Diabetic Type 2 Communication Forum,Forum komunikasi Dibetes tipe 2 :Diabetic Type 2 And Related Info

Forum Komunikasi Diabetes Tipe 2

Diabetic type 2 Communication Forum

Editor

Dr Iwan Suwandy.MHA

Siapa Saja yang berhubungan dengan Diabetes Tipe 2 dapat memanfaatkan forum komunikasi ini secara gratis untuk saling memberikan informasi, baik para profesional medis maupun para pasien

This Forum Special for Medical Professional and Dibetic Patiens and relarted disease communication to exchznge information freely

Editor

Dr Iwan Suwandy,MHA

Komunikasi Dan Konsultasi gratis  klik

https://driwancybermuseum.wordpress.com/2012/11/05/diabetic-type-communication-forumforum-komunikasi-dibetes-tipe-2-diabetic-type-2-and-related-info/

komunikasi liwat comment

The Study report Of Diabetic Type 2

Created by

Dr Iwan suwandy,MHA

copyright@2012

This Study dedicated To

my wife, sons and my brother ,lso for all Diavetic Type 2 community in all over the world,specially( khususnya) Indonesia.

Introductions

Indonesian version

Seseorang dengan diabetes tipe 2 dapat menggunakan latihan untuk membantu mengendalikan kadar gula darah mereka dan memberikan energi otot mereka perlu untuk berfungsi sepanjang hari.

Dengan mempertahankan diet sehat dan olahraga yang cukup, seseorang dengan diabetes tipe 2 NON Insulin dependend diabetes melittus (NIDDM) mungkin dapat menjaga gula darah mereka dalam rentang non-diabetes normal tanpa pengobatan.

Original info

A person with type 2 diabetes can use exercise to help control their blood sugar levels and provide energy their muscles need to function throughout the day.

By maintaining a healthy diet and sufficient exercise, a person with type 2 diabetes NON Insulin Dependend diabetes melittus(NIDDM) may be able to keep their blood sugar in the normal non-diabetic range without medication.

STUDI KEPUSTAKAAN

Diabetes tipe 2

Definisi

Diabetes tipe 2 adalah penyakit (kronis) seumur hidup di mana ada gula tingkat tinggi (glukosa) dalam darah.

Diabetes tipe 2 adalah bentuk paling umum diabetes.

Alternatif Nama Noninsulin-dependent diabetes; Diabetes – tipe 2;

Diabetes onset(Timbul)

saat dewasa Penyebab, kejadian, dan faktor risiko Diabetes disebabkan oleh masalah dalam cara tubuh Anda membuat atau menggunakan insulin. Insulin dibutuhkan untuk memindahkan gula darah (glukosa) ke dalam sel, di mana disimpan dan kemudian digunakan untuk energi.

Pathogenesis

Pada diabetes tipe 2, lemak, hati, dan sel-sel otot tidak merespon dengan benar terhadap insulin. Hal ini disebut resistensi insulin.

Akibatnya, gula darah tidak masuk ke sel-sel ini untuk disimpan untuk energi. Bila gula tidak dapat memasuki sel, gula tingkat tinggi membangun dalam darah. Hal ini disebut hiperglikemia.

Diabetes tipe 2 biasanya terjadi perlahan-lahan dari waktu ke waktu. Kebanyakan orang dengan penyakit kelebihan berat badan ketika mereka didiagnosis. Peningkatan lemak membuat lebih sulit bagi tubuh Anda untuk menggunakan insulin cara yang benar.

Diabetes tipe 2 juga dapat mengembangkan pada orang yang tipis. Ini lebih umum pada orang tua.

Riwayat keluarga dan gen memainkan peran besar pada diabetes tipe 2.

Kegiatan tingkat rendah, pola makan yang buruk, dan berat badan berlebih di sekitar pinggang meningkatkan risiko Anda.

Lihat juga: diabetes tipe 2 untuk daftar faktor risiko. Gejala Sering kali, orang dengan diabetes tipe 2 tidak menunjukkan gejala pada awalnya.

Mereka mungkin tidak memiliki gejala selama bertahun-tahun. Gejala-gejala awal diabetes meliputi:

• Kandung kemih, ginjal, kulit, atau infeksi lain yang lebih sering atau menyembuhkan perlahan • Kelelahan • Kelaparan • Meningkatnya rasa haus • Peningkatan buang air kecil Gejala pertama mungkin juga: • kabur visi • Disfungsi ereksi • Nyeri atau mati rasa pada kaki atau tangan

Tanda dan tes Dokter mungkin menduga bahwa Anda memiliki diabetes jika kadar gula darah Anda lebih tinggi dari 200 mg / dL.

Untuk memastikan diagnosa, satu atau lebih dari tes berikut harus dilakukan. Tes darah Diabetes : • kadar glukosa darah puasa –

diabetes didiagnosis jika lebih tinggi dari 126 mg / dL dua kali • Uji Hemoglobin A1c o Normal: Kurang dari 5,7% o Pra-diabetes: 5,7% – 6,4% o Diabetes: 6,5% atau lebih tinggi Sedamg 6,5-9 Bukurk lebih dari 9

Fakta Uji Hemoglobin A1c

The A1c AccuBase Kit Test adalah tes yang sangat akurat (kurang dari 1,0% CV) mampu mendeteksi varian hemoglobin abnormal dan / atau diam seperti S hemoglobin, dan C dan F dan lebih dari 850 lainnya.

Setiap sampel disaring lebih dulu karena keberadaan hemoglobin abnormal dan / atau kinetika eritrosit terganggu (usia normal atau volume sel darah merah) Contoh, anemia (yang palsu dapat menurunkan nilai A1C). Individu dengan diabetes yang berlangsung lama dapat hadir dengan kondisi yang disebut kekurangan eritropoietin (EPO) .

Kekurangan EPO dan / atau anemia dianggap kondisi serius yang memerlukan intervensi medis yang tepat. DEK dapat mempengaruhi jawaban A1c dan setiap sampel harus diskrining untuk kehadiran DEK.

Perkiraan melaporkan bahwa lebih dari 650.000 orang Amerika Hitam dengan diabetes yang tahu untuk memiliki Trait Sickle Cell (Hb “S, C atau F”) “Jangan tertipu oleh klaim akurasi ketika metode A1c dan / atau perangkat monitoring pakai memiliki CV ( koefisien variasi) lebih besar dari 2,0% atau tidak dapat mendeteksi hemoglobin abnormal “.

“Sebuah metode A1c dan / atau perangkat monitoring dengan CV sebesar 7,0% bisa berarti bahwa jika tingkat A1C Anda yang sebenarnya adalah 6,5% itu bisa dilaporkan di mana saja dari 5,0% menjadi 8,0% memberikan informasi palsu terapi dan / atau menyesatkan,” belum lagi dampak dari hemoglobin abnormal pada nilai A1c bahwa metode tertentu atau perangkat tidak mampu mendeteksi. Setiap sampel A1c AccuBase dianalisis dengan prosedur HPLC-IE dengan hasil Kromatogram dicetak seperti yang ditunjukkan di bawah ini. Staf laboratorium tersedia untuk membahas kromatogram individu dengan dokter Anda dan / atau tenaga medis.

The A1c AccuBase Test Kit adalah non-puasa, tongkat jari, mail-in test, dianggap tes A1C yang paling akurat dan tepat yang tersedia.

Tes ini dianggap sensitif dan cukup spesifik untuk mendeteksi diabetes (kurang dari 2,0% CV). CV berada di bawah 1,0%. CV menunjukkan tingkat akurasi diulang dibandingkan dengan nilai laboratorium diketahui A1c. CV rendah adalah tes yang lebih akurat A1c.

The A1c AccuBase Metode pengujian Kit adalah NGSP bersertifikat (nilai direferensikan ke DCCT). The A1c AccuBase Kit Uji tidak memerlukan waktu pengeringan, sampel dapat dikumpulkan dan dikirimkan dalam beberapa menit. Kit ini dilengkapi dengan pasien botol ID positif dan tabung kapiler plastik / perangkat. Metode analisis gangguan gratis. Sampel yang stabil selama 30 hari un-didinginkan.

Setiap hasil tes dilengkapi dengan perhitungan Glukosa Darah mean berdasarkan Persamaan MBG DCCT:% A1c X 31,7-66,1 = MBG di mg / dl. Hasil tes biasanya tersedia dalam 5 sampai 7 hari mailing bentuk.

Penanganan khusus dapat diatur untuk menyediakan, hari berikutnya, hasil sehari dua hari atau tiga. Ideal untuk diabetes rahasia (rata-rata glukosa darah) skrining, program penjangkauan dan jalur klinis .

Grafik pertama menunjukkan kromatogram normal dengan tidak hadir hemoglobin varian dan tingkat A1C yang normal.

The Kromatogram pada grafik kedua menunjukkan tingkat yang sangat tinggi dari F hemoglobin (25,6%). Tingkat peningkatan Hb F menghasilkan nilai A1c sub-normal 3,2%. Normal berkisar dari uji A1C (4,2% – 6,0%). Kecuali Anda telah disaring untuk varian hemoglobin Anda tidak akan tahu Anda membawa varian persisten turun-temurun, atau menyadari dampaknya terkait pada tingkat A1C Anda.

Peningkatan kadar Hemoglobin F dapat mewakili peningkatan risiko SIDS pada bayi, dan dapat mewakili sebagai asosiasi dalam berbagai jenis leukemia dan / atau tumor padat.

Ibu yang merokok atau telah terkena pencemaran lingkungan selama kehamilan mungkin memiliki tingkat yang jauh lebih tinggi dari Hb F pada bayi yang dapat meningkatkan risiko SIDS pada bayi baru lahir. AccuBase A1c Kit Uji Diselesaikan untuk digunakan OTC oleh FDA (tidak ada resep yang diperlukan di sebagian besar negara). Pasien dapat menerima salinan hasil tes.

Pelaporan elektronik kepada organisasi managed care kesehatan / penyedia tersedia. The AccuBase A1cTest Kit menggunakan “standar emas” HPLC-IE atau BA metodologi untuk mengumpulkan dan menganalisis sampel A1c di lokasi situs alternatif seperti rumah, kantor dokter dan / atau klinik • tes toleransi glukosa oral – diabetes didiagnosis jika kadar glukosa lebih tinggi dari 200 mg / dL setelah 2 jam Skrining diabetes dianjurkan untuk: • Kegemukan anak yang memiliki faktor risiko lain untuk diabetes, dimulai pada usia 10 dan diulang setiap 2 tahun • Kegemukan dewasa (BMI lebih besar dari 25) yang memiliki faktor risiko lain • Dewasa di atas usia 45 setiap 3 tahun Anda harus melihat dokter anda setiap 3 bulan. Pada kunjungan ini, Anda dapat mengharapkan dokter untuk: • Periksa tekanan darah Anda • Periksa kulit dan tulang pada kaki dan kaki • Periksa apakah kaki menjadi mati rasa • Periksa bagian belakang mata dengan alat khusus yang disebut terang ophthalmoscope Tes berikut akan membantu Anda dan dokter Anda memantau diabetes Anda dan mencegah masalah: • Apakah tekanan darah Anda diperiksa setidaknya setiap tahun (darah tujuan tekanan harus 130/80 mm / Hg atau lebih rendah). • Memiliki hemoglobin A1c Anda uji (HbA1c) setiap 6 bulan jika diabetes Anda terkontrol dengan baik, jika tidak setiap 3 bulan. • Apakah kolesterol dan trigliserida diperiksa tahunan (mencapai tingkat LDL di bawah 70-100 mg / dL). • Dapatkan tes tahunan untuk memastikan ginjal Anda bekerja dengan baik (mikroalbuminuria dan serum kreatinin). • Kunjungi dokter mata Anda setidaknya sekali setahun, atau lebih sering jika Anda memiliki tanda-tanda penyakit mata diabetes. • Lihat dokter gigi setiap 6 bulan untuk membersihkan gigi menyeluruh dan ujian. Pastikan dokter gigi dan ahli kesehatan tahu bahwa Anda memiliki diabetes.

Pengobatan

Tujuan pengobatan

pada awalnya adalah untuk menurunkan kadar glukosa darah tinggi.

Jangka panjang Tujuan pengobatan adalah untuk mencegah masalah dari diabetes.

Pengobatan utama untuk diabetes tipe 2 adalah olahraga dan diet. tes baru adalah Aggregasi Thrombosit(hemostasis tes untuk menentukan apakah anda hiper atau normal aggresasi): ADP 1 normal 0-15, ADP 2 normal 11-35, ADP 5 normal 25- 68 dan ADP 10 normal 49-84 (tes ini agak mahal sekitar Rp 300.000) Platelet Function Testing: Light Transmission Aggregometry [LTA] ________________________________________

english version

Introduction

Platelet function testing is difficult, time consuming and prone to a wide-variety of problems due to pre-analytical variables.

Before undertaking any tests of platelet function – consider: Variable Interpretation Clinical History & examination. Some syndromes [e.g. Hermansky Pudlak syndrome, Cheddiak Higashi syndrome, Wiskott-Aldrich syndrome, Velocardiofacial Syndrome (VCFS), Noonan syndrome, MYH9-related disorders] are associated with abnormal platelet function and you may get some idea of the diagnosis from the clinical history and examination. Drug History There are a large number of drugs and especially food substances that can interfere with platelet function. Full Blood Count (FBC) and Blood Film 1. Consider pseudothrombocytopenia often due to cold reacting platelet agglutinins or to platelet satellitism.

Approximately 0.1% of the healthy population show EDTA-induced pseudothrombocytopenia and it is important to exclude this before undertaking more extensive tests of platelet function. Similar findings have also been reported with the use of both citrate and heparin as anticoagulants.

A blood film may identify platelet clumps and provide a clue to the diagnosis. 2. Mean Platelet Volume [MPV – reference range 7-10fL]: the MPV is an often ignored parameter of the FBC but can provide important insights into the causes of a low platelet count. – It can also in some cases give a clue to the diagnosis e.g. the hereditary macrothrombocytopenias, Bernard Soulier Syndrome [BSS] – In individuals with an elevated MPV, an immunological-based platelet count may provide a more accurate and often significantly higher platelet count. –

The MPV can be an indication of platelet turnover – an increased MPV indicating accelerated platelet clearance as in ITP or gestational thrombocytopenia. –

The MPV may be reduced in cases of Wiskott-Aldrich Syndrome and in some cases of bone marrow failure. 3. An examination of the blood film and platelet morphology can be useful in both establishing a diagnosis of pseudothrombocytopenia but also in establishing a primary platelet problem e.g. Gray Platelet Syndrome.

In some cases of thrombocytopenia e.g. May Hegglin anomaly – the blood film may show the presence of Döhle bodies [light blue-gray, oval, basophilic, leukocyte inclusions located in the peripheral cytoplasm of neutrophils.] Pengujian Fungsi Trombosit : Cahaya Transmisi Aggregometry [LTA] ________________________________________

Pengantar

Pengujian fungsi platelet(thrombosit) sulit, memakan waktu dan rentan terhadap berbagai-masalah akibat pra-analitis variabel.

Sebelum melakukan apapun tes fungsi platelet – dipertimbangkan: Variabel Interpretasi Klinis Sejarah & pemeriksaan. Beberapa sindrom [misalnya Hermansky Pudlak sindrom, Cheddiak Higashi sindrom, Wiskott-Aldrich syndrome, Syndrome Velocardiofacial (VCFs), sindrom Noonan, MYH9 yang berhubungan dengan gangguan] yang berhubungan dengan fungsi trombosit yang abnormal dan Anda mungkin mendapatkan beberapa ide diagnosis dari sejarah klinis dan pemeriksaan.

Sejarah Obat Ada sejumlah besar obat dan terutama zat makanan yang dapat mengganggu fungsi trombosit. Darah penuh Count (FBC) dan Film Darah 1. Pertimbangkan pseudothrombocytopenia sering karena dingin agglutinins platelet bereaksi atau satellitism trombosit.

Sekitar 0,1% dari populasi menunjukkan pseudothrombocytopenia sehat EDTA-diinduksi dan penting untuk mengecualikan ini sebelum melakukan tes lebih luas dari fungsi platelet.

Temuan serupa juga telah dilaporkan dengan penggunaan kedua sitrat dan heparin sebagai antikoagulan. Sebuah film darah dapat mengidentifikasi gumpalan trombosit dan memberikan petunjuk untuk diagnosis. 2.

Volume rata-rata trombosit [MPV – referensi kisaran 7-10fL]: MPV adalah parameter sering diabaikan dari FBC tetapi dapat memberikan wawasan ke dalam penyebab dari jumlah platelet yang rendah. –

Hal ini dapat juga dalam beberapa kasus memberikan petunjuk untuk diagnosis misalnya yang turun-temurun macrothrombocytopenias, Bernard Soulier Syndrome [BSS] –

Pada individu dengan MPV ditinggikan, hitungan imunologi berbasis trombosit dapat memberikan jumlah trombosit lebih akurat dan sering lebih tinggi secara signifikan. –

The MPV bisa menjadi indikasi omset platelet – sebuah MPV meningkat menunjukkan izin trombosit dipercepat seperti di ITP atau trombositopenia kehamilan. –

The MPV dapat dikurangi dalam kasus Wiskott-Aldrich Syndrome dan dalam beberapa kasus kegagalan sumsum tulang.

3. Pemeriksaan film darah dan morfologi trombosit dapat berguna di kedua membangun diagnosis pseudothrombocytopenia tetapi juga dalam membangun misalnya masalah utama platelet Gray trombosit Syndrome. Dalam beberapa kasus trombositopenia misalnya Mei Hegglin anomali – film darah dapat menunjukkan adanya badan DOHLE [. Cahaya biru-abu-abu, oval, basofilik, inklusi leukosit terletak di sitoplasma perifer neutrofil]

english version

Principles of Light Transmission [Born] Aggregometry

Platelet aggregation testing measures the ability of various agonists to platelets to induce in vitro activation and platelet-to-platelet activation.

Classically Born aggregometry uses platelet rich plasma [PRP] but whole blood aggregometry can be also used. In the Born aggregometer, PRP is stirred in a cuvette at 37°C and the cuvette sits between a light course and a photocell.

When an agonist is added the platelets aggregate and absorb less light and so the transmission increases and this is detected by the photocell.

You can also see the principles of Born aggregometry as an animation on this site [http://www.platelet-research.org/3/aggregometry.htm] Light

Transmission Aggregometry:

Variable Variable Explanation Pre-Analytical Variables Drugs which can interfere with platelet function include aspirin and anti-inflammatory drugs, specific anti-platelet drugs including clopidogrel and imidazole. However, there are numerous other drugs whose primary role is not to inhibit platelet function but nevertheless can do so e.g. antibiotics, anti-depressants, beta-blockers etc – Click HERE for a list of drugs etc that may affect platelet function tests. Food stuffs – A high fat diet can lead to the presence of chylomicra in the plasma and interfere with light transmission in aggregation testing. –

Others include garlic, turmeric and caffeine. Platelet count: In individuals with very high or low platelet counts, it may be necessary to adjust the platelet count to achieve a count in the region of 200-400 x 109/L.

For very high counts the count can be adjusted with PPP. Platelet counts below 200 x 109/L can give rise to diminished aggregation responses. Although it seems logical to undertake additional centrifugation in such cases to increase the platelet count, in practice this can lead to activation of platelets and is not recommended.

