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ANATOMICAL CHART COMPANY

Table of Contents

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Anatomical Charts & Posters

27 Anatomical Chart Collections

Educate patients and staff easily and cost efficiently with essential aids for every clinical setting. Patients take greater responsibility for their self care to diminish the likelihood of readmission. Clinical personnel rapidly advance their knowledge with inservice support that meets your highest quality standards. And you accomplish it all at a price point that fits easily within your budget. Clear, succinct, and appropriately labeled, Anatomical Chart Company aids have proven their effectiveness with de- manding professionals in every health care specialty — from empowering patients to make a greater investment in their health to preparing staff for challenging certification exams. Ordering is EASY! • Click on the product image to enlarge and view additional details. • Click Buy Now to add to your cart on the LWW.com e Store . • Click the product ISBN to open a new browser window and purchase online at the LWW.com e Store .

31 Reference Materials & Study Aids 36 Alternative Therapy Resources Pediatric/Elementary Reference Materials 35

38 Nutrition Resources

39 Health Education Resources

41 Training Aids & Simulators

42 Anatomical Models

58 Skeletal Models

75 Gifts

76 Index

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Choose from hundreds of lifelike 3-dimensional models, comprehensive reference tools, and novelties to enhance your classroom, office, or exam room today!

Essential Aids for Focused Learning, Rapid Comprehension, and Quick Reference

Anatomical Chart Company helps you connect more effectively, whether you’re teaching patients about disorders to achieve better compliance — or helping staff advance their knowledge and prepare for certification exams. Interactivity… vibrant, interesting colors… accuracy in every detail … and clear, succinct commentary help you meet your goals. Choose from… • full-color charts • 3-Dimensional models • CD-ROMs • pocket guides • referencematerials • multi-lingual learning aids • mobile device software …andmore!

Human Spine Disorders Chart See page 6

Rapid Review Refer- ence Guide Online Deliverable See page 31

Budget Vertebral Column Model See page 61

Customers rate Anatomical Chart Company products

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Budget Skull ........................................................................................ See page 64 The Vertebral Column and Spine Disorders Study Guide, 2nd Edition. ......................................................................................... See page 31 Classic Anthology of Anatomical Charts, 8th Edition, 2-Volume Set. ................................................................... See page 30

4 Charts & Posters 27 Chart Collections 31 Reference Materials 35 Pediatric/Elementary 36 Alternative Therapy & Study Aids Reference Materials Resources

Anatomical Charts & Posters

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Poster sizes and materials • Heavy paper, 20” x 26” (50.8cm x 66cm), is ideal for framing or tacking on a wall. • Plastic laminate, 20” x 26” (50.8cm x 66cm), offers flexibility, durability, and metal eyelets at top corners for hanging or portable-stand display. Write-on/wipe-off surface is perfect for classrooms and offices. • Latex-free styrene plastic, 19-3/4” x 26”, (50.16cm x 66cm), has UV-resistant coating for color protection on durable, non-flexible, heavy- weight plastic. With write-on/ wipe-off surface and convenient eyelets for hanging. • Giant, 42” x 62” (106.7cm x 157.5cm), printed on sturdy tear-resistant light-weight plastic that’s ideal for demonstrations and lecture halls. With three eyelets for easy hanging. • 3-Dimensional, 18”x 25” (45.7cm x 63.5cm) made of durable, lightweight, non-toxic, recyclable plastic.

Spanish 3-D

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• Just the right level of detail for medical professionals, patients, students, and other specialists • At-a-glance format that speeds learning • Clearly labeled anatomical features that eliminate confusion • Striking, colorful images that capture and hold attention

• Enlarged views of key organs and structures • And each chart and model is comprehensive, allowing for complete learning that’s always enjoyable and accessible — never overwhelming. • Large Decal Chart - large peel and stick decals are moveable and reusable

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38 Nutrition Resources 39 Health Education 41 Training Aids 42 Anatomical 58 Skeletal

