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(blue c.) ; Txtscroll jump aplitude ; Txtscroll jump speed ; Txtscroll sineshape amplitude ; Txtscroll sineshape movement ; Txtscroll sineangle / pixel ; Memory deallocation delay Immune-Mediated Diabetes: Type 1 Diabetes What Is Immune-Mediated Diabetes? Immune-mediated diabetes (formerly called insulin-dependent diabetes) is a disease that affects the way your body uses food. Immune-mediated diabetes is also called type 1 diabetes. In type 1 diabetes your body destroys the cells in the pancreas that produce insulin, usually leading to a total failure to produce insulin. It typically starts in children or young adults who are slim, but can start at any age. Without insulin, your body cannot control blood levels of sugar. And without insulin, you would die. So people with type 1 diabetes give themselves at least one shot of insulin every day. More than 700,000 Americans have this type of diabetes. This is about 10 percent of all Americans diagnosed with diabetes. Why Insulin Shots? You must inject insulin under the skin -- in the fat -- for it to work. You cannot take insulin in a pill. The juices in your stomach would destroy the insulin before it could work. Scientists are looking for new ways to give insulin. But today, shots are the only method. What Are The Signs And Symptoms Of Type 1 Diabetes? Type 1 diabetes often appears suddenly. Signs and symptoms are: 1.High levels of sugar in the blood. 2.High levels of sugar in the urine. 3.Frequent urination (and/or bed-wetting in children). 4.Extreme hunger. 5.Extreme thirst. 6.Extreme weight loss. 7.Weakness and tiredness. 8.Feeling edgy and having mood changes. 9.Feeling sick to your stomach and vomiting. What Causes Type 1 Diabetes? We do not know exactly what causes diabetes. We do know that people inherit a tendency to get diabetes. But not all people who have this tendency will get the disease. Other things such as illnesses must also come into play for diabetes to begin. Diabetes is not like a cold. Your friends and family cannot catch it from you. What Does Living With Diabetes Mean? People with type 1 diabetes can live happy, healthy lives. The key is to follow your diabetes treatment plan. The goal of this plan is to keep your blood-sugar level as close to normal as possible (good blood-sugar control). Your treatment plan will probably include: 1.Insulin, which lowers blood sugar. Your health care practitioner will prescribe how much and when to take insulin and what kinds. 2.Food, which raises blood sugar. Most people with type 1 diabetes have a meal plan. A registered dietician makes a plan for you. It tells you much food you can eat and when to eat it. Most people have three meals and at least two snacks every day. Your meal plan can have foods you enjoy. 3.Exercise, which lowers blood sugar. Like insulin, exercise also helps your body to use blood sugar. So exercise will probably be prescribed for you. Your health care practitioner can help you fit exercise safely into your daily routine. 4.Blood and urine testing. Testing your blood lets you know if your blood-sugar level is high, low, or near normal. The tests are simple. You prick your finger to get a drop of blood. A nurse-educator can teach you how to do this test and use the test results. You may need to test your urine for ketones. Ketones in the urine may mean that your diabetes is not under good control. A nurse- educator can teach you how to test ketones. Problems You May Have Type 1 diabetes can cause problems that you should be prepared for. There are three key problems: •Hypoglycemia, or low blood sugar; sometimes called an insulin reaction. This occurs when your blood sugar drops too low. You correct this problem by eating some sugar (such as 3 glucose tablets, 6 ounces of regular soda, or 5 or 6 Lifesavers). Your health care practitioner will teach you the signs of hypoglycemia and show you how to treat it. •Hyperglycemia, or high blood sugar. This occurs when your blood sugar is too high. It can be a sign that diabetes is not well controlled. Your health care practitioner will explain the signs and symptoms and the best way to treat hyperglycemia. •Ketoacidosis, or diabetic coma. This is very serious. Discuss its signs with your health care practitioner. ----------------------------------- Type 2 Diabetes Type 2 diabetes is a disease that affects the way your body uses food. Type 2 diabetes used to be called non-insulin-dependent diabetes. The most common type of diabetes, it affects about 15 million Americans. Nine out of ten cases of diabetes are type 2. It usually occurs in people over 45 and overweight, among other factors. About 7 to 7.5 million Americans have been diagnosed, and another 8 million remain undiagnosed with type 2 diabetes. When you have type 2 diabetes, your body does not make enough insulin. Or, your body still makes insulin but can't properly use it. Without enough insulin, your body cannot move blood sugar into the cells. Sugar builds up in the bloodstream. High blood levels of sugar can cause problems. Medical experts do not know the exact cause of type 2 diabetes. They do know type 2 diabetes runs in families. A person can inherit a tendency to get type 2 diabetes. But it usually takes another factor such as obesity to bring on the disease. What Are The Signs And Symptoms Of type 2 Diabetes? Type 2 diabetes often develops slowly. Most people who get it have increased thirst and an increased need to urinate. Many also feel edgy, tired, and sick to their stomach. Some people have an increased appetite, but they lose weight. Other signs and symptoms are: 1.Repeated or hard-to-heal infections of the skin, gums, vagina, or bladder. 