Temperature: Blood samples for platelet aggregation testing should be stored at room temperature. pH: Platelet aggregation should be carried out at physiological pH.

Fibrinogen Concentration:

Platelets will only aggregate (although they may agglutinate) if fibrinogen is present and so it is important to check fibrinogen levels before undertaking platelet aggregation testing.

Anticoagulant: Current guidelines suggest that samples for platelet aggregation testing should be collected into citrate.

However, more recent data suggests that heparin , but not citrate, preserves platelet responses for up to 24 h as determined by a range of techniques Preparation of Platelet Rich Plasma [PRP] Platelets are very sensitive and can be readily activated during the preparation of PRP. Anticoagulant:

Venous blood with minimal venous occlusion, is collected into 3.2%/0.109M citrate in a ratio of 1:9 [1 part anticoagulant to 9 parts blood.] Whole blood samples should be processed within 4 hours of collection.

Blood samples for platelet aggregation testing should be stored at room temperature – cooling platelets can lead to activation. Transport samples to the laboratory at room temperature. PRP is prepared by centrifugation at 20°C for 10-15 minutes at 150-200g.

The PRP is carefully removed and placed into a stoppered plastic tube. PRP should be stored at room temperature. PPP can be prepared by further centrifugation of the remaining plasma at 2700g for 15 minutes. Agonists Addition of a platelet agonist to the PRP leads to platelet activation, a change in their shape from discoid to spiny spheres which is associated with a transient increase in optical density.

The only exceptions to this are epinephrine in which there is no shape change and ristocetin which causes platelet agglutination rather than aggregation i.e. there is no binding of fibrinogen.

There are two types of agonists: Strong Agonists e.g. Collagen, thrombin, TxA2: These directly induce platelet aggregation, TxA2 synthesis and platelet granule secretion. Weak Agonists e.g. ADP & epinephrine:

These induce platelet aggregation without inducing secretion. Platelet secretion can sometimes follow aggregation induced by a weak agonist, when the synthesis of endogenous TxA2 is triggered by the close platelet-to-platelet contact that occurs during platelet aggregation.

Strong agonists, when used at low concentrations, may act like weak agonists, but weak agonists even at high concentrations will not act as strong agonists. With some weak agonists [ADP and adrenaline] at critical concentrations, the platelet aggregation curve has a biphasic appearance: an initial wave of aggregation (primary wave), followed by a secondary wave of aggregation, which is usually irreversible [see illustration below.]

Secondary wave aggregation may not occur and the primary wave may disaggregate. At higher agonist concentrations (except with epinephrine) the two waves of aggregation combine and only a single wave is seen and the biphasic waveform is absent.

The aggregation response to an agonist is amplified by the production of TxA2 from membrane phospholipids and by the secretion of ADP from the dense granules. ADP and TxA2 are agonists, which, by interacting with their specific receptors, amplify the aggregation response of the platelet.

Transmisi cahaya Aggregometry: Variable Variabel Penjelasan Pra-Analytical

Variabel Obat yang dapat mengganggu fungsi trombosit meliputi obat aspirin dan anti-inflamasi, spesifik obat anti-platelet termasuk clopidogrel dan imidazol.

Namun, ada banyak obat lain peran utamanya adalah bukan untuk menghambat fungsi trombosit namun demikian dapat melakukannya misalnya antibiotik, anti-depressants, beta-blocker

obat yang dapat mempengaruhi tes fungsi platelet. Bahan makanan –

Diet tinggi lemak dapat menyebabkan kehadiran chylomicra dalam plasma dan mengganggu transmisi cahaya dalam pengujian agregasi. – Lainnya termasuk bawang putih, kunyit dan kafein. Platelet count: (perhitungan Thrombosit)

Pada individu dengan jumlah trombosit yang sangat tinggi atau rendah, mungkin perlu untuk menyesuaikan jumlah trombosit untuk mencapai hitungan di wilayah 200-400 x 109 / L.

Untuk jumlah yang sangat tinggi menghitung dapat disesuaikan dengan PPP. Jumlah trombosit di bawah 200 109 L x / dapat menimbulkan respon agregasi berkurang.

Meskipun tampaknya logis untuk melakukan sentrifugasi tambahan dalam kasus tersebut untuk meningkatkan jumlah trombosit, dalam praktek ini dapat menyebabkan aktivasi trombosit dan tidak dianjurkan. Suhu: Sampel darah untuk pengujian agregasi platelet harus disimpan pada suhu kamar. pH: agregasi trombosit harus dilakukan pada pH fisiologis.

Konsentrasi fibrinogen: Trombosit hanya akan agregat (meskipun mereka mungkin mengaglutinasi) jika fibrinogen hadir dan sehingga sangat penting untuk memeriksa tingkat fibrinogen sebelum melakukan pengujian agregasi platelet. Antikoagulan:

Pedoman saat ini menunjukkan bahwa sampel untuk pengujian agregasi platelet harus dikumpulkan ke sitrat. Namun, data yang lebih baru menunjukkan bahwa heparin, tetapi tidak sitrat, menjaga respon trombosit sampai 24 jam sebagaimana ditentukan oleh berbagai teknik Persiapan Plasma Kaya trombosit [PRP] Trombosit sangat sensitif dan dapat dengan mudah diaktifkan selama persiapan PRP. Antikoagulan:

vena darah dengan oklusi vena minimal, yang dikumpulkan ke 3,2% / sitrat 0.109M dalam rasio 1:9 [1 bagian antikoagulan untuk 9 bagian darah.]

Seluruh sampel darah harus diproses dalam waktu 4 jam dari koleksi. Sampel darah untuk pengujian agregasi platelet harus disimpan pada suhu kamar – trombosit pendinginan dapat menyebabkan aktivasi. Transportasi sampel ke laboratorium pada suhu kamar.

PRP disiapkan oleh sentrifugasi pada 20 ° C selama 10-15 menit pada 150-200g. PRP ini dengan hati-hati dihapus dan ditempatkan dalam tabung plastik tutup. PRP harus disimpan pada suhu kamar. PPP dapat dibuat dengan sentrifugasi lebih lanjut dari plasma yang tersisa pada 2700g selama 15 menit. Agonis

Penambahan suatu agonis trombosit untuk PRP mengarah ke aktivasi trombosit, perubahan dalam bentuk mereka dari diskoid ke bola berduri yang dikaitkan dengan peningkatan transien dalam densitas optik. Satu-satunya pengecualian untuk ini adalah epinephrine yang tidak ada perubahan bentuk dan ristocetin yang menyebabkan aglutinasi platelet daripada agregasi yaitu tidak ada pengikatan fibrinogen.

Ada dua jenis agonis: Kuat Agonis mis Kolagen, trombin, TXA2: Ini secara langsung menginduksi agregasi platelet, TXA2 sintesis dan sekresi granul trombosit. Lemah Agonis mis ADP & epinefrin: Ini menginduksi agregasi platelet tanpa mendorong sekresi.

Sekresi platelet(thrombosit) terkadang dapat mengikuti agregasi disebabkan oleh agonis lemah, ketika sintesis TXA2 endogen dipicu oleh kontak platelet-to-platelet dekat yang terjadi selama agregasi platelet. Agonis yang kuat, bila digunakan pada konsentrasi rendah, dapat bertindak seperti agonis lemah, tetapi agonis lemah bahkan pada konsentrasi tinggi tidak akan bertindak sebagai agonis yang kuat. Dengan beberapa agonis lemah [ADP dan adrenalin] pada konsentrasi kritis, kurva agregasi platelet memiliki penampilan biphasic: [.

Lihat ilustrasi di bawah ini] gelombang awal agregasi (gelombang primer), diikuti oleh gelombang sekunder agregasi, yang biasanya ireversibel agregasi gelombang sekunder tidak mungkin terjadi dan gelombang primer mungkin memisahkan. Pada konsentrasi agonis yang lebih tinggi (kecuali dengan epinefrin) dua gelombang agregasi menggabungkan dan hanya gelombang tunggal terlihat dan gelombang biphasic tidak ada.

Tanggapan agregasi untuk agonis yang diperkuat oleh produksi TXA2 dari fosfolipid membran dan oleh sekresi ADP dari butiran padat. ADP dan TXA2 adalah agonis, yang, dengan berinteraksi dengan reseptor khusus mereka, memperkuat respon agregasi platelet.

english version

Commonly used Agonists in Light Transmission Aggregometry

Commonly used agonists, their working concentration and mode of action are listed below. In practice many laboratories use a number of agonists and various dilutions but vary the actual agonists or agonist concentration depending upon the results of initial tests and the suspected abnormality. Not all laboratories necessarily use the concentrations shown below e.g. some labs may use collagen at 5μg/mL rather than 4μg/mL.

It is useful to consider the role of these various agonists by looking at an image of a platelet and the various receptors that are activated by the agonists discussed below and how these interact with the platelet.

This LINK takes you to an image that you may find useful to consider with the table below and this REFERENCE is to a paper that summarises the traces seen with various agonists.

Umumnya digunakan Agonis di Aggregometry Transmisi Cahaya Agonis umum digunakan, konsentrasi kerja dan cara kerja yang tercantum di bawah ini. Dalam prakteknya banyak laboratorium menggunakan sejumlah agonis dan pengenceran berbagai tapi bervariasi agonis aktual atau konsentrasi agonis tergantung pada hasil tes awal dan kelainan yang dicurigai.

Tidak semua laboratorium tentu menggunakan konsentrasi yang ditunjukkan di bawah misalnya beberapa laboratorium dapat menggunakan kolagen di 5μg/mL daripada 4μg/mL.

Hal ini berguna untuk mempertimbangkan peran tersebut agonis berbagai dengan melihat gambar trombosit dan reseptor berbagai yang diaktifkan oleh agonis dibahas di bawah ini dan bagaimana berinteraksi dengan platelet ini. LINK ini akan membawa Anda ke gambar yang Anda mungkin menemukan berguna untuk mempertimbangkan dengan tabel di bawah ini dan REFERENSI ini adalah sebuah makalah yang merangkum jejak dilihat dengan berbagai agonis.

Agonist Working Concentration Comment ADP Low dose: 1, 2.5, 5μM High dose: 10μM Dosis rendah: 1, 2,5, 5μM Dosis tinggi: 10ìm ADP binds to the ADP receptor on the surface of platelets.

Initial binding results in the release of intracellular calcium and a change in the shape of the platelet leading to the primary wave of aggregation.

The secondary wave reflects the release of ADP from platelet storage granules. Low dose ADP induces only primary aggregation and the effect is reversible. ADP and arachadonic acid are considered mild platelet agonists.

ADP binds to two G-protein coupled receptors: P2Y1 and P2Y12. Binding of ADP to the P2Y1 receptor induces shape change and initiates primary wave platelet aggregation through calcium mobilisation.

The P2Y12 receptor is considered to be the major ADP receptor and responsible for full platelet aggregation through the inhibition of adenyl cyclase. The P2Y12 receptor is also the target for clopidogrel.

With both ADP and Arachadonic acid – this second wave of aggregation is inhibited by aspirin and NSAID’s.

ADP mengikat ke reseptor ADP pada permukaan trombosit. Awal mengikat hasil dalam pelepasan kalsium intraseluler dan perubahan dalam bentuk platelet (thrombosit) menyebabkan gelombang utama agregasi.

Gelombang sekunder mencerminkan pelepasan ADP dari butiran penyimpanan trombosit. ADP dosis rendah hanya menginduksi agregasi primer dan efeknya reversibel. ADP dan asam arachadonic dianggap agonis trombosit ringan. ADP mengikat dua G-protein reseptor coupled: P2Y1 dan P2Y12.

Pengikatan ADP ke reseptor P2Y1 menginduksi perubahan bentuk dan memulai agregasi platelet gelombang primer melalui mobilisasi kalsium.

Reseptor P2Y12 dianggap reseptor ADP utama dan bertanggung jawab atas agregasi platelet penuh melalui penghambatan adenilat adenyl. Reseptor P2Y12 juga merupakan target untuk clopidogrel.

Dengan kedua ADP dan asam arachadonic – ini gelombang kedua agregasi dihambat oleh aspirin dan

NSAID Collagen 1, 4μg/mL Collagen binds to the GpVI and GpIa/IIa receptors inducing granule release, TXA2 generation and then sustained GPIIb-IIIa activation.

The GpIa/IIa receptor is involved in platelet adhesion. The GpVI receptor is involved in platelet signalling and TXA2 generation.

A lag phase is seen with collagen following addition of the agonist to the PRP and usually

3) tidak dibutuhkan oleh mayoritas pasien. APL merupakan faktor risiko yang spesifik untuk kegagalan terapi warfarin, sehingga INR terapetik pasien harus dipertahankan.

“Ada bukti peningkatan risiko APS rekuren, oleh karena itu pemberian warfarin yang tidak perlu atau dalam jangka waktu lama harus dipertimbangkan kembali, terutama setelah tromboemboli vena (VTE) pertama” jelas Ward.

Terapi Low molecular weight-heparin (LMVH) bisa diberikan dan terbukti bermanfaat untuk pasien APS yang gagal dengan warfarin.

Sedangkan antikoagulan oral atau penghambat trombin belum diketahui efikasinya. Pada intinya, manajemen tromboemboli arteri pada APS yang terbaik belum ditemukan.

Namun di awal terapi bisa diberikan kombinasi antikoagulan dan antiplatelet. Untuk mencegah keguguran berulang atau masalah obstetrik lainnya pada wanita dengan APL, bisa diberikan profilaksis heparin plus aspirin secara rutin, namun dasar ilmiahnya juga masih terbatas.

Dipaparkan Lee Lai Heng dari Departemen Hematologi, Singapore General Hospital, LMVH dikombinasikan dengan aspirin cukup efektif seperti halnya UFH plus aspirin dalam mencegah keguguran berulang akibat APS.

Pasien yang tidak tengah menjalani terapi antikoagulan, harus diberi aspirin sebelum konsepsi, dilanjutkan pemberian LMWH atau heparin ketika terjadi kehamilan.

Pasien yang menjalani terapi warfarin dalam waktu lama untuk trombosis yang dialami sebelumnya, harus dipertimbangkan dengan serius sebelum di-switch ke LMWH sebelum konsepsi untuk melihat efek teratogenik warfarin. Jika pasien akan mulai terapi dengan LMWH setelah konsepsi, sebaiknya dilakukan di usia kehamilan 6 minggu.

“Selama terapi harus dilakukan monitoring untuk mendeteksi masalah yang mungkin timbul seperti komplikasi pendarahan akibat trombositopenia terkait penggunaan heparin,” jelas Lee.

Untuk memastikan kelahiran yang aman, terapi antikoagula harus dihentikann 24 jam sebelum kelahiran dengan operasi. Setelah kelahiran, baik warfarin maupun LMWH dikonjugasi dengan stoking kompresi elastis harus dilanjutkan sebagai profilkasis

VTE maternal pada periode post-partum.

Profilaksi Fetal Loss Syndrome dengan kalsium nadroparin

Dijelaskan DR. dr. Djumhana Atmakusuma,

dari Divisi Hematologi dan Trombosis, Departemen Penyakit Dalam FKUI/RSCM, gangguan koagulasi , sebagai konsekuensi penyakit autoimun, menjadi penyebab utama keguguran berulang.

Angkanya mencapai 50-60% jika dibandingkan penyebab lain seperti abnormalitas kromosom (10%), gangguan anatomi (10%), dan masalah hormon (15-20%).

Gangguan koagulasi atau pembekuan darah yang menyebabkan keguguran, amat luas. Bisa disebabkan APS, trombositopenia, trombofilia, defisiensi antitrombin III (AT III), protein C dan Protein S, atau karena hipofibrinolisis, resistensi APC, dan faktor V leiden.

The American College of Chest Physician (APCC) tahun 2001

merekomendasikan terapi LMWH seperti enoxaparin, sebagai profilaksis antikoagulan dalam mencegah risiko keguguran berulang.

Alternatif lain adalah pemberian kalsium nadroparin yang merupakan kelompok antikoagulan parenteral.

Kalsium nadroparin selama ini digunakan untuk mencegah dan menangani VTE. Apakah ia cukup efektif dan aman untuk fetal loss syndrome?

Penelitian pernah dilakukan dengan melihat data pemberian kalsium nadroparin pada perempuan hamil di salah satu rumah sakit di Jakarta, antara tahun 2000-2004. Ada 648 (dari 731) subyek penelitian, yang mendapat terapi dan bisa dievaluasi. 77, 32% subyek memiliki gejala gangguan sirkulasi dan penyakit autoimun.

Dari seluruh subyek, 49% memiliki riwayat aborsi spontan, 6% memiliki riwayat IUFD, 2% memilki riwayat kematian perinatal dan lainnya.

Dari 648 pasien, 239 (73%) tangah hamil saat kunjungan pertama, 126 (20%) hamil setelah beberapa kali kunjungan, dan 283 (45%) dalam kondisi masih hamil.

Hasil tes laboratorium menujukkan pasien-pasien ini mengalami trombositosis (1,8%), hiperagregasi platelet (45,5%), hiperkoagulasi (56%), hiperfibrinogenemia (19,3%), defisiensi protein C (14,7%), defisiensi protein S (36,5%), dan defisiensi AT III (18,6%). Uji antibodi antifosfolipid (APL) menunjukkan ACA IgG moderat pada 2,7% (tes 1), tinggi pada 0,3% (tes 1), ACA IgM moderat pada 5,6% (tes 1), 5,9% (tes 2), dan 4% (tes 3).

Sedangkan ACA IgG tinggi ditemukan pada 2,4% (tes 1), 2,2% (tes 2), dan 4% (tes 3). Ada 234 subyek yang menerima profilaksis suntikan kalsium nadroparin, kebanyakan dikombinasi dengan aspirin dosis rendah. 181 bisa di-follow up dan sebanyak 166 subyek bisa melahirkan bayi dan 14 orang mengalami keguguran.

Efek samping selama terapi adalah gatal di seluruh tubuh (10 orang), gatal di bekas suntikann (43 orang) dan purpura (1 orang) .

Di luar pemberia kalsium nadroparin, ada 12 pasien yang menerima enoxapoarin dan 6 orang riteraoi dengan UFH. APS katastropik Di awal sempat disinggung tentang APS katastropik (CAPS) yang bisa berdampak kematian. Dijelaskan Dr. Inho Kim dari Seoul National University Hospital, Korea Selatan, APS katastropik dilaporkan kurang dari 1% dari prevalensi APS. CAPS didefinisikan sebagai kondisi yang dikarakteristikkan dengan kejadian penyumbatan vaskular yang multipel, biasanya menyerang pembuluh-pembuluh darah mikro dan hasil uji lab menunjukkan adanya antibodi antifosfolipid.

Dulu tingkat kematian akibat CAPS mencapai 50%, meskipu saat ini sudah turun hingga “hanya” 20%.

Turunnya angka kematian akibat CAPS disebabkan peningkatan terapi dengan antikoagulan, kortikosteroid, dan pergantian plasma.

Salah satu studi tentang CAPS menunjukkan bahwa tingkat kesembuhan tertinggi (77,8%) diperoleh melalui terapi kombinasi antikoagulan, kortikosterpid, dan peragntian plasma ini.