75 Gifts 76 Index

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A. 8946 The Muscular System 978-1-58779-035-5 Laminated 978-1-58779-035-5 Laminated 978-1-58779-683-8 Styrene Plastic 978-1-58779-036-2 Paper 978-1-58779-981-5 Giant 978-1-58779-996-9 Laminated (Spanish) 978-1-58779-995-2 Paper (Spanish) B. 8947 The Female Muscular System 978-1-58779-565-7 Laminated 978-1-58779-563-3 Paper

C. 8943 The Skeletal System 978-1-58779-062-1 Laminated 978-1-58779-682-1 Styrene Plastic

978-1-58779-063-8 Paper 978-1-58779-982-2 Giant D. The Skeletal System - Large Decal Chart 978-1-49637-117-1 Styrene Plastic E. The Muscular System - Large Decal Chart 978-1-49637-118-8 Styrene Plastic

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4 Charts & Posters 27 Chart Collections 31 Reference Materials 35 Pediatric/Elementary 36 Alternative Therapy & Study Aids Reference Materials Resources

ANATOMY AND INJURIES OF THE SPINE

Normal Anatomy of the Spine

Nuchal ligament

Supraspinous ligament

Ligamentum nuchae tear

Hyperflexion

Anterior longitudinal ligament

Hyperextension

Cervical vertebrae Thoracic vertebrae Lumbar vertebrae

Spinal nerve injury

Anterior longitudinal ligament tear

Intervertebraldisc tears

Branchesof spinal nerves

Vertebralbody fracture from hyperflexion

Spinousprocess fracture

Burner/stinger

Intervertebraldisc

Spondylolisthesis with cord injury

Head rotationand lateralbending

Brachialplexus traction injury

Shoulder depression

Anatomical Charts & Posters

Lateral intertransverse muscles Medial intertransverse muscles

B.

I N J U R I E S

Dermatomes

Burst fracture of thoracic vertebra

Dislocation of thoracic vertebra

Bone fragment into spinalcanal

Sacrum

Burst fracture

Anterior view

Vertebra cross-section, Superior View

Compression fracture

Annulus fibrosus

Herniated Disk

Intervertebral disc

Spondylolysis

Nucleuspulposus

Spinal nerve

Spinalnerve

Spinal cord

Spinal cord

Posterior view

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PublishedbyAnatomicalChartCompany, IL. Developed inconsultationwithDr.MarkHutchinson

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A. 6669 Anatomy and Injuries of the Spine 978-0-7817-8667-6 Laminated 978-0-7817-8666-9 Paper B. 9850 The Vertebral Column 978-1-58779-210-6 Laminated 978-1-58779-689-0 Styrene Plastic 978-1-58779-211-3 Paper C. 9850 Understanding Osteoporosis 978-1-4963-6248-3 Laminated 978-1-4963-6249-0 Paper D. 9970 Human Spine Disorders, 2nd Edition 978-1-58779-443-8 Laminated 978-1-58779-465-0 Styrene Plastic 978-1-58779-399-8 Paper

E. 9991 The Human Skull 978-1-58779-167-3 Laminated

I. 9799 Shoulder and Elbow 978-1-58779-755-2 Laminated 978-1-58779-685-2 Styrene Plastic 978-1-58779-754-5 Paper J. 9800 Anatomy and Injuries of the Shoulder 978-1-58779-808-5 Laminated 978-1-58779-809-2 Styrene Plastic 978-1-58779-807-8 Paper K. 6607 Joints of the Lower Extremities 978-0-7817-8663-8 Laminated 978-0-7817-8660-7 Paper L. 6560 Joints of the Upper Extremities 978-0-7817-8657-7 Laminated 978-0-7817-8656-0 Paper

978-1-58779-168-0 Paper F. 9990 Head and Neck 978-1-58779-147-5 Laminated 978-1-58779-728-6 Styrene Plastic 978-1-58779-148-2 Paper G. 9989 Whiplash Injuries of the Head and Neck 978-1-58779-375-2 Laminated 978-1-58779-376-9 Paper H. 6706 Anatomy and Injuries of the Head and Neck 978-0-7817-8671-3 Laminated 978-0-7817-8670-6 Paper

