Input: What are the treatments for National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ?

Output:
People treated with pituitary hGH in other countries also got CJD. HHS doctors share information with doctors around the world about health issues such as CJD and read reports about CJD and other health problems related to pituitary hGH treatment.

Country    Number of CJD Cases Reported*    Number of Individuals Treated    Source of hGH in Reported Cases        New Zealand***    6    159    United States        France    119    1,700    France        United Kingdom    75    1,849    United Kingdom        Holland    2    unpublished    Holland        Brazil    2    unpublished    United States         Australia    1**    608    Australia        Austria    1    unpublished    pharmaceutical (commercial)        Qatar    1    unpublished    France        Ireland    1    unpublished    Not known

*as of November 2014

**This case has been recognized by the Australian surveillance authorities as a "possible" (albeit unlikely) CJD case.

***New Zealand has reported six people with CJD among 159 who received pituitary hGH. All six were among 49 people who received pituitary hGH made by the U.S. lab that supplied most NHPP pituitary hGH before 1977. We don't know why this ratesix out of 49 (12.2 percent)is so high in those in New Zealand who received American hormone. HHS scientists believe that this U.S.-made hormone did not undergo the same filtering process used in the United States when the hormone was put into vials. In addition, some hormone preparations sent to New Zealand were not distributed in the United States.

New Zealand has little information on the hormone preparations used to treat the people who got CJD. Information provided to the HHS from medical authorities in New Zealand indicated the following dates of pituitary hGH treatment for the six New Zealand patients who developed CJD: 1964 to 1966, 1964 to 1970, 1965 to 1972, 1966 to 1972, 1967 to 1969, and 1970 to 1973. With no common period of treatment, it is unlikely that a single preparation exposed all six patients to CJD.

There is some information on the hormone sent to New Zealand from the lab that also produced hormone for the NHPP before 1977. Some preparations and components of preparations were used in both countries and others were distributed only in the United States or in New Zealand.

The time between the start of pituitary hGH treatment and the first sign of CJD symptoms was similar in the 29 United States patients (14 to 44 years) and the six New Zealand patients (17 to 37 years). The New Zealand patients who got CJD were treated with pituitary hGH for an average of 4.3 years. In the United States, average treatment time was 8.4 years in patients who got CJD.

In France, 119 people with CJD were among the 1,700 treated with pituitary hGH. The pattern of exposure to CJD in France is very different from the pattern in the United States. In France, people who received pituitary hGH in 1984 and 1985 appear to be at highest risk for CJD. We have learned from animal studies that when scientists injected a greater amount of CJD infectious agent into an animal, it took less time for CJD to develop. Because of the larger number of people with CJD and shorter times between treatment and CJD onset in France, the level of infection in French hormone was probably higher than in the U.S. hormone. The purification procedure used in France differed from that begun in 1977 in the United States.

The United Kingdom has reported 75 people with CJD among 1,849 who received pituitary hGH. Experts have also found CJD in two people in Holland, two people in Brazil, and one each in Australia, Austria, Qatar, and Ireland. France, the United Kingdom, Holland, and Australia made their own hormone. The Brazilian patients got pituitary hGH from a U.S. lab that also made NHPP hormone before 1977. This was a different lab than the U.S. lab that made hormone for New Zealand. The Qatar patient received pituitary hGH made in France. The Austrian patient received pituitary hGH made by a pharmaceutical company. Four Australian women developed CJD after receiving other human pituitary hormones as fertility treatments. </s>


Input: What are the treatments for National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ?

Output:
Most people were treated with pituitary hGH because their pituitary glands did not make enough of their own GH. Some of these people also had problems making other pituitary hormones. One of these hormones tells the adrenal glands to make cortisol, a hormone needed for life. People lacking this hormone are at risk of death from adrenal crisis, but adrenal crisis can be prevented. More pituitary hGH recipients have died from adrenal crisis than from CJD. Pituitary hGH did not cause adrenal problems, but some people who received hGH have a pituitary problem that puts them at risk for adrenal crisis. Please read the health alert and discuss this information with your doctor.

Besides CJD, no other serious or fatal health risks from pituitary hGH treatment have been found.

Mad Cow Disease

Starting in 1996, reports of a new form of CJD in young people who lived in the United Kingdom have raised concerns worldwide.

Since at least 1985, some cattle in the United Kingdom have developed a disease called bovine spongiform encephalopathy (BSE), or "mad cow" disease. "Mad cow" disease is a sickness in cattle that is caused by an agent that is similar, but not identical, to the agents that cause the most common forms of CJD in people. Individuals who consume products made from cattle infected with the agent that causes "mad cow" disease can become infected with the agent themselves and develop the human form of "mad cow" disease, called variant CJD (vCJD). In humans, vCJD and the more common forms of CJD (those without the word "variant") are separate diseases. As of November 2012, 227 cases of vCJD were confirmed worldwide, mostly from the United Kingdom. Researchers believe all but three of these 227 individuals got vCJD by eating beef from animals with "mad cow" disease. The three exceptions were persons who are believed to have developed vCJD because they received infected blood from a donor who had acquired the agent by eating beef from animals with "mad cow" disease.

In the United States, three cases of vCJD have been found. According to the Centers for Disease Control and Prevention (CDC), the investigation of these three cases indicated that they most likely acquired their infection in the United Kingdom (two cases) and Saudi Arabia (one case).

People who received pituitary hGH are not at higher risk for vCJD.

AIDS

HIV, also known as the human immunodeficiency virus, causes AIDS. Pituitary hGH does not cause AIDS. HIV is destroyed by the methods used to make pituitary hGH. People who have been treated with pituitary hGH do not have a higher risk for AIDS.

Low Levels of GH in Adults

Some people who received pituitary hGH as children may have low levels of GH as adults and might therefore benefit from bGH as adults. People with low levels of growth hormone as adults may have symptoms or changes like these:

- more body fat  - less muscle  - less bone mass  - less strength  - less energy

If you lacked GH as a child and have these problems as an adult, ask your doctor whether they might be due to low GH. Because these conditions are common in many people, they are not always due to low GH. Studies have shown that GH treatment in adults with low GH reduces fat and increases muscle mass. Effects on strength, energy, and bone fractures in GH-deficient adults receiving GH replacement are not as clear.

Today, GH is completely synthetic. It is not made from human pituitaries. It poses no threat of contamination. The Human Growth Foundation (HGF) is one source of information about growth-related disorders. The Foundation can be reached at 18004516434.

Cancer

HHS studies of people treated with pituitary hGH supplied by the NHPP show no increased risk of cancer in those who did not have tumors before pituitary hGH treatment. Many people who received NHPP pituitary hGH had brain tumors that caused their lack of GH. People who have had one tumor have an increased risk for getting other tumors.

In previous updates, we reported that in 1988, Japanese doctors reported an increased risk of leukemia in people treated with GH. Subsequent studies of individuals who were given pituitary hGH in the United States, Japan, and the United Kingdom found no higher rate of leukemia among those who did not have tumors and/or radiation before treatment with pituitary hGH.

Emotional Problems

No studies have shown that pituitary hGH causes changes in personality, emotional problems, or suicide. </s>


Input: What are the symptoms of National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ?

Output:
CJD does not cause the same symptoms in everyone. In most people who got CJD from pituitary hGH, the first signs they noticed were difficulty with walking and balance, dizziness, and/or clumsiness. Later, some began to slur words and have jerky movements. They also had trouble seeing, remembering, and/or thinking clearly. The disease becomes worse very quickly. When individuals have symptoms like these over a long period of time (such as a year) without getting much worse, they do not have CJD. Occasional forgetfulness, clumsiness, or headaches do not mean one has CJD. You should discuss concerns with your doctor if you are not sure.

CJD is a rare disease. Most cases of CJD are not linked to pituitary hGH. When CJD is not linked to pituitary hGH, the first symptoms are usually mental changes such as confusion, problems thinking clearly, memory loss, behavior changes, and dementia. Though symptoms may differ, there are similar changes in the brain tissue of all patients with CJD. </s>


Input: Who is at risk for National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report)? ?

Output:
No one can say what an individual person's risk is. Of the approximately 7,700 people who received NHPP pituitary hGH, 29 people got CJD. The two things that seem to be connected with getting CJD after pituitary hGH treatment are

1. How long a person was treated:

- In the United States, the average length of time for pituitary hGH treatment through the NHPP was about 3 years. For those individuals who developed CJD, the average length of treatment was about 8.4 years.  - Even though longer treatment time increased the risk for CJD in the United States, in other countries CJD has developed after shorter treatment periods.

2. When a person was treated:

- All of the 29 individuals treated with NHPP hGH who got CJD in the United States started pituitary hGH before 1977. No CJD has been reported in Americans who began treatment with NHPP hormone after 1977, when production of NHPP hormone was moved to a laboratory (headed by Dr. Albert Parlow) that used a new method of purifying pituitary hGH. Research in animals showed the newer purification steps introduced in 1977 reduced the risk of CJD transmission. Recently, an analysis of NHPP hGH recipients was completed taking into account the differences in follow-up time and the duration of treatment of recipients starting treatment before or after 1977. That analysis found that the new purification steps greatly reduced and may have eliminated the risk for CJD infection.  - Two cases of CJD have been reported in individuals who received commercially prepared pituitary hGH. An Austrian person was treated with pituitary hGH (Crescormon, from Kabi Pharma) for 14 months and died from CJD 22 years later. An American who was too tall to be eligible for NHPP hormone was treated with pituitary hGH made by two pharmaceutical companies (Asellacrin, from Serono, and Crescormon, from Kabi Pharma). This individual was treated with commercial hGH for 23 months and died just over 26 years later. The methods used to produce these commercial hormone preparations were not identical to the method used in Dr. Parlow's laboratory but did include a version of the important new purification step that has been shown to reduce CJD infectivity.  - Overall, one out of about 265 people (29 out of about 7,700 people) who were treated with NHPP pituitary hGH got CJD.  - However, one in about 91 people who began treatment before 1977 got CJD.  - People who started treatment before 1970 are at even higher risk. In that early group, one in about every 48 people (about 2.1 percent) got CJD.  - The appearance of new cases is decreasing, as there has only been one new case in the past 5 years. </s>


Input: What are the treatments for National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ?

