Types Of Diabetes

There are two kinds of diabetes that can happen at any age. In type 1 diabetes, the body makes little
or no insulin. This type of diabetes develops most often in children and young adults.
In type 2 diabetes, the body makes insulin, but doesn't use it the right way. It is the most common
kind of diabetes. You may have heard it called adult-onset diabetes. Your chance of getting type 2
diabetes is higher if you are overweight, inactive, or have a family history of diabetes.
Diabetes can affect many parts of your body. It's important to keep type 2 diabetes under control.
Over time it can cause problems like heart disease, stroke, kidney disease, blindness, nerve damage,
and circulation problems that may lead to amputation. People with type 2 diabetes have a greater risk
for Alzheimer's disease.

Pre-diabetes
Many people have "pre-diabetes." This means their glucose levels are higher than normal but not high
enough to be called diabetes. Pre-diabetes is a serious problem because people with pre-diabetes are
at high risk for developing type 2 diabetes. If your doctor says you have pre-diabetes, you may feel
upset and worried. But, there are things you can do to prevent or delay actually getting type 2
diabetes. Losing weight may help. Healthy eating andbeing physically active for at least 30 minutes, 5
days a week is a small change that can make a big difference. Work with your doctor to set up a plan
for good nutrition and exercise. Make sure to ask how often you should have your glucose levels
checked.

Symptoms
Some people with type 2 diabetes may not know they have it. But, they may feel tired, hungry, or
thirsty. They may lose weight without trying, urinate often, or have trouble with blurred vision. They
may also get skin infections or heal slowly from cuts and bruises. See your doctor right away if you
have one or more of these symptoms.

Tests For Diabetes

There are several blood tests doctors can use to help diagnosis of diabetes:

Random glucose testgiven at any time during the day

Fasting glucose testtaken after you have gone without food for at least 8 hours

Oral glucose tolerance testtaken after fasting overnight and then again 2 hours after having
a sugary drink

A1C blood testshows your glucose level for the past 23 months

Your doctor may want you to be tested for diabetes twice before making a diagnosis.

Managing Diabetes
Once you've been told you have type 2 diabetes, the doctor may prescribe diabetes medicines to help
control blood glucose levels. There are many kinds of medication available. Your doctor will choose the

best treatment based on the type of diabetes you have, your everyday routine, and other health
problems.
In addition, you can keep control of your diabetes by:

Tracking your glucose levels. Very high glucose levels or very low glucose levels (called
hypoglycemia) can be risky to your health. Talk to your doctor about how to check your glucose
levels at home.

Making healthy food choices. Learn how different foods affect glucose levels. For weight
loss, check out foods that are low in fat and sugar. Let your doctor know if you want help with meal
planning.

Getting exercise. Daily exercise can help improve glucose levels in older people with
diabetes. Ask your doctor to help you plan an exercise program.

Keeping track of how you are doing. Talk to your doctor about how well your diabetes care
plan is working. Make sure you know how often to check your glucose levels.

Your doctor may want you to see other healthcare providers who can help manage some of the extra
problems caused by diabetes. He or she can also give you a schedule for other tests that may be
needed. Talk to your doctor about how to stay healthy.
Here are some things to keep in mind:

Have yearly eye exams. Finding and treating eye problems early may keep your eyes
healthy.

Check your kidneys yearly. Diabetes can affect your kidneys. A urine and blood test will
show if your kidneys are okay.

Get flu shots every year and the pneumonia vaccine. A yearly flu shot will help keep you
healthy. If you're over 65, make sure you have had the pneumonia vaccine. If you were younger
than 65 when you had the pneumonia vaccine, you may need another one. Ask your doctor.

Check your cholesterol. At least once a year, get a blood test to check your cholesteroland
triglyceride levels. High levels may increase your risk for heart problems.

Care for your teeth and gums. Your teeth and gums need to be checked twice a year by a
dentist to avoid serious problems.

Find out your average blood glucose level. At least twice a year, get a blood test called
the A1C test. The result will show your average glucose level for the past 2 to 3 months.

Protect your skin. Keep your skin clean and use skin softeners for dryness. Take care of
minor cuts and bruises to prevent infections.

Look at your feet. Take time to look at your feet every day for any red patches. Ask someone
else to check your feet if you can't. If you have sores, blisters, breaks in the skin, infections, or
build-up of calluses, see a foot doctor, called a podiatrist.