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38 Nutrition Resources 39 Health Education 41 Training Aids 42 Anatomical 58 Skeletal

75 Gifts 76 Index

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4 Charts & Posters 27 Chart Collections 31 Reference Materials 35 Pediatric/Elementary 36 Alternative Therapy & Study Aids Reference Materials Resources

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38 Nutrition Resources 39 Health Education 41 Training Aids 42 Anatomical 58 Skeletal

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A. 9872 Knee Injuries 978-1-58779-757-6 Laminated 978-1-58779-696-8 Styrene Plastic 978-1-58779-756-9 Paper B. 6720 Athletic Injuries of the Knee 978-0-7817-8675-1 Laminated 978-0-7817-8672-0 Paper C. 9780 Hip and Knee, 2nd Edition 978-1-58779-866-5 Laminated 978-1-58779-867-2 Styrene Plastic 978-1-4963-6249-0 Paper D. 9802 Anatomy and Injuries of the Hip 978-1-58779-383-7 Laminated 978-1-58779-382-0 Paper E. 9781 Hip and Knee Inflammations, 2nd Edition 978-0-7817-7347-8 Laminated

978-0-7817-7345-4 Paper F. 9803 Understanding Arthritis 978-1-58779-386-8 Laminated 978-1-58779-385-1 Paper 978-0-7817-7303-4 Laminated (Spanish) 978-0-7817-7302-7 Paper (Spanish) G. 9790 Hand and Wrist 978-1-58779-142-0 Laminated 978-1-58779-694-4 Styrene Plastic 978-1-58779-143-7 Paper H. 9791 Understanding Carpal Tunnel Syndrome 978-1-58779-321-9 Laminated 978-1-58779-322-6 Paper I. 9138 Anatomy and Injuries of the Hand and Wrist 978-1-58779-914-3 Laminated

978-1-58779-913-6 Paper J. 9793 Ligaments of the Joints 978-1-58779-467-4 Laminated 978-1-58779-710-1 Styrene Plastic

978-1-58779-466-7 Paper K. 9795 Foot and Ankle 978-1-58779-137-6 Laminated 978-1-58779-686-9 Styrene Plastic 978-1-58779-138-3 Paper L. 8379 Anatomy and Injuries of the Foot and Ankle 978-1-58779-838-2 Laminated 978-1-58779-839-9 Styrene Plastic 978-1-58779-837-5 Paper

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4 Charts & Posters 27 Chart Collections 31 Reference Materials 35 Pediatric/Elementary 36 Alternative Therapy & Study Aids Reference Materials Resources

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A. 2425 Understanding Low Back Pain 978-0-7817-8243-2 Laminated 978-0-7817-8242-5 Paper B. 9839 Understanding Pain 978-1-58779-984-6 Laminated 978-1-58779-983-9 Paper 978-0-7817-8229-6 Laminated (Spanish) C. 8022 Dermatomes 978-1-58779-111-6 Laminated 978-1-58779-112-3 Paper D. 8949 The Nervous System 978-1-58779-044-7 Laminated 978-1-58779-690-6 Styrene Plastic 978-1-58779-045-4 Paper

E. 8024 The Spinal Nerves 978-1-58779-205-2 Laminated 978-1-58779-691-3 Styrene Plastic 978-1-58779-206-9 Paper F. 8026 The Autonomic Nervous System 978-1-58779-001-0 Laminated 978-1-58779-002-7 Paper G. 9716 Understanding Multiple Sclerosis 978-1-58779-972-3 Laminated 978-1-58779-971-6 Paper H. 9920 The Brain 978-1-58779-105-5 Laminated 978-1-58779-106-2 Paper I. 9921 Anatomy of the Brain

978-1-58779-089-8 Laminated 978-1-58779-090-4 Paper J. 9978 Understanding Parkinson’s Disease, 2nd Edition 978-0-7817-8636-2 Laminated 978-0-7817-8635-5 Paper K. 9868 Understanding Stroke, 2nd Edition 978-1-58779-988-4 Laminated 978-1-58779-987-7 Paper 978-1-58779-990-7 Laminated (Spanish) 978-1-58779-989-1 Paper (Spanish) L. 9976 Understanding Alzheimer’s Disease, 2nd Edition 978-0-7817-8634-8 Laminated 978-0-7817-8633-1 Paper

