The major eye complication of diabetes is called diabetic retinopathy. Diabetic retinopathy occurs in patients who have had diabetes for at least five years. Diseased small blood vessels in the back of the eye cause the leakage of protein and blood in the retina. Disease in these blood vessels also causes the formation of small aneurysms (microaneurysms), and new but brittle blood vessels (neovascularization). Spontaneous bleeding from the new and brittle blood vessels can lead to retinal scarring and retinal detachment, thus impairing vision.
Mind/Body: It is important to attend to stress in positive ways. Rather than using alcohol, tobacco, or television, try breathing exercises. They are simple, free, and right under your nose. Dr. Weil has compiled ten ways to reduce stress and promote relaxation, calm and peace within yourself. Some techniques take practice, and most require some commitment on your part to achieve results. However, the results are well worth the effort.
^ Jump up to: a b Go, AS; Bauman, M; King, SM; Fonarow, GC; Lawrence, W; Williams, KA; Sanchez, E (15 November 2013). "An Effective Approach to High Blood Pressure Control: A Science Advisory From the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention". Hypertension. 63 (4): 878–85. doi:10.1161/HYP.0000000000000003. PMID 24243703. Archived from the original on 20 November 2013. Retrieved 20 November 2013.
Blood pressure goals are generally set lower than 130/80. Some blood pressure medications offer more benefits than simply lowering blood pressure. For example, a class of blood pressure drugs called ACE inhibitors has been found to also reduce the levels of insulin resistance and actually deter the development of type 2 diabetes. This is an important consideration when discussing the choice blood pressure drugs in the metabolic syndrome.
Lifestyle changes and medications can lower blood pressure and decrease the risk of health complications.[8] Lifestyle changes include weight loss, physical exercise, decreased salt intake, reducing alcohol intake, and a healthy diet.[5] If lifestyle changes are not sufficient then blood pressure medications are used.[8] Up to three medications can control blood pressure in 90% of people.[5] The treatment of moderately high arterial blood pressure (defined as >160/100 mmHg) with medications is associated with an improved life expectancy.[14] The effect of treatment of blood pressure between 130/80 mmHg and 160/100 mmHg is less clear, with some reviews finding benefit[7][15][16] and others finding unclear benefit.[17][18][19] High blood pressure affects between 16 and 37% of the population globally.[5] In 2010 hypertension was believed to have been a factor in 18% of all deaths (9.4 million globally).[9]
Modern understanding of the cardiovascular system began with the work of physician William Harvey (1578–1657), who described the circulation of blood in his book "De motu cordis". The English clergyman Stephen Hales made the first published measurement of blood pressure in 1733.[152][153] However, hypertension as a clinical entity came into its own with the invention of the cuff-based sphygmomanometer by Scipione Riva-Rocci in 1896.[154] This allowed easy measurement of systolic pressure in the clinic. In 1905, Nikolai Korotkoff improved the technique by describing the Korotkoff sounds that are heard when the artery is ausculated with a stethoscope while the sphygmomanometer cuff is deflated.[153] This permitted systolic and diastolic pressure to be measured.
^ Qaseem, A; Wilt, TJ; Rich, R; Humphrey, LL; Frost, J; Forciea, MA; Clinical Guidelines Committee of the American College of Physicians and the Commission on Health of the Public and Science of the American Academy of Family, Physicians. (21 March 2017). "Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline From the American College of Physicians and the American Academy of Family Physicians". Annals of Internal Medicine. 166 (6): 430–437. doi:10.7326/m16-1785. PMID 28135725.
“Your doctor is probably not trained about the types of exercises and their related recommended intensities for improving specific parameters of this syndrome,” says Joey Gochnour, RDN, an exercise physiologist in Austin, Texas. Gochnour points out that even moderate aerobic exercise can improve cholesterol levels. He recommends exercising regularly, preferably at least 30 minutes a day, five days a week to help ward off metabolic syndrome.