Watch your blood pressure. Get your blood pressure checked often.

The word "arthritis" makes many people think of painful, stiff joints. But, there are
many kinds of arthritis, each with different symptoms and treatments. Most types of
arthritis are chronic. That means they can go on for a long period of time.
Arthritis can attack joints in almost any part of the body. Some types of arthritis cause
changes you can see and feelswelling, warmth, and redness in your joints. In some
kinds of arthritis, the pain and swelling last only a short time, but are very
uncomfortable. Other types of arthritis might be less painful, but still slowly cause
damage to your joints.

Common Kinds of Arthritis

Arthritis is one of the most common diseases in the United States. Older people most
often have osteoarthritis, rheumatoid arthritis, or gout.
Osteoarthritis (OA) is the most common type of arthritis in older people. OA starts
when tissue, called cartilage, that pads bones in a joint begins to wear away. When the
cartilage has worn away, your bones rub against each other. OA most often happens in
your hands, neck, lower back, or the large weight-bearing joints of your body, such as
knees and hips.
OA symptoms range from stiffness and mild pain that comes and goes to pain that
doesn't stop, even when you are resting or sleeping. Sometimes OA causes your joints
to feel stiff after you haven't moved them for a while, like after riding in the car. The
stiffness goes away when you move the joint. Over time, OA can make it hard to move
your joints. It can cause a disability if your back, knees, or hips are affected.
Why do you get OA? Growing older is what most often puts you at risk for OA, possibly
because your joints and the cartilage around them become less able to recover from
stress and damage. Also, OA in the hands may run in families. Or, OA in the knees can

be linked with being overweight. Injuries or overuse may cause OA in joints such as
knees, hips, or hands.
Rheumatoid arthritis (RA) is an autoimmune disease, a type of illness that makes
your body attack itself. RA causes pain, swelling, and stiffness that lasts for hours. RA
can happen in many different joints at the same time. People with RA often feel tired or
run a fever. RA is more common in women than men.
RA can damage almost any joint. It often happens in the same joint on both sides of
your body. RA can also cause problems with your heart, muscles, blood vessels,
nervous system, and eyes.
Gout is one of the most painful kinds of arthritis. It most often happens in the big toe,
but other joints can also be affected. Swelling may cause the skin to pull tightly around
the joint and make the area red or purple and very tender.
Eating foods rich in purines like liver, dried beans, peas, anchovies, or gravy can lead to
a gout attack in people with the disease. Using alcohol, being overweight, and taking
certainmedications may make gout worse. In older people, some blood
pressure medicines can also increase the chance of a gout attack. To decide if you have
gout, your doctor might do blood tests and x-rays.

Warning Signs
You might have some type of arthritis if you have:

Ongoing joint pain

Joint swelling

Joint stiffness

Tenderness or pain when touching a joint

Problems using or moving a joint normally

Warmth and redness in a joint

If any one of these symptoms lasts more than 2 weeks, see your regular doctor or one
who specializes in treating arthritis, called a rheumatologist. If you have a fever, feel
physically ill, suddenly have a swollen joint, or have problems using your joint, see your
doctor right away.

Treating Arthritis
Getting enough rest, doing the right exercise, eating a healthy, well-balanced diet, and
learning the right way to use and protect your joints are keys to living with any kind of
arthritis. The right shoes and a cane can help with pain in the feet, knees, and hips

when walking. But make sure the cane is fitted by a professional. Dont borrow one
from a friend or neighbor. There are also gadgets to help you open jars and bottles or
to turn the doorknobs in your house.
Some medicines can help with pain and swelling. Acetaminophen might ease arthritis
pain. Some people find NSAIDs (nonsteroidal anti-inflammatory drugs), like ibuprofen,
naproxen, and ketoprofen, helpful. Some NSAIDs are sold without a prescription, while
others must be prescribed by a doctor. Be very careful about possible side effects of
some NSAIDs, whether sold with or without a prescription. Read the warnings on the
package or insert that comes with the drug. Talk to your doctor about if and how you
should use acetaminophen or NSAIDs for your arthritis pain. The U.S. Food and Drug
Administration has more information about drugs such as those mentioned here.
Osteoarthritis (OA). Medicines can help you control the pain. Rest and exercise may
make it easier to move your joints. Keeping your weight down is a good idea. If pain
from OA is very bad, there are shots your doctor can give you.
Rheumatoid arthritis (RA). Treatment can help the pain and swelling. This might
slow down or stop joint damage. You may feel better and find it easier to move around.
Your doctor might also suggest anti-rheumatic drugs called DMARDs (diseasemodifying antirheumaticdrugs). These can slow damage from the disease. Other
medicines known as corticosteroids (like prednisone) can ease swelling. These are
strong medicine and should only be taken with a doctors prescription. Another kind of
drug, called a biologic response modifier, blocks the damage done by the immune
system. These may help people with mild-to-moderate RA when other treatments have
not worked.
Gout. The most common treatment for an acute attack of gout is NSAIDs or
corticosteroids. They can bring down the swelling, so you may start to feel better within
a few hours after treatment. The pain usually goes away within a few days. If you have
had an attack of gout, talk to your doctor to learn why you had the attack and how to
prevent future attacks. If you have had several attacks, your doctor might prescribe
medicines to prevent future ones.

