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Biopsy: What to know

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A biopsy is a method of diagnosing illnesses. A doctor extracts a sample of tissue or cells, typically under a microscope, to be examined by a pathologist.

A pathologist is a specialist qualified to examine a tissue sample under a microscope for signs and extent of illness.

Tissue is usually taken from a living subject for a biopsy.

The word biopsy comes from the Greek words “bios,” meaning “life,” and “opsis,” meaning “a view.” They mean “to view life” together.

Meaning

A doctor using microscope
Details regarding different conditions can be given by examining tissue under a microscope.

A biopsy can be excisional or incisional, depending on the goal:

  • An excisional biopsy is the surgical removal of a whole lump or targeted region
  • An incisional biopsy, or core biopsy, requires taking a tissue sample

There are different types of biopsy.

Scrape: The cells are separated from the surface of the tissue, such as the inside of the womb or the neck of the mouth or the cervix, for example. It is also used, widely known as pap smears, in cervical cancer screening. It can be used to confirm the existence of fungal skin infections.

A punch biopsy: A punch is a round-shaped knife which is used to cut and extract a tissue disk. This is used to collect a sample of skin tissue and can also be used to check for inflammation in order to check for malignancy or cancer.

A needle biopsy: A needle, typically made of liquid, is used to extract a sample. For a core biopsy, a large needle is used, while a thin one is used for a fine-needle aspiration biopsy (FNAB). It is also used for sampling breasts and thyroids.

A capsule biopsy: This is used to take a sample from the intestine.

Stereotactic biopsy: Samples are taken from the brain to find the biopsy site using stereotactic surgery. In order to locate small targets within the body, a stereotactic system uses three-dimensional coordinates.

Colposcopic biopsy: This is used to test a patient who has had a pap, or cervical, abnormal smear. The colposcope is a close-focus telescope that helps the physician to see in detail the areas of the cervix.

Endoscopic biopsy: In order to collect a sample, an endoscope is used. An endoscope is a long, thin, lighted optical instrument used to get deep inside the body and analyse or operate on organs.

Specially adapted endoscopes include a bladder cystoscope, a kidney nephroscope, a bronchial or lung bronchoscope, a speech box or larynx laryngoscope, and an ear otoscope.

Almost any organ can be biopsied.

Uses

We may not visualize the organs or tissues within our body, but by presenting a piece of tissue for analysis, a biopsy helps to make a diagnosis. Cancer is mostly associated with biopsies, but they may be used to identify various diseases and to see how far a disease has advanced. Sometimes, they help rule out cancer.

Conditions where there may be a role for a biopsy include:

  • Cancer: If the patient has a lump or swelling of no clear cause anywhere in the body, the only way to ascertain whether or not it is cancerous is through a biopsy.
  • Peptic ulcer: A biopsy will help a doctor decide if a non-steroidal anti-inflammatory drug (NSAIDs) is causing ulceration . To test patients with malabsorption, anemia, or celiac disease, a small bowel biopsy can be used.
  • Diagnosis of liver disease This may help the health care provider detect liver tumors or cancer. It may be used to diagnose cirrhosis or liver fibrosis when a previous injury or illness, such as long-term alcohol abuse or hepatitis, has completely scarred the liver. It may also be used, for example, in the case of hepatitis, to determine how well the patient responds to care.
  • Infection: A needle biopsy will help decide whether an infection is present and what kind of organism is causing it.
  • Inflammation: The doctor may be able to assess what is causing the inflammation by analyzing the cells in, for example, a needle biopsy.

Biopsies are often performed on transplanted organs to assess if the organ is being rejected by the body or if a disease has come back that made a transplant possible in the first place.

If a lump or tumor is present, it can be removed as part of a biopsy procedure at the same time.

Review and outcomes

Depending on the kind of biopsy, how long it takes to get the results will vary. Within 2 to 3 days, a simple outcome may be ready, but a more complicated case may take 7 to 10 days.

The surgeon may remove a suspicious lump during an excision biopsy.
The surgeon may remove a suspicious lump during an excision biopsy.

The tissue samples are sent to the laboratory where a pathologist tests them. They can be treated chemically and sliced into very thin sections. Under a microscope, they are normally examined. A blood specialist may also research the sample, or a hematologist.

The thin slice is attached to a glass slide and, for further studies, the remaining tissue is usually saved.

