Which Of The Following Statements About Diabetes Mellitus Is False

Hormonal Regulation Of The Reproductive System

Regulation of the reproductive system is a process that requires the action of hormones from the pituitary gland, the adrenal cortex, and the gonads. During puberty in both males and females, the hypothalamus produces gonadotropin-releasing hormone , which stimulates the production and release of follicle-stimulating hormone and luteinizing hormone from the anterior pituitary gland. These hormones regulate the gonads and therefore are called gonadotropins. In both males and females, FSH stimulates gamete production and LH stimulates production of hormones by the gonads. An increase in gonad hormone levels inhibits GnRH production through a negative feedback loop.

What Are The Kidneys And What Do They Do

The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the kidneys normally filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. The urine flows from the kidneys to the bladder through tubes called ureters. The bladder stores urine. When the bladder empties, urine flows out of the body through a tube called the urethra, located at the bottom of the bladder.

What Is Diabetes Insipidus

Diabetes insipidus is a rare disorder that occurs when a person’s kidneys pass an abnormally large volume of urine that is insipiddilute and odorless. In most people, the kidneys pass about 1 to 2 quarts of urine a day. In people with diabetes insipidus, the kidneys can pass 3 to 20 quarts of urine a day. As a result, a person with diabetes insipidus may feel the need to drink large amounts of liquids.

Diabetes insipidus and diabetes mellituswhich includes both type 1 and type 2 diabetesare unrelated, although both conditions cause frequent urination and constant thirst. Diabetes mellitus causes high blood glucose, or blood sugar, resulting from the body’s inability to use blood glucose for energy. People with diabetes insipidus have normal blood glucose levels however, their kidneys cannot balance fluid in the body.

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Screening For Type 2 Diabetes

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Type 2 diabetes, the most prevalent form of the disease, is often asymptomatic in its early stages and can remain undiagnosed for many years.

The chronic hyperglycemia of diabetes is associated with long-term dysfunction, damage, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels. Individuals with undiagnosed type 2 diabetes are also at significantly higher risk for stroke, coronary heart disease, and peripheral vascular disease than the nondiabetic population. They also have a greater likelihood of having dyslipidemia, hypertension, and obesity. Because early detection and prompt treatment may reduce the burden of diabetes and its complications, screening for diabetes may be appropriate under certain circumstances. This position statement provides recommendations for diabetes screenings performed in physicians offices and in other health care settings.

For information on screening for GDM, refer to the American Diabetes Associations position statement Gestational Diabetes Mellitus.

How Common Is Diabetes Mellitus

Diabetes mellitus is a public health problem around the world. In 1980, 108 million adults worldwide had diabetes . By 2014 this had risen to 422 million adults . By 2040, the number is expected to be 642 million adults. In the UK, there is estimated to be between 3 and 4 million people with diabetes. Type 2 diabetes accounts for more than 90% of all patients with diabetes.

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Diabetes Management During Transitions Of Care

Recommendations

• Care transitions are important times to revisit diabetes management targets, perform medication reconciliation, provide patient and caregiver education, reevaluate the patients ability to perform diabetes self-care behaviors, and have close communication between transferring and receiving care teams to ensure patient safety and reduce readmission rates. E

• At the time of admission to a facility, transitional care documentation should include the current meal plan, activity levels, prior treatment regimen, prior self-care education, laboratory tests , hydration status, and previous episodes of hypoglycemia . E

Transitions in care indicate that a patient is undergoing changes in health status, which may include physical and/or cognitive function, changes in dietary patterns, and ability to perform diabetes self-care behaviors. For example, an older adult on insulin may experience delirium as a common complication during and after hospitalization or may require a change in insulin dose when recuperating from acute illness and as nutritional intake improves. Inadequate communication between inpatient and outpatient providers and a lack of an effective communication infrastructure contribute to poor patient outcomes .

What Does The Pancreas Do

The pancreas carries out two important roles:

The pancreas produces hormones in its ‘endocrine’ cells. These cells are gathered in clusters known as islets of Langerhans and monitor what is happening in the blood. They then can release hormones directly into the blood when necessary. In particular, they sense when sugar levels in the blood rise, and as soon as this happens the cells produce hormones, particularly insulin. Insulin then helps the body to lower blood glucose levels and ‘store’ the sugar away in fat, muscle, liver and other body tissues where it can be used for energy when required.

The pancreas is very close to the stomach. As soon as food is eaten, the pancreas releases digestive enzymes into the bowel to break food down. As the food is digested, and nutrient levels in the blood rise, the pancreas produces insulin to help the body store the glucose away. Between meals, the pancreas does not produce insulin and this allows the body to gradually release stores of energy back into the blood as they are needed.

