CONTACTS 

SUBJECTS
Diabetes Mellitus Type 2 Diagnosed After 5 Years Not Feeling Well St

0903 -
0903 -    ..
0904 - Summary/Objective
0905 -
090501 - Follow up ref SDS 18 0000, ref SDS 1 3280.
090502 -
090503 - Diagnosis of diabetes introduces a long term chronic condition that
090504 - will impact lifestyle.  Medical treatment is through Kaiser.
090505 - ref SDS 0 5F70  Kaiser's doctor patient partnership model empowers
090506 - patients to support "project management" tasks that help the medical
090507 - team align the work with objectives, requirements, and commitments.
090508 - ref SDS 0 T16N  Morris plans to follow up on the SDS project maybe
090509 - next week. ref SDS 0 5E6M
090510 -
090511 -
090512 -
090514 -  ..
0906 -
0907 -
0908 - Progress
0909 -
090901 - Diabetes Diagnosed Possibly Started Few Years Ago
090902 -
090903 - Called Morris about progress following up the meeting last week on
090904 - 070907, when he planned to submit product specification based on
090905 - requirements review the past few weeks. ref SDS 18 JR97
090907 -  ..
090908 - Morris has been diagnosed with diabetes.  He saw the doctor last week,
090909 - and tests were performed.  The doctor called a few days ago and
090910 - reported results.  Blood sugar was over...
090911 -
090914 -  ..
090915 - The challenge is managing dietary changes that reduce blood surgar to
090916 - below 150 mg/dL and toward 120 mg/dL, per research below. ref SDS 0
090917 - GP45  This requires daily home care with tests to monitor blood surgar
090918 - (drawing blood with finger pricks several times a day??), and
090919 - adjusting diet.
090921 -  ..
090922 - The doctor has scheduled Morris to attend a series of diabetes
090923 - education classes beginning next week.
090924 -
090925 -
090926 -
090927 -
0910 -