2.Blurred vision. 3.Tingling or loss of feeling in the hands or feet. 4.Dry, itchy skin. These symptoms can be so mild that you don't notice them. Older people may confuse these symptoms with signs of aging and may not go to their health care practitioner. Half of all Americans who have diabetes may not know it. What does living with type 2 diabetes mean? People with diabetes can live happy, healthy lives. The key is to follow a diabetes treatment plan. The goal of this plan is to keep blood-sugar levels as close to normal as possible (good blood-sugar control). Your first step is to see your health care practitioner. He or she will prescribe a daily treatment plan. The plan should include a healthy diet and regular exercise. You can often control type 2 diabetes with diet and exercise-- alone. But some people also need medicine -- either diabetes pills or insulin shots. Many people find their diabetes gets better when they follow their treatment plan. For people who have type 2 diabetes, losing weight is important. Losing weight helps some overweight people to bring their blood sugars into the normal range. People who have a tendency to get type 2 diabetes can avoid it by losing weight or not becoming overweight. (The health care practitioner may allow some people who are overweight to stop their medication -- if they lose weight and follow a good meal plan.) Your health care practitioner may also want you to test your blood-sugar levels regularly. Testing will let you know if your diabetes is in control. Be sure to ask how to do these tests. Special Considerations Diabetes can cause problems with the kidneys, legs and feet, eyes, heart, nerves, and blood flow. If left untreated, these problems can lead to kidney failure, gangrene and amputation, blindness, or stroke. Many experts believe that good blood-sugar control may help prevent these problems. Diabetes should not be too much trouble if you follow your treatment plan and: 1.Follow a healthy diet. 2.Control your weight. 3.Exercise regularly. 4.Have regular checkups. 5.Do not smoke. ---------------------------- Diabetes and Seniors ------------------------------------------------------------------------ The Dangerous Toll Of Diabetes There are 15.7 million people or 5.9% of the population in the United States who have diabetes. While an estimated 10.3 million have been diagnosed, unfortunately, 5.4 million people are not aware that they have the disease. Each day approximately 2,200 people are diagnosed with diabetes. About 798,000 people will be diagnosed this year. Diabetes is the seventh leading cause of death (sixth-leading cause of death by disease) in the United States. Based on death certificate data, diabetes contributed to more than 187,000 deaths in 1995. Diabetes is a chronic disease that has no cure. Diabetes is a Silent Killer Many people first become aware that they have diabetes when they develop one of its life-threatening complications. •Blindness. Diabetes is the leading cause of new cases of blindness in people ages 20-74. Each year, from 12,000 to 24,000 people lose their sight because of diabetes. •Kidney Disease. Diabetes is the leading cause of end-stage renal disease, accounting for about 40% of new cases. In 1995, approximately 27,900 people initiated treatment for end stage renal disease (kidney failure) because of diabetes. •Nerve Disease and Amputations. About 60-70 percent of people with diabetes have mild to severe forms of diabetic nerve damage, which, in severe forms, can lead to lower limb amputations. In fact, diabetes is the most frequent cause of non-traumatic lower limb amputations. The risk of a leg amputation is 15-40 times greater for a person with diabetes. Each year, more than 56,000 amputations are performed among people with diabetes. •Heart Disease and Stroke. People with diabetes are 2 to 4 times more likely to have heart disease which is present in 75 percent of diabetes-related deaths (more than 77,000 deaths due to heart disease annually). And, they are 2 to 4 times more likely to suffer a stroke. Direct and Indirect Costs of Diabetes Diabetes is one of the most costly health problems in America. Health care and other costs directly related to diabetes treatment, as well as the costs of lost productivity, run $92 billion annually. Some estimates run as high as $138 billion which includes all health care costs incurred by people with diabetes. What is Diabetes? Diabetes is a disease in which the body does not produce or properly use insulin, a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes is a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles. There are two major types of diabetes: •Type 1. An autoimmune disease in which the body does not produce any insulin, most often occurring in children and young adults. People with type 1 diabetes must take daily insulin injections to stay alive. Type 1 diabetes accounts for 5-10 percent of diabetes. •Type 