The discovery underscores the importance of pregnant women, even those without other risk factors, maintain good oral health.

The study, led by Ananda P. Dasanayake, eliminating smoking and alcohol consumption among a group of 190 pregnant women in Sri Lanka, where a combination of cultural taboos and poverty, preventing women from smoking and drinking.

The findings support an earlier study that found evidence Dasanayake that pregnant women with periodontal disease were more likely to develop gestational diabetes than those with healthy gums.

That study, which followed 256 women with Bellevue Hospital Center in New York in its first six months of pregnancy, showed that 22 women gestational desarrollaron diabetes. Those women had significantly elevated levels of periodontal bacteria and inflammation compared with the other women in the study.

More than a third of women in the new study was developed over a year, said they had bleeding gums when brushing teeth. The women underwent a dental examination and a blood glucose test, which is used to detect gestational ladiabetes.

As pointed Dasanayake, women who had the highest amounts of bleeding in your gums also had higher levels of blood glucose. He says he expected the final figures show that between 20 and 30 per cent of women had gestational desarrolladodiabetes.

Gestational diabetes is characterized by an inability to transport glucose, the main energy source of the organism to the cells during pregnancy. The condition usually disappears when the pregnancy but women who have gestational tenidodiabetes have a higher risk of later developing the most common form of diabetes, type 2 diabetes.

In addition to its possible role in preterm delivery, evidence that gum disease may contribute to gestational diabetes suggests that women should see a dentist if they plan to become pregnant and then get it. Treating gum disease during pregnancy is safe and effective in improving women’s oral health and minimizing potential risks, concludes Dasanayake.

Although these diseases are rare, it is best to diagnose a good time to try to do everything possible to make your pregnancy reaches a successful conclusion.

About five percent of pregnant women develop gestational diabetes and although the figure is not very high, doctors usually make frequent glucose testing expectant mothers. For those diagnosed with this illness can be controlled with a good diet and exercise, pregnancy will end well.

Placenta previa is another of the complications of pregnancy and in it the placenta that surrounds the baby is lower in the normal uterus, right next to or covering the cervix. This condition occurs in about one in a hundred pregnancies, so the chances of developing it are not very high, but should be alert.

Placenta previa usually not a problem at the beginning of pregnancy, but if it continues in coming quarters may cause bleeding, so you can take the decision to bring forward the date of delivery. The location of your placenta will be reviewed during the ultrasound in the middle of your pregnancy, but very few women who have placenta previa at this stage of your state maintained until delivery. But if you go with it, the only option is to give birth by Caesarean section.

This is because during pregnancy the placenta produces hormones such as estrogen, cortisol and lactogen, which can block the work of insulin, which is responsible for regulating blood glucose. When gestational diabetes is not treated, can cause severe consequences on the health of the pregnant woman and baby, one of the most common infections are usually in the urinary tract.

You may also see preeclampsia, which is characterized by increased high blood pressure and a lot of fluid retention which can interfere with the development of the sick baby and the mom. A characteristic of babies born to mothers with gestational diabetes, is that they can grow so much and weigh more than 4 kg which is called (macrosomia), which can complicate delivery, and require much more effort the mother.

You can give these babies born with respiratory failure, poor lung development, which then has for some time in the neonatal intensive care unit until they can breathe on their own. Therefore it is necessary that the mother make the appropriate checks and if you detect gestational diabetes, observed to the letter the instructions of their doctors.

When a person has these conditions and not treated on time, your foot takes the form of a rocking chair, the arc disappears and the joints are destroyed, making it incapable of performing the most basic tasks.

Depending on the severity of injuries, the doctor will determine the treatment, but the main thing will be to prevent the occurrence of further injury, so it can be used to put plaster, crutches or wheelchairs or permanently total rest in bed.

If the injury is severe enough, will have to wear special shoes for the foot that made the deformity. Despite the foot and can not be returned to its original state, often the patient underwent surgery to fuse the broken joints or remove bumps, both are the more encouraging picture, because in most cases it is necessary resorting to amputation and save the patient’s life.

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It occurs with a frequency of 4-8 cases per 1000 diabetics per year, from 20% to 30% of cases occur in those who present with the disease. It occurs more frequently in type I diabetics and adults, typically between the youngest (28-38 years), with no predilection for any sex.