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How Are They Treated

Thereâs no cure for diabetes mellitus or diabetes insipidus, but you can manage them.

If you have type 1 or type 2 diabetes, youâll usually manage your blood sugar with insulin shots or other medications. Check it daily to make sure itâs in a safe range. Youâll need to eat a healthy diet and get regular exercise to keep your weight, cholesterol, and blood pressure down. See your doctor for regular checkups.

Treatment for diabetes insipidus depends on which of the four types you have:

• Central: A synthetic hormone called desmopressin can replace the vasopressin your body doesnât make to manage your symptoms. It comes as a nasal spray, shot, or pill.
• Nephrogenic:Diuretics and aspirin or ibuprofen can help with symptoms of nephrogenic diabetes insipidus. Your doctor also may check to make sure that the calcium and potassium in your body are in balance. Sometimes this type can go away once you treat it.
• Dipsogenic: In dipsogenic diabetes insipidus, the problems with your hypothalamus and pituitary gland extend to your thirst mechanism. This means that even though youâre losing a lot of fluid, youâre still not thirsty. Doctors are still at work on a treatment, but for now, they suggest that you suck on ice chips or hard, sour candy to trigger your urge to drink.
• Gestational: This type of diabetes insipidus can happen when youâre pregnant. Doctors often treat this with desmopressin. Most women donât continue to need treatment after they give birth.

Principles To Assess The Value Of Screening For Type 2 Diabetes

There is a major distinction between diagnostic testing and screening. When an individual exhibits symptoms or signs of the disease, diagnostic tests are performed, and such tests do not represent screening. The purpose of screening is to identify asymptomatic individuals who are likely to have diabetes. Separate diagnostic tests using standard criteria are required after positive screening tests to establish a definitive diagnosis.

Generally, screening in asymptomatic populations is appropriate when seven conditions are met: 1) the disease represents an important health problem that imposes a significant burden on the population 2) the natural history of the disease is understood 3) there is a recognizable preclinical stage during which the disease can be diagnosed 4) tests are available that can detect the preclinical stage of the disease, and the tests are acceptable and reliable 5) treatment after early detection yields benefits superior to those obtained when treatment is delayed 6) the costs of case finding and treatment are reasonable and are balanced in relation to health expenditures as a whole, and facilities and resources are available to treat newly diagnosed cases and 7) screening will be a systematic ongoing process and not merely an isolated one-time effort.

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Current Literature In Management Of Diabetes In Ltc Patients

Several organizations have developed diabetes guidelines for patients living in LTC settings. Almost all of these guidelines emphasize the need to individualize care goals and treatments related to diabetes, the need to avoid sliding scale insulin as a primary means of regulating blood glucose, and the importance of providing adequate training and protocols to LTC staff who may be operating without the presence of a practitioner for prolonged periods.

The American Medical Directors Association Guidelines

Other Guidelines

Along with the AMDA guidelines, guidelines from the ADA, the International Association of Gerontology and Geriatrics , and the European Diabetes Working Party for Older People have provided selective guidance for LTC populations. The ADA consensus panel identified the challenges of caring for patients in LTC facilities, such as irregular and unpredictable meal consumption, inadequate staffing, and frequent transitions in care . Additionally, the IAGG and EDWPOP have called to reduce the prevalence and burden of pressure ulcers .

Building on a core set of principles from these guidelines, this position statement elaborates on unique features of diabetes management in patients in LTC facilities and provides practical strategies to the clinical staff caring for them.

What Clinical Trials Are Open

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

This information may contain content about medications and, when taken as prescribed, the conditions they treat. When prepared, this content included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1-888-INFO-FDA or visit www.fda.gov. Consult your health care provider for more information.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank:Bessie Young, M.D., M.P.H., University of Washington Dr. Joseph Verbalis, M.D, Georgetown University

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What Are The Longer

Having diabetes requires life-long treatment and follow-up by health professionals. Diabetes can be linked to damage of the eyes, kidneys and feet. It is also associated with increased risk of strokes, heart attacks and poor blood circulation to the legs. Medical care aims to minimise these risks by controlling diabetes, blood pressure and cholesterol and screening for possible complications caused by the diabetes.

Maintaining a healthy lifestyle with regular exercise and a healthy diet helps with glucose control and managing diabetes in the long term. With careful monitoring and appropriate treatment, diabetes patients can lead full and active lives.

Women with diabetes who are planning to start a family should discuss this with their doctor as good glucose control is important both prior to conception and throughout pregnancy.