Output:
The best source for details on your treatment is the doctor or center that gave you pituitary hGH. To protect patient privacy, the HHS did not ask for the names of those treated with pituitary hGH until 1985, when the first CJD cases were reported. In 1985, the HHS asked doctors and treatment centers for the names and addresses of recipients to inform them of the risk of CJD.

We know which pituitary hGH preparations were sent to each treatment center and when they were sent. However, because individual doctors administered the pituitary hGH, we don't know which preparation each person might have gotten. We have tried to find this information in the medical records of patients who developed CJD, but many doctors did not note the specific preparation in their records. When records were incomplete, it was assumed that patients who got CJD might have been exposed to all preparations sent to their treatment center during the time they were treated. Since it is impossible to confidently identify high-risk or risk-free hormone, we do not think that details on the hormone preparations that individuals received will help to clarify individual level of risk. </s>


Input: What causes National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ?

Output:
We have not found any particular preparation of pituitary hGH that is especially likely to carry CJD. We believe that CJD did not come from a single infected pituitary gland or preparation. Prior to 1977, in an effort to extract as much hormone as possible from the pituitary glands, the glands were often processed repeatedly. Hormone extracted from the same pituitaries was often included in many hormone preparations. Also, patients who got CJD were treated on average for 8.4 years and received many different hormone preparations. This makes it very difficult to identify any preparation associated with transmitting CJD.

Doctors wanted to see if a specific preparation of pituitary hGH could transmit CJD. To try to find the pituitary hGH that could have caused CJD, HHS researchers did two things:

1. They set up a test in animals, injecting samples of all available preparations of pituitary hGH directly into the brains of monkeys. CJD develops more rapidly if injected into the brain than under the skin, as hGH was used in people. The animals were watched for 10 years. The brains of all animals were examined for signs of CJD. If an animal got sick with CJD, it would help researchers to understand which vials of pituitary hGH were contaminated with the agent that causes CJD.

2. They studied people treated with pituitary hGH to see who got CJD and which hormone preparation they might have received based on which preparations were sent to their doctor.

Results:

- The animal tests did not help find the pituitary hGH that might have caused CJD. One animal developed the disease 5 years after injection of pituitary hGH. Two other animals that received injections from different vials of the same pituitary hGH preparation did not develop CJD.  - None of the people who developed CJD are known to have received the hormone preparation that made the animal sick. At most, two patients (whose records are incomplete) may have received this pituitary hGH preparation. Because of this, we do not believe that the patients who received the hormone preparation that transmitted CJD to the animal have a greater risk of developing CJD than others treated with pituitary hGH. Because each preparation of pituitary hGH was used to fill multiple vials, it is not known if CJD contamination was spread evenly among all vials of pituitary hGH that came from a particular preparation. It's possible that one vial got more contamination and another got little or none from the same preparation of pituitary hGH. It is believed that multiple preparations of pituitary hGH probably had very low levels of the CJD infectious agent. With such low levels of contamination, some vials of a preparation might carry CJD while other vials would not. Further, most of the people who got CJD received pituitary hGH for long periods of time and received many different preparations. </s>


Input: How to diagnose National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ?

Output:
CJD is usually diagnosed based on signs and symptoms of the illness, how severe they are, and how quickly they become worse. However, doctors must study brain tissue from a biopsy or autopsy in order to make a definite diagnosis of CJD.

Other tests can suggest CJD. In 1996, researchers developed a test that helps doctors diagnose CJD in patients with symptoms. This test detects an abnormal protein in a sample of spinal fluid. When this protein is found, it helps make a diagnosis of CJD. It is much easier and safer to take a sample of spinal fluid than to do a brain biopsy. Unfortunately, this test cannot identify CJD in patients who do not have symptoms. The test cannot predict who may develop CJD in the future.

Researchers from many countries, including the United States, have reported success using MRI to diagnose CJD and vCJD in people with symptoms of the disease. MRI is a safe and painless tool that allows doctors to look at images of the brain and does not involve the collection of brain or spinal fluid samples. </s>


Input: what research (or clinical trials) is being done for National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ?

Output:
Although CJD is a rare disorder, some of the world's leading researchers are working hard to learn more about this disease.

About 10 percent of the people who get CJD have the inherited type. Some people have gotten CJD from medical procedures such as pituitary hGH injections, tissue grafts, or corneal transplants. Scientists don't fully understand what causes CJD. Evidence suggests that a unique infectious agent called a prion [PREE-on] may be the cause. A prion is an unusual infectious agent because it contains no genetic material. It is a protein that takes on different forms. In its normal, harmless form, the protein is curled into a spiral. In its infectious form, the protein folds into an abnormal shape. Somehow, these abnormal proteins change the shape of normal proteins. This change begins a serious chain reaction that results in brain problems.

People with inherited CJD have an abnormal gene that leads to changes in their prion protein. This gene makes the protein likely to assume the abnormal shape. Exposure to the abnormal form of the protein can also occur through injection of contaminated pituitary hGH, tissue grafts, and corneal transplants and through exposures to infected brain tissue.

If CJD results from a defect in protein folding, it may be possible to identify drugs that can help the prion protein assume its proper shape. Such drugs would slow or stop the progress of the disease. Treatments like these are being studied by researchers. Researchers in both Europe and the United States are also trying to develop a test that will identify CJD before symptoms appear.

More information and medical journal articles about CJD and growth hormone therapy can be found on the National Endocrine and Metabolic Diseases Information Service web page Human Growth Hormone and Creutzfeldt-Jakob Disease Resource List. </s>


Input: What are the treatments for National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ?

Output: Some parents did not tell their children about receiving treatment with pituitary hGH and the possible risk of CJD. These children are now adults. Although the HHS no longer sends annual information about the problem of CJD in pituitary hGH recipients, the HHS does maintain a mailing list should any important new information become available. If parents are no longer available to receive HHS mailings, their adult children may not have access to important new information. Some pituitary hGH recipients have learned about the risk of CJD from newspaper stories. Others heard about it when they tried to give blood. Those who were not told by their parents are often angry when they hear about it outside the family. Any parent of an individual who received pituitary hGH who has not received any mailings from the HHSthe last correspondence was sent in June 1999should contact the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) with the adult child's current address. Knowledgeable staff members are glad to answer any questions that parents or recipients may have. </s>


Input: What is (are) National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ?

Output:
The Creutzfeldt-Jakob Disease Foundation, Inc. (www.cjdfoundation.org) was created in 1993 by two families who lost relatives to CJD and the neurologist who treated their family members. This nonprofit corporation seeks to promote awareness of CJD through research and education and to reach out to people who have lost loved ones to this illness. For information on CJD from the NIH, see www.ninds.nih.gov.

The Human Growth Foundation (HGF) (www.hgfound.org) is a nonprofit organization concerned with children's growth disorders and adult GH deficiency. The HGF has information available online and through its toll-free number, 18004516434. The HGF also supports an Internet mailing list to help the exchange of information about adult GH deficiency and adult GH replacement therapy. </s>


Input: What is (are) Foodborne Illnesses ?

Output:
Foodborne illnesses are infections or irritations of the gastrointestinal (GI) tract caused by food or beverages that contain harmful bacteria, parasites, viruses, or chemicals. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. Common symptoms of foodborne illnesses include vomiting, diarrhea, abdominal pain, fever, and chills.

Most foodborne illnesses are acute, meaning they happen suddenly and last a short time, and most people recover on their own without treatment. Rarely, foodborne illnesses may lead to more serious complications. Each year, an estimated 48 million people in the United States experience a foodborne illness. Foodborne illnesses cause about 3,000 deaths in the United States annually.1 </s>


Input: What causes Foodborne Illnesses ?

Output:
The majority of foodborne illnesses are caused by harmful bacteria and viruses.2 Some parasites and chemicals also cause foodborne illnesses.

Bacteria

Bacteria are tiny organisms that can cause infections of the GI tract. Not all bacteria are harmful to humans.

Some harmful bacteria may already be present in foods when they are purchased. Raw foods including meat, poultry, fish and shellfish, eggs, unpasteurized milk and dairy products, and fresh produce often contain bacteria that cause foodborne illnesses. Bacteria can contaminate foodmaking it harmful to eatat any time during growth, harvesting or slaughter, processing, storage, and shipping.

Foods may also be contaminated with bacteria during food preparation in a restaurant or home kitchen. If food preparers do not thoroughly wash their hands, kitchen utensils, cutting boards, and other kitchen surfaces that come into contact with raw foods, cross-contaminationthe spread of bacteria from contaminated food to uncontaminated foodmay occur.

If hot food is not kept hot enough or cold food is not kept cold enough, bacteria may multiply. Bacteria multiply quickly when the temperature of food is between 40 and 140 degrees. Cold food should be kept below 40 degrees and hot food should be kept above 140 degrees. Bacteria multiply more slowly when food is refrigerated, and freezing food can further slow or even stop the spread of bacteria. However, bacteria in refrigerated or frozen foods become active again when food is brought to room temperature. Thoroughly cooking food kills bacteria.

