Types-1
Frozen Shoulder
Adhesive capsulitis is more generaly known as frozen shoulder, and with good reason: It can render your shoulder so stiff, it's almost impossible to button your shirt — that is, if you aren't in too much pain to get dressed in the first place.
In general, frozen shoulder can come on after an injury to your shoulder or a bout with another musculo-skeletal condition such as tendinitis or bursitis. It can also develop after a stroke. Quite often its cause can't be pinpointed. Nonetheless, any condition that causes you to refrain from moving your arm and using your shoulder joint can put you at risk for developing frozen shoulder.
Frozen shoulder affects 10-20 percent of people with diabetes according to the American Academy of Orthopaedic Surgeons. Women are more likely to develop frozen shoulder than men and it occurs most frequently in people between the ages of 40 and 60.
Frozen shoulder has three stages:
Freezing — Pain slowly becomes worse until range of motion is lost. (Lasts 6 weeks to 9 months)
Frozen — Pain improves, but the shoulder is still stiff. (Lasts 4 to 6 months)
Thawing — Ability to move the shoulder improves until normal or close to normal. (Lasts 6 months to 2 years)
Treatment of frozen shoulder focuses on controlling pain and getting movement back to normal through physical therapy. Sometimes surgery is also considered. Talk to your doctor about treatment options that are right for you.
Types-2
Hemochromatosis
Hereditary hemochromatosis is the most common single-gene disease in Western populations, affecting 1 out of every 200-300 people. Yet it is almost unheard of by the general public, and many health professionals are insufficiently aware of it. Because the disorder can cause diabetes via damage to the pancreas, it is something that deserves greater recognition in the American Diabetes Association community.
Hereditary hemochromatosis is the most common of several "iron overload" diseases, which are characterized by an excess accumulation of iron in the body. In the case of hemochromatosis, a single gene mutation causes extra iron to be absorbed from food in the intestine, and the body lacks an efficient means of excreting the excess iron it takes in. Over time, this iron accumulates in the tissues of the body, most notably the pancreas, the liver, and the heart. The extra iron builds up in the organs and damages them.
Without treatment, the disease can cause these organs to fail, leading to diabetes, cirrhosis, and heart disease. In many patients, the buildup of iron eventually becomes so excessive that it visibly shows up in the skin, turning it a dark gray or bronze color. In fact, hemochromatosis is sometimes referred to as "bronze diabetes" because of the appearance of some patients when they are diagnosed.
How Common is It?
As many as 1 in 200 Americans are believed to carry both copies of the gene for hemochromatosis, and it is estimated that about half of them will eventually develop complications. That puts it roughly on a par with type 1 diabetes for prevalence. Like type 2 diabetes, it is severely underdiagnosed.
What are the Symptoms?
Symptoms include the following and tend to occur in men between the ages of 30 and 50 and in women over age 50 with joint pain being the most common:
Joint pain
Fatigue
Lack of energy
Abdominal pain
Loss of sex drive
Symptoms typically seen with diabetes and heart disease
How is it Diagnosed?
Blood tests (a transferrin saturation test or a serum ferritin test) can determine whether the amount of iron stored in the body is too high. It is also possible to test directly for the defective gene. Despite its prevalence and the availability of simple tests for it, hemochromatosis is often undiagnosed and untreated. The initial symptoms can be diverse and vague and can mimic the symptoms of many other diseases. Also, doctors may focus on the conditions caused by hemochromatosis — arthritis, liver disease, heart disease, or diabetes — rather than on the underlying iron overload.
What Causes It?
Hemochromatosis is caused by a defect in a gene called HFE, which helps regulate the amount of iron absorbed from food. A person who inherits the defective gene from both parents (someone who is homozygous) may develop hemochromatosis. Studies indicate that virtually everyone who is homozygous for the HFE defect develops increased iron levels, with about half of them developing complications as a result. People who inherit the defective gene from only one parent (someone who is heterozygous) are carriers for the disease but usually do not develop it, although they may have slightly increased iron levels.