What Is Diabetes Mellitus

Diabetes mellitus is a condition in which the body does not produce enough of the hormone insulin, resulting in high levels of sugar in the bloodstream. There are many different types of diabetes the most common are type 1 and type 2 diabetes, which are covered in this article. Gestational diabetes occurs during the second half of pregnancy and is covered in a separate article. Diabetes can also be caused by disease or damage to the pancreas, Cushing’s syndrome, acromegaly and there are also some rare genetic forms.

Diabetes mellitus is linked with an increased risk of heart attacks, strokes, poor blood circulation to the legs and damage to the eyes, feet and kidneys. Early diagnosis and strict control of blood sugar, blood pressure and cholesterol levels can help to prevent or delay these complications associated with diabetes. Maintaining a healthy lifestyle is important in reducing the risk of developing type 2 diabetes.

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What Is The Treatment For Gestational Diabetes Mellitus

Specific treatment for gestational diabetes will be determined by your doctor based on:

• Your age, overall health, and medical history

• Extent of the disease

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

Treatment for gestational diabetes focuses on keeping blood glucose levels in the normal range. Treatment may include:

• Special diet

• Insulin injections

Which Of The Following Statements About Diabetes

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General Recommendations For The Evaluation Of High

Based on the lack of data from prospective studies on the benefits of screening and the relatively low cost-effectiveness of screening suggested by existing studies, the decision to test for diabetes should ultimately be based on clinical judgment and patient preference.

On the basis of expert opinion, screening should be considered by health care providers at 3-year intervals beginning at age 45, particularly in those with BMI 25 kg/m2. The rationale for this interval is that false negatives will be repeated before substantial time elapses, and there is little likelihood of an individual developing any of the complications of diabetes to a significant degree within 3 years of a negative screening test result. Testing should be considered at a younger age or be carried out more frequently in individuals who are overweight and have one or more of the other risk factors shown in .

Patients presenting to health care providers with symptoms of marked hyperglycemia, including polyuria, polydipsia, weight loss and blurred vision, should receive diagnostic testing for diabetes, as should those with potential complications of diabetes or with any other clinical presentation in which diabetes is included in the differential diagnosis. Such diagnostic testing, however, does not constitute screening.

Challenges In Transition Care

To date, there is no standard transition of care document with all the needed information for diabetes management that accompanies a patient from one setting to another . Discharge summaries often lack crucial information such as diagnostic test results, treatment or hospital course, discharge medications, test results pending at discharge, patient or family education, and follow-up plans . Therefore, the need to restart oral therapies , typically discontinued in the inpatient setting, can be overlooked. Additionally, pending results, such as those regarding renal function after contrast dye studies are performed, may not be shared with the LTC facility, leading to test duplication. In addition, continuance of SSI after admission or transfer back to the LTC facility is a long-standing problem for patients with diabetes .

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What Causes Diabetes Mellitus

Insulin is a hormone produced by the beta cells within the pancreas in response to the intake of food. The role of insulin is to lower blood sugar levels by allowing cells in the muscle, liver and fat to take up sugar from the bloodstream that has been absorbed from food, and store it away as energy. In type 1 diabetes , the insulin-producing cells are destroyed and the body is not able to produce insulin naturally. This means that sugar is not stored away but is constantly released from energy stores giving rise to high sugar levels in the blood. This in turn causes dehydration and thirst . To exacerbate the problem, because the body is not making insulin it thinks that it is starving so does everything it can to release even more stores of energy into the bloodstream. So, if left untreated, patients become increasingly unwell, lose weight, and develop a condition called diabetic ketoacidosis, which is due to the excessive release of acidic energy stores and causes severe changes to how energy is used and stored in the body.

The Dangers Of Synthetic Hormones

Some athletes attempt to boost their performance by using artificial hormones that enhance muscle performance. Anabolic steroids, a form of the male sex hormone testosterone, are one of the most widely known performance-enhancing drugs. Steroids are used to help build muscle mass. Other hormones that are used to enhance athletic performance include erythropoietin, which triggers the production of red blood cells, and human growth hormone, which can help in building muscle mass. Most performance enhancing drugs are illegal for non-medical purposes. They are also banned by national and international governing bodies including the International Olympic Committee, the U.S. Olympic Committee, the National Collegiate Athletic Association, the Major League Baseball, and the National Football League.

The side effects of synthetic hormones are often significant and non-reversible, and in some cases, fatal. Androgens produce several complications such as liver dysfunctions and liver tumors, prostate gland enlargement, difficulty urinating, premature closure of epiphyseal cartilages, testicular atrophy, infertility, and immune system depression. The physiological strain caused by these substances is often greater than what the body can handle, leading to unpredictable and dangerous effects and linking their use to heart attacks, strokes, and impaired cardiac function.

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