The slide has dyes applied to it often. These stain the tissue, and this allows the pathologist to more easily see the cells.

The pathologist would need to decide whether the sample is malignant, meaning cancerous, or benign in cases of cancer. They will decide how dangerous or advanced the cancer is because it is malignant. There are special stains that can be done to help direct care and prognosis if it is cancer.

Finally, a report that contains any abnormal or relevant findings is prepared by the pathologist. This report will be submitted to the physician who requested the biopsy.

The time it takes to get the results depends on the type of tests that are needed.

To collect the results, the patient would usually need to make another appointment with the doctor. This will extend the processing period for the findings if many experiments are carried out.

What to expect

A biopsy is an outpatient procedure in most cases, and the patient can go home immediately or very soon after it is finished.

Preparation is based on the biopsy type. There will not be any special training for a fine needle biopsy that is performed in the doctor’s office.

In order to claim they agree to the operation, the patient may need to sign a consent form and they will have to wear a gown instead of their own clothes.

The patient should not eat or drink beforehand in certain cases and should check with the doctor whether they should take their regular medications or supplements or not.

Sometimes, with or without a drug, a local anesthetic will be used to assist relaxation during the process.

The patient may require general anesthetic and may have to remain overnight in the hospital if a sample is to be taken from an internal organ. Otherwise, they can use a local anesthetic.

It normally takes no anesthesia to scrape a tissue sample from, for example, the inside of the mouth, but the area may feel sore for a while.

Often, it is essential to stitch an incision and a dressing may be necessary.

A patient who has a sample taken from a large organ, such as the liver or kidneys, may have to rest for a few hours in the hospital before going home.

There may be minor vaginal bleeding after a sample is taken from the womb lining or cervix.

Is it painful?

There should be no discomfort during the operation if anesthesia is used, but during the initial injection, there may be a skin prick.

A pin prick and a sharp pinch are felt during a needle biopsy.

For a few days, depending on the type of biopsy, there might be some soreness.

Is it safe?

Typically, a biopsy is healthy and it is known to be a very low risk procedure. There is a slight possibility of infection, as with any skin perforation, but the risk of an infection needing antibiotic treatment is possibly smaller than 1 in 1,000.

Occasionally, accidental injury may affect nearby organs, such as bowel damage during an abdominal biopsy.

Complications include the risk of bleeding, the absence of a suspicious tissue site that could lead to a false negative result, and the failure to obtain sufficient material so that the biopsy has to be replicated.

One research into the effects of biopsies used in clinical trials showed that complications contribute to 5.2 percent of those biopsies.

A breast biopsy research has shown that cancer cells will break away from a lump, spreading the disease to other regions.

Other studies into pancreatic cancer biopsies, meanwhile, concludes that the risk of mortality is not increased by endoscopic ultrasound-guided fine needle aspiration.

A biopsy may provide an early diagnosis of cancer and other diseases, whatever the risk, and early detection is crucial in many cases to increasing survival rates.

Sources

  • Biopsies. (2015, June 19)
    (LINK)
  • Biopsy. (2015, November)
    (LINK)
  • Biopsy. (n.d.)
    (LINK)
  • Breast biopsy. (n.d.)
    (LINK)
  • Hansen, N.M., Ye, X., Grube, B/J., & Giuliano, A.E. (2004, June). Manipulation of the primary breast tumor and the incidence of sentinel node metastases from invasive breast cancer. Archives of Surgery 1396: 634-9
    (LINK)
  • Biopsy: What you need to know (LINK)
  • NCI dictionary of cancer terms. (n.d.)
    (LINK)
  • Ngamruhengphong, S., Swanson, K.M., Wallace, M.B. (2015, July). Preoperative endoscopic ultrasound-guided fine needle aspiration does not impair survival of patients with resected pancreatic cancer [abstract]. Gut
    (LINK)
  • Overmann, M.J., Modak, J., Kopetz, S., Yao, J.C., Hicks, M.E., Abburzzese, J.L., & Tam, A.L. (2013, January). Use of research biopsies in clinical trials: Are risks and benefits adequately discussed? Journal of Clinical Oncology 17-22
    (LINK)

Alzheimer's / Dementia

Uses of vitamin B-12 level test: Normal ranges, and results

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The amount of vitamin B-12 in the blood or urine is measured in a vitamin B-12 level test to determine the body’s overall vitamin B-12 reserves.

