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Reference: Diabetes.org
Diabetes is a disease in which the body does not produce or properly use
insulin. Insulin is a hormone that is needed to convert sugar, starches and
other food into energy needed for daily life. The cause of diabetes continues to
be a mystery, although both genetics and environmental factors such as obesity
and lack of exercise appear to play roles.
There are 20.8 million children and adults in the United States, or 7% of the
population, who have diabetes. While an estimated 14.6 million have been
diagnosed with diabetes, unfortunately, 6.2 million people (or nearly one-third)
are unaware that they have the disease.
In order to determine whether or not a patient has pre-diabetes or diabetes,
health care providers conduct a Fasting Plasma Glucose Test (FPG) or an Oral
Glucose Tolerance Test (OGTT). Either test can be used to diagnose pre-diabetes
or diabetes. The American Diabetes Association recommends the FPG because it is
easier, faster, and less expensive to perform.
With the FPG test, a fasting blood glucose level between 100 and 125 mg/dl
signals pre-diabetes. A person with a fasting blood glucose level of 126 mg/dl
or higher has diabetes.
In the OGTT test, a person's blood glucose level is measured after a fast and
two hours after drinking a glucose-rich beverage. If the two-hour blood glucose
level is between 140 and 199 mg/dl, the person tested has pre-diabetes. If the
two-hour blood glucose level is at 200 mg/dl or higher, the person tested has
diabetes.
Recently Diagnosed?
This area of our Web site can help ease your fears and teach you more about
living with diabetes or caring for someone with diabetes, and connect you with
others affected by diabetes who will listen and share their own experiences.
Visit the Recently Diagnosed area of diabetes.org
Major Types of Diabetes
Type 1 diabetes
Results from the body's failure to produce insulin, the hormone that "unlocks"
the cells of the body, allowing glucose to enter and fuel them. It is estimated
that 5-10% of Americans who are diagnosed with diabetes have type 1 diabetes.
Type 2 diabetes
Results from insulin resistance (a condition in which the body fails to properly
use insulin), combined with relative insulin deficiency. Most Americans who are
diagnosed with diabetes have type 2 diabetes.
Gestational diabetes
Gestational diabetes affects about 4% of all pregnant women - about 135,000
cases in the United States each year.
Pre-diabetes
Pre-diabetes is a condition that occurs when a person's blood glucose levels are
higher than normal but not high enough for a diagnosis of type 2 diabetes. There
are 41 million Americans who have pre-diabetes, in addition to the 20.8 million
with diabetes.
Additional Information
Recently Diagnosed
You or someone you love has just been diagnosed with diabetes -- chances are you
have a million questions running through your head. This area of our Web site
can help ease your fears and teach you more about living with diabetes or caring
for someone with diabetes, and connect you with others affected by diabetes who
will listen and share their own experiences.
Diabetes Learning Center
Take the first steps toward better diabetes care by visiting the Diabetes
Learning Center -- an area for people who have been recently diagnosed with
diabetes, or those needing basic information.
Diabetes Symptoms
Often diabetes goes undiagnosed because many of its symptoms seem so harmless.
Learn what they are in this section.
The Complete Guide to Diabetes, 4th EditionFurther Reading . . .
The Complete Guide to Diabetes has been completely revised to bring you all the
information you need to live an active, healthy life with diabetes. Now in its
fourth edition, this guide gives you information on the best self-care
techniques and the latest medical advances. If you have diabetes, this guide
will answer all your questions.
For more books on healthy living, click here.
Diabetes Risk Test
More than 20 million Americans have diabetes - nearly one in three does not know
it! Take our diabetes risk test to see if you are at risk for having diabetes.
Diabetes is more common in African Americans, Latinos, Native Americans, Asian
Americans and Pacific Islanders.
Diabetes Myths
Find the truth about some of the most common myths about diabetes.
Diabetes Statistics
With so many people affected by diabetes, the American Diabetes Association has
compiled statistics on the impact of diabetes and its complications. We have
statistics listed by population, complication, and economic impact.
The Genetics of Diabetes
You've probably wondered how you got diabetes. You may worry that your children
will get it too. Unlike some traits, diabetes does not seem to be inherited in a
simple pattern. Yet clearly, some people are born more likely to get diabetes
than others.
Who's on your health care team?
