mirror of
https://github.com/Monadical-SAS/reflector.git
synced 2025-12-22 05:09:05 +00:00
update folder structure
This commit is contained in:
Gokul Mohanarangan
@@ -1,220 +0,0 @@
|
||||
import json
|
||||
import os
|
||||
import re
|
||||
from dataclasses import dataclass
|
||||
from pathlib import Path
|
||||
from typing import List, Union
|
||||
|
||||
from jiwer import wer
|
||||
from Levenshtein import distance
|
||||
from tqdm.auto import tqdm
|
||||
from whisper.normalizers import EnglishTextNormalizer
|
||||
|
||||
|
||||
@dataclass
|
||||
class EvaluationResult:
|
||||
"""
|
||||
Result object of the model evaluation
|
||||
"""
|
||||
|
||||
accuracy = float
|
||||
total_test_samples = int
|
||||
|
||||
def __init__(self, accuracy, total_test_samples):
|
||||
self.accuracy = accuracy
|
||||
self.total_test_samples = total_test_samples
|
||||
|
||||
def __repr__(self):
|
||||
return (
|
||||
"EvaluationResult("
|
||||
+ json.dumps(
|
||||
{
|
||||
"accuracy": self.accuracy,
|
||||
"total_test_samples": self.total_test_samples,
|
||||
}
|
||||
)
|
||||
+ ")"
|
||||
)
|
||||
|
||||
|
||||
@dataclass
|
||||
class EvaluationTestSample:
|
||||
"""
|
||||
Represents one test sample
|
||||
"""
|
||||
|
||||
reference_text = str
|
||||
predicted_text = str
|
||||
|
||||
def __init__(self, reference_text, predicted_text):
|
||||
self.reference_text = reference_text
|
||||
self.predicted_text = predicted_text
|
||||
|
||||
def update(self, reference_text, predicted_text):
|
||||
self.reference_text = reference_text
|
||||
self.predicted_text = predicted_text
|
||||
|
||||
|
||||
class TestDatasetLoader:
|
||||
"""
|
||||
Test samples loader
|
||||
"""
|
||||
|
||||
parent_dir = None
|
||||
total_samples = 0
|
||||
|
||||
def __init__(self, parent_dir: Union[Path | str]):
|
||||
if isinstance(parent_dir, str):
|
||||
self.parent_dir = Path(parent_dir)
|
||||
else:
|
||||
self.parent_dir = parent_dir
|
||||
|
||||
def _load_test_data(self) -> tuple[str, str]:
|
||||
"""
|
||||
Loader function to validate inout files and generate samples
|
||||
"""
|
||||
PREDICTED_TEST_SAMPLES_DIR = self.parent_dir / "predicted_texts"
|
||||
REFERENCE_TEST_SAMPLES_DIR = self.parent_dir / "reference_texts"
|
||||
|
||||
for filename in os.listdir(PREDICTED_TEST_SAMPLES_DIR.as_posix()):
|
||||
match = re.search(r"(\d+)\.txt$", filename)
|
||||
if match:
|
||||
sample_id = match.group(1)
|
||||
pred_file_path = (PREDICTED_TEST_SAMPLES_DIR / filename).as_posix()
|
||||
ref_file_name = "ref_sample_" + str(sample_id) + ".txt"
|
||||
ref_file_path = (REFERENCE_TEST_SAMPLES_DIR / ref_file_name).as_posix()
|
||||
if os.path.exists(ref_file_path):
|
||||
self.total_samples += 1
|
||||
yield ref_file_path, pred_file_path
|
||||
|
||||
def __iter__(self) -> EvaluationTestSample:
|
||||
"""
|
||||
Iter method for the test loader
|
||||
"""
|
||||
for pred_file_path, ref_file_path in self._load_test_data():
|
||||
with open(pred_file_path, "r", encoding="utf-8") as file:
|
||||
pred_text = file.read()
|
||||
with open(ref_file_path, "r", encoding="utf-8") as file:
|
||||
ref_text = file.read()
|
||||
yield EvaluationTestSample(ref_text, pred_text)
|
||||
|
||||
|
||||
class ModelEvaluator:
|
||||
"""
|
||||
Class that comprises all model evaluation related processes and methods
|
||||
"""
|
||||
|
||||
# The 2 popular methods of WER differ slightly. More dimensions of accuracy
|
||||
# will be added. For now, the average of these 2 will serve as the metric.
|
||||
WEIGHTED_WER_LEVENSHTEIN = 0.0
|
||||
WER_LEVENSHTEIN = []
|
||||
WEIGHTED_WER_JIWER = 0.0
|
||||
WER_JIWER = []
|
||||
|
||||
normalizer = None
|
||||
accuracy = None
|
||||
test_dataset_loader = None
|
||||
test_directory = None
|
||||
evaluation_config = {}
|
||||
|
||||
def __init__(self, **kwargs):
|
||||
self.evaluation_config = {k: v for k, v in kwargs.items() if v is not None}
|
||||
if "normalizer" not in self.evaluation_config:
|
||||
self.normalizer = EnglishTextNormalizer()
|
||||
self.evaluation_config["normalizer"] = str(type(self.normalizer))
|
||||
if "parent_dir" not in self.evaluation_config:
|
||||
self.test_directory = Path(__file__).parent
|
||||
self.test_dataset_loader = TestDatasetLoader(self.test_directory)
|
||||
self.evaluation_config["test_directory"] = str(self.test_directory)
|
||||
|
||||
def __repr__(self):
|
||||
return "ModelEvaluator(" + json.dumps(self.describe(), indent=4) + ")"
|
||||
|
||||
def describe(self) -> dict:
|
||||
"""
|
||||
Returns the parameters defining the evaluator
|
||||
"""
|
||||
return self.evaluation_config
|
||||
|
||||
def _normalize(self, sample: EvaluationTestSample) -> None:
|
||||
"""
|
||||
Normalize both reference and predicted text
|
||||
"""
|
||||
sample.update(
|
||||
self.normalizer(sample.reference_text),
|
||||
self.normalizer(sample.predicted_text),
|
||||
)
|
||||
|
||||
def _calculate_wer(self, sample: EvaluationTestSample) -> float:
|
||||
"""
|
||||
Based on weights for (insert, delete, substitute), calculate
|
||||
the Word Error Rate
|
||||
"""
|
||||
levenshtein_distance = distance(
|
||||
s1=sample.reference_text,
|
||||
s2=sample.predicted_text,
|
||||
weights=(
|
||||
self.evaluation_config["insertion_penalty"],
|
||||
self.evaluation_config["deletion_penalty"],
|
||||
self.evaluation_config["substitution_penalty"],
|
||||
),
|
||||
)
|
||||
wer = levenshtein_distance / len(sample.reference_text)
|
||||
return wer
|
||||
|
||||
def _calculate_wers(self) -> None:
|
||||
"""
|
||||
Compute WER
|
||||
"""
|
||||
for sample in tqdm(self.test_dataset_loader, desc="Evaluating", ncols=100):
|
||||
self._normalize(sample)
|
||||
wer_item_l = {
|
||||
"wer": self._calculate_wer(sample),
|
||||
"no_of_words": len(sample.reference_text),
|
||||
}
|
||||
wer_item_j = {
|
||||
"wer": wer(sample.reference_text, sample.predicted_text),
|
||||
"no_of_words": len(sample.reference_text),
|
||||
}
|
||||
self.WER_LEVENSHTEIN.append(wer_item_l)
|
||||
self.WER_JIWER.append(wer_item_j)
|
||||
|
||||
def _calculate_weighted_wer(self, wers: List[float]) -> float:
|
||||
"""
|
||||
Calculate the weighted WER from WER
|
||||
"""
|
||||
total_wer = 0.0
|
||||
total_words = 0.0
|
||||
for item in wers:
|
||||
total_wer += item["no_of_words"] * item["wer"]
|
||||
total_words += item["no_of_words"]
|
||||
return total_wer / total_words
|
||||
|
||||
def _calculate_model_accuracy(self) -> None:
|
||||
"""
|
||||
Compute model accuracy
|
||||
"""
|
||||
self._calculate_wers()
|
||||
weighted_wer_levenshtein = self._calculate_weighted_wer(self.WER_LEVENSHTEIN)
|
||||
weighted_wer_jiwer = self._calculate_weighted_wer(self.WER_JIWER)
|
||||
|
||||
final_weighted_wer = (weighted_wer_levenshtein + weighted_wer_jiwer) / 2
|
||||
self.accuracy = (1 - final_weighted_wer) * 100
|
||||
|
||||
def evaluate(self, recalculate: bool = False) -> EvaluationResult:
|
||||
"""
|
||||
Triggers the model evaluation
|
||||
"""
|
||||
if not self.accuracy or recalculate:
|
||||
self._calculate_model_accuracy()
|
||||
return EvaluationResult(self.accuracy, self.test_dataset_loader.total_samples)
|
||||
|
||||
|
||||
eval_config = {"insertion_penalty": 1, "deletion_penalty": 2, "substitution_penalty": 1}
|
||||
|
||||
evaluator = ModelEvaluator(**eval_config)
|
||||
evaluation = evaluator.evaluate()
|
||||
|
||||
print(evaluator)
|
||||
print(evaluation)
|
||||
print("Model accuracy : {:.2f} %".format(evaluation.accuracy))
|
||||
File diff suppressed because one or more lines are too long
File diff suppressed because one or more lines are too long
File diff suppressed because one or more lines are too long
File diff suppressed because it is too large
Load Diff
@@ -1,620 +0,0 @@
|
||||
Technologies ticker symbol w-e-l-l on
|
||||
|
||||
the TSX recently reported its 2023 q1
|
||||
|
||||
results beating the streets consensus
|
||||
|
||||
estimate for revenue and adjusted ebitda
|
||||
|
||||
and in a report issued this week Raymond
|
||||
|
||||
James analyst said quote we're impressed
|
||||
|
||||
by Wells capacity to drive powerful
|
||||
|
||||
growth across its diverse business units
|
||||
|
||||
in the absence of M A joining me today
|
||||
|
||||
is CEO Hamed chabazi to look at what's
|
||||
|
||||
next for well health good to see you sir
|
||||
|
||||
how are you great to see you Richard
|
||||
|
||||
thanks very much for having me great to
|
||||
|
||||
have you uh congratulations on your 17th
|
||||
|
||||
consecutive quarter of record Revenue
|
||||
|
||||
can you share some insights into what's
|
||||
|
||||
Driven these results historically and in
|
||||
|
||||
the past quarter as well
|
||||
|
||||
yeah thank you we we're very excited
|
||||
|
||||
about our uh q1 2023 results and as you
|
||||
|
||||
mentioned uh we've had a long you know
|
||||
|
||||
successful uh string of of uh you know
|
||||
|
||||
continued growth and record growth
|
||||
|
||||
um we also had accelerating organic
|
||||
|
||||
growth and I think um a big part of the
|
||||
|
||||
success of our franchise here is the
|
||||
|
||||
incredibly sticky and predictable
|
||||
|
||||
Revenue that we have you know well over
|
||||
|
||||
90 of our business is either highly
|
||||
|
||||
reoccurring as in uh the you know highly
|
||||
|
||||
predictable uh results of our two-sided
|
||||
|
||||
network of patients and providers or
|
||||
|
||||
truly recurring as in scheduled or
|
||||
|
||||
subscribed revenues and this allows us
|
||||
|
||||
to essentially make sure that that uh
|
||||
|
||||
you know we're on track it obviously you
|
||||
|
||||
know like any other business things
|
||||
|
||||
happen uh and sometimes it's hard to
|
||||
|
||||
meet those results but what's really
|
||||
|
||||
being unique about our platform is we do
|
||||
|
||||
have exposure to all kinds of different
|
||||
|
||||
aspects of healthcare you know we have
|
||||
|
||||
Prime primary care and Specialized Care
|
||||
|
||||
on both sides of the Border in the US
|
||||
|
||||
and Canada so we have exposure to
|
||||
|
||||
different types of business models we
|
||||
|
||||
have exposure to the U.S payer Network
|
||||
|
||||
which has higher per unit economics than
|
||||
|
||||
Canada and of course the stability and
|
||||
|
||||
uh and and sort of higher Fidelity uh
|
||||
|
||||
kind of Collections and revenue cycle
|
||||
|
||||
process that Canada has over the United
|
||||
|
||||
States where you don't have to kind of
|
||||
|
||||
deal with all of that uh at that payment
|
||||
|
||||
noise so just a lot of I think strength
|
||||
|
||||
built into the platform because of the
|
||||
|
||||
diversity of different Healthcare
|
||||
|
||||
businesses that we support
|
||||
|
||||
and uh where do you see Well's future
|
||||
|
||||
growth coming from which part of the
|
||||
|
||||
business uh excites you the most right
|
||||
|
||||
now yeah well look the centrifugal force
|
||||
|
||||
of well is the healthcare provider and
|
||||
|
||||
we exist to uh Tech enable and
|
||||
|
||||
ameliorate the business of that of that
|
||||
|
||||
Tech of that healthcare provider uh and
|
||||
|
||||
and and that's what we're laser focused
|
||||
|
||||
on and and what we're seeing is
|
||||
|
||||
providers not wanting to run businesses
|
||||
|
||||
anymore it's very simple and so we have
|
||||
|
||||
a digital platform and providers can
|
||||
|
||||
either acquire what they want and need
|
||||
|
||||
from our digital platform and implement
|
||||
|
||||
it themselves
|
||||
|
||||
or they can decide that they don't want
|
||||
|
||||
to run a business anymore they don't
|
||||
|
||||
want to configure and manage technology
|
||||
|
||||
which is becoming a bigger and bigger
|
||||
|
||||
part of their world every single day and
|
||||
|
||||
when we see what we've seen with that
|
||||
|
||||
Dynamic is that uh is that a lot of them
|
||||
|
||||
are now just wanting to work in a place
|
||||
|
||||
where where all the technology is
|
||||
|
||||
configured for them it's wrapped around
|
||||
|
||||
them and they have a competent operating
|
||||
|
||||
partner that is supporting the organ the