CLINICAL
Although the symptoms of poorly controlled diabetes mellitus may be present from several days earlier, the metabolic alterations typical of CAD usually develop quickly (usually within 24 hours).
The clinical picture includes a history of polyuria, polydipsia, weight loss, nausea, vomiting and decreased appetite. This anorexia relative importance as the first manifestation of the transition from simple hyperglycemia ketosis. Occasionally appears in the adult abdominal pain (more common in children)

COMPLICATIONS
The most common complications of DKA include: 1) hypoglycemia due to excessive treatment with insulin, 2) hypokalemia: caused by insulin administration and treatment of acidosis with bicarbonate and 3) hyperglycemia: secondary to insufficient insulin treatment (The first two have been significantly reduced with the use of low doses of insulin).
Cerebral edema is a rare but almost always fatal. The asymptomatic is not uncommon among children and young adults is extremely rare, while the development of symptoms in adults. Disease characterized by impairment of consciousness and headache, seizures can occur, changes in the lungs, respiratory arrest and bradycardia (symptoms and signs progress as if there was a herniation). Some patients have warning signs (headache of sudden onset or rapid decrease in level of consciousness), but in others the initial manifestation is respiratory arrest. Mortality is high (> 70%). Hyperventilation have been used, steroids and mannitol, but tend to be ineffective after respiratory arrest.

TREATMENT
The treatment is urgent and immediate, and has two main objectives:
1) correction of dehydration and
2) correction of hyperglycemia.

The information I have placed here is to create a little awareness about the seriousness of diabetes and the importance of regular checkups because this complication usually occurs in uncontrolled diabetes (patients not taking their medications and do not meet your diet or people who did not know they had diabetes)

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Charcot foot is just one of many injuries that can present in patients with diabetes, mainly due to the lack of control leads to loss of sensitivity of the lower extremities.

But what is the Charcot foot?

Every day our feet are exposed to long hours of walking, we can all experience injury, however, when a person has feeling in your legs, stop walking when you feel pain, in the case of a person with diabetes, you already have deficit sensitivity in the area, continue walking, intensifying the injury with the possible destruction of bone and joints, this is what is called Charcot foot.

In other words, the Charcot foot is a complex deformity of the foot, a complication seen as progressive, slow, chronic, painless and occurs in one or more joints due to neurological deficit, such as neuropathy.

It develops as a result of loss of sensation in the feet because the nerves are affected and because of a broken bone that is not detected due to lack of sensation. This evil advances and there is destruction of the soft tissues of the foot.

Without feeling pain, fracture patient continues to make daily life with the broken bone deteriorating medical condition, for which, in most cases only remains the possibility of amputation.

In other cases, joint destruction is severe enough to cause permanent deformities in the foot with bony protrusions. This condition requires special footwear forever.

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• ADVICE FOR ALREADY DETERIOTING LEG CONDITION DUE TO DIABETES

Diabetic retinopathy is divided into stages according to clinical features. It ranges from a little bleeding that can grow up to produce retinal detachment and glaucoma in advanced stages. Therefore, the most important thing is to control blood sugar levels to prevent future complications appear in the eyes.

It has been shown statistically that a person with diabetes with good metabolic control for 20 years no complications caused by diabetes and poorly controlled unlike people come to have other health problems at 5 years.

Intraocular pressure
Intraocular pressure does not necessarily increase with diabetes, ideally at each visit with your ophthalmologist to make a measurement of intraocular pressure and fundus review.

Screening Tests
Initially welcomed as is the vision, then makes a microscopic test of the presence of cataracts (a condition common in people with diabetes), then reviews the retina through a dilated while intraocular pressure is monitored.

The ophthalmologic examinations for people newly diagnosed should be done once a year, if you have 10 or more years living with diabetes it is best to attend every six months by an ophthalmologist.

Pregnancy and vision problems
During pregnancy it is common for many patients who have myopia increased, causing a decline in mild to moderate vision, however after delivery returns to normal.

Is the laser treatment can limit the passage of light?
The laser is the only thing that makes clotting or cauterizing the veins that are bleeding or are bleeding, does not in any way the passage of light. The passage of light may be limited by the presence of cataracts, common condition in people with diabetes.

