in 2012, making it the 8th leading cause of death.[12][101] However another 2.2 million deaths worldwide were attributable to high blood glucose and the increased risks of cardiovascular disease and other associated complications (e.g. kidney failure), which often lead to premature death and are often listed as the underlying cause on death certificates rather than diabetes.[101][104] For example, in 2017, the International Diabetes Federation (IDF) estimated that diabetes resulted in 4.0 million deaths worldwide,[8] using modeling to estimate the total number of deaths that could be directly or indirectly attributed to diabetes.[8]

Diabetes Canada is one of Canada’s largest charities, a Major 100, with donations and special events revenue of $27.8m in F2017. Administrative costs are 5% of revenues and fundraising costs are 40% of donations. Per dollar donated to the charity, $0.55 goes towards its programs and grants, which falls outside of Ci’s reasonable range for overhead spending. The charity’s funding reserves of $9.2m include $1.5m in donor-endowed funds. Excluding endowed funds, Diabetes Canada can cover 3 months of annual program and granting costs, indicating a need for donations.
"The mySugr Junior App was developed to make managing diabetes easier for kids. It also enables parents to keep control over the therapy, even when they're not around and their child is at school or out with friends. The app resembles a game in which the children get points for every entry. The goal is to score a particular amount of points every day. This encourages kids to take care of their diabetes regularly.
Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose comes from the foods you eat. Insulin is a hormone that helps the glucose get into your cells to give them energy. With type 1 diabetes, your body does not make insulin. With type 2 diabetes, the more common type, your body does not make or use insulin well. Without enough insulin, the glucose stays in your blood. You can also have prediabetes. This means that your blood sugar is higher than normal but not high enough to be called diabetes. Having prediabetes puts you at a higher risk of getting type 2 diabetes.
Low testosterone (low-T) can be caused by conditions such as type 2 diabetes, obesity, liver or kidney disease, hormonal disorders, certain infections, and hypogonadism. Signs and symptoms that a person may have low-T include insomnia, increased body fat, weight gain, reduced muscle, infertility, decreased sex drive, depression, and worsening of congestive heart failure or sleep apnea.
The guideline states that treatments should be added (as tolerated) to achieve hemoglobin A1c (HbA1c), blood pressure, and cholesterol targets in accordance with patient preferences and goals. Since the last guideline update in 2013, the main change in this aspect of the guideline reflects new evidence that canagliflozin, empagliflozin, and liraglutide reduce the risk of cardiovascular events in patients who have a history of vascular disease.8 (Similar evidence for additional medications was not available at the time of guideline development.) The guideline states that evidence-based medications for vascular protection should be prescribed whenever appropriate:
To explain what hemoglobin A1c is, think in simple terms. Sugar sticks, and when it's around for a long time, it's harder to get it off. In the body, sugar sticks too, particularly to proteins. The red blood cells that circulate in the body live for about three months before they die off. When sugar sticks to these hemoglobin proteins in these cells, it is known as glycosylated hemoglobin or hemoglobin A1c (HBA1c). Measurement of HBA1c gives us an idea of how much sugar is present in the bloodstream for the preceding three months. In most labs, the normal range is 4%-5.9 %. In poorly controlled diabetes, its 8.0% or above, and in well controlled patients it's less than 7.0% (optimal is <6.5%). The benefits of measuring A1c is that is gives a more reasonable and stable view of what's happening over the course of time (three months), and the value does not vary as much as finger stick blood sugar measurements. There is a direct correlation between A1c levels and average blood sugar levels as follows.
Diabetes is a metabolic disorder that occurs when your blood sugar (glucose), is too high (hyperglycemia). Glucose is what the body uses for energy, and the pancreas produces a hormone called insulin that helps convert the glucose from the food you eat into energy. When the body either does not produce enough insulin, does not produce any at all, or your body becomes resistant to the insulin, the glucose does not reach your cells to be used for energy. This results in the health condition termed diabetes.
Diabetes means your blood glucose, or blood sugar, levels are too high. With type 2 diabetes, the more common type, your body does not make or use insulin well. Insulin is a hormone that helps glucose get into your cells to give them energy. Without insulin, too much glucose stays in your blood. Over time, high blood glucose can lead to serious problems with your heart, eyes, kidneys, nerves, and gums and teeth.

In addition, getting too little sleep can increase your appetite and reduce your level of satiety, causing you to crave carbohydrates and sugary foods, in particular. Over time, indulging in these cravings or overeating, in general, can wreak havoc on your insulin and blood sugar levels, as well as your body weight. (Remember: Obesity is a major risk factor for type 2 diabetes.) Plus, when you’re short on sleep, you’re more likely to feel tired and less inclined to exercise, which is a problem because regular exercise helps with weight management and blood sugar control.

