Monogenic diabetes is caused by mutations, or changes, in a single gene. These changes are usually passed through families, but sometimes the gene mutation happens on its own. Most of these gene mutations cause diabetes by making the pancreas less able to make insulin. The most common types of monogenic diabetes are neonatal diabetes and maturity-onset diabetes of the young (MODY). Neonatal diabetes occurs in the first 6 months of life. Doctors usually diagnose MODY during adolescence or early adulthood, but sometimes the disease is not diagnosed until later in life.

The guideline D&I committee co-chairs developed a process of prioritizing and distilling key messages relevant to primary care from 313 recommendations in 38 guideline chapters (Figure 1).8 The prioritization was completed anonymously by members of the guideline writing committee, people with diabetes, and members of the D&I committee. Given the large number of recommendations, the first step of the prioritization exercise was to select guideline chapters; each member was asked to select 10 chapters, then, from these chapters, to select and rank 10 recommendations. Based on the number of votes for each recommendation, a list of 22 recommendations was compiled. This was followed by thematic analysis and member checking to summarize key messages. Specifically, the co-chairs (endocrinologist C.H.Y. and FP N.M.I.) collaboratively sorted the recommendations into conceptually similar groups (themes) and drafted key messages that represented these themes. Next, they sought input from the committee members to refine the key messages, similar to the process of member checking in qualitative research.11


The connection may be hard to imagine. But the primary reason that regularly skimping on shuteye can increase your risk of type 2 diabetes is because your hormone levels get thrown out of whack. Specifically, with ongoing sleep loss, less insulin (a hormone that regulates blood sugar) is released in the body after you eat. Meanwhile, your body secretes more stress hormones (such as cortisol), which helps you stay awake but makes it harder for insulin to do its job effectively. The net effect: Too much glucose stays in the bloodstream, which can increase your risk of developing type 2 diabetes.

Sleep talking, formally known as somniloquy, is a sleep disorder defined as talking during sleep without being aware of it. Sleep talking can involve complicated dialogues or monologues, complete gibberish or mumbling. The good news is that for most people it is a rare and short-lived occurrence. Anyone can experience sleep talking, but the condition is more common in males...

Type 2 (formerly called 'adult-onset' or 'non insulin-dependent') diabetes results when the body doesn’t produce enough insulin and/or is unable to use insulin properly (this is also referred to as ‘insulin resistance’). This form of diabetes usually occurs in people who are over 40 years of age, overweight, and have a family history of diabetes, although today it is increasingly found in younger people.


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 soon as I noticed the leaking fluids and the hemorrhaging, I suspected that they might be symptoms of diabetes,” recalls Dr. Clary, who practices in the Washington, D.C., suburb of Ashburn, Virginia. “In my 12 years of experience as an eye doctor, that kind of bleeding usually signals that a buildup of sugar in the patient’s bloodstream has begun to break down the capillaries that feed the retina. The result is often what we call diabetic retinopathy – a condition in which continuing damage to retinal tissue from diabetes can lead to impaired vision or even blindness, if left untreated.”

Though not routinely used any longer, the oral glucose tolerance test (OGTT) is a gold standard for making the diagnosis of type 2 diabetes. It is still commonly used for diagnosing gestational diabetes and in conditions of pre-diabetes, such as polycystic ovary syndrome. With an oral glucose tolerance test, the person fasts overnight (at least eight but not more than 16 hours). Then first, the fasting plasma glucose is tested. After this test, the person receives an oral dose (75 grams) of glucose. There are several methods employed by obstetricians to do this test, but the one described here is standard. Usually, the glucose is in a sweet-tasting liquid that the person drinks. Blood samples are taken at specific intervals to measure the blood glucose.

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).
This diabetes-management and weight-loss app (it works similarly on Apple and Android devices, despite the separate names) features a log for blood glucose readings, A1C results, food, exercise, blood pressure levels, and medication use plus reminders to check your blood glucose. Upgrade to the “maximum” version for integration with fitness trackers (such as Jawbone and Fitbit) and extra features—nutrition planning and more charts and reports. This is for people with type 1 or type 2 diabetes and for those seeking to lose weight.
Blood travels throughout your body, and when too much glucose (sugar) is present, it disrupts the normal environment that the organ systems of your body function within. In turn, your body starts to exhibit signs that things are not working properly inside—those are the symptoms of diabetes people sometimes experience. If this problem—caused by a variety of factors—is left untreated, it can lead to a number of damaging complications such as heart attacks, strokes, blindness, kidney failure, and blood vessel disease that may require an amputation, nerve damage, and impotence in men.