I see rainbows
The rainbow around the eyes coupled with eye pain may be due to increased intraocular pressure, sometimes it is taken for any discharge that is on the conjunctiva.

Lens prescription
The lens prescription changes according to glucose level, i.e if over 200mg/dl not worth be sent to make some new lenses for surely you will not see them properly.

Glycosylated hemoglobin gives a controlled parameter as they were last 6 months. For example, the level is 6 multiplied by 20 roughly handled over the past six months a blood glucose of 120mg/dl

The most convenient is to have a glycated hemoglobin test before graduating lenses, however for the costs is not always possible so it is advisable to check the levels are less than 160 mg / dl.

Can cause blurred vision insulin?
No. Some patients have the typical picture of hypoglycemia (low blood glucose levels), cold sweating, feeling of loss of consciousness and decreased vision. However, insulin is not related to vision problems, the contrary is one of the treatments to avoid future complications.

Conclusion
Diabetes is a progressive metabolic disease, so we can curb future complications or delay depends on the control of the individual.

Furthermore, diabetes affects the body’s immune system, decreasing the ability to fight infection. Small infections can worsen quickly and cause the death of the skin and other tissues, which may require amputation.

To prevent injury to the feet, inspect them and take care of them daily.

This pioneering initiative in our country, has been launched to improve care for patients suffering from severe mental illness. For Dr. Julio Bobes, President of the Spanish Society of Biological Psychiatry, “The consensus aims to initiate cooperation and joint attention between different professionals and enhance awareness of the psychiatrists who care for severely mentally ill regard to the screening and treatment of this increased incidence of cardiovascular risk factors and diabetes. ”

“This is warning of a problem that has largely been ignored until now. We have to consider that mental health is not just fighting a set of psychiatric symptoms, but health as a whole. The physical must accompany the mental and we can not neglect this aspect of such significance that accompanies this group of diseases, “says Dr. Jerome Saiz Ruiz, President of the Spanish Society of Psychiatry.

“The presence of schizophrenia or bipolar disorder significantly raises the risk of cardiovascular disease and also significantly increases the risk of premature death due to any cardiovascular complication. It is estimated that patients with schizophrenia have twice the risk of dying from a cardiovascular problem, the first cause of death in this group, “says Dr. Carlos Macaya, President of the Spanish Society of Cardiology.
The cardiovascular risk profile of people with serious mental illness is influenced by an unhealthy lifestyle such as smoking, poor diet or sedentary lifestyle. There is also a direct effect of the disease and / or antipsychotic treatment in the progressive development of cardiometabolic risk factors, since some medication induced weight gain and increased risk of adverse metabolic effects.

“Psychopharmacological treatments affect not only the brain but throughout the body, modifying the patient’s lifestyle and metabolism. However, not all drugs produce the same effect cardiometabolic, some are more neutral and more influence measure. Several studies have shown that while some antipsychotics cause weight gain, and impaired glucose and lipid metabolism, others have a minor or negligible effect on these parameters, “says Dr. Bobes.

With regard to diabetes, is shown an increased prevalence of this disease in patients with schizophrenia and bipolar disorder. Not only the prevalence is higher but the secondary complications of diabetes occur more frequently. “Therefore, in cases where we know they have a higher risk of developing diabetes or by family history, obesity and lack of exercise, it would be advisable to use those antipsychotics with lower metabolic risk,” said Dr. Edelmiro Menendez, Second Vice President of the Spanish Society of Diabetes. “The important thing is the approach to the multidisciplinary treatment of a form with a close collaboration between psychiatrists and endocrinologists, internists or family physicians,” concludes Dr. Menendez.

To prevent and reduce the impact of cardiovascular disease in this group, which is proposed from the consensus is “monitoring the overall health of patients diagnosed with serious mental illness periodically conduct a comprehensive patient intervention and those that present factors risk, both metabolic and cardiovascular diseases, assess the antipsychotic treatment based on your medical history, “concludes Dr. Bobe

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Glycemic control is to maintain glycosylated hemoglobin (HbA1c) between normal limitted, because we know that good glycemic control reduces the long-term risk of microvascular complications in both types of diabetes, 1 and 2. Researchers at ADVANCE and ACCORD studies examined the effect of glycemic control on the evolution of patients with type 2 diabetes and macrovascular and microvascular disease. Both studies failed to demonstrate that good glycemic control is associated with reduced cardiovascular risk.

