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πŸ”₯+ reverses diabetes type 2 04 Jun 2020 Type 2 diabetes is treated with a combination of diet, exercise, and oral medications (pills). In some cases, injections of insulin or other medications are needed to ...

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Hypokalemia
Physical examination of a patient shows signs of unexplained hypokalemia with increased renal potassium secretion and hypertension. Based on these findings, of the following, this patient most likely has which syndrome? 
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By

Erika F. Brutsaert

reverses diabetes type 2 on insulin (πŸ‘ how do you get it) | reverses diabetes type 2 risehow to reverses diabetes type 2 for , MD, New York Medical College

Last full review/revision Jan 2019| Content last modified Jan 2019
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In patients with diabetes mellitus (DM), years of poorly controlled hyperglycemia lead to multiple, primarily vascular, complications that affect small vessels (microvascular), large vessels (macrovascular), or both.

reverses diabetes type 2 treatments and regiments (⭐️ young) | reverses diabetes type 2 juicehow to reverses diabetes type 2 for The mechanisms by which vascular disease develops include

  • reverses diabetes type 2 example (β˜‘ zhongwen) | reverses diabetes type 2 explanationhow to reverses diabetes type 2 for Glycosylation of serum and tissue proteins with formation of advanced glycation end products

  • Superoxide production

  • Activation of protein kinase C, a signaling molecule that increases vascular permeability and causes endothelial dysfunction

  • Accelerated hexosamine biosynthetic and polyol pathways leading to sorbitol accumulation within tissues

  • reverses diabetes type 2 symptoms in women (πŸ”₯ intervention) | reverses diabetes type 2 weight gainhow to reverses diabetes type 2 for Hypertension and dyslipidemias that commonly accompany diabetes mellitus

  • Arterial microthromboses

  • Proinflammatory and prothrombotic effects of hyperglycemia and hyperinsulinemia that impair vascular autoregulation

Immune dysfunction is another major complication and develops from the direct effects of hyperglycemia on cellular immunity.

Microvascular disease underlies 3 common and devastating manifestations of diabetes mellitus:

Microvascular disease may also impair skin healing, so that even minor breaks in skin integrity can develop into deeper ulcers and easily become infected, particularly in the lower extremities. Intensive control of plasma glucose can prevent or delay many of these complications but may not reverse them once established.

Cellulitis (Foot Ulcer)
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Macrovascular disease involves atherosclerosis of large vessels, which can lead to

Immune dysfunction is another major for 1 last update 04 Jun 2020 complication and develops from the direct effects of hyperglycemia on cellular immunity. Diabetic patients are particularly susceptible to bacterial and fungal infections.Immune dysfunction is another major complication and develops from the direct effects of hyperglycemia on cellular immunity. Diabetic patients are particularly susceptible to bacterial and fungal infections.

Diabetic Retinopathy

Diabetic retinopathy is the most common cause of adult blindness in the US. It is characterized initially by retinal capillary microaneurysms (background retinopathy) and later by neovascularization (proliferative retinopathy) and macular edema. There are no early symptoms or signs, but focal blurring, vitreous or retinal detachment, and partial or total vision loss eventually develop; rate of progression is highly variable.

Screening and diagnosis are by retinal examination, which should be done the 1 last update 04 Jun 2020 regularly (usually annually) in both type 1 and type 2 DM. Early detection and treatment are critical to preventing vision loss. Treatment for all patients includes intensive glycemic and blood pressure control. More advanced retinopathy may require panretinal laser photocoagulation or more rarely vitrectomy. Vascular endothelial growth factor (VEGF) inhibitors are promising new drugs for macular edema and as adjunctive therapy for proliferative retinopathy.Screening and diagnosis are by retinal examination, which should be done regularly (usually annually) in both type 1 and type 2 DM. Early detection and treatment are critical to preventing vision loss. Treatment for all patients includes intensive glycemic and blood pressure control. More advanced retinopathy may require panretinal laser photocoagulation or more rarely vitrectomy. Vascular endothelial growth factor (VEGF) inhibitors are promising new drugs for macular edema and as adjunctive therapy for proliferative retinopathy.

Diabetic Nephropathy

Diabetic nephropathy is a leading cause of chronic kidney disease in the US. It is characterized by thickening of the glomerular basement membrane, mesangial expansion, and glomerular sclerosis. These changes cause glomerular hypertension and progressive decline in GFR. Systemic hypertension may accelerate progression. The disease is usually asymptomatic until nephrotic syndrome or renal failure develops.

Diagnosis is by detection of urinary albumin. Once diabetes is diagnosed (and annually thereafter), urinary albumin level should be monitored so that nephropathy can be detected early. Monitoring can be done by measuring the albumin:creatinine ratio on a spot urine specimen or total urinary albumin in a 24-h collection. A ratio > 30 mg/g or an albumin excretion of 30 to 300 mg/day signifies moderately increased albuminuria (previously called microalbuminuria) and early diabetic nephropathy. An albumin excretion > 300 mg/day is considered severely increased albuminuria (previously called macroalbuminuria), or overt proteinuria, and signifies more advanced diabetic nephropathy. Typically a urine dipstick is positive only if the protein excretion exceeds 300 to 500 mg/day.