The Founder Effect: An Interesting Genetic Story
Hereditary hemochromatosis represents a striking example of the "founder effect," which describes a genetic disease that arises from a mutation in just one or a few individuals. In the case of hemochromatosis, it is believed that a single individual in Europe, 60 to 70 generations ago, was the sole origin of most of the hemochromatosis seen in the world today. A chance mutation in the HFE gene in this individual was passed on, and because the defective gene didn't cause any problems in people through child-bearing age (and may have conferred some benefit in times of nutritional deficit), there was no negative selection to stop it from being passed on. Because of its origin, hemochromatosis today most often affects Caucasians of Northern European descent, although other ethnic groups can be affected by other iron overload diseases.
Men Versus Women
Although both men and women can inherit the hemochromatosis gene, men are much more likely to be diagnosed with the effects of hemochromatosis than women, and men also tend to develop problems from the excess iron at a younger age. The most likely explanation for the difference: menstruation and childbirth. Because women regularly lose a significant amount of blood every month until menopause, as well as during childbirth, they consequently lose a significant amount of iron associated with that blood. For women who are homozygous for hemochromatosis, the blood loss appears to be just enough to keep the hemochromatosis asymptomatic until well after menopause.
How is it Treat
Once it is diagnosed, it is managed extremely effectively via frequent phlebotomy (blood letting)
That difference between men and women in the progression of hemochromatosis is a clue to the simple, straightforward treatment for hemochromatosis: phlebotomy, or blood-letting. When first diagnosed, people with hemochromatosis are put on an intensive schedule of phlebotomy to bring their iron levels down. They must give a pint of blood once or twice a week, often for many months. Measures of blood iron levels are monitored, and when they are finally in the normal range, the patient is put on a maintenance schedule of giving a pint of blood at greater intervals, usually every 2 or 3 months. Unlike diabetes, hemochromatosis is virtually cured through its treatment, with patients remaining completely asymptomatic as long as iron levels are monitored and maintained in the normal range.
If treatment begins before any organs are damaged, associated conditions — such as liver disease, heart disease, arthritis, and diabetes — can be prevented. The outlook for people who already have these conditions at diagnosis depends on the degree of organ damage. For example, treating hemochromatosis can stop the progression of liver disease in its early stages, which means a normal life expectancy. However, if cirrhosis has developed, the person's risk of developing liver cancer increases, even if iron stores are reduced to normal levels. People with diabetes resulting from pancreatic damage usually see an improvement if not a reversal of their diabetes, depending on how much damage has occurred.
Where Does the Blood Go?
The American Red Cross, which controls about 45% of the nation's blood supply, does not currently accept donations from people with known hemochromatosis. Everyone agrees that the blood is safe and of high quality. There is no risk of passing on a genetic disease through blood transfusions. But the Red Cross has a long-standing policy that potential donors are not allowed to receive direct compensation for their donation (beyond the usual orange juice and cookie). Because people with hemochromatosis would otherwise have to pay for their therapeutic phlebotomies, they would in effect be getting something of value for being able to donate for free. Thus the Red Cross has ruled that such donations violate their policy.
FDA regulations do permit hemochromotosis patients to donate blood, but with some special restrictions on how the blood is marked and how the blood banks operate. As a consequence, few blood blanks in the US currently accept blood from people with hemochromatosis, and most of the blood given as a result of therapeutic phlebotomy is discarded. (People with hemochromatosis who wish to donate blood should check to see if any blood banks in their area will accept their donations.) This is not true in other countries, which have generally removed any restrictions on this blood. The American Medical Association and many other groups have advocated for removal of restrictions for the acceptance of blood donations from people with hemochromatosis.
Types-3
Agent Orange
Vietnam veterans with type 2 diabetes are eligible for disability compensation from the Department of Veterans Affairs (VA) based on their presumed exposure to Agent Orange or other herbicides.
In 2000, the VA added type 2 diabetes to the list of "presumptive diseases associated with herbicide exposure." That action followed a report from the National Academy of Sciences that found "limited/suggestive" evidence of an association between the chemicals used in herbicides during the Vietnam War, such as Agent Orange, and type 2 diabetes.
The evidence of a link between exposure to Agent Orange (or dioxin, the problematic contaminant in Agent Orange) and diabetes is modest. Most of the association between Agent Orange and diabetes comes from studies of people who lived near or worked at manufacturing plants that produced large quantities of Agent Orange dioxin. In those cases, there appears to be some relationship between Agent Orange exposure and increased insulin resistance, the precursor to type 2 diabetes.
In general the exposure that Vietnam veterans had to Agent Orange was much less than in the populations studied by scientists. Still, the VA has added diabetes to the list of conditions for which Vietnam veterans are eligible for disability compensation.
