DIABETES

What is Diabetes?

Diabetes is a common group of chronic metabolic diseases that cause high blood sugar (glucose) levels in the body due to defects in insulin production or function. Diabetes is also known as diabetes mellitus to distinguish it from a relatively rare metabolic disorder called diabetes insipidus that doesn’t affect blood sugar. Symptoms of diabetes occur when a lack of insulin or insulin resistance stops glucose from entering the cells and fueling and energizing the body. The resulting spike in glucose can result in symptoms such as increased hunger and thirst, weight loss, fatigue, and frequent infections. Long-term complications include kidney failure, nerve damage, and blindness.

Types of Diabetes

Diabetes is categorized into two main categories and one subcategory, but all are typified by problems of insulin resulting in high blood sugar levels in the body. The categories are:

Type 1 Diabetes
This type of diabetes is categorized as an autoimmune disease and occurs when the body’s misdirected immune system attacks and destroys insulin-producing beta cells in the pancreas. Although genetic or environmental triggers are suspected, the exact cause of type 1 diabetes—once referred to as insulin-dependent or juvenile-onset diabetes—is not completely understood. Type 1 accounts for only five to 10 percent of diabetes cases in the United States, and while it can occur at any age, most patients are diagnosed as children or young adults. Those with type 1 diabetes must take insulin daily to manage their condition.

Type 2 Diabetes
This type most often develops gradually with age and is characterized by insulin resistance in the body. Because of this resistance, the body’s fat, liver, and muscle cells are unable to take in and store glucose, which is used for energy. The glucose remains in the blood. The abnormal buildup of glucose (blood sugar) can result in hyperglycemia and impaired body functions. Type 2 diabetes occurs most often in people who are overweight because fat interferes with the body’s ability to use insulin, but it also can occur in thin people and the elderly. Family history and genetics play a major role in type 2 diabetes, and inactivity and poor diet can also increase the risk.

Gestational Diabetes
Gestational diabetes is defined as blood-sugar elevation during pregnancy and is known to affect about three to eight percent of women. Left undiagnosed or untreated, it can lead to problems such as high birth weight and breathing problems for the baby. Gestational diabetes usually resolves in the mother after the baby is born, but statistics show that women who have gestational diabetes have a much greater chance of developing type 2 diabetes within five to 10 years.

Prediabetes
This condition is marked by blood sugar levels that are too high to be considered normal but are not yet high enough to be in the range of a typical diabetes diagnosis. Prediabetes increases not only your risk of developing diabetes but also heart disease.

Diabetes Symptoms
Diabetes symptoms occur when glucose (blood sugar) levels in the body become abnormally elevated. The most common symptoms of diabetes include thirst, fatigue, frequent or increased urination, and blurry vision, but symptoms do vary from one person to the next and depend on which type of diabetes you have. Symptoms of type 1 diabetes tend to begin abruptly and dramatically. In type 2 diabetes, the symptoms are similar but develop slowly, or there may be no symptoms at all. It is common for no symptoms to be present in gestational diabetes. In some cases, your symptoms may seem vague or harmless. It is essential that if you experience one or more of these symptoms on a regular basis, you see your doctor immediately for a diabetes screening and blood tests.

Common Diabetes Symptoms

Thirst/Dehydration
Diabetes causes your blood glucose levels to rise. Increased glucose levels cause your body to pull fluid from your cells into the bloodstream and deliver the increased load to your kidneys, causing them to produce more urine than normal. Frequent urination, another common symptom, causes you to feel thirsty and thus drink more liquids, compounding the problem.

Weight loss
Your body’s inability to properly use the glucose generated from the foods you eat, as well as the significant number of calories lost to increased urination, cause your body to break down other energy sources available—such as fat—which can result in weight loss. You may be eating normally and constantly feel hungry yet continue to lose weight.

Fatigue
Glucose is a primary source of fuel for the body. If you have diabetes, your body’s inability to convert glucose into energy will inevitably lead to fatigue, ranging from a general worn-down feeling to exhaustion.

Blurred Vision
Abnormally high glucose levels in the blood can also lead to eye problems such as swelling of the lens, which causes blurred vision. Adequately controlling your blood sugar levels can help correct this symptom over time. Left undetected, though, diabetes can lead to more serious eye problems such as cataracts, glaucoma, and retinopathy. In fact, diabetes is the leading cause of blindness in adults age 20 to 74.

Recurring Infections
High glucose levels in your body’s tissues may hinder the body’s ability to heal and make you more susceptible to various kinds of bacteria and infections, especially of the skin, kidneys, bladder, and feet.

Advanced Diabetes Symptoms
Although some people with diabetes may have no symptoms or mild symptoms that seem relatively harmless, untreated diabetes can result in dangerously high levels of blood sugar, called ketoacidosis. (Ketoacidosis is rare in type 2 diabetes because insulin is still being produced.) This condition can cause:

• Deep, rapid breathing
• Nausea or vomiting
• Stomach pain
• Flushed complexion
• Confusion
• Bad breath
• Coma

Dangerously low levels of blood sugar, called hypoglycemia, are sometimes associated with diabetes treatments. Hypoglycemia can cause:

• Fainting
• Rapid heartbeat
• Sweating
• Dizziness and trembling
• Confusion
• Anxiety
• Drowsiness
• Cramps

Diabetes CausesDiabetes is a chronic disease that is caused by the body’s inability to use glucose (blood sugar) properly due to a lack of or defects in insulin production. The precise cause of this insulin malfunction isn’t entirely understood, but genetic and environmental factors come into play. Additional contributing factors include inactivity and obesity. Specific causes include the following:

Lack of Insulin
This is specific to type 1 diabetes. It occurs when insulin-producing beta-cells are damaged or destroyed and stop producing insulin. Insulin is needed to move blood sugar into cells throughout the body. The resulting insulin deficiency leads to elevated glucose in the blood and prevents the body from being fueled properly.

Insulin Resistance
This is specific to type 2 diabetes. It occurs when insulin is produced normally in the pancreas, but the body is unable to use it properly and move it into the cells for fuel. At first, the beta cells will produce more insulin in an attempt to overcome the body’s resistance to it, but over time, the cells will eventually “wear out.” At that point the body decreases its insulin production, which leads to elevated glucose levels in the blood.

