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"Our students are the future generation of leaders, and so it's important for us to help them promote sustainability and to become advocates and change agents in their own right. If not us, then who?"
Lori Bechtel-Wherry
Chancellor, Penn State Altoona

once again.thanks a lot. really appreciate your help.

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Donna says

I have Hashimotos Thyroiditis and severe Graves eye disease. My labs just came back and my B12 was 299pg/ml. After reading this article I an assuming that is low. What type of B12 would you recommend to enhance my levels…


yadab poudel says

HI, I found this site very helpful for me. Since last 10 years I have been feeling very tried, always feel sleepy, can’t getup from bed in morning. I did lots of tests and couldn’t find any thing.poor apatite, always looks like lazy. I was scared about this.Last year I came USA and I went to the hospital and it is identified as vitamin B12 deficiency. My B12 level was only 98. Since then, I took shot every week for one month and once a month for next four month. I am very new to USA. I don’t know the treatment process here. I had Free insurance in New York. Now I moved Texas due to my work and stopped getting shots and started getting oral supplement ( 1000 MCG Daily) I still feel fell same pain and tried. Because of this continuous pain (specially in the feet) I couldn’t sleep properly for couple of days and had to visit even mental doctor. Now I am also having sleeping pills as prescribed by the doctor. Can anybody please help me how long does it take to have effect of injection/ Tablet of vitamin b12. How long does it take to get well . How dangerous deficiency is. I am new immigrant here. I am scared lot regarding my health as I need to do physical work for long hour even for my survival. I am mentally also disturbed because of this problem. My age is 30. I am sorry for my bad English


sunshine 92 says

I’ve been doing a lot of research recently, and most of us cannot absorb b12 from pill form. Go get regular injections in a local clinic. Should be around $35 per shot.


yadab says

Thank you so much for your information. If I again start getting injection normally how long does it take to feel better.

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Rudy says

Testing for type 2 diabetes in asymptomatic people should be considered in adults of any age who are overweight or obese (BMI ≥25 kg/m 2 or ≥23 kg/m 2 in Asian Americans) and who have one or more additional risk factors for diabetes ( Perfect Stella Mccartney Woman Cutout Stretchdenim Dress Mid Denim Size 50 Stella McCartney With Paypal Free Shipping Get YM8yjjbsF
). B

To test for type 2 diabetes, fasting plasma glucose, 2-h plasma glucose during 75-g oral glucose tolerance test, and A1C are equally appropriate. B

In patients with diabetes, identify and treat other cardiovascular disease risk factors. B

Testing for type 2 diabetes should be considered in children and adolescents who are overweight or obese (BMI >85th percentile for age and sex, weight for height >85th percentile, or weight >120% of ideal for height) and who have additional risk factors for diabetes ( Table 2.5 ). E

View this table:
Table 2.5

Risk-based screening for type 2 diabetes or prediabetes in asymptomatic children and adolescents in a clinical setting


Type 2 diabetes, previously referred to as “noninsulin-dependent diabetes” or “adult-onset diabetes,” accounts for 90–95% of all diabetes. This form encompasses individuals who have relative (rather than absolute) insulin deficiency and have peripheral insulin resistance. At least initially, and often throughout their lifetime, these individuals may not need insulin treatment to survive.

There are various causes of type 2 diabetes. Although the specific etiologies are not known, autoimmune destruction of β-cells does not occur and patients do not have any of the other known causes of diabetes. Most but not all patients with type 2 diabetes are overweight or obese. Excess weight itself causes some degree of insulin resistance. Patients who are not obese or overweight by traditional weight criteria may have an increased percentage of body fat distributed predominantly in the abdominal region.

DKA seldom occurs spontaneously in type 2 diabetes; when seen, it usually arises in association with the stress of another illness such as infection or with the use of certain drugs (e.g., corticosteroids, atypical antipsychotics, and sodium–glucose cotransporter 2 inhibitors) ( 35 , 36 ). Type 2 diabetes frequently goes undiagnosed for many years because hyperglycemia develops gradually and, at earlier stages, is often not severe enough for the patient to notice the classic diabetes symptoms. Nevertheless, even undiagnosed patients are at increased risk of developing macrovascular and microvascular complications.

Whereas patients with type 2 diabetes may have insulin levels that appear normal or elevated, the higher blood glucose levels in these patients would be expected to result in even higher insulin values had their β-cell function been normal. Thus, insulin secretion is defective in these patients and insufficient to compensate for insulin resistance. Insulin resistance may improve with weight reduction and/or pharmacologic treatment of hyperglycemia but is seldom restored to normal.

The risk of developing type 2 diabetes increases with age, obesity, and lack of physical activity. It occurs more frequently in women with prior GDM, in those with hypertension or dyslipidemia, and in certain racial/ethnic subgroups (African American, American Indian, Hispanic/Latino, and Asian American). It is often associated with a strong genetic predisposition or family history in first-degree relatives, more so than type 1 diabetes. However, the genetics of type 2 diabetes is poorly understood. In adults without traditional risk factors for type 2 diabetes and/or younger age, consider antibody testing to exclude the diagnosis of type 1 diabetes (i.e., GAD).

Screening for prediabetes and type 2 diabetes through an informal assessment of risk factors ( Table 2.3 ) or with an assessment tool, such as the ADA risk test ( Fig. 2.1 ) ( diabetes.org/socrisktest ), is recommended to guide providers on whether performing a diagnostic test ( Table 2.2 ) is appropriate. Prediabetes and type 2 diabetes meet criteria for conditions in which early detection is appropriate. Both conditions are common and impose significant clinical and public health burdens. There is often a long presymptomatic phase before the diagnosis of type 2 diabetes. Simple tests to detect preclinical disease are readily available. The duration of glycemic burden is a strong predictor of adverse outcomes. There are effective interventions that prevent progression from prediabetes to diabetes (see Section 5 “ Prevention or Delay of Type 2 Diabetes ”) and reduce the risk of diabetes complications (see Section 9 “ Cardiovascular Disease and Risk Management ” and Section 10 “ Microvascular Complications and Foot Care ”).

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