Konsensus internasional pun merekpomendasikan kombinasi 3 terapi ini sebagai terapi lini pertama CAPS. Saat ini penggunaan imunoglobulin intravena (IVIG) belum banyak dipraktikkan untuk CAPS.

Terapi kombinasi antikoagulan+ kortikosteroid+ IVIG tidak menunjukkan tambahan manfaat (recovery 69%) dibandingkan kombinasi antikoagulan, kortikosterpid, dan peragntian plasma (77,8%).

Namun penggunaan IVIG bisa digunakan jika tidak ada terapi penggantian plasma. Hanya penggunaannya harus hati-hati pada pasien usia lanjut yang komorbid dengan diabetes, hipertensi atau hiperkolesterolemia.(Ana/Bali)

Method Platelet aggregometry is performed as follows: metode Aggregometry trombosit dilakukan sebagai berikut Step 1 Platelet aggregometry is performed at 37°C. 2 The aggregometer is calibrated by: –

A cuvette containing PRP which equates to 0% light transmission – A second cuvette containing PPP which equates to 100% light transmission. 3 Platelets will only aggregate if they are activated (with an agonist) and in contact with each other – so they must be stirred whilst testing is taking place.

Absence of stirring will lead to an absence of, at least a significant reduction in, aggregation. A check for spontaneous platelet aggregation [SPT] is made. SPA is rare in healthy individuals but seen in some cases of VWD,

in some patients with diabetes, in some lipid disorders and in a variety of other disorders] should be made in all patients by placing undiluted PRP in the aggregometer and stirring for 15 minutes. In cases of SPA, dilution of the PRP may abolish this and if the platelet count remains >200 x 109/L then aggregation testing can proceed.

Trombosit hanya akan agregat jika mereka diaktifkan (dengan agonis an) dan kontak dengan satu sama lain – sehingga mereka harus diaduk sementara pengujian berlangsung.

Tidak adanya pengadukan akan mengakibatkan tidak adanya, setidaknya penurunan yang signifikan dalam, agregasi.

Sebuah cek untuk agregasi platelet spontan [SPT] dibuat. SPA jarang terjadi pada orang sehat, tetapi dilihat dalam beberapa kasus VWD, pada beberapa pasien dengan diabetes, dalam beberapa gangguan lipid dan berbagai gangguan lain harus] dibuat pada semua pasien dengan menempatkan PRP murni di aggregometer dan diaduk selama 15 menit .

Dalam kasus SPA, cairan PRP dapat menghapus ini dan jika jumlah trombosit tetap> 200 x 109 / L maka pengujian agregasi dapat melanjutkan

4 In general – 270μL of PRP is added to the aggregometry cuvette and warmed at 37°C until a steady baseline is achieved. 30μL of the agonist is added the response recorded.

The tests are repeated using a panel of agonists. Secara umum – 270μL

dari PRP ditambahkan ke kuvet aggregometry dan dihangatkan pada 37 ° C sampai dasar stabil tercapai. 30μL agonis tersebut akan ditambahkan respon direkam. Tes diulang dengan menggunakan sebuah panel agonis

The following aggregation trace shows the events in classic biphasic aggregation:

Jejak agregasi berikut menunjukkan peristiwa di agregasi biphasic klasik 1. Baseline

2. Addition of agonist – this results in a change in platelet change and hence a drop in the baseline absorbance

3. Primary wave aggregation

4. Release of nucleotides 5. Secondary wave aggregation

dasar

2. Penambahan agonis – ini menghasilkan perubahan dalam perubahan trombosit dan karenanya penurunan absorbansi dasar

3. Primer gelombang agregasi

4. Pelepasan nukleotida

5. Sekunder gelombang agregasi

Adrenaline and low dose ADP

classically give a biphasic aggregation curve whereas with a number of other agonists only a single wave is seen and it is not possible to distinguish the primary wave from the secondary wave.

Adrenalin dan dosis rendah ADP klasik memberikan kurva agregasi biphasic s

edangkan dengan sejumlah agonis lain hanya gelombang tunggal terlihat dan tidak mungkin untuk membedakan gelombang primer dari gelombang sekunder.

Interpretation

Calculating the slope or the rate of aggregation Look at the image below: interpretasi

Menghitung kemiringan atau tingkat agregasi Lihatlah gambar di bawah ini Historically, percentage [%] maximal aggregation has been reported when analysing aggregation curves.

To calculate the % maximal aggregation, the distance between the baseline [0% aggregation – platelet rich plasma] and platelet poor plasma [100% aggregation] [Y] is divided by the maximal aggregation [X]. S

o in the example above if the Y = 100mm and X = 87mm then percentage maximal aggregation = X/Y = 87%

. Secara historis,

persentase [%] agregasi maksimal telah dilaporkan ketika menganalisis kurva agregasi. Untuk menghitung agregasi% maksimal, jarak antara baseline [agregasi 0% – plasma kaya platelet] dan plasma miskin trombosit [100% agregasi] [Y] dibagi oleh agregasi maksimal [X]. Jadi, dalam contoh di atas jika Y = 100mm dan X = 87mm maka persentase agregasi maksimal = X / Y = 87%

To calculate the slope [and this forms the basis of the VWF:RCo functional assay]:

1. Draw a line at a tangent to the aggregation curve.

2. Determine how many millimetres [mm] the chart recorder records in 1 minute.

3. Measure in mm from the point where the tangent intersects the baseline to the distance equal to 1 minute.

4. Draw a line perpendicular to the baseline from the ‘1 minute’ point to the intersect point of the tangent.

5. Measure the distance [in mm] covered from the baseline to the intersect point [X]. 6. Derive the maximal height of the aggregation [100% aggregation or maximal aggregation] from the y-axis [Y]. Divide X/Y to calculate the slope or rate of aggregation.

In the example above, if X = 23mm and Y = 97mm, the slope is X/Y = 0.24

Untuk menghitung lereng [dan ini membentuk dasar dari VWF: RCo uji fungsional]: 1. Menarik garis di bersinggungan dengan kurva agregasi. 2. Tentukan berapa banyak milimeter [mm] catatan perekam grafik dalam 1 menit. 3. Mengukur dalam mm dari titik di mana garis singgungnya memotong baseline untuk jarak yang sama dengan 1 menit. 4. Gambarkan garis tegak lurus ke baseline dari titik menit ‘1 ‘ke titik berpotongan garis singgungnya. 5. Ukur jarak [di mm] tertutup dari baseline ke titik berpotongan [X]. 6. Turunkan ketinggian maksimal agregasi [agregasi 100% atau agregasi maksimal] dari sumbu y [Y]. Bagilah X / Y untuk menghitung kemiringan atau tingkat agregasi. Dalam contoh di atas, jika X = 23mm dan 97mm Y =, kemiringan adalah X / Y = 0,2

4 Interpretation of Platelet Aggregation Traces

The interpretation of platelet aggregation traces can be difficult. The attached file [click HERE] provides a summary of the abnormalities that may be identified by platelet aggregation testing.

Common aggregation traces that you are likely to encounter in an an exam-type setting are: – Glanzmann’s Thrombasthenia [or afibrinogenaemia] – Bernard-Soulier Syndrome [or Von Willebrand Disease] – Storage Pool Disorder [or release defect] –

The effects of Aspirin [or an aspirin-like defect] – The effects of Aspirin Clopidogrel Representative traces for some disorders and shown below and others are covered in the data interpretation section.

In each case the control is shown in blue and the patient in red. 1. In the patient shown below, the only abnormality is a lack of agglutination with ristocetin. Possible diagnoses are therefore, Von Willebrand Disease or Bernard Soulier Syndrome. Interpretasi Jejak Agregasi trombosit Penafsiran jejak agregasi platelet bisa sulit.

File terlampir [klik DI SINI] menyediakan ringkasan dari kelainan-kelainan yang dapat diidentifikasi dengan tes agregasi trombosit.

Jejak agregasi umum bahwa Anda mungkin menghadapi dalam suasana ujian-jenis adalah: – Glanzmann ini Thrombasthenia [atau afibrinogenaemia] – Bernard-Soulier Syndrome [atau Von Willebrand Penyakit]

– Penyimpanan Renang Disorder [atau cacat release] –

Efek Aspirin [atau cacat aspirin-seperti] – Efek dari Clopidogrel Aspirin Perwakilan jejak untuk beberapa gangguan dan ditampilkan di bawah ini dan lain-lain akan dibahas dalam bagian interpretasi data.

Dalam setiap kasus kontrol ditampilkan dalam warna biru dan pasien dalam merah. 1. Pada pasien yang ditunjukkan di bawah, kelainan satunya adalah kurangnya aglutinasi dengan ristocetin.

Kemungkinan diagnosis karena itu, Von Willebrand Penyakit atau Bernard Soulier Syndrome

2. This is the converse of the patient shown above and the only agglutination [and this is not complete] is seen with the ristocetin.

There is no aggregation with ADP, adrenaline or collagen. Possible diagnoses include Glanzmann’s thrombasthenia or afibrinogenaemia.

Remember, platelet agglutination with ristocetin occurs independently of fibrinogen.

In the traces shown below it is clear that only partial agglutination is seen with ristocetin emphasising that for aggregation to occur, binding of fibrinogen to the GpIIb/IIIa receptor is necessary.

2. Ini adalah kebalikan dari pasien yang ditunjukkan di atas dan aglutinasi satunya [dan ini tidak lengkap] terlihat dengan ristocetin tersebut.

Tidak ada agregasi dengan ADP, adrenalin atau kolagen.

Diagnosis mungkin termasuk Glanzmann ini thrombasthenia atau afibrinogenaemia. Ingat, aglutinasi platelet dengan ristocetin terjadi secara independen dari fibrinogen.

Dalam jejak ditunjukkan di bawah ini jelas bahwa hanya aglutinasi parsial terlihat dengan ristocetin menekankan bahwa untuk agregasi terjadi, pengikatan fibrinogen ke reseptor GpIIb / IIIa diperlukan.

3. In this patient reversible, first wave aggregation is seen with ADP, adrenaline and collagen and only partial agglutination with ristocetin.

The picture is clearly different from the two traces above 1) or 2): the results suggest a failure of granule release and and is consistent with either platelet storage pool disorder or a defect in nucleotide release.

3. Pada pasien ini reversibel, agregasi gelombang pertama terlihat dengan ADP, adrenalin dan kolagen dan hanya aglutinasi parsial dengan ristocetin.

Gambar jelas berbeda dari dua jejak di atas 1) atau 2): hasil menunjukkan kegagalan pelepasan granul dan dan konsisten dengan baik gangguan kolam penyimpanan trombosit atau cacat dalam rilis nukleotida

4. Its useful to summarise the ‘commonly’ described abnormalities seen with light transmission aggregometry although in practice many of these are extremely rare.

The table below summarises these:

Tes ini berguna untuk merangkum kelainan ‘umum’ dijelaskan dilihat dengan aggregometry transmisi cahaya meskipun dalam prakteknya banyak di antaranya sangat langka.

Tabel di bawah ini merangkum ini

Disorder Characteristic

Findings on LTA Glanzmann’s Thrombasthenia OR afibrinogenaemia Absent or markedly impaired aggregation to all agonists except ristocetin. Ristocetin-induced agglutination shows only primary wave – aggregation cannot occur because fibrinogen cannot bind.

Afibrinogenaemia gives similar results.

Absen atau gangguan nyata agregasi

untuk semua agonis kecuali ristocetin. Ristocetin-diinduksi aglutinasi hanya menunjukkan gelombang primer – agregasi tidak bisa terjadi karena fibrinogen tidak dapat mengikat.

Afibrinogenaemia memberikan hasil yang sama Bernard Soulier Syndrome OR Von Willebrand Disease

Absent or markedly reduced platelet agglutination with ristocetin. Absen atau nyata mengurangi trombosit aglutinasi dengan ristocetin S

torage Pool Disorder OR Platelet Release Defect Primary aggregation only with ADP, adrenaline and collagen and only partial agglutination with ristocetin suggesting a failure of granule release or a deficiency of platelet granules .

Primer agregasi hanya dengan ADP, adrenalin dan kolagen dan hanya aglutinasi parsial dengan ristocetin menunjukkan kegagalan pelepasan granul atau butiran kekurangan trombosit Aspirin [or defects in the COX pathway] Absent aggregation to arachadonic acid.

Primary wave aggregation only with ADP. Decreased or absent aggregation with collagen.

Absen agregasi untuk asam arachadonic. Gelombang primer agregasi hanya dengan ADP. Penurunan atau tidak ada agregasi dengan kolagen Clopidogrel

Absent aggregation with ADP 2B VWD/Platelet-type [pseudo]VWD Aggregation with low dose ristocetin e.g. 0.5 mg/mL. What test next? On the basis of an abnormal platelet aggregation trace, you should establish if this fits in with any recognisable disorder. All abnormal results should be repeated and you may wish to undertake flow cytometry and nucleotide studies. Genetic testing can be of value in some cases. Don’t forget to establish a family pedigree – some of the rare platelet disorders are commoner in consanguineous relationships.

Apa tes berikutnya?

Atas dasar suatu jejak agregasi platelet normal, Anda harus menentukan apakah ini cocok dengan gangguan dikenali.

Semua hasil yang abnormal harus diulang dan Anda mungkin ingin melakukan cytometry aliran dan studi nukleotida.

Pengujian genetik dapat menjadi nilai dalam beberapa kasus. Jangan lupa untuk membuat silsilah keluarga – beberapa gangguan trombosit langka biasa dalam hubungan kerabat Data Interpretation

Interpretation Exercises. Comments

1. You can also see the principles of Light Transmission Aggregometry on this site [http://www.platelet-research.org/3/aggregometry.htm].

References

1. Remuzzi, G., et al., Platelet hyperaggregability and the nephrotic syndrome. Thromb Res, 1979. 16(3-4): p. 345-54. 2. Lages, B. and H.J. Weiss, Biphasic aggregation responses to ADP and epinephrine in some storage pool deficient platelets: relationship to the role of endogenous ADP in platelet aggregation and secretion.