SUBJECTS
Diabetes Mellitus Type 2 Diagnosed After 5 Years Not Feeling Well St

1003 -
100401 -  ..
100402 - Diabetes Type 2 Adult Insulin Resistant Pancreas Secretory defect
100403 - Complications May Involve Many Organs Heart Eyes Kidney Nerves
100404 -
100405 - Research today on an article on diabetes....
100406 -
100407 -              http://www.woodtv.com/Global/story.asp?S=1228809
100409 -         ..
100410 -        Digestion breaks down food into sugar (glucose) that passes
100411 -        into the bloodstream and into the body's cells via a hormone
100412 -        called insulin, produced by the pancreas.  Diabetes occurs when
100413 -        the pancreas either produces little or no insulin, or the cells
100414 -        do not respond normally to the insulin.  Sugar builds up in the
100415 -        blood, overflows into the urine and passes from the body
100416 -        unused.
100418 -         ..
100419 -        Diabetes can be associated with major complications involving
100420 -        many organs including the heart, eyes, kidneys, and nerves,
100421 -        especially if the blood sugar is poorly controlled over the
100422 -        years.
100423 -
100425 -  ..
100426 - Blood Sugar Over 120 mg/dL Primary Symptom Diabetes
100427 -
100428 - Normal blood surgar ranges from 70 - 100 mg/dL; some authorities list
100429 - 80 - 100 mg/dL, as the target where diabetes does not affect daily
100430 - life.  Diabetes occurs when blood sugar rises above 120 mg/dL, noted
100431 - by Morris this morning, per above. ref SDS 0 RT7J
100433 -  ..
100434 - Research shows...
100435 -
100436 -    Blood sugar levels and diabetes
100437 -    Provided by:  Healthwise
100438 -    Last Updated:  January 23, 2006
100439 -
100440 -              http://health.yahoo.com/topic/diabetes/resources/article/healthwise/aa135726
100442 -     ..
100443 -    The American Diabetes Association (ADA) recommends that you keep
100444 -    your blood sugar levels at: 1
100445 -
100446 -     •  80 mg/dL to 120 mg/dL before meals and 100 mg/dL to 140 mg/dL
100447 -        at bedtime when using a blood sample drawn from a vein (a
100448 -        whole-blood sample).
100450 -         ..
100451 -     •  90 mg/dL to 130 mg/dL before meals and 110 mg/dL to 150 mg/dL
100452 -        at bedtime when using a blood sample drawn from a fingertip
100453 -        (plasma blood sample).
100455 -         ..
100456 -     •  Less than 180 mg/dL one to two hours after meals.
100458 -  ..
100459 - Richard has had several heart surgeries possibly related to diabetes,
100460 - discussed most recently on 070413. ref SDS 17 5L7H
100462 -  ..
100463 - Research article contineus...
100464 -
100465 -        Types of Diabetes
100467 -         ..
100468 -        Diabetes mellitus is a chronic disease caused by the inability
100469 -        of the pancreas to produce insulin or by the body to
100470 -        appropriately use the insulin it does produce.
100472 -         ..
100473 -        There are two main types of diabetes, Type 1 and Type 2.
100475 -         ..
100476 -        Type 1 diabetes (also called insulin-dependent diabetes or
100477 -        juvenile diabetes) is caused by autoimmune destruction of the B
100478 -        cells of the pancreas which normally secrete insulin.  Those
100479 -        patients require insulin injections for survival.
100481 -         ..
100482 -        Type 2 diabetes (or non-insulin-dependent diabetes) is much
100483 -        more common and results from insulin resistance, mainly due to
100484 -        obesity, with inadequate additional production of insulin by
100485 -        the body.  In other words, the pancreas produces a reduced
100486 -        amount of insulin or the cells do not respond to the insulin,
100487 -        or both.
100489 -  ..
100490 - Further research explains Type 2 diabetes entails insulin-secretory
100491 - defect, as well as perpheral insulin resistance. ref SDS 0 2Y8K
100492 -
100493 -
100495 -  ..
100496 - Exercise may improve prognosis for Type 2 diabetes patients reported
100497 - from study conducted in Finland...
100498 -
100499 -        Exercise Training Improves Baroreflex Sensitivity in Type 2
100500 -        Diabetes
100501 -
100502 -              http://diabetes.diabetesjournals.org/cgi/content/full/52/7/1837
100504 -         ..
100505 -        We concluded that exercise training improves BRS sensitivity
100506 -        in type 2 diabetes subjects in addition to increasing the
100507 -        exercise capacity and muscle strength and improving glucose
100508 -        control. These beneficial effects in reflectory autonomic
100509 -        regulation and glucose control caused by exercise may be
100510 -        associated with improved prognosis of type 2 diabetes
100511 -        patients.
100513 -  ..
100514 - Infirmities from diabetes increase over time; a patient with diabetes
100515 - for 15 years unable to walk even one block for exercise. ref SDS 17
100516 - 6S8Q
100518 -  ..
100519 - Morris has a lot of good hiking routes in his neighborhood.  He has
100520 - beek walking to the college and back, about 3 miles.  Last week a
100521 - hike while waiting for him to get up for our meeting was also about 3
100522 - miles out to highway 9.
100524 -  ..
100525 - Another article.....
100526 -
100527 -        Emedicine...
100528 -
100529 -        Diabetes Mellitus, Type 2 - A Review Article
100530 -        Last Updated: Jun 6, 2007
100531 -
100532 -              http://www.emedicine.com/emerg/topic134.htm
100534 -         ..
100535 -        Author: Scott R Votey, MD, Assistant Dean for Graduate Medical
100536 -        Education, Professor of Medicine/Emergency Medicine, David
100537 -        Geffen School of Medicine at UCLA, UCLA Medical Center
100538 -
100539 -
100541 -         ..
100542 -        Diabetes Complications Target Case Management
100543 -
100544 -        Diabetes mellitus is a chronic disease that requires long-term
100545 -        medical attention both to limit the development of its
100546 -        devastating complications and to manage them when they do
100547 -        occur.
100548 -
100550 -         ..
100551 -        Diabetes Expensive Disease Compared to Treating Other Maladies
100552 -
100553 -        It is a disproportionately expensive disease; patients
100554 -        diagnosed with diabetes accounted for 6.2% of the US population
100555 -        in 2002, or 18.2 million people.  In that year, the per capita
100556 -        cost of healthcare for people with diabetes was $13,243 for
100557 -        people with diabetes and $2560 for people without diabetes.
100558 -
100560 -         ..
100561 -        Pathophysiology
100562 -
100563 -        Type 2 diabetes mellitus was once called adult-onset diabetes.
100564 -        Now, because the epidemic of obesity and inactivity in
100565 -        children, type 2 diabetes is occurring at younger and younger
100566 -        ages. Although type 2 diabetes typically affects individuals
100567 -        older than 40 years, it has been diagnosed in children as
100568 -        young as 2 years of age who have a family history of
100569 -        diabetes.
100571 -         ..
100572 -        Type 2 diabetes is characterized by peripheral insulin
100573 -        resistance with an insulin-secretory defect that varies in
100574 -        severity.  For type 2 diabetes to develop, both defects must
100575 -        exist:  All overweight individuals have insulin resistance, but
100576 -        only those with an inability to increase beta-cell production
100577 -        of insulin develop diabetes.  In the progression from normal
100578 -        glucose tolerance to abnormal glucose tolerance, postprandial
100579 -        glucose levels first increase.  Eventually, in hepatic
100580 -        gluconeogenesis increases, resulting in fasting hyperglycemia.
100582 -         ..
100583 -        About 90% of patients who develop type 2 diabetes are obese.
100584 -        Because patients with type 2 diabetes retain the ability to
100585 -        secrete some endogenous insulin, those who are taking insulin
100586 -        do not develop DKA if they stop taking it for some reason.
100587 -        Therefore, they are considered to require insulin but not to
100588 -        depend on insulin. Moreover, patients with type 2 diabetes
100589 -        often do not need treatment with oral antidiabetic medication
100590 -        or insulin if they lose weight.
100592 -         ..
100593 -        Maturity-onset diabetes of the young (MODY) is a form of type 2
100594 -        diabetes that affects many generations in the same family with
100595 -        an onset in individuals younger than 25 years.  Several types
100596 -        exist.  Some of the genes responsible can be detected by using
100597 -        commercially available assays.
100598 -
100600 -         ..
100601 -        Frequency United States
100602 -
100603 -        Approximately 13 million people in the United States have a
100604 -        diagnosis of diabetes, and diabetes is undiagnosed in another 5
100605 -        million.  Approximately 10% have type 1 diabetes, and the rest
100606 -        have type 2.
100607 -
100609 -         ..
100610 -        Mortality/Morbidity Complications
100611 -
100612 -        The morbidity and mortality associated with diabetes are
100613 -        related to short- and long-term complications.ú
100615 -             ..
100616 -        a.  Complications include hypoglycemia and hyperglycemia,
100617 -            increased risk of infections, microvascular complications
100618 -            (eg, retinopathy, nephropathy), neuropathic complications,
100619 -            and macrovascular disease. ú          ú
100621 -             ..
100622 -        b.  Diabetes is the major cause of blindness in adults aged
100623 -            20-74 years, as well as the leading cause of nontraumatic
100624 -            lower-extremity amputation and end-stage renal disease
100625 -            (ESRD).
100626 -
100628 -         ..
100629 -        Clinical Diagnosis
100630 -        Type 2 Asymptomatic Diagnosis Overlooked for Many Years
100631 -
100632 -        Many patients with type 2 diabetes are asymptomatic, and their
100633 -        disease is undiagnosed for many years.  Studies suggest that
100634 -        the typical patient with new-onset type 2 diabetes has had
100635 -        diabetes for at least 4-7 years before it is diagnosed.  Among
100636 -        patients with type 2 diabetes, 25% are believed to have
100637 -        retinopathy; 9%, neuropathy; and 8%, nephropathy at the time of
100638 -        diagnosis.
100639 -
100640 -
100641 -
1007 -