2. A metabolic disorder resulting from the body's inability to make enough, or properly use, insulin. It is the most common form of the disease. Type 2 diabetes accounts for 90-95 percent of diabetes. Type 2 diabetes is nearing epidemic proportions, due to an increased number of older Americans, and a greater prevalence of obesity and a sedentary lifestyle. •Gestational diabetes develops in 2 % to 5% of all pregnancies but disappears when a pregnancy is over. Women who have had gestational diabetes are at increased risk for later developing type 2 diabetes. •"Other specific types" of diabetes result from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses. Who is at Greater Risk for Type 1 Diabetes? •Siblings of people with type 1 diabetes •Children of parents with type 1 diabetes Who is at Greater Risk for Type 2 Diabetes? •People over age 45 •People with a family history of diabetes •People who are overweight •People who do not exercise regularly •People with low HDL or high triglycerides •Certain racial and ethnic groups (e.g., African Americans, Hispanic Americans, Asian & Pacific Islanders, and Native Americans) •Women who had gestational diabetes, a form of diabetes occurring in 2-5 percent of all pregnancies or who have had a baby weighing 9 pounds or more at birth. Impaired Glucose Homeostasis •Impaired Glucose Homeostasis (or metabolism) refers to a condition in which blood sugar levels are higher than normal but not high enough to be classified as diabetes. There are two categories that are considered risk factors for future diabetes and cardiovascular disease: 1.Impaired Glucose Tolerance (IGT) when results of a 2-hour oral glucose tolerance test are between 140 to 199 mg/dl. IGT is a major risk factor for type 2 diabetes and is present in about 11 percent of adults, or approximately 20 million Americans. About 40-45 percent of persons age 65 years of age or older have either type 2 diabetes or IGT. 2.Impaired Fasting Glucose (IFG) when results of an 8-hour fasting plasma glucose test are greater than 110 but less than 126 mg/dl. Type 2 diabetes is more common among these ethnic groups: •African Americans. African Americans are 1.7 times as likely to have type 2 diabetes as the general population. An estimated 2.3 million African Americans, or 10.8%, have diabetes. •Hispanic Americans. Hispanic Americans are almost twice as likely to have type 2 diabetes. For example, diabetes affects 1.2 million or 10.6% of the Mexican American population. •Native Americans. Overall prevalence of type 2 diabetes in Native Americans is 12.2% vs. 5.2% of the general population. In some tribes, 50% of the population has diabetes. Warning Signs of Diabetes Type 1 Diabetes: Type 2 Diabetes:· Frequent urination · Any of the type 1 symptoms· Unusual thirst  · Frequent infections· Extreme hunger · Blurred vision· Unusual weight loss  · Cuts/bruises that are slow to heal· Extreme fatigue · Tingling/numbness in the hands or feet· Irritability · Recurring skin, gum or bladder infections * Often people with type 2 diabetes have no symptoms. ------------------------------------------------------------------------ Direct and Indirect Costs of Diabetes The total annual economic cost of diabetes was estimated at $92 billion dollars in 1992 ($45 billion -- direct medical and treatment costs -- and $47 billion -- the value of productivity foregone due to disability and premature death). Some estimates run as high as $138 billion which includes all health care costs incurred by people with diabetes, including costs not resulting from diabetes. Diabetes' Direct Costs: •Estimated at $45.2 billion in 1992. •Represents 5.8 percent of total personal health-care expenditures in the U.S.; however, diagnosed diabetes patients account for only 2.8 percent of the total U.S. civilian population. •Represented 2.2 percent of total personal health-care expenditures in 1987. •$39.1 billion (more than 86 percent) was spent on institutional care -- $37.2 billion for hospital care and $1.8 billion for nursing home care. •Diabetes-related hospitalizations totaled 371,969 in 1992. •The mean length of stay was 6.2 days. •Patients with diabetic complications (heart and kidney disease, stroke, blindness, amputation) are hospitalized 2.8 days longer on average than nondiabetic patients with the same complications. •Nearly two-thirds of all hospitalizations were for diabetic patients less than 65 years old. •Diabetic patients are 11.7 times more likely to be hospitalized because of amputations. •Diabetic patients are at a 1.5 times greater risk to be hospitalized than nondiabetic patients. Diabetes' Indirect Costs: •Productivity losses were estimated at $46.6 billion in 1992. •Foregone productivity attributable specifically to diabetes is estimated at $26.9 billion in 1992. •A total of 1 million work-loss days were attributable to diabetes in 1992. Three-quarters lost by diabetes patients 45 to 65 years old. •A total of 47,800 workers were reported to be permanently disabled because of diabetes in 1992. •Diabetes was the underlying cause of death for 48,259 people in 1992. •Cardiovascular disease was the underlying cause of death of nearly 60 percent of deaths among people with diabetes. •Diabetes appeared as a contributory cause of death on an estimated 118,678 death certificates in 