No matter what kind of diabetes you have, it affects many parts of your life.
You can get help from health professionals trained to focus on different areas,
from head to toe. A health care team helps you use the health care system to its
fullest. So whom do you need on your team? Find out here.
Multimedia Education
This section contains Webcasts of several different diabetes-related topics.
Books & Magazines
Visit our bookstore for a variety of cookbooks, meal planners, self-care guides
and other educational materials to assist you in managing diabetes.
Type 1 diabetes is usually diagnosed in children and young adults, and was
previously known as juvenile diabetes. In type 1 diabetes, the body does not
produce insulin. Insulin is a hormone that is needed to convert sugar (glucose),
starches and other food into energy needed for daily life.
Finding out you have diabetes is scary. But don't panic. Type 1 diabetes is
serious, but people with diabetes can live long, healthy, happy lives.
Conditions & Treatment
Arm yourself with information about conditions associated with type 1 diabetes,
and how to prevent them. Conditions associated with type 1 diabetes include
hyperglycemia, hypoglycemia, ketoacidosis and celiac disease. You will also find
helpful information about insulin, choosing blood glucose meters, various
diagnostic tests including the A1c test, managing and checking your blood
glucose, kidney and islet transplantations, and tips on what to expect from your
health care provider.
A Field Guide to Type 1 DiabetesFurther Reading . . .
A Field Guide to Type 1 Diabetes gives checklists of what you need, what to do
in different situations, and what kinds of provisions you need.
For more books on healthy living, click here
Complications
Having type 1 diabetes increases your risk for many serious complications. Some
complications of type 1 diabetes include: heart disease (cardiovascular
disease), blindness (retinopathy), nerve damage (neuropathy), and kidney damage
(nephropathy). Learn more about these complications and how to cope with them.
Recently Diagnosed
You've just been diagnosed with diabetes. Chances are you have a million
questions running through your head. To help you answer those questions, and
take the first steps toward better diabetes care, visit the Recently Diagnosed
area for people who have just been diagnosed with diabetes, or those needing
basic information.
Your Body's Well Being
Make it a priority to take good care of your body. The time you spend now on eye
care, foot care and skin care, as well as your heart health and oral health,
could delay or prevent the onset of dangerous type 1 diabetes complications
later in life. Plus, some of the best things you can do for your body are to
stop smoking, and reduce the amount of alcohol you drink.
Common Concerns
This section addresses various areas to help you live with type 1 diabetes. What
do you do when you're sick? What do you do when you travel? Can you get a flu
shot with diabetes? How do you cope with having type 1 diabetes? Are you being
discriminated against because you have diabetes? You'll find answers to these
questions, and more in this section.
Ask the Pharmacist
The American Diabetes Association and Rite Aid "Ask the Pharmacist" area is
where you can ask a pharmacist a question to help you manage your diabetes. Rite
Aid and the ADA have partnered to allow you to access to Rite Aid's Drug
Information Center from our Web site.
Women and Diabetes
Learn how to ensure your own health and well-being.
Health Information For Men
Learn how to ensure your own health and well-being.
Related Links
* Physician Recognition Program
This Recognized Physician Directory helps individuals find doctors who have
demonstrated they meet important standards of care.
* Education Recognition Program
The following diabetes education programs in your area are Recognized by the
American Diabetes Association. These Recognized programs meet the National
Standards for excellence in diabetes education.
Type 2 diabetes is the most common form of diabetes. In type 2 diabetes, either
the body does not produce enough insulin or the cells ignore the insulin.
Insulin is necessary for the body to be able to use sugar. Sugar is the basic
fuel for the cells in the body, and insulin takes the sugar from the blood into
the cells. When glucose builds up in the blood instead of going into cells, it
can cause two problems:
* Right away, your cells may be starved for energy.
* Over time, high blood glucose levels may hurt your eyes, kidneys, nerves or
heart.
Finding out you have diabetes is scary. But don't panic. Type 2 diabetes is
serious, but people with diabetes can live long, healthy, happy lives.
While diabetes occurs in people of all ages and races, some groups have a higher
risk for developing type 2 diabetes than others. Type 2 diabetes is more common
in African Americans, Latinos, Native Americans, and Asian Americans/Pacific
Islanders, as well as the aged population.
A Field Guide to Type 2 DiabetesFurther Reading . . .