SUBJECTS
5 Years Poor Health Diabetes Mellitus Type 2 Diagnosed After 5 Years

1603 -
160401 -  ..
160402 - Medical Examination Delayed 5 Years of Ill Health
160403 - 5 Years Ill Health Delay Medical Examination Common Diabetes Patients
160404 -
160405 - Morris has not felt well for about 5 years, and, like most of us guys,
160406 - put off going to the doctor until recently, when his condition
160407 - woresned, per above. ref SDS 0 RT7J  Research today says diabetes is
160408 - often diagnosed only after onset of disease for many years,
160409 - ref SDS 0 PP4K, because patients are asymptomatic. ref SDS 0 PP4K
160410 - Diabetes is a growing pandemic due to diet and limited exercise, per
160411 - research today, ref SDS 0 2Y58, causing overwight issues that lead to
160412 - early death from complications of diabetes.
160413 -
160415 -  ..
160416 - Background Other Cases Show Diabetes Insidious Disease
160417 -
160418 - Millie was tested for diabetes on 050729, ref SDS 11 VT3O; fortunately
160419 - her symptoms turned out to be negative for diabetes, reported on
160420 - 050913. ref SDS 12 VT3O
160422 -  ..
160423 - Richard, who lives near Morris in Campbell, has suffered from diabetes
160424 - for about 15 years, reported on 011218. ref SDS 3 XV4K  He is not
160425 - doing well, has trouble now walking a short block, noted above citing
160426 - the record on 070413. ref SDS 17 5L7H
160428 -  ..
160429 - Polly down the hall at the Golden Gateway got diabetes.  One day she
160430 - knocked on the door needing emergency help just because she overslept
160431 - and missed a meal by an hour or so, also, reported on 011218.
160432 - ref SDS 4 VX5H
160434 -  ..
160435 - Cousin Rita's husband, Bob, got diabetes, which evidently can affect
160436 - eyes, kidneys, etc., reported on 040530. ref SDS 7 VZ6I
160437 -
160438 -
160439 -
1605 -

