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Eating Disorders

Anorexia

Definition

Anorexia nervosa is an eating disorder in which a person has an aversion to food that results in starvation and an inability to stay at the minimum body weight considered healthy for their age and height.

Persons with this disorder may have an intense fear of weight gain, even when they are underweight. Not eating enough food or exercising too much results in severe weight loss.

See also:

Alternative Names

Eating disorder - anorexia

Causes

The exact causes of anorexia nervosa are unknown. Genetics and social attitudes towards body appearance may play a role. Some experts have suggested that conflicts within a family may contribute to this eating disorder.

Anorexia is eight times more common in people who have relatives with the disorder.

Risk factors include:

  • Being female
  • Eating and gastrointestinal problems during early childhood
  • Childhood anxiety
  • Increased concern or attention to weight and shape
  • Negative self-image
  • Accepting societal attitudes towards thinness
  • Perfectionism and other personality traits

Anorexia nervosa usually occurs in adolescence or young adulthood. It is more common in females. The eating disorder is seen mainly in Caucasian women who are high academic achievers and have a goal-oriented family or personality.

Symptoms

A person with anorexia may severely limit the amount of food they eat, or eat and then make themself throw up. They may also use diuretic (water) pills and laxatives to lose weight.

Most individuals with anorexia nervosa do not recognize that they have an eating disorder.

Behaviors that may be noticed in a person with anorexia may include:

  • Going to the bathroom right after meals
  • Quickly eating large amounts of food
  • Compulsive exercising
  • Cutting food into small pieces
  • Restricting how much food they eat
  • Inappropriate use of laxatives, enemas, or diuretics (water pills) in an effort to lose weight

Symptoms may include:

  • Extreme weight loss (15% or greater below the expected weight)
  • Wasting away of muscle and loss of body fat
  • Poor memory or poor judgement
  • Confused or slow thinking
  • Very sensitive to cold (wearing several layers of clothing to stay warm)
  • No menstruation
  • Low blood pressure
  • Dental cavities due to self-induced vomiting
  • Dry mouth
  • Blotchy or yellow skin
  • Fine hair
  • Depression

Exams and Tests

A diagnosis of anorexia nervosa is not made until other causes of weight loss are ruled out. For example, extreme weight loss could be due to celiac disease, inflammatory bowel disease, Addison's disease, and many other metabolic, endocrine, digestive, or nervous system disorders.

Tests will be done to help determine the cause of weight loss or to determine what damage the weight loss has caused cause. They may include:

Treatment

The biggest challenge in treating anorexia nervosa is having the person recognize that their eating behavior is itself a problem, not a solution to other problems. However, most persons with anorexia nervosa deny that they have an eating disorder. Individuals often enter treatment when their condition is fairly advanced.

The goal of treatment is first to restore normal body weight and eating habits, and then attempt to resolve psychological issues.

A hospital stay may be needed if:

  • The person has lost a lot of weight (below 30% of their ideal body weight for their age and height)
  • Weight loss continues despite treatment
  • Medical complications, such as heart rate problems, changes in mental status, low potassium levels, or mental status problems, develop
  • The person has severe depression or thinks about committing suicide

Other treatment may include:

  • Antidepressant drug therapy for depression
  • Behavioral therapy
  • Psychotherapy
  • Supportive care

Severe and life-threatening malnutrition may require feedings through a vein.

Support Groups

See: Eating disorders - support group

Outlook (Prognosis)

Anorexia nervosa is a serious and potentially deadly medical condition. By some estimates, it leads to death in 10% of cases. Experienced treatment programs have a good success rate in restoring normal weight, but relapse is common.

Women who develop this eating disorder at an early age have a better chance of complete recovery. However, most people with anorexia will continue to prefer a lower body weight and be preoccupied with food and calories to some extent. Weight management may be difficult, and long-term treatment may be necessary to help maintain a healthy body weight.

Possible Complications

Complications can be severe. A hospital stay may be needed.

Complications may include:

  • Severe dehydration, possibly leading to shock
  • Electrolyte imbalance (such as potassium insufficiency)
  • Cardiac arrhythmias
  • Severe malnutrition
  • Thyroid gland deficiencies which can lead to cold intolerance and constipation
  • Appearance of fine baby-like body hair (lanugo)
  • Bloating or edema
  • Decrease in white blood cells which leads to increased susceptibility to infection
  • Osteoporosis
  • Tooth erosion and decay
  • Seizures related to fluid shifts due to excessive diarrhea or vomiting

When to Contact a Medical Professional

Talk to your doctor if your child is restricting his or her food intake, over-exercising, or is excessively preoccupied with weight. Getting early medical help before abnormal patterns are established can reduce the severity of an eating disorder.

Prevention

In some cases, prevention may not be possible. Encouraging healthy, realistic attitudes toward weight and diet may be helpful. Sometimes, counseling can help.

References

American Psychiatric Association. Treatment of patients with eating disorders, third edition. American Psychiatric Association. Am J Psychiatry. 2006 Jul;163(7 Suppl):4-54.

Berkman ND, Lohr KN, Bulik CM. Outcomes of eating disorders: a systematic review of the literature. Int J Eat Disord. 2007 May;40(4):293-309.

Bulik CM, Berkman ND, Brownley KA, Sedway JA, Lohr KN. Anorexia nervosa treatment: a systematic review of randomized controlled trials. Int J Eat Disord. 2007 May;40(4):310-20.

Marcus MD. Eating disorders. In: Goldman L, Ausiello D. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders; 2007:chap 238.

Morris J, Twaddle S. Anorexia nervosa. BMJ. 2007 Apr 28;334(7599):894-8.