|
||||
|
||||
the practice uh and and taking care of
|
||||
|
||||
the front office in the back office so
|
||||
|
||||
that they can focus on providing care
|
||||
|
||||
this results in them seeing more
|
||||
|
||||
patients uh and and being happier
|
||||
|
||||
because you know they became doctors to
|
||||
|
||||
see patients not so they can manage uh
|
||||
|
||||
workers and and deal with HR issues and
|
||||
|
||||
deal with labs and all that kind of
|
||||
|
||||
stuff excellent and I know too that
|
||||
|
||||
Acquisitions have played a key role in
|
||||
|
||||
well can you share any insights into how
|
||||
|
||||
the Acquisitions fit into Wells growth
|
||||
|
||||
strategy
|
||||
|
||||
sure in in look in 2020 and 2021 we did
|
||||
|
||||
a lot of Acquisitions in 2022 we took a
|
||||
|
||||
bit of a breather and we've really
|
||||
|
||||
focused on integration and I think
|
||||
|
||||
that's one of the reasons why you saw
|
||||
|
||||
this accelerating organic growth we
|
||||
|
||||
really were able to demonstrate that we
|
||||
|
||||
could bring together the different
|
||||
|
||||
elements of our technology platform we
|
||||
|
||||
started to sell bundles we started to
|
||||
|
||||
really derive Synergy uh and activate uh
|
||||
|
||||
you know more sales as a result of
|
||||
|
||||
selling uh all the different products
|
||||
|
||||
and services with one voice with One
|
||||
|
||||
Vision uh so we made it easier for
|
||||
|
||||
providers to use their technology and I
|
||||
|
||||
think that was a big reason uh for our
|
||||
|
||||
growth now M A as you know where Capital
|
||||
|
||||
allocation company we're never far from
|
||||
|
||||
it and so we did continue to have you
|
||||
|
||||
know tuck-ins here and there and in fact
|
||||
|
||||
today uh we announced that we've
|
||||
|
||||
acquired uh the Alberta operations of uh
|
||||
|
||||
MCI one Health and other publicly traded
|
||||
|
||||
company uh who was looking to raise
|
||||
|
||||
funds to support their business we're
|
||||
|
||||
very pleased with with this acquisition
|
||||
|
||||
it just demonstrates our continued
|
||||
|
||||
discipline these are you know great
|
||||
|
||||
primary care clinics in in Canada right
|
||||
|
||||
in the greater Calgary area and uh uh
|
||||
|
||||
you know just allows us to grow our
|
||||
|
||||
footprint in Alberta which is an
|
||||
|
||||
important Province for us and it it's
|
||||
|
||||
it's if you look at the price if you
|
||||
|
||||
look at what we're getting uh you know
|
||||
|
||||
it's just demonstrative of our continued
|
||||
|
||||
uh discipline and just you know a few
|
||||
|
||||
days ago at our conference call I
|
||||
|
||||
mentioned uh that we had you know a
|
||||
|
||||
really strong lineup of Acquisitions uh
|
||||
|
||||
and you know they're starting to uh uh I
|
||||
|
||||
think uh come to fruition for us
|
||||
|
||||
a company on the grown-up question I you
|
||||
|
||||
recently announced a new AI investment
|
||||
|
||||
program last month what specific areas
|
||||
|
||||
of healthcare technology or AI are you
|
||||
|
||||
focusing on and what's the strategy when
|
||||
|
||||
it comes to AI
|
||||
|
||||
yes uh look AI as as I'm sure you're
|
||||
|
||||
aware is it's become you know really uh
|
||||
|
||||
an incredibly important topic in in all
|
||||
|
||||
aspects of of business and and you know
|
||||
|
||||
not just business socially as well
|
||||
|
||||
everyone's talking about uh this this
|
||||
|
||||
new breakthrough disruptive technology
|
||||
|
||||
the large language models and generative
|
||||
|
||||
AI
|
||||
|
||||
um I mean look AI uh has been about a 80
|
||||
|
||||
year old overnight success a lot of
|
||||
|
||||
people have been working on this for a
|
||||
|
||||
long time generative AI is just sort of
|
||||
|
||||
you know the culmination of a lot of
|
||||
|
||||
things coming together and working uh
|
||||
|
||||
but it is uncorked enormous uh
|
||||
|
||||
Innovation and and we think that um this
|
||||
|
||||
there's a very good news story about
|
||||
|
||||
this in healthcare particularly where we
|
||||
|
||||
were looking to look we were looking to
|
||||
|
||||
unlock uh the value of of the data that
|
||||
|
||||
that we all produce every single day
|
||||
|
||||
um as as humans and and so we've
|
||||
|
||||
established an AI investment program
|
||||
|
||||
because no one company can can tackle
|
||||
|
||||
all of these Innovations themselves and
|
||||
|
||||
what well has done too is it's taken a
|
||||
|
||||
very much an ecosystem approach by
|
||||
|
||||
establishing its apps.health Marketplace
|
||||
|
||||
and so we're very excited about not only
|
||||
|
||||
uh allocating Capital into promising
|
||||
|
||||
young AI companies that are focused on
|
||||
|
||||
digital health and solving Healthcare
|
||||
|
||||
problems but also giving them access to
|
||||
|
||||
um you know safely and securely to our
|
||||
|
||||
provider Network to our uh you know to
|
||||
|
||||
to our Outpatient Clinic Network which
|
||||
|
||||
is the largest owned and operated
|
||||
|
||||
Network in Canada by far uh so
|
||||
|
||||
um and and when these and it's it was
|
||||
|
||||
remarkable when we announced this
|
||||
|
||||
program we've had just in the in the
|
||||
|
||||
first uh week to 10 days we've had over
|
||||
|
||||
a hundred uh inbound prospects come in
|
||||
|
||||
uh that that wanted to you know
|
||||
|
||||
collaborate with us and again I don't
|
||||
|
||||
think that's necessarily for the money
|
||||
|
||||
you know we're saying we would invest a
|
||||
|
||||
minimum of a quarter of a million
|
||||
|
||||
dollars you know a lot of them will
|
||||
|
||||
likely be higher than a quarter of a
|
||||
|
||||
million dollars
|
||||
|
||||
so it's not life-changing money but but
|
||||
|
||||
our structural advantages and and and
|
||||
|
||||
the benefits that we have in the Well
|
||||
|
||||