Vitamin B-12 is required for a variety of body functions, including neuron function, DNA and red blood cell formation.

Treatment is required if a person’s vitamin B-12 levels fall outside of the usual range. Vitamin B12 deficiency can cause neurological symptoms as well as fatigue, constipation, and weight loss. B-12 levels that are too high could indicate liver disease, diabetes, or another condition.

Continue reading to learn more about B-12 testing and what the results indicate.

Purpose of a vitamin B-12 level test

worried lady

The vitamin B-12 level test determines the amount of vitamin B-12 in your body. Doctors can use the data to see if low vitamin B-12 levels are causing symptoms.

If a person exhibits any of the following symptoms, a doctor may recommend a vitamin B-12 level test:

Vitamin B-12 insufficiency

Vitamin B-12 deficiency is thought to affect up to 15% of people in the United States, according to research. The following are signs and symptoms of a deficiency:

  • fast heartbeat
  • numbness and tingling in the hands and feet
  • poor memory
  • a sore mouth or tongue
  • confusion
  • dementia
  • depression
  • difficulty maintaining balance

Vitamin B-12 deficiency in infants can cause them to underachieve. They may have mobility issues in addition to developmental delays.

Pernicious anaemia

A vitamin B-12 level test may be required for people who have signs of low iron. Pernicious anaemia is caused by a lack of vitamin B-12 absorption, resulting in poor red blood cell causes.

It usually affects the elderly or people who are deficient in intrinsic factor. Intrinsic factor is a gastric material that binds to vitamin B-12 and allows it to be absorbed by the body.

The following are signs and symptoms of pernicious anaemia:

  • pale skin
  • weakness
  • weight loss
  • constipation
  • fatigue
  • loss of appetite

High levels of folate in the blood

The level of folic acid in the blood is known as serum folate. High levels of serum folate might disguise the signs and symptoms of vitamin B-12 deficiency, exacerbating the neurological symptoms.

They can also make you more susceptible to anaemia.

Symptoms of other illnesses

Vitamin B-12 levels that are unusually high can be a symptom of liver disease, diabetes, or certain types of leukaemia. The findings of a vitamin B-12 test may be used by a doctor to help them make a diagnosis.

Risk factors

Vitamin B-12 deficiency is more common in some people than in others, especially those with low stomach acid or other digestive problems. Stomach acid helps the body absorb vitamin B-12 more effectively by separating it from meals.

Low vitamin B-12 levels are more common in the following groups of people than in others:

  • people with conditions that reduce vitamin B-12 absorption, including celiac disease and Crohn’s disease
  • people who have had gastric bypass surgery
  • those who are breast-feeding
  • people who are taking medicines such as chloramphenicol, proton pump inhibitors, or H2 blockers
  • older adults
  • children
  • vegans and vegetarians
  • people with diabetes

How does the B-12 vitamin level test work?

Vitamin B-12 status is normally determined by a blood test, but home urine tests are now available. Vitamin B-12 levels can be checked as part of a routine blood test by a doctor.

Although fasting is not required before a B-12 test, it may be necessary if the doctor is utilising the test to check at other blood components.

It is important that patients inform their doctors about any medications or supplements they are taking, as some may have an impact on the outcome.

Acknowledging the results

The following are possible results:

  • Low. Vitamin B-12 levels below 200 pg/mL are considered low. This indicates that you may have a vitamin B-12 deficiency, pernicious anaemia, or an overactive thyroid. Neurological symptoms are common in people who have low vitamin B-12 levels.
  • High. Anything over 900 pg/mL is considered excessively high vitamin B-12 status. This result could indicate problems with the liver or kidneys, diabetes, or certain types of leukaemia.

Because the ranges of results differ from one laboratory to the next, it’s important to talk to a doctor about the results and what they signify.

To rule out vitamin B-12 deficiency, the doctor may measure levels of methylmalonic acid (MMA) and other chemicals. These lab results aid in the early detection of vitamin B-12 deficiency.

Vitamin B-12 deficiency treatment

Vitamin B-12 injections are frequently required by people who have low amounts of the vitamin. These shots are more successful at boosting vitamin B-12 levels than supplements, especially when people have medical issues that make supplements difficult to absorb.