Pregnancy
A small percentage—studies show less than eight percent—of pregnant women may develop gestational diabetes. Hormones developed in the placenta interfere with the body’s normal insulin response and lead to insulin resistance and high levels of glucose in the blood.

Genetics
Inherited risk factors are believed to be a factor in causing all types of diabetes, but because most people with these risk factors do not develop the disease, researchers believe environmental triggers—diet and even climate—may also play a role. Genetics are believed to play an even stronger role in type 2 diabetes, in which family history is one of the leading factors. At the same time, type 2 diabetes also has a stronger environmental basis than type 1 diabetes. In other words, a family history of type 2 diabetes is a hugely important risk factor, but only in western cultures where high-fat diets and sedentary lifestyles are common. People living in non-western cultures rarely develop type 2 diabetes, no matter what their genetic risk.

Diabetes Risk Factors

Diabetes affects more than 20 million Americans, and 57 million Americans have prediabetes (early type 2 diabetes). There are many common risk factors to both type 1 and type 2 diabetes, but some are more specific to one or the other. Here’s a comprehensive overview of risk factors.

Family History
Genetics play a role in determining how likely you are to develop some type of diabetes. Although researchers don’t fully understand the role of genetics in the development of diabetes, statistics show that if you have a parent or sibling with diabetes, your odds of developing it yourself increase.

Age
According to the American Diabetes Association, about one in 13 people in the United States have diabetes. But statistics show that your risk of type 2 diabetes increases as you get older, especially after age 45. In fact, more than 80 percent of cases occur in people over age 45, though recent statistics indicate that the incidence of type 2 diabetes is increasing dramatically among children, adolescents, and younger adults. Likely factors include reduced exercise, decreased muscle mass, and weight gain as you age. Type 1 diabetes is usually diagnosed by the age of 30.

Obesity
Excess body fat—especially around your middle—can lead to insulin resistance and increased blood sugar levels. Research suggests that excess fatty tissue can trigger inflammation in the body that leads to insulin resistance. But many people who are overweight never develop diabetes, so research remains inconclusive on the link between obesity and diabetes.

Poor Diet
Studies have shown that malnutrition—especially low protein and fiber intake—is a contributing factor in developing type 2 diabetes. A diet high in calories, fat, and cholesterol raises your risk, as does obesity, which increases your body’s resistance to insulin.

Lack of Exercise
Studies show that exercise makes muscle tissue more responsive to insulin, which is why regular exercise such as aerobic and/or resistance training can help lower your risk of diabetes. Talk to your healthcare provider about an exercise plan that’s right for you.

Ethnicity
Although research is inconclusive, some ethnic groups (particularly African Americans, Native Americans, Asians, Pacific Islanders, and Hispanic Americans) have a higher incidence of diabetes.

Gestational Diabetes
Women who develop gestational diabetes during pregnancy are at higher risk for developing type 2 diabetes later in life. Women who deliver a baby weighing more than 9 pounds are also at greater risk.

Diabetes Diagnosis

The results of specific glucose tests play a major role in diagnosing diabetes. These tests include:

• Fasting blood glucose test
• Random (non-fasting) glucose test
• Oral glucose tolerance test
• Glycated hemoglobin (A1C) test
• Urine test

In addition, your physician will review your medical history and your family’s medical history, document your diabetes symptoms or lack of symptoms, and conduct a physical exam before making a diagnosis. Because some people with diabetes may not yet have noticeable symptoms, it’s important to have a regular physical or checkup. Random or fasting blood glucose tests are commonly part of an annual physical for diabetes patients.

Diabetes Tests

A series of urine and blood tests are used to diagnose all types of diabetes.

Fasting Blood Glucose (FPG) Test
This is one of the most common and preferred tests; it measures blood glucose in a person who has not eaten anything for at least eight hours. Both diabetes and prediabetes can be diagnosed this way. A blood glucose level of 126 milligrams per deciliter (mg/dL) or higher indicates diabetes.

Random (Non-fasting) Plasma Glucose Test
This measures blood glucose without fasting. This test, along with an assessment of symptoms, is used to diagnose diabetes but not prediabetes. A blood glucose level of 200 mg/dL or higher indicates diabetes.

Oral Glucose Tolerance Test (OGTT)
This blood glucose test, administered after fasting for at least eight hours, is performed two hours after drinking a glucose-containing beverage. It is also common to test blood prior to the glucose drink and then every 30 to 60 minutes afterwards for up to three hours. Both diabetes and prediabetes can be diagnosed this way, and it is routinely used to screen for gestational diabetes. A blood glucose level of 200 mg/dL or higher (two hours after drinking a beverage containing 75 grams of glucose) indicates diabetes. Because glucose levels are normally lower during pregnancy, gestational diabetes is based on slightly different numbers: 155 mg/dL two hours after drinking the glucose beverage.

Glycated Hemoglobin (A1C) Test
The higher your blood sugar levels, the more hemoglobin you’ll have with sugar attached. The A1C test measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The goal of the A1C test is to measure your average glucose levels for two to three months. A long-term average can be more accurate than a one-time test. An A1C level of 6.5 percent or higher on two separate tests indicates you have diabetes.

Urine Test
Although this test alone cannot diagnose diabetes, a urine analysis for abnormal levels of glucose and ketones from the breakdown of fat is often used as part of an overall diagnosis.

Diabetes Treatments

There is no cure for diabetes, but it usually can be treated and managed effectively. In fact, some people with mild type 2 diabetes can manage their condition with just diet and exercise and can avoid even having to take medication. Your healthcare provider will consider a comprehensive list of factors—your age; overall health; medical history; type of diabetes; extent of the disease; tolerance for specific medications, procedures, or therapies; expectations for the course of the disease; and your opinion or preferences—when assessing your treatment options. Treatments primarily involve diabetes medication, insulin therapy, and/or a diet and exercise plan.

Diabetes Drugs
Several different classes of oral medications are available to treat type 2 diabetes, and they are effective because these patients still have some ability to produce insulin in the pancreas. There are many types of diabetes pills, each with a specific purpose, and most patients take several different medications. There are no similar medications to treat people with type 1 diabetes. However, these medications may be used in combination with an insulin regime to manage blood glucose levels in type 1 diabetics. Learn more about drugs that lower blood sugar levels.