Many types of bacteria cause foodborne illnesses. Examples include

- Salmonella, a bacterium found in many foods, including raw and undercooked meat, poultry, dairy products, and seafood. Salmonella may also be present on egg shells and inside eggs.  - Campylobacter jejuni (C. jejuni), found in raw or undercooked chicken and unpasteurized milk.  - Shigella, a bacterium spread from person to person. These bacteria are present in the stools of people who are infected. If people who are infected do not wash their hands thoroughly after using the bathroom, they can contaminate food that they handle or prepare. Water contaminated with infected stools can also contaminate produce in the field.  - Escherichia coli (E. coli), which includes several different strains, only a few of which cause illness in humans. E. coli O157:H7 is the strain that causes the most severe illness. Common sources of E. coli include raw or undercooked hamburger, unpasteurized fruit juices and milk, and fresh produce.  - Listeria monocytogenes (L. monocytogenes), which has been found in raw and undercooked meats, unpasteurized milk, soft cheeses, and ready-to-eat deli meats and hot dogs.  - Vibrio, a bacterium that may contaminate fish or shellfish.  - Clostridium botulinum (C. botulinum), a bacterium that may contaminate improperly canned foods and smoked and salted fish.

Viruses

Viruses are tiny capsules, much smaller than bacteria, that contain genetic material. Viruses cause infections that can lead to sickness. People can pass viruses to each other. Viruses are present in the stool or vomit of people who are infected. People who are infected with a virus may contaminate food and drinks, especially if they do not wash their hands thoroughly after using the bathroom.

Common sources of foodborne viruses include

- food prepared by a person infected with a virus  - shellfish from contaminated water  - produce irrigated with contaminated water

Common foodborne viruses include

- norovirus, which causes inflammation of the stomach and intestines  - hepatitis A, which causes inflammation of the liver

Parasites

Parasites are tiny organisms that live inside another organism. In developed countries such as the United States, parasitic infections are relatively rare.

Cryptosporidium parvum and Giardia intestinalis are parasites that are spread through water contaminated with the stools of people or animals who are infected. Foods that come into contact with contaminated water during growth or preparation can become contaminated with these parasites. Food preparers who are infected with these parasites can also contaminate foods if they do not thoroughly wash their hands after using the bathroom and before handling food.

Trichinella spiralis is a type of roundworm parasite. People may be infected with this parasite by consuming raw or undercooked pork or wild game.

Chemicals

Harmful chemicals that cause illness may contaminate foods such as

- fish or shellfish, which may feed on algae that produce toxins, leading to high concentrations of toxins in their bodies. Some types of fish, including tuna and mahi mahi, may be contaminated with bacteria that produce toxins if the fish are not properly refrigerated before they are cooked or served.  - certain types of wild mushrooms.  - unwashed fruits and vegetables that contain high concentrations of pesticides. </s>


Input: Who is at risk for Foodborne Illnesses? ?

Output:
Anyone can get a foodborne illness. However, some people are more likely to develop foodborne illnesses than others, including

- infants and children  - pregnant women and their fetuses  - older adults  - people with weak immune systems

These groups also have a greater risk of developing severe symptoms or complications of foodborne illnesses. </s>


Input: What are the symptoms of Foodborne Illnesses ?

Output:
Symptoms of foodborne illnesses depend on the cause. Common symptoms of many foodborne illnesses include

- vomiting  - diarrhea or bloody diarrhea  - abdominal pain  - fever  - chills

Symptoms can range from mild to serious and can last from a few hours to several days.

C. botulinum and some chemicals affect the nervous system, causing symptoms such as

- headache  - tingling or numbness of the skin  - blurred vision  - weakness  - dizziness  - paralysis </s>


Input: What are the complications of Foodborne Illnesses ?

Output:
Foodborne illnesses may lead to dehydration, hemolytic uremic syndrome (HUS), and other complications. Acute foodborne illnesses may also lead to chronicor long lastinghealth problems.

Dehydration

When someone does not drink enough fluids to replace those that are lost through vomiting and diarrhea, dehydration can result. When dehydrated, the body lacks enough fluid and electrolytesminerals in salts, including sodium, potassium, and chlorideto function properly. Infants, children, older adults, and people with weak immune systems have the greatest risk of becoming dehydrated.

Signs of dehydration are

- excessive thirst  - infrequent urination  - dark-colored urine  - lethargy, dizziness, or faintness

Signs of dehydration in infants and young children are

- dry mouth and tongue  - lack of tears when crying  - no wet diapers for 3 hours or more  - high fever  - unusually cranky or drowsy behavior  - sunken eyes, cheeks, or soft spot in the skull

Also, when people are dehydrated, their skin does not flatten back to normal right away after being gently pinched and released.

Severe dehydration may require intravenous fluids and hospitalization. Untreated severe dehydration can cause serious health problems such as organ damage, shock, or comaa sleeplike state in which a person is not conscious.

HUS

Hemolytic uremic syndrome is a rare disease that mostly affects children younger than 10 years of age. HUS develops when E. coli bacteria lodged in the digestive tract make toxins that enter the bloodstream. The toxins start to destroy red blood cells, which help the blood to clot, and the lining of the blood vessels.

In the United States, E. coli O157:H7 infection is the most common cause of HUS, but infection with other strains of E. coli, other bacteria, and viruses may also cause HUS. A recent study found that about 6 percent of people with E. coli O157:H7 infections developed HUS. Children younger than age 5 have the highest risk, but females and people age 60 and older also have increased risk.3

Symptoms of E. coli O157:H7 infection include diarrhea, which may be bloody, and abdominal pain, often accompanied by nausea, vomiting, and fever. Up to a week after E. coli symptoms appear, symptoms of HUS may develop, including irritability, paleness, and decreased urination. HUS may lead to acute renal failure, which is a sudden and temporary loss of kidney function. HUS may also affect other organs and the central nervous system. Most people who develop HUS recover with treatment. Research shows that in the United States between 2000 and 2006, fewer than 5 percent of people who developed HUS died of the disorder. Older adults had the highest mortality rateabout one-third of people age 60 and older who developed HUS died.3

Studies have shown that some children who recover from HUS develop chronic complications, including kidney problems, high blood pressure, and diabetes.

Other Complications

Some foodborne illnesses lead to other serious complications. For example, C. botulinum and certain chemicals in fish and seafood can paralyze the muscles that control breathing. L. monocytogenes can cause spontaneous abortion or stillbirth in pregnant women.

Research suggests that acute foodborne illnesses may lead to chronic disorders, including

- reactive arthritis, a type of joint inflammation that usually affects the knees, ankles, or feet. Some people develop this disorder following foodborne illnesses caused by certain bacteria, including C. jejuni and Salmonella. Reactive arthritis usually lasts fewer than 6 months, but this condition may recur or become chronic arthritis.4  - irritable bowel syndrome (IBS), a disorder of unknown cause that is associated with abdominal pain, bloating, and diarrhea or constipation or both. Foodborne illnesses caused by bacteria increase the risk of developing IBS.5  - Guillain-Barr syndrome, a disorder characterized by muscle weakness or paralysis that begins in the lower body and progresses to the upper body. This syndrome may occur after foodborne illnesses caused by bacteria, most commonly C. jejuni. Most people recover in 6 to 12 months.6

A recent study found that adults who had recovered from E. coli O157:H7 infections had increased risks of high blood pressure, kidney problems, and cardiovascular disease.7 </s>


Input: How to diagnose Foodborne Illnesses ?

Output:
To diagnose foodborne illnesses, health care providers ask about symptoms, foods and beverages recently consumed, and medical history. Health care providers will also perform a physical examination to look for signs of illness.

Diagnostic tests for foodborne illnesses may include a stool culture, in which a sample of stool is analyzed in a laboratory to check for signs of infections or diseases. A sample of vomit or a sample of the suspected food, if available, may also be tested. A health care provider may perform additional medical tests to rule out diseases and disorders that cause symptoms similar to the symptoms of foodborne illnesses.

If symptoms of foodborne illnesses are mild and last only a short time, diagnostic tests are usually not necessary. </s>


Input: What are the treatments for Foodborne Illnesses ?

Output:
The only treatment needed for most foodborne illnesses is replacing lost fluids and electrolytes to prevent dehydration.

Over-the-counter medications such as loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol and Kaopectate) may help stop diarrhea in adults. However, people with bloody diarrheaa sign of bacterial or parasitic infectionshould not use these medications. If diarrhea is caused by bacteria or parasites, over-the-counter medications may prolong the problem. Medications to treat diarrhea in adults can be dangerous for infants and children and should only be given with a health care providers guidance.

If the specific cause of the foodborne illness is diagnosed, a health care provider may prescribe medications, such as antibiotics, to treat the illness.

Hospitalization may be required to treat lifethreatening symptoms and complications, such as paralysis, severe dehydration, and HUS. </s>


Input: What to do for Foodborne Illnesses ?

Output:
The following steps may help relieve the symptoms of foodborne illnesses and prevent dehydration in adults:

- drinking plenty of liquids such as fruit juices, sports drinks, caffeine-free soft drinks, and broths to replace fluids and electrolytes  - sipping small amounts of clear liquids or sucking on ice chips if vomiting is still a problem  - gradually reintroducing food, starting with bland, easy-to-digest foods such as rice, potatoes, toast or bread, cereal, lean meat, applesauce, and bananas  - avoiding fatty foods, sugary foods, dairy products, caffeine, and alcohol until recovery is complete

Infants and children present special concerns. Infants and children are likely to become dehydrated more quickly from diarrhea and vomiting because of their smaller body size. The following steps may help relieve symptoms and prevent dehydration in infants and children:

- giving oral rehydration solutions such as Pedialyte, Naturalyte, Infalyte, and CeraLyte to prevent dehydration  - giving food as soon as the child is hungry  - giving infants breast milk or fullstrength formula, as usual, along with oral rehydration solutions

Older adults and adults with weak immune systems should also drink oral rehydration solutions to prevent dehydration. </s>


Input: How to prevent Foodborne Illnesses ?

Output:
Foodborne illnesses can be prevented by properly storing, cooking, cleaning, and handling foods.