A Field Guide to Type 2 Diabetes is an excellent book for the patient or family
member.
For more books on healthy living, click here
Conditions & Treatment
Arm yourself with information about conditions associated with type 2 diabetes,
and how to prevent them. Conditions associated with type 2 diabetes include
hyperglycemia and hypoglycemia. You will also find helpful information about
insulin, oral medications, various diagnostic tests including the A1c test,
managing and checking your blood glucose, and tips on what to expect from your
health care provider.
Complications
Having type 2 diabetes increases your risk for many serious complications. Some
complications of type 2 diabetes include: heart disease (cardiovascular
disease), blindness (retinopathy), nerve damage (neuropathy), and kidney damage
(nephropathy). Learn more about these complications and how to cope with them.
Diabetes Learning Center for the Recently Diagnosed
You've just been diagnosed with diabetes. Chances are you have a million
questions running through your head. To help you answer those questions, and
take the first steps toward better diabetes care, visit the Diabetes Learning
Center -- an area for people who are newly diagnosed with diabetes, or those
needing basic information.
Your Body's Well Being
Make it a priority to take good care of your body. The time you spend now on eye
care, foot care and skin care, as well as your heart health and oral health,
could delay or prevent the onset of dangerous type 2 diabetes complications
later in life. Plus, some of the best things you can do for your body are to
stop smoking, and reduce the amount of alcohol you drink.
Common Concerns
This section addresses various areas to help you live with type 2 diabetes. What
do you do when you're sick? What do you do when you travel? Can you get a flu
shot with diabetes? How do you cope with having type 2 diabetes? Are you being
discriminated against because you have diabetes? You'll find answers to these
questions, and more in this section.
Ask the Pharmacist
The American Diabetes Association and Rite Aid "Ask the Pharmacist" area is
where you can ask a pharmacist a question to help you manage your diabetes. Rite
Aid and the ADA have partnered to allow you to access to Rite Aid's Drug
Information Center from our Web site.
Women and Diabetes
Learn how to ensure your own health and well-being.
Health Information For Men
Learn how to ensure your own health and well-being.
Related Links
* Want to learn more about diabetes? Visit the Healthy Body Healthy Mind Web
site and click on the link for "diabetes." Dr. Nathaniel Clark, Vice President
of Clinical Affairs for the Association, and Dr. James Gavin, former president
of the Association, joined other diabetes experts to share their insight on
diabetes.
* Physician Recognition Program
This Recognized Physician Directory helps individuals find doctors who have
demonstrated they meet important standards of care.
* Education Recognition Program
The following diabetes education programs in your area are Recognized by the
American Diabetes Association. These Recognized programs meet the National
Standards for excellence in diabetes education.
Women and Diabetes
Breast Cancer
Complications
Coronary Heart Disease
Eating Disorders
Gastroparesis and Diabetes
Mental Health
Osteoporosis
Polycystic Ovarian Syndrome
Pregnancy
Sexual Health
For more information, visit the FDA's Office of Women's Health.
Breast Cancer
Breast cancer is the most common malignancy in women and the second leading
cause of cancer death (exceeded by lung cancer in 1985). Breast cancer is three
times more common than all gynecologic malignancies put together. The incidence
of breast cancer has been increasing steadily from an incidence of 1:20 in 1960
to 1:7 women today.
About 212,920 women in the United States will be found to have invasive breast
cancer in 2006. About 40,970 women will die from the disease this year. Right
now there are slightly over 2 million women living in the United States who have
been treated for breast cancer. The chance of a woman having invasive breast
cancer some time during her life is about 1 in 8. The chance of dying from
breast cancer is about 1 in 33. Breast cancer death rates are going down. This
decline is probably the result of finding the cancer earlier and improved
treatment.
For more information, visit the National Breast Cancer Foundation site, or the
American Cancer Society.
Complications
Having diabetes increases your risk for many serious complications. Some
complications of diabetes include: heart disease (cardiovascular disease),
blindness (retinopathy), nerve damage (neuropathy), and kidney damage
(nephropathy). Learn more about these complications and how to cope with them.