Insulin Therapy
Insulin therapy is needed for people with type 1 diabetes because their pancreases no longer produce it naturally. In type 2 diabetics, the pancreas produces low levels of insulin and may need lower levels of insulin therapy if other types of treatment do not adequately maintain healthy glucose levels.

Because stomach enzymes interfere with insulin, ingesting insulin orally isn’t effective in lowering blood sugar in diabetics. Insulin must be directly introduced into the bloodstream via injection. Common forms of delivery include a needle and syringe, an insulin pen that contains an insulin cartridge, or an insulin pump that continuously administers proper doses.

Not all insulin is the same. They differentiate from each other by several factors: when the isulin begins working after injection, when it works the hardest, and how long it lingers in the body. For these reasons, your doctor may prescribe different types of insulin to use at different times of the day. These include:

• rapid-acting insulin
• short-acting insulin
• long-acting insulin
• intermediate options

Glucose Monitoring
Regularly checking your blood sugar level is the only way to know if your blood sugar levels remain within your target range. Food, exercise, medications, illnesses, alcohol, time of day, and stress can all affect your glucose levels, causing many unwanted fluctuations.

The more you test your blood sugar and know how your body responds to those factors, the safer you will be. Also, paying attention to any signs of hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar) can help manage your diabetes. Should you experience symptoms of either, immediately check your glucose level.

You doctor also may recommend regular testing, beyond your regular blood-sugar monitoring, of how effective your diabetes treatment plan is. A common way to do this through called A1C testing. It is not only the international standard for a diabetes diagnosis, but it measures your average blood sugar level over a period of two to three months. The test determines if changes need to be made to diet, insulin regimen, or other factors. While a patient’s target A1C goal varies depending on age and other factors, the American Diabetes Association recommends an A1C reading of below seven percent for most people.

Diet
Diet plays a crucial part in managing diabetes. However, no single diet is perfect for everyone. Diabetics, possibly in conjunction with advice from a dietician, should stick to highly nutritious foods that are low in fat and calories, such as fruits, vegetables, and whole grains. Limiting animal products and sugars also helps in maintaining healthy blood sugar levels. Balancing proportionate amounts of carbohydrates, proteins, sugars, and fats are key to managing diabetes. Regular blood sugar monitoring after meals can help you and your doctor or dietician discover the foods are best for you and those you should avoid.

Exercise
Exercise helps diabetics by lowering their blood sugar. Physical activity not only helps maintain a healthy weight, but it also transports sugar to cells where it is turned into energy. Along with this, aerobic exercise increases a person’s sensitivity to insulin. With exercise, a person’s body needs less insulin to transport sugar. While every person’s diabetes treatment varies, getting about 30 minutes of aerobic exercise each day can help manage your diabetes. As with any part of your diabetes treatment, work with your doctor on an exercise program that fits your age and fitness level.

Pancreas Transplant
Pancreas transplants are usually reserved for people whose diabetes has become so severe that it is unmanageable through traditional treatments. As with any organ transplants, pancreas transplants require immune system-suppressing drugs to prevent the body from rejecting the new organ. Those drugs increase the likelihood of serious side effects, including infection, organ injury, and even cancer. However, if a pancreas transplant is successful, the patient no longer will need insulin treatment because the new pancreas will naturally produce insulin and regulate glucose.

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CANCER

Cancer is an umbrella term for a large group of diseases caused when abnormal cells divide and invade other tissue and organs. Cancer is the second leading cause of death in the U.S., and more than 1.5 million Americans are diagnosed with some form of it every year. According to the American Cancer Society, half of all men and a third of all women in the U.S. will develop cancer in their lifetimes.

Cancer Growth and Metastasis

Healthy cells have a specific life cycle, reproducing and dying off in a way that is determined by the type of cell. But sometimes, because of abnormalities, the cells multiply out of control and also do not die off when they should. This process may result in growths called tumors, which in turn can cause a variety of symptoms, depending on where they grow.

However, not all tumors are cancerous. Benign tumors are noncancerous and do not spread to nearby tissues, though they can sometimes grow large and cause problems when they press against neighboring organs and tissue. Malignant tumors are cancerous, and they have the ability to invade other parts of the body.

Cancer cells can also migrate through the bloodstream or lymphatic system from the place they originally grew to distant areas of the body. This process is called metastasis. Cancers that have metastasized are considered more advanced than those that have not, and metastatic cancers tend to be harder to treat and more fatal.

Types of Cancer

Cancers are named for the area in which they begin, even if they spread to other parts of the body. For example, a cancer that begins in the lungs and spreads to the liver is still called lung cancer. There are also several clinical terms used for certain cancers:

• Carcinoma is a cancer that starts in the skin or the tissues that line other organs.Sarcoma is
• a cancer of connective tissues such as bones, muscles, cartilage, and blood vessels.
• Leukemia is a cancer of bone marrow, which creates blood cells.
• Lymphoma and myeloma are cancers of the immune system.

Risk Factors & Treatment

Not all of the causes of cancer are known, but many things have been found to affect a person's risk for developing certain kinds of cancer.

• Diet
• Exposure to chemicals
• Unprotected exposure to the sun
• Genetics
• Certain viruses, such as HPV
• Smoking

Visit the Cancer Prevention section for more information.

Treatment depends on the type of cancer and how advanced it is, but the most common types are:

• Surgery to remove tumors
• Chemotherapy (the use of toxic medications to kill cancer cells)
• Radiation therapy (the use of focused beams of radiation to kill cancer cells)

There is no way to prevent cancer with 100 percent certainty, but there are several ways to significantly reduce your risk of developing it.

Quit Smoking

In addition to lung cancer, smoking tobacco is known to cause cancers of the mouth, throat, larynx, esophagus, stomach, pancreas, kidney, bladder, and cervix. Scientists estimate that 30 percent of all cancer deaths in the U.S. are due to smoking. Secondhand smoke, the smoke that nonsmokers are exposed to by being around smokers, is also known to increase the risk of cancer.

Although smokers who quit do not reduce their cancer risk to the level of someone who has never smoked, quitting still helps. According to the National Cancer Institute, people who stop smoking before age 30 have a 90 percent lower risk of dying due to smoking-related disease (such as lung cancer, emphysema, and chronic bronchitis), and those who quit before age 50 have a 50 percent lower risk.