Globally, black adults have among the highest rates of hypertension, with an increasing prevalence. Although white adults also have an increasing incidence of high BP, they develop this condition later in life than black adults and have much lower average BPs. In fact, compared to hypertensive white persons, hypertensive black individuals have a 1.3-fold higher rate of nonfatal stroke, a 1.8-fold higher rate of fatal stroke, a 1.5-fold higher mortality rate due to heart disease, and a 4.2-fold higher rate of end-stage renal disease (ESRD). [38]
A blood pressure reading measures both the systolic and diastolic forces, with the systolic pressure listed first. The numbers show your pressure in units of millimeters of mercury (mm Hg)—how high the pressure inside your arteries would be able to raise a column of mercury. For example, a reading of 120/80 mm Hg means a systolic pressure of 120 mm Hg and diastolic pressure of 80 mm Hg.
In a meta-analysis of pooled data from 19 prospective cohort studies involving 762,393 patients, Huang et al reported that, after adjustment for multiple cardiovascular risk factors, prehypertension was associated with a 66% increased risk for stroke, compared with an optimal blood pressure (< 120/80 mm Hg). [41, 42] Patients in the high range of prehypertension (130-139/85-89 mm Hg) had a 95% increased risk of stroke, compared with a 44% increased risk for those in the low range of prehypertension (120-129/80-84 mm Hg). [41, 42]
Prevention and treatment involve maintaining a healthy diet, regular physical exercise, a normal body weight, and avoiding use of tobacco.[2] Control of blood pressure and maintaining proper foot care are important for people with the disease.[2] Type 1 DM must be managed with insulin injections.[2] Type 2 DM may be treated with medications with or without insulin.[9] Insulin and some oral medications can cause low blood sugar.[13] Weight loss surgery in those with obesity is sometimes an effective measure in those with type 2 DM.[14] Gestational diabetes usually resolves after the birth of the baby.[15]

Blood pressure was traditionally measured using a stethoscope and a blood pressure cuff (called a sphygmomanometer), a device that includes a cuff, a bulb, and a pressure dial that reads the pressure in millimeters of mercury (mm Hg). This is still considered the best method but, more commonly, devices that combine a blood pressure cuff with electronic sensors are used to measure blood pressure.
Studies in type 1 patients have shown that in intensively treated patients, diabetic eye disease decreased by 76%, kidney disease decreased by 54%, and nerve disease decreased by 60%. More recently the EDIC trial has shown that type 1 diabetes is also associated with increased heart disease, similar to type 2 diabetes. However, the price for aggressive blood sugar control is a two to three fold increase in the incidence of abnormally low blood sugar levels (caused by the diabetes medications). For this reason, tight control of diabetes to achieve glucose levels between 70 to120 mg/dl is not recommended for children under 13 years of age, patients with severe recurrent hypoglycemia, patients unaware of their hypoglycemia, and patients with far advanced diabetes complications. To achieve optimal glucose control without an undue risk of abnormally lowering blood sugar levels, patients with type 1 diabetes must monitor their blood glucose at least four times a day and administer insulin at least three times per day. In patients with type 2 diabetes, aggressive blood sugar control has similar beneficial effects on the eyes, kidneys, nerves and blood vessels.
Treatment of hypertension is important, despite the fact that it rarely causes noticeable symptoms at the early stages. Hypertension accelerates atherosclerosis, which leads to coronary artery disease, heart attacks, heart failure, strokes, kidney failure, peripheral artery disease, and aortic aneurysms. Treating hypertension in the early stages has been shown to prevent these complications.
During Induction you were consuming about 20 grams of carbs per day. The carbohydrate level was extremely low to demonstrate that it's possible for virtually everybody to experience lipolysis—from the person who can lose weight quite easily on almost any program to the hardest case, the person who, until doing Atkins, thought that losing weight was almost impossible.
Let’s be real. Metabolic Resistance Training is numero uno for a reason; it’s a nearly perfect method for losing fat. If you’re looking for something more in-depth, Jen Sinkler’s Lift Weights Faster 2 has over 180 metabolic workouts. ONE HUNDRED EIGHTY of them! You’ve got workouts for the next year, and that’s if you train every other day and don’t repeat any.