- Raw and cooked perishable foodsfoods that can spoilshould be refrigerated or frozen promptly. If perishable foods stand at room temperature for more than 2 hours, they may not be safe to eat. Refrigerators should be set at 40 degrees or lower and freezers should be set at 0 degrees.  - Foods should be cooked long enough and at a high enough temperature to kill the harmful bacteria that cause illnesses. A meat thermometer should be used to ensure foods are cooked to the appropriate internal temperature:      - 145 degrees for roasts, steaks, and chops of beef, veal, pork, and lamb, followed by 3 minutes of rest time after the meat is removed from the heat source    - 160 degrees for ground beef, veal, pork, and lamb    - 165 degrees for poultry    - Cold foods should be kept cold and hot foods should be kept hot.  - Fruits and vegetables should be washed under running water just before eating, cutting, or cooking. A produce brush can be used under running water to clean fruits and vegetables with firm skin.  - Raw meat, poultry, seafood, and their juices should be kept away from other foods.  - People should wash their hands for at least 20 seconds with warm, soapy water before and after handling raw meat, poultry, fish, shellfish, produce, or eggs. People should also wash their hands after using the bathroom, changing diapers, or touching animals.  - Utensils and surfaces should be washed with hot, soapy water before and after they are used to prepare food. Diluted bleach1 teaspoon of bleach to 1 quart of hot watercan also be used to sanitize utensils and surfaces.

More information about preventing foodborne illnesses is available at www.foodsafety.gov. </s>


Input: What to do for Foodborne Illnesses ?

Output: - Foodborne illnesses are infections or irritations of the gastrointestinal (GI) tract caused by food or beverages that contain harmful bacteria, parasites, viruses, or chemicals.  - Anyone can get a foodborne illness. However, some people are more likely to develop foodborne illnesses than others, including infants and children, pregnant women and their fetuses, older adults, and people with weakened immune systems.  - Symptoms of foodborne illnesses depend on the cause. Common symptoms of many foodborne illnesses include vomiting, diarrhea or bloody diarrhea, abdominal pain, fever, and chills.  - Foodborne illnesses may lead to dehydration, hemolytic uremic syndrome (HUS), and other complications. Acute foodborne illnesses may also lead to chronicor long lastinghealth problems.  - The only treatment needed for most foodborne illnesses is replacing lost fluids and electrolytes to prevent dehydration.  - Foodborne illnesses can be prevented by properly storing, cooking, cleaning, and handling foods. </s>


Input: What are the treatments for Analgesic Nephropathy (Painkillers and the Kidneys) ?

Output: If you have been taking analgesics regularly to control chronic pain, you may be advised to find new ways to treat your pain, such as behavior modification or relaxation techniques. Depending on how much your kidney function has declined, you may be advised to change your diet, limit the fluids you drink, or take medications to avoid anemia and bone problems caused by kidney disease. Your doctor will monitor your kidney function with regular urine and blood tests. </s>


Input: What is (are) Cyclic Vomiting Syndrome ?

Output:
Cyclic vomiting syndrome, sometimes referred to as CVS, is an increasingly recognized disorder with sudden, repeated attacksalso called episodesof severe nausea, vomiting, and physical exhaustion that occur with no apparent cause. The episodes can last from a few hours to several days. Episodes can be so severe that a person has to stay in bed for days, unable to go to school or work. A person may need treatment at an emergency room or a hospital during episodes. After an episode, a person usually experiences symptom-free periods lasting a few weeks to several months. To people who have the disorder, as well as their family members and friends, cyclic vomiting syndrome can be disruptive and frightening.

The disorder can affect a person for months, years, or decades. Each episode of cyclic vomiting syndrome is usually similar to previous ones, meaning that episodes tend to start at the same time of day, last the same length of time, and occur with the same symptoms and level of intensity. </s>


Input: What is (are) Cyclic Vomiting Syndrome ?

Output: The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anusthe opening through which stool leaves the body. The body digests food using the movement of muscles in the GI tract, along with the release of hormones and enzymes. Cyclic vomiting syndrome affects the upper GI tract, which includes the mouth, esophagus, stomach, small intestine, and duodenum, the first part of the small intestine. The esophagus is the muscular tube that carries food and liquids from the mouth to the stomach. The stomach slowly pumps the food and liquids through the duodenum and into the rest of the small intestine, which absorbs nutrients from food particles. This process is automatic and people are usually not aware of it, though people sometimes feel food in their esophagus when they swallow something too large, try to eat too quickly, or drink hot or cold liquids. </s>


Input: What causes Cyclic Vomiting Syndrome ?

Output:
The cause of cyclic vomiting syndrome is unknown. However, some experts believe that some possible problems with bodily functions may contribute to the cause, such as the following:

- gastrointestinal motilitythe way food moves through the digestive system  - central nervous system functionincludes the brain, spinal cord, and nerves that control bodily responses  - autonomic nervous system functionnerves that control internal organs such as the heart  - hormone imbalanceshormones are a chemical produced in one part of the body and released into the blood to trigger or regulate particular bodily functions  - in children, an abnormal inherited gene may also contribute to the condition

Specific conditions or events may trigger an episode of cyclic vomiting:

- emotional stress, anxiety, or panic attacksfor example, in children, common triggers of anticipatory anxiety are school exams or events, birthday parties, holidays, family conflicts, or travel  - infections, such as a sinus infection, a respiratory infection, or the flu  - eating certain foods, such as chocolate or cheese, or additives such as caffeine, nitritescommonly found in cured meats such as hot dogsand monosodium glutamate, also called MSG  - hot weather  - menstrual periods  - motion sickness  - overeating, fasting, or eating right before bedtime  - physical exhaustion or too much exercise </s>


Input: How many people are affected by Cyclic Vomiting Syndrome ?

Output: Cyclic vomiting syndrome is more common in children than adults, although reports of the syndrome in adults have increased in recent years.1 Usually, children are about 5 years old when diagnosed with cyclic vomiting syndrome, which occurs in every three out of 100,000 children.2 </s>


Input: What are the symptoms of Cyclic Vomiting Syndrome ?

Output:
The main symptoms of cyclic vomiting syndrome are severe nausea and sudden vomiting lasting hours to days. A person may also experience one or more of the following symptoms:

- retching, or making an attempt to vomit  - heaving or gagging  - lack of appetite  - abdominal pain  - diarrhea  - fever  - dizziness  - headache  - sensitivity to light

Intensity of symptoms will vary as a person cycles through four distinct phases of an episode:

- Prodrome phase. During the prodrome phase, the person feels that an episode of nausea and vomiting is about to start. Often marked by intense sweating and nauseawith or without abdominal painthis phase can last from a few minutes to several hours. The person may appear unusually pale.  - Vomiting phase. This phase consists of intense nausea, vomiting, and retching. Periods of vomiting and retching can last 20 to 30 minutes at a time. The person may be subdued and responsive, immobile and unresponsive, or writhing and moaning with intense abdominal pain. An episode can last from hours to days.  - Recovery phase. This phase begins when the vomiting and retching stop and the nausea subsides. Improvement of symptoms during the recovery phase can vary. Healthy color, appetite, and energy return gradually or right away.  - Well phase. This phase occurs between episodes when no symptoms are present. </s>


Input: What are the complications of Cyclic Vomiting Syndrome ?

Output:
The severe vomiting and retching that define cyclic vomiting syndrome increase the chance of developing several complications, including dehydration, esophagitis, a Mallory-Weiss tear, and tooth decay.

- Dehydration may occur when a person does not replace fluids that were lost because of vomiting and diarrhea. When dehydrated, the body lacks enough fluid and electrolytesminerals in salts, including sodium, potassium, and chlorideto function properly. Severe dehydration may require intravenous (IV) fluids and hospitalization.  - Esophagitisinflammation or irritation of the esophaguscan result from the stomach acid that exits through the esophagus during vomiting.  - A Mallory-Weiss teara tear in the lower end of the esophagusis caused by severe vomiting. A person with bloody vomit and stool should see a health care provider right away.  - Tooth decay or corroding tooth enamel is damage caused by stomach acid.

Seek Help for Signs or Symptoms of Severe Dehydration   People who have any signs or symptoms of severe dehydration should call or see a health care provider right away:   - excessive thirst   - dark-colored urine   - infrequent urination   - lethargy, dizziness, or faintness   - dry skin    Infants, children, older adults, and people with weak immune systems have the greatest chance of becoming dehydrated. People should watch for the following signs and symptoms of dehydration in infants, young children, and people who are unable to communicate their symptoms:   - dry mouth and tongue   - lack of tears when crying   - infants with no wet diapers for 3 hours or more   - infants with a sunken soft spot   - unusually cranky or drowsy behavior   - sunken eyes or cheeks   - fever    If left untreated, severe dehydration can cause serious health problems, such as organ damage, shock, or comaa sleeplike state in which a person is not conscious. </s>


Input: What are the symptoms of Cyclic Vomiting Syndrome ?

Output:
People who have any signs or symptoms of severe dehydration should call or see a health care provider right away:

- excessive thirst  - dark-colored urine  - infrequent urination  - lethargy, dizziness, or faintness  - dry skin

Infants, children, older adults, and people with weak immune systems have the greatest chance of becoming dehydrated. People should watch for the following signs and symptoms of dehydration in infants, young children, and people who are unable to communicate their symptoms:

- dry mouth and tongue  - lack of tears when crying  - infants with no wet diapers for 3 hours or more  - infants with a sunken soft spot  - unusually cranky or drowsy behavior  - sunken eyes or cheeks  - fever

If left untreated, severe dehydration can cause serious health problems, such as organ damage, shock, or comaa sleeplike state in which a person is not conscious. </s>


Input: How to diagnose Cyclic Vomiting Syndrome ?