High doses of vitamin B-12 supplements may help some people improve their B-12 status. Supplements are sold in the form of capsules or liquids in pharmacies, supermarkets, health food stores. It may also be beneficial to consume extra vitamin B-12-rich foods.

Treatment for high vitamin B-12 levels

There is no upper limit on vitamin B-12 consumption because high amounts do not cause problems. Having naturally high levels of vitamin B-12 in the body, on the other hand, could be cause for alarm, since it could indicate a serious underlying condition. Doctors will focus on treating the underlying medical condition rather than the vitamin B-12 levels.

Vitamin B-12  foods.

Eggs are rich in vitamin B-12.
Vitamin B-12 is abundant in eggs.

Although low vitamin B-12 levels are frequently caused by absorption problems and other medical conditions, some people may be deficient because they do not acquire enough vitamin B-12 through their food. This is especially true for vegans and vegetarians who have been vegetarian for a long time.

Vitamin B-12-rich foods include:

  • fortified plant-based dairy alternatives
  • fortified breakfast cereals
  • fortified nutritional yeast
  • fish and seafood
  • meat
  • eggs
  • dairy products

Vitamin supplements can help vegans and strict vegetarians make up for dietary deficiencies. Older persons should seek to achieve their vitamin B-12 needs through fortified meals and vitamin supplements, as supplements are simpler for their bodies to absorb than naturally occurring vitamin B-12.

Vitamin B-12 dietary recommendations

Vitamin B-12 is required in 2.4 micrograms (mcg) per day for adults and adolescents over the age of 14. During pregnancy, this rises to 2.6 mcg, and breast-feeding raises it to 2.8 mcg.

Conclusion

Vitamin B-12 is an essential nutrient that is necessary for good health. The status of a person’s vitamin B-12 is determined by a vitamin B-12 level test. This test may be recommended by a doctor to people who have symptoms of a deficiency or who are at risk of having low vitamin B-12 levels in their bodies.

Vitamin B-12 deficiency can be avoided by eating a well-balanced diet that includes many sources of the vitamin on a daily basis, or by taking supplements. If they have trouble absorbing vitamin B-12 from food, oral supplements or injections can help them avoid symptoms and consequences.

Sources:

  • https://academic.oup.com/qjmed/article/106/6/505/1538806
  • https://labtestsonline.org/tests/methylmalonic-acid
  • https://www.medicalnewstoday.com/articles/322286
  • https://academic.oup.com/nutritionreviews/article-abstract/71/2/110/1940320
  • https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/
  • https://www.hsph.harvard.edu/nutritionsource/b-12-deficiency/

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Diabetes

Symptoms, stages, causes, and treatment of diabetic nephropathy

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Diabetic nephropathy is a type of kidney disease that affects people who have diabetes for a long time. It happens when a person’s kidneys are damaged by high blood glucose levels.

Diabetic nephropathy is a type of chronic kidney disease caused by diabetes. The kidneys aid in the regulation of fluid and salt levels in the body, which is critical for blood pressure control and cardiovascular health.

When a person has diabetes, whether type 1 or type 2, or gestational diabetes, their bodies are unable to use or manufacture insulin properly. Gestational diabetes is a kind of diabetes that develops during pregnancy and increases the risk of developing type 2 diabetes later in life.

High blood sugar levels are a symptom of diabetes. High glucose levels can harm several parts of the body over time, including the cardiovascular system and the kidneys. Diabetic nephropathy is the term for the kidney damage that occurs as a result of diabetes.

Diabetic nephropathy is a leading cause of chronic kidney disease and end-stage renal disease in people with diabetes (ESRD). The kidneys in ESRD are no longer able to satisfy the demands of daily life. Kidney failure can occur as a result of ESRD, which can be life-threatening.

This page examines how diabetes affects the kidneys, as well as the treatment options and ways to prevent the risk.

Definition

alzheimer’s patients

Because nephropathy is caused by damage caused by high blood glucose levels, it can affect people with any kind of diabetes.

High blood glucose levels have an effect on the arteries in the body, and the kidneys filter the blood that passes through them.

According to the authors of a 2016 study, 20–40 percent of people with diabetes suffer renal disease.

A person’s tests may reveal one or both of the following:

High levels of albumin in the urine: When the kidneys are in good shape, the urine should include no albumin protein.

