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ANATOMICAL CHART COMPANY
16
Anatomical Charts & Posters
I.
G.
H.
What is Diabetes?
UNDERSTANDING DIABETES
Normalbeta cells
secrete insulinwhichdrives
glucose intomuscle, liver and fat
cellsmaintainingblood sugar
levels in thenormal range
Diabeticbeta cells
Duringpre-diabetes,up to 80% of
beta cell function is lost, insulin
levelsdrop,glucose levels rise
while fasting and after eating.
WhatHappens inDiabetes
Diabetesmellitusordiabetes isagroupofdiseases thataffect thebody’s cellsability to convertanduse sugar
(glucose) from food for energy. The result is toomuch sugar (glucose) in the blood.Hyperglycemia (high
blood sugar) candamageorgans suchas the eyes,kidneys,nerves,heartandbloodvessels, increasing riskof
stroke andheart attacks.
Patients with hypertension, high cholesterol, heart disease, a family history of diabetes, those who are
overweight orHispanic orAfricanAmerican should be screened for diabetes beginning at age 45. Early
diagnosis can slow theprogression of thedisease and lessen the risk of long term complications.
Blood tests areused todiagnosediabetes.Alldiabetesblood tests involvedrawingblood and sending it to a
lab for analysis.Yourhealth careprovidermayperform the following to test fordiabetes:
•A1C blood test
shows the average blood glucose levels over the past 3months, and is reported as a
percentage, the higher the percentage, the higher your blood glucose levels have been.AnA1C test of
greater than 6.5% is considered abnormal.
•Fastingplasmaglucose test
measuresbloodglucoseafter fasting forat least8hours.Fastingglucose levels
above 126mg/dLare considered abnormal.
• 2-HourOralGlucose test
measuresbloodglucose levelsbefore and 2hours afterdrinking a special sweet
liquid. 2-hourpostmealglucose levelsgreater than 200mg/dLare considered abnormal.
Type 1DiabetesMellitus (T1DM)
Peoplewith T1DM do not produce insulin because their immune system (the body’s
system for fighting infection)attacksanddestroys the insulin-producingbetacells in thepancreas, leaving littleorno insulin.Without
insulin, sugarbuildsup in theblood instead ofbeing transferred to the cells.
The cause of T1DM is not known but it is thought to be a combination of genetic and environmental factors (exposure to certain
viruses).T1DM accounts for about 5% ofdiagnoseddiabetes in theUnited States. It can appear at any age, butdevelopsmost often
in children andyoung adults.
Type 2DiabetesMellitus (T2DM)
iswhen thepancreasdoesnotproduce enough insulin, or the body cannotuse insulin
properly (a condition called insulin resistance).T2DM is themost common formofdiabetesandgeneticsand environmental triggers
mayplayapart in itsdevelopment.The following factorsplayan important role in causing
highblood sugarand insulin resistance
in individualsgeneticallyprone to type 2diabetes:
•
Beta cells in thepancreas slowly stopproducing insulin.
•
Alpha cells in thepancreasproduce toomuchofahormone calledglucagon that stimulates the liver tomake sugarwhich thebody
can’tuse and it’s released into theblood.
•
The liver fails to store sugar as an energy source.
•
Thekidney overproducesglucose and INCREASES absorption ofglucose into theblood.
•
Low insulin levels cause the fat cells tobreakdown and release “free fatty acids” (FFAs).FFAs cause the liver tomakemore sugar,
destroy the insulinproducingbeta cells in thepancreas andblock themuscles fromusingglucose for energy.
•
Muscle cells areunable to absorb anduseglucose for energy.Unusedglucose stays in theblood, increasing sugar levels.
•
Eating releaseshormones that tell thepancreas toproduce/release insulin,prevent the liver frommaking sugar, slow thepassage
of food thru the stomach and send the brain amessage to “feel full”. In T2DM, these hormones are impaired resulting inweight
gain and reduced insulin levels.
•
As onegainsweight, appetite is increased causingmoreweightgain and adding to insulin resistance.
Pre-diabetes
iswhen the blood sugar level is higher than normal, but is still low
enoughnot tobe considereddiabetes.92millionAmericanshaveprediabeteswhich
isdefined ashaving fasting blood sugars levels of 100-125mg/dL, 2-hourpost
meal blood sugars levels of 140-199mg/dL or anA1C of 5.7-6.4%. People
withprediabetesareathigh risk for somediabetes related complications,
especially heart disease. Weight loss and exercise can reverse
prediabetes. 11% of patients with prediabetes convert to clinical
diabetes eachyear.