Output:
A specific test to diagnose cyclic vomiting syndrome does not exist; instead, a health care provider will rule out other conditions and diagnose the syndrome based upon

- a medical and family history  - a physical exam  - a pattern or cycle of symptoms  - blood tests  - urine tests  - imaging tests  - upper GI endoscopy  - a gastric emptying test

Often, it is suspected that one of the following is causing their symptoms:

- gastroparesisa disorder that slows or stops the movement of food from the stomach to the small intestine  - gastroenteritisinflammation of the lining of the stomach, small intestine, and large intestine

A diagnosis of cyclic vomiting syndrome may be difficult to make until the person sees a health care provider. A health care provider will suspect cyclic vomiting syndrome if the person suffers from repeat episodes of vomiting.

Medical and Family History

Taking a medical and family history is one of the first things a health care provider may do to help diagnose cyclic vomiting syndrome. He or she will ask the patient to provide a medical and family history.

Physical Exam

A physical exam may help diagnose other conditions besides cyclic vomiting syndrome. During a physical exam, a health care provider usually

- examines a patients body  - taps on specific areas of the patients body

Pattern or Cycle of Symptoms in Children3

A health care provider will often suspect cyclic vomiting syndrome in a child when the child

- has at least five separate episodes, or at least three separate episodes over 6 months  - has episodes of intense nausea and vomiting lasting 1 hour to 10 days and occurring at least 1 week apart  - has episodes that are similar to previous onesthey tend to start at the same time of day, last the same length of time, and occur with the same symptoms and level of intensity  - vomits during episodes at least four times per hour for at least 1 hour  - vomits and it is not attributed to another disorder  - has absence of nausea and vomiting between episodes

Pattern or Cycle of Symptoms in Adults4,5

A health care provider will often suspect cyclic vomiting syndrome in adults when the following is present for at least 3 months and the symptoms started more than 6 months ago:

- Each episode of cyclic vomiting syndrome is usually similar to previous ones, meaning that episodes tend to start at the same time of day and last the same length of timeless than 1 week.  - Three or more separate episodes in the past year.  - Absence of nausea or vomiting between episodes.

Blood Tests

A nurse or technician will draw blood samples at a health care providers office or a commercial facility and send the samples to a lab for analysis. The blood test can tell the health care provider if the patient has any signs of dehydration or other problems.

Urine Tests

Urinalysis involves testing a urine sample. The patient collects a urine sample in a special container in a health care providers office or a commercial facility. A health care provider tests the sample in the same location or sends the sample to a lab for analysis. A urinalysis can rule out kidney problems or an infection.

Imaging Tests

The health care provider decides which test to order based on the symptoms, medical history, and physical exam.

Upper GI series. A health care provider may order an upper GI series to look at the upper GI tract. A radiologista doctor who specializes in medical imagingperforms this test at a hospital or an outpatient center. This test does not require anesthesia. The patient should not eat or drink for 8 hours before the procedure, if possible. During the procedure, the patient will stand or sit in front of an x-ray machine and drink barium, a chalky liquid. Infants lie on a table and a health care provider gives them barium through a tiny tube placed in the nose that runs into the stomach. Barium coats the GI tract, making signs of obstruction or other problems that can cause vomiting show up more clearly on x rays. A patient may experience bloating and nausea for a short time after the test. The upper GI series can show other problems that may be causing symptoms, such as an ulcer or obstruction.

Abdominal ultrasound. A health care provider may order an ultrasound to look at the organs in the abdomen. A technician uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. The technician performs the procedure in a health care providers office, an outpatient center, or a hospital. A radiologist interprets the images. A patient does not need anesthesia. The abdominal ultrasound can show other problems that may be causing symptoms, such as gallstones.

Upper Gastrointestinal Endoscopy

This procedure involves using an endoscopea small, flexible tube with a lightto see the upper GI tract. A gastroenterologista doctor who specializes in digestive diseasesperforms the test at a hospital or an outpatient center. A health care provider may give a patient a liquid anesthetic to gargle or may spray anesthetic on the back of the patients throat. A nurse or technician will place an IV needle in a vein in the arm to administer sedation or anesthesia. Sedatives or anesthesia help a patient stay relaxed and comfortable. The gastroenterologist carefully inserts the endoscope into the mouth and feeds the endoscope down the esophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the intestinal lining. The upper GI endoscopy can show other problems that may be causing symptoms, such as an ulcer. A gastroenterologist may obtain a biopsya procedure that involves taking a small piece of tissue for examination with a microscopeof the small-intestinal lining during an upper GI endoscopy. The patient will not feel the biopsy.

Gastric Emptying Test

Also called gastric emptying scintigraphy, this test involves eating a bland mealsuch as eggs or an egg substitutethat contains a small amount of radioactive material. A specially trained technician performs the test in a radiology center or hospital, and a radiologist interprets the results; the patient does not need anesthesia. An external camera scans the abdomen to show where the radioactive material is located. The radiologist is then able to measure the rate of gastric emptying at 1, 2, 3, and 4 hours after the meal. </s>


Input: What are the treatments for Cyclic Vomiting Syndrome ?

Output:
A health care provider may refer patients to a gastroenterologist for treatment.

People with cyclic vomiting syndrome should get plenty of rest and take medications to prevent a vomiting episode, stop an episode in progress, speed up recovery, or relieve associated symptoms.

The health care team tailors treatment to the symptoms experienced during each of the four cyclic vomiting syndrome phases:

- Prodrome phase treatment. The goal during the prodrome phase is to stop an episode before it progresses. Taking medication early in the phase can help stop an episode from moving to the vomiting phase or becoming severe; however, people do not always realize an episode is coming. For example, a person may wake up in the morning and begin vomiting. A health care provider may recommend the following medications for both children and adults:      - ondansetron (Zofran) or lorazepam (Ativan) for nausea    - ibuprofen for abdominal pain    - ranitidine (Zantac), lansoprazole (Prevacid), or omeprazole (Prilosec, Zegerid) to control stomach acid production    - sumatriptan (Imitrex)prescribed as a nasal spray, an injection, or a pill that dissolves under the tonguefor migraines    - Vomiting phase treatment. Once vomiting begins, people should call or see a health care provider as soon as possible. Treatment usually requires the person to stay in bed and sleep in a dark, quiet room. A health care provider may recommend the following for both children and adults:      - medication for pain, nausea, and reducing stomach acid and anxiety    - anti-migraine medications such as sumatriptan to stop symptoms of a migraine or possibly stop an episode in progress    - hospitalization for severe nausea and vomiting    - IV fluids and medications to prevent dehydration and treat symptoms    - IV nutrition if an episode continues for several days    - Recovery phase treatment. During the recovery phase, drinking and eating will replace lost electrolytes. A person may need IV fluids for a period of time. Some people find their appetite returns to normal right away, while others start by drinking clear liquids and then moving slowly to other liquids and solid food. A health care provider may prescribe medications during the recovery phase and well phase to prevent future episodes.  - Well phase treatment. During the well phase, a health care provider may use medications to treat people whose episodes are frequent and long lasting in an effort to prevent or ease future episodes. A person may need to take a medication daily for 1 to 2 months before evaluating whether it helps prevent episodes. A health care provider may prescribe the following medications for both children and adults during the well phase to prevent cyclic vomiting syndrome episodes, lessen their severity, and reduce their frequency:      - amitriptyline (Elavil)    - propranolol (Inderal)    - cyproheptadine (Periactin) </s>


Input: How to prevent Cyclic Vomiting Syndrome ?

Output:
A person should stay away from known triggers, especially during the well phase, as well as

- get adequate sleep to prevent exhaustion  - treat sinus problems or allergies  - seek help on reducing stress and anxiety  - avoid foods that trigger episodes or foods with additives

A health care provider may refer people with cyclic vomiting syndrome and anxiety to a stress management specialist for relaxation therapy or other treatments.

A health care provider may prescribe medications to prevent migraines for people with cyclic vomiting syndrome. </s>


Input: What to do for Cyclic Vomiting Syndrome ?

Output:
During the prodrome and vomiting phases of cyclic vomiting syndrome, a person will generally take in little or no nutrition by mouth. During the recovery phase, the person may be quite hungry as soon as the vomiting stops. As eating resumes, a person or his or her family should watch for the return of nausea. In some cases, a person can start with clear liquids and proceed slowly to a regular diet.

During the well phase, a balanced diet and regular meals are important. People should avoid any trigger foods and foods with additives. Eating small, carbohydrate-containing snacks between meals, before exercise, and at bedtime may help prevent future attacks. A health care provider will assist with planning a return to a regular diet. </s>


Input: What to do for Cyclic Vomiting Syndrome ?

Output: - Cyclic vomiting syndrome, sometimes referred to as CVS, is an increasingly recognized disorder with sudden, repeated attacksalso called episodesof severe nausea, vomiting, and physical exhaustion that occur with no apparent cause.  - The disorder can affect a person for months, years, or decades.  - The cause of cyclic vomiting syndrome is unknown.  - The severe vomiting and retching that define cyclic vomiting syndrome increase the chance of developing several complications, including dehydration, esophagitis, a Mallory-Weiss tear, and tooth decay.  - Intensity of symptoms will vary as a person cycles through four distinct phases of an episode.  - The main symptoms of cyclic vomiting syndrome are severe nausea and sudden vomiting lasting hours to days.  - People with cyclic vomiting syndrome should get plenty of rest and take medications to prevent a vomiting episode, stop an episode in progress, speed up recovery, or relieve associated symptoms.  - During the well phase, a balanced diet and regular meals are important. A health care provider will assist with planning a return to a regular diet. </s>


Input: What is (are) Causes of Diabetes ?

Output:
Diabetes is a complex group of diseases with a variety of causes. People with diabetes have high blood glucose, also called high blood sugar or hyperglycemia.