A low glomerular filtration rate (GFR): The kidneys’ primary role is to filter the blood. Their ability to do so is hampered by kidney disease. The kidneys should ideally function at 100% or have a GFR of 100Trusted Source. A doctor will not diagnose renal disease unless the GFR is 60 percent or higher. Kidney disease affects 15–60% of the population. Kidney failure is indicated by a percentage of less than 15%.

The end stage of renal disease is ESRD. In the United States, diabetic nephropathy is the most common cause of ESRD. Diabetes is responsible for 40–50% of all occurrences of ESRD, according to Trusted Source. Dialysis will be required if a person has ESRD.

Controlling blood sugar levels can help to lower the risk. Whether you have type 1 or type 2 diabetes, you can lower your risk of diabetic nephropathy by doing the following:

  • blood glucose levels should be monitored and kept within the target range
  • consuming a nutritious, low-sugar, low-salt diet
  • exercising on a regular basis
  • adhering to a treatment plan that may include the use of insulin or other drugs
  • keeping a healthy weight is important.

What is chronic kidney disease? Find out more here.

Causes

Kidney damage puts a strain on these critical organs, preventing them from functioning normally.

When this occurs:

  • the kidneys cannot maintain healthy fluid levels in the body
  • the kidneys cannot remove waste products from the blood
  • the body starts to lose protein through the urine

Diabetic nephropathy takes time to develop. According to one study, 15 years after a diabetes diagnosis, a third of people have high levels of albumin in their urine. Only about half of these people will acquire complete nephritis.

Kidney disease is uncommon in people who have had diabetes for less than ten years, according to statistics. Also, if a person does not get nephropathy 20–25 years after diabetes begins, they have a low probability of developing it later.

Diabetic nephropathy is less likely if a diabetic’s blood glucose levels are well controlled.

Because of the damage to blood vessels, high blood glucose levels raise the risk of high blood pressure. Hypertension, or high blood pressure, can aggravate kidney disease.

Other potential dangers

Other aspects to consider are:

Smoking: A relationship between smoking and increased levels of inflammation may cause kidney injury. While the exact link between smoking and diabetes is unknown, people appear to have a higher risk of diabetes, as well as hypertension and kidney disease.

Age: Kidney disease, particularly a low GFR, is more common in people over the age of 65.

Sex: The condition is more common in men than in women.

Ethnicity, race, or both: African Americans, Native Americans, and Asian Americans are more likely to have it.

Conditions of health: Obesity, chronic inflammation, high blood pressure, insulin resistance, and high blood lipids (fats) are all risk factors for kidney disease.

Some of these risks are or appear to be contributing factors to diabetes or complications.

Diabetic nephropathy is distinct from diabetic neuropathy, a condition that affects the nerve system.

Stages and symptoms

A person with diabetic nephropathy may not experience any symptoms in the early stages. Changes in blood pressure and fluid balance in the body, on the other hand, may already be evident. Waste materials can accumulate in the blood over time, causing symptoms.

Stages

Depending on the GFR, which also measures the proportion of functional kidney function, a clinician may divide renal disease into phases.

Stage 1: Kidney damage is present, but kidney function is normal and the GFR is 90 percent or higher.

Stage 2: Kidney impairment, with some function loss and a GFR of 60–89%.

Stage 3: Mild to severe function loss, with a GFR of 30–59%.

Stage 4: Severe impairment of function with a GFR of 15–29%.

Stage 5: Kidney failure with a GFR of less than 15%.

Symptoms

A person may not detect any symptoms in the early stages. They may feel sick and exhibit the following symptoms at stage 4 or 5:

  • fatigue due to lack of oxygen in the blood
  • nausea or vomiting
  • a metallic taste in the mouth
  • swollen ankles, feet, lower legs, or hands due to water retention
  • darker urine due to blood in the urine
  • shortness of breath

Cardiovascular disease is a complication of late-stage renal disease.

Following a diabetic treatment plan and getting frequent health checks can help a person with diabetes maintain their blood sugar levels, lower their risk of kidney problems, and detect problems early.

A urine test is used to check for proteins in the urine during screening. Protein in the urine, on the other hand, does not always indicate kidney disease; it could also be the result of a urinary tract infection.

Treatment

Diabetic nephropathy can be delayed or prevented with early treatment.

The major goal of treatment is to keep blood glucose and blood pressure under control. This may entail the administration of drugs.

Drug treatment

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) can help to control blood pressure, protect renal function, and avoid future damage.