Thromb Haemost, 1980. 43(2): p. 147-53. 3. Guidelines on platelet function testing. The British Society for Haematology BCSH Haemostasis and Thrombosis Task Force. 4. Lages, B. and H.J. Weiss, Heterogeneous defects of platelet secretion and responses to weak agonists in patients with bleeding disorders. Br J Haematol, 1988. 68(1): p. 53-62. 5. Hardisty, R.M., Disorders of platelet secretion. Baillieres Clin Haematol, 1989. 2(3): p. 673-94. 6. Michelson, A.D., Flow cytometry: a clinical test of platelet function. Blood, 1996. 87(12): p. 4925-36. 7. Rao, A.K., Congenital disorders of platelet function: disorders of signal transduction and secretion. Am J Med Sci, 1998. 316(2): p. 69-76. 8. Rodgers, G.M., Overview of platelet physiology and laboratory evaluation of platelet function. Clin Obstet Gynecol, 1999. 42(2): p. 349-59. 9. Shapiro, A.D., Platelet function disorders. Haemophilia, 2000. 6 Suppl 1: p. 120-7. 10. Kottke-Marchant, K. and G. Corcoran, The laboratory diagnosis of platelet disorders. Arch Pathol Lab Med, 2002. 126(2): p. 133-46. 11. Handin, R.I., Inherited platelet disorders. Hematology Am Soc Hematol Educ Program, 2005: p. 396-402. 12. Harrison, P., Platelet function analysis. Blood Rev, 2005. 19(2): p. 111-23. 13. Bolton-Maggs, P.H., et al., A review of inherited platelet disorders with guidelines for their management on behalf of the UKHCDO. Br J Haematol, 2006. 135(5): p. 603-33. 14. Hayward, C.P., Diagnostic approach to platelet function disorders. Transfus Apher Sci, 2008. 38(1): p. 65-76. 15. Harrison, P. and A. Mumford, Screening tests of platelet function: update on their appropriate uses for diagnostic testing. Semin Thromb Hemost, 2009. 35(2): p. 150-7. 16. Mezzano, D., T. Quiroga, and J. Pereira, The level of laboratory testing required for diagnosis or exclusion of a platelet function disorder using platelet aggregation and secretion assays. Semin Thromb Hemost, 2009. 35(2): p. 242-54. 17. Zhou L, Schmaier AH. Platelet aggregation testing in platelet-rich plasma: description of procedures with the aim to develop standards in the field. Am J Clin Pathol. 2005 Feb;123(2):172-83. 18. Simon D, Kunicki T, Nugent D. Platelet function defects. Haemophilia. 2008 Nov;14(6):1240-9. 19. Truss, N.J., Armstrong, P.C., Liverani, E., Vojnovic, I. & Warner, T.D. (2009) Heparin but not citrate anticoagulation of blood preserves platelet function for prolonged periods. J Thromb Haemost, 7, 1897-1905. 20. Quiroga et al BJH 2009 21. Nurden A, Nurden P. Advances in our understanding of the molecular basis of disorders of platelet function. J Thromb Haemost 2011;9 Suppl 1:76-91. Data Interpretasi Klik DI SINI untuk pergi ke Latihan Interpretasi data. Komentar 1. Anda juga dapat melihat prinsip-prinsip Aggregometry Transmisi Cahaya di situs ini [http://www.platelet-research.org/3/aggregometry.htm]. Referensi 1. Remuzzi, G., et al., Hyperaggregability trombosit dan sindrom nefrotik. Thromb Res, 1979. 16 (3-4): p. 345-54. 2. Lages, B. dan HJ Weiss, respon agregasi Biphasic ke ADP dan epinefrin dalam beberapa trombosit storage pool kekurangan: hubungan peran ADP endogen dalam agregasi platelet dan sekresi. Thromb Haemost, 1980. 43 (2): p. 147-53. 3. Pedoman pengujian fungsi platelet. Masyarakat Inggris untuk Haemostasis BCSH Hematologi dan Angkatan Trombosis Tugas. 4. Lages, B. dan HJ Weiss, cacat heterogen sekresi platelet dan tanggapan terhadap agonis lemah pada pasien dengan gangguan perdarahan. Br J Haematol, 1988. 68 (1): p. 53-62. 5. Hardisty, R.M., Gangguan sekresi platelet. Baillieres Clin Haematol, 1989. 2 (3): p. 673-94. 6. Michelson, AD, Arus cytometry: tes klinis fungsi platelet. Darah, 1996. 87 (12): p. 4925-36. 7. Rao, AK, gangguan kongenital fungsi trombosit: gangguan transduksi sinyal dan sekresi. Am J Med Sci, 1998. 316 (2): p. 69-76. 8. Rodgers, GM, Ikhtisar fisiologi trombosit dan evaluasi laboratorium fungsi platelet. Clin Obstet Gynecol, 1999. 42 (2): p. 349-59. 9. Shapiro, M, gangguan fungsi trombosit. Hemofilia, 2000. 6 Suppl 1: p. 120-7. 10. Kottke-Marchant, K. dan G. Corcoran, Diagnosis laboratorium kelainan trombosit. Arch Pathol Lab Med, 2002. 126 (2): p. 133-46. 11. Handin, R.I., warisan gangguan trombosit. Hematologi Am Soc Hematol Educ Program, 2005: p. 396-402. 12. Harrison, P., analisis fungsi trombosit. Darah Rev, 2005. 19 (2): p. 111-23. 13. Bolton-Maggs, PH, et al, Sebuah tinjauan gangguan trombosit diwariskan dengan pedoman untuk manajemen mereka atas nama UKHCDO.. Br J Haematol, 2006. 135 (5): p. 603-33. 14. Hayward, CP, pendekatan Diagnostik gangguan fungsi trombosit. Transfus Apher Sci, 2008. 38 (1): p. 65-76. 15. Harrison, P. dan A. Mumford, Screening tes fungsi platelet: update pada penggunaan yang sesuai untuk tes diagnostik. Semin Thromb Hemost, 2009. 35 (2): p. 150-7. 16. Mezzano, D., T. Quiroga, dan J. Pereira, Tingkat pengujian laboratorium diperlukan untuk diagnosis atau pengecualian dari gangguan fungsi trombosit menggunakan agregasi platelet dan tes sekresi. Semin Thromb Hemost, 2009. 35 (2): p. 242-54. 17. Zhou L, Schmaier AH. Agregasi platelet pengujian di platelet-kaya plasma: deskripsi prosedur dengan tujuan untuk mengembangkan standar di lapangan. Am J Clin Pathol. 2005 Feb, 123 (2) :172-83. 18. Simon D, Kunicki T, Nugent D. cacat fungsi trombosit. Hemofilia. 2.008 November, 14 (6) :1240-9. 19. Truss, NJ, Armstrong, PC, Liverani, E., Vojnovic, I. & Warner, TD (2009) Heparin tetapi tidak sitrat antikoagulasi darah mempertahankan fungsi trombosit untuk waktu yang lama. J Thromb Haemost, 7, 1.897-1.905. 20. Quiroga et al BJH 2.009 21. Nurden A, Nurden P. Kemajuan dalam pemahaman kita tentang dasar molekul dari gangguan fungsi trombosit. J Thromb Haemost 2011; 9 Suppl 1:76-91. BELAJAR KETERAMPILAN-KETERAMPILAN Anda harus belajar keterampilan diabetes manajemen dasar. Mereka akan membantu mencegah masalah dan kebutuhan untuk perawatan medis. Keterampilan ini meliputi: • Bagaimana menguji dan merekam glukosa darah Anda (Lihat: pemantauan glukosa darah) • Apa yang harus makan dan kapan • Bagaimana untuk mengambil obat, jika diperlukan • Bagaimana mengenali dan mengobati gula darah rendah dan tinggi • Bagaimana menangani hari sakit • Dimana dapat membeli persediaan diabetes dan bagaimana menyimpannya Ini mungkin membutuhkan beberapa bulan untuk mempelajari keterampilan dasar. Selalu terus belajar tentang diabetes, komplikasi, dan bagaimana mengontrol dan hidup dengan penyakit. Tetap up-to-date pada penelitian baru dan perawatan. MENGELOLA GULA DARAH ANDA Pengujian diri berarti bahwa Anda memeriksa gula darah Anda di rumah sendiri. Memeriksa kadar gula darah Anda di rumah dan menuliskan hasilnya akan memberitahu Anda seberapa baik Anda mengelola diabetes Anda. Perangkat yang disebut glucometer bisa memberi Anda membaca gula darah yang tepat. Ada berbagai jenis perangkat. Biasanya, Anda menusuk jari Anda dengan jarum kecil yang disebut lanset. Ini akan memberikan Anda setetes kecil darah. Anda menempatkan darah pada strip tes dan menempatkan strip ke dalam perangkat. Hasil yang diberikan dalam 30 – 45 detik. Sebuah perawatan kesehatan atau pendidik diabetes akan membantu mengatur jadwal di rumah pengujian untuk Anda. Dokter akan membantu Anda menetapkan tujuan darah gula. • Kebanyakan orang dengan diabetes tipe 2 hanya perlu memeriksa gula darah mereka sekali atau dua kali sehari. • Jika kadar gula darah Anda berada di bawah kontrol, Anda mungkin hanya perlu memeriksa mereka beberapa kali seminggu. • Anda dapat menguji diri sendiri ketika Anda bangun tidur, sebelum makan, dan sebelum tidur. • Anda mungkin perlu menguji lebih sering ketika Anda sakit atau sedang stres. Hasil tes dapat digunakan untuk mengubah makanan Anda, aktivitas, atau obat-obatan untuk menjaga kadar gula darah dalam kisaran yang tepat. Pengujian dapat mengidentifikasi kadar gula darah tinggi dan rendah sebelum Anda memiliki masalah serius. Mencatat gula darah Anda untuk diri sendiri dan penyedia layanan kesehatan Anda. Ini akan membantu jika Anda mengalami kesulitan mengelola diabetes. DIET DAN PENGENDALIAN BERAT Bekerja sama dengan dokter, perawat, dan ahli diet untuk mengetahui berapa banyak lemak, protein, dan karbohidrat yang Anda butuhkan dalam diet Anda. Rencana makan Anda harus sesuai dengan gaya hidup sehari-hari dan kebiasaan, dan harus mencoba untuk memasukkan makanan yang Anda sukai. Mengelola berat badan dan makan makanan yang seimbang adalah penting. Beberapa orang dengan diabetes tipe 2 dapat berhenti memakai obat setelah kehilangan berat badan (meskipun mereka masih memiliki diabetes). Lihat juga: • Diabetes diet • Ngemil bila Anda memiliki diabetes Pasien sangat gemuk yang diabetes tidak dikelola dengan baik dengan diet dan obat-obatan dapat mempertimbangkan bariatrik (berat badan) operasi. Lihat: • operasi pintas lambung • Laparoskopi gastric banding KEGIATAN FISIK REGULER Olahraga teratur adalah penting bagi semua orang. Hal ini bahkan lebih penting Anda memiliki diabetes. Latihan di mana jantung Anda berdetak lebih cepat dan Anda bernapas lebih cepat membantu menurunkan tingkat gula darah Anda tanpa pengobatan. Hal ini juga membakar kalori ekstra dan lemak sehingga Anda dapat mengelola berat badan Anda. Olahraga dapat membantu kesehatan Anda dengan meningkatkan aliran darah dan tekanan darah. Olahraga juga meningkatkan tingkat energi tubuh, menurunkan ketegangan, dan meningkatkan kemampuan Anda untuk menangani stres. Tanyakan pada dokter Anda sebelum memulai program latihan. Orang dengan diabetes tipe 2 harus mengambil langkah khusus sebelum, selama, dan setelah aktivitas fisik yang intensif atau berolahraga. Lihat juga: Diabetes dan olahraga PENGOBATAN UNTUK MENGOBATI DIABETES Jika diet dan olahraga tidak membantu menjaga gula darah pada tingkat normal atau mendekati normal, dokter mungkin meresepkan obat. Karena obat ini membantu menurunkan kadar gula darah dengan cara yang berbeda, dokter Anda mungkin telah mengambil lebih dari satu obat. Beberapa jenis yang paling umum dari obat tercantum di bawah ini. Mereka diminum atau injeksi. • Alpha-glukosidase inhibitor (seperti acarbose) • Biguanides (Metformin) • injeksi obat-obatan (termasuk exenatide, mitiglinide, pramlintide, sitagliptin saxagliptin, dan) • meglitinides (termasuk repaglinide dan Nateglinide) • Sulfonylureas (seperti glimepiride, glyburide, dan tolazamide) • thiazolidinediones (seperti rosiglitazone dan pioglitazone). (Rosiglitazone dapat meningkatkan risiko gangguan jantung Bicarakan dengan dokter Anda..) Obat ini dapat diberikan dengan insulin, atau insulin dapat digunakan sendiri. Anda mungkin perlu insulin jika Anda terus memiliki kontrol glukosa darah yang buruk. Ini harus disuntikkan di bawah kulit menggunakan jarum suntik insulin atau perangkat pena. Hal ini tidak dapat diambil melalui mulut. Lihat juga: Diabetes tipe 1 Tidak diketahui apakah obat hiperglikemia diminum aman untuk digunakan dalam kehamilan. Wanita yang memiliki diabetes tipe 2 dan hamil dapat beralih ke insulin selama kehamilan dan saat menyusui. MENCEGAH KOMPLIKASI Dokter mungkin meresepkan obat atau perawatan lain untuk mengurangi peluang Anda untuk mengembangkan penyakit mata, penyakit ginjal, dan kondisi lain yang lebih sering terjadi pada penderita diabetes. Lihat juga: • Diabetes – mencegah serangan jantung dan stroke Konsultasi dengan dokter ahli Jantung • Komplikasi jangka panjang diabetes PERAWATAN KAKI Orang dengan diabetes lebih mungkin untuk memiliki masalah kaki. Diabetes dapat merusak saraf, yang berarti Anda mungkin tidak merasa cedera pada kaki sampai Anda mendapatkan sakit besar atau infeksi. Diabetes juga dapat merusak pembuluh darah. Diabetes juga menurunkan kemampuan tubuh untuk melawan infeksi. Infeksi kecil dapat dengan cepat memburuk dan menyebabkan kematian kulit dan jaringan lain. Untuk mencegah cedera pada kaki Anda, memeriksa dan merawat kaki Anda setiap hari. Lihat juga: Diabetes kaki Dukungan Grup Untuk informasi lebih lanjut, lihat sumber diabetes. Harapan (prognosis) Setelah bertahun-tahun, diabetes dapat menyebabkan masalah serius dengan mata, ginjal, saraf, jantung, pembuluh darah, atau daerah lain dalam tubuh Anda. Jika Anda memiliki diabetes, risiko serangan jantung adalah sama dengan seseorang yang sudah mengalami serangan jantung. Baik wanita maupun pria dengan diabetes memiliki risiko. Anda mungkin tidak memiliki tanda-tanda normal dari serangan jantung. Jika Anda mengontrol gula darah dan tekanan darah, Anda dapat mengurangi risiko kematian, stroke, gagal jantung, dan masalah diabetes lainnya. Beberapa orang dengan diabetes tipe 2 tidak lagi membutuhkan obat jika mereka menurunkan berat badan dan menjadi lebih aktif. Ketika mereka mencapai berat badan ideal mereka, insulin tubuh mereka dan diet yang sehat dapat mengendalikan kadar gula darah mereka. Komplikasi Setelah bertahun-tahun, diabetes dapat menyebabkan masalah serius: • Anda bisa memiliki masalah mata, termasuk kesulitan untuk melihat (terutama pada malam hari), dan sensitivitas cahaya. Anda bisa menjadi buta. • Kaki dan kulit dapat mengembangkan luka dan infeksi. Setelah lama, kaki atau kaki mungkin perlu dihapus. Infeksi juga dapat menyebabkan nyeri dan gatal-gatal di bagian lain dari tubuh. • Diabetes dapat membuat lebih sulit untuk mengontrol tekanan darah dan kolesterol. Hal ini dapat menyebabkan serangan jantung, storke, dan masalah lainnya. Hal ini dapat menjadi lebih sulit untuk darah mengalir ke kaki dan kaki. • Saraf dalam tubuh Anda dapat rusak, menyebabkan nyeri, kesemutan, dan hilangnya perasaan. • Karena kerusakan saraf, Anda bisa memiliki masalah mencerna makanan yang Anda makan. Anda bisa merasakan kelemahan atau kesulitan pergi ke kamar mandi. Kerusakan saraf dapat membuat lebih sulit bagi pria untuk memiliki ereksi. • gula darah tinggi dan masalah lainnya dapat menyebabkan kerusakan ginjal. Ginjal tidak dapat bekerja dengan baik, dan mereka bahkan dapat berfungsi lagi. Infeksi pada kulit, saluran kelamin wanita, dan saluran kemih juga lebih umum. Untuk mencegah masalah dari diabetes, kunjungi dokter anda atau pendidik diabetes setidaknya empat kali setahun. Bicara tentang masalah yang Anda mengalami. Apa Hubungan antara Trigliserida dan Diabetes? Trigliserida ini telah disebut sebagai “lemak jelek” tapi itu lebih merupakan respons emosional dari satu yang kukuh berakar pada fakta ilmiah. Namun hubungannya dengan diabetes tidak bisa diabaikan. Kolesterol telah diidentifikasi sebagai faktor risiko penyakit jantung. Ada iklan yang tak terhitung jumlahnya dan outlet informasi yang mengkonfirmasi masalah yang berhubungan dengan diet yang tidak terkontrol. Demikian juga ada pil dan pilihan makanan yang dipromosikan sebagai bagian dari solusi. Konsumen mendapatkan hasil yang bervariasi tergantung pada genetik dan tahap di mana kondisi ini ditangkap. Program latihan juga direkomendasikan sebagai bagian dari proses hidup sehat. Pertanyaannya tetap, apakah semua intervensi ini telah efektif atau apakah mereka hanya cara bagi instansi periklanan untuk membuat lebih banyak uang. • Kumpulan lemak yang dapat menyebabkan kerusakan: Dengan konsensus, trigliserida adalah bundel kecil lemak yang ditemukan dalam aliran darah. Mereka meningkat jumlahnya setelah kita mengkonsumsi makanan. Tubuh akan memproduksi lemak-lemak dari makanan yang kita makan terutama jika mereka lemak di alam. Diperkirakan bahwa 90% dari seluruh kandungan lemak non-daging tanpa lemak terdiri dari trigliserida. Oleh karena itu kebiasaan belanja dari kelompok risiko harus mencerminkan bahaya. • Trigliserida tidak universal buruk: Diet yang seimbang harus mengandung semua elemen yang relevan. Telah diperkirakan bahwa trigliserida memiliki proporsi 99% dari semua lemak yang tersimpan dalam tubuh manusia. Anda mendapatkan sumber energi jangka panjang dari deposito ini lemak. Mereka benar-benar disimpan dalam lebih padat daripada protein dari otot atau bahkan pati. Insulin diperlukan untuk membentuk lemak. Antara makan dan semalam, trigliserida diubah menjadi energi. Kadar insulin puasa dan rendah akan memicu reaksi ini. Sel-sel lemak memiliki kapasitas penyimpanan yang sangat tinggi dan ini dapat menyebabkan obesitas pada situasi tertentu. Jika Anda sedang menjalani puasa luas atau sama sekali tidak ada insulin dalam tubuh maka hati akan mengkonversi produk pemecahan lemak menjadi keton. • komplikasi kesehatan dan manifestasi mereka: Hal ini sering terjadi rendahnya tingkat HDL atau kolesterol baik dikaitkan dengan tingkat tinggi trigliserida. Ini kemudian didiagnosis sebagai dislipidemia diabetik. Ini adalah kombinasi dari faktor-faktor yang dapat menempatkan hidup pasien dalam bahaya. Pasien dalam situasi ini akan memiliki kelompok kecil, padat dan akhirnya berbahaya dari LDL atau kolesterol berbahaya. Format yang terakhir ini tidak diinginkan berdasarkan sifat aterogenik nya. Akhirnya orang tersebut akan mengembangkan obesitas sentral. Ini adalah salah satu fitur mendefinisikan sindrom metabolik. • Sekitar 80% dari semua penderita diabetes tipe 2 akan memiliki kondisi ini. Akhirnya orang tersebut meninggal lebih cepat akibat penyakit jantung. • Menetapkan tolok ukur untuk orang yang sehat: Sangat penting bahwa Anda memiliki beberapa tujuan pada seberapa banyak trigliserida yang Anda akan merekam pada skala standar. Ini merupakan indikator yang mendasari kondisi sehat. Oleh karena itu Anda akan berada dalam posisi untuk menerapkan strategi pencegahan bila diperlukan untuk melakukannya. Tingkat normal trigliserida adalah 150 mg / dl. Angka batas adalah antara 150 dan 199. Tingginya adalah antara 200 dan 499 sedangkan apa pun lebih dari 500 adalah hal yang mendesak. Keadaan puasa normal akan memiliki tingkat membaca antara 100 dan 150 mg / dl. Setelah makan yang normal angkanya akan meningkat menjadi 300. Pasien dengan diabetes tipe 2 akan mengalami peningkatan kadar di kedua saat baik puasa dan maupun sesuah makan. Sebelum tes lipid panel, Anda harus memiliki beberapa puasa semalam setidaknya selama 12 jam. Demikian juga tidak dianjurkan untuk mengambil alkohol minimal 24 jam sebelum tes. • Mengelola tingkat trigliserida dalam tubuh Anda: Hal ini untuk keuntungan Anda bahwa Anda menjaga kadar zat ini relatif rendah. Pasien dengan diabetes tipe 2 memiliki faktor risiko tinggi dan perlu bekerja sedikit yang ekstra untuk memastikan bahwa tingkat mereka 150 mg / dl atau bahkan lebih rendah. Ini akan membantu mereka mengurangi kemungkinan terkena penyakit kardiovaskular. Beberapa orang dalam kategori ini telah melakukan tingkat yang lebih dari 400. Setelah Anda mulai memukul tanda 1000 maka Anda akan menderita lesi kulit atau xanthomas, kehilangan memori, pankreas dan sakit perut. Intervensi diperlukan pada tahap ini untuk menyelamatkan hidup Anda. Tips diet diabetic type 2 Tips for Eating Well with Diabetes Knowing what to eat with type 2 diabetes is the best way to feel in control and feel better. This first lesson in your quick-start guide gives an overview of the five simple key things to know: 1. Eating the Right Balanced Mix of Foods 2. Portions: How to Fill Your Plate 3. Calories Needed to Lose Weight 4. How Food Choices Can Lower Blood Sugar 5. Easy Ways to Count Carbs Type 2 Diabetes Diet Plan by American Diabetes Association Posted on December 18th, 2007 by DietMan Diet diabetes tipe 2: Dengan lebih dari 14,6 juta orang Amerika menderita diabetes, telah menjadi masalah kesehatan utama di Amerika Serikat saat ini. Diet Diabetes Tipe 2 perlu dibarengi dengan gaya hidup sehat dalam rangka untuk menempatkan cek pada diabetes tipe 2. Diet diabetes Tipe 2 bersama dengan olahraga teratur, dapat membantu signifikan dalam mengendalikan gula darah Anda dan mengelola diabetes Anda. Dengan mengurangi asupan kalori dan termasuk latihan rutin Anda, Anda dapat membuat tubuh Anda lebih sensitif terhadap insulin nya. Idealnya, Anda harus mengikuti rencana diet yang mengurangi asupan gula sederhana dan karbohidrat