Diabetes

What is diabetes?

Diabetes, also known as diabetes mellitus, is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose is your body's main source of energy. Your body can make glucose, but it also comes from the food you eat. Insulin is a hormone made by your pancreas. Insulin helps move glucose from your bloodstream into your cells, where it can be used for energy.

If you have diabetes, your body can't make insulin, can't use insulin as well as it should, or both. Too much glucose stays in your blood and doesn't reach your cells. This can cause glucose levels to get too high. Over time, high blood glucose levels can lead to serious health conditions. But you can take steps to manage your diabetes and try to prevent these health problems.

What are the types of diabetes?

There are different types of diabetes:

• Type 1 diabetes. If you have type 1 diabetes, your body makes little or no insulin. It happens when your immune system attacks and destroys the cells that produce insulin.
• Type 2 diabetes. This is the most common form of diabetes. If you have type 2 diabetes, your body may still be able to make insulin, but your cells don't respond well to insulin. They can't easily take up enough glucose from your blood.
• Gestational diabetes. This is a form of diabetes that develops during pregnancy. It happens when your body can't make the extra insulin it needs during pregnancy.

What causes diabetes?

The different types of diabetes have different causes:

• Researchers think type 1 diabetes is caused by genes and factors in the environment that might trigger the disease.
• Type 2 diabetes is caused by several factors, including lifestyle factors and genes. The lifestyle factors include not being physically active and being overweight or having obesity.
• Researchers think gestational diabetes is caused by the hormonal changes of pregnancy along with genetic and lifestyle factors.

Who is more likely to develop diabetes?

The different types of diabetes have different risk factors:

• You can develop type 1 diabetes at any age, but it most often starts in childhood. Having a parent or sibling with type 1 diabetes may increase your chance of developing it.
• You are at higher risk of developing type 2 diabetes if you:
• Are overweight or have obesity.
• Are over age 35. Children, teenagers, and younger adults can get diabetes, but it is more common in middle-aged and older adults.
• Have a family history of diabetes.
• Have prediabetes. This means that your blood glucose is higher than normal, but it's not high enough to be called diabetes.
• Had gestational diabetes.
• Have given birth to a baby weighing 9 pounds or more.
• Are African American, American Indian, Asian American, Hispanic/Latino, or Pacific Islander.
• Are not physically active.
• Have certain other health conditions, such as high blood pressure or polycystic ovary syndrome (PCOS).
• You are at higher risk of developing gestational diabetes if you:
• Are overweight or have obesity.
• Have a family history of diabetes.
• Had gestational diabetes in a previous pregnancy.
• Have given birth to a baby weighing 9 pounds or more.
• Have polycystic ovary syndrome (PCOS).
• Are African American, Hispanic/Latino, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander.

What are the symptoms of diabetes?

The symptoms of diabetes may include:

• Feeling very thirsty
• Feeling very hungry
• Urinating (peeing) more often, including at night
• Fatigue
• Blurry vision
• Numbness or tingling in the feet or hands
• Sores that do not heal
• Losing weight without trying

But it's important to know that your symptoms may vary, depending on which type you have:

• The symptoms of type 1 diabetes usually come on quickly and can be severe.
• With type 2 diabetes, the symptoms often develop slowly, over several years. The symptoms can be so mild that you might not even notice them.
• Gestational diabetes often has no symptoms. If you do have symptoms, they may be mild. If you are pregnant, you will usually be screened for this condition between 24 and 28 weeks of pregnancy.

How is diabetes diagnosed?

To find out if you have diabetes, your health care provider will use one or more glucose blood tests. There are several types, including the A1C test.

What are the treatments for diabetes?

Treatment for diabetes involves managing your blood glucose levels:

• If you have type 1 diabetes, you will need to take daily doses of insulin, either by injection or through a special pump. Some people also need to take another type of diabetes medicine that works with insulin.
• If you have type 2 diabetes, you may be able to manage or even reverse it by making lifestyle changes. These include eating a healthy diet, staying at healthy weight, and getting regular physical activity. Some people also need to take diabetes medicines to manage their diabetes.
• If you have gestational diabetes, you may be able to lower your glucose levels by eating a healthy diet and getting regular exercise. But be sure to talk to your provider about your treatment options. Gestational diabetes usually goes away after you give birth. But you will have a higher risk of developing type 2 diabetes later.