Network those are extremely hard to come
|
||||
|
||||
by uh and I think and I think uh uh
|
||||
|
||||
you'll see us uh you know help some of
|
||||
|
||||
these companies uh succeed and they will
|
||||
|
||||
help us drive uh you know more
|
||||
|
||||
Innovation to that helps the provider
|
||||
|
||||
but speaking of this very interesting AI
|
||||
|
||||
I know your company just launched well
|
||||
|
||||
AI voice this is super interesting tell
|
||||
|
||||
me what it is and the impact it could
|
||||
|
||||
have on health care providers
|
||||
|
||||
yeah thanks for uh asking Richard our
|
||||
|
||||
providers uh are thrilled with this you
|
||||
|
||||
know we've we've had a number of of of
|
||||
|
||||
our own well providers testing this
|
||||
|
||||
technology and it it it really feels
|
||||
|
||||
like magic to them it's essentially an
|
||||
|
||||
ambient AI powered scribe so it's a it's
|
||||
|
||||
a service that with the consent of the
|
||||
|
||||
parties involved listens to the
|
||||
|
||||
conversation between a patient and
|
||||
|
||||
provider and then uh essentially
|
||||
|
||||
condenses that into a medically relevant
|
||||
|
||||
note for the chart files uh typically
|
||||
|
||||
that is a lengthy process a doctor has
|
||||
|
||||
to transcribe notes then review those
|
||||
|
||||
notes and make sure that uh a a a a
|
||||
|
||||
appropriate medically oriented and
|
||||
|
||||
structured node is is is uh prepared and
|
||||
|
||||
put into the chart and that could take
|
||||
|
||||
you know sometimes more than more time
|
||||
|
||||
than the actual consultation uh time and
|
||||
|
||||
so we believe that on average if it's
|
||||
|
||||
used regularly and consistently this can
|
||||
|
||||
give providers back at least a third of
|
||||
|
||||
their day
|
||||
|
||||
um and and it's it's just a game changer
|
||||
|
||||
uh and and uh we have now gone into
|
||||
|
||||
General release with this product it's
|
||||
|
||||
widely available in Canada uh it has
|
||||
|
||||
been integrated into our EMR which makes
|
||||
|
||||
it even more valuable tools like this
|
||||
|
||||
are going to start popping up but if
|
||||
|
||||
they're not integrated into your
|
||||
|
||||
practice management system then you have
|
||||
|
||||
to kind of have data in in more than one
|
||||
|
||||
place and and move that around a little
|
||||
|
||||
bit which which makes it a little bit
|
||||
|
||||
more difficult especially with HIPAA
|
||||
|
||||
requirements and and regulations so
|
||||
|
||||
again I think this is the first of many
|
||||
|
||||
types of different products and services
|
||||
|
||||
that allow doctors to place more
|
||||
|
||||
emphasis and focus on the patient
|
||||
|
||||
experience instead of having their head
|
||||
|
||||
in a laptop and looking at you once in a
|
||||
|
||||
while they'll be looking at you and
|
||||
|
||||
speaking to their practice management
|
||||
|
||||
system and I think this you know think
|
||||
|
||||
about it as Alexa for for our doctors uh
|
||||
|
||||
you know this this ability to speak uh
|
||||
|
||||
and and have you know uh you know Voice
|
||||
|
||||
driven AI assistant that does things
|
||||
|
||||
like this I think are going to be you
|
||||
|
||||
know incredibly helpful and valuable uh
|
||||
|
||||
for for healthcare providers
|
||||
|
||||
super fascinating I mean we're just
|
||||
|
||||
hearing you know more about AI maybe AI
|
||||
|
||||
for the first time but here you are with
|
||||
|
||||
a product already on the market in the
|
||||
|
||||
in the healthcare field that's going to
|
||||
|
||||
be pretty attractive to be out there uh
|
||||
|
||||
right ahead of many other people right
|
||||
|
||||
thank you Richard thanks for that
|
||||
|
||||
recognition that's been Our intention we
|
||||
|
||||
we want to demonstrate that we uh you
|
||||
|
||||
know that we're all in on ensuring that
|
||||
|
||||
technology that benefits providers uh is
|
||||
|
||||
is is accelerated and uh de-risked and
|
||||
|
||||
provided uh you know um in in a timely
|
||||
|
||||
way you know providers need this help we
|
||||
|
||||
we have a healthcare crisis in the
|
||||
|
||||
country that is generally characterized
|
||||
|
||||
as a as a lack of doctors and so imagine
|
||||
|
||||
if we can get our doctors to be 20 or 30
|
||||
|
||||
percent more productive through the use
|
||||
|
||||
of these types of tools well they're
|
||||
|
||||
going to just see more patience and and
|
||||
|
||||
that's going to help all of us and uh
|
||||
|
||||
and look if you step back Wells business
|
||||
|
||||
model is all about having exposure to
|
||||
|
||||
the success of doctors and doing our
|
||||
|
||||
best to help them be more successful
|
||||
|
||||
because we're in a revenue share
|
||||
|
||||
relationship with most of the doctors
|
||||
|
||||
that we work with and so this uh this is
|
||||
|
||||
good for the ecosystem it's great for
|
||||
|
||||
the provider and it's great for well as
|
||||
|
||||
well super fascinating I'm Ed shabazzi
|
||||
|
||||
CEO well Health Technologies ticker
|
||||
|
||||
w-e-l-l great to catch up again thank
|
||||
|
||||
you sir
|
||||
|
||||
thank you Richard appreciate you having
|
||||
|
||||
me
|
||||
|
||||
[Music]
|
||||
|
||||
thank you
|
||||
|
||||
@@ -1,970 +0,0 @@
|
||||
learning medicine is hard work osmosis
|
||||
|
||||
makes it easy it takes our lectures and
|
||||
|
||||
notes to create a personalized study
|
||||
|
||||
plan with exclusive videos practice
|
||||
|
||||
questions and flashcards and so much
|
||||
|
||||
more try it free today
|
||||
|
||||
in diabetes mellitus your body has
|
||||
|
||||
trouble moving glucose which is the type
|
||||
|
||||
of sugar from your blood into your cells
|
||||
|
||||
this leads to high levels of glucose in
|
||||
|
||||
your blood and not enough of it in your
|
||||
|
||||
cells and remember that your cells need
|
||||
|
||||
glucose as a source of energy so not
|
||||
|
||||