Schmidt U, Lee S, Beecham J, et al. A randomized controlled trial of family therapy and cognitive behavior therapy guided self-care for adolescents with bulimia nervosa and related disorders. Am J Psychiatry. 2007 Apr;164(4):591-8.


Review Date: 6/28/2008
Reviewed By: Timothy A. Rogge, MD, private practice in Psychiatry, Kirkland, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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 an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. 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 policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics 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 medical professional 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. © 1997- 2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Obesity

Definition

Obesity is a term used to describe body weight that is much greater than what is considered healthy. If you are obese, you have a much higher amount of body fat than lean muscle mass.

Adults with a body mass index (BMI) greater than 25 but less than 30 are considered overweight.

Adults with a BMI greater than 30 are considered obese.

Anyone more than 100 pounds overweight or with a BMI greater than 40 is considered morbidly obese.

Alternative Names

Morbid obesity; Fat - obese

Causes

Rates of obesity are climbing. The percentage of children who are overweight has doubled in the last 20 years. The percentage of adolescents who are obese has tripled in the last 20 years.

Consuming more calories than you burn leads to being overweight and, eventually, obesity. The body stores unused calories as fat. Obesity can be the result of:

  • Eating more food than the body can use
  • Drinking too much alcohol
  • Not getting enough exercise

Certain thyroid problems may also lead to signficant weight gain. Genetic factors play some part in the development of obesity -- children of obese parents are 10 times more likely to be obese than children with parents of normal weight.

Obesity is a significant health threat. The extra weight puts unusual stress on all parts of the body. It raises your risk of diabetes, stroke, heart disease, kidney disease, and gallbladder disease. Conditions such as high blood pressure and high cholesterol, which were once thought to mainly affect adults, are often seen in children who are obese. Obesity may also increase the risk for some types of cancer. Persons who are obese are more likely to develop osteoarthritis and sleep apnea.

Exams and Tests

The health care provider will perform a physical exam and ask questions about your medical history, eating habits, and exercise routine.

Skin fold measurements may be taken to check your body composition.

Blood tests may be done to look for thyroid or endocrine problems, which could lead to weight gain.

Treatment

DIET AND EXERCISE

A combination of dieting and exercise (when you stick to it) appears to work better than either one alone. Sticking to a weight reduction program is difficult and requires a lot of support from family and friends.

When dieting, your main goal should be to learn new, healthy ways of eating and make them a part of your everyday routine. Work with your doctor and nutritionist to set realistic, safe daily calorie counts that assure both weight loss and good nutrition. Remember that if you drop pounds slowly and steadily, you are more likely to keep them off. Your nutritionist can teach you about healthy food choices, appropriate portion sizes, and new ways to prepare food.

Even modest weight loss can improve your health. For most people, weight can be lost by eating a healthier diet, exercising more, and adopting new behaviors such as keeping a food diary, avoiding food triggers, and thinking positively.

The decision to keep fit requires a lifelong commitment of time and effort. Patience is essential. You should always check with your health care provider before you begin any new form of exercise.

Several simple behavioral changes can have an impact on your weight loss success:

  • Eat only at the table. No snacking in front of the TV, in bed, while driving, or while standing in front of the open refrigerator.
  • Learn about appropriate portion sizes.
  • Consider learning meditation or yoga as a way of managing stress, rather snacking.
  • Find ways to socialize and enjoy your friends and family that don't involve a meal or dessert.
  • Consider keeping a diet and exercise journal. This may help you identify overeating triggers in your life.
  • Find a support group or consider psychotherapy to help support you in the difficult but worthy goal of weight loss.

Exercise can also help control some of the diseases associated with obesity, including high blood pressure, heart disease, diabetes, osteoporosis, and certain cancers. Exercise is also a major mood lifter, a great way to increase energy, and will help strengthen your bones.

MEDICATIONS AND HERBAL REMEDIES

There are many over-the-counter diet products. Most do not work and some can be dangerous. Before using one, talk to your health care provider.

Several prescription weight loss drugs are available. Such medicines include subutramine (Meridia) and orlistat (Xenical). Ask your health care provider if these are right for you.

While weight loss drugs in general have shown some benefit, the overall weight loss achieved is generally limited. In addition, people will usually regain the weight when they discontinue the medication, unless they have made lasting lifestyle changes.

SURGERY

Surgery may be an option for persons who are morbidly obese and who cannot lose weight using other methods. Weight loss surgery, such as placing adjustable bands around the stomach and gastric bypass surgery, can significantly improve weight and health in the right candidate. Talk to your doctor to learn if this is a good option for you.

Support Groups

Many people find it easier to follow a diet and exercise program if they join a group of people with similar problems.

See: Eating disorders - support group

Possible Complications

Medical problems commonly resulting from untreated obesity and morbid obesity include:

Obesity can lead to a gradual decrease in the level of oxygen in your blood, a condition called hypoxemia. Persons who are obese may temporarily stop breathing while asleep (sleep apnea). Decreased blood oxygen levels and sleep apnea may cause a person to feel sleepy during the day. The conditions may also lead to high blood pressure and pulmonary hypertension. In extreme cases, especially when left untreated, this can lead to right-sided heart failure and ultimately death.

When to Contact a Medical Professional

Schedule an appointment with your health care provider if you or your child are obese or gaining weight at an extremely rapid rate. Remember that catching the problem early is much simpler than trying to fix it after the person has gained an excessive amount of weight.

Prevention

A healthy diet and regular exercise can help prevent weight gain. Increase your daily activity. Take the stairs rather than the elevator, or walk instead of driving (when possible).

See also:

References

DeMaria EJ. Bariatric surgery for morbid obesity. N Engl J Med. 2007;356(21): 2176-2183.