In individuals with CKD associated with type 2 diabetes, Kerendia (finerenone) is a prescription drug that can minimize the risk of persistent GFR decline, end-stage renal disease, cardiovascular death, nonfatal myocardial infarction, and hospitalization for heart failure.

In addition, because people with kidney disease generally have low vitamin D levels, a doctor may give vitamin D or a statin to lower cholesterol levels.

For people with type 2 diabetes and CKD, the American College of Cardiology issued guidelines in 2018 supporting the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors or glucagon-like peptide-1 receptor agonists (GLP-1RAs). These medications may lower the risk of CKD progression, heart attacks, or both.

Dietary changes

If you have kidney disease, your doctor may advise you to track the following nutrients:

Water: Although necessary, drinking too much water or fluid can lead to edema and high blood pressure.

Sodium: Because it is a salt component, it might elevate blood pressure.

Protein: Protein can cause waste to build up in the blood, putting extra strain on the kidneys in people who have kidney disease.

Phosphorus: This can be found in a variety of protein and dairy sources. Phosphorus overload can weaken bones and put strain on the kidneys.

Potassium: Potassium levels in people with kidney disease can be greater than they should be, which can harm nerve cells.

Keeping blood sugar levels in check

This is critical for reducing the risk of diabetes complications such as renal disease, cardiovascular disease, and diabetic neuropathy, a nerve system disorder.

These disorders can also lead to additional difficulties. Blood sugar control can also help prevent these problems from arising.

Late-stage treatment options

Diabetic nephropathy can proceed to end-stage renal disease (ESRD), which necessitates dialysis or a kidney transplant. They will very certainly require dialysis for the remainder of their lives or until a kidney donation becomes available.

Dialysis

Kidney dialysis is a process that separates waste items from the blood and removes them from the body using a machine. Dialysis is used to replace a healthy kidney.

Dialysis comes in a variety of forms:

Hemodialysis: Blood is drawn from the body by a needle in the forearm and transported to a dialysis machine via a tube. The blood is filtered outside the body by the machine, then returned through a tube and needle.

Depending on the choice selected, a person may need to do this three to seven times a week and spend two to ten hours per session.

Dialysis can be done at a dialysis facility or at home, and in some cases, overnight alternatives are available. People are increasingly able to incorporate dialysis into their work and personal routines because to flexible choices.

Peritoneal dialysis: The peritoneum, or lining of the abdomen, is used to filter blood inside the body.

  • Dialysis fluid enters the abdomen by a catheter in continuous ambulatory peritoneal dialysis (CAPD). Before draining out, the fluid lingers inside for several hours, filtering waste materials. It takes 30–40 minutes to drain.
  • Continuous cycler-assisted peritoneal dialysis (CCPD), also known as automated peritoneal dialysis, involves a person sleeping linked to a dialysis machine for 8–10 hours. The fluid drainage is controlled by the machine.

Peritoneal dialysis can be done at home, at work, or while traveling. It provides flexibility and gives the individual some control over their condition. If a person is going to travel, for example, they will need to learn how to operate the essential equipment and make sure they have all of the necessary materials.

Kidney transplant

If diabetic nephropathy has progressed to the point where a kidney transplant is necessary and a qualified donor is available, a doctor may propose it. It may take some time to find a donor.

Because a person can live with only one functioning kidney, some people offer to donate a kidney to a loved one.

The individual who receives the kidney, on the other hand, may find that their body rejects the new organ. The body has the best chance of accepting a kidney donation from a family member.

To lessen the risk of the new kidney being rejected by the body, the individual who has had a kidney transplant will need to take medicine. This can have some negative consequences, such as raising the risk of infection.

Financial help

Many people can get financial assistance. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Medicare and Medicaid normally cover kidney failure treatment.

If all of the following apply, a person can acquire Medicare for ESRD at any age:

  • Their kidneys are no longer functional.
  • They require dialysis on a regular basis or have had a kidney transplant.
  • They have worked for Social Security, the Railroad Retirement Board, or as a government employee for the required amount of time.
  • They are receiving Social Security or Railroad Retirement payments or are eligible for them.
  • They are the dependent kid or spouse of someone who fits one of the aforementioned criteria.

The individual should discuss their options with their insurance provider or their doctor.

Prevention

Controlling blood sugar and blood pressure is the greatest strategy for someone with diabetes to lower their risk of diabetic nephropathy.

