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Poorly Controlled Diabetes Mellitus


Presentation

  • Physicians should consider DMI in the differential diagnosis of patients with diabetes who present with painful, swollen muscles without systemic signs of infection.[ncbi.nlm.nih.gov]
  • PARTICIPANTS: Veterans (N 5,317) with poorly controlled DM receiving regular medical care MEASUREMENTS: An increase in hypoglycemic medications, or intensification of therapy, was considered present at the visit if a new hypoglycemic medication was started[ncbi.nlm.nih.gov]
  • Four years after diagnosis he presented following a school camp with respiratory distress, decreased level of consciousness (GCS 10), poor perfusion (capillary refill time 4 seconds) and pH 6.92.[nzma.org.nz]
  • His presentation, clinical examination and imaging all suggested the diagnosis of muscle infarction. He was managed conservatively with analgesia, and allowed to mobilise. He made a good recovery.[endocrine-abstracts.org]
Weight Loss
  • At the time of presentation, he reported nausea and a 10-kg weight loss. Physical examination revealed epigastric tenderness without rebound tenderness. Abdominal computed tomography revealed periduodenal edema.[acgcasereports.gi.org]
  • Weight loss. Since sugars can’t be used to produce energy, your body tries to produce it using fats, which causes sugars stored in fat tissue to mobilize. This is one of the possible reasons for weight loss in people with diabetes.[ihhub.org]
  • An enlarged, fluid-filled gallbladder can lead to early satiety; dyspepsia; and chronic backache, as noted in Case 3 and significant weight loss, seen in Case #2.[pancreas.imedpub.com]
  • Ten-year followup of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009 Nov 14;374(9702):1677-86. 3 Centers for Disease Control and Prevention.[healthypeople.gov]
  • For many Type II diabetics, weight loss may be an important goal in helping them to control their diabetes.[medical-dictionary.thefreedictionary.com]
Fatigue
  • ., obesity, hypertension, hyperglycemia, edema, hypokalemia, fatigue, mood disorders, and insomnia) are common but nonspecific; others (e.g. easy bruising, purple striae, facial plethora, and proximal-muscle weakness) are more specific and particularly[blogs.nejm.org]
  • Symptoms Extreme fatigue and excessive hunger. As a consequence of lack of food in the cells, they do not produce energy and their functions become altered.[ihhub.org]
  • Signs of diabetes When undiagnosed or uncontrolled, the effects of diabetes on the body can be noticed by the classic symptoms of diabetes , namely: Increased thirst Frequent need to urinate Fatigue Blurred vision and Tingling or pain in the hands, feet[diabetes.co.uk]
  • The common symptoms are fatigue, extreme thirst and hunger, excessive urination, and weight loss. This type of diabetes requires a person to receive insulin, either through multiple injections each day, or a continuous pump.[verywell.com]
  • Fatigue. If your cells are deprived of sugar, you may become tired and irritable. Blurred vision. If your blood sugar is too high, fluid may be pulled from the lenses of your eyes. This may affect your ability to focus.[mayoclinic.org]
Cushingoid
  • In 1930 Mauriac noted hepatomegaly, impaired growth, pubertal delay and Cushingoid features in poorly controlled diabetic children. 2 The term glycogenic hepatopathy (GH) has been applied to diabetic patients (including adults) with hepatic glycogen deposition[nzma.org.nz]
Polydipsia
  • This leads to a certain level of dehydration that can be perceived by the person with diabetes as an increase in thirst (polydipsia). Water elimination makes people with poorly controlled diabetes tend to urinate more often than normal (polyuria).[ihhub.org]
  • Characteristically the course is progressive and includes polyuria, polydipsia, weight loss, polyphagia, hyperglycemia, and glycosuria.[medical-dictionary.thefreedictionary.com]
  • In both children and adults, obesity increases the risk of developing type 2 diabetes. 3 Symptoms of both types of diabetes include fatigue, weight loss, polyuria and polydipsia, resulting from hyperglycemia.[decisionsindentistry.com]