^ Vancampfort D, Correll CU, Wampers M, Sienaert P, Mitchell AJ, De Herdt A, Probst M, Scheewe TW, De Hert M (July 2014). "Metabolic syndrome and metabolic abnormalities in patients with major depressive disorder: a meta-analysis of prevalences and moderating variables". Psychological Medicine. 44 (10): 2017–28. doi:10.1017/S0033291713002778. PMID 24262678.
^ Jump up to: a b Daskalopoulou, Stella S.; Rabi, Doreen M.; Zarnke, Kelly B.; Dasgupta, Kaberi; Nerenberg, Kara; Cloutier, Lyne; Gelfer, Mark; Lamarre-Cliche, Maxime; Milot, Alain (2015-01-01). "The 2015 Canadian Hypertension Education Program Recommendations for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension". Canadian Journal of Cardiology. 31 (5): 549–68. doi:10.1016/j.cjca.2015.02.016. PMID 25936483.
High-sensitivity C-reactive protein has been developed and used as a marker to predict coronary vascular diseases in metabolic syndrome, and it was recently used as a predictor for nonalcoholic fatty liver disease (steatohepatitis) in correlation with serum markers that indicated lipid and glucose metabolism.[45] Fatty liver disease and steatohepatitis can be considered as manifestations of metabolic syndrome, indicative of abnormal energy storage as fat in ectopic distribution. Reproductive disorders (such as polycystic ovary syndrome in women of reproductive age), and erectile dysfunction or decreased total testosterone (low testosterone-binding globulin) in men can be attributed to metabolic syndrome.[46]

Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections.

^ Jump up to: a b Picot J, Jones J, Colquitt JL, Gospodarevskaya E, Loveman E, Baxter L, Clegg AJ (September 2009). "The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation". Health Technology Assessment. 13 (41): 1–190, 215–357, iii–iv. doi:10.3310/hta13410. PMID 19726018.
But, the metabolism compensates. This person starts feeling hungry all the time. Their energy begins to suffer, and they feel cravings for sweet, salty, and fatty foods. This makes it harder for them to comply. But worse than that, depending on their individual response to the law of metabolic compensation, their metabolism has now put on the brakes, slowing their daily calorie burn rate by between 200 and 800 calories per day.
Type 1 and type 2 diabetes were identified as separate conditions for the first time by the Indian physicians Sushruta and Charaka in 400–500 CE with type 1 associated with youth and type 2 with being overweight.[108] The term "mellitus" or "from honey" was added by the Briton John Rolle in the late 1700s to separate the condition from diabetes insipidus, which is also associated with frequent urination.[108] Effective treatment was not developed until the early part of the 20th century, when Canadians Frederick Banting and Charles Herbert Best isolated and purified insulin in 1921 and 1922.[108] This was followed by the development of the long-acting insulin NPH in the 1940s.[108]
^ Piwernetz K, Home PD, Snorgaard O, Antsiferov M, Staehr-Johansen K, Krans M (May 1993). "Monitoring the targets of the St Vincent Declaration and the implementation of quality management in diabetes care: the DIABCARE initiative. The DIABCARE Monitoring Group of the St Vincent Declaration Steering Committee". Diabetic Medicine. 10 (4): 371–77. doi:10.1111/j.1464-5491.1993.tb00083.x. PMID 8508624.
In addition to the problems with an increase in insulin resistance, the release of insulin by the pancreas may also be defective and suboptimal. In fact, there is a known steady decline in beta cell production of insulin in type 2 diabetes that contributes to worsening glucose control. (This is a major factor for many patients with type 2 diabetes who ultimately require insulin therapy.) Finally, the liver in these patients continues to produce glucose through a process called gluconeogenesis despite elevated glucose levels. The control of gluconeogenesis becomes compromised.
Patients with metabolic syndrome can have several disorders of coagulation that make it easier for blood clots to form within blood vessels. These blood clots are often a precipitating factor in developing heart attacks. Patients with metabolic syndrome should generally be placed on daily aspirin therapy to help prevent such clotting events. You should speak to a doctor, of course, before starting any new medication regimen.
Ambulatory blood pressure monitoring can be done by using at-home devices that measure your blood pressure at periodic increments throughout a 24-hour or 48-hour time period. This provides your medical team with an average blood pressure reading that is believed to be more accurate than one taken at the doctor's office. Accumulating evidence supports the reliability of this approach.
