Neuropathy is a kidney disease that is caused by damaged capillaries (blood vessels) in the kidneys due to excess sugar in the blood. The kidneys are responsible for filtering the blood in the body and regulating blood pressure. When the amount of sugar in the blood exceeds what the kidneys are able to filter, the kidneys become fatigued and eventually be unable to function properly. As a result less blood is filtered causing  increased waste in the blood and fluid accumulates in the body. Hallmarks of early kidney disease: Albuminuria and high GFR. Aluminuria is protein in the urine due to an inability of the kidneys to filter the protein and it spilling into the urine. High GFR or  glomerular filtration rate is the rate in which the kidneys filter blood. Elevated GFR suggesting increased work of the kidneys due to excess sugar in the blood Hallmarks of later kidney disease: Protein in the urine, high serum creatinine, low GFR. A low GFR rate signals the kidneys are failing. Symptoms Symptoms vary based on stage of kidney failure, but include: Swelling of feet, legs, hands due to excess fluid in the body Electrolyte imbalance due to inability to filter blood properly too much potassium can cause heart arrhythmias Nausea Increased urination Shortness of breath due to excess fluid in the body Build up of waste in the blood leads to skin rashes fatigue itching confusion dizziness How to prevent/treat kidney disease Keep blood sugar  in healthy range and blood pressure below <130/70.

Diabetic Neuropathy is characterized by damage to the nerves due to chronically elevated blood sugar. The nerves are needed to carry signals from the brain to the body and affect all body systems. Therefore, while the most common symptoms of neuropathy involve the small nerves of the hands and feet, symptoms in other areas such as the gi tract, sex organs, and heart can also occur. Neuropathy is a very common condition for diabetic patients, nearly 60% of all people with diabetes will have some form of neuropathy ranging from mild to severe. Symptoms: may begin gradually or have a sudden onset reduced sensation in feet and hands numbness and tingling pain burning sensation weakness sexual dysfunction slowed digestion and constipation carpal tunnel syndrome loss of bladder control Treatment will be individualized based on symptoms, but prevention with tight blood sugar control is key. Treatment of pain Avoid alcohol Physical therapy/ massage Capsaicin and lidocaine patches Antidepressants Anticonvulsants *Tip: Make sure to also check for B-12 deficiency, which can also cause many of these symptoms. Normal B12 range is 200-900. Types of Neuropathy Peripheral Neuropathy Effects the nerves that control movement and sensation in the most distal portion of the body (feet/leg, hands/ arms)The most common form or neuropathySymptoms include numbness, tingling, burning, weakness, and increased sensation of the lower limpsPain occurs in 1 in 4 patientsTypically affects feet first then handsSymptoms are typically worse at night time Autonomic Neuropathy Effects the parasympathetic (relax) and sympathetic (fight or flight response) nerve fibers of the central nervous system May effect any organ in the body Gastric Bloating and feeling of fullness early in meal due to slowed digestion and delayed gastric emptying Nausea Vomiting Constipation Diarrhea Heartburn Genitourinary Loss of bladder control Impotence Cardiovascular Orthostatic (blood pressure that is affected by change in position) Cardiovascular disease

Patients with diabetes are 3 times more likely to develop PVD than non diabetic patients. Peripheral vascular disease is the reduction of blood flow to the muscles due to plaque. Plaque is a buildup of fat and cells that forms on the blood vessel walls, decreasing the space in the vessels for the blood to travel through. This results in a reduced amount of nutrient carrying blood reaching the muscles. Risks Smoking Hypertension High cholesterol Over age 50yr Symptoms Cramping of the leg muscles Muscle weakness and fatigue A sensation of heaviness in the legs Intermittent claudication pain in legs during activity which goes away after activity stops Ulcers open wounds which can lead to infection and limb amputation is not treated properly Treatment Lifestyle changes Stop smoking Low fat, low cholestrol diet Exercise Glucose control BP control Treatment of high cholesterol with statins Medications that inhibit platelt aggregation (prevent clot from forming) Medications that decrease blood thickness Atherectomy: surgical procedure where a catheter is inserted into the artery and then the plaque is removed from the vessel wall using a drill or balloon technique Tests ABI (ankle brachail index) is used to measure the flow of blood in your limbs Blood pressure cuff is placed on your ankle and bicep The highest pressure recorded at the ankle is divided by the highest pressure at arm Normal resting ankle bracial index is >1.0 Abnormal is <0.9 which signifies decreased blood flow Treadmill Test:

A1c is one of the most effects tests at measuring blood sugar levels over an extended period of time. The A1C test is used to track the amount of sugar in the blood over the past 3 months. The American Diabetes Association suggests at least two to three A1C tests a year for the best chances of diabetes management. A healthy and normal blood sugar level is a A1C of 5.7% or lower. Anything up to 6.4% usually signifies pre-diabetes and it is important for the individual to employ healthier nutrition in order to reduce the A1C levels in their body. Anything over 6.5% is officially labeled as type 2 diabetes and it can be reversed by significantly lowering the amount of blood sugar in the body. By making sure that you are taking the right steps towards lowering your A1C, you can avoid further complications and possibly reduce the effects of your diabetes. This guide shows six handy ways to lower your A1C. Read on for more information. 6 Ways to Lower Your A1C Level While everyone’s diabetes treatment plan will be personalized and individuals will have different A1C goals, the overall rule is to keep A1c levels below 6%. This can vastly improve health and prevent other debilitating conditions that may arise due to chronically high blood sugar levels.

Insulin is a common term in households with a diabetic patient. The injection and use of insulin is important part of a diabetic’s daily life. While insulin is mainly used by those with type 1 diabetes, it is often necessary for those with type 2 diabetes as well. There are many different insulin routines that a doctor may suggest. Since diabetes is a highly individualized disease, with symptoms and reactions differing from person to person, there are a variety of insulin therapy plans available. There are several ways to inject or use insulin and this guide can help you find a plan that works best for you. Insulin Use for Type 1 Diabetes Those with type 1 diabetes are usually put on a traditional syringe plan. The patient can inject insulin twice per day, gradually increasing the amount to three or four injections per day depending on the insulin type and need. Since each individual’s blood glucose levels are different, there are many different types of insulin available to assist with the maintaining of those glucose levels. With the frequent injection of insulin, those with type 1 diabetes can prevent stroke, nerve damage, kidney failure, and more. Insulin Use for Type 2 Diabetes Individuals with type 2 diabetes do often require insulin, but not as frequently as those with type 1 diabetes.