Gardner CD, Kiazand A, Alhassan S, et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. JAMA. 2007;297(9): 969-977.

Hughes AR, Stewart L, Chapple J, et al. Randomized, controlled trial of a best-practice individualized behavioral program for treatment of childhood overweight: Scottish Childhood Overweight Treatment Trial (SCOTT). Pediatrics. 2008;121(3):e539-546.

Thompson WG, Cook DA, Clark MM, et al. Treatment of obesity. Mayo Clin Proc. 2007;82(1):93-101

Svetke, LP, Stevens VJ, Brantley PJ, et al. Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial. JAMA. 2008;299(10):1139-48.

Lichtenstein AH, Appel LJ, Brands M, et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation. 2006;114:82-96.

Kaplan LM, Klein S, Boden G, Brenner DA, Gostout CJ, Lavine JE, Popkin BM, Schirmer BD, Seeley RJ, Yanovski SZ, Cominelli F. Report of the American Gastroenterological Association (AGA) Institute Obesity Task Force. Gastroenterology. 2007;132(6):2272-5.

Tsai WS, Inge TH, Burd RS. Bariatric surgery in adolescents: recent national trends in use and in-hospital outcome. Arch Pediatr Adolesc Med. 2007;161(3):217-21.


Review Date: 9/7/2008
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Decreased Appetite

Definition

Appetite is the desire to eat. A decreased appetite is when you have a reduced desire to eat. This occurs despite the body's basic caloric (energy) needs.

Alternative Names

Loss of appetite; Decreased appetite

Considerations

Any illness can affect a previously hearty appetite. If the illness is treatable, the appetite should return when the condition is cured.

Loss of appetite can cause unintentional weight loss.

Depression in the elderly is a common cause of weight loss that is not explained by other factors.

Causes

  • Anorexia nervosa
  • Cancer
  • Chronic liver disease
  • Chronic kidney failure
  • Emotional upset, nervousness, loneliness, boredom, tension, anxiety, loss, and depression
  • HIV
  • Hypothyroidism
  • Infections
  • Medications and street drugs
    • Amphetamines
    • Antibiotics
    • Chemotherapy drugs
    • Codeine
    • Cough and cold medications
    • Digitalis
    • Demerol
    • Morphine
    • Sympathomimetics, including ephedrine
  • Pregnancy (first trimester)

Home Care

Increase protein and calorie intake by eating high-calorie, nutritious snacks or several small meals during the day. Liquid protein drinks may be helpful.

Family members should try to supply favorite foods to help stimulate the person's appetite.

Keep a record of what you eat and drink for 24 hours. This is called a diet history.

If a person with anorexia nervosa consistently exaggerates food intake, someone else should keep strict calorie and nutrient counts.

For loss of appetite caused by taking medications, ask your health care provider about changing the dosage or drug. Never stop taking medications without first talking to your health care provider.

See also: Weight management

When to Contact a Medical Professional

Call your health care provider if you are losing a lot of weight without trying.

What to Expect at Your Office Visit

Your doctor will perform a physical exam and will check your height and weight. Your diet and medical history will be reviewed. The doctor wll ask questions about your decreased appetite, including:

  • Quality
    • Is the decreased appetite severe or mild?
    • How much weight have you lost?
  • Time pattern
    • Is loss of appetite a new symptom?
    • If so, did it start after an upsetting event, such as the death of a family member?
  • What other symptoms are present?

Tests that may be done to determine the cause of a decreased appetite may include:

In cases of severe malnutrition, nutrients are given through a vein (intravenously). This may require a hospital stay.


Review Date: 7/22/2008
Reviewed By: Linda Vorvick, MD, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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 an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. 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 policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics 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 medical professional 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. © 1997- 2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Increased Appetite

Definition

Increased appetite means you have an excess desire for food.

Alternative Names

Hyperphagia; Increased appetite; Hunger; Excessive hunger; Polyphagia

Considerations

An increased appetite can be a symptom of different diseases. For example, it may be due to certain mental conditions and endocrine gland disorders.

An increased appetite can come and go (intermittent), or it can last for long periods of time (persistent), depending on the cause. It does not always result in weight gain.

The terms "hyperphagia" and "polyphagia" refer to someone who is focused only on eating, or who eats excessively before feeling full.

Causes

Causes of increased appetite include:

Home Care

Emotional support, and in some cases counseling, are recommended.

If a medication is causing increased appetite and weight gain, your health care provider may decrease your dosage or recommend a different drug. Never stop taking your medication without first talking to your health care provider.

When to Contact a Medical Professional

Contact your health care provider if:

  • You have an unexplained, persistent increase in appetite
  • You have other unexplained symptoms

What to Expect at Your Office Visit

Your health care provider will perform a physical exam. During the physical examination, the health care provider will probably weigh you. You also may have a psychological evaluation

The doctor will ask you questions about your medical history, with emphasis on your eating habits. Questions may include:

  • Eating habits
    • Have you changed your eating habits?
    • Have you begun dieting?
    • Do you have concerns about your weight?
    • What do you eat in a typical day?
    • How much do you eat?
  • Medication
    • What medications are you taking?
    • Are you taking any new medications, or have you changed the dose of your medications?
    • Do you use any illicit drugs? If so, which ones?
  • Time pattern
    • Does the hunger occur during the sleep period?
    • Does the hunger seem to occur in a pattern related to your menstrual cycle?
  • Other
    • What other symptoms are you having at the same time?
    • Have you noticed an increase in anxiety?
    • Do you frequently urinate?
    • Do you have an increased heart rate?
    • Do you have palpitations?
    • Do you feel more thirsty?
    • Have you had an unintentional weight gain?
    • Do you experience intentional or unintentional vomiting?