Diabetes is a disorder of metabolismthe way the body uses digested food for energy. The digestive tract breaks down carbohydratessugars and starches found in many foodsinto glucose, a form of sugar that enters the bloodstream. With the help of the hormone insulin, cells throughout the body absorb glucose and use it for energy. Diabetes develops when the body doesnt make enough insulin or is not able to use insulin effectively, or both.

Insulin is made in the pancreas, an organ located behind the stomach. The pancreas contains clusters of cells called islets. Beta cells within the islets make insulin and release it into the blood.

If beta cells dont produce enough insulin, or the body doesnt respond to the insulin that is present, glucose builds up in the blood instead of being absorbed by cells in the body, leading to prediabetes or diabetes. Prediabetes is a condition in which blood glucose levels or A1C levelswhich reflect average blood glucose levelsare higher than normal but not high enough to be diagnosed as diabetes. In diabetes, the bodys cells are starved of energy despite high blood glucose levels.

Over time, high blood glucose damages nerves and blood vessels, leading to complications such as heart disease, stroke, kidney disease, blindness, dental disease, and amputations. Other complications of diabetes may include increased susceptibility to other diseases, loss of mobility with aging, depression, and pregnancy problems. No one is certain what starts the processes that cause diabetes, but scientists believe genes and environmental factors interact to cause diabetes in most cases.

The two main types of diabetes are type 1 diabetes and type 2 diabetes. A third type, gestational diabetes, develops only during pregnancy. Other types of diabetes are caused by defects in specific genes, diseases of the pancreas, certain drugs or chemicals, infections, and other conditions. Some people show signs of both type 1 and type 2 diabetes. </s>


Input: What causes Causes of Diabetes ?

Output:
Type 1 diabetes is caused by a lack of insulin due to the destruction of insulin-producing beta cells in the pancreas. In type 1 diabetesan autoimmune diseasethe bodys immune system attacks and destroys the beta cells. Normally, the immune system protects the body from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. But in autoimmune diseases, the immune system attacks the bodys own cells. In type 1 diabetes, beta cell destruction may take place over several years, but symptoms of the disease usually develop over a short period of time.

Type 1 diabetes typically occurs in children and young adults, though it can appear at any age. In the past, type 1 diabetes was called juvenile diabetes or insulin-dependent diabetes mellitus.

Latent autoimmune diabetes in adults (LADA) may be a slowly developing kind of type 1 diabetes. Diagnosis usually occurs after age 30. In LADA, as in type 1 diabetes, the bodys immune system destroys the beta cells. At the time of diagnosis, people with LADA may still produce their own insulin, but eventually most will need insulin shots or an insulin pump to control blood glucose levels.

Genetic Susceptibility

Heredity plays an important part in determining who is likely to develop type 1 diabetes. Genes are passed down from biological parent to child. Genes carry instructions for making proteins that are needed for the bodys cells to function. Many genes, as well as interactions among genes, are thought to influence susceptibility to and protection from type 1 diabetes. The key genes may vary in different population groups. Variations in genes that affect more than 1 percent of a population group are called gene variants.

Certain gene variants that carry instructions for making proteins called human leukocyte antigens (HLAs) on white blood cells are linked to the risk of developing type 1 diabetes. The proteins produced by HLA genes help determine whether the immune system recognizes a cell as part of the body or as foreign material. Some combinations of HLA gene variants predict that a person will be at higher risk for type 1 diabetes, while other combinations are protective or have no effect on risk.

While HLA genes are the major risk genes for type 1 diabetes, many additional risk genes or gene regions have been found. Not only can these genes help identify people at risk for type 1 diabetes, but they also provide important clues to help scientists better understand how the disease develops and identify potential targets for therapy and prevention.

Genetic testing can show what types of HLA genes a person carries and can reveal other genes linked to diabetes. However, most genetic testing is done in a research setting and is not yet available to individuals. Scientists are studying how the results of genetic testing can be used to improve type 1 diabetes prevention or treatment.

Autoimmune Destruction of Beta Cells

In type 1 diabetes, white blood cells called T cells attack and destroy beta cells. The process begins well before diabetes symptoms appear and continues after diagnosis. Often, type 1 diabetes is not diagnosed until most beta cells have already been destroyed. At this point, a person needs daily insulin treatment to survive. Finding ways to modify or stop this autoimmune process and preserve beta cell function is a major focus of current scientific research.

Recent research suggests insulin itself may be a key trigger of the immune attack on beta cells. The immune systems of people who are susceptible to developing type 1 diabetes respond to insulin as if it were a foreign substance, or antigen. To combat antigens, the body makes proteins called antibodies. Antibodies to insulin and other proteins produced by beta cells are found in people with type 1 diabetes. Researchers test for these antibodies to help identify people at increased risk of developing the disease. Testing the types and levels of antibodies in the blood can help determine whether a person has type 1 diabetes, LADA, or another type of diabetes.

Environmental Factors

Environmental factors, such as foods, viruses, and toxins, may play a role in the development of type 1 diabetes, but the exact nature of their role has not been determined. Some theories suggest that environmental factors trigger the autoimmune destruction of beta cells in people with a genetic susceptibility to diabetes. Other theories suggest that environmental factors play an ongoing role in diabetes, even after diagnosis.

Viruses and infections. A virus cannot cause diabetes on its own, but people are sometimes diagnosed with type 1 diabetes during or after a viral infection, suggesting a link between the two. Also, the onset of type 1 diabetes occurs more frequently during the winter when viral infections are more common. Viruses possibly associated with type 1 diabetes include coxsackievirus B, cytomegalovirus, adenovirus, rubella, and mumps. Scientists have described several ways these viruses may damage or destroy beta cells or possibly trigger an autoimmune response in susceptible people. For example, anti-islet antibodies have been found in patients with congenital rubella syndrome, and cytomegalovirus has been associated with significant beta cell damage and acute pancreatitisinflammation of the pancreas. Scientists are trying to identify a virus that can cause type 1 diabetes so that a vaccine might be developed to prevent the disease.

Infant feeding practices. Some studies have suggested that dietary factors may raise or lower the risk of developing type 1 diabetes. For example, breastfed infants and infants receiving vitamin D supplements may have a reduced risk of developing type 1 diabetes, while early exposure to cows milk and cereal proteins may increase risk. More research is needed to clarify how infant nutrition affects the risk for type 1 diabetes.

Read more in the Centers for Disease Control and Preventions (CDCs) publication  National Diabetes Statistics Report, 2014 at  www.cdc.gov for information about research studies related to type 1 diabetes. </s>


Input: What causes Causes of Diabetes ?

Output:
Type 2 diabetesthe most common form of diabetesis caused by a combination of factors, including insulin resistance, a condition in which the bodys muscle, fat, and liver cells do not use insulin effectively. Type 2 diabetes develops when the body can no longer produce enough insulin to compensate for the impaired ability to use insulin. Symptoms of type 2 diabetes may develop gradually and can be subtle; some people with type 2 diabetes remain undiagnosed for years.

Type 2 diabetes develops most often in middle-aged and older people who are also overweight or obese. The disease, once rare in youth, is becoming more common in overweight and obese children and adolescents. Scientists think genetic susceptibility and environmental factors are the most likely triggers of type 2 diabetes.

Genetic Susceptibility

Genes play a significant part in susceptibility to type 2 diabetes. Having certain genes or combinations of genes may increase or decrease a persons risk for developing the disease. The role of genes is suggested by the high rate of type 2 diabetes in families and identical twins and wide variations in diabetes prevalence by ethnicity. Type 2 diabetes occurs more frequently in African Americans, Alaska Natives, American Indians, Hispanics/Latinos, and some Asian Americans, Native Hawaiians, and Pacific Islander Americans than it does in non-Hispanic whites.

Recent studies have combined genetic data from large numbers of people, accelerating the pace of gene discovery. Though scientists have now identified many gene variants that increase susceptibility to type 2 diabetes, the majority have yet to be discovered. The known genes appear to affect insulin production rather than insulin resistance. Researchers are working to identify additional gene variants and to learn how they interact with one another and with environmental factors to cause diabetes.

Studies have shown that variants of the TCF7L2 gene increase susceptibility to type 2 diabetes. For people who inherit two copies of the variants, the risk of developing type 2 diabetes is about 80 percent higher than for those who do not carry the gene variant.1 However, even in those with the variant, diet and physical activity leading to weight loss help delay diabetes, according to the Diabetes Prevention Program (DPP), a major clinical trial involving people at high risk.

Genes can also increase the risk of diabetes by increasing a persons tendency to become overweight or obese. One theory, known as the thrifty gene hypothesis, suggests certain genes increase the efficiency of metabolism to extract energy from food and store the energy for later use. This survival trait was advantageous for populations whose food supplies were scarce or unpredictable and could help keep people alive during famine. In modern times, however, when high-calorie foods are plentiful, such a trait can promote obesity and type 2 diabetes.

Obesity and Physical Inactivity

Physical inactivity and obesity are strongly associated with the development of type 2 diabetes. People who are genetically susceptible to type 2 diabetes are more vulnerable when these risk factors are present.

An imbalance between caloric intake and physical activity can lead to obesity, which causes insulin resistance and is common in people with type 2 diabetes. Central obesity, in which a person has excess abdominal fat, is a major risk factor not only for insulin resistance and type 2 diabetes but also for heart and blood vessel disease, also called cardiovascular disease (CVD). This excess belly fat produces hormones and other substances that can cause harmful, chronic effects in the body such as damage to blood vessels.

The DPP and other studies show that millions of people can lower their risk for type 2 diabetes by making lifestyle changes and losing weight. The DPP proved that people with prediabetesat high risk of developing type 2 diabetescould sharply lower their risk by losing weight through regular physical activity and a diet low in fat and calories. In 2009, a follow-up study of DPP participantsthe Diabetes Prevention Program Outcomes Study (DPPOS)showed that the benefits of weight loss lasted for at least 10 years after the original study began.2

Read more about the DPP, funded under National Institutes of Health (NIH) clinical trial number NCT00004992, and the DPPOS, funded under NIH clinical trial number NCT00038727 in  Diabetes Prevention Program.