Exercise Can Help

Along with taking the right medicine and properly resting your joints, exercise might
help with arthritis symptoms. Daily exercise, such as walking or swimming, helps keep
joints moving, lessens pain, and makes muscles around the joints stronger.
Three types of exercise are best if you have arthritis:

Range-of-motion exercises, like dancing, might relieve stiffness, keep you

flexible, and help you keep moving your joints.

Strengthening exercises, such as weight training, will keep or add to muscle

strength. Strong muscles support and protect your joints.

Aerobic or endurance exercises, like bicycle riding, make your heart and arteries
healthier, help prevent weight gain, and also may lessen swelling in some joints.

What Is a Stroke?
A stroke happens when something changes how blood flows through the brain. Blood brings oxygen
and nutrients to brain cells. If blood cant flow to a part of the brain, cells that do not receive enough
oxygen suffer and eventually die. If brain cells are without oxygen for only a short time, they can
sometimes get better. But brain cells that have died cant be brought back to life. So, someone who
has had a stroke may have trouble speaking, thinking, or walking.
There are two major types of strokes. The most common kind (ischemic) is caused by a blood clot or
the narrowing of a blood vessel (an artery) leading to the brain. This keeps blood from flowing into
other parts of the brain and keeps needed oxygen and nutrients from reaching brain cells. In the
second major kind of stroke (hemorrhagic), a broken blood vessel causes bleeding in the brain. This
break in the vessel also stops oxygen and nutrients from reaching brain cells.

What Will the Doctor Do?

The doctor will diagnose a stroke based on symptoms, medical history, and medical tests, like a CT
scan. A CT scan is a test that lets doctors look closely at pictures of the brain.
All strokes benefit from immediate medical treatment! But, only people with ischemic stroke, the kind
caused by a clot, can be helped by a drug called t-PA (tissue-plasminogen activator). This drug breaks
up blood clots and can greatly lessen the damage caused by an ischemic stroke. Starting treatment
with t-PA within 3 hours after an ischemic stroke is important to recovery. Getting to a hospital right
away allows time for a CT scan of the brain. This scan will show whether the clot-busting medicine
is the right treatment choice.

What Happens After a Stroke?

A stroke can cause a variety of health problems. Someone who has had a stroke might be paralyzed or
have weakness, usually on one side of the body. He or she might have trouble speaking or using

words. There could be swallowing or memory problems. Someone who has had a stroke might
feel depressed or find it hard to control emotions. There might be pain or numbness.
There are many different ways to help people get better after a stroke. Many treatments start in the
hospital and continue at home. Drugs and physical therapy can help improvebalance, coordination,
and some problems such as trouble speaking and using words. Occupational therapy can make it
easier to do things like taking a bath or cooking.
A family doctor will provide follow-up care. Some people make a full recovery soon after a stroke.
Others take months or even years. But, sometimes the damage is so serious that therapy cannot
really help.

Lower Your Risk of Stroke

Talk to your doctor about what you can do to lower your risk of stroke. Even if youre in perfect health,
follow these suggestions:

Control your blood pressure. Have your blood pressure checked often. If it is high, follow
your doctors advice to lower it. Treating high blood pressure lowers the risk of both stroke and
heart disease.

Stop smoking. Smoking increases your risk for stroke. Its never too late to quit.

Control your cholesterol. If you have high cholesterol, work with your doctor to lower it.
Cholesterol, a type of fat in the blood, can build up on the walls of your arteries. In time, this can
block blood flow and lead to a stroke.