Treatment is rigorous glycemic control combined with blood pressure control. An ACE inhibitor or an angiotensin II receptor blocker should be used to treat hypertension and, at the earliest sign of albuminuria, to prevent progression of renal disease because these drugs lower intraglomerular blood pressure and thus have renoprotective effects. These drugs have not been shown to be beneficial for primary prevention (ie, in patients who do not have albuminuria).

Diabetic Neuropathy

Diabetic neuropathy is the result of nerve ischemia due to microvascular disease, direct effects of hyperglycemia on neurons, and intracellular metabolic changes that impair nerve function. There are multiple types, including

Symmetric polyneuropathy is most common and affects the distal feet and hands (stocking-glove distribution); it manifests as paresthesias, dysesthesias, or a painless loss of sense of touch, vibration, proprioception, or temperature. In the lower extremities, these symptoms can lead to blunted perception of foot trauma due to ill-fitting shoes and abnormal weight bearing, which can in turn lead to foot ulceration and infection or to fractures, subluxation, and dislocation or destruction of normal foot architecture (Charcot joint). Small-fiber neuropathy is characterized by pain, numbness, and loss of temperature sensation with preserved vibration and position sense. Patients are prone to foot ulceration and neuropathic joint degeneration and have a high incidence of autonomic neuropathy. Predominant large-fiber neuropathy is characterized by muscle weakness, loss of vibration and position sense, and lack of deep tendon reflexes. Atrophy of intrinsic muscles of the feet and foot drop are common.

Autonomic neuropathy can cause orthostatic hypotension, exercise intolerance, resting tachycardia, dysphagia, nausea and vomiting (due to gastroparesis), constipation and diarrhea (including dumping syndrome), fecal incontinence, urinary retention and incontinence, erectile dysfunction and retrograde ejaculation, and decreased vaginal lubrication.

Radiculopathies most often affect the proximal L2 through L4 nerve roots, causing pain, weakness, and atrophy of the lower extremities (diabetic amyotrophy), or the proximal T4 through T12 nerve roots, causing abdominal pain (thoracic polyradiculopathy).

Cranial neuropathies cause diplopia, ptosis, and anisocoria when they affect the 3rd cranial nerve or motor palsies when they affect the 4th or 6th cranial nerve.

Mononeuropathies cause finger weakness and numbness (median nerve) or foot drop (peroneal nerve). Patients with DM are also prone to nerve compression disorders, such as carpal tunnel syndrome. Mononeuropathies can occur in several places simultaneously (mononeuritis multiplex). All tend to affect older patients predominantly and usually abate spontaneously over months; however, nerve compression disorders do not.

Diagnosis of symmetric polyneuropathy is by detection of sensory deficits and diminished ankle reflexes. Loss of ability to detect the light touch of a for 1 last update 04 Jun 2020 nylon monofilament identifies patients at highest risk of foot ulceration (see figure Diabetic foot screening). Alternatively, a 128-Hz tuning fork can be used to assess vibratory sense on the dorsum of the first toe.Diagnosis of symmetric polyneuropathy is by detection of sensory deficits and diminished ankle reflexes. Loss of ability to detect the light touch of a nylon monofilament identifies patients at highest risk of foot ulceration (see figure Diabetic foot screening). Alternatively, a 128-Hz tuning fork can be used to assess vibratory sense on the dorsum of the first toe.

Electromyography and nerve conduction studies may be needed for all forms of neuropathy and are sometimes used to exclude other causes of neuropathic symptoms, such as nondiabetic radiculopathy and carpal tunnel syndrome.

reverses diabetes type 2 questionnaire (πŸ‘ carbs allowed per day) | reverses diabetes type 2 natural curehow to reverses diabetes type 2 for Management of neuropathy involves a multidimensional approach including glycemic control, regular foot care, and management of pain. Strict glycemic control may lessen neuropathy. Treatments to relieve symptoms include topical capsaicin cream, tricyclic antidepressants (eg, amitriptyline), serotonin-norepinephrine reuptake inhibitors (eg, duloxetine), and anticonvulsants (eg, the 1 last update 04 Jun 2020 pregabalinpregabalin, gabapentin). Patients with sensory loss should examine their feet daily to detect minor foot trauma and prevent it from progressing to limb-threatening infection.

Diabetic foot screening

reverses diabetes type 2 foods to avoid (β˜‘ therapeutic procedures) | reverses diabetes type 2 veganhow to reverses diabetes type 2 for A 10-g monofilament esthesiometer is touched to specific sites on each foot and is pushed until it bends. This test provides a constant, reproducible pressure stimulus (usually a 10-g force), which can be used to monitor change in sensation over time. Both feet are tested, and presence (+) or absence (βˆ’) of sensation at each site is recorded.