Gestationaldiabetes
isacondition thatwomencangetwhen
they are pregnant. The exact cause is unknown but it is believed
that pregnancy hormones make your cells more resistant to
insulin resulting inhighblood sugar.Gestationaldiabetesusually
disappears after thebaby isborn,butwomenwhohavehad it are
athigher risk ofdevelopingT2DM later.
Types of Diabetes
Patients with type 1 diabetes usually report rapidly developing
symptoms.With type 2 diabetes, symptoms usually develop gradually
andmaynot appearuntilmanyyears after the onset of thedisease.
•Weight loss evenwhen eatingproperly
•Frequenturination
•Excessive thirst
•Extremehunger
•Fatigue
•Blurredvision
•Dry, itchy skin
•More infections thanusual
•Numbness in feet and/orhands
• Slow-healing cuts or sores
•No symptoms
Symptoms ofDiabetes
Risk factors
5 Tips for Successful Diabetes Self-Management
1
Pancreas
Liver
Kidney
Pancreas
Heart
Large intestine
Small intestine
Insulin acts as a “key” to open adoor in the cell that lets
glucose enter,where itwillbe converted to energy.
Cellsdevelop a resistance to insulin, the insulindoesnotwork
correctly ornot enough insulin ismadeby thepancreas.Cellsdonot
get the fuel theyneed for energy and sugarbuildsup in theblood.
Celldoor is closed,
glucose isnot able
to enter andmoves
into theblood
Insulin cannot
attach to cell
Energy-deprived
cell
Glucose converted to
energy
DiabeticBodyCell
NormalBodyCell
Glucose
from food
Cell "door" is opened
allowingglucose (sugar)
to enter the cell
Insulin attaches to cell and
opens a "door" allowing
glucose to enter
Increasedblood sugar
(glucose) level
Glucosemoves
into theblood
Insulin
Food isbrokendown intoglucose.Glucose
is a form of sugar in theblood and is the
main source of energy for thebody.
Glucoseneeds thehelp of ahormone
called
insulin
to enter the cells.
Ahormone is a chemical substancemade
inonepartof thebodywhich travels to
otherpartsof thebody tohelp cells
andorgansdo their jobs.
Insulin
ismadeby special cells in
thepancreas calledbeta cells.
Insulinmakes itpossible for
glucose toenter the cells.The
insulinopensadoor in the cell
thatallowsglucose toenter.
2
3
Indiabetes,yourpancreas
doesn'tmake enough insulin,
oryour cellsdon’t respond
properly to the insulin
produced,ora combination
ofboth.
4
Without thehelp of insulin,
glucosebuildsup inyourblood
causingyourblood
sugar levels to rise.
5
Knowyourmetabolic
targets:bloodsugar levels
(A1C),bloodpressure,
and cholesterol.
Insulin frompancreas
attaches to cell
1
Takeyourmedication
asprescribed.
4
Followup frequently
withhealth careproviders
who areknowledgeable
aboutdiabetes.
5
Stop smoking.
3
Practice living ahealthy
lifestyle: exercise, lose
weight ifoverweight, and
makehealthy food choices.
2
Lung
Brain
Redblood cells
Developed in consultationwith JeffUngerMD,ABFM,FACE.
© 2015
Type 2Diabetes andPrediabetes
•Overweight or obesity
•Physical inactivity/lack of exercise
•Familyhistory ofdiabetes
•Certain racial and ethnicgroups (African
Americans,Hispanic/LatinoAmericans,Asian
Americans,Pacific Islanders,NativeAmericans
andAlaskaNatives)
•Older age –but onset is increasingdramatically
among children,adolescentsandyoungeradults
•History ofgestationaldiabetes ordelivery
of ababyweighing 9pounds ormore atbirth
•Highbloodpressure, lowHDL (good)
cholesterol and/orhigh triglyceride levels
•Polycystic ovary syndrome
Type 1Diabetes
•Parent or siblingwhohasT1DM
•Environmental factors (exposure toavirusor toxin)
•Race –T1DM ismore common inwhites than in
other races
•Geography - certain countries, such asFinland and
Sweden,havehigher rates ofT1DM
Diabetes inYouth
Diabetes isoneof themost common chronicdiseases in children
and adolescents.About 1 in 400 people younger than 20 years
have type 1 or type 2 diabetes.Although type 1 diabetes ismore
prevalentamongchildrennationwide, type2diabetes isbecomingmore
common inU.S.kidsand teens,especially if theyareoverweight.There is
noknownway toprevent type1diabetes,but, expertsagree thathealthy
eatingandanactive lifestyle canhelp toprevent type2diabetes inyouth.