1992. ------------------------------------------------------------------------ Profile Of The Diagnosed There are 15.7 million people in the United States who have diabetes. There are two main types of diabetes. Type 1, which usually occurs during childhood or adolescence, and type 2, the most common form of the disease, usually occurring after age 45. What is type 1 (immune-mediated) diabetes? Type 1 (formerly known as insulin dependent) diabetes is a disease which results from the body's failure to produce insulin -- the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel them. There are two forms of type 1. Immune-mediated diabetes mellitus results from an automimmune process in which the body's immune system attackes and destroys the insulin producing cells of the pancreas. Since glucose cannot enter the cells, it builds up in the blood and the body's cells literally starve to death. The second, Idiopathic type 1, refers to rare forms of the disease that have no known cause. People with type 1 diabetes must take daily insulin injections to stay alive. •There are an estimated 500,000 to 1 million people with type 1 diabetes in the United States today. •The risk of developing type 1 diabetes is higher than virtually all other severe chronic diseases of childhood. •Peak incidence occurs during puberty, around 10 to 12 years of age in girls and 12 to 14 years of age in boys.z •The symptoms for type 1 diabetes can mimic the flu in children. •Type 1 diabetes tends to run in families. Brothers and sisters of children with type 1diabetes have about a 10% chance of developing the disease by age 50. •The identical twin of a person with type 1 diabetes has a 25 to 50 percent chance of developing type 1 diabetes. •There is a higher incidence of diabetes in whites than in other racial groups. What is type 2 diabetes? Type 2 diabetes results from the body's inability to make enough or properly use insulin. The underlying problem is insulin resistance, with some degree of insulin deficiency. Often type 2 diabetes can be controlled through losing weight, improved nutrition and exercise alone, but sometimes these are not enough and either oral medications and/or insulin must be used. •Of the nearly 16 million Americans with diabetes, 90-95% (14.9 million) have type 2 diabetes. Of these, roughly a third are unaware they have the disease. •People with type 2 diabetes often develop the disease after age 45, but are not aware they have diabetes until severe symptoms occur or they are treated for one of its serious complications. •The risk for type 2 diabetes increases with age. Nearly 18.4% of the United States population between 65 and 74 years of age has diabetes. •Studies indicate that diabetes is generally under-reported on death certificates, particularly in the cases of older persons with multiple chronic conditions such as heart disease and hypertension. Because of this, the toll of diabetes is believed to be much higher than officially reported. What are the other types of diabetes? Gestational diabetes is a temporary form of insulin resistance that usually occurs halfway through a pregnancy as a result of excessive hormone production in the body, or the pancreas’ inability to make the additional insulin that is needed during some pregnancies in women with no previous history of type 1 or type 2 diabetes. Gestational diabetes usually goes away after pregnancy, but women who have had gestational diabetes are at an increased risk for later developing type 2 diabetes. Researchers have identified a small percentage of diabetes cases that result from specific genetic syndromes, surgery, chemicals, drugs, malnutrition, infections, viruses and other illnesses. What are the complications of diabetes? With its complications, diabetes is the seventh leading cause of death (sixth-leading cause of death by disease) in the United States. Each year, at least 180,000 people die as a result of diabetes and its complications. •Blindness due to diabetic retinopathy. Each year 12,000 to 24,000 people lose their sight because of diabetes. Diabetes is the leading cause of new blindness in people 20-74 years of age. •Kidney Disease due to diabetic nephropathy. Ten to twenty-one percent of all people with diabetes develop kidney disease. Diabetic nephropathy is the most common cause of end-stage renal disease, a condition where the patient requires dialysis or a kidney transplant in order to live. •Heart Disease and Stroke. People with diabetes are 2 to 4 times more likely to have heart disease (more than 77,000 deaths due to heart disease annually). Heart disease death rates are also 2 to 4 times as high as adults without diabetes. And, people with diabetes are 2 to 4 times more likely to suffer a stroke. •Nerve Disease and Amputations. About 60-70% of people with diabetes have mild to severe forms of diabetic nerve damage, which, in severe forms, can lead to lower limb amputations. In fact, diabetes is the most frequent cause of non-traumatic lower limb amputations. The risk of a leg amputation is 15-40 times greater for a person with diabetes. Each year, 56,200 people lose their foot or leg to diabetes. •Impotence due to diabetic neuropathy or blood vessel blockage. Impotence afflicts approximately 13% of men who have type 1 diabetes and 8% of men who have type 2 diabetes. It