This can be aided by making the following lifestyle changes:

  • checking blood glucose levels regularly
  • following any treatment plan their doctor suggests
  • limiting stress where possible
  • eating a nutritious diet that is high in fiber and low in sugar, processed carbohydrates, and salt
  • exercising regularly
  • limiting alcohol intake
  • avoiding tobacco

Learning as much as possible about diabetes and related consequences, such as kidney disease, can make a person feel more confident and in charge of their condition and prevention options.

The National Kidney Disease Education Program of the National Institute of Diabetes and Digestive and Kidney Diseases provides a downloadable record of test results that can assist a person maintain track of their kidney testing and development.

Outlook

The outlook for diabetic nephropathy people will be determined by how well they manage their blood sugar and blood pressure levels, as well as the stage at which they are diagnosed. The sooner therapy begins, the better the outlook.

Diabetic nephropathy can be slowed or stopped with treatment. People with diabetes should have their blood pressure checked as recommended by their doctor and take precautions to prevent kidney disease from worsening.

Sources:

  • https://www.nejm.org/doi/full/10.1056/NEJMoa2025845
  • https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/choosing-treatment
  • https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/tests-diagnosis
  • https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/eating-right
  • https://www.kidney.org/atoz/content/gfr
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5297507/
  • https://www.medicalnewstoday.com/articles/319686
  • https://www.ahajournals.org/doi/10.1161/JAHA.116.003280
  • https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/hemodialysis
  • https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/kidney-transplant
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4206379/
  • https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/peritoneal-dialysis
  • https://www.medicare.gov/information-for-my-situation/signing-up-for-medicare-if-you-have-esrd
  • https://www.jwatch.org/fw114803/2018/11/27/sglt2-inhibitors-glp-1ras-recommended-type-2-diabetes-and

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Blood / Hematology

Exercise-induced hypoglycemia: Things to know

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The medical name for low blood sugar during or after exercise is exercise-induced hypoglycemia (EIH). The condition can cause itself in a variety of ways, including weakness, shakiness, and extreme exhaustion.

The body’s major source of energy is glucose. The body requires more energy during activity and hence uses more glucose. EIH is caused by an increase in the desire for glucose. Other factors could also be at play.

The symptoms, causes, treatment, and prevention of EIH are all covered in this article. It also covers if EIH is an indication of diabetes and when EIH should be treated.

When to ask assistance

If blood glucose levels go too low, hypoglycemia can be fatal. If you have one or more of the following symptoms, you should get medical help right away:

  • loss of consciousness
  • confusion
  • symptoms that persist despite resting or consuming more food
  • seizure

If people commonly develop EIH or hypoglycemia at other times, they should see a doctor. If the person has diabetes, this could indicate that they are taking too much insulin or that their diabetes medicine dosage is inaccurate.

What is EIH?

Exercise-induced hypoglycemia

Hypoglycemia is a condition in which the blood glucose level is insufficient to supply the body’s energy requirements. Hypoglycemia is defined as a blood glucose level of less than 70 milligrams per deciliter (mg/dl) according to doctors. Most people, however, do not experience hypoglycemia symptoms until their blood glucose levels fall below 55 mg/dl.

Carbohydrates are broken down into glucose by the body. The glucose then enters the bloodstream, prompting the pancreas to produce insulin in response. Insulin aids glucose entry into the body’s cells, allowing it to be used as fuel.

Because active muscles require more fuel, exercise raises glucose demand. Exercise may also make a person more insulin sensitive, which means the insulin works more efficiently and lowers blood glucose levels faster. These factors, when combined, can cause in EIH.

If a person has the following characteristics, they are more prone to develop EIH:

  • have insulin sensitivity or take insulin
  • already have low blood glucose, such as from hunger or from diabetes medication
  • do an intense workout that demands more energy

Symptoms of EIH

Glucose fuels the majority of major bodily activities. As a result, EIH symptoms can vary. The following are some probable signs and symptoms:

  • weakness
  • confusion
  • anxiety
  • fainting
  • shaking
  • dizziness

Hypoglycemia that lasts for a long time or is severe might be fatal. It could result in the following:

Causes

Exercise increases the body’s energy demands, causing it to respond by burning more glucose. People with low glucose levels or those whose bodies metabolize glucose quickly can develop hypoglycemia.