DiabetesManagement
Peoplewith type 1 diabetes require insulin tomanage their diabetes.
Insulinpensand insulinpumpsare safe, effectiveandaccurateways to
take insulin.Treatment for type 1diabetes is a lifelong commitment to
blood sugarmonitoring, taking insulin, healthy eating, exercise and
regularvisits toyourhealth careprovider.
Type 2Diabetesmaybe treatedwith avarietyofdifferent anti-diabetic
medications determined by blood sugar levels and symptoms.
Patientsmay also be prescribedmedicine to control cholesterol and
bloodpressure.
Peoplewithdiabetes canprevent ordelayproblems by keeping blood
sugar levels as close tonormal aspossible,keepingbloodpressure and
cholesterol under control and by getting regular medical care.
Although diabetes is a common disease, every individual needs
personalized care.Consultingwithadiabeteshealthcare teamwillhelp
you tomaintain the correct balance betweenmedication, blood sugar
monitoring,diet, and exercise.
A.
What is Type 1 Diabetes?
SHORT-TERM
Hypoglycemia iswhenblood sugar fallsbelow70mg/dl.This
is also known as an insulin reaction. Low blood sugar can be
caused by eating too little, not eating often enough, by too
much physical activity without eating, or toomuch insulin.
Hypoglycemia candevelopquickly inpeoplewithdiabetes.
Symptoms include:
Energy-
deprived
cell
Glucose
converted
to energy
Diabetesmellitus type1or type1diabetes (T1DM),onceknownas insulin-dependentor juvenilediabetes isachronic
metabolic disorder that prevents the body frommaking energy from food.Most people develop T1DMwhen they
are children oryoung adults,but it can occur at any age.
People with T1DM cannot produce the hormone insulin, because their immune system (the body’s system for
fighting infection)attacksordestroys the insulin-producingbetacells in thepancreas.Without thebetacells, thebody
can no longerproduce the insulin needed to help sugar (glucose) enter the cell to beused for energy and the sugar
(glucose)buildsup in theblood.Highblood sugar levels can lead tomany long-termhealthproblems.
Although theexact causeof type1diabetes isnotknown, it is thought that thedestructionof thepancreaticbeta cells
by the immune system is triggered ingenetically susceptible individuals after exposure to a series ofviral illnesses.
•Frequenturination
•Fatigue
• Increased thirst
•Blurredvision
•Thirst
•Fatigue
•Nausea andvomiting
• Stomachpain
•Possible Infection
•Loss of consciousness
Glucose
molecule
Redblood cell
•Weakness/dizziness
• Sweating
•Headache
•Loss of coordination
• Seizure
•Hunger
•Loss of consciousness
• Inability to concentrate
•Blurredvision
•Fatigue
•Tremor
• Irritability
• Slurred speech
•Awakening from sleep
•Falling out ofbed
•Facial tingling
Hyperglycemia iswhenblood sugar increases and stays above
the normal level (greater than 120 mg/dl before meals and
greater than 180mg/dl aftermeals). Symptoms can develop
slowly, sometimes over a period of days so it is important to
monitor blood sugar levels.High blood sugar for an extended
time can result indamage tovariouspartsof thebody.
Symptoms include:
When the body cannotmake enough insulin to help glucose
enter cells forenergy; thebodybegins tobreakdown fat.When
fat isused forenergy, chemicals calledketonesare released into
the blood. Some of the ketones are passed out of the body
through theurine,butketonescanbuildup toapoisonous level
in theblood causing
diabeticketoacidosis (DKA)
.
This condition candevelop slowly and can lead to adiabetic
coma or evendeath.