Insulin Resistance

Insulin resistance is a common condition in people who are overweight or obese, have excess abdominal fat, and are not physically active. Muscle, fat, and liver cells stop responding properly to insulin, forcing the pancreas to compensate by producing extra insulin. As long as beta cells are able to produce enough insulin, blood glucose levels stay in the normal range. But when insulin production falters because of beta cell dysfunction, glucose levels rise, leading to prediabetes or diabetes.

Abnormal Glucose Production by the Liver

In some people with diabetes, an abnormal increase in glucose production by the liver also contributes to high blood glucose levels. Normally, the pancreas releases the hormone glucagon when blood glucose and insulin levels are low. Glucagon stimulates the liver to produce glucose and release it into the bloodstream. But when blood glucose and insulin levels are high after a meal, glucagon levels drop, and the liver stores excess glucose for later, when it is needed. For reasons not completely understood, in many people with diabetes, glucagon levels stay higher than needed. High glucagon levels cause the liver to produce unneeded glucose, which contributes to high blood glucose levels. Metformin, the most commonly used drug to treat type 2 diabetes, reduces glucose production by the liver.

The Roles of Insulin and Glucagon in Normal Blood Glucose Regulation

A healthy persons body keeps blood glucose levels in a normal range through several complex mechanisms. Insulin and glucagon, two hormones made in the pancreas, help regulate blood glucose levels:

- Insulin, made by beta cells, lowers elevated blood glucose levels.  - Glucagon, made by alpha cells, raises low blood glucose levels.

- Insulin helps muscle, fat, and liver cells absorb glucose from the bloodstream, lowering blood glucose levels.  - Insulin stimulates the liver and muscle tissue to store excess glucose. The stored form of glucose is called glycogen.  - Insulin also lowers blood glucose levels by reducing glucose production in the liver.

- Glucagon signals the liver and muscle tissue to break down glycogen into glucose, which enters the bloodstream and raises blood glucose levels.  - If the body needs more glucose, glucagon stimulates the liver to make glucose from amino acids.

Metabolic Syndrome

Metabolic syndrome, also called insulin resistance syndrome, refers to a group of conditions common in people with insulin resistance, including

- higher than normal blood glucose levels  - increased waist size due to excess abdominal fat  - high blood pressure  - abnormal levels of cholesterol and triglycerides in the blood

Cell Signaling and Regulation

Cells communicate through a complex network of molecular signaling pathways. For example, on cell surfaces, insulin receptor molecules capture, or bind, insulin molecules circulating in the bloodstream. This interaction between insulin and its receptor prompts the biochemical signals that enable the cells to absorb glucose from the blood and use it for energy.

Problems in cell signaling systems can set off a chain reaction that leads to diabetes or other diseases. Many studies have focused on how insulin signals cells to communicate and regulate action. Researchers have identified proteins and pathways that transmit the insulin signal and have mapped interactions between insulin and body tissues, including the way insulin helps the liver control blood glucose levels. Researchers have also found that key signals also come from fat cells, which produce substances that cause inflammation and insulin resistance.

This work holds the key to combating insulin resistance and diabetes. As scientists learn more about cell signaling systems involved in glucose regulation, they will have more opportunities to develop effective treatments.

Beta Cell Dysfunction

Scientists think beta cell dysfunction is a key contributor to type 2 diabetes. Beta cell impairment can cause inadequate or abnormal patterns of insulin release. Also, beta cells may be damaged by high blood glucose itself, a condition called glucose toxicity.

Scientists have not determined the causes of beta cell dysfunction in most cases. Single gene defects lead to specific forms of diabetes called maturity-onset diabetes of the young (MODY). The genes involved regulate insulin production in the beta cells. Although these forms of diabetes are rare, they provide clues as to how beta cell function may be affected by key regulatory factors. Other gene variants are involved in determining the number and function of beta cells. But these variants account for only a small percentage of type 2 diabetes cases. Malnutrition early in life is also being investigated as a cause of beta cell dysfunction. The metabolic environment of the developing fetus may also create a predisposition for diabetes later in life.

Risk Factors for Type 2 Diabetes

People who develop type 2 diabetes are more likely to have the following characteristics:

- age 45 or older  - overweight or obese  - physically inactive  - parent or sibling with diabetes  - family background that is African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander American  - history of giving birth to a baby weighing more than 9 pounds  - history of gestational diabetes  - high blood pressure140/90 or aboveor being treated for high blood pressure  - high-density lipoprotein (HDL), or good, cholesterol below 35 milligrams per deciliter (mg/dL), or a triglyceride level above 250 mg/dL  - polycystic ovary syndrome, also called PCOS  - prediabetesan A1C level of 5.7 to 6.4 percent; a fasting plasma glucose test result of 100125 mg/dL, called impaired fasting glucose; or a 2-hour oral glucose tolerance test result of 140199, called impaired glucose tolerance  - acanthosis nigricans, a condition associated with insulin resistance, characterized by a dark, velvety rash around the neck or armpits  - history of CVD

The American Diabetes Association (ADA) recommends that testing to detect prediabetes and type 2 diabetes be considered in adults who are overweight or obese and have one or more additional risk factors for diabetes. In adults without these risk factors, testing should begin at age 45. </s>


Input: What causes Causes of Diabetes ?

Output:
Insulin Resistance and Beta Cell Dysfunction

Hormones produced by the placenta and other pregnancy-related factors contribute to insulin resistance, which occurs in all women during late pregnancy. Insulin resistance increases the amount of insulin needed to control blood glucose levels. If the pancreas cant produce enough insulin due to beta cell dysfunction, gestational diabetes occurs.

As with type 2 diabetes, excess weight is linked to gestational diabetes. Overweight or obese women are at particularly high risk for gestational diabetes because they start pregnancy with a higher need for insulin due to insulin resistance. Excessive weight gain during pregnancy may also increase risk.

Family History

Having a family history of diabetes is also a risk factor for gestational diabetes, suggesting that genes play a role in its development. Genetics may also explain why the disorder occurs more frequently in African Americans, American Indians, and Hispanics/Latinos. Many gene variants or combinations of variants may increase a womans risk for developing gestational diabetes. Studies have found several gene variants associated with gestational diabetes, but these variants account for only a small fraction of women with gestational diabetes.

Future Risk of Type 2 Diabetes

Because a womans hormones usually return to normal levels soon after giving birth, gestational diabetes disappears in most women after delivery. However, women who have gestational diabetes are more likely to develop gestational diabetes with future pregnancies and develop type 2 diabetes.3 Women with gestational diabetes should be tested for persistent diabetes 6 to 12 weeks after delivery and at least every 3 years thereafter.

Also, exposure to high glucose levels during gestation increases a childs risk for becoming overweight or obese and for developing type 2 diabetes later on. The result may be a cycle of diabetes affecting multiple generations in a family. For both mother and child, maintaining a healthy body weight and being physically active may help prevent type 2 diabetes. </s>


Input: What causes Causes of Diabetes ?

Output:
Other types of diabetes have a variety of possible causes.

Genetic Mutations Affecting Beta Cells, Insulin, and Insulin Action

Some relatively uncommon forms of diabetes known as monogenic diabetes are caused by mutations, or changes, in a single gene. These mutations are usually inherited, but sometimes the gene mutation occurs spontaneously. Most of these gene mutations cause diabetes by reducing beta cells ability to produce insulin.

The most common types of monogenic diabetes are neonatal diabetes mellitus (NDM) and MODY. NDM occurs in the first 6 months of life. MODY is usually found during adolescence or early adulthood but sometimes is not diagnosed until later in life. More information about NDM and MODY is provided in the NIDDK health topic, Monogenic Forms of Diabetes.

Other rare genetic mutations can cause diabetes by damaging the quality of insulin the body produces or by causing abnormalities in insulin receptors.

Other Genetic Diseases

Diabetes occurs in people with Down syndrome, Klinefelter syndrome, and Turner syndrome at higher rates than the general population. Scientists are investigating whether genes that may predispose people to genetic syndromes also predispose them to diabetes.

The genetic disorders cystic fibrosis and hemochromatosis are linked to diabetes. Cystic fibrosis produces abnormally thick mucus, which blocks the pancreas. The risk of diabetes increases with age in people with cystic fibrosis. Hemochromatosis causes the body to store too much iron. If the disorder is not treated, iron can build up in and damage the pancreas and other organs.

Damage to or Removal of the Pancreas

Pancreatitis, cancer, and trauma can all harm the pancreatic beta cells or impair insulin production, thus causing diabetes. If the damaged pancreas is removed, diabetes will occur due to the loss of the beta cells.

Endocrine Diseases

Endocrine diseases affect organs that produce hormones. Cushings syndrome and acromegaly are examples of hormonal disorders that can cause prediabetes and diabetes by inducing insulin resistance. Cushings syndrome is marked by excessive production of cortisolsometimes called the stress hormone. Acromegaly occurs when the body produces too much growth hormone. Glucagonoma, a rare tumor of the pancreas, can also cause diabetes. The tumor causes the body to produce too much glucagon. Hyperthyroidism, a disorder that occurs when the thyroid gland produces too much thyroid hormone, can also cause elevated blood glucose levels.

Autoimmune Disorders

Rare disorders characterized by antibodies that disrupt insulin action can lead to diabetes. This kind of diabetes is often associated with other autoimmune disorders such as lupus erythematosus. Another rare autoimmune disorder called stiff-man syndrome is associated with antibodies that attack the beta cells, similar to type 1 diabetes.