Coronary Heart Disease in Women with Diabetes
One of three women will die of heart disease compared to one of nine women dying
of breast cancer. Forty percent of heart attacks result in death. Diabetes is a
powerful risk factor for heart disease in women. Heart disease is the leading
cause of death in women with diabetes. Women with diabetes are twice as likely
to have a second heart attack and 4 times more likely to have heart failure than
women without diabetes.
Many women with type 2 diabetes already have heart disease when they are
diagnosed or have many of the risk factors such as high lipids levels, high
blood pressure, abdominal obesity, and abnormalities in blood vessel function.
Women with type 1 diabetes can develop heart disease when they are young. Women
with diabetes are not only at greater risk for heart disease, but also
experience more adverse outcomes.
What you can do to protect yourself
* Don't Smoke
* Control your blood pressure
* Maintain a healthy weight
* Exercise regularly
* Eat a low-fat diet
* Take care of diabetes
* Be aware of chest pain
* Know your family history
For more information, visit Family Doctor or the American Heart Association.
Eating Disorders
Research suggests that eating disorders are probably more common among women
with diabetes than women who do not have diabetes. Bulimia is the most common
eating disorder in women with type 1 diabetes. Among women with type 2 diabetes,
binge eating is more common.
Because both diabetes and eating disorders involve attention to body states,
weight management, and control of food, some people develop a pattern in which
they use the disease to justify or camouflage the disorder. Because the
complications of diabetes and eating disorders can be serious, even fatal,
responsible, healthy behavior is essential.
Eating disorders are illnesses with a biological basis modified and influenced
by emotional and cultural factors. The stigma associated with eating disorders
has long kept individuals suffering in silence, inhibited funding for crucial
research and created barriers to treatment. Because of insufficient information,
the public and professionals fail to recognize the dangerous consequences of
eating disorders. While eating disorders are serious, potentially life
threatening illnesses, there is help available and recovery is possible.
Types of Eating Disorders
Anorexia (or anorexia nervosa) is an eating disorder centered around an
obsessive fear of weight gain. Anorexia involves self-starvation and excessive
weight loss. Although anorexia is a psychological disorder, the physical
consequences are serious and sometimes life-threatening.
Bulimia is characterized by recurrent binge eating (the rapid controlled
consumption of large amounts of food). Purging may occur with self-induced
vomiting, laxatives, diuretics, insulin omission or reduction, fasting, severe
diets, or vigorous exercise.
Binge Eating Disorder (also known as Compulsive Overeating) is characterized
primarily by periods of uncontrolled, impulsive, or continuous eating beyond the
point of feeling comfortably full. While there is no purging, there may be
sporadic fasts or repetitive diets and often feelings of shame or self-hatred
after a binge.
Eating Disorders Not Otherwise Specified (EDNOS)
A range of other disordered eating patterns doesn't fit the other specific
types. These conditions are still serious, and intervention and attention are
necessary.
EDNOS, or other types of eating disorders, may include:
* Eating problems or disordered eating with some, but not all, of the
characteristics of an eating disorder; for example, people who severely restrict
food intake, but who do not meet the full criteria for anorexia nervosa.
* Chewing food and spitting it out (without swallowing).
* Bingeing and purging irregularly, such as at times of increased stress.
Eating Disorders and Pregnancy
Women with eating disorders have higher rates of miscarriage than do healthy,
normal women. Also, your baby might be born prematurely, meaning that it would
not weigh as much, or be as well developed, as babies who are born full term.
Women with anorexia nervosa are underweight and may not gain enough weight
during pregnancy. They risk having a baby with abnormally low birth weight and
related health problems. Women with bulimia nervosa who continue to purge may
suffer dehydration, chemical imbalances or even cardiac irregularities.
Pregnancy heightens these health risks. Women who are overweight due to binge
eating are at greater risk of developing high blood pressure, gestational
diabetes and overgrown babies. Low birth weight babies are at risk of many
medical problems, some of them life threatening.
Your teeth and bones might become weak and fragile because the baby's need for
calcium takes priority over yours. If you don't replenish calcium with dairy
products and other sources, you could find yourself with stress fractures and
broken bones in later years. Once calcium is gone from your bones, it is
difficult, if not impossible, to replace it.
For more information, visit the National Eating Disorders Association Web site.