Reports of a potential increase in mortality rates associated with intensive glycemic control resulted in a debate on the recommendations for the treatment of type 2 diabetes, specifically aiming to establish an optimal HbA1c. Researchers have suggested that in diabetics, hypoglycemia is a possible increased risk of mortality. Because intensive glycemic control increases the risk of hypoglycemia, with some drugs than with others, it is important to assess the risks associated with the various schemes to lower blood sugar. In two meta-analysis, researchers pooled data from several major works and concluded that intensive glycemic control has a positive effect on cardiovascular outcomes. However, these meta-analysis were limited by the limitations of clinical trials analyzed.

In this retrospective cohort study, the objective was to evaluate the association between mortality from all causes and HbA1c in type 2 diabetic patients seen at primary care and establish the existence of any apparent association that was independent of treatment regimen diabetes.

Test of HbA1c of approximately 7.5% was associated with lower mortality from all causes and a lower progression to disease events of the great vessels. An increase or decrease the lower value of HbA1c was associated with increased risk of adverse outcomes. The lower pattern is the association of risk was sufficiently similar in both treatment groups as to suggest that the risk of mortality for HbA1c was independent of treatment regimen. On the other hand, observed that the risk of mortality in two cohorts of treatment was different, showing that treatment with insulin was associated with higher mortality. This pattern of association remained consistent with time-dependent HbA1c as a covariate. The results, say, support the evidence of the ACCORD study. In this study, the results showed that mortality increased (RR 1.22, 95% CI 1.01 -1 46) in patients with cardiovascular disease or had at least two risk factors for cardiovascular disease or atherosclerosis severe and HbA1c 7.5%, subject to intensive glycemic control (target HbA1c <6.0% vs. 7.0 -7 * 9%). However, these data are in contradiction with the monitoring data from the UK Prospective Diabetes Study (UKPDS) showed that intensive treatment was associated with a reduced risk for all outcomes related to diabetes. However, less than 15% of UKPDS patients achieved an HbA1c level below 6.5%.

The results of the initial phase of the UKPDS randomization showed a significant reduction in relative risk of myocardial infarction of 14% for every 1% reduction HbA1c.Los results of this analysis confirmed a weak association between HbA1c and reduced risk of sick pictures of the great vessels, with HbA1c values above 7.5%, but, unlike the results of the UKPDS, we found an increased mortality to a level of HbA1c less than 6.5 % in patients with and without large vessel disease recorded.

THE ADVANCE study evaluated the effects of intensive control of blood pressure and blood sugar (HbA1c HbA1c <7.5%) on micro and macrovascular complications in patients treated with oral hypoglycemic regimens. After an average of 5 years of follow up, a good glycemic control was associated with less frequent microvascular events, but not macrovascular events. Improved glycemic control was not associated with higher mortality. The difference between the observations of the ADVANCE study and this work could be partly due to statistical power issues, a low cardiovascular risk profile in the ADVANCE study or, as the authors, their results are not representative.

Both the ACCORD study and the Veterans Affairs study raised reservations about the safety for patients with type 2 diabetes receiving intensive insulin therapy. Moreover, the study’s researchers EDIC (Epidemiology of Diabetes Interventions and Complications) of patients with type 1 diabetes reported cardiovascular benefits in patients with intensive glycemic control, but not in those with evidence of less than 6.5% HbA1c . The mechanisms that could explain this finding is unknown. The first reports of the ACCORD trial were unable to identify the causes of death among both groups studied, mortality rates were higher for the extreme values of HbA1c, regardless of treatment regimen and some cardiovascular risk factors. The decrease in survival in patients achieving low percentages of the average HbA1c could be related to hypoglycemia, a common complication of intensive control of blood glucose. In this study, patients with severe hipooglucemia mortality was 3 times higher than those who did not experience severe hypoglycemia, both in patients treated conventionally and intensively. Moreover, in the Veterans Affairs study, the occurrence of more than 1 episode of severe hypoglycemia was associated with an increase of 88% of the risk of sudden death.