Symptoms include:
UNDERSTANDING TYPE 1 DIABETES
ThePancreas and
Type 1Diabetes
NormalBodyCell
BodyCellwithDiabetes
Complications
HeartDisease and Stroke
KidneyDisease (Nephropathy)
EyeProblems
NerveDamage (Neuropathy)
LONG-TERM
When you eat, your pancreas automatically
makes the right amount of insulin to help
glucose enter the cells. The cells in the
pancreas that produce insulin are called
beta cells. In type 1 diabetes, the body’s
immune system sees the beta cells as a
“potentialdanger“ anddestroys them.
2
Digestive System
Food from the digestive system is broken
down into sugar (glucose). It iseither stored in
the liver or absorbed into the bloodstream,
where it isusedby thebody for energy.
1
How InsulinWorks
(NormalCellsvs.DiabeticCells)
Insulinmakes it possible for our cells to take in glucose (sugar). Insulin
actsasa“key” toopenadoor in thecell thatallowsglucose from theblood
to enter the cellwhere itwill be converted to energy.Without insulin, the
doorsdonot open and the cellsdonotget the fuel theyneed.
3
GlucoseBuildup
Asa resultofnoor little insulin,glucosebuildsup
in theblood,damagingvessels andvitalorgans.
4
What happens in Type 1 Diabetes?
Toomuch sugar
in one’sblood
Hyperglycemia
Too little sugar
in one’sblood
Hypoglycemia
Hypoglycemia (low-blood sugar)
Hyperglycemia (high-blood sugar)
Ketoacidosis
Managing Type 1 Diabetes
At this time, there isno cureorprevention for type 1diabetes.Patientswith type 1diabetes require insulin tomanage theirdiabetes. Insulinpens and insulinpumps are safe, effective
and accurateways to take insulin.Managing thisdisease requires individualized care from adiabeteshealthcare team tohelpmaintain the correctbalancebetweenmedication,blood
sugarmonitoring,diet, and exercise.
•Knowyourprescribedmetabolic targets (blood sugar (A1C),
bloodpressure, cholesterol)
•Exercise 5days eachweek for 30-45minutesper session
•Eathealthymeals, see a certifieddiabetic educator or a registereddietician
for assistance inmealplanning
•Never stop takingyour insulin orprescriptionmedicineswithout the consent
ofyourhealth careprovider
• Stop smoking andminimizeyour alcohol consumption
•Make sure thatyourhealth careprovider iswell trained inmanagingpatients
with type 1diabetes
Normal
pancreatic
islet of
Langerhans
Diabetic
pancreatic islet
ofLangerhans
CellularViewofPancreas
Glucosemolecules
(fromdigestive system)
Insulin
molecules
Glucose
molecules
Opened
glucose
door
Closed
glucose
door
Destruction of
beta cells
Beta cell
Alpha cell
Developed in consultationwith JeffUngerMD,ABFP,FACE
© 2015
Insulin
molecules
•Rapidheart rate
•Dizzinesswhen
standingupright
• Inability to completely
empty thebladder or
urinary incontinence
•Fullness in the abdomen
after eating a fewbites
•Diarrhea and/
or constipation
•Erectiledysfunction/
vaginaldryness
•Loss of ability to sweat
•Excessive sweating
while eating
•Charcot foot and ankle
Other examples ofdiabeticneuropathy include:
High levelsofbloodglucosecandamage
the glomeruli (the filtering units of the
kidney),which can reduce thekidney’s
ability to remove waste and retain
importantnutrients such asprotein.
Poorbloodsugar (glucose)control,high
blood pressure, and high cholesterol
can damage arteries increasing risk for
heartattackor stroke.
• Diabetic Retinopathy occurs when
oneof the arteries that suppliesblood
to the retina becomes blocked causing
diminishedblood flow to the retinaand
can lead toblindness.
•DiabeticMacular Edema (DME) results in vision loss due
to the effects of chronic inflammation from exposure to
highblood sugar levels.
High blood sugar levels can damage
nerves resulting in pain and loss of
function. Sensory neuropathy results
in tingling andburning sensation in the
feetwhileat rest. If sensation to the feet is
lost completely, patients risk developing
ulcers, infections and footdeformitieswhichmay require an
amputation. Sleep andbalancemaybedisrupted.
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9781469894395_r2_DiabetesType1_3E_9781469894947 8/25/14 7:01PM Page 1
B.
D.
E.
F.