olahan. Diet kaya karbohidrat serat dan kompleks direkomendasikan untuk pasien diabetes tipe 2. Karbohidrat kompleks yang ditemukan dalam buah-buahan, biji-bijian, dan sayuran dipecah sangat lambat akibat yang pelepasan glukosa dalam aliran darah diperlambat. Sebaliknya, karbohidrat sederhana dipecah dalam tidak ada waktu yang mengarah ke peningkatan pesat dalam tingkat gula darah. Pasien diabetes tipe 2 dapat mencakup lebih sedikit lemak jenuh dalam makanan mereka. Diabetes rencana diet: Sebuah rencana diet diabetes harus diikuti hanya setelah berkonsultasi seorang dokter ahli. Dokter Anda juga akan mempertimbangkan masalah kesehatan lainnya, jika ada, sebelum resep Anda rencana diet diabetes. Original info Type 2 diabetes diet: With more than 14.6 million Americans suffering from diabetes, it has become a major health concern in the United States today. Type 2 diabetes diet needs to be coupled with a healthy lifestyle in order to put a check on type 2 diabetes. Type 2 diabetes diet along with regular exercise, can be of significant help in controlling your blood sugar and managing your diabetes. By reducing your calorie intake and including exercise in your routine, you can make your body more sensitive to its insulin. Ideally, you need to follow a diet plan that reduces your intake of simple sugars and refined carbohydrates. A diet rich in fiber and complex carbohydrates is recommended for type 2 diabetes patients. Complex carbohydrates found in fruits, whole grains, and vegetables are broken down very slowly as a result of which the release of glucose in the bloodstream is slowed down. On the contrary, simple carbohydrates are broken down within no time leading to a rapid rise in the blood sugar levels. Type 2 diabetic patients can include less saturated fat in their diet. Diabetes diet plan: A diabetes diet plan should be followed only after consulting an expert physician. Your doctor will also take into account any other health problems, if any, before prescribing you a diabetes diet plan. Diet yang direkomendasikan oleh American Diabetes Association: Diet yang direkomendasikan oleh American Diabetes Association adalah semua tentang membuat pilihan makanan sehat. Diet meletakkan lebih menekankan pada buah-buahan, non – sayuran bertepung (wortel, bayam, kacang hijau, brokoli), kacang kering, dan lentil. Anda dapat memilih untuk makan makanan gandum bukan produk gandum olahan dan juga termasuk beras merah dalam diet Anda. Diet yang disarankan oleh American Diabetes Association dapat membantu Anda mengelola diabetes Anda secara efektif asalkan Anda menonton ukuran porsi saat makan. Bahkan makanan sehat, jika dimakan dalam jumlah besar, dapat meningkatkan berat badan Anda membuat manajemen diabetes lebih sulit. Original info Diet recommended by American Diabetes Association: The diet recommended by American Diabetes Association is all about making healthy food choices. The diet lays more emphasis on fruits, non – starchy vegetables (carrots, spinach, green beans, broccoli), dried beans, and lentils. You may choose to eat whole grain foods instead of processed grain products and also include brown rice in your diet. The diet recommended by American Diabetes Association can help you manage your diabetes effectively provided that you watch the portion sizes while eating. Even healthy foods, if eaten in large quantities, can increase your weight making diabetes management more difficult. An Excellent Type 2 Diabetes Diet program Rencana makan sehat Diabetes Tipe 2 adalah hanya untuk mereka yang memiliki tipe yang paling khas dari diabetes, tipe 2. Hal ini terjadi ketika tubuh Anda tidak dapat mengembangkan insulin yang cukup, yang penting untuk membantu Anda menyerap glukosa dalam sel sampai kembali atau keperluan energi. Apa yang menghentikan insulin dari fungsi ini seringkali dibangun lemak, itu sebabnya rencana diet mutlak diperlukan untuk membantu Anda mengendalikan penyakit dan kemudian menghentikannya dari semakin buruk. Maka persis bagaimana seharusnya setiap orang memulai / nya nya 2 rencana diabetes makan agar benar-benar akan menghasilkan efek? 1. Mencatat segala macam hal yang terutama mengkonsumsi dan minum. Tanpa diragukan lagi, kebenaran menyakitkan, tetapi banyak kali orang harus telah mengungkap semua dari mereka dan menghadapi mereka sehingga kami dapat melampaui semua masalah ini. Membuat daftar hanya apa yang Anda sering makan pasti akan membuat Anda menemukan bahwa kita satu-satunya yang dapat tetap mengontrol kesehatan kita sendiri dan kesehatan dan kita dapat melestarikan atau merusaknya. (Menyembuhkan diabetes tipe 2) 2. Temukan produk yang lebih sehat. Sekarang ada tentu akan menjadi pengganti bahkan jika pada awalnya, mereka mungkin tampak tidak mudah untuk menemukan. Misalnya, sangat sangat mudah untuk hanya memindahkan dari roti normal untuk roti gandum! Apa yang perlu Anda lakukan adalah memiliki sedikit kesabaran pada eksplorasi tentang alternatif signifikan lebih sehat yang akan memberikan kesehatan yang lebih baik dalam jangka panjang. 3. Hilangkan Praktik Negatif resep diet diabetes Gula pemanis soda bersama-sama dengan minuman dapat dengan mudah menyebabkan kondisi lebih buruk, jadi tinggal dengan air dan teh sehat. Ketika Anda minum soda terlalu banyak, hal ini dapat meningkatkan gula darah, yang tidak akan menstabilkan perkembangan insulin darah. Demikian juga, daripada makan junk food serta makanan cepat saji, kenapa tidak mencoba buah dan sayuran sebagai camilan? Anda juga bisa mencoba popcorn bebas lemak. Berkaitan dengan saus, Anda juga dapat mencoba mustard bukan mayones terlalu banyak. Mencoba mengatakan pelayaran bon untuk produk makanan goreng hanya karena benar-benar diisi dengan lemak dan kalori. Anda mungkin dapat mencoba memanggang, mengukus, panas sekali, atau panfrying menggunakan sedikit minyak zaitun sebagai pengganti. Tak bisakah kau melihat bahwa ada begitu banyak pilihan? Perlu diingat bahwa tidak ada diet mudah. Jika ingin melihat hasil yang baik, maka Anda benar-benar perlu melalui diet diabetes tipe 2 yang sulit. Original info Type 2 Diabetes Healthy eating plan is just for those who have the most typical type of diabetes, Type 2. This happens when your body cannot develop enough insulin, that is important to help you absorb glucose in the cells for back up or energy purposes. What stops insulin from functioning is oftentimes built up fat, that is why a diet plan is definitely needed to help you control the illness and then stop it from getting worse. And so exactly how should everyone start up her / his 2 diabetes meal plan in order that it’ll really yield effects? 1. Take note of all kinds of things you mainly consume and drink. Without a doubt, the truth hurts, but many times people have to have uncover all of them and face them so that we’re able to go beyond all these issues. Creating listing just what you frequently eat will definitely make you discover that we’re the only ones who can keep control of our own health and wellness and we can conserve it or wreck it. (cure for type 2 diabetes) 2. Discover more healthy products. Now there will certainly be substitutes even if in the beginning, they might seem not easy to discover. For instance, it is very very easy to just move from normal bread to whole wheat bread! What you need to do is to have a little patience on exploring regarding significantly more healthy alternatives which will give you a better health in the long run. 3. Eliminate Negative Practices for the diabetes diet recipes Sugar sweetened sodas together with drinks can easily cause the condition even worse, so stay with waters and healthful teas. When you drink too much soda, this could increase the blood sugar, which will not stabilize the blood insulin development. Likewise, rather than of eating junk food as well as fast food, why not try fruits and vegetables as snacks? You could likewise try fat free popcorn. Relating to sauces, you can also try mustard instead of too much mayo. Attempt saying bon voyage to fried food products simply because these are really stuffed with fats and calories. You possibly can try grilling, steaming, broiling, or panfrying using a bit of olive oil as a substitute. Cannot you see that there are so many choices? Keep in mind that there is no effortless diet. If you’d like see the good results, then you really need to go through a difficult type 2 diabetes diet. Resource: EzineArticles.Com Respon klinis: Kombinasi obat dan manajemen diet dapat memiliki hasil positif. Pertama-tama Anda harus bertujuan untuk pengendalian glukosa. Sebuah resep khas akan mencakup Statin seperti Zocor, Lipitor, Pravachol, Zetia, Crestor dan Vytorin. Obat-obat ini dimaksudkan untuk menurunkan kadar kolesterol Anda secara umum. Pasien diabetes tipe 2 mungkin memerlukan terapi kombinasi untuk mencapai tingkat yang aman dari trigliserida. Anda juga harus memikirkan cara-cara menurunkan kadar LDL Anda. Kadang-kadang dokter akan merekomendasikan serangkaian fibrate seperti gemfibrozil Lopid, Trico fenofibrate dan asam nikotinat atau niasin. Hal ini juga dianjurkan untuk memasukkan minyak ikan dalam diet Anda. Setelah menyadari bahaya yang dapat timbul dari trigliserida dalam kaitannya dengan diabetes, Anda harus datang dengan perubahan gaya hidup praktis yang akan membantu Anda menghindari fase berbahaya. Dalam beberapa kasus Anda mungkin harus membatasi asupan lemak Anda sepenuhnya. Masalahnya adalah bahwa langkah ini dapat menyebabkan Anda mengambil karbohidrat bahkan lebih dan karena itu meningkatkan tingkat trigliserida dalam aliran darah Anda. Beberapa buku merekomendasikan lemak substitusi sehat seperti minyak zaitun dan lemak tak jenuh tunggal lainnya. Tidak meningkatkan asupan produk tepung gula atau putih. Asupan Alkohol harus disimpan ke minimum. Ambil minyak ikan seperti tuna, sarden, salmon, makarel dan ikan. Mereka mengandung asam lemak omega-3 yang dikenal untuk mengurangi trigliserida. Kelainan genetik seperti hipotiroidisme dapat menggabungkan dengan penyakit untuk memperburuk situasi. Mengambil obat-obatan seperti steroid, pil KB dan Tamoxifen juga bisa menimbulkan masalah. Anda beresiko jika Anda menderita penyakit ginjal, gagal hati dan tekanan darah tinggi Original Info Type 2 diabetes Definition Type 2 diabetes is a lifelong (chronic) disease in which there are high levels of sugar (glucose) in the blood. Type 2 diabetes is the most common form of diabetes. Alternative Names Noninsulin-dependent diabetes; Diabetes – type 2; Adult-onset diabetes Causes, incidence, and risk factors Diabetes is caused by a problem in the way your body makes or uses insulin. Insulin is needed to move blood sugar (glucose) into cells, where it is stored and later used for energy. When you have type 2 diabetes, your fat, liver, and muscle cells do not respond correctly to insulin. This is called insulin resistance. As a result, blood sugar does not get into these cells to be stored for energy. When sugar cannot enter cells, high levels of sugar build up in the blood. This is called hyperglycemia. Type 2 diabetes usually occurs slowly over time. Most people with the disease are overweight when they are diagnosed. Increased fat makes it harder for your body to use insulin the correct way. Type 2 diabetes can also develop in people who are thin. This is more common in the elderly. Family history and genes play a large role in type 2 diabetes. Low activity level, poor diet, and excess body weight around the waist increase your risk. See also: Type 2 diabetes for a list of risk factors. Symptoms Often, people with type 2 diabetes have no symptoms at first. They may not have symptoms for many years. The early symptoms of diabetes may include: • Bladder, kidney, skin, or other infections that are more frequent or heal slowly • Fatigue • Hunger • Increased thirst • Increased urination The first symptom may also be: • Blurred vision • Erectile dysfunction • Pain or numbness in the feet or hands Signs and tests Your health care provider may suspect that you have diabetes if your blood sugar level is higher than 200 mg/dL. To confirm the diagnosis, one or more of the following tests must be done. Diabetes blood tests: • Fasting blood glucose level — diabetes is diagnosed if it is higher than 126 mg/dL two times • Hemoglobin A1c test — o Normal: Less than 5.7% o Pre-diabetes: 5.7% – 6.4% o Diabetes: 6.5% or higher Read more Hemoglobin A1c Test – facts The AccuBase A1c Test Kit is a highly accurate test (CV’s less than 1.0%) capable of detecting abnormal and/or silent hemoglobin variants such as hemoglobin S, and C and F and over 850 others. Each sample is first screened for presence of abnormal hemoglobins and/or disturbed erythrocyte kinetics (abnormal age or volume of red blood cells) Example; anemia (which can falsely lower the A1c value). Individuals with long-standing diabetes may present with a condition called erythropoietin (EPO) deficiency. EPO deficiency and/or anemia are considered serious conditions requiring appropriate medical intervention. DEK can adversely affect the A1c answer and each sample should be screened for the presence of DEK. Estimates report that over 650,000 Black Americans with diabetes are know to have the Sickle Cell Trait (Hb “S, C or F”) “Don’t be fooled by claims of accuracy when an A1c method and/or disposable monitoring device has CV’s (coefficient of variation) greater than 2.0% or can not detect an abnormal hemoglobin”. “An A1c method and/or monitoring device with a CV of 7.0 % could mean that if your actual A1c level was 6.5% it could be reported anywhere from 5.0% to 8.0% providing false and/or misleading therapeutic information,” not to mention the impact of an abnormal hemoglobin on the A1c value that the particular method or device is incapable of detecting. Each AccuBase A1c sample is analyzed by an HPLC-IE procedure with resulting printed Chromatogram as shown below. The laboratory staff is available to discuss individual chromatograms with your physician and/or medical personnel. The AccuBase A1c Test Kit is a non-fasting, finger stick, mail-in test, considered the most accurate and precise A1c test available. The test is considered sensitive and specific enough to detect diabetes (less than 2.0% CV’s). CV’s are under 1.0%. CV’s indicate the level of repeated accuracy compared to a known laboratory A1c value. The lower the CV’s the more accurate the A1c test. The AccuBase A1c Test Kit method is NGSP certified (values referenced to the DCCT). The AccuBase A1c Test Kit does not require any drying time, samples can be collected and mailed within minutes. The kit comes complete with patient positive ID vials and plastic capillary tubes/device. The analytical method is interference free. Samples are stable for 30 day un-refrigerated. Each test result comes with a Mean Blood Glucose calculation based on the DCCT MBG Equation: % A1c X 31.7 – 66.1 = MBG in mg/dl. Test results are typically available within 5 to 7 days form mailing. Special handling can be arranged to provide, next-day, two-day or three day results. Ideal for confidential diabetes (mean blood glucose) screening, outreach programs and clinical trails. The first graph demonstrates a normal chromatogram with no hemoglobin variants present and a normal A1c level. The Chromatogram on the second graph demonstrates an highly elevated level of hemoglobin F (25.6%). This elevated level of Hb F resulted in a sub-normal A1c value of 3.2%. Normal range of A1c assay (4.2% – 6.0%). Unless you have been screened for hemoglobin variants you would not know you carry the hereditary persistent variant, or be aware of its associated impact on your A1c level. Increased levels of Hemoglobin F may represent an increased risk for SIDS in infants, and may represent as association in various types of leukemia and/or solid tumors. Mothers that smoke or have been exposed to environmental pollution during pregnancy may have a much higher level of Hb F in the baby which may increase the risk of SIDS in the newborn. AccuBase A1c Test Kit Cleared for OTC use by the FDA (no prescription needed in most states). Patients can receive a copy of the test results. Electronic reporting to managed care health organizations/providers is available. The AccuBase A1cTest Kit uses the “gold standard” HPLC-IE or BA methodology to collect and analyze A1c samples in alternate site locations such as the home, physicians office and/or clinic • Oral glucose tolerance test — diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours Diabetes screening is recommended for: • Overweight children who have other risk factors for diabetes, starting at age 10 and repeated every 2 years • Overweight adults (BMI greater than 25) who have other risk factors • Adults over age 45 every 3 years You should see your health care provider every 3 months. At these visits, you can expect your health care provider to: • Check your blood pressure • Check the skin and bones on your feet and legs • Check to see if your feet are becoming numb • Examine the back part of the eye with a special lighted instrument called an ophthalmoscope The following tests will help you and your doctor monitor your diabetes and prevent problems: • Have your blood pressure checked at least every year (blood pressure goals should be 130/80 mm/Hg or lower). • Have your hemoglobin A1c test (HbA1c) every 6 months if your diabetes is well controlled; otherwise every 3 months. • Have your cholesterol and triglyceride levels checked yearly (aim for LDL levels below 70-100 mg/dL). • Get yearly tests to make sure your kidneys are working well (microalbuminuria and serum creatinine). • Visit your eye doctor at least once a year, or more often if you have signs of diabetic eye disease. • See the dentist every 6 months for a thorough dental cleaning and exam. Make sure your dentist and hygienist know that you have diabetes. Treatment The goal of treatment at first is to lower high blood glucose levels. The long-term goals of treatment are to prevent problems from diabetes. The main treatment for type 2 diabetes is exercise and diet. LEARN THESE SKILLS You should learn basic diabetes management skills. They will help prevent problems and the need for medical care. These skills include: • How to test and record your blood glucose (See: Blood glucose monitoring) • What to eat and when • How to take medications, if needed • How to recognize and treat low and high blood sugar • How to handle sick days • Where to buy diabetes supplies and how to store them It may take several months to learn the basic skills. Always keep learning about diabetes, its complications, and how to control and live with the disease. Stay up-to-date on new research and treatments. MANAGING YOUR BLOOD SUGAR Self testing means that you check your blood sugar at home yourself. Checking your blood sugar levels at home and writing down the results will tell you how well you are managing your diabetes. A device called a glucometer can give you an exact blood sugar reading. There are different types of devices. Usually, you prick your finger with a small needle called a lancet. This gives you a tiny drop of blood. You place the blood on a test strip and put the strip into the device. Results are given in 30 – 45 seconds. A health care provider or diabetes educator will help set up an at-home testing schedule for you. Your doctor will help you set your blood sugar goals. • Most people with type 2 diabetes only need to check their blood sugar once or twice a day. • If your blood sugar levels are under control, you may only need to check them a few times a week. • You may test yourself when you wake up, before meals, and at bedtime. • You may need to test more often when you are sick or under stress. The results of the test can be used to change your meals, activity, or medications to keep your blood sugar levels