  • Clinical manifestations include the following: Classic symptoms: Polyuria, polydipsia, polyphagia, and weight loss Blurred vision Lower-extremity paresthesias Yeast infections (eg, balanitis in men) See Presentation for more detail.[emedicine.medscape.com]
Thigh Pain
  • We herein describe the case of a 56-year-old man with a 10-year history of poorly controlled type 2 diabetes mellitus with multiple microvascular and macrovascular complications who presented with the sudden onset of left thigh pain and swelling.[ncbi.nlm.nih.gov]
  • This report describes a gentleman who presented with two weeks of thigh pain and swelling, and had been referred to hospital for exclusion of deep vein thrombosis (DVT). His right thigh was markedly swollen, but soft.[endocrine-abstracts.org]
Blurred Vision
  • Signs of diabetes When undiagnosed or uncontrolled, the effects of diabetes on the body can be noticed by the classic symptoms of diabetes , namely: Increased thirst Frequent need to urinate Fatigue Blurred vision and Tingling or pain in the hands, feet[diabetes.co.uk]
  • Blurred vision. If your blood sugar is too high, fluid may be pulled from the lenses of your eyes. This may affect your ability to focus. Slow-healing sores or frequent infections. Type 2 diabetes affects your ability to heal and resist infections.[mayoclinic.org]
  • These include: Frequent urination Excessive thirst and/or hunger Dry mouth Unexplained weight loss Blurred vision Lack of energy and extreme tiredness What to do if you have high blood sugar: Call the doctor to see if a change in medication is needed.[onetouch.com]
  • Other symptoms may include sudden weight loss, slow wound healing, urinary tract infections, gum disease, or blurred vision.[medical-dictionary.thefreedictionary.com]
  • Clinical manifestations include the following: Classic symptoms: Polyuria, polydipsia, polyphagia, and weight loss Blurred vision Lower-extremity paresthesias Yeast infections (eg, balanitis in men) See Presentation for more detail.[emedicine.medscape.com]
Delayed Wound Healing
Polyuria
  • Water elimination makes people with poorly controlled diabetes tend to urinate more often than normal (polyuria).[ihhub.org]
  • Characteristically the course is progressive and includes polyuria, polydipsia, weight loss, polyphagia, hyperglycemia, and glycosuria.[medical-dictionary.thefreedictionary.com]
  • In both children and adults, obesity increases the risk of developing type 2 diabetes. 3 Symptoms of both types of diabetes include fatigue, weight loss, polyuria and polydipsia, resulting from hyperglycemia.[decisionsindentistry.com]
  • Clinical manifestations include the following: Classic symptoms: Polyuria, polydipsia, polyphagia, and weight loss Blurred vision Lower-extremity paresthesias Yeast infections (eg, balanitis in men) See Presentation for more detail.[emedicine.medscape.com]
Peripheral Neuropathy
  • At presentation, his glycosylated hemoglobin was 9.1% with known diabetic complications of proliferative diabetic retinopathy, peripheral neuropathy, and nephropathy (stage 4 chronic kidney disease).[pancreas.imedpub.com]
  • Microvascular complications of diabetes, such as peripheral neuropathy, diabetic retinopathy and diabetic nephropathy, are directly related to poor glycaemic control [ 9 ] [ 10 ].[em-consulte.com]
  • The most common form is peripheral neuropathy, which mainly affects the sensory nerves in the feet. This can lead to pain, tingling, and loss of sensation.[onetouch.com]
  • Peripheral neuropathy also increases the risk for diabetic foot infections. Immune system in diabetes mellitus Hyperglycemia may compromise the immune system.[diapedia.org]
  • Patients with pseudotabes typically have pupillary and gait abnormalities from associated cranial and peripheral neuropathy.[spectrum.diabetesjournals.org]
Extrapyramidal Symptoms
  • There are 2 clinical variants of MBD; the acute form manifests with rapidly progressing decline and even death, and a subacute and chronic form, seen in our case, which progresses with dementia, extrapyramidal symptoms, incontinence, difficulty walking[elsevier.es]