However, medication is needed to sufficiently reduce blood pressure for most stage 1 and almost all stage 2 hypertension cases. There are a vast number of prescription medications that have been approved for the treatment of hypertension, and guidelines have been developed to help doctors quickly find an effective and well-tolerated treatment regimen for almost anyone with this concern.
Diabetes was one of the first diseases described,[107] with an Egyptian manuscript from c. 1500 BCE mentioning "too great emptying of the urine".[108] The Ebers papyrus includes a recommendation for a drink to be taken in such cases.[109] The first described cases are believed to be of type 1 diabetes.[108] Indian physicians around the same time identified the disease and classified it as madhumeha or "honey urine", noting the urine would attract ants.[108][109]
Although treatment of sleep apnea with continuous airway positive pressure (CPAP) would logically seem to improve CV outcomes and hypertension, studies evaluating this mode of therapy have been disappointing. A 2016 review of several studies indicated that CPAP either had no effect or a modest BP-lowering effect. [29] Findings from the SAVE study showed no effect of CPAP therapy on BP above usual care. [30] It is likely that patients with sleep apnea have other etiologies of hypertension, including obesity, hyperaldosteronism, increased sympathetic drive, and activation of the renin/angiotensin system that contribute to their hypertension. Although CPAP remains an effective therapy for other aspects of sleep apnea, it should not be expected to normalize BP in the majority of patients.
Metabolic syndrome is believed to develop due to insulin resistance. Insulin is a hormone that is produced by the pancreas (an organ located near stomach). It helps blood sugar enter cells, where it is used for energy. With insulin resistance, the body fails to recognize the insulin that is produced, causing the sugar to accumulate in the blood instead of being absorbed into other cells. Because blood sugar levels remain high, the pancreas keeps producing more and more insulin, leading to high insulin levels. While blood sugar levels are not high enough to be classified as diabetes, they do increase the risk of developing serious health problems.
Lifestyle changes can help lower the risk of developing hypertension. For many people with mild high blood pressure, reaching and maintaining a healthy weight, exercising regularly, limiting alcohol and salt, and stopping smoking can decrease blood pressure levels to normal and may be the only "treatment" required. Risks associated with sex (gender), race, and increasing age, however, do not disappear with lifestyle changes and, in many cases, a treatment plan that includes medications is necessary to control high blood pressure.
Insulin is released into the blood by beta cells (β-cells), found in the islets of Langerhans in the pancreas, in response to rising levels of blood glucose, typically after eating. Insulin is used by about two-thirds of the body's cells to absorb glucose from the blood for use as fuel, for conversion to other needed molecules, or for storage. Lower glucose levels result in decreased insulin release from the beta cells and in the breakdown of glycogen to glucose. This process is mainly controlled by the hormone glucagon, which acts in the opposite manner to insulin.[61]
In a meta-analysis of pooled data from 19 prospective cohort studies involving 762,393 patients, Huang et al reported that, after adjustment for multiple cardiovascular risk factors, prehypertension was associated with a 66% increased risk for stroke, compared with an optimal blood pressure (< 120/80 mm Hg). [41, 42] Patients in the high range of prehypertension (130-139/85-89 mm Hg) had a 95% increased risk of stroke, compared with a 44% increased risk for those in the low range of prehypertension (120-129/80-84 mm Hg). [41, 42]

Insulin is vital to patients with type 1 diabetes - they cannot live without a source of exogenous insulin. Without insulin, patients with type 1 diabetes develop severely elevated blood sugar levels. This leads to increased urine glucose, which in turn leads to excessive loss of fluid and electrolytes in the urine. Lack of insulin also causes the inability to store fat and protein along with breakdown of existing fat and protein stores. This dysregulation, results in the process of ketosis and the release of ketones into the blood. Ketones turn the blood acidic, a condition called diabetic ketoacidosis (DKA). Symptoms of diabetic ketoacidosis include nausea, vomiting, and abdominal pain. Without prompt medical treatment, patients with diabetic ketoacidosis can rapidly go into shock, coma, and even death may result.