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38 Nutrition Resources 39 Health Education 41 Training Aids 42 Anatomical 58 Skeletal

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I. 8953 Deep Vein Thrombosis 978-1-58779-671-5 Laminated 978-1-58779-670-8 Paper J. 9878 Anatomy of the Heart, 3rd Edition 978-1-4963-6959-8 Laminated K. 8023 The Heart 978-1-4963-6962-8 Laminated L. 8824 Heart Conditions 978-1-58779-883-2 Laminated 978-1-58779-882-5 Paper M. 9912 Heart Disease, 2nd Edition 978-0-7817-7338-6 Laminated 978-0-7817-7337-9 Paper 978-0-7817-8219-7 Laminated (Spanish) 978-0-7817-8218-0 Paper (Spanish) H. 8952 The Vascular System and Viscera 978-1-58779-076-8 Laminated 978-1-58779-077-5 Paper

A. 6423 Understanding Schizophrenia 978-0-7817-8644-7 Laminated 978-0-7817-8642-3 Paper B. 9974 Understanding Depression, 2nd Edition 978-0-7817-7316-4 Laminated 978-0-7817-7314-0 Paper C. 9197 Understanding Sleep Disorders 978-1-58779-920-4 Laminated D. 9979 Migraines & Headaches, 2nd Edition 978-0-7817-7660-8 Laminated 978-0-7817-7659-2 Paper

E. 9867 Understanding Epilepsy 978-1-58779-335-6 Laminated 978-1-58779-336-3 Paper F. 9878 Heart Failure 978-1-4963-6996-3 Laminated G. 8937 The Lymphatic System 978-1-58779-025-6 Laminated 978-1-58779-026-3 Paper

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4 Charts & Posters 27 Chart Collections 31 Reference Materials 35 Pediatric/Elementary 36 Alternative Therapy & Study Aids Reference Materials Resources

What is High Blood Pressure? When the heart beats, it pumps blood out to all parts of the body thru the arteries creating force or pressure against thewalls of the arteries.Likeair ina tire,bloodfillsarteries toacertaincapacity.But justas toomuchairpressurecandamagea tire,highbloodpressure candamagehealthyarteries.Whenbloodpressure ishigh theheartmustworkharder topump the sameamountofblood through the arteries.Bloodpressure rises and fallsduring theday, butwhen bloodpressure stayshigh over time, it is calledhigh bloodpressure (HBP)orhypertension.Thewear and tear causedbyuntreatedhighbloodpressure can causedamage to theheart,kidneys and eyes, and increases the risk forheart attack, stroke,kidney failure, coronary arterydisease, andother serioushealthproblems. Signs and Symptoms of High Blood Pressure Most of the time, high bloodpressuredoes not cause any symptoms. It is oftendiagnosedwhen apatient visits theirphysician for a routine check-up.Many people do not realize they have high blood pressure until it has causeddamage to their body. In rare cases, headaches can result from extremelyhighbloodpressure. Understanding High Blood Pressure

Complications of High Blood Pressure

HighBloodpressure that isnot controlled can cause long-termdamage toyourblood vessels,brain,heart,kidneys, and eyes.Learningaboutyourbloodpressure canhelp reduceyour riskofhaving a strokeorheart attack. Askyourhealth careprovider to checkyourbloodpressure today.

BRAIN Stroke –Bloodvessels in thebrain thataredamaged,weakened andnarrowedbyhighbloodpressuremaybulgeout (aneurysm) andburst causingblood to seep into thebrain tissue (hemorrhage). Orblood clotsmay form in the arteries leading to thebrain, blockingbloodflow. Transient IschemicAttack –TIA (ministroke) is abrief, temporarydisruptionofblood supply to thebrain. It’soften causedby atherosclerosisorablood clot—bothofwhich canbe a resultofhighbloodpressure.

