Interviews: Is It Better To Disclose
Theres no law that requires you to disclose your diabetes, and employers arent allowed to ask about your medical background before offering you a job. Even if you choose to disclose your diabetes to your employer, your employer is required to keep that information confidential. Some job offers may depend on your ability to pass a medical evaluation after the initial offer, such as police officers or firefighters. However, these results will only affect your offer if they prevent you from doing your job or put your coworkers at risk.
Whether or not you talk about your diabetes is up to you. However, if your employer doesnt know about your diabetes, you may have a hard time proving discrimination based on your condition in the future. Let them know about hypoglycemia, hyperglycemia and other complications that can arise.
Is Type 1 Diabetes Dangerous
A person with untreated type 1 diabetes is at risk of developing DKA, which can be life threatening.
If they take too much insulin, they also face a risk of hypoglycemia, also known as low blood sugar. Symptoms
weeks or months after initial symptoms. Now, with medical help, it is possible for individuals with the condition to live a full and active life, although it may affect their life expectancy.
Research shows that people with type 1 diabetes will have a lifespan that is 12 years shorter, on average, than those without the disease. However, this will not be true for everyone. Genetic and other factors can affect a persons chance of developing specific complications. They may play a role in determining their outcome.
One potentially life threatening complication of diabetes is neuropathy, which is also known as nerve damage. The symptoms tend to peak 1520 years after a diabetes diagnosis. People who do not develop neuropathy by this time appear to have a higher chance of living into older age, according to some research. The outlook for type 1 diabetes is improving as new information and treatment options emerge.
Is Type 1 Diabetes An Autoimmune Disease
When type 1 diabetes is triggered by a virus, someone predisposed to autoimmune conditions may develop an autoimmune response. This means that their bodys immune system will start attacking its own cells. In type 1 diabetes, the body attacks the beta cells in the pancreas that are responsible for producing insulin.
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Managing Type 1 Diabetes Takes Constant Work And Planning I Never Get A Break
Type 1 diabetes is very unique, says Ramage. If Ive been diagnosed with type 1, Ive had one of my organs fail. And the pancreas is a vital organ, not like an appendix. Its key for glucose metabolism, which we need to live. Imagine if my heart stopped beating properly and that every 10 beats I was the one responsible for making sure its of that gravity, she says.
Diabetes never takes a break. I check my blood sugar around six times a day, and probably in the middle of the night at least three nights a week, says McKean. I also give insulin when I first wake up, and then anytime I eat or my blood sugar goes high during the day.
Even more taxing can be the mental energy required to manage type 1 diabetes. Theres constant thinking that goes into diabetes calculating how many carbs you’re eating, if it’s worth eating them, wondering if you’re a bit tired because your blood sugar is high or if you just didn’t sleep well, not to mention playing detective if your blood sugar is not what you expected, McKean says.
People with type 1 diabetes are just like the rest of us sometimes they wish they could just relax. My endocrinologist noted that my blood sugar levels are consistently in a good range during the week, but not so much on Saturday and Sunday, says Grady Cecile, 45, a senior services worker in North Carolina. I jokingly told him, Thats because I dont have diabetes on the weekend! In reality, having type 1 means being on every day of the week.
Type 1 And Type 2 Diabetes Are Distinct Conditions
Diabetes is a disorder in which the body has trouble regulating blood glucose, or blood sugar, levels. The two main types of diabetes are type 1 and type 2.
Type 1 diabetes is an autoimmune disease in which the immune system attacks and destroys the cells in the pancreas that make insulin. Insulin is a hormone that enables sugar to enter the bloodstream to be used by cells for energy or stored for later use. Without it, a person with type 1 diabetes cant process glucose and their blood sugar levels can get dangerously high.
Type 2 diabetes is a metabolic disorder the pancreas still produces insulin but is unable to use it effectively or the body has developed a resistance to it.
In general, theres not a lot of awareness about type 1 diabetes, says Melinda Ramage, FNP-BC, a certified diabetes educator practicing in Asheville, North Carolina. When you say diabetes, type 2 is what most people think of thats what the majority of the awareness campaigns have focused on. Many people falsely assume that all diabetes is the same.
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How Does Metformin Treat Diabetes
Many healthcare providers prescribe because it helps lower your blood sugar levels after meals and your bodys baseline blood sugar levels . Both of these measurements are important when it comes to managing prediabetes and type 2 diabetes and keeping blood sugar under control.
Metformin lowers blood sugar in 3 major ways:
How Diabetes Affects The Stomach
According to doctors, the other term for gastroparesis is diabetic stomach. Autonomic neuropathy that is the damaging of the vagus nerve, makes the movement of the food slow, thus retaining it for an extended period. This accumulation of solid mass in the stomach leads to awful pain and discomfort.