letting the glucose enter means that the
|
||||
|
||||
cells star for energy despite having
|
||||
|
||||
glucose right on their doorstep in
|
||||
|
||||
general the body controls how much
|
||||
|
||||
glucose is in the blood relative to how
|
||||
|
||||
much gets into the cells with two
|
||||
|
||||
hormones insulin and glucagon insulin is
|
||||
|
||||
used to reduce blood glucose levels and
|
||||
|
||||
glucagon is used to increase blood
|
||||
|
||||
glucose levels both of these hormones
|
||||
|
||||
are produced by clusters of cells in the
|
||||
|
||||
pancreas called islets of langerhans
|
||||
|
||||
insulin is secreted by beta cells in the
|
||||
|
||||
center of these islets and glucagon is
|
||||
|
||||
secreted by alpha cells in the periphery
|
||||
|
||||
of the islets insulin reduces the amount
|
||||
|
||||
of glucose in the blood by binding to
|
||||
|
||||
insulin receptors embedded in the cell
|
||||
|
||||
membrane of various insulin responsive
|
||||
|
||||
tissues like muscle cells in adipose
|
||||
|
||||
tissue when activated the insulin
|
||||
|
||||
receptors cause vesicles containing
|
||||
|
||||
glucose transporter that are inside the
|
||||
|
||||
cell to fuse with the cell membrane
|
||||
|
||||
allowing glucose to be transported into
|
||||
|
||||
the cell glucagon does exactly the
|
||||
|
||||
opposite it raises the blood glucose
|
||||
|
||||
levels by getting the liver to generate
|
||||
|
||||
new molecules of glucose from other
|
||||
|
||||
molecules and also break down glycogen
|
||||
|
||||
into glucose so that I can all get
|
||||
|
||||
dumped into the blood diabetes mellitus
|
||||
|
||||
is diagnosed when blood glucose levels
|
||||
|
||||
get too high and this is seen among 10
|
||||
|
||||
percent of the world population there
|
||||
|
||||
are two types of diabetes type 1 and
|
||||
|
||||
type 2 and the main difference between
|
||||
|
||||
them is the underlying mechanism that
|
||||
|
||||
causes the blood glucose levels to rise
|
||||
|
||||
about 10% of people with diabetes have
|
||||
|
||||
type 1 and the remaining 90% of people
|
||||
|
||||
with diabetes have type 2 let's start
|
||||
|
||||
with type 1 diabetes mellitus sometimes
|
||||
|
||||
just called type 1 diabetes in this
|
||||
|
||||
situation the body doesn't make enough
|
||||
|
||||
insulin the reason this happens is that
|
||||
|
||||
in type 1 diabetes there's a type 4
|
||||
|
||||
hypersensitivity response or a cell
|
||||
|
||||
mediated immune response where a
|
||||
|
||||
person's own T cells at
|
||||
|
||||
the pancreas as a quick review remember
|
||||
|
||||
that the immune system has T cells that
|
||||
|
||||
react to all sorts of antigens which are
|
||||
|
||||
usually small peptides polysaccharides
|
||||
|
||||
or lipids and that some of these
|
||||
|
||||
antigens are part of our own body cells
|
||||
|
||||
it doesn't make sense to allow T cells
|
||||
|
||||
that will attack our own cells to hang
|
||||
|
||||
around until there's this process to
|
||||
|
||||
eliminate them called self tolerance in
|
||||
|
||||
type 1 diabetes there's a genetic
|
||||
|
||||
abnormality that causes a loss of self
|
||||
|
||||
tolerance among T cells that
|
||||
|
||||
specifically target the beta cell
|
||||
|
||||
antigens losing self tolerance means
|
||||
|
||||
that these T cells are allowed to
|
||||
|
||||
recruit other immune cells and
|
||||
|
||||
coordinate an attack on these beta cells
|
||||
|
||||
losing beta cells means less insulin and
|
||||
|
||||
less insulin means that glucose piles up
|
||||
|
||||
in the blood because it can't enter the
|
||||
|
||||
body's cells one really important group
|
||||
|
||||
of genes involved in regulation of the
|
||||
|
||||
immune response is the human leukocyte
|
||||
|
||||
antigen system or HLA system even though
|
||||
|
||||
it's called a system it's basically this
|
||||
|
||||
group of genes on chromosome 6 that
|
||||
|
||||
encode the major histocompatibility
|
||||
|
||||
complex or MHC which is a protein that's
|
||||
|
||||
extremely important in helping the
|
||||
|
||||
immune system recognize foreign
|
||||
|
||||
molecules as well as maintaining self
|
||||
|
||||
tolerance MHC is like the serving
|
||||
|
||||
platter that antigens are presented to
|
||||
|
||||
the immune cells on interestingly people
|
||||
|
||||
with type 1 diabetes often have specific
|
||||
|
||||
HLA genes in common with each other one
|
||||
|
||||
called
|
||||
|
||||
HLA dr3 and another called HLA dr4 but
|
||||
|
||||
this is just a genetic clue right
|
||||
|
||||
because not everyone with HLA dr3 and
|
||||
|
||||
HLA dr4 develops diabetes in diabetes
|
||||
|
||||
mellitus type 1 destruction of beta
|
||||
|
||||
cells usually starts early in life but
|
||||
|
||||
sometimes up to 90% of the beta cells
|
||||
|
||||
are destroyed before symptoms crop up
|
||||
|
||||
for clinical symptoms of uncontrolled
|
||||
|
||||
diabetes that all sound similar our
|
||||
|
||||
polyphagia glycosuria polyuria and
|
||||
|
||||
polydipsia let's go through them one by
|
||||
|
||||
one even though there's a lot of glucose
|
||||
|
||||
in the blood it cannot get into the
|
||||
|
||||
cells which leaves cells starved for
|
||||
|
||||
energy so in response adipose tissue
|
||||
|
||||
starts breaking down fat called
|
||||
|
||||
lipolysis
|
||||
|
||||
and muscle tissue starts breaking down
|
||||
|
||||
proteins both of which results in weight
|
||||
|
||||
loss for someone with uncontrolled
|
||||
|
||||
diabetes this catabolic state leaves
|
||||
|
||||
people feeling hungry
|
||||
|
||||
also known as poly fascia Faiza means
|
||||
|
||||
eating and poly means a lot now with
|
||||
|
||||
high glucose levels that means that when
|
||||
|
||||
blood gets filtered through the kidneys
|
||||
|
||||
some of it starts to spill into the
|
||||
|
||||
urine called glycosuria glyco surfers to
|
||||
|
||||
glucose and urea the urine since glucose
|
||||
|
||||
is osmotically active water tends to