Avoid Carcinogens

A carcinogen is a chemical known to cause cancer. Cigarette smoke, discussed above, contains more than 50 carcinogens. Other carcinogens include:

• Asbestos
• Benzene
• Cadmium
• Nickel
• Radon
• Uranium
• Vinyl chloride

Minimize Exposure to UV and Other Radiation

Ultraviolet (UV) radiation from the sun (and tanning beds) can damage the DNA of skin cells and cause skin cancer. When going out in the sun, always take precautions to protect yourself by wearing a hat, sunglasses, and clothing that covers most of your skin, or by applying sunscreen frequently. Learn more about UV rays, SPF, and the most affective sunscreens.

Other forms of radiation—such as high levels of radon (a radioactive gas) in your home and medical tests that use radiation (x-rays, CT scans)—can also cause cancer. To avoid unnecessary exposure to radiation, test your home for radon (find simple, inexpensive test kits at hardware stores), and avoid excessive x-rays and similar tests when possible.

Eat Healthy and Exercise

Studies have shown that a diet high in fat and red and processed meats increases the risk of colon, prostate, and other cancers. Excessive alcohol consumption—more than one drink per day for women and two per day for men—is also linked to cancers of the mouth, esophagus, and liver. On the other hand, a diet rich in fruits, vegetables, and whole grains has been found to decrease the risk of digestive system, lung, and other cancers.

Exercising regularly can also lower your cancer risk. Adults who get at least 2.5 hours of moderate intensity physical activity per week lower their risk of colon cancer by a third compared to those who do not exercise.

Obesity and Cancer
A combination of good food choices and exercise helps to achieve and maintain a healthy weight. These lifestyle habits help reduce the risk of cancer (and other diseases such as heart disease and diabetes). Studies have shown that being overweight or obese can increase your risk of breast, colon, esophageal, kidney, gallbladder, and uterine cancers.

Get Tested

Routine cancer tests do not prevent cancer from developing, but they do allow cancers to be detected early, which greatly improves a patient’s prognosis. The American Cancer Society recommends regular screenings for the following:

Breast Cancer
There has been a recent controversy regarding when women should begin regular screenings for breast cancer. The American Cancer Society (ACS) recommends annual mammograms starting at age 40. The U.S. Preventive Services Task Force (USPSTF) recommends that women between the ages of 50 and 74 years should have a screening mammogram every other year to check for breast cancer. Talk to your doctor about the right screening plan for you.

Cervical Cancer
The ACS recommends that women begin cervical cancer screening three years after their first vaginal intercourse but no later than 21 years of age, after which they should be screened every year if they are sexually active. Women between ages 30 and 65 whose previous pap smears have been normal should have the test done every three years.

Prostate Cancer
The ACS is less definitive about prostate cancer screening, stating that men should “make informed decisions with their doctor about whether to be tested.” This is due to the lack of research to prove that the potential benefits of screening outweigh the harms of testing and treatment. Men who are 50 years of age should discuss the pros and cons of screening. Those at a higher risk of prostate cancer—such as African-American men or men with a family history of prostate cancer—should start talk to their doctors at age 45.

Colorectal Cancer
There are several tests to screen for colorectal cancer and/or polyps. According to the ACS, women and men over the age of 50 should have an annual fecal occult blood test, which screens for cancer. Other recommended tests that screen for cancer and polyps include a flexible sigmoidoscopy (recommended every five years), a colonoscopy (every 10 years), a double-contrast barium enema (ever 5 years), or a CT colonography (every 5 years). Talk to your doctor about which tests and screening schedule is right for you.

Get Vaccinated

HPV
Some types of human papillomavirus (HPV) can infect the genital area; in fact, genital HPV is the most common sexually transmitted infection. Certain types of HPV can cause genital warts, while other types can cause cervical cancer. A vaccine against HPV called Gardasil has been approved by the FDA and is recommended for all girls and women between ages 9 and 26.

Hepatitis B
Hepatitis B virus causes inflammation of the liver, potentially resulting in serious liver disease including chronic infection, scarring, and cancer. According to the Centers for Disease Control and Prevention (CDC), children should get their first dose of the vaccine—usually given in a series of three or four shots—at birth and should have complete the vaccine by 6 to 18 months of age. It is recommended for anybody under age 18 who did not get the vaccine at birth and for unvaccinated adults at higher risk for the disease.

The vaccine is not recommended for anyone severely allergic to baker’s yeast or other components of the vaccine. Those are ill or who have had a previous severe allergic reaction to the vaccine should not be vaccinated.

There are a variety of symptoms that may indicate the presence of cancer. Unfortunately, other diseases can cause similar problems, so it’s important that you see a doctor if you are having problems with one or more of the symptoms below. Conversely, cancer may be present even in the absence of symptoms, so regular screenings are important for certain cancers.

• Pain
• A lump under the skin
• A new mole or a mole that changes size, or a lesion that doesn’t heal
• Hoarseness
• A cough that doesn't go away, coughing up blood, or shortness of breath
• Trouble swallowing or pain/heartburn after eating
• Changes in bowel or bladder habits, or blood in the stool or urine
• Unexplained weight gain or loss
• Enlarged lymph nodes
• Neurologic symptoms such as tingling sensations, changes in vision, or seizures
• Extreme weakness or fatigue
• Depression

Cancer Treatments

Depending on the type of cancer, where it is located, how advanced it is, and whether it has spread to multiple areas of the body, doctors will choose one or a combination of the treatments below. These treatments can be used as primary therapy (used to kill existing cancer cells) or as adjuvant therapy (used to prevent cancer from coming back).

Surgery

The goal of surgery is to remove all or most of the cancerous tumor(s). Surgery is a very common cancer treatment, but it cannot be used in all cases. For example, cancers of the blood, such as leukemia, do not form tumors. Some tumors may be inoperable because they have grown into or are very close to vital organs. Cancer that has metastasized throughout the body cannot be treated with surgery.

The side effects of cancer surgery are the same as any other kind of surgery and include pain and possible infection. In addition, surgery may damage nearby organs or other important tissue, causing a range of problems.