The principal cause of this has been owed to diabetes. Although it occurs in both type 1 and type 2 diabetes, but according to WHO, type 1 patients are more frequented by it. Type 1 diabetes stomach problems include irregular bowel movements, accidental bowel leakage, prolonged removal of the stomachs content and bloating of the stomach.
Normally, the surplus glucose in the body, if any, is flushed out through urine. However, a diabetic patient with high glucose level can acquire urinary tract infection due to the bacterial development in the excretory system. It can also result in the damage of nerves and kidney.
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Pathogenesis Of Gi Symptoms In Diabetes
In the broadest sense, GI symptoms in diabetes can be regarded as the outcome of a disordered gut-brain axis. Potential pathogenic factors include autonomic and peripheral neuropathy, structural and functional central nervous system changes , acute and chronic dysglycemia, psychological dysfunction, and pharmacotherapy. Specific pathogenic factors relevant to each section of the GI tract are discussed subsequently.
The putative association of GI symptoms with disordered GI motor function arising from irreversible autonomic neuropathy is long-standing . The few tests that specifically evaluate GI autonomic function are not widely available , and standardized tests of cardiovascular reflexes typically are used as a surrogate . Autonomic neuropathy, as assessed by these tests, is closely associated with symptoms and signs of peripheral neuropathy in diabetes . However, the relationships between GI symptoms and the presence of autonomic or peripheral neuropathy are weak .
Structural and functional changes in the CNS may influence the perception and generation of symptoms, with evidence of both gastric hypersensitivity and rectosigmoid hyposensitivity . Brock et al. investigated neurophysiological changes in a predominantly type 1 diabetes cohort and reported evidence of rectosigmoid hyposensitivity and bilateral anterior shifting of the insula and cingulate sources of brain activity, which correlated positively with postprandial fullness and nausea.
What Are The Contraindications To Taking Metformin
There are a few scenarios in which taking metformin is contraindicated .
- Kidney disease or poor kidney function
- Current or history of lactic acidosis
- Allergy or hypersensitivity to metformin
If you need radiological studies with intravenous contrast, like a CT scan, you should temporarily stop your metformin to prevent kidney problems. Also, people with liver disease, in general, should avoid using metformin because it increases your risk of developing lactic acidosis .
Cvd Screening And Treatment
Much of the existing data on the risk of CVD in individuals with diabetes is based on people with type 2 diabetes who often have additional CVD risk factors, such as metabolic syndrome, hypertension, and dyslipidemia. How much is applicable to people with type 1 diabetes is unknown. However, people with type 1 diabetes are at increased risk for CVD, particularly those with additional risk factors.
In type 1 diabetes, standard risk factors apply, such as hyperlipidemia, hypertension, age, family history, smoking, weight, and presence of albuminuria. As such, these should be considered when determining the need for evaluation and treatment for CVD. However, even in the absence of classic risk factors, there may be high CVD risk. An adult with childhood-onset type 1 diabetes of 20-year duration has a substantially increased risk of coronary artery disease of 1% per year , thus meriting high-intensity statin therapy according to the new joint American College of Cardiology/American Heart Association guidelines . In some cases, measurement of coronary artery calcification may be a helpful method for determining CVD risk . Here, as with all management issues for people with type 1 diabetes, providers need to individualize assessment and treatment options.
Chart Of Normal What Are The Early Signs Of Diabetes Blood Sugar
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Dm And The Balance Of Excitatory And Inhibitory Neurotransmitters
The main excitatory neurotransmitter of enteric nervous system is acetylcholine followed by neurokinin and substance P that are released by enteric motor neurons and have receptors on ICC-IM, mediating the contraction of smooth muscles. Inhibitory neurotransmission in enteric nervous system happens through non-adrenergic non-cholinergic pathway. Nitric oxide is the main inhibitory neurotransmitter, with neuronal nitric oxide being the rate controlling enzyme in its production within ENS, . Studies of animal models with DM have demonstrated that the sources of nitrergic nerve terminals are both from intrinsic motor neurons and vagal and parasympathetic afferents. The distribution of nitrergic neurons is not equal throughout the GI tract, with them being more prevalent in the stomach and proximal parts of the intestine, .
Few studies in human patients with DM have confirmed the findings from animal models. Studying the gastric tissue obtained from patients with gastric cancer and DM revealed that the expression of nNOS is markedly decreased in the antrum, especially in the areas that have reduced density of ICC. In another study, we examined the colonic tissue obtained during colonoscopy from patients with and without diabetes and demonstrated that the population of nNOS containing enteric neurons is reduced. In addition to NO, other inhibitory neurotransmitters such as neuropeptide Y and vasoactive intestinal peptide are also reported to be reduced in DM.
What Causes Gastroparesis
Gastroparesis is caused by nerve injury, including damage to the vagus nerve. In its normal state, the vagus nerve contracts the stomach muscles to help move food through the digestive tract. In cases of gastroparesis, the vagus nerve is damaged by diabetes. This prevents the muscles of the stomach and intestine from working properly, which keeps food from moving from the stomach to the intestines.