Tests that may be done includee:

References

Jensen MD. Obesity. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 239.

Saper CB. Autonomic disorders and their management. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 445.


Review Date: 11/16/2008
Reviewed By: Linda Vorvick, MD, Family Physician, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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 an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. 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 policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics 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 medical professional 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. © 1997- 2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

 

Binge Eating

Definition

Binge eating is a disorder characterized by eating more than a person needs to satisfy hunger.

Alternative Names

Eating - binge

Considerations

The eating disorder bulimia is most common among female adolescents or young adults. People with bulimia typically consume large quantities of easily ingested high-calorie foods, usually in secrecy. This binge eating is usually followed by self-induced vomiting and accompanied by feelings of guilt or depression.

Complications resulting from prolonged bulimia include gastric dilatation, pancreatitis, dental decay, pharyngitis, esophagitis, pulmonary (lung) aspiration, and electrolyte abnormalities. Constipation and hemorrhoids are also common in people with bulimia.

Although death from bulimia is rare, the long-term outcome in severe bulimia can be worse than the outcome in anorexia nervosa, which suggests that the psychiatric disorder that causes bulimia is usually more severe.

Causes

While binge eating often begins during or after strict dieting, and may be caused by stress related to insufficient food intake, its cause remains unknown.

Home Care

Take measures to reduce stress and improve overall health.

Medication is usually not necessary for this disorder. However, antidepressants, as prescribed by a doctor, are often helpful. Supportive care and counseling are recommended. Individual, group, family, and behavioral therapy may provide some help.

When to Contact a Medical Professional

  • bulimia is suspected

What to Expect at Your Office Visit

The health care provider will perform a physical examination. A history of the person's eating patterns may be sought from one or more family members because the person may not acknowledge that they are binge eating.

Medical history questions documenting binge eating in detail may include:

  • How long has this been occurring?
  • Are "purge" behaviors (such as self-induced vomiting or laxative abuse) also present?
  • What other symptoms are also present?

Possible diagnostic tests include blood studies, such as electrolyte levels.

INTERVENTION

Behavior is usually controlled with counseling, biofeedback training (a process of monitoring body functions and altering these functions through relaxation), and individual or group psychotherapy.

References

Schmidt U, Lee S, Beecham J, et al. A randomized controlled trial of family therapy and cognitive behavior therapy guided self-care for adolescents with bulimia nervosa and related disorders. Am J Psychiatry. 2007;164:591-598.


Review Date: 2/27/2008
Reviewed By: Rachel A. Lewis, MD, FAAP, Columbia University Pediatric Faculty Practice, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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 an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. 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 policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics 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 medical professional 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. © 1997- 2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Bulimia

Definition

Bulimia is an illness defined by food binges or recurrent episodes of significant overeating accompanied by a sense of loss of control. The affected person then uses various methods -- such as vomiting or laxative abuse -- to prevent weight gain.

Many, but not all, people with bulimia may also have anorexia nervosa, another eating disorder.

Alternative Names

Bulimia nervosa; Binge-purge behavior; Eating disorder - bulimia

Causes

In bulimia, eating binges may occur as often as several times daily for many months. These binges cause a sense of self-disgust, which leads to compensatory behaviors like self-induced vomiting or excessive exercise. A person with bulimia may also abuse laxatives, diuretics, or enemas in order to prevent weight gain.

Such behaviors can be quite dangerous and may lead to serious medical complications over time. For example, the stomach acid which is introduced into the esophagus (the tube from the mouth to the stomach) during frequent vomiting can permanently damage this area.

Many more women than men have bulimia, and the disorder is most common in adolescent girls. The affected person is usually aware that her eating pattern is abnormal and may experience fear or guilt associated with the binge-purge episodes. Although the behavior is usually secretive, clues to this disorder include overactivity, peculiar eating habits or rituals, and frequent weighing.

Body weight is usually normal, although the person may perceive themselves as overweight. If bulimia is accompanied by anorexia, body weight may be extremely low.

The exact cause of bulimia is unknown, but genetic, constitutional, psychological, trauma, family, society, or cultural factors may play a role. Any given case is likely due to more than one factor.

Symptoms

  • Binge eating
  • Self-induced vomiting
  • Inappropriate use of diuretics or laxatives
  • Overachieving behavior

Exams and Tests

A dental exam may show dental cavities or gum infections (such as gingivitis). The enamel of the teeth may be eroded or pitted because of excessive exposure to acid in vomitus.

A chem-20 may show an electrolyte imbalance (such as hypokalemia) or dehydration.

Treatment

Treatment focuses on breaking the binge-purge cycles. Outpatient treatment may include behavior modification techniques as well as individual, group, or family counseling.

Antidepressant drugs may also be used in cases that involve depression.

Support Groups

Self-help groups like Overeaters Anonymous may help some people with bulimia. The American Anorexia/Bulimia Association is a source of information about this disorder.

See: Eating disorders - support group

Outlook (Prognosis)

Bulimia is a chronic illness and many people continue to have some symptoms despite treatment. People with fewer medical complications of bulimia, and who are willing and able to engage in therapy, tend to have a better chance of recovery.

Possible Complications

When to Contact a Medical Professional

Call for an appointment with your health care provider if you (or your child) have symptoms of an eating disorder.

Prevention

Less social and cultural emphasis on physical perfection may eventually help reduce the frequency of this disorder.

References

American Psychiatric Association. Treatment of patients with eating disorders, 3rd ed. American Psychiatric Association. Am J Psychiatry. 2006 Jul;163(7 Suppl):4-54.

Berkman ND, Lohr KN, Bulik CM. Outcomes of eating disorders: a systematic review of the literature. Int J Eat Disord. 2007 May;40(4):293-309.