|
||||
|
||||
follow it resulting in an increase in
|
||||
|
||||
urination or polyuria poly again refers
|
||||
|
||||
to a lot and urea again refers to urine
|
||||
|
||||
finally because there's so much
|
||||
|
||||
urination people with uncontrolled
|
||||
|
||||
diabetes become dehydrated and thirsty
|
||||
|
||||
or polydipsia poly means a lot and dip
|
||||
|
||||
SIA means thirst even though people with
|
||||
|
||||
diabetes are not able to produce their
|
||||
|
||||
own insulin they can still respond to
|
||||
|
||||
insulin so treatment involves lifelong
|
||||
|
||||
insulin therapy to regulate their blood
|
||||
|
||||
glucose levels and basically enable
|
||||
|
||||
their cells to use glucose
|
||||
|
||||
one really serious complication with
|
||||
|
||||
type 1 diabetes is called diabetic
|
||||
|
||||
ketoacidosis or DKA to understand it
|
||||
|
||||
let's go back to the process of
|
||||
|
||||
lipolysis where fat is broken down into
|
||||
|
||||
free fatty acids after that happens the
|
||||
|
||||
liver turns the fatty acids into ketone
|
||||
|
||||
bodies like Osito acetic acid in beta
|
||||
|
||||
hydroxy butyrate acid a seed of acetic
|
||||
|
||||
acid is a keto acid because it has a
|
||||
|
||||
ketone group in a carboxylic acid group
|
||||
|
||||
beta hydroxy rhetoric acid on the other
|
||||
|
||||
hand even though it's still one of the
|
||||
|
||||
ketone bodies isn't technically a keto
|
||||
|
||||
acid since its ketone group has been
|
||||
|
||||
reduced to a hydroxyl group these ketone
|
||||
|
||||
bodies are important because they can be
|
||||
|
||||
used by cells for energy but they also
|
||||
|
||||
increase the acidity of the blood which
|
||||
|
||||
is why it's called ketoacidosis and the
|
||||
|
||||
blood becoming really acidic can have
|
||||
|
||||
major effects throughout the body
|
||||
|
||||
individuals can develop custom all
|
||||
|
||||
respiration which is a deep and labored
|
||||
|
||||
breathing as the body tries to move
|
||||
|
||||
carbon dioxide out of the blood in an
|
||||
|
||||
effort to reduce its acidity cells also
|
||||
|
||||
have a transporter that exchanges
|
||||
|
||||
hydrogen ions or protons for potassium
|
||||
|
||||
when the blood gets acidic it's by
|
||||
|
||||
definition loaded with protons that get
|
||||
|
||||
sent into cells while potassium gets
|
||||
|
||||
sent into the fluid outside cells
|
||||
|
||||
another thing to keep in mind is that in
|
||||
|
||||
addition to helping glucose enter cells
|
||||
|
||||
insulin stimulates the sodium potassium
|
||||
|
||||
ATPase --is which help potassium get
|
||||
|
||||
into the cells and so without insulin
|
||||
|
||||
more potassium stays in the fluid
|
||||
|
||||
outside cells both of these mechanisms
|
||||
|
||||
lead to increased potassium in the fluid
|
||||
|
||||
outside cells which quickly makes it
|
||||
|
||||
into the blood and causes hyperkalemia
|
||||
|
||||
the potassium is then excreted so over
|
||||
|
||||
time even though the blood potassium
|
||||
|
||||
levels remain high over all stores of
|
||||
|
||||
potassium in the body which include
|
||||
|
||||
potassium inside cells starts to run low
|
||||
|
||||
individuals will also have a high anion
|
||||
|
||||
gap which reflects a large difference in
|
||||
|
||||
the unmeasured negative and positive
|
||||
|
||||
ions in the serum largely due to the
|
||||
|
||||
build-up of ketoacids
|
||||
|
||||
diabetic ketoacidosis can happen even in
|
||||
|
||||
people who have already been diagnosed
|
||||
|
||||
with diabetes and currently have some
|
||||
|
||||
sort of insulin therapy
|
||||
|
||||
in states of stress like an infection
|
||||
|
||||
the body releases epinephrine which in
|
||||
|
||||
turn stimulates the release of glucagon
|
||||
|
||||
too much glucagon can tip the delicate
|
||||
|
||||
hormonal balance of glucagon and insulin
|
||||
|
||||
in favor of elevating blood sugars and
|
||||
|
||||
can lead to a cascade of events we just
|
||||
|
||||
described increased glucose in the blood
|
||||
|
||||
loss of glucose in the urine loss of
|
||||
|
||||
water dehydration and in parallel and
|
||||
|
||||
need for alternative energy generation
|
||||
|
||||
of ketone bodies and ketoacidosis
|
||||
|
||||
interestingly both ketone bodies break
|
||||
|
||||
down into acetone and escape as a gas by
|
||||
|
||||
getting breathed out the lungs which
|
||||
|
||||
gives us sweet fruity smell to a
|
||||
|
||||
person's breath in general though that's
|
||||
|
||||
the only sweet thing about this illness
|
||||
|
||||
which also causes nausea vomiting and if
|
||||
|
||||
severe mental status changes and acute
|
||||
|
||||
cerebral edema
|
||||
|
||||
treatment of a DKA episode involves
|
||||
|
||||
giving plenty of fluids which helps with
|
||||
|
||||
dehydration insulin which helps lower
|
||||
|
||||
blood glucose levels and replacement of
|
||||
|
||||
electrolytes like potassium all of which
|
||||
|
||||
help to reverse the acidosis now let's
|
||||
|
||||
switch gears and talk about type 2
|
||||
|
||||
diabetes which is where the body makes
|
||||
|
||||
insulin but the tissues don't respond as
|
||||
|
||||
well to it the exact reason why cells
|
||||
|
||||
don't respond isn't fully understood
|
||||
|
||||
essentially the body's providing the
|
||||
|
||||
normal amount of insulin but the cells
|
||||
|
||||
don't move their glucose transporters to
|
||||
|
||||
their membrane in response which
|
||||
|
||||
remember is needed for the glucose to
|
||||
|
||||
get into the cells these cells therefore
|
||||
|
||||
have insulin resistance some risk
|
||||
|
||||
factors for insulin resistance are
|
||||
|
||||
obesity lack of exercise and
|
||||
|
||||
hypertension the exact mechanisms are
|
||||
|
||||
still being explored for example in
|
||||
|
||||
excess of adipose tissue or fat is
|
||||
|
||||
thought to cause the release of free
|
||||
|
||||
fatty acids in so-called edible kinds
|
||||
|
||||