Anatomy of the stomach
Other causes of gastroparesis include:
- Viral infections.
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How T1d Is Managed
Type 1 diabetes is a 24/7 disease that requires constant management. People with T1D continuously and carefully balance insulin intake with eating, exercise and other activities. They also measure blood-sugar levels through finger pricks, ideally at least six times a day, or by wearing a continuous glucose monitor.
Even with a strict regimen, people with T1D may still experience dangerously high or low blood-glucose levels that can, in extreme cases, be life threatening. Every person with T1D becomes actively involved in managing his or her disease.
How Can I Manage My Symptoms
- Walk after you eat. This may help speed digestion.
- Follow the meal plan that your healthcare or dietitian gave you. This meal plan can help decrease your symptoms. The following may also help you manage your symptoms:
- Eat less fat and fiber. High-fat and high-fiber foods may be hard for your stomach to digest. You may need to avoid fruits and vegetables such as oranges and broccoli.
- Eat 4 to 6 small meals a day. Smaller, more frequent meals are easier for your stomach to handle.
- Drink more liquids with your meals. Your healthcare provider may recommend liquid meals, such as soup. Liquid is easier to digest than solid food.
- Ask if you should prepare your food in a blender. Blended foods are easier to digest. Ask for directions on which foods to use and how to blend the food correctly.
- Ask about vitamins you may need and how to add them to your meals.
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More Severe Symptoms Of Untreated Type 1 Diabetes
When type 1 diabetes goes untreated, it can lead to organ failure, coma, and even death. This happens because the body can no longer turn glucose into fuel, and it starts burning fat, which then produces ketones in the blood and urine.
A small amount of ketones aren’t dangerous and can usually be detected if a person has been fasting or is on a low-carbohydrate diet. But too many ketones can actually change the bloods acidity and result in a life-threatening condition called diabetic ketoacidosis.
If you have one or more of these symptoms contact your doctor.
Symptoms of type1 diabetes tend to look different in children than adults, according to Dr. Christofides.
Testing For Type 1 Diabetes
A simple blood test will let you know if you have diabetes. If youve gotten your blood sugar tested at a health fair or pharmacy, follow up at a clinic or doctors office to make sure the results are accurate.
If your doctor thinks you have type 1 diabetes, your blood may also be tested for autoantibodies that are often present with type 1 diabetes but not with type 2. You may have your urine tested for ketones , which also indicate type 1 diabetes instead of type 2.
Blood Glucose And Insulin
The pancreas has many islets that contain insulin-producing beta cells and glucagon-producing alpha cells.
Since diabetes is a disease that affects your body’s ability to use glucose, let’s start by looking at what glucose is and how your body controls it. Glucose is a simple sugar that provides energy to all of the cells in your body. The cells take in glucose from the blood and break it down for energy . The glucose in the blood comes from the food that you eat.
When you eat food, glucose gets absorbed from your intestines and distributed by the bloodstream to all of the cells in your body. Your body tries to keep a constant supply of glucose for your cells by maintaining a constant glucose concentration in your blood — otherwise, your cells would have more than enough glucose right after a meal and starve in between meals and overnight. So, when you have an oversupply of glucose, your body stores the excess in the liver and muscles by making glycogen, long chains of glucose. When glucose is in short supply, your body mobilizes glucose from stored glycogen and/or stimulates you to eat food. The key is to maintain a constant blood-glucose level.
To maintain a constant blood-glucose level, your body relies on two hormones produced in the pancreas that have opposite actions: insulin and glucagon.
Insulin and glucagon have opposite effects on liver and other tissues for controlling blood-glucose level
See the next page to learn about glucagon.
Applying For A Job With Diabetes
When you apply for a new job, your potential employer will want to find out if you fit the person specification and have the necessary skills and experience for the role. If you meet the needs of the job description, you should feel confident. Having diabetes doesnt mean youre less likely to get the job.
For most jobs, theres no legal obligation to tell an employer you have diabetes. The Equality Act makes it unlawful for them to ask about your health before offering you work.
But talking about your diabetes from the start can show that youre positive about your condition. It can even be an opportunity to give examples of how resourceful and well organised you are.
In some cases, the organisation may ask if you have a disability. For example:
- to find out if you need any support during the recruitment process,
- to increase the representation of disabled people in the organisation,
- if they have signed up to the ‘Disability Confident’ scheme, committing to offer disabled people an interview if they meet the minimum criteria for the role,
- or to monitor how many disabled people apply for jobs.
Telling them about your diabetes shouldnt affect your application. Any information you give them must be kept separate and confidential.
If you are applying for a job that involves driving, we have information on how to apply for a licence for different vehicles.
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