SUBJECTS
Complications Diebetes High Risk Heart Kidney Eyes Nerves Infection

2303 -
230401 -  ..
230402 - Complications Change Life Style Reduce Risks of Diabetes
230403 - Life Style Changes Required Reduce Risks of Complications
230404 -
230406 -  ..
230407 - Complications from diabetes place patients at risk of heart, eye,
230408 - kidney, and problems with nerves, per research above. ref SDS 0 2Z30
230410 -  ..
230411 - Diabetes patients may need treatment with antibiotics after just the
230412 - smallest of injuries, even without signs of trouble, reported on
230413 - 060417. ref SDS 14 L23K
230415 -  ..
230416 - This means Morris has to be careful doing physical tasks in the
230417 - garage, like welding, soldering, and assembly in his ham radio
230418 - business.  Even seemingly benign work in the garden, playing with the
230419 - cat (cat bites can quickly escalate out of control, e.g., on 050212,
230420 - ref SDS 9 0001) anything that can cause cuts and scratches can affect
230421 - blood counts, temperature, immune system and so must be avoided.
230423 -  ..
230424 - Morris' experience dieting the past number of years helps accilimate
230425 - to treatment regimen with less dramatic changes to life style.
230426 -
230428 -  ..
230429 - Palliation Treatment Regimen Including Exercise
230430 -
230431 - Treatment is mostly palliative to relieve symptoms without cure, as
230432 - reported on 050712, ref SDS 10 CW5M, and explained again on 051007.
230433 - ref SDS 13 IU6K  Research today indicates in some cases exercise may
230434 - improve prognosis. ref SDS 0 KA6M
230435 -
230436 -
230437 -
230438 -
2305 -

SUBJECTS
Kaiser Outstanding Health Care Provider Doctor Patient Partnership P

3703 -
370401 -  ..
370402 - Kaiser Outstanding Health Care Provider Doctor Patient Partnership
370403 - Project Management Support Patient Empowers Kaiser Team Care Practice
370404 -
370405 - Morris is being treated at Kaiser through his health care insurance
370406 - coverage from working at San Jose State College.  He seemed to
370407 - indicate his doctor is a young woman emigrated from India, who is
370408 - about the age of his graduate students.  She seems very careful and
370409 - well trained.
370411 -  ..
370412 - Quality of care at Kaiser was reviewed 060809, ref SDS 15 LX5H, which
370413 - compares favorably with other providers, noted on 020221. ref SDS 5
370414 - WJ5V
370416 -  ..
370417 - Andy Grove, former CEO at Intel, where Morris retired this past
370418 - January, commented that patients must perform routine "project
370419 - manager" tasks for their own health care, because medical practice
370420 - does not support effective case management, reported on 041212.
370421 - ref SDS 8 FQ3G  Kaiser support for a doctor patient partnership called
370422 - out in the Healthwise Handbood facilitates proactive patient
370423 - assistance for case management, reviewed on 990625. ref SDS 2 4185
370425 -  ..
370426 - Case studies reported on 061018 working with Kaiser may help
370427 - guide care for Morris. ref SDS 16 0001
370428 -
370429 -
370430 -
370431 -
3705 -

SUBJECTS
Default Null Subject Account for Blank Record

5003 -
500401 -  ..
500402 - SDS Project Specification Production Delayed
500403 -
500404 - Follow up ref SDS 18 JR97.
500405 -
500406 - Morris feels he needs a few days to absorb this new situation, and
500407 - then will try to resume work on SDS project, per planning on 070907.
500408 - ref SDS 18 JR97
500409 -
500410 -
500411 -
500412 -
500413 -
500414 -
500415 -
5005 -