Blood clot Hemorrhage

Aneurysm

EYES Thickened,narrowedor tornbloodvessels in the eyesmay result invision loss.

How is Blood Pressure Measured? Bloodpressure ismeasuredwith a simple testusingabloodpressure cuff.The cuff iswrapped aroundyour upper arm and inflated enough to stop thebloodflow inyour artery for a few seconds.When the cuff is releasedordeflated, thefirst soundheardbyyourhealth careprovider through the stethoscope is the whooshing soundofyourheartpushingblood intoyour arteries.This is called the“systolic”bloodpressure. The “diastolic”bloodpressure iswhen thisnoisedisappears, indicating theheart is relaxed. The systolicbloodpressurenumber is always statedfirst followedby thediastolicnumber. For example,yourbloodpressuremaybe read as“117over76”,orwritten“117/76”.

Damagedbloodvessels in the retinaof the eye

Two numbers are used to describe blood pressure:

BLOODVESSELS Highbloodpressure candamage the innerwallsof arteries causing them to thicken andharden,a condition called arteriosclerosis .Cholesterol andother substances (plaque) in theblood can collecton thedamagedwallsof the arteries; a condition called atherosclerosis ; andmayblockbloodflow causingproblems such as chest pain (angina),heart attack,heart failure,kidney failure, stroke,blocked arteries inyour legsorarms (peripheralarterialdisease), eyedamage, and aneurysms.

Diastolic (bottom number) The second number is lower than the systolic pressure and measures blood pressure when the heart relaxes between beats.This is called “diastolic bloodpressure.”Anormal healthy number is around 76. Your blood pressure normally changes throughout the day. It rises when you are active, and lowerswhenyouare resting. Systolic (top number) The top number called “systolic blood pressure” measures bloodpressurewhen the heartpumps blood forward through the arteries to the restofyourbody.This force createspressureon thearteries.Bloodpressure ishighest when theheartbeats,pumping theblood.Anormalhealthynumber is around 117. mmHg is ameasurementofpressure

117 76

mm Hg

Healthy and Unhealthy Blood Pressure Levels

Thickened arterywalls Arteriosclerosis

Plaquebuilduponwallsofartery Atherosclerosis

Anatomical Charts & Posters ANEURYSM Over time, the constantpressureofbloodmoving throughaweakenedartery cancauseasectionof itswall toenlargeand formabulge (aneurysm).Ananeurysm canburst and cause internalbleeding.Aneurysms can form in any artery in thebody,but they’remost common in theaorta, thebody’s largest artery.

Diastolic mmHg (lower#)

Blood Pressure Category

Systolic mmHg (upper#)

B.

Normal

less than 80

less than 120

and

120 – 139

80 – 89

or

Prehypertension

140 – 159

90 – 99

or

High Blood Pressure (Hypertension) Stage 1

Aortic aneurysm

Burst aneurysm

160 orhigher

100 orhigher

High Blood Pressure (Hypertension) Stage 2

HEART CoronaryArteryDisease (CAD) –Affects the arteries that supplyblood to theheart.Thickenedandnarrowed coronary arteriespreventblood from flowing freely to theheart, causing chestpain (angina),heart attackor irregular heart rhythms (arrhythmias). LeftVentricularHypertrophy (LVH) –Highbloodpressure forces theheart to workharder topumpblood to the restof thebody.This causes theheart’s leftpumping chamber (the leftventricle) to thickenor stiffen limiting theventricle’s ability topump blood, increasing the riskofheart attack,heart failure and sudden cardiacdeath. Heart failure –Over time, the strainon theheart fromhighbloodpressure can cause theheart toweakenandwork less efficiently, eventually failing tomeet thebody’sdemand forblood.

or

Hypertensive Crisis (Emergency care needed)

or

Higher than 180

Higher than 110

*Your doctor should evaluateunusually low blood pressure readings.