MultipleFactorsCauseHighBlood Sugar
and InsulinResistance inType 2Diabetes
Liver
Stomach
Pancreas
Large intestine
Small intestine
Heart
CellularViewofPancreas
The insulin acts as a “key” to
open a door in the cell that lets
glucose enter the cell where it
willbe converted to energy.
In Type 2 diabetes, the body’s cells develop
a resistance to insulin, the pancreas does not
make enough insulin or the insulin does not
workcorrectly.Without insulin, thecellsdonot
get the fuel they need for energy and sugar
buildsup in theblood.
Glucose (sugar)
fromdigestive
system
Normal
insulinproducing
pancreatic cells
Diabetic
beta cells cannotproduce the
insulinneeded tohelp cells
convertglucose to energy
Insulin
from
pancreas
Redblood cells
Celldoor is
closed,glucose
isnot able to
enter and
moves into the
blood.
Insulin receptor
Energy-
deprived cell
Glucose
converted
to energy
Complications
Poor
blood
sugar
control, high blood
pressure, and high
cholesterol can damage
arteriesand increase risk
ofheartattackor stroke.
HeartDisease
and Stroke
High blood sugar levels
can cause damage to the
blood vessels of the
retina.Bloodvesselsmay
become blocked causing
diminishedblood flow to
the retinaandcan lead to
blindness.
High levels of blood
sugar can damage the
smallbloodvessels inthe
filtering units of the
kidney (the glomeruli),
andmay cause them to
leakor lose their filtering
ability leading to CKD
(chronickidneydisease) andpossiblekidney failure.
KidneyDisease
(Nephropathy)
Poor diabetes control
can cause circulation
problems in the blood
vessels of the legs and
feet.Healing ofwounds
and infectionsmay also
be affected. In extreme
situations, gangrene can
develop and amputationsmaybenecessary.
VascularDisease
High blood sugar levels
can damage nerves that
control vital functions
and/orpainperception.
Tinglingandpain in feet
from nerve damage
may progress to loss of
feeling.Neuropathy can
also affect balance, sleep, sexual function, and can
causeurinary tract incontinence.
NerveDamage
(Diabeticneuropathy)
What IsType 2Diabetes?
Type 2 diabetes or T2DM, once known as non-insulin-
dependent or adult-onset diabetes, is a progressive
metabolic disorder that affects how your body uses sugar
(glucose) from food. Glucose is an important source of
energy for the cells of your body and organs. If you have
diabetes, itmeans you have toomuch glucose (sugar) in
yourblood,which can lead to serioushealthproblems.
T2DM isacomplexdiseasewithmultiple factors linked to its
cause and development, but ismainly characterized by a
reduction in insulin secretion from the pancreas alongwith
the body’s inability to use insulin properly (a condition
called insulin resistance) tokeepbloodglucose (bloodsugar)
levels normal. Insulin is the hormone that is needed to
transportglucose (sugar) from the foodyoueat toyour cells.
Type 2 diabetes is the most common and increasingly
widespread form ofdiabetes, and it is believed that genetic
and environmental factors play a role in its development.
Being overweight is strongly linked to the development of
T2DM, but not everyone with T2DM is overweight. It is
most often associated with older age, but is a growing
problem among U.S. children and adolescents. Type 2
diabetes in youth can have a devastating effect on one’s
kidneys andheart at ayoung age.
Symptoms
(Manypatientsmayhaveno symptoms)
• Increased thirst
• Initialweightgain followedbyweight loss
•Fatigue
•Frequenturination
•Dry skin
•Blurredvision
•Tingling inhands and feet
•Erectiledysfunction,vaginaldryness
RiskFactors
High riskpatientswithout symptoms shouldbe screened
every 3yearsbeginning at age 45.Patientswith symptoms
shouldbe screened as soon aspossible.