What is Agent Orange and What is Dioxin?
Agent Orange was a herbicide used in Vietnam to kill unwanted plants and to remove leaves from trees which otherwise provided cover for the enemy. In the 1970s some veterans became concerned that exposure to Agent Orange might cause delayed health effects. The concern about Agent Orange focuses not on the active ingredient, an herbicide with little or no effect on animals, but on a trace contaminant in the herbicide, dioxin. Studies have shown that dioxin and dioxin-like compounds (DLCs) can cause a variety of illnesses in laboratory animals. More recent studies have suggested that the chemical may be related to a number of types of cancer and other disorders.
In 1978, the Veterans Administration set up the Agent Orange Registry health examination program for Vietnam veterans who were concerned about the possible long-term medical effects of exposure to Agent Orange. Vietnam veterans who are interested in participating in this Agent Orange program should contact the nearest VA medical center for an examination.
Veterans who participate in the Agent Orange examination program are asked a series of questions about their possible exposure to herbicides or Agent Orange in Vietnam. A medical history is taken, a physical examination is performed, and there is a series of basic laboratory tests. If medically required, consultations with other health specialists are scheduled. However, no special Agent Orange tests are offered since there is no test to show if any individual veteran's medical problem was caused by Agent Orange or other herbicides used in Vietnam. There are tests that show body dioxin levels, but such tests are not done by the VA because there is a serious question about their value to veterans. The VA simply makes a presumption of Agent Orange exposure for Vietnam veterans.
In its 1994 report on Agent Orange, the National Academy of Sciences (NAS) concluded that individual dioxin levels in Vietnam veterans are usually not meaningful because of background exposures to dioxin, poorly understood variations among individuals in dioxin metabolism, relatively large measurement errors, and exposure to herbicides that did not contain dioxin.
Benefits of the Agent Orange examination
The veteran is informed of the results of the Agent Orange examination during a personal interview and gets a follow-up letter further describing the findings. Each veteran is given the opportunity to ask for an explanation and advice. Where medically necessary, a follow-up examination or additional laboratory tests are scheduled. The examination and tests sometime reveal previously undetected medical problems. These discoveries permit veterans to get prompt treatment for their illnesses. Some veterans feel they are in good health, but are worried that exposure to Agent Orange and other substances may have caused some hidden illness. The knowledge that a complete medical examination does not show any problems can be reassuring or helpful to Registry participants. All examination and test results are kept in the veteran's permanent medical record. These data are entered into the VA Agent Orange Registry.
Vietnam veterans can get medical treatment for Agent Orange-related illnesses. Under Section 102, Public Law 104-262, the Veterans' Health Care Eligibility Reform Act of 1996, the VA shall furnish hospital care and medical services, and may furnish nursing home care to veterans exposed to herbicides in Vietnam. There are some restrictions. The VA cannot provide such care for 1) a disability which VA determines did not result from exposure to Agent Orange, or 2) a disease which the NAS has determined that there is "limited/suggestive" evidence of no association between occurrence of the disease and exposure to a herbicide agent.
The VA pays disability compensation to Vietnam veterans with injuries or illnesses incurred in or aggravated by their military service. Veterans do not have to prove that Agent Orange caused their medical problems to be eligible for compensation. Rather, the VA must determine that the disability is "service-connected." A Veterans Services Representative, at a VA medical center or regional office, can explain the compensation program in greater detail and assist veterans who need help in applying. For more information about the VA's Agent Orange Program, call the toll-free helpline 1-800-749-8387. For disability compensation program information, call toll-free 1-800-827-1000.
Additional Resources
Vietnam Veterans of America's Agent Orange / Dioxin Committee.
Legal services and further information on the VA's benefits regarding Agent Orange from the National Veterans Legal Services Program.
Additional information on how the VA is handling Agent Orange claims.
The National Academy of Sciences report on Agent Orange and diabetes.
Types-4
HIV/AIDS and Diabetes
HIV treatments may raise your risk of developing diabetes. If you have diabetes, HIV treatments may also make it harder for you to control your blood glucose levels.
Diabetes Basics
After you eat, your body breaks food down into glucose and sends it into the blood. Insulin then helps move the glucose from the blood into your cells. When glucose enters your cells, it is either used as a fuel for energy right away or stored for later use. The level of glucose in your blood stays within a narrow range.