http://www.heart.org/HEARTORG/

Types and Causes of High Blood Pressure (Hypertension) Primary or essential hypertension is themost common type of high blood pressure. Inmost cases the exact causes are unknown;however there are several factors that increaseor contribute toyour chancesofdevelopinghighbloodpressure: •Obesityorbeingoverweight •Lackofphysical activity •Poordiet, especiallyone that includes toomuch salt and too littlepotassium •Genetics and familymedicalhistory •Age andgender •High levelsofalcohol consumption •Ethnicbackground •Stress •Smoking and secondhand smoke Secondaryhypertension may result from aknown cause such as: •Chronickidneydisease •Adrenaland thyroidproblemsor tumors •Diabetes •Pregnancy •Someneurologicdisorders :

Blocked coronary arteries Angina

Thickenedheartmuscle LeftVentricularHypertrophy

KIDNEYS Highbloodpressure isoneof themost common causesof kidney failure. It candamageboth the large arteries leading to thekidneys and the tinybloodvesselswithin thekidneys. Damage to eitherprevents thekidneys from effectivelyfilteringwaste from theblood,allowingdangerous levelsoffluidandwaste toaccumulate. Glomerulus –filterswaste from blood

High Blood Pressure in Children Teens, children and evenbabies canhavehighbloodpressure.Althoughhigh bloodpressure is farmore common among adults, the rate amongkids ison the rise, a trend that experts link to the increase in childhoodobesity.Early diagnosisand treatment can reduceorprevent theharmful complications ofhighbloodpressure.TheAmericanHeartAssociation recommends thatall childrenhave theirbloodpressuremeasuredyearly.Children have the same test forhighbloodpressure as adults;however,

Bloodvesseldamagedby Arteriosclerosis

Prevention and Management

interpreting thenumbers ismoredifficult.Your child’s physicianwilluse chartsbasedonyour child’sgender, height, age andbloodpressurenumbers todetermine whetherornotyour childhashighbloodpressure.

Highbloodpressure canbepreventedandmanagedbestby adjustingyour lifestyle.Decreaseyourbloodpressureby: •Reducebodyweight ifoverweight •Maintain ahealthyweight •Eathealthy foods •Decrease salt inyourdiet •Decrease fat inyourdiet • Increasefiber inyourdiet •Donot smoke •Avoid excessive alcohol intake •Exercise regularly •Manage stress •Followyourphysician’s instructions and take anymedications asprescribed

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Cardiology Chart Set 1 CARDIO1 • Includes 2 charts: The Heart; and Heart Disease

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Cardiology Chart Set 2 CARDIO2 • Includes 4 charts: Understanding Hypertension; Understanding Type 2 Diabetes; Understanding Cholesterol; and Cardiovascular Disease

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38 Nutrition Resources 39 Health Education 41 Training Aids 42 Anatomical 58 Skeletal

75 Gifts 76 Index

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A. Understanding High Blood Pressure, 2nd Edition 978-1-4698-7289-6 Laminated 978-1-4698-7288-9 Paper B. 9915 Cardiovascular Disease, 3rd Edition 978-1-4963-6979-6 Laminated C. 9798 Understanding Hypertension, 2nd Edition 978-1-4963-6981-9 Laminated D. 3251 Understanding High Cholesterol, 2nd Edition 978-1-4511-9324-4 Laminated 978-1-4511-9325-1 Paper E. 9882 Understanding Cholesterol 978-1-58779-326-4 Laminated 978-1-58779-327-1 Paper F. 9894 Keys to Healthy Eating, 3rd Edition 978-1-60547-107-5 Laminated 978-1-60547-106-8 Paper G. 3201 Understanding Your Weight 978-0-7817-7322-5 Laminated

Spanish

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978-0-7817-7331-7 Laminated (Spanish) H. 9779 Maintaining a Healthy Weight 978-1-58779-410-0 Laminated 978-1-58779-409-4 Paper 978-0-7817-7340-9 Laminated (Spanish) 978-0-7817-7339-3 Paper (Spanish) I. 2226 BMI & Waist Circumference 978-0-7817-7227-3 Laminated

978-0-7817-7226-6 Paper J. 9776 Risks of Obesity 978-1-58779-380-6 Laminated 978-1-58779-379-0 Paper