Guidelines do not implement themselves.5 To integrate guideline recommendations into routine clinical care, FPs must not only be aware of and agree with them, but also must be able to adopt and adhere to them whenever applicable.6 To this end, a clinical practice guideline dissemination and implementation (D&I) committee, composed of interprofessional diabetes providers from across the country (some of whom contributed to writing the guideline but many of whom did not), was organized by Diabetes Canada to develop strategies for both people with diabetes and providers, hoping to support translating evidence-based recommendations into practice. Evaluation of the effects of these efforts is ongoing.7
^ Emadian A, Andrews RC, England CY, Wallace V, Thompson JL (November 2015). "The effect of macronutrients on glycaemic control: a systematic review of dietary randomised controlled trials in overweight and obese adults with type 2 diabetes in which there was no difference in weight loss between treatment groups". The British Journal of Nutrition. 114 (10): 1656–66. doi:10.1017/S0007114515003475. PMC 4657029. PMID 26411958.

Discuss progress on self-management goals and address barriers Individuals with diabetes should be regularly screened for diabetes-related psychological distress (eg, diabetes distress, psychological insulin resistance, fear of hypoglycemia) and psychiatric disorders (eg, depression, anxiety disorders) by validated self-report questionnaire or clinical interview (grade D, consensus). Plans for self-harm should be asked about regularly as well (grade C, level III) Handouts about self-management:

The Public Health Agency of Canada is not permanently storing or collecting information users provide while completing the CANRISK questionnaire. Any information provided is automatically deleted when the user closes the online session linked to the questionnaire. To protect your personal information when online it is good practice to clear the Web browser cache regularly, delete any search history and protect any printed personal information.
Injections of insulin may either be added to oral medication or used alone.[24] Most people do not initially need insulin.[13] When it is used, a long-acting formulation is typically added at night, with oral medications being continued.[23][24] Doses are then increased to effect (blood sugar levels being well controlled).[24] When nightly insulin is insufficient, twice daily insulin may achieve better control.[23] The long acting insulins glargine and detemir are equally safe and effective,[100] and do not appear much better than neutral protamine Hagedorn (NPH) insulin, but as they are significantly more expensive, they are not cost effective as of 2010.[101] In those who are pregnant insulin is generally the treatment of choice.[23]

The word mellitus (/məˈlaɪtəs/ or /ˈmɛlɪtəs/) comes from the classical Latin word mellītus, meaning "mellite"[114] (i.e. sweetened with honey;[114] honey-sweet[115]). The Latin word comes from mell-, which comes from mel, meaning "honey";[114][115] sweetness;[115] pleasant thing,[115] and the suffix -ītus,[114] whose meaning is the same as that of the English suffix "-ite".[116] It was Thomas Willis who in 1675 added "mellitus" to the word "diabetes" as a designation for the disease, when he noticed the urine of a diabetic had a sweet taste (glycosuria). This sweet taste had been noticed in urine by the ancient Greeks, Chinese, Egyptians, Indians, and Persians.
Diabetes Canada (DC) offers a toll‐free information line that provides access to knowledgeable staff who can help with support, information and referrals related to Type 1, Type 2 and gestational diabetes. It also offers an award-winning website with numerous resources on diabetes prevention and management. Printed resources and information packages can be picked up or mailed out on request.
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
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.
A type 2 diabetes diet or a type 2 diabetic diet is important for blood sugar (glucose) control in people with diabetes to prevent complications of diabetes. There are a variety of type 2 diabetes diet eating plans such as the Mediterranean diet, Paleo diet, ADA Diabetes Diet, and vegetarian diets.Learn about low and high glycemic index foods, what foods to eat, and what foods to avoid if you have type 2 diabetes.
You are more likely to develop type 2 diabetes if you are not physically active and are overweight or obese. Extra weight sometimes causes insulin resistance and is common in people with type 2 diabetes. The location of body fat also makes a difference. Extra belly fat is linked to insulin resistance, type 2 diabetes, and heart and blood vessel disease. To see if your weight puts you at risk for type 2 diabetes, check out these Body Mass Index (BMI) charts.
This diabetes-management and weight-loss app (it works similarly on Apple and Android devices, despite the separate names) features a log for blood glucose readings, A1C results, food, exercise, blood pressure levels, and medication use plus reminders to check your blood glucose. Upgrade to the “maximum” version for integration with fitness trackers (such as Jawbone and Fitbit) and extra features—nutrition planning and more charts and reports. This is for people with type 1 or type 2 diabetes and for those seeking to lose weight.
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