Medications and Chemical Toxins

Some medications, such as nicotinic acid and certain types of diuretics, anti-seizure drugs, psychiatric drugs, and drugs to treat human immunodeficiency virus (HIV), can impair beta cells or disrupt insulin action. Pentamidine, a drug prescribed to treat a type of pneumonia, can increase the risk of pancreatitis, beta cell damage, and diabetes. Also, glucocorticoidssteroid hormones that are chemically similar to naturally produced cortisolmay impair insulin action. Glucocorticoids are used to treat inflammatory illnesses such as rheumatoid arthritis, asthma, lupus, and ulcerative colitis.

Many chemical toxins can damage or destroy beta cells in animals, but only a few have been linked to diabetes in humans. For example, dioxina contaminant of the herbicide Agent Orange, used during the Vietnam Warmay be linked to the development of type 2 diabetes. In 2000, based on a report from the Institute of Medicine, the U.S. Department of Veterans Affairs (VA) added diabetes to the list of conditions for which Vietnam veterans are eligible for disability compensation. Also, a chemical in a rat poison no longer in use has been shown to cause diabetes if ingested. Some studies suggest a high intake of nitrogen-containing chemicals such as nitrates and nitrites might increase the risk of diabetes. Arsenic has also been studied for possible links to diabetes.

Lipodystrophy

Lipodystrophy is a condition in which fat tissue is lost or redistributed in the body. The condition is associated with insulin resistance and type 2 diabetes. </s>


Input: What causes Causes of Diabetes ?

Output:
Other types of diabetes have a variety of possible causes.

Genetic Mutations Affecting Beta Cells, Insulin, and Insulin Action

Some relatively uncommon forms of diabetes known as monogenic diabetes are caused by mutations, or changes, in a single gene. These mutations are usually inherited, but sometimes the gene mutation occurs spontaneously. Most of these gene mutations cause diabetes by reducing beta cells ability to produce insulin.

The most common types of monogenic diabetes are neonatal diabetes mellitus (NDM) and MODY. NDM occurs in the first 6 months of life. MODY is usually found during adolescence or early adulthood but sometimes is not diagnosed until later in life. More information about NDM and MODY is provided in the NIDDK health topic, Monogenic Forms of Diabetes.

Other rare genetic mutations can cause diabetes by damaging the quality of insulin the body produces or by causing abnormalities in insulin receptors.

Other Genetic Diseases

Diabetes occurs in people with Down syndrome, Klinefelter syndrome, and Turner syndrome at higher rates than the general population. Scientists are investigating whether genes that may predispose people to genetic syndromes also predispose them to diabetes.

The genetic disorders cystic fibrosis and hemochromatosis are linked to diabetes. Cystic fibrosis produces abnormally thick mucus, which blocks the pancreas. The risk of diabetes increases with age in people with cystic fibrosis. Hemochromatosis causes the body to store too much iron. If the disorder is not treated, iron can build up in and damage the pancreas and other organs.

Damage to or Removal of the Pancreas

Pancreatitis, cancer, and trauma can all harm the pancreatic beta cells or impair insulin production, thus causing diabetes. If the damaged pancreas is removed, diabetes will occur due to the loss of the beta cells.

Endocrine Diseases

Endocrine diseases affect organs that produce hormones. Cushings syndrome and acromegaly are examples of hormonal disorders that can cause prediabetes and diabetes by inducing insulin resistance. Cushings syndrome is marked by excessive production of cortisolsometimes called the stress hormone. Acromegaly occurs when the body produces too much growth hormone. Glucagonoma, a rare tumor of the pancreas, can also cause diabetes. The tumor causes the body to produce too much glucagon. Hyperthyroidism, a disorder that occurs when the thyroid gland produces too much thyroid hormone, can also cause elevated blood glucose levels.

Autoimmune Disorders

Rare disorders characterized by antibodies that disrupt insulin action can lead to diabetes. This kind of diabetes is often associated with other autoimmune disorders such as lupus erythematosus. Another rare autoimmune disorder called stiff-man syndrome is associated with antibodies that attack the beta cells, similar to type 1 diabetes.

Medications and Chemical Toxins

Some medications, such as nicotinic acid and certain types of diuretics, anti-seizure drugs, psychiatric drugs, and drugs to treat human immunodeficiency virus (HIV), can impair beta cells or disrupt insulin action. Pentamidine, a drug prescribed to treat a type of pneumonia, can increase the risk of pancreatitis, beta cell damage, and diabetes. Also, glucocorticoidssteroid hormones that are chemically similar to naturally produced cortisolmay impair insulin action. Glucocorticoids are used to treat inflammatory illnesses such as rheumatoid arthritis, asthma, lupus, and ulcerative colitis.

Many chemical toxins can damage or destroy beta cells in animals, but only a few have been linked to diabetes in humans. For example, dioxina contaminant of the herbicide Agent Orange, used during the Vietnam Warmay be linked to the development of type 2 diabetes. In 2000, based on a report from the Institute of Medicine, the U.S. Department of Veterans Affairs (VA) added diabetes to the list of conditions for which Vietnam veterans are eligible for disability compensation. Also, a chemical in a rat poison no longer in use has been shown to cause diabetes if ingested. Some studies suggest a high intake of nitrogen-containing chemicals such as nitrates and nitrites might increase the risk of diabetes. Arsenic has also been studied for possible links to diabetes.

Lipodystrophy

Lipodystrophy is a condition in which fat tissue is lost or redistributed in the body. The condition is associated with insulin resistance and type 2 diabetes. </s>


Input: What to do for Causes of Diabetes ?

Output: - Diabetes is a complex group of diseases with a variety of causes. Scientists believe genes and environmental factors interact to cause diabetes in most cases.  - People with diabetes have high blood glucose, also called high blood sugar or hyperglycemia. Diabetes develops when the body doesnt make enough insulin or is not able to use insulin effectively, or both.  - Insulin is a hormone made by beta cells in the pancreas. Insulin helps cells throughout the body absorb and use glucose for energy. If the body does not produce enough insulin or cannot use insulin effectively, glucose builds up in the blood instead of being absorbed by cells in the body, and the body is starved of energy.  - Prediabetes is a condition in which blood glucose levels or A1C levels are higher than normal but not high enough to be diagnosed as diabetes. People with prediabetes can substantially reduce their risk of developing diabetes by losing weight and increasing physical activity.  - The two main types of diabetes are type 1 diabetes and type 2 diabetes. Gestational diabetes is a third form of diabetes that develops only during pregnancy.  - Type 1 diabetes is caused by a lack of insulin due to the destruction of insulin-producing beta cells. In type 1 diabetesan autoimmune diseasethe bodys immune system attacks and destroys the beta cells.  - Type 2 diabetesthe most common form of diabetesis caused by a combination of factors, including insulin resistance, a condition in which the bodys muscle, fat, and liver cells do not use insulin effectively. Type 2 diabetes develops when the body can no longer produce enough insulin to compensate for the impaired ability to use insulin.  - Scientists believe gestational diabetes is caused by the hormonal changes and metabolic demands of pregnancy together with genetic and environmental factors. Risk factors for gestational diabetes include being overweight and having a family history of diabetes.  - Monogenic forms of diabetes are relatively uncommon and are caused by mutations in single genes that limit insulin production, quality, or action in the body.  - Other types of diabetes are caused by diseases and injuries that damage the pancreas; certain chemical toxins and medications; infections; and other conditions. </s>


Input: What is (are) Urinary Retention ?

Output:
Urinary retention is the inability to empty the bladder completely. Urinary retention can be acute or chronic. Acute urinary retention happens suddenly and lasts only a short time. People with acute urinary retention cannot urinate at all, even though they have a full bladder. Acute urinary retention, a potentially life-threatening medical condition, requires immediate emergency treatment. Acute urinary retention can cause great discomfort or pain.

Chronic urinary retention can be a long-lasting medical condition. People with chronic urinary retention can urinate. However, they do not completely empty all of the urine from their bladders. Often people are not even aware they have this condition until they develop another problem, such as urinary incontinenceloss of bladder control, resulting in the accidental loss of urineor a urinary tract infection (UTI), an illness caused by harmful bacteria growing in the urinary tract. </s>


Input: What is (are) Urinary Retention ?

Output:
The urinary tract is the bodys drainage system for removing urine, which is composed of wastes and extra fluid. In order for normal urination to occur, all body parts in the urinary tract need to work together in the correct order.

Kidneys. The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine. The kidneys work around the clock; a person does not control what they do.

Ureters. Ureters are the thin tubes of muscleone on each side of the bladderthat carry urine from each of the kidneys to the bladder.

Bladder. The bladder, located in the pelvis between the pelvic bones, is a hollow, muscular, balloon-shaped organ that expands as it fills with urine. Although a person does not control kidney function, a person does control when the bladder empties. Bladder emptying is known as urination. The bladder stores urine until the person finds an appropriate time and place to urinate. A normal bladder acts like a reservoir and can hold 1.5 to 2 cups of urine. How often a person needs to urinate depends on how quickly the kidneys produce the urine that fills the bladder. The muscles of the bladder wall remain relaxed while the bladder fills with urine. As the bladder fills to capacity, signals sent to the brain tell a person to find a toilet soon. During urination, the bladder empties through the urethra, located at the bottom of the bladder.

Three sets of muscles work together like a dam, keeping urine in the bladder.

The first set is the muscles of the urethra itself. The area where the urethra joins the bladder is the bladder neck. The bladder neck, composed of the second set of muscles known as the internal sphincter, helps urine stay in the bladder. The third set of muscles is the pelvic floor muscles, also referred to as the external sphincter, which surround and support the urethra.

To urinate, the brain signals the muscular bladder wall to tighten, squeezing urine out of the bladder. At the same time, the brain signals the sphincters to relax. As the sphincters relax, urine exits the bladder through the urethra. </s>