T2DM risk factors include:
•Obesity or overweight
•Lack ofphysical activity
•Parent or siblingwithT2DM
•High-risk
ethnicity:AfricanAmerican,Latino,
NativeAmerican,AsianAmerican,Pacific Islander
•Womenwhohadgestationaldiabetes (highblood sugar
duringpregnancy), orwhohavehad ababyweighing
9pounds ormore atbirth
•History ofprediabetes,prediabetes isblood sugar levels
higher thannormal,butnotyethigh enough tobe
diagnosed asdiabetes
•History ofhighbloodpressure (hypertension) and/or
cardiovasculardisease
•Abnormal cholesterol
•Exposure to secondhand smoke
•Abnormal sleeppatterns
•History ofmental illness
•Womenwith ahistory ofpolycystic ovarian syndrome
ManagingType 2Diabetes
People with T2DM can prevent or delay problems by
keeping the levelofglucose (sugar) in thebloodas close to
normal as possible (85-130 mg/dL), keeping blood
pressure and cholesterol under control and by getting
regular medical care. Although diabetes is a common
disease, every individual needs personalized care. T2DM
may be treated with a variety of different medications
determinedby blood sugar levels and symptoms.Patients
may be prescribed medicine to control cholesterol and
blood pressure. Your diabetes healthcare provider will
help you to maintain the correct balance between
medications,blood sugarmonitoring,diet, and exercise.
Pancreas:
•Not enough insulin ismade and secretedby thebeta cells of thepancreas
•Alpha cells of thepancreasproduce toomuch of ahormone called
glucagonwhich stimulates the liver tomake sugar
Liver:
•Toomuchglucagon stimulates the liver tomake
extra sugarwhich thebody can’tuse and it’s
released into theblood
•Liver’s ability to store sugar is reduced
Kidney:
• Insteadof allowing extraglucose topass
from thebody in theurine, thekidney
INCREASES absorptionofglucose
whichmakes insulin resistanceworse
•Thekidney itself increases the amount
ofglucose itmakes
Brain:
•As onegainsweight, appetite
is increased
•Obesepeoplehave ahigh risk
ofdevelopingdiabetes
because theyhavedifficulty
controlling their appetite
SkeletalMuscles:
•Muscle cells areunable to absorb
anduseglucose for energy
•Unusedglucose stays in theblood,
increasing sugar levels, adding to
insulin resistance
Fat cells:
•Low insulin levels cause the fat cells tobreak
down and release “free fatty acids” (FFAs)
•FFAs cause the liver tomakemore sugar,
destroy the insulinproducingbeta cells in
thepancreas andblock themuscles from
usingglucose for energy.
Alimentary canal orgut:
•Whenyou eat,yourgut releaseshormones that tell thepancreas to:
produce/release insulin,prevent the liver frommaking sugar, slow
thepassage of food thru the stomach and send thebrain amessage
to “feel full”
• InT2DM, thesehormones are impairedwhich stops thepancreas
frommaking insulin, stimulates the liver tomakemore sugar and
causes the stomach to empty faster
•Thebraindoesnot feel full after eating resulting inweightgain and
increasedblood sugar levels
Insulinmolecules
Glucosemolecules
DiabeticBodyCell
NormalBodyCell
Whathappens inType 2Diabetes
Much of the foodyou eat isbrokendown intoglucose.Glucose is the form of sugar in theblood and is themain source of energy for thebody.
Glucoseneeds thehelp of ahormone called insulin to enter thebody cells.Normally thepancreas releases the right amount of insulinneeded to
transferglucose fromyourblood toyour cells. InType 2diabetes,problems occurwhen the insulin that isproduced in thepancreasdoesn’twork
correctly,not enough insulin ismade or thebody’s cells resist insulin.
UNDERSTANDING TYPE 2 DIABETES
Glucosemolecules
Cell "door" is opened
allowingglucose (sugar)
to enter the cell
Beta cell
Alpha cell
Insulinmolecules
Insulin attaches to cell
and opens a "door"
Increased
blood sugar
level
Glucosemoves
into theblood
Insulinmolecules
Long-termdiabetes candamagemanypartsof thebody.Seeyourhealth careprovider at leastonce ayear to find and treat anyproblems early.
1
.Knowyourmetabolic target levels forglucose,bloodpressure, and cholesterol.
2
. Incorporatehealthy lifestylepractices intoyour life: exercise, loseweight ifyou areoverweight, andmakehealthy food choices.
3.
Stop smoking.
4.
Takeyourprescribedmedicines.
5.
Followup frequentlywithhealthcareproviderswho areknowledgeable indiabetes.
The 5Keys toSuccessfulDiabetesManagement
The followingmetabolicdisorders result in abovenormalblood sugar levels.
Developed in consultationwith JeffUngerMD,ABFP,FACE.
© 2015
EyeDisease
(DiabeticRetinopathy)
C.
UPDATED
UPDATED
UPDATED