K. 9778 Metabolic Syndrome 978-1-58779-805-4 Laminated 978-1-58779-804-7 Paper 978-0-7817-7309-6 Laminated (Spanish) 978-0-7817-7308-9 Paper (Spanish)

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4 Charts & Posters 27 Chart Collections 31 Reference Materials 35 Pediatric/Elementary 36 Alternative Therapy & Study Aids Reference Materials Resources 9781469894395_r2_DiabetesType1_3E_9781469894947 8/25/14 7:01PM Page1

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

UNDERSTANDING TYPE 1 DIABETES

What is Diabetes? UNDERSTANDING DIABETES Types of Diabetes

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: •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 •Obesity or overweight •Lack ofphysical activity •Parent or siblingwithT2DM

What is Type 1 Diabetes?

Complications

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.

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.

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.

SHORT-TERM

CellularViewofPancreas

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: Hypoglycemia (low-blood sugar)

Alpha cell

Brain

Beta cell

Diabetic beta cells cannotproduce the insulinneeded tohelp cells convertglucose to energy

What happens in Type 1 Diabetes?

•Weakness/dizziness • Sweating •Headache •Loss of coordination

•Fatigue •Tremor • Irritability • Slurred speech •Awakening from sleep •Falling out ofbed •Facial tingling

Normal insulinproducing pancreatic cells

CellularViewofPancreas

• Seizure •Hunger

Insulin molecules

•Loss of consciousness • Inability to concentrate •Blurredvision

Destruction of beta cells

Insulinmolecules

Alpha cell

Beta cell

WhatHappens inDiabetes

Heart

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,

Diabetic pancreatic islet ofLangerhans

Glucose (sugar) fromdigestive system

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Pancreas

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.

Normal pancreatic islet of Langerhans

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.

Too little sugar in one’sblood Hypoglycemia

Liver

Stomach

Toomuch sugar in one’sblood Hyperglycemia

Lung

MultipleFactorsCauseHighBlood Sugar and InsulinResistance inType 2Diabetes

Insulin from pancreas

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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

Pancreas

The followingmetabolicdisorders result in abovenormalblood sugar levels.

Heart

Large intestine

Glucosemolecules (fromdigestive system)

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: Hyperglycemia (high-blood sugar)

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

Small intestine

Symptoms ofDiabetes

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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

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ThePancreas and Type 1Diabetes 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.

Liver

thepancreas calledbeta cells. Insulinmakes itpossible for glucose toenter the cells.The insulinopensadoor in the cell thatallowsglucose toenter. Indiabetes,yourpancreas doesn'tmake enough insulin, oryour cellsdon’t respond properly to the insulin produced,ora combination ofboth. Without thehelp of insulin, glucosebuildsup inyourblood

•Frequenturination •Fatigue

• Increased thirst •Blurredvision

Glucosemolecules

•Excessive thirst •Extremehunger •Fatigue

Kidney

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Pancreas

Ketoacidosis

Insulinmolecules

•Blurredvision •Dry, itchy skin •More infections thanusual

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

Large intestine

Diabeticbeta cells Duringpre-diabetes,up to 80% of beta cell function is lost, insulin levelsdrop,glucose levels rise while fasting and after eating.

Redblood cells

Normalbeta cells secrete insulinwhichdrives glucose intomuscle, liver and fat cellsmaintainingblood sugar levels in thenormal range

•Numbness in feet and/orhands • Slow-healing cuts or sores •No symptoms

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Small intestine

causingyourblood sugar levels to rise.

