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What is a Subchorionic Hemorrhage? Subchorionic Hemorrhage is bleeding behind the placenta, often caused by a clot.

In most cases, this clot will dissolve away, resolving the problem and allowing the pregnancy to progress normally. It may take several weeks for this clot to dissolve. Treatment for a Subchorionic hemorrhage is typically bed rest. Rarely, the clot dissects between the placenta and the attachment to mother. This may lead to placental abruption. Risk factors that may increase the chance of experiencing this include high blood pressure, smoking and cocaine use. Symptoms may include: contractions that don't stop pain in the uterus tenderness in the abdomen over the uterus vaginal bleeding What is Diabetes Mellitus Type 2?

Type 2 Diabetes Mellitus is a chronic metabolic syndrome defined by resistance to the hormone insulin. This leads to inappropriate hyperglycaemia(increased blood sugar levels) and deranged metabolism of carbohydrate, fats and proteins. Insulin is a key metabolic hormone secreted by the pancreas. Insulin exerts its actions in the liver and peripheral tissues such as muscle and fat. In type 2 diabetes mellitus, relative insulin deficiency usually occurs because of resistance to the actions of insulin in muscle, fat, and the liver. This abnormality results in decreased glucose transport in muscle, increased liver glucose production, and increased breakdown of fat. Type 2 diabetes mellitus is also known as Non Insulin Dependent Diabetes Mellitus (NIDDM). This name is no longer used as some patients with type 2 diabetes mellitus do require insulin treatment in advanced stages. Risk Factors for Diabetes Mellitus Type 2 In type 2 diabetes, peripheral resistance to the actions of insulin is combined with a pancreatic secretory deficiency of varying severity. Insulin resistance means the body is unable to take glucose (sugar) up into cells. Normally, the body would compensate for this by producing increased amounts of insulin, but in type 2 diabetes mellitus the pancreas cannot respond. This means not enough insulin is produced, and excess sugar remains in the bloodstream (hyperglycemia) instead of being taken up into cells and used for energy. Type 2 diabetes is partly a genetic disease and partly a lifestyle disease. While some people have a genetic predisposition to diabetes, they may not actual develop the disease without 'lifestyle' triggers such as excess fat and sugar intake or inadequate physical exercise. While there is no single cause for developing Type 2 diabetes, there are well-known risk factors. Some of these can be changed (avoidable) and some cannot (unavoidable).

Unavoidable risk factors A family history of diabetes. Identical twins of an affected person have more than 80% chance of developing diabetes, and 25% of patients have an affected first degree relative. Age - people greater than 45 years have higher rates of disease. The risk increases as we get older. Ethnic background - Aboriginal or Torres Strait Islander men, and people with Melanesian, Polynesian, Chinese or Indian background are more likely to develop type 2 diabetes mellitus. Having Polycystic Ovarian Syndrome or a history of gestational diabetes during pregnancy. Low birth weight is thought to predispose to diabetes due to poor beta-cell development and function. Avoidable risk factors Obesity (Click the relevent links to explore possible treatment options to combat obesity: meal replacement programs, lifestyle changes, drugs and surgery). Physical inactivity High blood pressure Diet Cholesterol Smoking Progression of Diabetes Mellitus Type 2 Type 2 diabetes mellitus may have an onset over several months, or be asymptomatic and be detected on a routine blood test. It is generally not recognised and diagnosed until the patient seeks health care for another problem. Some common presenting symptoms of type 2 diabetes mellitus include: Excessive thirst. Increased urine output (polyuria). Hunger. Weight loss or gain. Slow healing or frequent infections. Blurred vision. Dry eyes Headaches. Numbness, tingling or burning of the feet (peripheral neuropathy). Without treatment patients may develop acute complications due to dehydration (HONKC, see below) and long-term complications will develop much more rapidly. The main acute complication is hyperosmolar nonketotic coma (HONKC), sometimes also known as hyperosmolar hyperglycaemic nonketotic coma (HHNC). This is a condition that develops over several days in poorly controlled diabetes involving high blood glucose and potentially lethal secondary dehydration and electrolyte disturbances. Long-term complications include: Microvascular disease: Diabetic retinopathy (eye disease). Diabetic nephropathy (kidney disease). Peripheral neuropathy and autonomic neuropathy (nerve disease). Impotence (difficulty maintaining an erection). Macrovascular disease - i.e. atherosclerosis (hardening of the arteries) causing: Coronary artery disease or heart attack. Cerebrovascular disease (stroke). Peripheral vascular disease - potentially causing gangrene and leading to need for leg or toe amputation. Men are particularly susceptible to diabetic complications and often have higher rates of mortality than females. Symptoms of Diabetes Mellitus Type 2 Diabetes can be easily diagnosed if you present with the classic symptoms of: Thirst. Polyuria- Passing urine often or waking at night several times to pass urine (nocturia). Fatigue.