If you're not taking a diuretic and your blood pressure remains high, talk to your doctor about adding one or replacing a drug you currently take with a diuretic. Diuretics or calcium channel blockers may work better for people of African heritage and older people than do angiotensin-converting enzyme (ACE) inhibitors alone. A common side effect of diuretics is increased urination.
Metabolic syndrome is a burgeoning global problem. Approximately one fourth of the adult European population is estimated to have metabolic syndrome, with a similar prevalence in Latin America. [25] It is also considered an emerging epidemic in developing East Asian countries, including China, Japan, and Korea. The prevalence of metabolic syndrome in East Asia may range from 8-13% in men and from 2-18% in women, depending on the population and definitions used. [29, 30, 31]
Approximately half of individuals with hypertension have OSA, and approximately half with OSA have hypertension. Ambulatory BP monitoring normally reveals a "dip" in BP of at least 10% during sleep. However, if a patient is a "nondipper," the chances that the patient has OSA is increased. Nondipping is thought to be caused by frequent apneic/hypopneic episodes that end with arousals associated with marked spikes in BP that last for several seconds. Apneic episodes are associated with striking increases in sympathetic nerve activity and enormous elevations of BP. Individuals with sleep apnea have increased cardiovascular mortality, in part likely related to the high incidence of hypertension.
Merck & Co., Inc., Kenilworth, NJ, USA is a global healthcare leader working to help the world be well. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world.  The Merck Manual was first published in 1899 as a service to the community.  The legacy of this great resource continues as the Merck Manual in the US and Canada and the MSD Manual outside of North America.  Learn more about our commitment to Global Medical Knowledge.
Interestingly enough, some data suggests that consumption of sodas (diet or regular) and other products containing high-fructose corn syrup (HFCS) like salad dressings and ketchup, jams, jellies, ice cream and many more foods may be linked to obesity, insulin resistance, and metabolic syndrome in both adults and children. Interrupted sleep patterns (such as sleep apnea) may also be a factor in increasing the incidence of insulin resistance and metabolic syndrome in the adult population.

You are more likely to develop type 2 diabetes if you are age 45 or older, have a family history of diabetes, or are overweight. Physical inactivity, race, and certain health problems such as high blood pressure also affect your chance of developing type 2 diabetes. You are also more likely to develop type 2 diabetes if you have prediabetes or had gestational diabetes when you were pregnant. Learn more about risk factors for type 2 diabetes.
However, medication is needed to sufficiently reduce blood pressure for most stage 1 and almost all stage 2 hypertension cases. There are a vast number of prescription medications that have been approved for the treatment of hypertension, and guidelines have been developed to help doctors quickly find an effective and well-tolerated treatment regimen for almost anyone with this concern.,140,558,697.jpg
Maddy Arnstein has lived with T1D for over 50 years. She became involved with JDRF when she saw the dramatic difference technologies like the insulin pump could have on her life. Maddy was quickly drawn to advocacy—initially to help secure continued renewal of funding for the Special Diabetes Program (SDP). But once she started using a continuous glucose monitor, she dedicated herself to fighting for Medicare coverage.
People who have metabolic syndrome or are at risk for it may need to take medicine as treatment. This is especially true if diet and other lifestyle changes have not made a difference. Your doctor may prescribe medicine to help lower blood pressure, improve insulin metabolism, lower LDL cholesterol and raise HDL cholesterol, increase weight loss, or some combination of these.
The good news is that if you suspect you might have metabolic damage there are real answers and solutions and even tests to tell you what is going wrong in your body.  For those looking to get answers on how to fix metabolism problems and metabolic damage we have created a FREE  3 part Metabolic Repair Video Course that walks you through all the steps.  From how to get the correct tests to a done for you comprehensive metabolism assessment we cover it all in the course.  The course will teach you:

Creatinine is a chemical waste molecule that is generated from muscle metabolism. Creatinine is produced from creatine, a molecule of major importance for energy production in muscles. Creatinine has been found to be a fairly reliable indicator of kidney function. As the kidneys become impaired the creatinine level in the blood will rise. Normal levels of creatinine in the blood vary from gender and age of the individual.