Insulinmolecules

INCREASES absorptionofglucose whichmakes insulin resistanceworse •Thekidney itself increases the amount ofglucose itmakes

cardiovasculardisease •Abnormal cholesterol •Exposure to secondhand smoke

Risk factors

Insulin receptor

•Thirst •Fatigue •Nausea andvomiting coma or evendeath. Symptoms include:

Insulin

• Stomachpain •Possible Infection •Loss of consciousness

Type 2Diabetes andPrediabetes •Overweight or obesity •Physical inactivity/lack of exercise •Familyhistory ofdiabetes

•Abnormal sleeppatterns •History ofmental illness •Womenwith ahistory ofpolycystic ovarian syndrome

Insulin frompancreas attaches to cell

Brain: •As onegainsweight, appetite is increased •Obesepeoplehave ahigh risk ofdevelopingdiabetes because theyhavedifficulty controlling their appetite

Insulin cannot attach to cell

LONG-TERM

Glucose from food

•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

Glucosemolecules

Cell "door" is opened allowingglucose (sugar) to enter the cell

Cell "door" is opened allowingglucose (sugar) to enter the cell

Glucosemoves into theblood

HeartDisease and Stroke

Glucosemoves into theblood

Celldoor is closed,glucose isnot able to enter and moves into the blood.

Glucose molecules

Poorbloodsugar (glucose)control,high blood pressure, and high cholesterol can damage arteries increasing risk for heartattackor stroke.

Celldoor is closed, glucose isnot able to enter andmoves into theblood

Energy- deprived cell

Glucose converted to energy

Opened glucose door

Insulin attaches to cell and opens a "door"

SkeletalMuscles: •Muscle cells areunable to absorb anduseglucose for energy •Unusedglucose stays in theblood, increasing sugar levels, adding to insulin resistance

Glucose converted to energy

Energy-deprived cell

Energy- deprived cell

Insulin attaches to cell and opens a "door" allowing glucose to enter

Glucose converted to energy

Redblood cells

Insulin molecules

KidneyDisease (Nephropathy)

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.

High levelsofbloodglucosecandamage the glomeruli (the filtering units of the kidney),which can reduce thekidney’s ability to remove waste and retain importantnutrients such asprotein.

Closed glucose door

Increasedblood sugar (glucose) level

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.

EyeProblems

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.

DiabeticBodyCell NormalBodyCell

• Diabetic Retinopathy occurs when oneof the arteries that suppliesblood to the retina becomes blocked causing diminishedblood flow to the retinaand can lead toblindness.

NormalBodyCell

DiabeticBodyCell

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.

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.

Redblood cell

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.

NormalBodyCell

BodyCellwithDiabetes

Increased blood sugar level

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

Glucose molecule

3

•DiabeticMacular Edema (DME) results in vision loss due to the effects of chronic inflammation from exposure to highblood sugar levels.

How InsulinWorks (NormalCellsvs.DiabeticCells)

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

5 Tips for Successful Diabetes Self-Management

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GlucoseBuildup Asa resultofnoor little insulin,glucosebuildsup in theblood,damagingvessels andvitalorgans.

NerveDamage (Neuropathy)

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.

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, infectionsand footdeformitieswhichmay require an amputation. Sleep andbalancemaybedisrupted.

Complications

Long-termdiabetes candamagemanypartsof thebody.Seeyourhealth careprovider at leastonce ayear to find and treat anyproblems early.

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 UPDATED

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. UPDATED EyeDisease (DiabeticRetinopathy)

NerveDamage (Diabeticneuropathy)

KidneyDisease (Nephropathy)

Other examples ofdiabeticneuropathy include:

VascularDisease

2 UPDATED

•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

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.

Poor sugar control, high blood pressure, and high cholesterol can damage arteriesand increase risk ofheartattackor stroke. blood

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

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.

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Anatomical Charts & Posters Knowyourmetabolic targets:blood sugar levels (A1C),bloodpressure, and cholesterol. Takeyourmedication asprescribed. Followup frequently withhealth careproviders who areknowledgeable aboutdiabetes. Stop smoking. Practice living ahealthy lifestyle: exercise, lose weight ifoverweight, and makehealthy food choices. Developed in consultationwith JeffUngerMD,ABFM,FACE. © 2015

develop and amputationsmaybenecessary.

Developed in consultationwith JeffUngerMD,ABFP,FACE.

© 2015

© 2015

Developed in consultationwith JeffUngerMD,ABFP,FACE

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Cyan Angle@23 B.

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ANATOMICAL CHART COMPANY