Chemotherapy

Chemotherapy uses powerful drugs to kill cancer cells. It is usually given in cycles where the patient is treated for several days and then has a recovery period before another cycle of treatment. There are dozens of chemotherapy drugs, each with its own set of side effects, but the most common side effects are hair loss, nausea, vomiting, diarrhea, weakness, fatigue, and a weakened immune system.

Radiation therapy

Radiation therapy is the use of concentrated radiation to kill cancer cells. While chemotherapy affects the entire body, radiation is usually targeted to specific areas, either by implanting radioactive materials in the body or by using computerized machines that control beams of radiation to deliver a very specific dose. Common side effects of radiation therapy are nausea, vomiting, skin sensitivity or burns, and fatigue.

Other Cancer Treatments

Surgery, chemotherapy, and radiation therapy are the most common treatment types, but other options may be available:

• Hormone therapy uses drugs and surgery to reduce levels of hormones that make certain kinds of cancers grow, especially breast and prostate cancers.
• Biological therapy (or immunotherapy) attempts to train the body's own immune system to recognize and fight cancer cells.
• Gene therapy attempts to alter the DNA of cancer cells, either to return them to normal or to make them more susceptible to other types of treatment.
• Palliative care focuses on improving overall quality of life for patients and families facing serious illness. Recent research has found that cancer patients receiving palliative care had a better quality life and lived longer than those who only received standard treatment.

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Allergy

Also called: Hypersensitivity

An allergy is a reaction of your immune system to something that does not bother most other people. People who have allergies often are sensitive to more than one thing. Substances that often cause reactions are

• Pollen
• Dust mites
• Mold spores
• Pet dander
  
• Insect stings
• Food
• Medicines

How do you get allergies? Scientists think both genes and the environment have something to do with it. Normally, your immune system fights germs. It is your body's defense system. In most allergic reactions, however, it is responding to a false alarm.
Allergies can cause a runny nose, sneezing, itching, rashes, swelling or asthma. Symptoms vary. Although allergies can make you feel bad, they usually won't kill you. However, a severe reaction called anaphylaxis is life-threatening.

NIH: National Institute of Allergy and Infectious Diseases

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Asthma in Children

Asthma is a chronic disease that causes the airways - the tubes that carry air in and out of your lungs - to become sore and swollen. In the United States, about 20 million people have asthma. Nearly 9 million of them are children. Children have smaller airways than adults, which makes asthma especially serious for them. Children with asthma may experience wheezing, coughing, chest tightness and trouble breathing, especially early in the morning or at night.

Many things can cause asthma, including :

• Allergens - mold, pollen, animals
• Irritants - cigarette smoke, air pollution
• Weather - cold air, changes in weather
• Exercise
• Infections - flu, common cold

When asthma symptoms become worse than usual, it is called an asthma attack. Asthma is treated with two kinds of medicines: quick-relief medicines to stop asthma symptoms and long-term control medicines to prevent symptoms.

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Asthma

Asthma is a chronic disease that affects your airways. Your airways are tubes that carry air in and out of your lungs. If you have asthma, the inside walls of your airways become sore and swollen. That makes them very sensitive, and they may react strongly to things that you are allergic to or find irritating. When your airways react, they get narrower and your lungs get less air. This can cause wheezing, coughing, chest tightness and trouble breathing, especially early in the morning or at night.

When your asthma symptoms become worse than usual, it's called an asthma attack. In a severe asthma attack, the airways can close so much that your vital organs do not get enough oxygen. People can die from severe asthma attacks.
Asthma is treated with two kinds of medicines: quick-relief medicines to stop asthma symptoms and long-term control medicines to prevent symptoms.

NIH: National Heart, Lung, and Blood Institute

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Anthrax, NIAID Fact Sheet

About the Microbe

Anthrax is an acute infectious disease caused by the spore-forming, rod-shaped bacterium Bacillus anthracis. Predominantly a cause of livestock disease, B. anthracis forms durable spores that can lie dormant in the soil for years. Once eaten by a grazing animal, the spores are activated and the bacteria reproduce. After the bacteria spread, they typically kill the infected animal and return to the soil or water once again as spores.

The bacterium's destructive properties are due largely to toxins, which consist of three proteins: protective antigen, edema factor, and lethal factor.

• Protective antigen (PA) binds to select cells of an infected person or animal and forms a channel that permits edema factor and lethal factor to enter those cells.
• Edema factor (EF), once inside the cell, causes fluid to accumulate at the site of infection. EF can contribute to a fatal buildup of fluid in the cavity surrounding the lungs. It also can inhibit some of the body's immune functions.
• Lethal factor (LF), once inside the cell, disrupts a key molecular switch that regulates the cell's functions. LF can kill infected cells or prevent them from working properly.

About the Disease

People rarely contract anthrax from healthy animals. Contact with infected livestock or their products such as leather and wool does, however, cause a limited number of anthrax cases throughout the world. In the United States, only 236 anthrax cases were reported between 1955 and 1999, an average of about five per year. Most of those cases were occupational exposures in people who work with animal carcasses or products. The treatable cutaneous (skin) form of the disease is most common. Worldwide incidence is unknown, but anthrax occurs more frequently in developing countries, especially those without strong veterinary public health programs. Anthrax is not transmitted from person to person.

Human anthrax occurs primarily in three forms: cutaneous, gastrointestinal, and inhalation.

• Cutaneous anthrax occurs when the bacteria, usually from infected animal products, enter a break in the skin. The skin reddens and swells, much like an insect bite, then develops a painless blackened lesion or ulcer that may form a brown scab. If left untreated, the infection can spread through the body. Cutaneous anthrax is the most common form of the diseases and responds well to antibiotics. It is rarely fatal if treated before it becomes invasive.
• Gastrointestinal anthrax may arise when a person eats contaminated food. The infection often causes fever accompanied by gastrointestinal problems such as vomiting, abdominal pain, diarrhea, or loss of appetite. In some cases, lesions may form in the nose and throat instead of the lower digestive tract. In both cases, gastrointestinal anthrax can spread through the body and is often fatal if not treated immediately. This form of anthrax, however, is not known to have occurred in the United States.
• Inhalation anthrax, sometimes called respiratory or pulmonary anthrax, occurs when the bacterial spores are inhaled. The early symptoms resemble those of a common cold or sore throat. The spores travel from the lungs to immune cells called macrophages in the nearby lymph nodes. There they begin to reproduce and secrete their toxins, causing severe breathing problems and shock. Treatment is difficult once the bacteria have reached that stage, and death often ensues. Naturally occurring inhalation anthrax is rare. Prior to the bioterrorist attack of 2001, the last known case of inhalation anthrax in the United States occurred in 1976 in a California craftsman who apparently contracted the infection from contaminated, imported yarn.