If you have diabetes, your body’s insulin doesn’t work well. This causes blood glucose to go higher than normal. If your blood glucose levels reach a certain level, you have diabetes.
Risk Factors for Diabetes
You are at higher risk for type 2 diabetes if you:are over age 45
have a family history of diabetes
are overweight
do not exercise regularly
have low HDL cholesterol or high triglycerides, or high blood pressure
are a member of certain racial and ethnic groups (e.g., African Americans, Hispanic/Latino Americans, Asian Americans, Pacific Islanders, and American Indians)
have had gestational diabetes, or have had a baby weighing 9 pounds or more at birth
have a history of prediabetes.
You can lower your risk of type 2 diabetes by losing excess weight and by being active most days of the week.
HIV Treatment and Blood Glucose Levels
Your doctor may want to screen you for diabetes before you begin treatment for HIV. Some HIV treatments and treatments for its complications may increase blood glucose and lead to diabetes. If you have one or more of the diabetes risk factors listed above, you are more likely to develop diabetes.
If you develop high blood glucose, your doctor may change your therapy to keep your blood glucose at normal levels.
If you are pregnant and treating HIV, you should be screened for gestational diabetes at 24 to 28 weeks’ gestation. Your doctor may want you screened earlier in your pregnancy if you are taking certain HIV medications, especially if you have another risk factor for diabetes.
If you have diabetes and start taking some HIV medications, you may need to check your blood glucose levels more often and your doctor may add more diabetes medications to help control your blood glucose levels.
People taking metformin plus certain HIV treatments may be at higher risk of lactic acidosis. If you have liver or kidney problems, or you binge drink or drink a lot of alcohol regularly, you are also at higher risk of lactic acidosis. Discuss your medications, alcohol habits, and general health with your doctor.
When You Start a New Medication
Talk to your pharmacist when you start a new medication. Ask about the side effects you may be at risk for, and about interactions your new medication may have with any you already take. Tell your pharmacist about any other medications you take: prescription, over-the-counter, and recreational drugs, as well as dietary supplements and alternative therapies.
Types-5
Hepatitis B
People with diabetes have higher rates of hepatitis B then the general population.
The hepatitis B virus is usually spread when blood or other body fluids from a person with the hepatitis B virus enters your body. This can occur if you share blood glucose meters, lancets or other diabetes care supplies like syringes or insulin pens.
The hepatitis B virus can also spread through sexual contact and from an infected mother to her baby during childbirth.
What is Hepatitis B?
Hepatitis B is a liver disease. At first, you develop an "acute" infection. Acute hepatitis B is the first 6 months after being infected. Some people can fight the virus and clear the infection.
For others, the infection remains and leads to a "chronic" or lifelong, illness. Over time, this can cause serious damage to the liver and lead to complications.
What Can I Do?
Prevent exposure to hepatitis B by not sharing diabetes care equipment.
The best way to prevent hepatitis B is by getting vaccinated. The CDC recommends hepatitis B vaccination for all unvaccinated adults with diabetes younger than 60 years of age. The hepatitis B vaccine is given as a series of 3 shots over a period of 6 months (0,1, 6 month schedule). The entire series is needed for long-term protection.
If you have not received the hepatitis B vaccine series talk to your doctor about getting vaccinated. If you think you have already been vaccinated, confirm with your doctor.
More Resources
CDC hepatitis B information
Diabetes and Hepatitis B Vaccination - Information for Diabetes Educators (PDF)
Types-6
Sleep Apnea
Many people with diabetes also suffer from obstructive sleep apnea (OSA), a breathing disorder where the airway is blocked when the mouth and throat relax during sleep, often for more than 10 seconds.
Are you ever jolted awake by the sound of your own snoring? Loud snoring is a sign that you may have OSA. Your family or partner may make jokes about snoring at your expense but sleep apnea is no laughing matter. Sleep apnea can be dangerous to your health. Untreated sleep apnea can increase your risk of having high blood pressure and even having a heart attack or stroke. Sleep apnea can also increase the risk of diabetes and the risk for work-related accidents and driving accidents.
Although anyone can have sleep apnea, the greater risk factors include:
Being male
Smoking
Being overweight or obese
If you fit this profile, you should talk to your health care provider about taking a test to determine if you suffer from sleep apnea.