Fat distribution. If you store fat mainly in the abdomen, you have a greater risk of type 2 diabetes than if you store fat elsewhere, such as in your hips and thighs. Your risk of type 2 diabetes rises if you're a man with a waist circumference above 40 inches (101.6 centimeters) or a woman with a waist that's greater than 35 inches (88.9 centimeters).
Lifestyle factors are important to the development of type 2 diabetes, including obesity and being overweight (defined by a body mass index of greater than 25), lack of physical activity, poor diet, stress, and urbanization.[10][31] Excess body fat is associated with 30% of cases in those of Chinese and Japanese descent, 60–80% of cases in those of European and African descent, and 100% of cases in Pima Indians and Pacific Islanders.[13] Among those who are not obese, a high waist–hip ratio is often present.[13] Smoking appears to increase the risk of type 2 diabetes mellitus.[32]
For our bodies to work properly we need to convert glucose (sugar) from food into energy. A hormone called insulin is essential for the conversion of glucose into energy. In people with diabetes, insulin is no longer produced or not produced in sufficient amounts by the body. When people with diabetes eat glucose, which is in foods such as breads, cereals, fruit and starchy vegetables, legumes, milk, yoghurt and sweets, it can’t be converted into energy.

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.[49] However, after pregnancy approximately 5–10% of women with GDM are found to have DM, most commonly type 2.[49] 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.
^ Sattar N, Preiss D, Murray HM, Welsh P, Buckley BM, de Craen AJ, Seshasai SR, McMurray JJ, Freeman DJ, Jukema JW, Macfarlane PW, Packard CJ, Stott DJ, Westendorp RG, Shepherd J, Davis BR, Pressel SL, Marchioli R, Marfisi RM, Maggioni AP, Tavazzi L, Tognoni G, Kjekshus J, Pedersen TR, Cook TJ, Gotto AM, Clearfield MB, Downs JR, Nakamura H, Ohashi Y, Mizuno K, Ray KK, Ford I (February 2010). "Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials". Lancet. 375 (9716): 735–42. doi:10.1016/S0140-6736(09)61965-6. PMID 20167359.
Diabetes can also result from other hormonal disturbances, such as excessive growth hormone production (acromegaly) and Cushing's syndrome. In acromegaly, a pituitary gland tumor at the base of the brain causes excessive production of growth hormone, leading to hyperglycemia. In Cushing's syndrome, the adrenal glands produce an excess of cortisol, which promotes blood sugar elevation.
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).
Inhalable insulin has been developed.[125] The original products were withdrawn due to side effects.[125] Afrezza, under development by the pharmaceuticals company MannKind Corporation, was approved by the United States Food and Drug Administration (FDA) for general sale in June 2014.[126] An advantage to inhaled insulin is that it may be more convenient and easy to use.[127]
High-quality diabetes care involves a series of periodic conversations about self-management and about both 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 both diabetes and comorbid conditions. Family physicians can access the guideline at guidelines.diabetes.ca and might consider downloading the free smartphone app for quick access to guideline chapters and interactive tools at guidelines.diabetes.ca/app.
"The mySugr Junior App was developed to make managing diabetes easier for kids. It also enables parents to keep control over the therapy, even when they're not around and their child is at school or out with friends. The app resembles a game in which the children get points for every entry. The goal is to score a particular amount of points every day. This encourages kids to take care of their diabetes regularly.
People with diabetes can benefit from education about the disease and treatment, good nutrition to achieve a normal body weight, and exercise, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds. In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications are recommended to control blood pressure.[80][81]
An individual with type 2 diabetes has the same level of heart attack risk as someone who's already had a heart attack, according to the National Heart, Lung, and Blood Institute. There are numerous reasons for the link between diabetes and heart disease, Dr. Sullivan says, including a "group attack" from diabetes and other heart disease risk factors like high blood pressure and high cholesterol, which already affect many people with type 2 diabetes.
The following questions will help you to find out if you are at higher risk of having pre-diabetes or type 2 diabetes. Pre-diabetes is a condition where blood sugar levels are higher than normal, but not high enough to be diagnosed as diabetes. You can have pre-diabetes or undiagnosed type 2 diabetes without having any obvious warning signs or symptoms.

^ Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KG, Zimmet PZ, Del Prato S, Ji L, Sadikot SM, Herman WH, Amiel SA, Kaplan LM, Taroncher-Oldenburg G, Cummings DE (June 2016). "Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations". Diabetes Care. 39 (6): 861–77. doi:10.2337/dc16-0236. PMID 27222544.