Review Date: 5/19/2008
Reviewed By: Christos Ballas, M.D., Attending Psychiatrist, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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 an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. 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 policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics 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 medical professional 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. © 1997- 2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Constipation

Definition

Constipation refers to infrequent or hard stools, or difficulty passing stools. Constipation may involve pain during the passage of a bowel movement, inability to pass a bowel movement after straining or pushing for more than 10 minutes, or no bowel movements after more than 3 days. Infants who are still exclusively breastfed may go 7 days without a stool.

Alternative Names

Irregularity of bowels; Lack of regular bowel movements

Considerations

Normal patterns of bowel elimination vary widely from person to person and you may not have a bowel movement every day. While some healthy people have consistently soft or near-runny stools, others have consistently firm stools, but no difficulty passing them.

When the stool is hard, infrequent, and requires significant effort to pass, you have constipation. The passage of large, wide stools may tear the mucosal membrane of the anus, especially in children. This can cause bleeding and the possibility of an anal fissure.

Causes

Constipation is most often caused by a low-fiber diet, lack of physical activity, not drinking enough water, or delay in going to the bathroom when you have the urge to defecate. Stress and travel can also contribute to constipation or other changes in bowel habits.

Other times, diseases of the bowel (such as irritable bowel syndrome), pregnancy, certain medical conditions (like an underactive thyroid or cystic fibrosis), mental health problems, neurological diseases, or medications may be the reason for your constipation. More serious causes, like colon cancer, are much less common.

Constipation in children often occurs if they hold back bowel movements when they aren't ready for toilet training or are afraid of it.

Home Care

Children and adults should get enough fiber in their diet. Vegetables, fresh fruits, dried fruits, and whole wheat, bran, or oatmeal cereals are excellent sources of fiber. To reap the benefits of fiber, drink plenty of fluids to help pass the stool.

For infants with constipation:

  • Over 2 months old -- try 2-4 ounces of fruit juice (grape, pear, apple, cherry, or prune) twice a day.
  • Over 4 months old -- if the baby has begun solid foods, try baby foods with high-fiber content (peas, beans, apricots, prunes, peaches, pears, plums, spinach) twice a day.

Regular exercise is also important in establishing regular bowel movements. If you are confined to a wheelchair or bed, change position frequently and perform abdominal contraction exercises and leg raises. A physical therapist can recommend exercises appropriate for your physical abilities.

Stool softeners (such as those containing docusate sodium) may help. Additionally, bulk laxatives such as psyllium may help add fluid and bulk to the stool. Suppositories or gentle laxatives, such as milk of magnesia liquid, may establish regular bowel movements. Enemas or laxatives should be reserved for severe cases only. These methods should be used only if fiber, fluids, and stool softeners do not provide enough relief.

DO NOT give laxatives or enemas to children without first asking your doctor.

When to Contact a Medical Professional

Call your doctor if you have:

  • Sudden constipation with abdominal cramps and an inability to pass gas or stool (DO NOT take any laxatives -- call immediately!)
  • Sharp or severe abdominal pain, especially if you're also bloated
  • Blood in your stool
  • Constipation alternating with diarrhea
  • Thin, pencil-like stools
  • Rectal pain
  • Unexplained weight loss
  • Been using laxatives for several weeks or self care is not working

Call if:

  • An infant younger than 2 months is constipated
  • An infant (except those exclusively breastfed) goes 3 days without a stool -- call immediately if the child is vomiting or irritable
  • A child is holding back bowel movements in order to resist toilet training

What to Expect at Your Office Visit

Your doctor will perform a physical examination, which may include a rectal exam, and ask questions such as:

  • How long have you had constipation?
  • How many days between two bowel movements?
  • Is it worse when you are stressed?
  • What is the color, shape, and consistency of the stools?
  • Is there any bleeding with bowel movements?
  • Do you have any abdominal pain?
  • What surgeries or injuries have you had?
  • What medications do you take?
  • Do you drink coffee or drink alcohol? Do you smoke?
  • What other symptoms are also present?

The following tests may help diagnose the cause of constipation:

Prevention

Avoiding constipation altogether is easier than treating it, but involves the same lifestyle measures:

  • Eat lots of fiber.
  • Drink plenty of fluids each day (at least 8 glasses of water per day).
  • Exercise regularly.
  • Go to the bathroom when you have the urge. Don't wait.

References

National Digestive Diseases Information Clearinghouse. Constipation page. Available at: https://digestive.niddk.nih.gov/ddiseases/pubs/constipation/index.htm. Accessed March 23, 2005.

Bleser S, Brunton S, Carmichael B, Older K, Rasch R, Steele J. Management of chronic constipation: Recommendations from a consensus panel. J Fam Pract. 2005 Aug;54(8):691-8.

Rao SS. Constipation: evaluation and treatment of colonic and anorectal motility disorders. Gastroenterol Clin North Am. 2007;36:687-711.

Wyllie R. Motility Disorders and Hirschsprung Disease. In: Kliegman RM, Jenson HP, Stanton BF, eds. Kliegman: Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 329.


Review Date: 8/22/2008
Reviewed By: Linda Vorvick, MD, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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 an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. 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 policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics 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 medical professional 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. © 1997- 2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Nausea & Vomiting

Definition

Nausea is the sensation of having an urge to vomit. Vomiting is forcing the contents of the stomach up through the esophagus and out of the mouth.

Alternative Names

Emesis; Vomiting; Stomach upset; Upset stomach

Considerations

Your body has a few main ways to respond to an ever-changing, wide variety of invaders and irritants. Sneezing ejects the intruders from the nose, coughing from the lungs and throat, diarrhea from the intestines, and vomiting from the stomach.