Gastroparesis and Diabetes
Gastroparesis is a disorder affecting people with both type 1 and type 2
diabetes, where the stomach takes too long to empty its contents. It happens
when nerves to the stomach are damaged or stop working. The vagus nerve controls
the movement of food through the digestive tract. If the vagus nerve is damaged,
the muscles of the stomach and intestines do not work normally, and the movement
of food is slowed or stopped.
Gastroparesis can make diabetes worse by making it more difficult to manage
blood glucose. When food that has been delayed in the stomach finally enters the
small intestine and is absorbed, blood glucose levels rise.
The most important treatment goal for diabetes-related gastroparesis is to
manage your blood glucose levels as well as possible. Treatments include
insulin, oral medications, changes in what and when you eat, and in severe
cases, feeding tubes and intravenous feeding. Learn more about gastroparesis.
Related Link
* National Digestive Diseases Information Clearinghouse.
Mental Health
Anxiety
Anxiety disorders are serious medical illnesses that affect approximately 40
million American adults. These disorders fill people's lives with overwhelming
anxiety and fear. Unlike the relatively mild, brief anxiety caused by a
stressful event such as a business presentation or a first date, anxiety
disorders are chronic, relentless, and can grow progressively worse if not
treated.
Types of Anxiety
Generalized Anxiety Disorder (GAD)
is much more than the normal anxiety people experience day to day. It's chronic
and fills one's day with exaggerated worry and tension, even though there is
little or nothing to provoke it.
Panic Attacks and Panic Disorder
People with panic disorder have feelings of terror that strike suddenly and
repeatedly with no warning. They can't predict when an attack will occur, and
many develop intense anxiety between episodes, worrying when and where the next
one will strike.
Phobias
Social phobia, also called social anxiety disorder, involves overwhelming
anxiety and excessive self-consciousness in everyday social situations. People
with social phobia have a persistent, intense, and chronic fear of being watched
and judged by others and being embarrassed or humiliated by their own actions.
Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) is a debilitating condition that can
develop following a terrifying event. Often, people with PTSD have persistent
frightening thoughts and memories of their ordeal and feel emotionally numb,
especially with people they were once close to.
Obsessive Compulsive Disorder (OCD)
Obsessive-compulsive disorder, or OCD, involves anxious thoughts or rituals you
feel you can't control.
Depression
The rate of depression in people with diabetes is much higher than in the
general population. Women experience depression about twice as often as men. The
risk of depression increases in women with diabetes. Many hormonal factors may
contribute to the increased rate of depression in women -- particularly such
factors as menstrual cycle changes, pregnancy, miscarriage, postpartum period,
pre-menopause, and menopause. Many women also face additional stresses such as
responsibilities both at work and home, single parenthood, and caring for
children and for aging parents.
Previous studies have shown individuals who are insulin-resistant may have
higher serotonin concentrations and may be more prone to depression and even
suicide. Women with diabetes may be more likely to suffer depression because of
the clinical diagnosis.
Types of Depression
Major depression is characterized by a combination of symptoms that interfere
with the ability to work, study, sleep, eat, and enjoy once pleasurable
activities.
Dysthymia, a less severe type of depression, involves long-term, chronic
symptoms that are not disabling, but keep one from functioning well or feeling
good.
Bipolar disorder (also known as manic-depressive illness) is not nearly as
prevalent as other forms of depression.
Seasonal affective disorder (SAD) is a major depression that occurs in the
winter when the amount of sunlight is limited.
Postpartum depression occurs within four weeks of childbirth. Most new mothers
suffer from some form of the "baby blues."
Psychotic depression is a rare form of depression characterized by delusions or
hallucinations, such as believing you are someone you are not and hearing
voices.
For more information, visit the National Institute of Mental Health Web site.
Osteoporosis
Osteoporosis is a disease in which bones become fragile and more likely to
break. If not prevented or if left untreated, osteoporosis can progress
painlessly until a bone breaks. These broken bones, also known as fractures,
occur typically in the hip, spine, and wrist.
In the U.S., 10 million individuals are estimated to already have the disease
and almost 34 million more are estimated to have low bone mass, placing them at
increased risk for osteoporosis. Of the 10 million Americans estimated to have
osteoporosis, eight million are women and two million are men. Women can lose up
to 20 percent of their bone mass in the five to seven years following menopause,
making them more susceptible to osteoporosis.
To learn more, visit the National Osteoporosis Foundation.
Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome (PCOS) is the most common cause of female
infertility. In women with PCOS, immature follicles bunch together to form large
cysts or lumps. The eggs mature within the bunched follicles, but the follicles
don't break open and release them. As a result, women with PCOS often don't have
menstrual periods, or they have periods only on occasion.
No one knows the exact cause of PCOS, but studies are looking at whether it is
caused by genetics. Also, because many women with PCOS also have diabetes,
studies are examining the relationship between PCOS and the body's ability to
produce insulin.
Because there is no cure for PCOS, it needs to be managed to prevent further
problems. There are many medications to control the symptoms of PCOS. Management
focuses on each woman's main concerns, such as infertility, acne or obesity.
Long term, the most important aspect of treatment is managing cardiovascular
risks such as obesity, high blood cholesterol, diabetes and high blood pressure.
Researchers are looking at how male hormone levels change as women with PCOS
grow older. They think that as women reach menopause, ovarian function changes
and the menstrual cycle may become more normal. But even with falling male
hormone levels, excessive hair growth continues, and male pattern baldness or
thinning hair gets worse after menopause.
Learn more about PCOS.
Related Links
* Women's Health.gov
* Polycystic Ovarian Syndrome Association
Pregnancy
Gestational Diabetes
Pregnant women who have never had diabetes before but who have high blood sugar
(glucose) levels during pregnancy are said to have gestational diabetes.
Gestational diabetes affects about 4% of all pregnant women -- about 135,000
cases of gestational diabetes in the United States each year.
Diabetes and Pregnancy
The key to a healthy pregnancy for a woman with diabetes is keeping blood
glucose (sugar) in the target range -- both before she is pregnant and during
her pregnancy. To do this, you need a diabetes treatment plan that keeps meals,
exercise, and insulin in balance. This plan will change as you change with
pregnancy.
Related Links
* Mayo Clinic
* Centers for Disease Control & Prevention
Women's Sexual Health
Sex is an important part of life and relationships. But diabetes can affect a
woman's sex life. Some women with diabetes have less interest in sex because of
depression or levels can make some women feel tired all the time. Problems with
having sex aren't a normal part of getting older and don't happen to all women
who have diabetes.
Menopause
Menopause and the years leading up to it when your body gradually produces less
estrogen and progesterone (perimenopause) may present unique challenges if you
have diabetes. How these hormonal changes affect blood glucose may vary
depending on the individual. Many women, however, notice that their blood
glucose levels are more variable (increasing and decreasing) and less
predictable than before. The hormonal changes as well as swings in your blood
glucose levels can contribute to menopausal symptoms such as mood changes,
fatigue and hot flashes.
Menopause and diabetes produce similar symptoms. You may mistake menopausal
symptoms such as hot flashes, moodiness and short-term memory loss for symptoms
of low blood glucose. If you incorrectly assume these symptoms are a result of
low blood glucose, you may consume unnecessary calories in an effort to raise
your blood glucose, and inadvertently cause a surge in blood glucose.
Because of your diabetes, however, you may experience stronger and more frequent
episodes of low blood glucose, especially at night. This can further compromise
sleep already interrupted by menopause-associated hot flashes and night sweats.
Such sleep deprivation can cause fluctuations in blood glucose that make control
more difficult.
Hormone Replacement Therapy (HRT) and Diabetes
Women with diabetes are at an increased risk for heart disease. The estrogen
hormone which is lost at menopause is a powerful factor in preventing heart
disease. Women with diabetes develop a greatly increased risk of developing
heart disease after menopause. HRT can help reduce this risk.
HRT replaces the estrogen and progestin once produced by your body. HRT is
sometimes used to treat women who experience serious or very unpleasant effects
of menopause. In all women, there are risks and benefits. Women with diabetes
are no exception.
Benefits: reduces risk of heart disease and reduces risk of osteoporosis, lipid
effects, blood vessel effects
Risks: increases risk of breast cancer
For more information, visit the MedlinePlus Web site, or the Mayo Clinic Web
site.
Health Information for Men
Men with diabetes have similar health issues as people without diabetes.
However, there are some concerns which are magnified by diabetes.
Diabetes and Men's Sexual Health
What you should know about diabetes and men's sexual health.
Gastroparesis
Learn about this disorder that affects people with both type 1 and type 2
diabetes.
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