Workup

  • Overweight and 1 or more other risk factors for diabetes (eg, first-degree relative with diabetes, BP 140/90 mm Hg, and HDL 35 mg/dL and/or triglyceride level 250 mg/dL) ADA recommends screening at age 45 years in the absence of the above criteria See Workup[emedicine.medscape.com]

Treatment

  • The pathology, clinical features, diagnosis and treatment of this disorder are discussed.[ncbi.nlm.nih.gov]
  • Antidiabetic treatment was readjusted. Three months after treatment, her gait and ideomotor apraxia had improved but the cognitive sequelae persisted.[elsevier.es]
  • In all patients, intensive insulin treatment had been applied for 6 months. After 6 months, HbA 1c was measured.[termedia.pl]
  • CONCLUSIONS: These results demonstrate a significant treatment effect from the MyCareTeam application. A larger randomized control trial is under way at the Boston Veterans Administration Healthcare System.[ncbi.nlm.nih.gov]
  • OBJECTIVE: We examined the effect of hospital admissions on the medical treatment of poorly controlled diabetes mellitus among Veterans Affairs (VA) patients.[ncbi.nlm.nih.gov]

Prognosis

  • Cortical involvement in Marchiafava-Bignami disease can be a predictor of a poor prognosis: a case report and review of the literatura.[elsevier.es]
  • The increased occurrence of Staphylococcus aureus as a causative organism is a likely explanation for the worse prognosis of patients with endocarditis and diabetes mellitus.[diapedia.org]
  • Macroangiopatia Patologia cerebrovascolare Il rischio di patologia cerebrovascolare è aumentato nel diabetico, con incremento di 3 volte dell’ictus La prognosi è peggiore nel diabetico che nel non diabetico (minori possibilità di ricupero funzionale e[federica.unina.it]
  • Prognosis Uncontrolled diabetes is a leading cause of blindness, end-stage renal disease, and limb amputations. It also doubles the risks of heart disease and increases the risk of stroke.[medical-dictionary.thefreedictionary.com]
  • Prognosis The prognosis in patients with diabetes mellitus is strongly influenced by the degree of control of their disease.[emedicine.medscape.com]

Etiology

  • The etiology of type 2 diabetes mellitus appears to involve complex interactions between environmental and genetic factors.[emedicine.medscape.com]
  • Etiology Type 1 DM is caused by autoimmune destruction of the insulin-secreting beta cells of the pancreas. The loss of these cells results in nearly complete insulin deficiency; without exogenous insulin, type 1 DM is rapidly fatal.[medical-dictionary.thefreedictionary.com]

Epidemiology

  • Clinical and epidemiological research Poorly controlled type 2 diabetes mellitus is associated with a decreased risk of incident gout: a population-based case-control study Saskia G Bruderer 1 , 2 , Michael Bodmer 3 , Susan S Jick 4 , Christoph R Meier[ard.bmj.com]
  • Epidemiological studies indicate that diabetes is likely to reach epidemic proportions within the next few decades.[em-consulte.com]
  • National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants.[healthypeople.gov]
  • The Gastroparesis Registry; an observational study to clarify the epidemiology, natural history, clinical course, and other outcomes of gastroparesis; has already shown that cholecystectomy undertaken in patients with a combination of functional biliary[pancreas.imedpub.com]
  • OBJECTIVES After reading this course, the participant should be able to: Describe the epidemiology of diabetes in pediatric patients, and common oral complications in this population.[decisionsindentistry.com]
Sex distribution
Age distribution

Pathophysiology

  • These authors suggest that osmotic changes secondary to glycaemic fluctuations constitute the pathophysiological mechanism. These descriptions match those of our patient, who had been admitted repeatedly due to hyperglycaemic episodes.[elsevier.es]
  • Recent studies propose a common pathophysiology between diabetes and Alzheimer’s disease. The similarities in the pathophysiology have given way to the thought that Alzheimer’s disease could be viewed as a new form of diabetes mellitus.[brainblogger.com]
  • […] settings where the test may be helpful Evaluating the long-term control of blood glucose concentrations in diabetic patients Diagnosing diabetes Identifying patients at increased risk for diabetes (prediabetes) Clinical Information Discusses physiology, pathophysiology[mayomedicallaboratories.com]
  • Diabetes Care 1992; 15: 318-354 Pathophysiology of type 2 diabetes Type 2 diabetes is a heterogeneous disorder Characterised by two fundamental defects Insulin Resistance Beta-cell dysfunction Type 2 diabetes Part of the Insulin Resistance Syndrome (a[federica.unina.it]
  • Explain the pathophysiology of diabetes, and its potential impact on oral health. Discuss research that indicates parents and caregivers of children with diabetes may not be aware of the relationship between diabetes and oral health.[decisionsindentistry.com]

Prevention

  • Rodondi: University Outpatient Clinic and University Institute of Social and Preventive Medicine, Department of Community Medicine and Public Health, University of Lausanne, Bugnon 44, 1011 Lausanne, Switzerland. Ms. Peng and Drs.[annals.org]
  • The Declaration aims to integrate eight strategies as part of a healthy lifestyle initiative for the prevention of all noncommunicable diseases.[em-consulte.com]
  • Available from: 4 Centers for Disease Control and Prevention. Diabetes Report Card 2014.[healthypeople.gov]
  • A well‐rounded diabetes management plan can help prevent diabetes‐related health problems.[onetouch.com]
  • Vas deferens is cut, preventing sperm from entering the urethra and thus preventing fertilization.[quizlet.com]

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