EIH can be caused by a number of reasons, including:

  • exercising immediately after a meal
  • being sick
  • drinking too much alcohol without food
  • using insulin or other diabetes medications
  • not eating enough, or fasting
  • not consuming enough carbohydrates

Exercise causes a significant increase in insulin, which eliminates glucose from the blood, in certain people. Even if a person is well-nourished and does not take blood glucose-lowering drugs, this rise might cause hypoglycemia.

If a person has persistent EIH, a doctor may prescribe medicine to help them recover. Most people, however, can solve the problem by making proper lifestyle modifications.

Is EIH a sign of diabetes?

EIH is not always a symptom of diabetes. Exercise by itself can significantly lower blood glucose levels. People with diabetes, on the other hand, have increased risk factors for hypoglycemia.

Hyperglycemia, or high blood glucose, is a complication of untreated diabetes. If people who take diabetes drugs take more than they need, they are more likely to develop hypoglycemia. It’s also possible that you’re not getting enough nourishment to match your exercise level.

Also, if people with diabetes take diabetic medicine while fasting or commencing a restrictive diet, they may develop hypoglycemia.

Treatment for EIH

Mild EIH normally does not necessitate therapy. In many cases, the condition arises as a result of a person not eating enough food before exercising. Individuals should consume a carbohydrate-rich meal 1–2 hours before a workout to avoid EIH.

Chronic EIH might occasionally indicate a problem with insulin manufacturing. A doctor may administer diazoxide to treat low blood sugar in people who have chronic EIH.

A doctor may consider removing a portion of the pancreas to reduce insulin production in rare circumstances.

Prevention in people with diabetes

People who take diabetic drugs to control their blood glucose levels should check their blood glucose levels before exercising, according to the American Diabetes Association (ADA). If their blood glucose level is below 100 mg/dl, they should consume 15–20 grams (g) of carbs to raise it.

Among the possibilities are:

  • 4 glucose tablets
  • 1 glucose gel tube
  • 1 tablespoon of honey or sugar
  • 4 ounces (oz) of soda or juice

The American Diabetes Association recommends that a person recheck their blood glucose after 15 minutes. If the blood sugar level stays below 100 mg/dl, they should eat another 15 g carbohydrate portion. They should do this every 15 minutes until their blood glucose level reaches at least 100 mg/dl.

Anaerobic exercise, such as high intensity interval training (HIIT), may reduce the incidence of hypoglycemia in people with diabetes, according to a 2019 review. Short bursts of intensive activity are followed by a rest and then another brief burst of intense activity in HIIT.

Prevention in people without diabetes

People without diabetes can usually avoid EIH by doing the following:

  • avoiding drinking alcohol before a workout
  • eating regular meals throughout the day
  • gradually building up to new exercise routines to give the body time to adapt

Stop and take a break if you start to feel unsteady or dizzy throughout your workout. They should drink 4 oz (113 g) of juice or eat a slice of toast before continuing their workout.

Conclusion

Hypoglycemia occurs when blood glucose levels fall too low to meet a person’s body’s energy needs. Hypoglycemia that happens during or after exercise is known as EIH. The condition can affect both people and non-diabetics.

Diabetes patients are more likely to develop EIH, especially if they use insulin or other blood glucose-controlling drugs. In such circumstances, a person should consult a doctor to see whether their drug amounts can be adjusted.

EIH is most commonly caused by not eating enough before exercising or not giving the body enough time to acclimatize to a new exercise schedule in people who do not have diabetes. If a person continues to have regular EIH despite following the necessary precautions, they should seek medical advice to establish the underlying cause.

Sources:

  • https://www.diabetes.org/healthy-living/fitness/getting-started-safely/blood-glucose-and-exercise
  • https://www.frontiersin.org/articles/10.3389/fendo.2019.00326/full
  • https://drc.bmj.com/content/6/1/e000578.abstract
  • https://www.medicalnewstoday.com/articles/exercise-induced-hypoglycemia-what-to-know
  • https://www.cdc.gov/diabetes/basics/insulin-resistance.html
  • https://www.ncbi.nlm.nih.gov/books/NBK534841/
  • https://www.hormone.org/diseases-and-conditions/diabetes/non-diabetic-hypoglycemia
  • https://www.frontiersin.org/articles/10.3389/fendo.2020.00578/full

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