Checking your blood glucose levels is also an important part of managing your diabetes. Ask your provider about the best way to check your blood glucose level and how often you should check it.

Can diabetes be prevented?

Type 1 diabetes can't be prevented.

You may be able to delay or prevent type 2 diabetes through the same lifestyle changes that are used to manage diabetes (eating a healthy diet, staying at a healthy weight, and getting regular physical activity). These lifestyle changes may also help prevent gestational diabetes.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Encephalitis

What is encephalitis?

Encephalitis is inflammation (swelling) of the brain. It can happen when an infection or medical condition that affects the brain activates your immune system. The inflammation can cause a wide range of symptoms. In extreme cases, it can lead to brain damage, stroke, or even death.

What causes encephalitis?

There are different types of encephalitis, based on what the cause is. The two main types are infectious encephalitis and autoimmune encephalitis.

Infectious encephalitis is usually caused by a virus. In fact, viruses are the most common cause of encephalitis. Some of the different viruses that cause it include:

• Herpes viruses, including herpes simplex (HSV), the Epstein-Barr virus (which causes infectious mononucleosis) and the varicella-zoster virus (which causes chickenpox).
• Viruses you can get if you are bitten by an infected tick, such as tick-borne encephalitis (TBE virus) and Powassan virus.
• Viruses you can get if you are bitten by an infected mosquito, such as eastern equine encephalitis virus, West Nile virus, and La Crosse virus.
• Enteroviruses, which are a common group of viruses that mostly cause mild illness or respiratory infection. These infections usually happen in the summer and fall.

Bacteria, fungi, and parasites can also cause infectious encephalitis. But this is not common.

Autoimmune encephalitis happens when your immune system mistakenly attacks healthy brain cells. It can be triggered by conditions such as certain cancers, benign tumors, and infections. Sometimes the cause is not known.

Who is more likely to get encephalitis?

Anyone can get encephalitis, but you are more likely to get it if you:

• Have a weakened immune system, for example from having HIV or taking certain medicines. These could include medicines taken after an organ transplant, certain chemotherapy medicines, and specialized treatments for certain autoimmune diseases.
• Are a young child or older adult.
• Live in areas where there are ticks and mosquitoes that carry viruses that can cause encephalitis.

What are the symptoms of encephalitis?

The symptoms of encephalitis can vary a lot, depending on how severe it is. Many people do not have any symptoms. Others may have mild flu-like symptoms such as fever, fatigue, headache, or body aches. If encephalitis becomes more serious, it can cause:

• Severe headache
• Stiff neck
• Vomiting
• Seizures
• Behavior changes
• Drowsiness
• Muscle weakness
• Partial paralysis in your arms and legs
• Coma

Encephalitis can be dangerous in infants. Their symptoms may include:

• Fever
• Lethargy (weakness or drowsiness)
• Poor feeding
• Vomiting
• Body stiffness
• Unusual irritability or crying
• A full or bulging fontanel (the soft spot on the top of the head)

If you or your child is having symptoms of encephalitis, it's important to get medical care right away.

How is encephalitis diagnosed?

To find out if you have encephalitis, your health care provider:

• Will do a physical exam
• Will take your medical history, which includes asking about your symptoms
• May do a neurologic exam
• May order imaging tests, such as a brain CT scan or MRI
• May order an EEG (electroencephalography), which use small electric sensors to measure your brain activity
• May order blood and cerebrospinal fluid (CSF) tests

What are the treatments for encephalitis?

Most people with encephalitis will need treatment in the hospital. Depending on the cause, treatments may include antiviral medicines, antibiotics, corticosteroids, and other medicines.

For some types of encephalitis, there is no medicine to treat it. But rest, nutrition, and fluids can help your body fight the infection and relieve symptoms.

Some people may need physical, speech, and occupational therapy once the illness is under control.

Can encephalitis be prevented?

There are steps you can take to help prevent encephalitis that is caused by infections:

• Use good hygiene, including washing your hands often with soap and water.
• Don't share food, drinks, utensils, and glasses with other people.
• Get vaccines for viruses that can cause encephalitis.
• Avoid mosquito and tick bites, for example by:
  • Wearing insect repellent with DEET or another U.S. Environmental Protection Agency (EPA)-registered insect repellent. Make sure to follow the instructions for using the repellant.
  • Wearing clothes that cover your arms, legs and feet.
  • Treating your clothing and gear with products containing 0.5% permethrin before you go in grassy or woody areas.