Control your diabetes. Untreated diabetes can damage blood vessels and also leads to
narrowed arteries and stroke. Follow your doctors suggestions for keeping diabetes under control.

Eat healthy foods. Eat foods that are low in cholesterol and saturated fats. Include a variety
of fruits and vegetables every day.

Exercise regularly. Try to make physical activity a part of your everyday life. Do things you
like; for example, take a brisk walk, ride a bicycle, or go swimming. Talk with your healthcare
provider if you havent been exercising and you want to start a vigorous program or increase your
physical activity. For more information on exercise and physical

Kidney Disease
Kidney disease can sometimes develop very quickly, and when this happens, it is called
acute kidney injury. Depending on the cause and severity of the problem, this form of
kidney disease can sometimes get better. The more common form of kidney disease
happens slowly, over a long period of time. This is called chronic kidney disease. You
might hear it called CKD. Chronic kidney disease is a lifetime illness; it will not go away.

Chronic kidney disease is a widespread problem, especially in older people. In an early

stage of the disease, the kidneys dont do a good job of removing extra water and
waste out of the blood.
Over time, the problem gets worse, and the kidneys may completely stop working. This
is called end-stage renal disease or ESRD. Renal is another word for kidney. When
kidney disease gets very bad, it can cause other problems like heart disease, bone
disease, arthritis, and nerve damage.

Medicine And Your Kidneys

Older people often take lots of medicines. Kidneys help to filter out parts of the
medicines that the body does not use. Kidney disease makes it hard for the kidneys to
do this job. If you have kidney disease, your doctor may need to change the dose of
some of your medicines. Sometimes this can make the kidney problem get better. Your
doctor may also tell you not to take some over-the-counter medicines, like those for
arthritis.

Who Is At Risk?
Diabetes and high blood pressure are two major causes of kidney disease. People who have heart
disease also have an increased risk for kidney disease.
Family history may also play a role in your risk for kidney disease. This means that if someone in your
family, like your mother, father, sister, or brother, has kidney disease, you are more likely to have it
too.
In addition, people of certain races and ethnicities, such as African Americans, Hispanics, and Native
Americans, seem to have a greater chance of developing kidney disease.
Age is another factor. As you get older, your kidneys may not work as well as when you were younger.
Ask your doctor to help you keep track of how well your kidneys are working.

Tests For Kidney Disease

Kidney disease often does not have any symptoms. In fact, you might feel fine right up to the point
when your kidneys nearly stop working. Only your doctor can tell if you have kidney disease.
There are two kinds of tests your doctor can do to see if you have kidney disease: a blood test and a
urine test.

The blood test, called GFR, measures how much blood your kidneys filter each minute. Your doctor
uses this information to see how well your kidneys are working. A GFR of over 60 means your kidneys
are working fine. A GFR of 60 or lower may mean you have kidney disease. You cannot raise your
GFR, but there are things you can do to keep it from getting lower (see the section Prevent Your
Kidneys From Getting Worse).
The urine test shows if you have a kind of protein, called albumin, in your urine. Protein in your urine
can be a sign of kidney damage. It is more common in people who have diabetes. Your doctor may
need to do additional tests to confirm whether or not you have kidney disease.
Because most people who have kidney disease also have diabetes, high blood pressure, or both, your
doctor might also check to see if you have these problems.
The earlier kidney disease is found, the sooner you can start a treatment to keep your kidneys
healthier longer.

Prevent Your Kidneys From Getting Worse

There is no cure for kidney disease. There are things you can do to help keep your kidneys from
getting worse.
If your kidney disease is in an early stage, meaning your kidneys are still working, your doctor may
prescribe blood pressure medicine and a diuretic (water pill) to lower your blood pressure and protect
kidney function. You may also have to make some lifestyle changes, like eating a special low-salt diet
and exercising regularly to keep a healthy weight.

reatment For End-Stage Renal Disease

If your kidneys have stopped working, meaning you are in end-stage renal disease, there are
treatments that can replace your kidney function. Two main options are dialysis and a transplant.
Dialysis is a special process that removes waste and water from your blood. Dialysis is done at a
special center about three times a week or at home while you sleep. Your doctor will decide which is
right for you.
A transplant is when you get a healthy kidney from a donor. Because people have two kidneys, a living
person, usually a family member, can give you one of his or her kidneys.
Talk with your doctor about whether dialysis or a transplant might work for you.