Vomiting is a forceful action accomplished by a fierce, downward contraction of the diaphragm. At the same time, the abdominal muscles tighten against a relaxed stomach with an open sphincter. The contents of the stomach are propelled up and out.

You may have more saliva just before vomiting.

Vomiting is a complex, coordinated reflex orchestrated by the vomiting center of the brain. It responds to signals coming from:

  • The mouth, stomach, and intestines
  • The bloodstream, which may contain medicines or infections
  • The balancing systems in the ear (motion sickness)
  • The brain itself, including unsettling sights, smells, or thoughts

An amazing variety of stimuli can trigger vomiting, from migraines to kidney stones. Sometimes, just seeing someone else vomit will start you vomiting, in your body's effort to protect you from possible exposure to the same danger.

Vomiting is common. Almost all children will vomit several times during their childhood. In most cases, it is due to a viral gastrointestinal infection.

“Spitting up,” the gentle sloshing of stomach contents up and out of the mouth, sometimes with a burp, is an entirely different process. Some spitting up is normal for babies, and usually gets gradually better over time. If spitting up worsens or is more frequent, it might be reflux disease. Discuss this with your child's doctor.

Most of the time, nausea and vomiting do not require urgent medical attention. However, if the symptoms continue for days, they are severe, or you cannot keep down any food or fluids, you may have a more serious condition.

Dehydration is the main concern with most vomiting. How fast you become dehydrated depends on your size, frequency of vomiting, and whether you also have diarrhea.

Causes

The following are possible causes of vomiting:

These are possible causes of vomiting in infants (0 - 6 months):

  • Congenital pyloric stenosis, a constriction in the outlet from the stomach (the infant vomits forcefully after each feeding but otherwise appears to be healthy)
  • Food allergies or milk intolerance
  • Gastroenteritis (infection of the digestive tract that usually causes vomiting with diarrhea)
  • Gastroesophageal reflux
  • An inborn error of metabolism
  • Hole in the bottle nipple may be wrong size, leading to overfeeding
  • Infection, often accompanied by fever or runny nose
  • Intestinal obstruction, evidenced by recurring attacks of vomiting and crying or screaming as if in great pain
  • Accidentally ingesting a drug or poison

Call the doctor immediately or take the child to an emergency care facility if you suspect poisoning or drug ingestion!

Home Care

It is important to stay hydrated. Try steady, small amounts of clear liquids, such as electrolyte solutions. Other clear liquids -- such as water, ginger ale, or fruit juices -- also work unless the vomiting is severe or it is a baby who is vomiting.

For breastfed babies, breastmilk is usually best. Formula-fed babies usually need clear liquids.

Don’t drink too much at one time. Stretching the stomach can make nausea and vomiting worse. Avoid solid foods until there has been no vomiting for six hours, and then work slowly back to a normal diet.

An over-the-counter bismuth stomach remedy like Pepto-Bismol is effective for upset stomach, nausea, indigestion, and diarrhea. Because it contains aspirin-like salicylates, it should NOT be used in children or teenagers who might have (or recently had) chickenpox or the flu.

Most vomiting comes from mild viral illnesses. Nevertheless, if you suspect the vomiting is from something serious, the person may need to be seen immediately.

If you have morning sickness, ask your doctor about the many possible treatments.

The following may help treat motion sickness:

  • Lying down
  • Over-the-counter antihistamines (such as Dramamine)
  • Scopolamine prescription skin patches (such as Transderm Scop) are useful for extended trips, such as an ocean voyage. Place the patch 4 - 12 hours before setting sail. Scopolamine is effective but may produce dry mouth, blurred vision, and some drowsiness. Scopolamine is for adults only. It should NOT be given to children.

When to Contact a Medical Professional

Call 911 or go to an emergency room if you think vomiting is from poisoning or a child has taken aspirin.

Call if the person has:

  • Vomiting longer than 24 hours
  • Blood or bile in the vomit
  • Severe abdominal pain
  • Headache and stiff neck
  • Signs of dehydration

Signs of dehydration include:

  • Increased thirst
  • Infrequent urination or dark yellow urine
  • Dry mouth
  • Eyes that appear sunken
  • Crying without tears
  • Loss of normal skin elasticity (if you touch or squeeze the skin, it doesn't bounce back the way it usually does)

You should also call if:

  • A young child is lethargic or has marked irritability.
  • An infant vomits repeatedly.
  • A child is unable to retain any fluids for 8 hours or more.
  • Vomiting is recurrent.
  • An adult is unable to retain any fluids for 12 hours or more.
  • There is a decrease in urination (including a baby who is not wetting the normal amount of diapers).
  • Nausea persists for a prolonged period of time (in a person who is not pregnant).

What to Expect at Your Office Visit

Your health care provider will perform a physical examination, particularly to look for signs of dehydration.

To help diagnose the cause of the nausea or vomiting, your doctor will ask medical history questions, such as:

  • Are you vomiting fresh blood? Do you have repeated episodes of vomiting blood?
  • Are you vomiting material that looks like coffee grounds?
  • Are you vomiting undigested food?
  • Are you vomiting greenish material?
  • Is the nausea or vomiting severe enough to cause unintentional weight loss?
  • Is the vomiting self-induced?
  • Have you been traveling? Where?
  • What medications do you take?
  • Did other people that ate at the same location as you have the same symptoms?
  • Are you pregnant or could you be pregnant?
  • When did the vomiting begin? How long has it lasted?
  • Does it occur several hours after meals?
  • What other symptoms are also present -- abdominal pain, fever, diarrhea, poor skin turgor, other signs of dehydration, abdominal swelling, headaches?