which are signaling molecules that can
|
||||
|
||||
cause inflammation which seems related
|
||||
|
||||
to insulin resistance
|
||||
|
||||
however many people that are obese are
|
||||
|
||||
not diabetic so genetic factors probably
|
||||
|
||||
play a major role as well we see this
|
||||
|
||||
when we look at twin studies as well
|
||||
|
||||
we're having a twin with type-2 diabetes
|
||||
|
||||
increases the risk of developing type 2
|
||||
|
||||
diabetes completely independently of
|
||||
|
||||
other environmental risk factors in type
|
||||
|
||||
2 diabetes since tissues don't respond
|
||||
|
||||
as well to normal levels of insulin the
|
||||
|
||||
body ends up producing more insulin in
|
||||
|
||||
order to get the same effect and move
|
||||
|
||||
glucose out of the blood
|
||||
|
||||
they do this through beta cell
|
||||
|
||||
hyperplasia an increased number of beta
|
||||
|
||||
cells and beta cell hypertrophy where
|
||||
|
||||
they actually grow in size all in this
|
||||
|
||||
attempt to pump out more insulin this
|
||||
|
||||
works for a while and by keeping insulin
|
||||
|
||||
levels higher than normal blood glucose
|
||||
|
||||
levels can be kept normal called normal
|
||||
|
||||
glycemia now along with insulin beta
|
||||
|
||||
cells also secrete islet amyloid
|
||||
|
||||
polypeptide or amylin so while beta
|
||||
|
||||
cells are cranking out insulin they also
|
||||
|
||||
secrete an increased amount of amylin
|
||||
|
||||
over time Emlyn builds up and aggregates
|
||||
|
||||
in the islets this beta cell
|
||||
|
||||
compensation though is not sustainable
|
||||
|
||||
and over time those maxed out beta cells
|
||||
|
||||
get exhausted and they become
|
||||
|
||||
dysfunctional and undergo hypo trophy
|
||||
|
||||
and get smaller as well as hypoplasia
|
||||
|
||||
and die off as beta cells are lost in
|
||||
|
||||
insulin levels decrease glucose levels
|
||||
|
||||
in the blood start to increase in
|
||||
|
||||
patients develop hyperglycemia which
|
||||
|
||||
leads to similar clinical signs that we
|
||||
|
||||
mentioned before like Paul aphasia
|
||||
|
||||
glycosuria polyuria polydipsia but
|
||||
|
||||
unlike type 1 diabetes there's generally
|
||||
|
||||
some circulating insulin in type 2
|
||||
|
||||
diabetes from the beta cells that are
|
||||
|
||||
trying to compensate for the insulin
|
||||
|
||||
resistance this means that the insulin
|
||||
|
||||
glucagon balances such that diabetic
|
||||
|
||||
ketoacidosis does not usually develop
|
||||
|
||||
having said that a complication called
|
||||
|
||||
hyperosmolar hyperglycemic state or HHS
|
||||
|
||||
is much more common in type 2 diabetes
|
||||
|
||||
than type 1 diabetes and it causes
|
||||
|
||||
increased plasma osmolarity due to
|
||||
|
||||
extreme dehydration and concentration of
|
||||
|
||||
the blood to help understand this
|
||||
|
||||
remember that glucose is a polar
|
||||
|
||||
molecule that cannot passively diffuse
|
||||
|
||||
across cell membranes which means that
|
||||
|
||||
it acts as a solute so when levels of
|
||||
|
||||
glucose are super high in the blood
|
||||
|
||||
meaning it's a hyperosmolar State water
|
||||
|
||||
starts to leave the body cells and enter
|
||||
|
||||
the blood vessels leaving the cells were
|
||||
|
||||
relatively dry in travailed rather than
|
||||
|
||||
plump and juicy blood vessels that are
|
||||
|
||||
full of water lead to increased
|
||||
|
||||
urination and total body dehydration and
|
||||
|
||||
this is a very serious situation because
|
||||
|
||||
the dehydration of the body's cells and
|
||||
|
||||
in particular the brain can cause a
|
||||
|
||||
number of symptoms including mental
|
||||
|
||||
status changes in HHS you can sometimes
|
||||
|
||||
see mild ketone emia and acidosis but
|
||||
|
||||
not to the extent that it's seen in DKA
|
||||
|
||||
and in DKA you can see some hyper
|
||||
|
||||
osmolarity so there's definitely overlap
|
||||
|
||||
between these two syndromes
|
||||
|
||||
besides type 1 and type 2 diabetes there
|
||||
|
||||
are also a couple other subtypes of
|
||||
|
||||
diabetes mellitus gestational diabetes
|
||||
|
||||
is when pregnant women have increased
|
||||
|
||||
blood glucose which is particularly
|
||||
|
||||
during the third trimester although
|
||||
|
||||
ultimately unknown the cause is thought
|
||||
|
||||
to be related to pregnancy hormones that
|
||||
|
||||
interfere with insulins action on
|
||||
|
||||
insulin receptors also sometimes people
|
||||
|
||||
can develop drug-induced diabetes which
|
||||
|
||||
is where medications have side effects
|
||||
|
||||
that tend to increase blood glucose
|
||||
|
||||
levels the mechanism for both of these
|
||||
|
||||
is thought to be related to insulin
|
||||
|
||||
resistance like type 2 diabetes rather
|
||||
|
||||
than an autoimmune destruction process
|
||||
|
||||
like in type 1 diabetes diagnosing type
|
||||
|
||||
1 or type 2 diabetes is done by getting
|
||||
|
||||
a sense for how much glucose is floating
|
||||
|
||||
around in the blood and has specific
|
||||
|
||||
standards that the World Health
|
||||
|
||||
Organization uses very commonly a
|
||||
|
||||
fasting glucose test is taken where the
|
||||
|
||||
person doesn't eat or drink except the
|
||||
|
||||
water that's okay for a total of eight
|
||||
|
||||
hours and then has their blood tested
|
||||
|
||||
for glucose levels levels of 100
|
||||
|
||||
milligrams per deciliter to 120
|
||||
|
||||
five milligrams per deciliter indicates
|
||||
|
||||
pre-diabetes and 126 milligrams per
|
||||
|
||||
deciliter or higher indicates diabetes a
|
||||
|
||||
non fasting a random glucose test can be
|
||||
|
||||
done at any time with 200 milligrams per
|
||||
|
||||
deciliter or higher being a red flag for
|
||||
|
||||
diabetes another test is called an oral
|
||||
|
||||
glucose tolerance test where person is
|
||||
|
||||
given glucose and then blood samples are
|
||||
|
||||
taken at time intervals to figure out