Hunger. Weight loss. However, many patients with diabetes remain assymptomatic for many years but are still subject to the damaging effects of high blood sugars. Unlike type 1 diabetes which tends to present acutely, type 2 diabetes presents gradually over several years. At the time of diagnosis of type 2 diabetes, you may already have several complications of the disease, such as heart or eye problems. You may have noticed blurring of your vision, pins and needles in the feet (due to damage to the nerves) and recurrent infections. Diabetes or impaired glucose tolerance may be detected on routine blood tests as part of a general health check-up or investigation for other symptoms or diseases. If you are obese, suffer from high blood pressure, have a family history of diabetes, have high cholesterol or come from a high risk population (e.g. Aboriginal background) it is important that you get tested for diabetes. Clinical Examination of Diabetes Mellitus Type 2 Your doctor will perform a careful examination mainly looking for the various complications of diabetes. This will include cardiovascular, neurological and retinal (eye) examinations. In the early stages of disease your examination may be completely normal, however as the duration and severity of disease progressed it is likely you will have some end-organ damage. Your doctor will use a special device (called an opthalmoscope) to look at the back of your eye (retina). Here the doctor may see various degrees of diabetic retinopathy which basically represents damage to and leaking from the small vessels at the back of your eyes. Often cataracts (white opacities) may also be found in the lens. These develop because the excess sugar upsets the normal consistency of the lens. You may also have dry eyes. Cardiovascular exam may reveal signs of heart failure due to ischaemic heart disease. You may have an abnormal heart rhythm or crackles at the base of your lungs from accumulated fluid. In addition, your blood pressure will be checked and your doctor may perform an ECG to detect any obvious ischaemic changes. Leg examination may reveal diabetic ulcers (on pressure points in the feet) and peripheral vascular disease (poor peripheral pulses and circualtion), diabetic foot disease and trophic skin changes and skin infections. Your doctor will also test the nerves in your legs. You may have the classic 'glove and stocking' neuropathy which refers to reduced sensation in the distal portions of your limbs (i.e. where gloves and stockings are usually positioned). The neuropathy starts distally and progresses further up the limb as the condition worsens. Your sensations of vibration (tested with a tuning fork placed on the bone) and propioception (recognition of joint space position, tested by wiggling your toe or finger with your eyes closed) tend to be affected first. In advanced cases you may have severe pain and impaired motor function. Finally your doctor may request a urine sample to measure the amount of protein present. This reflects your kidney function as damaged kidneys tend to leak protein. How is Diabetes Mellitus Type 2 Diagnosed? Type 2 diabetes mellitus is diagnosed when any of the following criteria are reached: Symptoms of diabetes are present (increased urination, increased thirst or weight loss) with a random plasma glucose (RPG) level of >11.0mmol/L Fasting plasma glucose (FPG) >7.0mmol/L Oral glucose tolerance test (OGTT) 2 hour plasma glucose >11.1mmol/L Patients who do not reach these criteria may still be classified as having impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) on the basis of fasting blood glucose or oral glucose tolerance test results. These patients are at increased risk of developing type 2 diabetes mellitus. Other tests which may be ordered include: Glycosylated haemoglobin (HbA1c): this test is not used as a diagnostic or screening test for diabetes but may be used in the ongoing monitoring of diabetes. HbA1c reflects blood glucose levels over the past 2-3 months. Results >7% suggest poor blood glucose control and correlate with poor clinical outcomes. When a diagnosis of diabetes mellitus is first made, several tests are often ordered to check for organ function and exclude complications of diabetes. These may include: Full blood count. Urea and electrolytes (potentially showing kidney impairment). Urinalysis to check for infection or protein loss through the kidneys. Liver function tests.

Chest x-ray. ECG. Blood lipids (including cholesterol). Prognosis of Diabetes Mellitus Type 2 Diabetes is associated with a significant long-term risk of early mortality and morbidity. Heart disease (heart attacks 3-5 times more likely), peripheral vascular disease (amputation 50 times more likely), and stroke (twice as likely) are the major causes of death in patients over the age of 50. In addition, diabetic eye disease and renal failure due to diabetic nephropathy are important causes of morbidity. In addition, renal failure is potentially fatal. However, several large trials have proven that the risks of longterm complications from diabetes can be reduced with good blood glucose (sugar) control. The acute complication of hyperosmolar non-ketotic coma has a mortality approaching 50% due to the fact that it affects elderly patients with extensive medical problems. Hypoglycaemia due to inappropriate use of insulin or as a side-effect of medications is also potentially fatal.