Treatment and Prevention

Antibiotics

Several different antibiotics kill B. anthracis as it reproduces within people and animals. If diagnosed early, anthrax can be treated. Unfortunately, infected people often confuse early symptoms with more common infections and do not seek medical help until severe symptoms appear. At that point the destructive anthrax toxins, which are not affected by antibiotics, have risen to high levels, making treatment difficult. Although cutaneous anthrax has telltale signs and symptoms making diagnosis easy, early stage gastrointestinal and inhalation anthrax are more likely to be mistaken for common maladies.

Vaccine

An anthrax vaccine is licensed for limited use. The vaccine is currently used to protect members of the military and individuals most at risk for occupational exposure to the bacteria, such as abattoir workers, veterinarians, laboratory workers, and livestock handlers. The vaccine consists of filtered proteins and other components of a weakened B. anthracis strain adsorbed to aluminum hydroxide. PA is the major component of the vaccine that provides protection against infection. The vaccine contains no whole bacteria.

Health experts currently do not recommend the vaccine for general use by the public due to the rarity of anthrax and the potential for adverse side effects. Researchers have not determined the safety and efficacy of the vaccine in children, the elderly, and people with weakened immune systems. In addition, the recommended vaccination schedule is 6 doses given over an 18-month period, so the vaccine would likely offer little protection in response to a bioterrorist attack. For these reasons, a new anthrax vaccine is needed.

NIAID Basic Research

Several biologic factors contribute to B. anthracis's ability to cause disease. By uncovering the molecular pathways that enable the bacterium to form spores, survive in people, and cause illness, NIAID hopes to identify new ways to diagnose, prevent, and treat anthrax.

Toxin Biology

Scientists are studying the anthrax toxins to learn how to block their production or action. Recently, NIAID grantees determined the three-dimensional structure of the LF protein as it attaches to its target inside cells. The research showed for the first time that LF uses a long groove on its side to latch onto that target. At the same time, another group of researchers identified a protein receptor on the surface of host cells to which PA attaches. Using a specific fragment of that receptor protein, the researchers were able to block the attachment of PA, thereby preventing formation of the PA channel and inhibiting the toxic effects of LF and EF in test-tube experiments. Other investigators have engineered mutant, inactive PAs that prevent bacteria-produced PAs from forming the channel. The studies of PA and LF should enable researchers to develop small molecules that can be used as therapeutics to treat anthrax by inhibiting its toxins.

The Anthrax Bacterium Genome

The instructions that dictate how a microbe works are encoded within its genes. Bacteria often contain genes at two locations. The bacterial chromosome is a long stretch of DNA that houses most of those genes, but smaller loops of DNA called plasmids also carry genes that can be exchanged between different bacteria. Because plasmids often contain genes for toxins and antibiotic resistance, knowing their DNA sequence is important.

In B. anthracis, the genes for PA, LF, and EF are found on plasmids that have already been sequenced. In addition, researchers recently reported the complete chromosomal DNA sequence of two B. anthracis isolates, including the bacterium that infected a Florida victim of the recent anthrax attack. Genome sequencing of more than a dozen other B. anthracis strains and related bacteria has already begun.

By comparing the DNA blueprints of different B. anthracis strains, researchers hope to learn why some strains are more virulent than others. Small variations among the genomes of different strains may also help investigators pinpoint the origin of an anthrax outbreak. Knowing the genetic fingerprint of B. anthracis might lead to gene-based detection mechanisms that can alert scientists to the bacteria in the environment or allow rapid diagnosis of anthrax in infected people. Variations between strains might also point to differences in antibiotic susceptibility, permitting doctors to immediately determine the appropriate treatment.

DNA sequencing also opens the door to functional genomics, in which the B. anthracis genome will be analyzed to determine the function of each of its genes and how they interact with each other or with host-cell components to cause disease. Genes are the instructions for making proteins, which in turn build components of the cell or carry out its biochemical processes. Knowing the sequence of B. anthracis genes therefore helps scientists discover key bacterial proteins that can then be targeted by new drugs or vaccines.

Spore Biology

B. anthracis spores are essentially dormant and therefore must wake up, or germinate, to become reproductive, disease-causing bacteria. Researchers are therefore studying the germination process to learn more about the signals that cause spores to become active once inside an animal. Efforts are underway to develop models of spore germination in laboratory animals; scientists hope those models will enable discoveries leading to drugs that block the germination process.

Host Immunity

People who contract anthrax produce antibodies to PA, and similar antibodies appear to protect animals from infection. Recent studies also suggest that some animals can produce antibodies to components of B. anthracis spores. Those antibodies, when studied in a test tube, prevent spores from germinating and increase their uptake by the immune system's microbe-eating cells. It therefore might be possible to develop a vaccine that can be given after exposure to fight both the reproductive form of B. anthracis and any spores that may linger in the lungs following antibiotic treatment.

As part of NIAID's strategic plan, researchers will study how both the innate and adaptive immune responses are triggered by a B. anthracis infection. The adaptive immune response consists of B cells and T cells which specifically recognize components of the anthrax bacterium. The innate immune system, however, responds more generally to a wide range of microbial invaders and likely plays a key role in the body's front-line defenses. Scientists will conduct studies of how those two arms of the immune system act to counter infection, including how B. anthracis spore germination affects individual immune responses.

NIAID Therapeutics Research

Following the recent discoveries of how PA and LF interact with their cellular targets, researchers are screening thousands of small molecules in hopes of finding a compound that is practical for use as an anti-anthrax drug. In addition, NIAID is working with the Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), and Department of Defense (DoD) to accelerate testing of collections of compounds for their effectiveness against inhalation anthrax. Many of those compounds have already been approved by FDA for other indications and therefore could quickly be approved for use in treating anthrax should they prove effective.