has been reported that men with diabetes, over the age of 50, have impotence rates as high as 50-60%. ------------------------------------------------------------------------ Diabetes Among African Americans How Does Diabetes Affect African Americans? Approximately 2.3 million or 10.8% of all African Americans have diabetes, however, half of them do not know it. With its complications -- blindness, kidney failure, amputations, heart attack and stroke -- diabetes is the seventh leading cause of death (sixth leading cause of death by disease) in the United States. Diabetes is a chronic disease that has no cure. Prevalence •African Americans are 1.7 times more likely to have diabetes than non-Hispanic whites. •Twenty-five percent of African Americans between the ages of 65 and 74 have diabetes. •One in four African American women over 55 years of age has diabetes. African Americans and Diabetic Complications •African Americans experience higher rates of at least three of the serious complications of diabetes: blindness, amputation and end stage renal disease (kidney failure). •Diabetic retinopathy is a term used for all abnormalities of the small blood vessels of the retina caused by diabetes, such as weakening of blood vessel walls or leakage from blood vessels. African Americans are twice as likely to suffer from diabetes-related blindness. •Diabetes is the most frequent cause of non-traumatic lower limb amputations. The risk of a leg amputation is 15 to 40 times greater for a person with diabetes. Each year 54,000 people lose their foot or leg to diabetes. Among people with diabetes, African Americans are 1.5 to 2.5 times more likely to suffer from lower limb amputations. •Ten to twenty-one percent of all people with diabetes develop kidney disease. In 1995, 27,900 people initiated treatment for end stage renal disease (kidney failure) because of diabetes. African Americans with diabetes are 2.6 to 5.6 times more likely to suffer from kidney disease with more than 4,000 new cases of end stage renal disease each year. What is Needed? In ideal circumstances, African Americans with diabetes will have their disease under good control and be monitored frequently by a health care team knowledgeable in the care of diabetes. •Patient education is critical. People with diabetes can reduce their risk for complications if they are educated about their disease, learn and practice the skills necessary to better control their blood glucose levels, and receive regular checkups from their health care team. •People with diabetes, with the help of their health care providers, should set goals for better control of blood glucose levels, as close to the normal range as is possible for them. •Health care team education is vital. Because people with diabetes have a multi-system chronic disease, they are best monitored and managed by highly skilled health care professionals trained with the latest information on diabetes to help ensure early detection and appropriate treatment of the serious complications of the disease. A team approach to treating and monitoring this disease serves the best interests of the patient. ------------------------------------------------------------------------ Diabetes Among Hispanics How Does Diabetes Affect Hispanic Americans? Prevalence •Approximately 24% of Mexican Americans and 26% of Puerto Ricans between the ages of 45-74 have diabetes. •Nearly 16% of Cuban Americans between the ages of 45-74 have diabetes. •The prevalence of type 2 diabetes is 2-4 times higher in Hispanics than non-Hispanic whites. Hispanic Americans and Diabetic Complications •Diabetic retinopathy is a term used for all abnormalities of the small blood vessels of the retina caused by diabetes, such as weakening of blood vessel walls or leakage from blood vessels. The prevalence of diabetic retinopathy in Mexican Americans is 32-40%. •Ten to twenty-one percent of all people with diabetes develop kidney disease. In 1992, 19,800 people initiated treatment for end stage renal disease (kidney failure) because of diabetes. Among people with diabetes, Mexican Americans are 4.5 to 6.6 times more likely to suffer from end stage renal disease. What is Needed? In ideal circumstances, Hispanic Americans with diabetes will have their disease under good control and be monitored frequently by a health care team knowledgeable in the care of diabetes. •Patient education is critical. People with diabetes can reduce their risk for complications if they are educated about their disease, learn and practice the skills necessary to better control their blood glucose levels, and receive regular checkups from their health care team. •People with diabetes, with the help of their health care providers, should set goals for better control of blood glucose levels, as close to the normal range as is possible for them. •Health care team education is vital. Because people with diabetes have a multi-system chronic disease, they are best monitored and managed by highly skilled health care professionals trained with the latest information on diabetes to help ensure early detection and appropriate treatment of the serious complications of the disease. A team approach to treating and monitoring this disease serves the best interests of the patient.

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