The following diagnostic tests may be performed:

If dehydration is severe, you may need intravenous fluids. This may require hospitalization, although it can often be done in the doctor's office. The use of antivomiting drugs (anti-emetics) is controversial, and they should be used only in severe cases.

Prevention

A number of medicines are effective at preventing vomiting. In some situations, preventing the vomiting makes life much better.

References

Koch KL. Nausea and vomiting during pregnancy. Gastroenterol Clin North Am. 2003; 32(1): 201-234, vi.

Quigley EM. AGA technical review on nausea and vomiting. Gastroenterology. 2001; 120(1): 263-286.

This article uses information by permission from Alan Greene, M.D., © Greene Ink, Inc.


Review Date: 7/25/2007
Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Jefferson Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network.
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 an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. 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 policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics 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 medical professional 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. © 1997- 2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Diabetes

Definition

Diabetes is a chronic (lifelong) disease marked by high levels of sugar in the blood.

See also:

Causes

Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both.

To understand diabetes, it is important to first understand the normal process by which food is broken down and used by the body for energy. Several things happen when food is digested:

  • A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body.
  • An organ called the pancreas makes insulin. The role of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be used as fuel.

People with diabetes have high blood sugar. This is because:

  • Their pancreas does not make enough insulin
  • Their muscle, fat, and liver cells do not respond to insulin normally
  • Both of the above

There are three major types of diabetes:

  • Type 1 diabetes is usually diagnosed in childhood. Many patients are diagnosed when they are older than age 20. In this disease, the body makes little or no insulin. Daily injections of insulin are needed. The exact cause is unknown. Genetics, viruses, and autoimmune problems may play a role.
  • Type 2 diabetes is far more common than type 1. It makes up most of diabetes cases. It usually occurs in adulthood, but young people are increasingly being diagnosed with this disease. The pancreas does not make enough insulin to keep blood glucose levels normal, often because the body does not respond well to insulin. Many people with type 2 diabetes do not know they have it, although it is a serious condition. Type 2 diabetes is becoming more common due to increasing obesity and failure to exercise.
  • Gestational diabetes is high blood glucose that develops at any time during pregnancy in a woman who does not have diabetes.

Diabetes affects more than 20 million Americans. Over 40 million Americans have prediabetes.

There are many risk factors for type 2 diabetes, including:

  • Age over 45 years
  • A parent, brother, or sister with diabetes
  • Gestational diabetes or delivering a baby weighing more than 9 pounds
  • Heart disease
  • High blood cholesterol level
  • Obesity
  • Not getting enough exercise
  • Polycystic ovary disease (in women)
  • Previous impaired glucose tolerance
  • Some ethnic groups (particularly African Americans, Native Americans, Asians, Pacific Islanders, and Hispanic Americans)

Symptoms

High blood levels of glucose can cause several problems, including:

  • Blurry vision
  • Excessive thirst
  • Fatigue
  • Frequent urination
  • Hunger
  • Weight loss

However, because type 2 diabetes develops slowly, some people with high blood sugar experience no symptoms at all.

Symptoms of type 1 diabetes:

  • Fatigue
  • Increased thirst
  • Increased urination
  • Nausea
  • Vomiting
  • Weight loss in spite of increased appetite

Patients with type 1 diabetes usually develop symptoms over a short period of time. The condition is often diagnosed in an emergency setting.

Symptoms of type 2 diabetes:

  • Blurred vision
  • Fatigue
  • Increased appetite
  • Increased thirst
  • Increased urination

Exams and Tests

A urine analysis may be used to look for glucose and ketones from the breakdown of fat. However, a urine test alone does not diagnose diabetes.

The following blood glucose tests are used to diagnose diabetes:

  • Fasting blood glucose level -- diabetes is diagnosed if higher than 126 mg/dL on two occasions. Levels between 100 and 126 mg/dL are referred to as impaired fasting glucose or pre-diabetes. These levels are considered to be risk factors for type 2 diabetes and its complications.
  • Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours. (This test is used more for type 2 diabetes.)
  • Random (non-fasting) blood glucose level -- diabetes is suspected if higher than 200 mg/dL and accompanied by the classic diabetes symptoms of increased thirst, urination, and fatigue. (This test must be confirmed with a fasting blood glucose test.)

You need your hemoglobin A1c (HbA1c) level checked every 3 - 6 months. The HbA1c is a measure of average blood glucose during the previous 2 - 3 months. It is a very helpful way to determine how well treatment is working.

Treatment

The immediate goals are to treat diabetic ketoacidosis and high blood glucose levels. Because type 1 diabetes can start suddenly and have severe symptoms, people who are newly diagnosed may need to go to the hospital.

The long-term goals of treatment are to:

  • Prolong life
  • Reduce symptoms
  • Prevent diabetes-related complications such as blindness, heart disease, kidney failure, and amputation of limbs

These goals are accomplished through:

  • Careful self testing of blood glucose levels
  • Education
  • Exercise
  • Foot care
  • Meal planning and weight control
  • Medication or insulin use

There is no cure for diabetes. Treatment involves medicines, diet, and exercise to control blood sugar and prevent symptoms.

LEARN THESE SKILLS

Basic diabetes management skills will help prevent the need for emergency care. These skills include:

  • How to recognize and treat low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia)
  • What to eat and when
  • How to take insulin or oral medication
  • How to test and record blood glucose
  • How to test urine for ketones (type 1 diabetes only)
  • How to adjust insulin or food intake when changing exercise and eating habits
  • How to handle sick days
  • Where to buy diabetes supplies and how to store them

After you learn the basics of diabetes care, learn how the disease can cause long-term health problems and the best ways to prevent these problems. Review and update your knowledge, because new research and improved ways to treat diabetes are constantly being developed.