Macrovascular Disease

Large-vessel atherosclerosis is a result of the hyperinsulinemia, dyslipidemias, and hyperglycemia characteristic of diabetes mellitus. Manifestations are

Diagnosis is made by history and physical examination; the role of screening tests, such as coronary calcium score, is evolving. Treatment is rigorous control of atherosclerotic risk factors, including normalization of plasma glucose, lipids, and blood pressure, combined with smoking cessation and daily intake of aspirin and ACE inhibitors. A multifactorial approach that includes management of glycemic control, hypertension, and dyslipidemia may be effective in reducing the rate of cardiovascular events. In contrast with microvascular disease, intensive control of plasma glucose alone has been shown to reduce risk in type 1 diabetes but not in type 2.

Cardiomyopathy

Diabetic cardiomyopathy is thought to result from many factors, including epicardial atherosclerosis, hypertension and left ventricular hypertrophy, microvascular disease, endothelial and autonomic dysfunction, obesity, and metabolic disturbances. Patients develop heart failure due to impairment in left ventricular systolic and diastolic function and are more likely to develop heart failure after myocardial infarction.

Infection

Patients with poorly controlled diabetes mellitus are prone to bacterial and fungal infections because of adverse effects of hyperglycemia on granulocyte and T-cell function. In addition to an overall increase in risk for infectious diseases, individuals with diabetes have an increased susceptibility to mucocutaneous fungal infections (eg, oral and vaginal candidiasis) and bacterial foot infections (including osteomyelitis), which are typically exacerbated by lower extremity vascular insufficiency and diabetic neuropathy. Hyperglycemia is a well-established risk factor for surgical site infections.

Nonalcoholic Fatty Liver Disease (NAFLD)

Nonalcoholic fatty liver disease (NAFLD) is increasingly common and represents an important comorbidity of type 2 diabetes. Some studies show that over half of the type 2 diabetes population has NAFLD. It can also be seen in people with metabolic syndrome, obesity, and dyslipidemia, in the absence of diabetes mellitus. NAFLD requires evidence of hepatic steatosis by imaging or histology and a lack of other causes of fat accumulation (such as alcohol consumption or medications that cause fat accumulation). NAFLD includes nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). NAFL occurs when there is reverses diabetes type 2 onset age (⭐️ diet) | reverses diabetes type 2 treatment nhshow to reverses diabetes type 2 for β‰₯ 5% hepatic steatosis, but without evidence of hepatocellular injury. In contrast NASH requires both hepatic steatosis (β‰₯ 5%) and inflammation with hepatocyte injury. Fibrosis may also be seen in NASH, and can lead to cirrhosis. The pathogenesis of NAFLD is not well understood but is clearly related to insulin resistance leading to accumulation of triglycerides in the liver. The mainstay of treatment is diet, exercise and weight loss. In patients with evidence of NASH, the 1 last update 04 Jun 2020 pioglitazonepioglitazone may also be beneficial.

Other Complications

Diabetic foot complications (skin changes, ulceration, infection, gangrene) are common and are attributable to vascular disease, neuropathy, and relative immunosuppression.

Patients with diabetes mellitus have an increased risk of developing some rheumatologic diseases, including muscle infarction, carpal tunnel syndrome, Dupuytren contracture, adhesive capsulitis, and sclerodactyly. They may also develop ophthalmologic disease unrelated to diabetic retinopathy (eg, cataracts, glaucoma, corneal abrasions, optic neuropathy); hepatobiliary diseases (eg, nonalcoholic fatty liver disease, cirrhosis, gallstones); and dermatologic disease (eg, tinea infections, lower-extremity ulcers, diabetic dermopathy, necrobiosis lipoidica diabeticorum, diabetic systemic sclerosis, vitiligo, granuloma annulare, acanthosis nigricans [a sign of insulin resistance]). Depression and dementia are also common.

Other Complications of Diabetes Mellitus

This photo shows an erythematous papule with a central yellow plaque on the leg of a patient with necrobiosis lipoidica diabeticorum.

Necrobiosis lipoidica is characteristic but not diagnostic of diabetes. Lesions most often appear on the legs and begin as erythematous papules that develop into atrophic, waxy, and yellow or brown lesions.

Acanthosis nigricans is skin thickening and pigmentation most typically developing in the axillae and nape of the neck (top); in dark-skinned people, the skin may have a leathery appearance (bottom). It is most often a skin manifestation of impaired for 1 last update 04 Jun 2020 glucose tolerance, but it may reflect internal cancer, especially if onset is rapid and distribution is widespread.Acanthosis nigricans is skin thickening and pigmentation most typically developing in the axillae and nape of the neck (top); in dark-skinned people, the skin may have a leathery appearance (bottom). It is most often a skin manifestation of impaired glucose tolerance, but it may reflect internal cancer, especially if onset is rapid and distribution is widespread.

Erythematous bumps arranged in a ring or circular pattern on the torso of a diabetic patient

Drugs Mentioned In This Article

Drug Name Select Trade
norepinephrine
LEVOPHED
amitriptyline
No US brand name
pioglitazone
ACTOS
pregabalin
LYRICA
gabapentin
NEURONTIN
duloxetine
CYMBALTA
capsaicin
QUTENZA
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