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.
Type 2 diabetes is often treated with oral medication because many people with this type of diabetes make some insulin on their own. The pills people take to control type 2 diabetes do not contain insulin. Instead, medications such as metformin, sulfonylureas, alpha-glucosidase inhibitors and many others are used to make the insulin that the body still produces more effective.
Mechanism of interaction between excess amounts of fatty acids, diacylglycerol, and ceramide and insulin action within the hepatocyte. Diacylglycerol activates PKCε and inhibits activation of IRS-1 by the insulin receptor. Ceramides cause sequestration of Akt2 by PKCζ and inhibit insulin control of gluconeogenesis. These mechanisms have recently been reviewed (99). FFA, free-fatty acid; TG, triacylglycerol.
iSage – A prescription-only patient-facing iOS and Android app that works in conjunction with a web portal used by the doctor. The doctor sets target levels for insulin based on the patient’s glucose levels. Then the algorithm takes over. Patients can enter their blood glucose levels and iSage will change their insulin dosing levels based on the doctor’s plan and the entered values.
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Type 2 diabetes can occur at any age, but it most commonly begins in middle age or later. Signs and symptoms develop slowly over years. They include frequent urination (polyuria), excessive thirst (polydipsia), fatigue, blurred vision, tingling or loss of feeling in the hands and feet (diabetic neuropathy), sores that do not heal well, and weight loss. If blood sugar levels are not controlled through medication or diet, type 2 diabetes can cause long-lasting (chronic) health problems including heart disease and stroke; nerve damage; and damage to the kidneys, eyes, and other parts of the body.

Nerve damage from diabetes is called diabetic neuropathy and is also caused by disease of small blood vessels. In essence, the blood flow to the nerves is limited, leaving the nerves without blood flow, and they get damaged or die as a result (a term known as ischemia). Symptoms of diabetic nerve damage include numbness, burning, and aching of the feet and lower extremities. When the nerve disease causes a complete loss of sensation in the feet, patients may not be aware of injuries to the feet, and fail to properly protect them. Shoes or other protection should be worn as much as possible. Seemingly minor skin injuries should be attended to promptly to avoid serious infections. Because of poor blood circulation, diabetic foot injuries may not heal. Sometimes, minor foot injuries can lead to serious infection, ulcers, and even gangrene, necessitating surgical amputation of toes, feet, and other infected parts.

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Rosiglitazone, a thiazolidinedione, has not been found to improve long-term outcomes even though it improves blood sugar levels.[95] Additionally it is associated with increased rates of heart disease and death.[96] Angiotensin-converting enzyme inhibitors (ACEIs) prevent kidney disease and improve outcomes in those with diabetes.[97][98] The similar medications angiotensin receptor blockers (ARBs) do not.[98] A 2016 review recommended treating to a systolic blood pressure of 140 to 150 mmHg.[99]
A Great Diabetic Log Program. I have been using this program for several months now and cannot go without it. I can accurately keep my glucose and dietary levels. I can also keep track of my blood pressure readings, weight levels, A1C levels and much more. I can prepare and print many different reports for my doctors. If you are a diabetic, you should use this program.
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 relationship between type 2 diabetes and the main modifiable risk factors (excess weight, unhealthy diet, physical inactivity and tobacco use) is similar in all regions of the world. There is growing evidence that the underlying determinants of diabetes are a reflection of the major forces driving social, economic and cultural change: globalization, urbanization, population aging, and the general health policy environment.[74]
Childhood obesity rates are rising, and so are the rates of type 2 diabetes in youth. More than 75% of children with type 2 diabetes have a close relative who has it, too. But it’s not always because family members are related; it can also be because they share certain habits that can increase their risk. Parents can help prevent or delay type 2 diabetes by developing a plan for the whole family:

The kidney doctor, called a nephrologist, will plan your treatment with you, your family and your dietitian. Two things to keep in mind for keeping your kidneys healthy are controlling high blood pressure in conjunction with an ACE inhibitor and following your renal diabetic diet. Restricting protein in your diet also might be helpful. You and your dietitian can plan your diet together. For Kidney and Diabetes friendly recipes click here to visit our Kidney Kitchen.


Diabetes Canada is one of Canada’s largest charities, a Major 100, with donations and special events revenue of $27.8m in F2017. Administrative costs are 5% of revenues and fundraising costs are 40% of donations. Per dollar donated to the charity, $0.55 goes towards its programs and grants, which falls outside of Ci’s reasonable range for overhead spending. The charity’s funding reserves of $9.2m include $1.5m in donor-endowed funds. Excluding endowed funds, Diabetes Canada can cover 3 months of annual program and granting costs, indicating a need for donations.
Coheso also has an app specifically for pregnant women with gestational diabetes. "This Diabetes in Pregnancy App helps you track all of the factors that keep your blood sugar balanced during and after your pregnancy," the app description reads. "The app makes it a snap to log food (nutrition), blood sugar levels, exercise, oral medications and insulin. You can email the logbook as a PDF file or a spreadsheet that you can share with your doctor."
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