SELF-TESTING

If you have diabetes, your doctor may tell you to regularly check your blood sugar levels at home. There are a number of devices available, and they use only a drop of blood. Self-monitoring tells you how well diet, medication, and exercise are working together to control your diabetes. It can help your doctor prevent complications.

The American Diabetes Association recommends keeping blood sugar levels in the range of:

  • 80 - 120 mg/dL before meals
  • 100 - 140 mg/dL at bedtime

Your doctor may adjust this depending on your circumstances.

WHAT TO EAT

You should work closely with your health care provider to learn how much fat, protein, and carbohydrates you need in your diet. A registered dietician can help you plan your dietary needs.

People with type 1 diabetes should eat at about the same times each day and try to be consistent with the types of food they choose. This helps to prevent blood sugar from becoming extremely high or low.

People with type 2 diabetes should follow a well-balanced and low-fat diet.

See: Diabetes diet

HOW TO TAKE MEDICATION

Medications to treat diabetes include insulin and glucose-lowering pills called oral hypoglycemic drugs.

People with type 1 diabetes cannot make their own insulin. They need daily insulin injections. Insulin does not come in pill form. Injections are generally needed one to four times per day. Some people use an insulin pump. It is worn at all times and delivers a steady flow of insulin throughout the day. Other people may use a new type of inhaled insulin.

Unlike type 1 diabetes, type 2 diabetes may respond to treatment with exercise, diet, and medicines taken by mouth. There are several types of medicines used to lower blood glucose in type 2 diabetes.

Medications may be switched to insulin during pregnancy and while breastfeeding.

Gestational diabetes is treated with changes in diet.

EXERCISE

Regular exercise is especially important for people with diabetes. It helps with blood sugar control, weight loss, and high blood pressure. People with diabetes who exercise are less likely to experience a heart attack or stroke than those who do not exercise regularly.

Here are some exercise considerations:

  • Always check with your doctor before starting a new exercise program.
  • Ask your doctor or nurse if you have the right footwear.
  • Choose an enjoyable physical activity that is appropriate for your current fitness level.
  • Exercise every day, and at the same time of day, if possible.
  • Monitor blood glucose levels before and after exercise.
  • Carry food that contains a fast-acting carbohydrate in case you become hypoglycemic during or after exercise.
  • Carry a diabetes identification card and a cell phone in case of emergency.
  • Drink extra fluids that do not contain sugar before, during, and after exercise.

You may need to change your diet or medication dose if you change your exercise intensity or duration to keep blood sugar levels from going too high or low.

FOOT CARE

People with diabetes are more likely to have foot problems. Diabetes can damage blood vessels and nerves and decrease the body's ability to fight infection. You may not notice a foot injury until an infection develops. Death of skin and other tissue can occur.

If left untreated, the affected foot may need to be amputated. Diabetes is the most common condition leading to amputations.

To prevent injury to the feet, check and care for your feet every day.

See: Diabetes foot care

Support Groups

For additional information, see diabetes resources.

Outlook (Prognosis)

With good blood glucose and blood pressure control, many of the complications of diabetes can be prevented.

Studies have shown that strict control of blood sugar and blood pressure levels in persons with diabetes helps reduce the risk of kidney disease, eye disease, nervous system disease, heart attack, and stroke.

Possible Complications

Emergency complications include:

Long-term complications include:

When to Contact a Medical Professional

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of ketoacidosis:

  • Abdominal pain
  • Deep and rapid breathing
  • Increased thirst and urination
  • Loss of consciousness
  • Nausea
  • Sweet-smelling breath

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of extremely low blood sugar (hypoglycemic coma or severe insulin reaction):

Prevention

Maintaining an ideal body weight and an active lifestyle may prevent type 2 diabetes.

Currently there is no way to prevent type 1 diabetes.

There is no effective screening test for type 1 diabetes in people who don't have symptoms.

Screening for type 2 diabetes and people with no symptoms is recommended for:

  • Overweight children who have other risk factors for diabetes starting at age 10 and repeating every 2 years
  • Overweight adults (BMI greater than 25) who have other risk factors
  • Adults over 45, repeated every 3 years

To prevent complications of diabetes, visit your health care provider or diabetes educator at least four times a year. Talk about any problems you are having.

Regularly have the following tests:

  • Have your blood pressure checked every year (blood pressure goals should be 130/80 mm/Hg or lower).
  • Have your glycosylated hemoglobin (HbA1c) checked 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 100 mg/dL).
  • Get yearly tests to make sure your kidneys are working well (microalbuminuria and serum creatinine).
  • Visit your ophthalmologist (preferably one who specializes in diabetic retinopathy) at least once a year, or more often if you have signs of diabetic retinopathy.
  • See the dentist every 6 months for a thorough dental cleaning and exam. Make sure your dentist and hygienist know that you have diabetes.
  • Make sure your health care provider inspects your feet at each visit.

Stay up-to-date with all of your vaccinations and get a flu shot every year in the fall.

References

Alemzadeh R, Wyatt DT. Diabetes Mellitus. In: Kliegman RM, ed. Kliegman: Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders;2007:chap 590.

American Diabetes Association. Standards of medical care in diabetes -- 2008. Diabetes Care. 2008;31:S12-S54.

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.

Standards of medical care in diabetes--2007. Diabetes Care. Jan 2007;30 Suppl 1:S4-S41.


Review Date: 6/17/2008
Reviewed By: Elizabeth H. Holt, MD, PhD, Assistant Professor of Medicine, Section of Endocrinology and Metabolism, Yale University. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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 an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. 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 policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics 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 medical professional 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. © 1997- 2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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