Type 1 Diabetes is much less common than type 2, accounting for only 5-10% of diabetes cases. Unlike type 2 which is more common in older adults, type 1 is typically diagnosed before the age of 30. What is Type 1 Diabetes? Diabetes type 1 is an autoimmune disease in which the beta cells (insulin producing cells) located in the pancreas are destroyed over a period of time. The more beta cells are destroyed the less insulin that can be made. This results in a lifelong deficiency of insulin and dependency on insulin from external sources. Autoimmune refers to a condition in which the body mistakes its own cells (the beta cells) for invader cells and destroys them. While the exact cause is unknown, the autoimmune process is thought to be the result of genetic predisposition and an environmental trigger. This event sets off a chain reaction that causes the B cells of the immune system to creates proteins called antibodies that mark the beta cells and signal for their destruction by other parts of the immune response team. The CD4 and CD8T Cells are the soldiers who sniff out and destroy the tagged beta cells Progression of Type 1 Diabetes Before overt diabetes occurs the patient will be in a phase called pre-diabetes.

Type 2 Diabetes occurs when the body is unable to produce enough insulin to keep blood sugar at a healthy level and/or when the cells of the body are no longer responsive to the insulin that is being produced. Like Type 1 diabetes, the exact cause is unknown, but thought result from a combination of genetic predisposition and lifestyle factors. Lifestyle factors such as weight, food choices, substance use, physical activity level, and environment. Accounts for greater than 90% of diabetes cases. Type 2 used to be associated with older patients, but due to western lifestyles and increasing obesity rates in all ages is now becoming an epidemic in the youth as well. Progression of Type 2 Diabetes: Early in this disease the pancreas is able to overcome the bodies cellular resistance to insulin and maintain normal blood sugar levels by producing extra amounts of insulin (hyperinsulinemia). Over time the beta cells of the pancreas become fatigued and are unable to keep up with the insulin demand, which results in impaired (decreased) insulin production. This leads to chronically elevated blood sugar levels and the diagnosis of diabetes. Pre Diabetes- the beta cells are fatigued and there is an impairment in the secretion of insulin.

Elevated blood sugar over time can lead to a complication that affects many systems of the body from the heart to the eyes. One way to think of this is to think of how sugar mixes with water. When sugar is added to water, the result is a thicker substance that tends to be sticky. When blood sugar levels remain high for extended periods of time, the blood becomes thicker and harder to pump or flow through the vessels. This causes distress on the heart and body. When blood sugars remain high, there also tends to be more of a congregation of blood fats which can lead to thinks like heart attack and stroke. Types of Diabetes Complications Include: Cardiovascular Complications Dermatological Complications Eye Complications Kidney Complications Nerve Complications Peripheral Vascular Complications

Prevalence of Rheumatoid Arthritis Worldwide, the prevalence of RA is believed to be between 0.4 and 1.3 percent of the population. The incidence of rheumatoid arthritis in the United States is a little lower than the international average. In 2005, 1.5 million Americans—about 0.6 percent of the population were diagnosed with RA. In the United States, between 1995 and 2007, 41 people out of 100,000 were diagnosed with the condition. While RA can develop in the younger years, the likelihood of developing rheumatoid arthritis increases with age. The chances of being diagnosed with this disorder increase after 40, peak at 74 years of age, and then decline. What is Rheumatoid Arthritis? Rheumatoid arthritis (RA) is an autoimmune disorder of the joints that can lead to chronic pain and permanent disability if not treated properly. In rheumatoid arthritis, the patient’s own body basically attacks itself via the components of the immune system known as antibodies. Everyone has antibodies, which are designed to ward off infection and evict anything that is foreign to the body. In the RA patient, however, these antibodies mistake healthy tissues of the joint for enemies and attack those cells leading to a breakdown of the joint integrity.

Symptoms of Rheumatoid Arthritis The first sign of rheumatoid arthritis is generally going to be pain and inflammation in the smaller joints such as those in the fingers and toes. As the disease progresses, pain and inflammation spread to larger joints, including wrists, ankles, knees, shoulders, etc. Further progression of the disease involves erosion of the tissues at the joints, and this can lead to short-term or long-term deformity or loss of mobility. This deformity is more likely to present in hands and feet and can cause a deviation of the finger mimicking a swan neck in shape. In its more advanced state, rheumatoid arthritis often causes a condition known as rheumatoid nodules. These are cyst-like lumps of tissue that typically accumulate around pressure points like elbows. However, they can occur in any part of the body and have been known to compromise the patient’s lungs. Rheumatoid arthritis can lead to a number of other health issues including dry mouth and dry eyes, increased body fat in people who are not overeating, and carpal tunnel syndrome. The most serious complications of RA are hardening and blocking of arteries leading to and from the heart, leading to heart disease; scarring and inflammation of lungs; lymphoma; and liver damage.