|
||||
|
||||
how well it's being cleared from the
|
||||
|
||||
blood the most important interval being
|
||||
|
||||
two hours later levels of 140 milligrams
|
||||
|
||||
per deciliter to 199 milligrams per
|
||||
|
||||
deciliter indicate pre-diabetes
|
||||
|
||||
and 200 or above indicates diabetes
|
||||
|
||||
another thing to know is that when blood
|
||||
|
||||
glucose levels get high the glucose can
|
||||
|
||||
also stick to proteins that are floating
|
||||
|
||||
around in the blood or in cells so that
|
||||
|
||||
brings us to another type of test that
|
||||
|
||||
can be done which is the hba1c test
|
||||
|
||||
which tests for the proportion of
|
||||
|
||||
hemoglobin in red blood cells that has
|
||||
|
||||
glucose stuck to it called glycated
|
||||
|
||||
hemoglobin hba1c levels of 5.7% 26.4%
|
||||
|
||||
indicate pre-diabetes
|
||||
|
||||
and 6.5 percent or higher indicates
|
||||
|
||||
diabetes this proportion of glycated
|
||||
|
||||
hemoglobin doesn't change day to day so
|
||||
|
||||
it gives a sense for whether the blood
|
||||
|
||||
glucose levels have been high over the
|
||||
|
||||
past two to three months finally we have
|
||||
|
||||
the c-peptide test which tests for
|
||||
|
||||
byproducts of insulin production if the
|
||||
|
||||
level of c-peptide is low or absent it
|
||||
|
||||
means the pancreas is no longer
|
||||
|
||||
producing enough insulin and the glucose
|
||||
|
||||
cannot enter the cells
|
||||
|
||||
for type one diabetes insulin is the
|
||||
|
||||
only treatment option for type 2
|
||||
|
||||
diabetes on the other hand lifestyle
|
||||
|
||||
changes like weight loss and exercise
|
||||
|
||||
along with a healthy diet and an oral
|
||||
|
||||
anti-diabetic medication like metformin
|
||||
|
||||
in several other classes can sometimes
|
||||
|
||||
be enough to reverse some of that
|
||||
|
||||
insulin resistance and keep blood sugar
|
||||
|
||||
levels in check however if oral
|
||||
|
||||
anti-diabetic medications fail type 2
|
||||
|
||||
diabetes can also be treated with
|
||||
|
||||
insulin something to bear in mind is
|
||||
|
||||
that insulin treatment comes with a risk
|
||||
|
||||
of hypoglycemia especially if insulin is
|
||||
|
||||
taken without a meal symptoms of
|
||||
|
||||
hypoglycemia can be mild like weakness
|
||||
|
||||
hunger and shaking but they can progress
|
||||
|
||||
to a loss of consciousness in seizures
|
||||
|
||||
in severe cases in mild cases drinking
|
||||
|
||||
juices or eating candy or sugar might be
|
||||
|
||||
enough to bring blood sugar up but in
|
||||
|
||||
severe cases intravenous glucose should
|
||||
|
||||
be given as soon as possible
|
||||
|
||||
the FDA has also recently approved
|
||||
|
||||
intranasal glucagon as a treatment for
|
||||
|
||||
severe hypoglycemia all right now over
|
||||
|
||||
time high glucose levels can cause
|
||||
|
||||
damage to tiny blood vessels while the
|
||||
|
||||
micro vasculature in arterioles a
|
||||
|
||||
process called hyaline
|
||||
|
||||
arteriolosclerosis is where the walls of
|
||||
|
||||
the arterioles develop hyaline deposits
|
||||
|
||||
which are deposits of proteins and these
|
||||
|
||||
make them hard and inflexible in
|
||||
|
||||
capillaries the basement membrane can
|
||||
|
||||
thicken and make it difficult for oxygen
|
||||
|
||||
to easily move from the capillary to the
|
||||
|
||||
tissues causing hypoxia
|
||||
|
||||
one of the most significant effects is
|
||||
|
||||
that diabetes increases the risk of
|
||||
|
||||
medium and large arterial wall damage
|
||||
|
||||
and subsequent atherosclerosis which can
|
||||
|
||||
lead to heart attacks and strokes which
|
||||
|
||||
are major causes of morbidity and
|
||||
|
||||
mortality for patients with diabetes in
|
||||
|
||||
the eyes diabetes can lead to
|
||||
|
||||
retinopathy and evidence of that can be
|
||||
|
||||
seen on a fundus copic exam that shows
|
||||
|
||||
cotton-wool spots or flare hemorrhages
|
||||
|
||||
and can eventually cause blindness in
|
||||
|
||||
the kidneys the a ferrant and efferent
|
||||
|
||||
arterioles as well as the glomerulus
|
||||
|
||||
itself can get damaged which can lead to
|
||||
|
||||
an F Radek syndrome that slowly
|
||||
|
||||
diminishes the kidneys ability to filter
|
||||
|
||||
blood over time and can ultimately lead
|
||||
|
||||
to dialysis diabetes can also affect the
|
||||
|
||||
function of nerves causing symptoms like
|
||||
|
||||
a decrease in sensation in the toes and
|
||||
|
||||
fingers sometimes called a stocking
|
||||
|
||||
glove distribution as well as causes the
|
||||
|
||||
autonomic nervous system to malfunction
|
||||
|
||||
and that system controls a number of
|
||||
|
||||
body functions
|
||||
|
||||
everything from sweating to passing gas
|
||||
|
||||
finally both the poor blood supply and
|
||||
|
||||
nerve damage can lead to ulcers
|
||||
|
||||
typically on the feet that don't heal
|
||||
|
||||
quickly and can get pretty severe and
|
||||
|
||||
need to be amputated these are some of
|
||||
|
||||
the complications of uncontrolled
|
||||
|
||||
diabetes which is why it's important to
|
||||
|
||||
diagnose and control diabetes through a
|
||||
|
||||
healthy lifestyle medications to reduce
|
||||
|
||||
insulin resistance and even insulin
|
||||
|
||||
therapy if beta cells have been
|
||||
|
||||
exhausted while type 1 diabetes cannot
|
||||
|
||||
be prevented type 2 diabetes can in fact
|
||||
|
||||
many people with diabetes can control
|
||||
|
||||
their blood sugar levels really
|
||||
|
||||
effectively and live a full and active
|
||||
|
||||
life without any of the complications
|
||||
|
||||
thanks for watching if you're interested
|
||||
|
||||
in a deeper dive on this topic take a
|
||||
|
||||
look at as Moses org where we have
|
||||
|
||||
flashcards questions and other awesome
|
||||
|
||||
tools to help you learn medicine
|
||||
|
||||
you
|
||||
|
||||
Reference in New Issue
Block a user