NIH: National Institute of Neurological Disorders and Stroke

Fatty Liver Disease

What is fatty liver disease?

Your liver is the largest organ inside your body. It helps your body digest food, store energy, and remove poisons. Fatty liver disease is a condition in which fat builds up in your liver. There are two main types:

• Nonalcoholic fatty liver disease (NAFLD)
• Alcoholic fatty liver disease, also called alcoholic steatohepatitis

What is nonalcoholic fatty liver disease (NAFLD)?

NAFLD is a type of fatty liver disease that is not related to heavy alcohol use. There are two kinds:

• Simple fatty liver, in which you have fat in your liver but little or no inflammation or liver cell damage. Simple fatty liver typically does not get bad enough to cause liver damage or complications.
• Nonalcoholic steatohepatitis (NASH), in which you have inflammation and liver cell damage, as well as fat in your liver. Inflammation and liver cell damage can cause fibrosis, or scarring, of the liver. NASH may lead to cirrhosis or liver cancer.

What is alcoholic fatty liver disease?

Alcoholic fatty liver disease is due to heavy alcohol use. Your liver breaks down most of the alcohol you drink, so it can be removed from your body. But the process of breaking it down can generate harmful substances. These substances can damage liver cells, promote inflammation, and weaken your body's natural defenses. The more alcohol that you drink, the more you damage your liver. Alcoholic fatty liver disease is the earliest stage of alcohol-related liver disease. The next stages are alcoholic hepatitis and cirrhosis.

Who is at risk for fatty liver disease?

The cause of nonalcoholic fatty liver disease (NAFLD) is unknown. Researchers do know that it is more common in people who:

• Have type 2 diabetes and prediabetes
• Have obesity
• Are middle aged or older (although children can also get it)
• Are Hispanic, followed by non-Hispanic Whites. It is less common in African Americans.
• Have high levels of fats in the blood, such as cholesterol and triglycerides
• Have high blood pressure
• Take certain drugs, such as corticosteroids and some cancer drugs
• Have certain metabolic disorders, including metabolic syndrome
• Have rapid weight loss
• Have certain infections, such as hepatitis C
• Have been exposed to some toxins

NAFLD affects about 25% of people in the world. As the rates of obesity, type 2 diabetes, and high cholesterol are rising in the United States, so is the rate of NAFLD. NAFLD is the most common chronic liver disorder in the United States.

Alcoholic fatty liver disease only happens in people who are heavy drinkers, especially those who have been drinking for a long period of time. The risk is higher for heavy drinkers who are women, have obesity, or have certain genetic mutations.

What are the symptoms of fatty liver disease?

Both NAFLD and alcoholic fatty liver disease are usually silent diseases with few or no symptoms. If you do have symptoms, you may feel tired or have discomfort in the upper right side of your abdomen.

How is fatty liver disease diagnosed?

Because there are often no symptoms, it is not easy to find fatty liver disease. Your doctor may suspect that you have it if you get abnormal results on liver tests that you had for other reasons. To make a diagnosis, your doctor will use:

• Your medical history
• A physical exam
• Various tests, including blood and imaging tests, and sometimes a biopsy

As part of the medical history, your doctor will ask about your alcohol use, to find out whether fat in your liver is a sign of alcoholic fatty liver disease or nonalcoholic fatty liver (NAFLD). He or she will also ask which medicines you take, to try to determine whether a medicine is causing your NAFLD.

During the physical exam, your doctor will examine your body and check your weight and height. Your doctor will look for signs of fatty liver disease, such as:

• An enlarged liver
• Signs of cirrhosis, such as jaundice, a condition that causes your skin and whites of your eyes to turn yellow

You will likely have blood tests, including liver function tests and blood count tests. In some cases you may also have imaging tests, like those that check for fat in the liver and the stiffness of your liver. Liver stiffness can mean fibrosis, which is scarring of the liver. In some cases you may also need a liver biopsy to confirm the diagnosis, and to check how bad the liver damage is.

What are the treatments for fatty liver disease?

Doctors recommend weight loss for nonalcoholic fatty liver. Weight loss can reduce fat in the liver, inflammation, and fibrosis. If your doctor thinks that a certain medicine is the cause of your NAFLD, you should stop taking that medicine. But check with your doctor before stopping the medicine. You may need to get off the medicine gradually, and you might need to switch to another medicine instead.