in the right range. Testing can identify high and low blood sugar levels before you have serious problems. Keep a record of your blood sugar for yourself and your health care provider. This will help if you are having trouble managing your diabetes. DIET AND WEIGHT CONTROL Work closely with your doctor, nurse, and dietitian to learn how much fat, protein, and carbohydrates you need in your diet. Your meal plans should fit your daily lifestyle and habits, and should try to include foods that you like. Managing your weight and eating a well-balanced diet are important. Some people with type 2 diabetes can stop taking medications after losing weight (although they still have diabetes). See also: • Diabetes diet • Snacking when you have diabetes Very overweight patients whose diabetes is not well managed with diet and medicine may consider bariatric (weight loss) surgery. See: • Gastric bypass surgery • Laparoscopic gastric banding REGULAR PHYSICAL ACTIVITY Regular exercise is important for everyone. It is even more important you have diabetes. Exercise in which your heart beats faster and you breathe faster helps lower your blood sugar level without medication. It also burns extra calories and fat so you can manage your weight. Exercise can help your health by improving blood flow and blood pressure. Exercise also increases the body’s energy level, lowers tension, and improves your ability to handle stress. Ask your health care provider before starting any exercise program. People with type 2 diabetes must take special steps before, during, and after intense physical activity or exercise. See also: Diabetes and exercise MEDICATIONS TO TREAT DIABETES If diet and exercise do not help keep your blood sugar at normal or near-normal levels, your doctor may prescribe medication. Since these drugs help lower your blood sugar levels in different ways, your doctor may have you take more than one drug. Some of the most common types of medication are listed below. They are taken by mouth or injection. • Alpha-glucosidase inhibitors (such as acarbose) • Biguanides (Metformin) • Injectable medicines (including exenatide, mitiglinide, pramlintide, sitagliptin, and saxagliptin) • Meglitinides (including repaglinide and nateglinide) • Sulfonylureas (like glimepiride, glyburide, and tolazamide) • Thiazolidinediones (such as rosiglitazone and pioglitazone). (Rosiglitazone may increase the risk of heart problems. Talk to your doctor.) These drugs may be given with insulin, or insulin may be used alone. You may need insulin if you continue to have poor blood glucose control. It must be injected under the skin using a syringe or insulin pen device. It cannot be taken by mouth. See also: Type 1 diabetes It is not known whether hyperglycemia medications taken by mouth are safe for use in pregnancy. Women who have type 2 diabetes and become pregnant may be switched to insulin during their pregnancy and while breast-feeding. PREVENTING COMPLICATIONS Your doctor may prescribe medications or other treatments to reduce your chances of developing eye disease, kidney disease, and other conditions that are more common in people with diabetes. See also: • Diabetes — preventing heart attack and stroke • Long-term complications of diabetes FOOT CARE People with diabetes are more likely to have foot problems. Diabetes can damage nerves, which means you may not feel an injury to the foot until you get a large sore or infection. Diabetes can also damage blood vessels. Diabetes also decreases the body’s ability to fight infection. Small infections can quickly get worse and cause the death of skin and other tissues. To prevent injury to your feet, check and care for your feet every day. See also: Diabetes foot care Support Groups For more information, see diabetes resources. Expectations (prognosis) After many years, diabetes can lead to serious problems with your eyes, kidneys, nerves, heart, blood vessels, or other areas in your body. If you have diabetes, your risk of a heart attack is the same as that of someone who has already had a heart attack. Both women and men with diabetes are at risk. You may not even have the normal signs of a heart attack. If you control your blood sugar and blood pressure, you can reduce your risk of death, stroke, heart failure, and other diabetes problems. Some people with type 2 diabetes no longer need medicine if they lose weight and become more active. When they reach their ideal weight, their body’s own insulin and a healthy diet can control their blood sugar levels. Complications After many years, diabetes can lead to serious problems: • You could have eye problems, including trouble seeing (especially at night), and light sensitivity. You could become blind. • Your feet and skin can develop sores and infections. After a long time, your foot or leg may need to be removed. Infection can also cause pain and itching in other parts of the body. • Diabetes may make it harder to control your blood pressure and cholesterol. This can lead to a heart attack, storke, and other problems. It can become harder for blood to flow to your legs and feet. • Nerves in your body can get damaged, causing pain, tingling, and a loss of feeling. • Because of nerve damage, you could have problems digesting the food you eat. You could feel weakness or have trouble going to the bathroom. Nerve damage can make it harder for men to have an erection. • High blood sugar and other problems can lead to kidney damage. Your kidneys may not work as well, and they may even stop working. Infections of the skin, female genital tract, and urinary tract are also more common. To prevent problems from diabetes, visit your health care provider or diabetes educator at least four times a year. Talk about any problems you are having. Calling your health care provider Call 911 right away if you have: • Chest pain or pressure • Fainting or unconsciousness • Seizure • Shortness of breath These symptoms can quickly get worse and become emergency conditions (such as convulsions or hypoglycemic coma). Call your doctor if you have: • Numbness, tingling, or pain in your feet or legs • Problems with your eyesight • Sores or infections on your feet • Symptoms of high blood sugar (being very thirsty, having blurry vision, having dry skin, feeling weak or tired, needing to urinate a lot) • Symptoms of low blood sugar (feeling weak or tired, trembling, sweating, feeling irritable, having trouble thinking clearly, fast heartbeat, double or blurry vision, feeling uneasy) Prevention You can help prevent type 2 diabetes by keeping a healthy body weight and an active lifestyle. Stay up-to-date with all your vaccinations and get a flu shot every year. References American Diabetes Association. Standards of medical care in diabetes–2011. Diabetes Care. 2011;34 Suppl 1:S11-S61. Eisenbarth GS, Polonsky KS, Buse JB. Type 1 Diabetes Mellitus. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR. Kronenberg: Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 31. Pignone M, Alberts MJ, colwell JA, Cushman M, Inzucchi SE, Mukherjee D, et al. Aspirin for primary prevention of cardiovascular events in people with diabetes: a position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation. Circulation. 2010;121:2694-2701. Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP, Sledge I. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009 Mar;122(3):248-256.e5. Review. PubMed PMID: 19272486. ACCORD Study Group, Gerstein HC, Miller ME, Genuth S, Ismail-Beigi F, Buse JB, et al. Long-term effects of intensive glucose lowering on cardiovascular outcomes. N Engl J Med. 2011;364:818-828. Alemzadeh R, Ali O. Diabetes Mellitus. In: Kliegman R, ed. 19th ed. Nelson Textbook of Pediatrics. Philadelphia, Pa: Saunders Elsevier; 2011: chap 583. Review Date: 6/28/2011 Diabetic Diva ~ What is the Relationship between Triglycerides and Diabetes? The triglyceride has been referred to as the “ugly fat” but that is more of an emotional response than one that is firmly anchored in scientific fact. Nonetheless its association with diabetes cannot be ignored. Cholesterol has already been identified as a risk factor for heart disease. There are countless adverts and information outlets which confirm the problems that are associated with an uncontrolled diet. Likewise there are pills and food choices which are promoted as part of the solution. Consumers get variable results depending on their genetic makeup and the stage at which the condition is arrested. Exercise programs are also recommended as part of a healthy living process. The question remains as to whether all these interventions have been effective or whether they are simply a way for the advertizing agencies to make even more money. • Bundles of fat that can cause havoc: By consensus, triglycerides are small bundles of fat which are found in the blood stream. They increase in number after we consume food. The body will manufacture these fats from the foods which we eat especially if they are fatty in nature. It has been estimated that 90% of all the fat content in non-lean meat consists of triglyceride. Therefore the shopping habits of the risk groups have to reflect this imminent danger. • Triglycerides are not universally bad: A balanced diet should contain all the relevant elements. It has been estimated that triglyceride have a proportion of 99% of all the fat stored within the human body. You get long term energy sources from these fatty deposits. They are actually stored in a denser from than muscle protein or even starch. Insulin is required in order to form fat. Between meals and overnight, the triglycerides are converted into energy. Fasting and low insulin levels will trigger this reaction. The fat cells have a very high storage capacity and this can lead to obesity in certain situations. If you are undergoing extensive fasting or there is absolutely no insulin in the body then the liver will convert the fat breakdown products into ketones. • The health complications and their manifestations: It is often the case the low levels of HDL or good cholesterol is associated with high levels of triglyceride. This is then diagnosed as diabetic dyslipidemia. This is a combination of factors that can place the life of the patient in danger. Patients in this situation will have small, dense and ultimately harmful clusters of LDL or harmful cholesterol. The latter format is undesirable by virtue of its atherogenic properties. Eventually the person will develop central obesity. This is one of the defining features of the metabolic syndrome. • Around 80% of all the people with type 2 diabetes will have this condition. Eventually the person will die prematurely from heart disease. • Setting the benchmarks for a healthy person: It is imperative that you have some goals on how much triglyceride which you are going to record on the standard scale. This is an indicator of underlying healthy conditions. Therefore you will be in a position to implement a preventative strategy when required to do so. The normal levels of triglycerides are 150 mg/dl. The borderline figure is between 150 and 199. The high level is between 200 and 499 while anything over 500 is a matter of urgency. The normal fasting state will have levels reading between 100 and 150 mg/dl. After a normal meal the figure will rise to 300. Patients with type 2 diabetes will have elevated levels in both the fasting and even state. Prior to the lipid panel test, you should have some overnight fasting for at least 12 hours. Likewise it is not advisable to take alcohol at least 24 hours prior to the test. • Managing the level of triglyceride in your body: It is to your advantage that you keep the levels of this substance relatively low. Patients with type 2 diabetes have high risk factors and need to work that bit extra to ensure that their levels are 150 mg/dl or even lower. This will help them reduce the possibility of developing cardiovascular diseases. Some people in this category have carried levels that are well over 400. Once you start hitting the 1000 mark then you will suffer skin lesions or xanthomas, memory loss, pancreatic and abdominal pain. Intervention is required at this stage in order to save your life. • The clinical response: A combination of medication and diet management can have positive results. First of all you have to aim for glucose control. A typical prescription will include Statins such as Zocor, Lipitor, Pravachol, Zetia, Crestor and Vytorin. These medications are meant to lower your cholesterol levels in general. Type 2 diabetes patients may require combination therapy in order to reach the safe levels of triglycerides. You also have to think of ways of lowering your LDL levels. Sometimes the clinician will recommend a series of Fibrates such as Lopid gemfibrozil, Trico fenofibrate and Nicotinic acid or niacin. It is also advisable to include fish oil in your diet. Having recognized the dangers that can arise from triglycerides in relation to diabetes, you should come up with practical lifestyle changes that will help you avoid the dangerous phases. In some instances you may have to restrict your fat intake completely. The problem is that this step can cause you to take even more carbohydrates and therefore increase the level of triglyceride in your bloodstream. Some books recommend substitution healthy fats such as olive oil and other monounsaturated fats. Do not increase your intake of sugar or white flour products. Alcohol intake should be kept to a minimum. Take oily fish such as tuna, sardines, salmon, mackerel and anchovies. They contain omega-3 fatty acids which are known to reduce triglycerides. Genetic disorders such as hypothyroidism can combine with diseases in order to exacerbate the situation. Taking drugs such as steroids, birth control pills and Tamoxifen can also be problematic. You are at risk if you suffer from kidney disease, liver failure and high blood pressure. The writer of this article is a blogger of ayurvedic health care tips. BEWARE ALWAYS NO STARCHY FOOD All food that you eat turns to sugar in your body. Carbohydrate-containing foods alter your sugar levels more than any other type of food. Carbohydrates are found in starchy or sugary foods, such as bread, rice, pasta, cereal, potatoes, peas, corn, fruit, fruit juice, milk, yogurt, cookies, candy, soda, and other sweets. Simple carbohydrates are broken down quickly by the body to be used as energy. Simple carbohydrates are found naturally in foods such as fruits, milk, and milk products. They are also found in processed and refined sugars such as candy, table sugar, syrups, and soft drinks. The majority of carbohydrate intake should come from complex carbohydrates (starches) and naturally occurring sugars rather than processed or refined sugars. All food that you eat turns to sugar in your body. Carbohydrate-containing foods alter your sugar levels more than any other type of food. Carbohydrates are found in starchy or sugary foods, such as bread, rice, pasta, cereal, potatoes, peas, corn, fruit, fruit juice, milk, yogurt, cookies, candy, soda, and other sweets. Exercises Food and insulin release Insulin is a hormone secreted by the pancreas in response to increased glucose levels in the blood. Glucose test . Monitor blood glucose – series Part one Set up the meter according to the specific directions that come with your meter. Get the supplies ready, including a new test strip and disposable lancet. Place the lancet into the lancing device. Rabu, 02 Mei 2012 PELATIHAN NASIONAL EDUKATOR DIABETES INDONESIA Jakarta, 21 April 2012 Menteri Kesehatan, diwakili oleh Direktur Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan (PP dan PL), Prof. dr. Tjandra Yoga Aditama, Sp.P(K), MARS, DTM&H, DTCE membuka secara resmi Pelatihan Nasional Edukator Diabetes Indonesia yang ke 10 yang diselenggarakan oleh Perhimpunan Edukator Diabetes Indonesia (PEDI) di Jakarta (20/4/12). Kementerian Kesehatan menyambut baik pelatihan ini, karena 4 hal, yang pertama Diabetes Mellitus (DM) merupakan masalah kesehatan penting di Indonesia, sebab DM merupakan penyebab kematian ke 6, prevalensi DM perkotaan 5,7%, dan prevalensi Toleransi Glukosa Terganggu 10,2%. Alasan kedua karena pengendalian DM haruslah merupakan continum care, dimana edukasi merupakan salah satu faktor amat penting. Kemudian para mereka yang sudah dilatih akan langsung dapat menangani pasien DM dan keluarganya sehingga mereka dapat tetap sehat, bugar dan mandiri. Sedangkan yang terakhir adalah pelatihan ini merupakan bentuk nyata partisipasi aktif masyarakat kesehatan untuk bersama pemerintah menanggulangi masalah kesehatan di Indonesia, dalam hal ini Diabetes Mellitus. Pelatihan berlangsung selama 3 hari dan diikuti lebih dari 200 peserta, terdiri dari dokter, perawat, diietesien, dan petugas lain. Pelatihan sudah berjalan 10 tahun dan mempunyai 3 tingkatan yaitu dasar, lanjut dan berkelanjutan. Metode pelatihan dalam bentuk : teori, loka karya, serta simulasi. Berita ini disiarkan oleh Pusat Komunikasi Publik, Sekretariat Jenderal Kementerian Kesehatan RI. welcome Dear iwansuwandy, Welcome to Diabetic Living Online! Congratulations on taking control now — we’re glad you’re here! We have the information to help you make the best choices for your health. You can live well with diabetes. Get immediate access and must-have information: •More than 1,000 delicious recipes guaranteed by the Better Homes and Gardens® Test Kitchen. •Practical and clear answers to your questions about carb counting, weight loss, diabetes meal plans, medications, and much more! •FREE recipes and tips delivered to your in-box each week. •FREE quick-start diabetes education course on What to Eat with Diabetes. •Great deals on Diabetic Living Magazine subscriptions. Be sure to find our page on Facebook and join our community of people with diabetes for support, information, and day-to-day tips on living well with diabetes. Here’s to our good health, Martha Miller Johnson Editor of Diabetic Living®, wife, mother, friend, PWD type 1 PATHOGENESIS OF DIABETIC NEUUOROPATHY Nerve Complications Elevated blood sugars can damage the peripheral nerves. Symptoms of neuropathy include: • pain, numbness, and tingling of hands and feet • muscle weakness such as trouble climbing stairs • nausea and vomiting • dizziness and lightheadedness Elevated levels of blood sugar can injure the blood vessels supplying the peripheral nerves, irritating and damaging them in the process. Such accumulated nerve damage is called diabetic neuropathy. Better blood glucose control can help restore healthy nerve function. Nerve Disease The nervous system includes our brain (central nervous system) and all of the nerves going from the brain to the rest of the body (peripheral nervous system). The nervous system is always at work. Sometimes – when we move or feel something – we are aware of it. But much happens automatically, including the control of our heart rate, the movement of food through the stomach and intestines and regulation of our blood pressure. Your health care provider can determine that your symptoms are related to diabetes and not to some other condition. The best way to improve all forms of diabetic neuropathy is to control your blood sugar levels. There are two categories of diabetic neuropathy: • Sensory and motor neuropathy • Autonomic neuropathy Symptoms of neuropathy include: • Pain, numbness, and tingling of hands and feet • Muscle weakness such as foot drop, double vision, trouble climbing stairs and getting out of a chair • Stomach symptoms including bloating, nausea, vomiting of undigested food many hours after a meal, feeling full without eating much food. This is also referred to as gastroparesis. • Bowel trouble such as episodes of diarrhea especially at night • Difficulty with bladder emptying • Sexual dysfunction • Dizziness and lightheadedness from a very fast heart rate and trouble keeping the blood pressure high enough when sitting or standing up. What is the treatment? Before any treatment can be decided upon, you need to report any of these symptoms to your health provider. Your provider needs to make sure that the symptoms are due to diabetic neuropathy and not something else. Near normal blood sugar control will usually improve all forms of diabetic neuropathy. Pain medications should be used as needed. Your provider may refer you to an doctor for specialized treatment and evaluation. Foot Complications Taking good care of your feet prevents serious complications. • Get regular foot exams that test for any nerve damage • Wash, dry and inspect your feet each day • Wear shoes and socks that fit • Control your blood glucose Foot problems are caused by neuropathy, poor circulation or a combination of both. The loss of feeling that comes with neuropathy is especially dangerous, as you may not be aware of cuts, blisters and bruises. The loss of sensation can change the way you walk or can damage bones and joints. Delays in treatment can lead to serious problems. Poor blood circulation means that less oxygen and fewer white blood cells that fight infection can get to a wound. It also means that antibiotic treatments that travel through the bloodstream are not as effective because they cannot get to the tissue in proper concentrations. Foot problems Foot problems include: • Changes in sensation from severe pain to numbness • Increased likelihood of infection (bacterial and fungal) • Slow wound healing • Deformation of the joints (Charcot joints, hammertoes, bunions, fallen arches) Recommendations: • If you have foot problems, consult a doctor right away. Early diagnosis can make a dramatic difference. Treatment for infection includes antibiotics and regular wound dressing. • Impaired circulation sometimes can be helped by blood vessel bypass. This procedure also may help heal wounds and ulcers in combination with skin or tissue growth factors. • Unfortunately, in advanced cases of poor circulation and uncontrolled infection, amputation may be necessary, usually just a toe or part of a bone is removed. In the most severe cases, it may necessary to remove part of the foot or leg. It is important to: • Get regular foot exams that test for any nerve damage • Not go barefoot • Not use sharp objects or over-the-counter chemical treatments such as corn/wart removers • Not use excessively hot water, electric blankets or heating pads, hot water bottles • Not smoke • Wash, dry and inspect your feet each day • Check between your toes • Wear shoes and socks that fit • Make sure there is nothing sharp or irritating in your shoes • Report corns and calluses and injuries that don’t heal to your medical provider • Cut toenails straight across and not too close to the quick; this will help prevent ingrown nails and associated infections • Control your blood glucose Eye Complications Eye problems range from minor changes to significant visual loss. Complications include: • Retinopathy • Cataracts • Macular edema • Glaucoma People with diabetes are at risk of eye problems, ranging from minor changes with no effect on vision to significant visual loss. With regular screening and eye exams by an eye doctor (ophthalmologist), and with stable and near normal blood glucose control, most of the serious complications can be avoided or successfully treated. Vision complications Putting off an eye exam is very risky. Usually there are few or no symptoms at the time the damage is occurring. Exams will reveal the problem and allow your eye doctor to treat it. Treatment can slow down the progression and maintain vision even in those who have developed significant eye complications. Eye complications include: • Retinopathy • Cataracts • Macular edema • Glaucoma Healthy eyes require that you: • Control your blood sugar • Control your blood pressure • Control your cholesterol • Don’t smoke and avoid second hand smoke • Use Ultra-violet protected eye glasses • See your ophthalmologist regularly and get retinal exams and eye pressure checked Symptoms of eye emergencies: • Loss of vision, • Holes in vision, • Showers of sparking white lights, • Black curtains over vision, • Spots of fuzzy print, hazy vision, If you have symptoms of any of the eye emergencies, seek medical care or contact your eye doctor immediately Self-assessment Quiz Self assessment quizzes are available for topics covered in this website. To find out how much you have learned about Diabetes Complications, take our self assessment quiz when you have completed this section. The quiz is multiple choice. Please choose the single best answer to each question. At the end of the quiz, your score will display. If your score is over 70% correct, you are doing very well. If your score is less than 70%, you can return to this section and review the information Quizzes Take quizzes! Test your knowledge about diabetes management, treatment, complications, and more. You may want to see how much you have learned using this website. Below are a series of self assessment quizzes. The questions cover the most important teaching points in each section. If you have trouble with a quiz, you may want to go back and review the section in the website. Read each section of the site and then take one of our self-assessment quizzes to test your new skills! • Coping With Your Emotions • Facts About Diabetes • Diabetes and Alcohol • Diabetes Complications • Diabetes and Exercise • Insulin Pumps • Managing Your Weight • Traveling with Diabetes • Understanding Carbohydrates • Understanding Fats and Oils • Understanding Food • Understanding Protein • Monitoring Your Type 1 Diabetes • Self-management Solutions for Type 1 Diabetes • Sick Days for Type 1 Diabetes • Treatment of Type 1 Diabetes • Monitoring Your Type 2 Diabetes • Self-management Solutions for Type 2 Diabetes • Sick Days for Type 2 Diabetes • Treatment for Type 2 Diabetes • Treatment of Type 2 Diabetes – Insulin Therapy Diabetes and Exercise Take the Diabetes and Exercise quiz. Test your knowledge about how exercise can help people with diabetes. The benefits of exercise include: Improved insulin sensitivity Lowered risk of heart disease Reduced stress and enhanced quality of life All of the above All of the answers are correct. Aerobic exercise, including brisk walking, swimming and cycling, has a long list of health benefits. Other benefits include reduced body fat, preserved bone mass and improved circulation. Managing Your Weight Take the Managing Your Weight quiz. Test your knowledge about tips and techniques for managing your weight. If you are overweight or obese, the health benefits of losing weight through diet and exercise include: Improved sensitivity to the action of insulin and improved blood sugar levels Lowered risk of developing heart disease, like heart attacks and stroke Prevention or delaying of serious health conditions, like breathing problems, joint and bone disorders All of the above. All of the answers are correct. However, the best answer is “All of the above”. While weight loss may prevent or delay serious health conditions, weight loss also lowers your risk for heart disease, decreases insulin resistance and improves blood sugar levels. Understanding Carbohydrates Take the Understanding Carbohydrates quiz. Test your knowledge about carbohydrates. Carbohydrates are found in which foods? Starch, fruit, milk, starchy vegetables Cheese, steak, chicken Olive oil, butter and fish Starch, fruit, milk, and starchy vegetables contain carbohydrate. Cheese, steak, chicken, and fish are types of protein, while olive oil and butter are types of fat. Understanding Food Take the Understanding Food quiz. Test your knowledge about food. What are the 3 primary sources of nutrition in a balanced diet? Carbohydrate, protein and fat Carbohydrate, protein and alcohol Fat, protein and leafy vegetables Carbohydrate, protein and fat are the 3 primary sources of nutrition in a balanced diet. While alcohol has calories, it is not one of the 3 main sources of nutrition in the diet. Leafy vegetables also have some carbohydrates, but they do not supply all of your daily carbohydrate requirements. Monitoring Your Type 1 Diabetes Take the Monitoring Your Type 1 Diabetes quiz. Test your knowledge about monitoring type 1 diabetes. Monitoring your blood glucose will: Ensure that your blood glucose levels stay normal Give you the feedback you need to keep your blood glucose in target range Not be necessary, as long as you eat right Monitoring alone does not change the blood glucose level, but the only way to know if you are keeping your blood glucose levels in the target range is to monitor your blood glucose. While it is important to eat a healthy diet, diet alone may not be sufficient. Monitoring your blood glucose will give you the feedback you need. Monitoring Your Type 2 Diabetes Take the Monitoring Your Type 2 Diabetes quiz. Test your knowledge about monitoring type 2 diabetes. Monitoring your blood glucose will: Ensure that your blood glucose levels stay normal Give you the feedback you need to keep your blood glucose in target range Not be necessary, as long as you eat right Monitoring alone does not change the blood sugar level, but it does help you know if your treatment plan is successful. The only way to find out if you are keeping your blood sugar levels in the target range is to monitor your blood sugar. Self-management Solutions for Type 1 Diabetes Take the Self-management Solutions for Type 1 Diabetes quiz. Test your knowledge about self-management solutions for type 1 diabetes. When your blood sugar is not well controlled, it is helpful to: Monitor your blood sugar at different times of the day such as before and after meals, bedtime, middle of the night, and whenever feeling low Keep a logbook of your blood sugar test results, food, activity/exercise and medication doses Discuss the problem with your medical provider All of the above All of the above All of the answers are correct. However, the best answer is “All of the above”. When your blood sugar is not well controlled, it is useful to monitor your blood sugar more frequently throughout the day including overnight. Also, keep a logbook of your blood sugar results, exercise/activity, the carbohydrate content of the food, and the insulin dose. You can review the log book with your medical provider to problem solve why you are having difficulty controlling your blood sugar. Self-management Solutions for Type 2 Diabetes Take the Self-management Solutions for Type 2 Diabetes quiz. Test your knowledge about self-management solutions for type 2 diabetes. When your blood sugar is not well controlled, it is helpful to: Monitor your blood sugar at different times during the day Keep a logbook of your blood sugar test results, food, exercise and medication doses Discuss the problem with your medical provider All of the above All of the answers are correct. However, the best answer is “All of the above”. When your blood sugar is not well controlled, it is useful to monitor your blood sugar more frequently and at different times of the day. Also, keep a logbook of your blood sugar results, exercise/activity, the carbohydrate content of the food, and medication doses (including insulin). You can review the log book with your medical provider to problem solve why you are having difficulty controlling your blood sugar. Diabetic Neurophaty treatment Research Front Maps Research front maps are diagrammatic representations of the core papers comprising each front. They are selected from the current Research Front set that are relevant to the featured special topic. The title for this Research Front Map is “DIABETIC NEUROPATHIC PAIN TREATMENT,” containing 30 core papers. Source dates: 1999-February 28, 2009 (first bimonthly period 2009). Each circle represents a highly cited paper whose bibliographic information is displayed when the user clicks on the circle. The solid lines between circles represent the strongest co-citation links for each paper (that is, indicating that the papers are frequently cited together); weaker links are indicated by dashed lines. Papers close to each other on the map are generally more highly co-cited. The most recent paper(s) are indicated in pink. Annotations may have been added to this map which represent the main research themes. These appear as labels attached to specific regions on the maps. Note: For best results use the “landscape orientation” option when printing this page. Treatment of Type 1 Diabetes Take the Treatment of Type 1 Diabetes quiz. Test your knowledge about type 1 diabetes treatment. The ultimate goal of insulin therapy is to mimic normal insulin levels. True False If you have type 1 diabetes, your body is no longer producing enough insulin. We try to mimic normal insulin levels with insulin injections or infusion through an insulin pump. Treatment for Type 2 Diabetes Take the Treatment quiz. Test your knowledge about diabetes treatment. Type 2 diabetes mellitus is treated with: Lifestyle changes – a healthy diet, adequate activity/exercise and, as needed, losing weight Pills that help return the blood sugar (plasma glucose) to the normal range Pills that increase the secretion of insulin from the pancreas Insulin All of the above All of the answers are correct. However, the best answer is “All of the above”. There are many different treatments for type 2 diabetes mellitus. Every treatment regimen starts with lifestyle changes – a healthy diet, adequate activity/exercise, and, as needed, losing weight. If lifestyle changes are not sufficient to control the blood sugar, then medications are added. Usually the first medication to be added is Metformin (a biguanide). It helps to return the blood sugar (plasma glucose) back to the normal, non-diabetic range. Other medications, including insulin, may be added to the metformin and lifestyle therapy. There is not a single treatment plan that is best for everyone. Talk with your provider about the best treatment plan for you. Metformin (a biguanide) Alpha-glucosidase inhibitors Diabetic blood circulation in foot People with diabetes are at risk for blood vessel injury, which may be severe enough to cause tissue damage in the legs and feet. The type one Isulin dependend diabetis mellitus A person with diabetes constantly manages their blood’s sugar (glucose) levels. After a blood sample is taken and tested, it is determined whether the glucose levels are low or high. If glucose levels are too low carbohydrates are ingested.� If glucose in the blood is too high, the appropriate amount of insulin is administered into the body such as through an insulin pump REFERENCES A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC’s accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.’s editorial reviewers. A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch). The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsements of those other sites. Copyright 2003 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited. Recognition of Any Warning Symptoms for Diabetic Neuropathy By Hendra Excel Recognition of any warning symptoms for DIABETIC NEUROPATHY happen to be for serious great importance given that that will lose him or her can get daily life switching or violent strikes. Diabetic neuropathy is certainly because of any the wall surfaces within the problematic veins who supply any phobia being more powerful. The decreases the option within the phobia that will run impulses back in the brain. Sorbitol at the same time methods together with gathers during the Schwann debris inducing deeper sensors conduction disadvantages. One can find several different types of neuropathies which can mode utilizing diabetes; polynueropathies together with mononeuropathies. When the warning symptoms seem to be would depend what precisely phobia components happen to be infected. Any warning symptoms may vary among the consumers as well as being impacted by the sum of hurt finished into the phobia. Many other warning symptoms consist of some sort of soreness problems, a good eliminating or simply blasting impression, or simply becoming like your story own frigid your feet. When the neuropathy progresses any warning symptoms consist of drunken sensations for problems, impression, environment, vibration, together with two-point discrimination. In order to remedy polyneuropathy is certainly thru direction within the diabetes again. Mononeuropathies happen to be remoted gatherings the fact that change simple phobia. Any warning symptoms for this style of neuropathy happen to be wholly impacted by which unfortunately a sensor is certainly infected. They’ll change any coulometer sensors which unfortunately lead to annoyance, total eye problems together with some sort of failing to safely move a person’s eye in any focus. Most of the victims of diabetes, irrespective of whether model 1 or simply model a pair of, have to pay attention to any warning symptoms for diabetic neuropathy. The sooner it is actually sent to the interest within the victims of diabetes health-related service providers the sooner it really is monitored thru adequate standard of living opportunities that will be devoted to eating routine, activity, together with adequate health related direction. Diabetic Neuropathy Remedy? The actual DIABETIC NEUROPATHY is actually neural harm to entire body extremities, your toes as well as fingers for instance, in addition neural harm to internal organs, digestive system and also the center for instance . Here Are the Actual Diabetic Neuropathy Treatments *The remedy with regard to diabetic neuropathy very first choice would be to manage the actual blood sugar amounts therefore you will find not really inconsistent levels as well as levels. Administration consists of diet plan as well as physical exercise, in addition medicine in the event that recommended. * In order to avoid heartburn, physicians claim that diabetes sufferers ought to consume lower foods as well as restrict body fat as well as meals full of dietary fiber. Additionally bloodstream stress medicines probably will advantage the actual diabetic as well. An average lotion is actually capsaicin lotion. The Actual Diabetic Neuropathy Details 1 most unfortunate problems associated with diabetes may be the neural harm already been brought on by diabetes. The actual diabetes neuropathy may cause moderate uneasiness for many people, while with regard to other people this particular condition is actually disabling as well as sometimes crucial. Here Are the Actual Diabetic Neuropathy Signs and Symptoms The actual DIABETIC NEUROPATHY signs and symptoms tend to be based on the kind as well as which anxiety which obtained impacted. The actual signs and symptoms consist of muscle mass coordination difficulties, heartburn, weak point, numbness, discomfort or even tingling (usually within the ft or even fingers), nausea or vomiting as well as bladder difficulties. It might curiosity you to definitely realize that extended blood sugar levels extreme conditions blood sugar levels that is possibly excessive or even as well reduced with regard to too much time could cause numerous problems, which can result in the diabetic coma. REFRENCES Core Papers ________________________________________ Label: Dworkin-2003 Title: Advances in neuropathic pain – Diagnosis, mechanisms, and treatment recommendations Journal: ARCH NEUROL, 60 (11): 1524-1534 NOV 2003 Citations: 274 Authors: Dworkin, RH;Backonja, M;Rowbotham, MC;Allen, RR;Argoff, CR;Bennett, GJ;Bushnell, MC;Farrar, JT;Galer, BS;Haythornthwaite, JA;Hewitt, DJ;Loeser, JD;Max, MB;Saltarelli, M;Schmader, KE;Stein, C;Thompson, D;Turk, DC;Wallace, MS;Watkins, LR;Weinstein, SM Addresses: Univ Rochester, Sch Med & Dent, Dept Anesthesiol, 601 Elmwood Ave,Box 604, Rochester, NY 14642 USA Univ Rochester, Sch Med & Dent, Dept Anesthesiol, Rochester, NY 14642 USA [Back to Map] Label: Dworkin-2003 Title: Pregabalin for the treatment of postherpetic neuralgia – A randomized, placebo-controlled trial Journal: NEUROLOGY, 60 (8): 1274-1283 APR 22 2003 Citations: 171 Authors: Dworkin, RH;Corbin, AE;Young, JP;Sharma, U;LaMoreaux, L;Bockbrader, H;Garofalo, EA;Poole, RM Addresses: Univ Rochester, Sch Med & Dent, 601 Elmwood Ave,Box 604, Rochester, NY 14642 USA Univ Rochester, Sch Med & Dent, Rochester, NY 14642 USA Pfizer Global Res & Dev, Ann Arbor, MI USA [Back to Map] Label: Ballantyne-2003 Title: Opioid therapy for chronic pain Journal: N ENGL J MED, 349 (20): 1943-1953 NOV 13 2003 Citations: 162 Authors: Ballantyne, JC;Mao, JR Addresses: Massachusetts Gen Hosp, Dept Anesthesia & Crit Care, Pain Ctr, 15 Parkman St,WACC 333, Boston, MA 02114 USA Massachusetts Gen Hosp, Dept Anesthesia & Crit Care, Pain Ctr, Boston, MA 02114 USA Harvard Univ, Sch Med, Boston, MA USA [Back to Map] Label: Goldstein-2005 Title: Duloxetine vs. placebo in patients with painful diabetic neuropathy Journal: PAIN, 116 (1-2): 109-118 JUL 2005 Citations: 144 Authors: Goldstein, DJ;Lu, YL;Detke, MJ;Lee, TC;Iyengar, S Addresses: Lilly Corp Ctr, Lilly Res Labs, Indianapolis, IN 46285 USA Lilly Corp Ctr, Lilly Res Labs, Indianapolis, IN 46285 USA PRN Consulting, Indianapolis, IN USA Indiana Univ, Sch Med, Dept Pharmacol & Toxicol, Indianapolis, IN 46202 USA Indiana Univ, Sch Med, Dept Psychiat, Indianapolis, IN 46202 USA McLean Hosp, Dept Psychiat, Belmont, MA 02178 USA Harvard Univ, Sch Med, Boston, MA USA [Back to Map] Label: Finnerup-2005 Title: Algorithm for neuropathic pain treatment: An evidence based proposal Journal: PAIN, 118 (3): 289-305 DEC 5 2005 Citations: 143 Authors: Finnerup, NB;Otto, M;McQuay, HJ;Jensen, TS;Sindrup, SH Addresses: Aarhus Univ Hosp, Danish Pain Res Ctr, Dept Neurol, Aarhus Sygehus, Norrebrogade 44, Aarhus 8000, Denmark Aarhus Univ Hosp, Danish Pain Res Ctr, Dept Neurol, Aarhus Sygehus, Aarhus 8000, Denmark Odense Univ Hosp, Dept Neurol, Odense 5000, Denmark Churchill Hosp, Pain Relief Unit, Oxford OX3 7LJ, England [Back to Map] Label: Gilron-2005 Title: Morphine, gabapentin, or their combination for neuropathic pain Journal: N ENGL J MED, 352 (13): 1324-1334 MAR 31 2005 Citations: 142 Authors: Gilron, I;Bailey, JM;Tu, DS;Holden, RR;Weaver, DF;Houlden, RL Addresses: Queens Univ, Dept Anesthesiol, 76 Stuart St, Kingston, ON K7L 2V7, Canada Queens Univ, Dept Anesthesiol, Kingston, ON K7L 2V7, Canada Queens Univ, Dept Pharmacol & Toxicol, Kingston, ON K7L 2V7, Canada Queens Univ, Dept Math & Stat, Kingston, ON K7L 2V7, Canada Queens Univ, Dept Epidemiol & Community Hlth, Kingston, ON K7L 2V7, Canada Queens Univ, Dept Psychol, Kingston, ON K7L 2V7, Canada Queens Univ, Dept Med, Div Endocrinol, Kingston, ON K7L 2V7, Canada Dalhousie Univ, Dept Med, Div Neurol, Halifax, NS, Canada Dalhousie Univ, Dept Chem, Halifax, NS, Canada [Back to Map] Label: Rosenstock-2004 Title: Pregabalin for the treatment of painful diabetic peripheral neuropathy: a double-blind, placebo-controlled trial Journal: PAIN, 110 (3): 628-638 AUG 2004 Citations: 141 Authors: Rosenstock, J;Michael, TB;LaMoreaux, L;Sharma, U Addresses: Dallas Diabet & Endo Res Ctr, 7777 Forest Lane,C618, Dallas, TX 75230 USA Dallas Diabet & Endo Res Ctr, Dallas, TX 75230 USA Palm Beach Neurol Ctr, Palm Beach Gardens, FL USA Pfizer Global Res & Dev, Ann Arbor, MI USA [Back to Map] Label: Rowbotham-2003 Title: Oral opioid therapy for chronic peripheral and central neuropathic pain Journal: N ENGL J MED, 348 (13): 1223-1232 MAR 27 2003 Citations: 127 Authors: Rowbotham, MC;Twilling, L;Davies, PS;Reisner, L;Taylor, K;Mohr, D Addresses: Univ Calif San Francisco, Sch Med, Pain Clin, Res Ctr,Dept Neurol, 1701 Divisadero St,Ste 480, San Francisco, CA 94115 USA Univ Calif San Francisco, Sch Med, Pain Clin, Res Ctr,Dept Neurol, San Francisco, CA 94115 USA Univ Calif San Francisco, Sch Med, Dept Anesthesia, San Francisco, CA 94115 USA Univ Calif San Francisco, Sch Pharm, San Francisco, CA 94115 USA [Back to Map] Label: Arnold-2004 Title: A double-blind, multicenter trial comparing duloxetine with placebo in the treatment of fibromyalgia patients with or without major depressive disorder Journal: ARTHRITIS RHEUM, 50 (9): 2974-2984 SEP 2004 Citations: 122 Authors: Arnold, LM;Lu, YL;Crofford, LJ;Wohlreich, M;Detke, MJ;Iyengar, S;Goldstein, DJ;Duloxetine Fibromyalgia Trial Grp Addresses: Univ Cincinnati, Coll Med, Med Arts Bldg,Suite 8200,222 Piedmont Ave, Cincinnati, OH 45219 USA Univ Cincinnati, Coll Med, Cincinnati, OH 45219 USA Eli Lilly & Co, Indianapolis, IN 46285 USA Univ Michigan, Ann Arbor, MI 48109 USA Indiana Univ, Sch Med, Indianapolis, IN USA Harvard Univ, Sch Med, Boston, MA 02115 USA McLean Hosp, Belmont, MA 02178 USA PRN Consulting, Indianapolis, IN USA [Back to Map] Label: Kalso-2004 Title: Opioids in chronic non-cancer pain: systematic review of efficacy and safety Journal: PAIN, 112 (3): 372-380 DEC 2004 Citations: 122 Authors: Kalso, E;Edwards, JE;Moore, RA;McQuay, HJ Addresses: Univ Helsinki, Pain Clin, Dept Anaesthesia & Intens Care Med, Cent Hosp, POB 340, FIN-00029 HUS, Finland Univ Helsinki, Pain Clin, Dept Anaesthesia & Intens Care Med, Cent Hosp, FIN-00029 HUS, Finland Univ Oxford, Oxford Radcliffe Hosp, Pain Res & Nuffield Dept Anaesthet, Oxford OX3 7LJ, England [Back to Map] Label: Goldenberg-2004 Title: Management of fibromyalgia syndrome Journal: JAMA-J AM MED ASSN, 292 (19): 2388-2395 NOV 17 2004 Citations: 119 Authors: Goldenberg, DL;Burckhardt, C;Crofford, L Addresses: Newton Wellesley Hosp, Dept Rheumatol, 2000 Washington St, Newton, MA 02462 USA Newton Wellesley Hosp, Dept Rheumatol, Newton, MA 02462 USA Tufts Univ, Sch Med, Dept Med, Boston, MA 02111 USA Oregon Hlth & Sci Univ, Sch Nursing, Portland, OR USA Univ Michigan, Sch Med, Dept Internal Med, Div Rheumatol, Ann Arbor, MI USA [Back to Map] Label: Lesser-2004 Title: Pregabalin relieves symptoms of painful diabetic neuropathy – A randomized controlled trial Journal: NEUROLOGY, 63 (11): 2104-2110 DEC 14 2004 Citations: 117 Authors: Lesser, H;Sharma, U;LaMoreaux, L;Poole, RM Addresses: 1415 Portland Ave,Suite 480, Rochester, NY 14621 USA Univ Rochester, Sch Med & Dent, Rochester, NY USA Pfizer Global Res & Dev, Ann Arbor, MI USA Pfizer Global Res & Dev, New London, CT USA [Back to Map] Label: Crofford-2005 Title: Pregabalin for the treatment of fibromyalgia syndrome – Results of a randomized, double-blind, placebo-controlled trial Journal: ARTHRITIS RHEUM, 52 (4): 1264-1273 APR 2005 Citations: 110 Authors: Crofford, LJ;Rowbotham, MC;Mease, PJ;Russell, IJ;Dworkin, RH;Corbin, AE;Young, JP;LaMoreaux, LK;Martin, SA;Sharma, U;Pregabalin 1008-15 Study Grp Addresses: Kentucky Clin, Room J-503,740 S Limestone St, Lexington, KY 40539 USA Kentucky Clin, Lexington, KY 40539 USA Univ Michigan, Ann Arbor, MI 48109 USA Univ Calif San Francisco, San Francisco, CA 94143 USA Rheumatol Associates, Seattle, WA USA Swedish Med Ctr, Seattle, WA USA Univ Texas, Ctr Hlth Sci, San Antonio, TX USA Univ Rochester, Sch Med & Dent, Rochester, NY USA Pfizer Global Res & Dev, Ann Arbor, MI USA [Back to Map] Label: Sabatowski-2004 Title: Pregabalin reduces pain and improves sleep and mood disturbances in patients with post-herpetic neuralgia: results of a randomised, placebo-controlled clinical trial Journal: PAIN, 109 (1-2): 26-35 MAY 2004 Citations: 108 Authors: Sabatowski, R;Galvez, R;Cherry, DA;Jacquot, F;Vincent, E;Maisonobe, P;Versavel, M;1008-045 Study Grp Addresses: Univ Cologne, Anasthesiol Klin, Dept Anaesthesiol, D-50924 Cologne, Germany Univ Cologne, Anasthesiol Klin, Dept Anaesthesiol, D-50924 Cologne, Germany Univ Hosp Virgen Nieves, Pain Clin, Granada, Spain Flinders Med Ctr, Bedford Pk, SA, Australia Pfizer Global Res & Dev, Fresnes, France [Back to Map] Label: Goldstein-2004 Title: Duloxetine in the treatment of depression – A double-blind-placebo-controlled comparison with paroxetine Journal: J CLIN PSYCHOPHARMACOL, 24 (4): 389-399 AUG 2004 Citations: 107 Authors: Goldstein, DJ;Lu, YL;Detke, MJ;Wiltse, C;Mallinckrodt, C;Demitrack, MA Addresses: Eli Lilly & Co, Lilly Corp Ctr, Lilly Res Labs, Indianapolis, IN 46285 USA Eli Lilly & Co, Lilly Corp Ctr, Lilly Res Labs, Indianapolis, IN 46285 USA PRN Consulting, Indianapolis, IN USA Indiana Univ, Sch Med, Dept Pharmacol & Toxicol, Indianapolis, IN 46204 USA Indiana Univ, Sch Med, Dept Psychiat, Indianapolis, IN 46204 USA McLean Hosp, Dept Psychiat, Belmont, MA 02178 USA Harvard Univ, Sch Med, Boston, MA 02115 USA Neuronet Inc, Malvern, PA USA [Back to Map] Label: Freynhagen-2005 Title: Efficacy of pregabalin in neuropathic pain evaluated in a 12-week, randomised, double-blind, multicentre, placebo-controlled trial of flexible- and fixed-dose regimens Journal: PAIN, 115 (3): 254-263 JUN 2005 Citations: 97 Authors: Freynhagen, R;Strojek, K;Griesing, T;Whalen, E;Balkenohl, M Addresses: Univ Klinikum Dusseldorf, Anasthesiol Klin, Moorenstr 5, D-40225 Dusseldorf, Germany Univ Klinikum Dusseldorf, Anasthesiol Klin, D-40225 Dusseldorf, Germany Dept Internal Dis Diabetol & Nephrol, Zabrze, Poland Pfizer Inc, New York, NY USA Pfizer Global Pharamceut, Freiburg, Germany [Back to Map] Label: Detke-2004 Title: Duloxetine in the acute and long-term treatment of major depressive disorder: a placebo- and paroxetine-controlled trial Journal: EUR NEUROPSYCHOPHARMACOL, 14 (6): 457-470 DEC 2004 Citations: 89 Authors: Detke, MJ;Wiltse, CG;Mallinckrodt, CH;McNamara, RK;Demitrack, MA;Bitter, I Addresses: Eli Lilly & Co, Lilly Corp Ctr, Lilly Res Labs, Indianapolis, IN 46285 USA Eli Lilly & Co, Lilly Corp Ctr, Lilly Res Labs, Indianapolis, IN 46285 USA Indiana Univ, Sch Med, Dept Psychiat, Indianapolis, IN 46202 USA McLean Hosp, Dept Psychiat, Belmont, MA 02178 USA Harvard Univ, Sch Med, Dept Psychiat, Boston, MA 02115 USA Neuronet Inc, Malvern, PA USA Semmelweis Univ Med, Dept Psychiat & Psychotherapy, H-1085 Budapest, Hungary [Back to Map] Label: Richter-2005 Title: Relief of painful diabetic peripheral neuropathy with pregabalin: A randomized, placebo-controlled trial Journal: J PAIN, 6 (4): 253-260 APR 2005 Citations: 83 Authors: Richter, RW;Portenoy, R;Sharma, U;Lamoreaux, L;Bockbrader, H;Knapp, LE Addresses: Beth Israel Med Ctr, Dept Pain Med & Palliat Care, 1st Ave 16th St, New York, NY 10003 USA Beth Israel Med Ctr, Dept Pain Med & Palliat Care, New York, NY 10003 USA St Johns Hosp, Dept Neurol, Tulsa, OK USA Pfizer Global Res & Dev, Ann Arbor, MI USA [Back to Map] Label: Raskin-2005 Title: A double-blind, randomized multicenter trial comparing duloxetine with placebo in the management of diabetic peripheral neuropathic pain Journal: PAIN MED, 6 (5): 346-356 SEP-OCT 2005 Citations: 78 Authors: Raskin, J;Pritchett, YL;Wang, FJ;D’Souza, DN;Waninger, AL;Iyengar, S;Wernicke, JF Addresses: Eli Lilly Canada, Lilly Res Labs, 3650 Danforth Ave, Toronto, ON MIN 2E8, Canada Eli Lilly Canada, Lilly Res Labs, Toronto, ON MIN 2E8, Canada Eli Lilly & Co, Lilly Corp Ctr, Lilly Res Labs, Indianapolis, IN 46285 USA [Back to Map] Label: Eisenberg-2005 Title: Efficacy and safety of opioid agonists in the treatment of neuropathic pain of nonmalignant origin – Systematic review and meta-analysis of randomized controlled trials Journal: JAMA-J AM MED ASSN, 293 (24): 3043-3052 JUN 22 2005 Citations: 75 Authors: Eisenberg, E;McNicol, ED;Carr, DB Addresses: Rambam Med Ctr, Pain Relief Unit, POB 9602, IL-31096 Haifa, Israel Rambam Med Ctr, Pain Relief Unit, IL-31096 Haifa, Israel Technion Israel Inst Technol, Haifa Pain Res Grp, Haifa, Israel Tufts New England Med Ctr, Dept Anesthesia, Boston, MA USA Tufts New England Med Ctr, Dept Pharm, Boston, MA USA Tufts New England Med Ctr, Div Clin Care Res, Boston, MA USA Tufts Univ, Sch Med, Boston, MA 02111 USA [Back to Map] Label: Arnold-2005 Title: A randomized, double-blind, placebo-controlled trial of duloxetine in the treatment of women with fibromyalgia with or without major depressive disorder Journal: PAIN, 119 (1-3): 5-15 DEC 15 2005 Citations: 68 Authors: Arnold, LM;Rosen, A;Pritchett, YL;D’Souza, DN;Goldstein, DJ;Iyengar, S;Wernicke, JF Addresses: Univ Cincinnati, Coll Med, Womens Hlth Res Program, Dept Psychiat, 222 Piedmont Ave,Suite 8200, Cincinnati, OH 45219 USA Univ Cincinnati, Coll Med, Womens Hlth Res Program, Dept Psychiat, Cincinnati, OH 45219 USA Lilly Res Labs, Indianapolis, IN USA Indiana Univ, Sch Med, Indianapolis, IN 46204 USA PRN Consulting, Indianapolis, IN 46204 USA [Back to Map] Label: Furlan-2006 Title: Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects Journal: CAN MED ASSN J, 174 (11): 1589-1594 MAY 23 2006 Citations: 63 Authors: Furlan, AD;Sandoval, JA;Mailis-Gagnon, A;Tunks, E Addresses: Toronto Western Hosp, Comprehens Pain Program, 399 Bathurst St,Rm 4F811, Toronto, ON M5T 2S8, Canada Toronto Western Hosp, Comprehens Pain Program, Toronto, ON M5T 2S8, Canada Univ Toronto, Ctr Study Pain, Toronto, ON, Canada Univ Toronto, Inst Work & Hlth, Toronto, ON, Canada Toronto Western Hosp, Krembil Neurosci Ctr, Toronto, ON M5T 2S8, Canada McMaster Univ, Chedoke Rehabil Ctr, Hamilton Hlth Sci Hosp, Hamilton, ON, Canada [Back to Map] Label: Attal-2006 Title: EFNS guidelines on pharmacological treatment of neuropathic pain Journal: EUR J NEUROLOGY, 13 (11): 1153-1169 NOV 2006 Citations: 50 Authors: Attal, N;Cruccu, G;Haanpaa, M;Hansson, P;Jensen, TS;Nurmikko, T;Sampaio, C;Sindrup, S;Wiffen, P Addresses: Hop Ambroise Pare, Ctr Evaluat & Traitement Douleur, EFNS Panel Neuropath Pain, Boulogne, France Hop Ambroise Pare, Ctr Evaluat & Traitement Douleur, EFNS Panel Neuropath Pain, Boulogne, France Hop Ambroise Pare, Ctr Evaluat & Traitement Douleur, INSERM, U792, Boulogne, France Univ Versailles St Quentin, Boulogne, France Univ Versailles St Quentin, Boulogne, France Univ Roma La Sapienza, Dept Neurol Sci, Rome, Italy Helsinki Univ Hosp, Dept Anaesthesiol, Pain Clin, Helsinki, Finland Helsinki Univ Hosp, Dept Neurosurg, Pain Clin, Helsinki, Finland Univ Hosp, Karolinska Inst, Dept Mol Med, Stockholm, Sweden Univ Hosp, Karolinska Inst, Surg Sect Clin Pain Res, Stockholm, Sweden Univ Hosp, Karolinska Inst, Pain Ctr, Dept Neurosurg, Stockholm, Sweden Aarhus Univ Hosp, Dept Neurol, DK-8000 Aarhus, Denmark Aarhus Univ Hosp, Danish Pain Res Ctr, DK-8000 Aarhus, Denmark Univ Liverpool, Pain Res Inst, Div Neurol Sci, Sch Clin Sci, Liverpool L69 3BX, Merseyside, England Univ Lisbon, Inst Farmacol & Terapeut Geral, Lisbon Sch Med, P-1699 Lisbon, Portugal Odense Univ Hosp, Dept Neurol, DK-5000 Odense, Denmark Cochrane Pain & Palliat Care Review Grp, Oxford, England [Back to Map] Label: Brannan-2005 Title: Duloxetine 60 mg once-daily in the treatment of painful physical symptoms in patients with major depressive disorder Journal: J PSYCHIAT RES, 39 (1): 43-53 JAN 2005 Citations: 50 Authors: Brannan, SK;Mallinckrodt, CH;Brown, EB;Wohlreich, MM;Watkin, JG;Schatzberg, AF Addresses: Eli Lilly & Co, Lilly Res Labs, Indianapolis, IN 46285 USA Eli Lilly & Co, Lilly Res Labs, Indianapolis, IN 46285 USA Cyberon, Houston, TX 77058 USA Stanford Univ, Dept Psychiat & Behav Sci, Stanford, CA 94305 USA [Back to Map] Label: Martell-2007 Title: Systematic review: Opioid treatment for chronic back pain: Prevalence, efficacy, and association with addiction Journal: ANN INTERN MED, 146 (2): 116-127 JAN 16 2007 Citations: 46 Authors: Martell, BA;O’Connor, PG;Kerns, RD;Becker, WC;Morales, KH;Kosten, TR;Fiellin, DA Addresses: Yale Univ, Sch Med, 333 Cedar St,POB 208025, New Haven, CT 06520 USA Yale Univ, Sch Med, New Haven, CT 06520 USA VA Connecticut Hlth Care Syst, West Haven, CT USA Univ Penn, Sch Med, Philadelphia, PA 19104 USA [Back to Map] Label: Ballantyne-2007 Title: Opioid dependence and addiction during opioid treatment of chronic pain Journal: PAIN, 129 (3): 235-255 JUN 2007 Citations: 32 Authors: Ballantyne, JC;LaForge, KS Addresses: Massachusetts Gen Hosp, Div Pain Med, Pain Ctr, 15 Parkman St,WACC 333, Boston, MA 02114 USA Massachusetts Gen Hosp, Div Pain Med, Pain Ctr, Boston, MA 02114 USA Harvard Univ, Sch Med, Boston, MA 02115 USA Univ Helsinki, Finnish Genome Ctr, FIN-00014 Helsinki, Finland [Back to Map] Label: Ives-2006 Title: Predictors of opioid misuse in patients with chronic pain: a prospective cohort study Journal: BMC HEALTH SERV RES, 6: art. no.-46 APR 4 2006 Citations: 29 Authors: Ives, TJ;Chelminski, PR;Hammett-Stabler, CA;Malone, RM;Perhac, JS;Potisek, NM;Shilliday, BB;DeWalt, DA;Pignone, MP Addresses: Univ N Carolina, Sch Med, Dept Med, Div Gen Internal Med, Chapel Hill, NC 27599 USA Univ N Carolina, Sch Pharm, Div Pharmacotherapy & Expt Therapeut, Chapel Hill, NC USA Univ N Carolina, Sch Med, Dept Pathol & Lab Med, Chapel Hill, NC USA Univ N Carolina Hlth Syst, Ctr Excellence Chron Illness Care, Chapel Hill, NC USA [Back to Map] Label: Arnold-2007 Title: Gabapentin in the treatment of fibromyalgia – A randomized, double-blind, placebo-controlled, multicenter trial Journal: ARTHRITIS RHEUM, 56 (4): 1336-1344 APR 2007 Citations: 28 Authors: Arnold, LM;Goldenberg, DL;Stanford, SB;Lalonde, JK;Sandhu, HS;Keck, PE;Welge, JA;Bishop, F;Stanford, KE;Hess, EV;Hudson, JI Addresses: Univ Cincinnati, Coll Med, Med Arts Bldg,222 Piedmont Ave,Suite 8200, Cincinnati, OH 45219 USA Univ Cincinnati, Coll Med, Cincinnati, OH 45219 USA Newton Wellesley Hosp, Newton, MA USA Tufts Univ, Sch Med, Boston, MA 02111 USA McLean Hosp, Belmont, MA 02178 USA Harvard Univ, Sch Med, Boston, MA 02115 USA [Back to Map] Label: Vinik-2007 Title: Lamotrigine for treatment of pain associated with diabetic neuropathy: Results of two randomized, double-blind, placebo-controlled studies Journal: PAIN, 128 (1-2): 169-179 MAR 2007 Citations: 28 Authors: Vinik, AI;Tuchman, M;Safirstein, B;Corder, C;Kirby, L;Wilks, K;Quessy, S;Blum, D;Grainger, J;White, J;Silver, M Addresses: Eastern Virginia Med Sch, Inst Diabet, 855 W Brandleton, Norfolk, VA 23510 USA Eastern Virginia Med Sch, Inst Diabet, Norfolk, VA 23510 USA Palm Beach Neurol Ctr, Palm Beach Gardens, FL USA Baumel Eisner Neuromed Inst, Bay Harbor, FL USA COR Clin Res, Oklahoma City, OK USA Pivotal Res Ctr, Peoria, AZ USA IMR, Towson, MD USA GlaxoSmithKline Inc, Res Triangle Pk, NC USA [Back to Map] Label: Raskin-2007 Title: Efficacy of duloxetine on cognition, depression, and pain in elderly patients with major depressive disorder: An 8-week, double-blind, placebo-controlled trial Journal: AMER J PSYCHIAT, 164 (6): 900-909 JUN 2007 Citations: 17 Authors: Raskin, J;Wiltse, CG;Siegal, A;Sheikh, J;Xu, J;Dinkel, JJ;Rotz, BT;Mohs, RC Addresses: Eli Lilly Canada, Lilly Res Labs, 3650 Danforth Ave, Toronto, ON M1N 2E8, Canada Eli Lilly Canada, Lilly Res Labs, Toronto, ON M1N 2E8, Canada Eli Lilly & Co, Lilly Res Labs, Indianapolis, IN 46285 USA Geriatr & Adult Psychiat LLC, Hamden, CT USA Stanford Univ, Sch Med, Dept Psychiat & Behav Sci, Stanford, CA 94305 USA [Back to Map] KEYWORDS: NEUROPATHIC PAIN TREATMENT; RANDOMIZED MULTICENTER TRIAL COMPARING DULOXETINE; DIABETIC PERIPHERAL NEUROPATHIC PAIN; CENTRAL NEUROPATHIC PAIN; NEUROPATHIC PAIN EVALUATED. [5770: (2002-2008_6) (CLI-NEU: ST Diabetes)]

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2 responses to “Diabetic Type 2 Communication Forum,Forum komunikasi Dibetes tipe 2 :Diabetic Type 2 And Related Info

  1. Pingback: Forum Komunikasi Dan Konsultasi Gratis Diabetes tipe 2 | Iwansuwandy's Blog

    • pplease all dibetic type 2 send info and cummonnicate with this forum
      silahkan para dibetes tipe 2 berkomunikasi liwat foryum ini untuk tukar informasi dan membaca penemuan baru terkait dengan diabetes tipe 2

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