NIAID is seeking new drugs that attack B. anthracis at many levels. These include agents that prevent the bacterium from attaching to cells, compounds that inhibit spore germination, and inhibitors that block the activity of key enzymes such as anthrax lethal factor. The Institute will also develop the capacity to synthesize promising anti-anthrax compounds in sufficient purity and quantity for preclinical testing.

NIAID Vaccine Research

Researchers are working on new, improved anthrax vaccines that may be more easily given to a diverse population. NIAID is collaborating with DoD to develop a next-generation vaccine based on a laboratory-produced, or recombinant, PA variant. Antibodies to PA also appear to recognize some components of the bacterial spore, making PA-based vaccines promising candidates for broad protection against anthrax. The Institute will supervise phase I and phase II trials of the recombinant PA vaccine in different formulations.

To help move potential vaccines into clinical testing, NIAID will develop the infrastructure to produce pilot lots of promising candidates and expand the Institute's testing capacity. To assist in its vaccine research efforts, NIAID will establish a centralized immunology laboratory to assess the efficacy of different vaccine candidates.

NIAID Diagnostics Research

Research is underway to develop improved techniques for spotting B. anthracis in the environment and diagnosing it in infected individuals. A key part of that research is the functional genomic analysis of the bacterium, which should lead to new genetic markers for sensitive and rapid identification. Genomic analysis will also reveal differences in individual B. anthracis strains that may affect how those bacteria cause disease or respond to treatment.

Anthrax and Bioterrorism

CDC has classified B. anthracis as a Category A agent. Those agents are considered the highest threat to national security due to their ease of transmission, high rate of death or serious illness, and potential for causing public panic.

In October 2001, anthrax spores were sent through the U.S. mail and caused 18 confirmed cases of anthrax (11 inhalation, 7 cutaneous). Five individuals with inhalation anthrax died; none of the cutaneous cases was fatal.

More Information

National Institute of Allergy and Infectious Diseases
National Institutes of Health
31 Center Drive, MSC 2520
Bethesda, MD 20892-2520
http://www.niaid.nih.gov/newsroom/releases/anthraxspec.htm

National Library of Medicine
MEDLINEplus
8600 Rockville Pike
Bethesda, MD 20894
1-800-338-7657
http://www.nlm.nih.gov/medlineplus/anthrax.html

U.S. Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
1-888-232-3228
http://www.bt.cdc.gov/Agent/Anthrax/Anthrax.asp

World Health Organization
Avenue Appia 20
1211 Geneva 27
Switzerland
(00 41 22) 791 21 11
http://www.who.int/emc/diseases/anthrax/

U.S. Department of Agriculture
Washington, D.C. 20250
http://www.usda.gov/homelandsecurity/anthraxfs.htm

U.S. Food and Drug Administration
Food and Drug Administration
5600 Fishers Lane
Rockville, Maryland 20857
1-888-INFO-FDA (1-888-463-6332)
http://www.fda.gov/oc/opacom/hottopics/bioterrorism.html

Johns Hopkins University Center for Civilian Biodefense Studies
http://www.hopkins-biodefense.org/pages/agents/agentanthrax.html

NIAID is a component of the National Institutes of Health (NIH). NIAID supports basic and applied research to prevent, diagnose, and treat infectious and immune-mediated illnesses, including HIV/AIDS and other sexually transmitted diseases, illness from potential agents of bioterrorism, tuberculosis, malaria, autoimmune disorders, asthma and allergies.

Press releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.

Prepared by:
Office of Communications and Public Liaison
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, MD 20892

U.S. Department of Health and Human Services

READ MORE - Anthrax, NIAID Fact Sheet

HIV Infection in Minority Populations

Overview

Minority populations in the United States, primarily African Americans and Hispanics, constitute 57 percent of the more than 700,000 cases of AIDS reported to the U.S. Centers for Disease Control and Prevention (CDC) since the epidemic began in 1981. African Americans make up almost 38 percent of all AIDS cases reported in the United States, yet according to the U.S. Census Bureau, they comprise only 12 percent of the U.S. population. Hispanics represent 19 percent of all AIDS cases. Including residents of Puerto Rico, they represent 13 percent of the population in this country. According to CDC

• As of June 2001, African Americans and Hispanics represented 51 percent of AIDS cases reported among males and 77 percent of those in females.
• As of June 2001, 58 percent of all women reported with AIDS are African American and 20 percent are Hispanic
• African American children represent 58 percent of all pediatric AIDS cases.
• Of the 194 pediatric AIDS cases reported between July 2000 and June 2001, 163 (84 percent) were in African Americans and Hispanics.
• In 1999, AIDS accounted for an estimated 50 percent of deaths among African Americans and 18 percent among Hispanics. It is the leading cause of death among African-American men ages 25-44.
• Injection drug use is a major factor in the spread of HIV in minority communities. Through June 2001, injection drug users accounted for 20 percent of all AIDS cases among both African Americans and Hispanics.

NIAID Research on HIV Infection and AIDS

The National Institute of Allergy and Infectious Diseases (NIAID), the lead component for AIDS research at the National Institutes of Health (NIH), is at the forefront of the war against this continuing health crisis, which disproportionately affects minority populations.

NIAID supports scientific research at universities, medical schools, hospitals and research institutions, both in the United States and abroad, aimed at preventing, diagnosing, and treating HIV infection and AIDS and other infectious diseases as well as allergic and other immune system disorders.

NIAID's AIDS research agenda includes conducting clinical trials that address the specific needs and concerns of minority populations, ensuring that minority patients have access to all clinical trials and sharing the latest information on AIDS treatment and prevention. In addition, NIAID's Office of Special Populations Research and Training encourages research aimed at improving the health of minority populations. The office also works to increase the effectiveness of outreach and education programs.

Through its Office of Communications and Public Liaison and the Dale and Betty Bumpers Vaccine Research Center, NIAID works with community-based organizations to disseminate information about HIV infection and AIDS and NIAID research activities to minority communities.

