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Diabetes Management

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Bone and joint problems associated with diabetes

INTRODUCTION
If you have diabetes, you're at increased risk of various bone and joint disorders. Certain factors, such as nerve damage (diabetic neuropathy), arterial disease and obesity, may contribute to these problems — but often the cause isn't clear.

CHARCOT JOINT
What is it?
Charcot (shahr-KOH) joint, also called neuropathic arthropathy, occurs when a joint deteriorates because of nerve damage — a common complication of diabetes. Charcot joint primarily affects the feet. 
What are the symptoms?
You might have numbness and tingling or loss of sensation in the affected joints. They may become unstable, swollen or deformed.
How is it treated?
If detected early, progression of the disease can be slowed. Limiting weight-bearing activities and use of orthotic supports to the affected joint and surrounding structures can help.

DIABETIC HAND SYNDROME
What is it?
Diabetic hand syndrome, also called cheiroarthropathy, is a disorder in which the skin on the hands becomes waxy and thickened. Eventually finger movement is limited. What causes diabetic hand syndrome isn't known. It's most common in people who have had diabetes for a long time.
What are the symptoms?
You may be unable to fully extend your fingers or to press your palms together flat.
How is it treated?
Better management of blood glucose levels and physical therapy can slow the progress of this condition.

OSTEOPOROSIS
What is it?
Osteoporosis is a disorder that causes bones to become weak and prone to fracture. People who have type 1 diabetes have an increased risk of osteoporosis.
What are the symptoms?
Osteoporosis rarely causes symptoms in the early stages. Eventually, when the disease is more advanced, you may experience loss of height, stooped posture or bone fractures.
How is it treated?
A healthy lifestyle, including weight-bearing exercise, such as walking, and eating a well-balanced diet rich in calcium and vitamin D — including supplements if needed — are the best ways to address this condition.

Causes of diabetes

CAUSES OF TYPE 1 DIABETES
The exact cause of type 1 diabetes is unknown. What is known is that your immune system — which normally fights harmful bacteria or viruses — attacks and destroys your insulin-producing cells in the pancreas. This leaves you with little or no insulin. Instead of being transported into your cells, sugar builds up in your bloodstream. 

Type 1 is thought to be caused by a combination of genetic susceptibility and environmental factors, though exactly what many of those factors are is still unclear.

CAUSES OF PREDIABETES AND TYPE 2 DIABETES
In prediabetes — which can lead to type 2 diabetes — and in type 2 diabetes, your cells become resistant to the action of insulin, and your pancreas is unable to make enough insulin to overcome this resistance. Instead of moving into your cells where it's needed for energy, sugar builds up in your bloodstream. 

Exactly why this happens is uncertain, although it's believed that genetic and environmental factors play a role in the development of type 2 diabetes. Being overweight is strongly linked to the development of type 2 diabetes, but not everyone with type 2 is overweight.

CAUSES OF GESTATIONAL DIABETES
During pregnancy, the placenta produces hormones to sustain your pregnancy. These hormones make your cells more resistant to insulin. 

Normally, your pancreas responds by producing enough extra insulin to overcome this resistance. But sometimes your pancreas can't keep up. When this happens, too little glucose gets into your cells and too much stays in your blood, resulting in gestational diabetes.

Complications in diabetes

Long-term complications of diabetes develop gradually. The longer you have diabetes — and the less controlled your blood sugar — the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening. Possible complications include:

CARDIOVASCULAR DISEASE.
Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you have diabetes, you are more likely to have heart disease or stroke.

NERVE DAMAGE (NEUROPATHY).
Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in your legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward.

KIDNEY DAMAGE (NEPHROPATHY).
The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.

EYE DAMAGE (RETINOPATHY). 
Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.

FOOT DAMAGE.
Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infections, which often heal poorly. These infections may ultimately require toe, foot or leg amputation.

SKIN CONDITIONS.
Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.

HEARING IMPAIRMENT.
Hearing problems are more common in people with diabetes.

COMPLICATIONS OF GESTATIONAL DIABETES
Most women who have gestational diabetes deliver healthy babies. However, untreated or uncontrolled blood sugar levels can cause problems for you and your baby.
Complications in your baby can occur as a result of gestational diabetes, including:

Excess growth: Extra glucose can cross the placenta, which triggers your baby's pancreas to make extra insulin. This can cause your baby to grow too large (macrosomia). Very large babies are more likely to require a C-section birth.
Low blood sugar: Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth because their own insulin production is high. Prompt feedings and sometimes an intravenous glucose solution can return the baby's blood sugar level to normal.

Type 2 diabetes later in life.Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.
Death. Untreated gestational diabetes can result in a baby's death either before or shortly after birth.

Diabetes and dental care

DIABETES AND DENTAL CARE: GUIDE TO A HEALTHY MOUTH
What do brushing and flossing have to do with diabetes? Plenty. If you have diabetes, here's why dental care matters — and how to take care of your teeth and gums

CAVITIES AND GUM DISEASE
Whether you have type 1 diabetes or type 2 diabetes, managing your blood sugar level is key. The higher your blood sugar level, the higher your risk of:

Tooth decay (cavities): Your mouth naturally contains many types of bacteria. When starches and sugars in food and beverages interact with these bacteria, a sticky film known as plaque forms on your teeth. The acids in plaque attack the surfaces of your teeth (enamel and dentin). This can lead to cavities. The higher your blood sugar level, the greater the supply of sugars and starches — and the more acid wearing away at your teeth.

Early gum disease (gingivitis): Diabetes reduces your ability to fight bacteria. If you don't remove plaque with regular brushing and flossing, it'll harden under your gumline into a substance called tartar (calculus). The longer plaque and tartar remain on your teeth, the more they irritate the gingiva — the part of your gums around the base of your teeth. In time, your gums become swollen and bleed easily. This is gingivitis.

Advanced gum disease (periodontitis): Left untreated, gingivitis can lead to a more serious infection called periodontitis, which destroys the soft tissue and bone that support your teeth. Eventually, periodontitis causes your gums and jawbone to pull away from your teeth, which in turn causes your teeth to loosen and possibly fall out.