Hypoglycemia is associated with different consequences. For example, a relationship between the manifestations of sympathomimetic (adrenergic) or hypokalemic of hypoglycemia and the onset of cardiac arrhythmia, including long QT syndrome in diabetic patients with established cardiovascular disease. Intensive glycemic control associated with hypoglycemia may enhance the variability of glucose, which contributes to oxidative stress and vascular inflammation. This result may predispose to atherosclerotic plaque destabilization and vascular disfuncióln.

The lower survival in the group treated with insulin may be that insulin may increase the risk of mortality in patients with type 2 diabetes. Margolis et al. reported that the use of insulin is associated with an increased risk of serious ischemic cardiac complications. One possible explanation, as it is derived from an evaluation conducted diabetics undergoing coronary bypass surgery is that the insulin-treated patients were older and had more comorbidities as well as a longer duration of diabetes patients in group treated with oral hypoglycemic agents. In this study, the reference frequency of comorbidities such as renal failure was greater in those who used insulin. There was no evidence to support the idea that insulin has a direct toxic effect in patients with type 2 diabetes without cardiovascular disease or autonomic, however, this disorder has been reported the existence of a link between insulin use and progression and mortality of cancer.

The authors state that differences between cohorts at baseline could have affected the results. Compared with patients in group 1, more patients in group 2 had experienced a prior cardiovascular table and had a creatinine greater than 1.50 mg/100 ml. Tables previous cardiovascular and renal initial cardiovascular risk factors that herald poor outcomes in patients with atherosclerosis or diabetes. However, when we excluded patients without documented the large vessels, the Cox analysis showed that those treated with insulin had an increased risk of macrovascular disease progression than patients treated with oral agents combined.

In this study, adjustments were made for different morbidities between cohorts and gave a detailed sensitivity analysis comparing the two cohorts, as the adjustment of duration of diabetes. The differences in survival and the frame rate of disease of large vessels between the cohorts persisted under all conditions of analysis. For the authors, another plausible idea is that the causes of death and the underlying pathology in the extreme values of HbA1c were of different categories among the study’s limitations CPRD mentions that collects data from routine practice, therefore Some data is lost, there may be imperfections in encoding and HbA1c determinations are not standardized.

The normal range of HbA1c vary among centers and biochemical determinations could have been done with different periodicity. By using techniques such as linear interpolation of values, the authors measured the total exposure to the risk parameters unreliable. The variability in the frequency of the measurement of HbA1c could have created a bias. However, the bias was tested by three different methods and findings remain the same. Moreover, the study was not randomized. Although standardized when possible confounding factors recognized, it is possible that some effects have not yet been detected. Also you may not have appeared other confounding factors because other variables that might have been important were not recorded or included in the model. In addition, HbA1c groups differed systematically, although the survival models may have taken account of some of these differences.

As for the details of the cause of death, they were considered too imprecise to be informed and in this study. No data are available to characterize ethnic origin. Other limitations are that its not made a separate analysis of cases to assess the duration of response or the effect of severe hypoglycemia in mortality due to insufficient data. One possible source of confusion was the difference in prescription rates for cardiovascular prophylaxis in deciles of HbA1c. Although these data are not shown, the researchers concluded that patients with higher HbA1c received less treatment for cardiovascular prophylaxis.

The decision by the authors to include cases of dual membership cohort is an argument that can influence litigation for and against. Although this factor could have introduced bias into the study, the authors made a sensitivity analysis by introducing an indicator covariance members of both groups for the parameter of insulin regimen. These data, therefore, still need to be interpreted with caution. However, the large number of patients represents what actually took place in clinical practice. Given these limitations, the authors say, “We believe that the resultant force of our evidence suggests that this association is reliable, although these findings need further confirmation.” “Our study, together with evidence of ACCORD, could have important implications care of people with type 2 diabetes. Both in our data and the ACCORD study findings, these results are applicable to type 1 diabetic patients is unclear and needs to be investigated. “These data imply that for a broad range of HbA1c, combined oral treatment is safe with respect to mortality from all causes and pictures of the great vessels, but for insulin-based therapy, it is desirable to establish tighter limits. This involvement does not mean that there is unquestionable value in achieving the current glycemic targets to reduce microvascular disease. Still require more research and evaluation of overall risk assessment to determine whether intensification of glycemic control by insulin therapy increases the risk of death in the dibéticos. The findings suggest that it may be necessary to revise the guidelines for diabetes and include a definition of a minimum value of HbA1c.

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