Clinical Research

NIAID programs and/or networks evaluate promising therapies to fight HIV infection and its associated complications, as well as approaches to reconstitute HIV-damaged immune systems. These include the Adult AIDS Clinical Trials Group (AACTG),the Pediatric AIDS Clinical Trials Group(PACTG), the Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA), the HIV Prevention Trials Network (HPTN), the Acute Infection and Early Disease Research Program (AIEDRP), and the Division of Intramural Research Clinical Program.

Together, these programs represent the largest AIDS treatment and prevention initiative in the United States. Recruiting minorities into clinical trials is a priority for NIAID to ensure that research results will apply to all populations affected by HIV. With the epidemic moving swiftly into minority communities, inclusion of these patients is particularly urgent.

The AACTG investigates therapeutic interventions for HIV infection, AIDS, and complications of HIV-associated immune deficiency in adults. AACTG sites receive additional funding from the National Institute on Drug Abuse (NIDA) to increase participation of injection drug users, who are also hard hit by the AIDS epidemic.

The PACTG evaluates clinical interventions for treating HIV infection and HIV-associated illnesses in neonates, infants, children, adolescents. Both the PACTG and the HPTN are researching approaches to interrupt mother-to-infant transmission in pregnant women. In 2001, 6,186 and 6,426 participants were enrolled in AACTG and PACTG studies respectively. In the AACTG, 26 percent were African American, 19 percent were Hispanic, and 3 percent were Asian/Pacific Islander or Native American. In the PACTG, 47 percent were African American, 25 percent were Hispanic, and 1 percent Asian/Pacific Islander or Native American.

The HPTN is a global multicenter network dedicated to non-vaccine prevention research with a focus on HIV endpoints. They have directed their educational outreach efforts to minority communities working to increase trial volunteerism.

CPCRA is a network of community-based health centers and clinics which support clinical research in community settings by conducting large comparative studies that examine how to use available therapies more effectively as well as the long-term consequences of different treatments. Currently, CPCRA trials are under way in 17 cities at 18 units. In 2001, 4,244 people participated in CPCRA studies. Of those, 49 percent were African American, 13 percent were Hispanic, and 1 percent were Native American or Asian/Pacific Islander.

NIAID also supports clinical research on vaccine and non-vaccine strategies to prevent HIV infection. Vaccine studies are carried out through the HIV Vaccine Trials Network (HVTN) and non-vaccine prevention studies are conducted by the HPTN. The HVTN is a global network of clinical sites which evaluate preventive HIV vaccine in all phases of clinical trials. They allow for studies that examine differences in HIV diversity and genetic background , all of which may prove crucial to developing an effective vaccine for use around the world. Through close collaborations and education outreach programs with communities where vaccines will be tested, the HVTN hopes to enroll a diversified population in its clinical trials, ensuring access and representation of populations most affected by and vulnerable to HIV spread.

The HVTN and HPTN opened in 2000 and have enrolled thousands of study participants. In 2001, 383 and 9,517 people participated in the HVTN and HPTN, respectively. Of those in the HVTN, 21 percent were African American, 3 percent were Hispanic, and 1 percent Native American or Asian/Pacific Islander. In the HPTN, 57 percent of participants were African American, 7 percent Hispanic, and about 3 percent Native American or Asian/Pacific Islander.

In addition, NIAID supports two major programs to enhance basic and clinical HIV research performed at minority institutions: Research Centers in Minority Institutions and AIDS Clinical Trials Infrastructures in Minority Institutions.

Epidemiologic Research

NIAID conducts and supports research on HIV infection in a variety of population groups, including minority populations. These studies are conducted through the Women and Infants Transmission Study (WITS/WITS II), the Women's Interagency HIV Study (WIHS), and the Multicenter AIDS Cohort Study (MACS). Inner-city women, children, and injection drug users are the focus of WITS/WITS II. Eighty-four percent of the women in this study are from minority populations.

Similar populations of women are the focus of the WIHS, which NIAID established and awarded funds to six U.S. sites in 1993 to investigate primarily the impact of HIV infection on women. Several other NIH institutes also collaborate on WIHS and provide funds for various components. They include NIDA, the National Cancer Institute, National Institute of Child Health and Human Development, and National Institute of Dental and Craniofacial Research.

Active community involvement through the WIHS sites and the WIHS National Community Advisory Board helps encourage minority women to participate in the studies. More than 80 percent of the women currently enrolled in WIHS are from minority populations.

In the United States, the Multicenter AIDS Cohort Study (MACS) and WIHS are the two largest observational studies of HIV/AIDS in homosexual or bisexual men and in women, respectively. These studies have made major contributions to understanding how HIV is spread, how the disease progresses, and how it can best be treated. Over the past year, these studies expanded their enrollment to increase the size of the study groups by 60 percent and increase the number of minority participants. The enlarged groups will focus on contemporary questions regarding HIV infection and treatment.

More Information

For information about Food and Drug Administration-approved HIV-related clinical trials being conducted throughout the United States, contact the AIDS Clinical Trials Information Service.
1-800-TRIALS-A (1-800-874-2572)
301-519-0459 (International)
1-888-480-3739 (TTY/Deaf Access)
http://actis.org

For federally approved treatment guidelines on HIV/AIDS, contact the HIV/AIDS Treatment Information Service:

1-800-HIV-0440 (1-800-448-0440)
1-888-480-3739 (TTY/Deaf Access)
301-519-0459 (International)
http://hivatis.org

Both services operate from 12 p.m. to 5 p.m. Eastern Time, Monday through Friday. Spanish-speaking specialists are available.

To receive materials or to talk with a Health Communication Specialist, contact the CDC National HIV and STD Hotline. This service is available 24 hours a day.

1-800-227-8922
1-800-342-2437
1-800-243-7889 (TTY/Deaf Access)

To get information specifically about clinical trials conducted by the NIAID Intramural AIDS Research Program, call 1-800-243-7644 (http://clinicaltrials.gov).

NIAID is a component of the National Institutes of Health (NIH). NIAID supports basic and applied research to prevent, diagnose, and treat infectious and immune-mediated illnesses, including HIV/AIDS and other sexually transmitted diseases, illness from potential agents of bioterrorism, tuberculosis, malaria, autoimmune disorders, asthma and allergies.

Press releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.

Prepared by:
Office of Communications and Public Liaison
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, MD 20892

U.S. Department of Health and Human Services
June 2002

READ MORE - HIV Infection in Minority Populations