There are no medicines that have been approved to treat NAFLD. Studies are investigating whether a certain diabetes medicine or Vitamin E can help, but more studies are needed.

The most important part of treating alcohol-related fatty liver disease is to stop drinking alcohol. If you need help doing that, you may want to see a therapist or participate in an alcohol recovery program. There are also medicines that can help, either by reducing your cravings or making you feel sick if you drink alcohol.

Both alcoholic fatty liver disease and one type of nonalcoholic fatty liver disease (nonalcoholic steatohepatitis) can lead to cirrhosis. Doctors can treat the health problems caused by cirrhosis with medicines, operations, and other medical procedures. If the cirrhosis leads to liver failure, you may need a liver transplant.

What are some lifestyle changes that can help with fatty liver disease?

If you have any of the types of fatty liver disease, there are some lifestyle changes that can help:

• Eat a healthy diet, limiting salt and sugar, plus eating lots of fruits, vegetables, and whole grains
• Get vaccinations for hepatitis A and B, the flu and pneumococcal disease. If you get hepatitis A or B along with fatty liver, it is more likely to lead to liver failure. People with chronic liver disease are more likely to get infections, so the other two vaccinations are also important.
• Get regular exercise, which can help you lose weight and reduce fat in the liver
• Talk with your doctor before using dietary supplements, such as vitamins, or any complementary or alternative medicines or medical practices. Some herbal remedies can damage your liver.

Germs and Hygiene

What are germs?

Germs are microorganisms. This means that they can be seen only through a microscope. They can be found everywhere - in the air, soil, and water. There are also germs on your skin and in your body. Many germs live in and on our bodies without causing harm. Some even help us to stay healthy. But some germs can make you sick. Infectious diseases are diseases that are caused by germs.

The main types of germs are bacteria, viruses, fungi, and parasites.

How do germs spread?

There are different ways that germs can spread, including:

• Through touching a person who has the germs or making other close contact with them, such as kissing, hugging, or sharing cups or eating utensils
• Through breathing air after a person with the germs coughs or sneezes
• Through touching the feces (poop) of someone who has the germs, such as changing diapers, then touching your eyes, nose, or mouth
• Through touching objects and surfaces that have germs on them, then touching your eyes, nose, or mouth
• From mother to baby during pregnancy and/or childbirth
• From insect or animal bites
• From contaminated food, water, soil, or plants

How can I protect myself and others from germs?

You can help protect yourself and others from germs:

• When you have to cough or sneeze, cover your mouth and nose with a tissue or use the inside of your elbow
• Wash your hands well and often. You should scrub them for at least 20 seconds. It is important to do this when you are most likely to get and spread germs:
  • Before, during, and after preparing food
  • Before eating food
  • Before and after caring for someone at home who is sick with vomiting or diarrhea
  • Before and after treating a cut or wound
  • After using the toilet
  • After changing diapers or cleaning up a child who has used the toilet
  • After blowing your nose, coughing, or sneezing
  • After touching an animal, animal feed, or animal waste
  • After handling pet food or pet treats
  • After touching garbage
• If soap and water are not available, you can use an alcohol-based hand sanitizer that contains at least 60% alcohol
• Stay home if you are sick
• Avoid close contact with people who are sick
• Practice food safety when handling, cooking, and storing food
• Regularly clean and disinfect frequently touched surfaces and objects

Giant Cell Arteritis

Giant cell arteritis is a disorder that causes inflammation of your arteries, usually in the scalp, neck, and arms. It narrows the arteries, which keeps blood from flowing well. Giant cell arteritis often occurs with another disorder called polymyalgia rheumatica. Both are more common in women than in men. They almost always affect people over the age of 50.

Early symptoms of giant cell arteritis resemble the flu: fatigue, loss of appetite, and fever. Other symptoms include:

• Headaches
• Pain and tenderness over the temples
• Double vision or visual loss, dizziness
• Problems with coordination and balance
• Pain in your jaw and tongue

Your doctor will make the diagnosis based on your medical history, symptoms, and a physical exam. There is no specific test for giant cell arteritis, but you may have tests that measure inflammation.

Treatment is usually with corticosteroids. Early treatment is important; otherwise there is a risk of permanent vision loss or stroke. However, when properly treated, giant cell arteritis rarely comes back.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases