Part 1: make a diabetes treatment plan.
1, consult a doctor before starting the treatment plan. 1 type diabetes, also known as juvenile diabetes, is a chronic disease. Despite the name, people of any age can get this disease. 1 type diabetes broke out without warning. If left untreated, the symptoms will become serious and even life-threatening. Therefore, the opinions of qualified doctors or experts are very important when making anti-diabetes plans. The content of this article is only applicable to general situations and cannot replace the opinions of real doctors. Although 1 type or type 2 diabetes cannot be completely cured, as long as you follow the treatment plan all your life, you can control them and lead a normal life. After suffering from diabetes, the sooner you start treatment, the better. If you think you may have diabetes, don't delay and see a doctor as soon as possible. Because the initial symptoms of 1 diabetes may be very serious, patients often need short-term hospitalization after diagnosis.
2. inject insulin every day. 1 The body of diabetic patients cannot produce insulin. The function of this compound is to break down sugar (glucose) in the blood. Without insulin, the symptoms of 1 type diabetes will deteriorate rapidly and eventually lead to death. Specifically, 1 diabetic patients need to inject insulin every day, or they will die. The daily insulin dosage will depend on your body shape, diet, activity and genes. That's why you should see a doctor first and comprehensively evaluate all aspects before starting a diabetes treatment plan. Insulin can usually be divided into several types, each of which has a specific purpose, namely: prandial (pre-prandial) insulin and quick-acting insulin. Generally, it is injected before meals to prevent blood sugar from rising after meals.
Basic insulin: slow effect. Generally, 1-2 times a day during non-meal time to control the blood sugar level when the body is resting (non-meal).
Premixed insulin: a mixed preparation made of pre-prandial insulin and basal insulin in a certain proportion. It can be injected before breakfast and dinner to maintain blood sugar levels after meals and throughout the day.
3. Exercise. Generally speaking, diabetics should try their best to make themselves strong. Physical exercise can lower the body's glucose level, and sometimes the effect can last for 24 hours. The biggest harm of diabetes is the increase of blood sugar level, so exercise is a valuable way to help patients control blood sugar. In addition, diabetic patients can get the same benefits as non-diabetic patients from exercise, such as improving overall health, losing weight, increasing physical strength and endurance, improving energy and improving mood. Diabetes-related resources usually advise patients to exercise at least several times a week. Most resources suggest that it is best to combine aerobic exercise, strength training, balance or flexibility training. You can refer to the article How to Exercise for more information.
For diabetic patients, although it is best to control the blood sugar level at a controllable low level, exercise will lead to hypoglycemia when the blood sugar is low, and the blood sugar in the body is insufficient, so it is impossible to provide enough energy for the muscles in exercise and the important functions of maintaining life. Hypoglycemia causes dizziness, weakness and fainting. In order to avoid hypoglycemia, you can bring sugary carbohydrates that can take effect quickly during exercise, such as soda or sports drinks.
Step 4 decompress. As we all know, both physical and psychological stress will lead to fluctuations in blood sugar levels. In the long run, long-term stress will lead to an increase in blood sugar levels. You may need to take more medicine or exercise more frequently to stay healthy. The best way to combat stress is to prevent it. Regular exercise, adequate sleep, trying to avoid stressful situations and discussing with others before the problem becomes serious can help you avoid stress from the beginning. Other stress management skills include consulting a therapist, meditation, abstaining from caffeine and developing healthy hobbies. You can refer to the article Decompression for more information.
5. Avoid getting sick. Disease not only makes the body suffer from the disease, but also indirectly causes stress and makes the blood sugar level fluctuate. Long-term or serious illness may even affect your diabetes medication and daily exercise. When it comes to getting sick, the best way to deal with it is to avoid getting sick and try to live a healthy, happy and stress-free life. But if you are really sick, you must rest more, take the medicine you need and get better as soon as possible. If you have a cold, you can drink more water, take over-the-counter cold medicine (avoid sugary cough syrup) and have more rest. Because a cold can lead to loss of appetite, you must also consume about 15 grams of carbohydrates per hour. Cold flu often raises blood sugar levels, but if you don't eat because of it, it may bring blood sugar down to dangerous levels.
If it is a serious disease, you usually need to see a doctor. Special drugs and methods are needed to treat serious diseases of diabetic patients. If you are a diabetic and think that you have a more serious disease than the common cold, please see a doctor immediately.
6. Modify the diabetes control plan to solve the problems caused by menstruation and menopause. Women with diabetes face severe challenges in controlling blood sugar during menstruation and menopause. Although diabetes affects every woman differently, many women say that their blood sugar level rises a few days before menstruation, so they must take more insulin or change their diet and exercise habits to control their blood sugar. However, your menstrual blood sugar level may be different from others, so you should consult a doctor or gynecologist for specific suggestions. In addition, menopause will also change the way blood sugar levels fluctuate. Many women say that during menopause, blood sugar levels become more elusive. Menopause will also lead to weight gain, lack of sleep and temporary vaginal diseases, which will lead to the increase of stress hormones and glucose levels in the body. If you have diabetes and are entering menopause, you can discuss with your doctor and find a treatment plan that suits you.
7. Arrange regular check-ups by doctors. 1 After the diagnosis of diabetes, you may need to see a doctor frequently (almost once a week or more) to know what to do to effectively control your blood sugar level. It may take several weeks for the doctor to work out an appropriate insulin treatment plan according to your diet and activity. Once you have a daily treatment plan for diabetes, you don't need to see a doctor often. However, you need to maintain a good relationship with the doctor and arrange follow-up visits from time to time. Doctors can find differences in blood sugar levels before the problem becomes serious; It can also give you valuable advice on how to control diabetes when you are faced with stress, illness, pregnancy and other situations. In short, 1 diabetic patients should see a doctor every 3 to 6 months after making a daily treatment plan.
Type 2 diabetes mellitus
1, consult a doctor before starting treatment. If you have type 2 diabetes, your body can still produce some insulin, instead of no insulin at all like 1 diabetes. However, the body's ability to produce insulin decreases, or insulin cannot be used correctly. Because of this key difference, the symptoms of type 2 diabetes are milder than those of 1 diabetes, and the onset is slower, so intensive treatment is not needed (with some exceptions). Like 1 diabetes, you must see a doctor before you can start treatment. Only qualified medical experts have the knowledge to diagnose diabetes accurately and make a treatment plan according to your personal needs.
2. Try to control diabetes through diet and exercise. As mentioned above, the body of patients with type 2 diabetes is not completely unable to produce and use insulin, but its ability has declined. Because the body can also make some insulin, it is possible for patients with type 2 diabetes to control their condition without artificial insulin. Pay attention to diet and exercise can do this. This means that you need to eat less sugary food, keep a healthy weight and exercise regularly. As long as they pay attention to diet and exercise, some patients with mild type 2 diabetes can basically live a "normal life". However, it must be remembered that some people's type 2 diabetes is more serious than others. They can't control it only by diet and exercise, and may need insulin or other drugs.
Note: For information about diet and medicine, please refer to the following sections.
Be prepared, one day you must receive higher intensity treatment. As we all know, type 2 diabetes is a progressive disease, which will get worse after a long time. This is probably because the insulin-secreting cells in the patient are overworked and "exhausted". Therefore, patients with type 2 diabetes who once only needed mild treatment will eventually need more intensive treatment, including insulin treatment, in a few years. This is not the fault of the patient. Like 1 diabetes, if you have type 2 diabetes, you should keep close contact with your doctor. Regular check-ups can help you find the progress of type 2 diabetes before it gets worse.
4. Obese people can consider bariatric surgery. Obesity is one of the main causes of type 2 diabetes, which will make the disease more dangerous and difficult to control. Obesity brings extra pressure to the body, making it difficult for the body to keep blood sugar at a healthy level. If the patient's body mass index is high (usually over 35), doctors sometimes advise them to have weight-loss surgery to control their weight quickly. In order to control weight, there are two kinds of weight-loss surgery: gastric bypass surgery-reducing the stomach to the size of thumb and shortening the small intestine, thus reducing the heat absorbed by the body from food. This change is permanent.
Laparoscopic gastric banding surgery (hereinafter referred to as "gastric banding")-Use a band to bind your stomach. You eat less food, but you feel fuller. If necessary, adjust or remove restraining strap.
Part 2: Diabetes detection
1, check blood sugar every day. The harm of diabetes is because the blood sugar level rises, so patients must always check their blood sugar level. Nowadays, only a small portable instrument is needed to measure the blood sugar level from a small drop of blood. When, where and how to check your blood sugar depends on your age, type of diabetes and health. Therefore, you need to discuss with your doctor before you start monitoring blood sugar levels. The following opinions are applicable to general situations and cannot replace the doctor's advice. 1 Diabetic patients often need to check their blood sugar three or more times a day, usually before or after meals, before or after exercise, before going to bed or even at night. When you are sick or taking new drugs, you must monitor your blood sugar more closely.
On the other hand, patients with type 2 diabetes don't need to check their blood sugar so often, and doctors may instruct them to check it once or more every day. If this situation can be controlled by non-insulin drugs, or only by diet and exercise, you may not even need to check your blood sugar every day.
2. Check glycosylated hemoglobin several times a year. It is important for diabetics to monitor their blood sugar every day, but it is also important to fully understand the long-term trend of blood sugar levels. Patients should receive special examination of glycosylated hemoglobin regularly. The doctor may instruct you to have this examination once a month or every two or three months to monitor the average blood sugar level (rather than the instantaneous blood sugar index) in the past few months to see if the treatment scheme is effective. This special test analyzes molecules called hemoglobin in blood. When glucose enters the blood, some glucose binds to hemoglobin molecules. Because the life span of hemoglobin is generally only 3 months, analyzing the percentage of hemoglobin bound to glucose can reflect how high the blood sugar level has been in the past few months.
If you have symptoms of ketoacidosis, you must check the ketone bodies in your urine. Insulin in the body is not enough to break down glucose in the blood, and organs and tissues will soon lack energy. This will lead to a dangerous situation called ketoacidosis. The body begins to break down the stored fat to provide energy for important body functions. Although this can maintain the normal operation of the body, it will also produce a large number of ketone bodies, which may be life-threatening if this toxic compound is allowed to accumulate. If your blood sugar reading exceeds 250 mg/dl for two consecutive times, or the following symptoms appear, please immediately check whether you have ketoacidosis (you can buy a simple urine analysis test paper at the counter of the drugstore to check for yourself). If the test results show that your urine contains a lot of ketone bodies, contact your doctor immediately and seek emergency treatment. The symptom of ketoacidosis is nausea.
vomit
The body smells good, and the breath smells like fruit.
Lose weight for no reason.
4. Regular foot and eye examinations. Type 2 diabetes is getting worse, and it is difficult for patients to detect the progress of the disease, so it is important to check whether there are complications in order to solve them before the situation becomes serious. Diabetes can cause nerve damage and change the blood circulation in certain parts of the body, especially the feet and eyes. Over time, patients will lose their feet or become blind. These complications may occur in 1 and type 2 diabetes. However, since type 2 diabetes will gradually worsen unconsciously, it is very important to arrange regular foot and eye examinations to avoid any kind of complications. A comprehensive mydriasis examination should be arranged every year to confirm whether there is diabetic retinopathy (vision loss caused by diabetes). During pregnancy or illness, you need to have this check-up more frequently.
An annual foot examination should be arranged to check the pulse, feeling and whether there are sores or ulcers. If you have ever had a foot ulcer, you may need to have it checked every 3 months.
Part III: Diet Control
1, follow the advice of dietotherapy experts. Diet is very important for controlling diabetes. Careful control of the type and quantity of food you eat can control the blood sugar level, which directly affects the severity of diabetes. This part of the advice comes from reputable sources of diabetes information, but the diabetes treatment plan should be tailored according to your age, size, activity, disease and genetic factors. Therefore, this can only be used as general advice and cannot replace the advice of qualified doctors or nutritionists. If you are not sure how to get special dietary information, you can discuss it with your doctor or general practitioner. He or she can guide your diet plan or recommend experts in this field.
2. Aim at a low-calorie and high-nutrient diet. If you consume more calories than you burn, your blood sugar will rise. The symptoms of diabetes are caused by elevated blood sugar levels, so patients must avoid this situation. Patients should try to eat foods rich in essential nutrients, while keeping the total calorie intake at a low enough level. Foods rich in nutrients and low in calories, such as various vegetables, should constitute a large part of a healthy diet for diabetes. A low-calorie, high-nutrient diet can help you maintain a healthy weight and help you treat diabetes. As we all know, obesity is the main factor leading to type 2 diabetes.
3. Give priority to healthy carbohydrates, such as whole grains. In recent years, the harm of carbohydrates to health has caused a lot of controversy. In fact, most diabetes resources recommend a certain amount of carbohydrates, more specifically, healthy and nutritious carbohydrates. Basically, diabetics need to reduce their carbohydrate intake to a moderately low level and ensure that they eat whole grains and high-fiber carbohydrates. Here's a more detailed explanation: most carbohydrates come from wheat, oats, rice, barley and similar grains. They can be divided into two categories: whole grains and flour and rice. Whole grains retain whole grains, including nutritious hulls (called wheat bran and germ). In flour and rice, only the innermost starch part (called endosperm) is left, which has low nutritional value. With the same calories, whole grains are more nutritious than flour and rice, so we try to eat whole grains first, followed by rice made of white bread, pasta and wheat.
4. Eat foods rich in fiber. Fiber is a nutrient contained in vegetables, fruits and other plant foods. The fiber is basically undigested, and most of the fiber eaten in the abdomen is undigested and directly enters the intestine. Although fiber can't provide much nutrition, it has many benefits to health. For example, it helps to control hunger and help you control your food intake at a healthy level. It can also keep the digestive system healthy and help you defecate smoothly. For diabetics, high fiber food is a good choice, which makes it easier for them to control their daily food intake at a healthy level. High fiber foods include most fruits (especially raspberries, pears and apples), whole grains, wheat bran, beans (especially beans and lentils) and vegetables (especially artichokes, broccoli and beans).
5. Take protein from lean meat. Protein is often praised as a healthy energy source and nutrition for muscle exercise, but it is true. But some protein sources also contain a lot of fat. If you want to eat protein more wisely, you can choose a lean protein source with low fat and high nutrition. It is understood that protein can not only provide nutrition for a strong body, but also give you a stronger and more lasting satiety than other heat sources. The sources of lean meat protein include skinless white broilers (dark meat such as chicken legs contains a little more fat, while the skin contains a little more fat), most fish, dairy products, beans, eggs, pork tenderloin and lean meat.
6. Eat some "good" fat in moderation. Contrary to popular belief, fat in the diet is not useless. In fact, some types of fats, namely monounsaturated fats and polyunsaturated fats (including omega-3 fatty acids), are good for health and can lower the level of low-density lipoprotein in the body, which is called "bad" cholesterol. However, all fats are high in calories, so you need to eat less fat to maintain a healthy weight. Try adding a small amount of "good" fat to your diet without increasing the total daily calories. Doctors or dietotherapy experts can help you do this. Foods rich in "good" fats (monounsaturated fats and polyunsaturated fats) include avocados, most nuts (including almonds, pecans, cashews and peanuts), fish, tofu and flaxseed.
On the other hand, foods rich in "bad" fats (saturated fats and trans fats) include fats (including ordinary beef or ground beef, bacon, sausages and so on). ), high-fat dairy products (including cream, ice cream, whole milk, cheese, butter, etc. ), chocolate, lard, coconut oil, poultry skin, processed snacks, fried food.
7. Avoid foods with high cholesterol content. Cholesterol is oil, a fat molecule naturally produced by human body and an important component of cell membrane formation. Although the human body needs a certain amount of cholesterol, the increase of blood cholesterol will cause various serious cardiovascular problems, such as heart disease and stroke. The cholesterol level of diabetic patients is inherently unhealthy, so it is very important to monitor their cholesterol intake compared with non-diabetic patients. They must choose their food carefully and reduce their cholesterol intake. Cholesterol is divided into low-density cholesterol and high-density cholesterol, which are called "bad" cholesterol and "good" cholesterol. Bad cholesterol is deposited on the inner wall of arteries, which eventually leads to heart attack and stroke, while good cholesterol helps to remove destructive cholesterol from the blood. Diabetic patients must try their best to control the "bad" cholesterol level to the lowest level, and at the same time, they must take in a proper amount of "good" cholesterol.
The sources of "bad" cholesterol include: high-fat dairy products, egg yolk, liver and other internal organs, fat meat and poultry skin.
Good sources of cholesterol include oats, nuts, most fish, olive oil and foods containing phytosterols.
8. Drink carefully. Alcohol is often called a non-nutritive heat source, which is not without reason. Alcoholic beverages such as beer, wine and spirits contain calories, but there is almost no actual nutrition. Most diabetics can still enjoy these recreational drinks moderately (no nutrition). According to the American Diabetes Association, moderate drinking actually has no effect on blood sugar control and will not cause heart disease. Therefore, they basically encourage patients to follow the same drinking guidelines as non-diabetic patients: men can drink 2 glasses of wine a day and women can drink 1 cup. Note that medically, 1 glass of wine is the standard weight of a specific beverage, with beer being 355 ml, wine being 148 ml and spirits being 44 ml.
In addition, these guidelines do not include sugary drinks and additives that may be added to cocktails, which will negatively affect the blood sugar level of diabetic patients.
9. Control components wisely. The most frustrating thing in any diet plan (including diabetes diet) is to eat too much. Even healthy and nutritious food will lead to weight gain, which will lead to health problems. Diabetes patients must maintain their weight at a healthy level, so weight control is a problem that must be seriously concerned. Basically, in a big meal (such as dinner), patients must eat a lot of nutritious high-fiber vegetables, a certain amount of lean protein and cereals or carbohydrates containing starch. Many sources of diabetes information provide samples of diet lists to educate patients about the importance of weight control. Most wizards provide advice that is very similar to the following example:
Half of the whole diet is high-fiber vegetables without starch, such as kale, spinach, broccoli, beans, cabbage, onion, pepper, turnip, tomato and cauliflower.
A quarter of the whole diet is healthy starch and grains, such as whole wheat bread, oats, rice, pasta, potatoes, beans, peas, grits, pumpkins and popcorn.
The remaining quarter is lean protein, such as skinless chicken or turkey, fish, seafood, lean beef or pork, tofu and eggs.
Part 4: Drug therapy
1, consult your doctor before taking any diabetes drugs. Diabetes is a serious disease, which needs special medication. If used improperly, these drugs can also cause serious diseases. Before taking any diabetes drugs, discuss with your doctor and make a plan that takes into account all treatment plans, including diet and exercise. Diabetes, like all serious diseases, needs the advice of qualified professionals. The information in this section is for reference only and should not be used as the basis for drug selection or dosage decision. In addition, if you find that you have diabetes, you don't necessarily need to stop taking the drugs you are currently taking. When making a diabetes treatment plan, the doctor must evaluate all the variables that work, including the drugs you are taking now.
Eating too much or too little diabetes drugs will have serious consequences. For example, excessive insulin can lead to hypoglycemia, and in severe cases it can lead to dizziness, fatigue, confusion and even coma.
2. Use insulin to control blood sugar. Insulin is probably the most widely known diabetes drug. Insulin is a naturally occurring chemical substance in the pancreas, which helps to deal with blood sugar, while most of the insulin prescribed by doctors for diabetic patients is synthetic. When blood sugar rises after a meal, healthy people's bodies secrete insulin to break down sugar, transfer it out of the blood and convert it into usable energy. Injecting insulin can help the body deal with blood sugar correctly. Because medicinal insulin has different strengths and types, you must get the doctor's advice before you can start injecting insulin. Note 1 Diabetic patients must receive insulin therapy. Their bodies can't secrete insulin at all, so patients must inject insulin into their bodies themselves. Patients with type 2 diabetes may or may not need insulin, depending on the severity of the disease.
3, oral diabetes drugs to control blood sugar. There are many kinds of oral diabetes drugs (pills) to choose from. If the condition is only moderate, doctors will usually suggest trying these oral drugs first, and then using insulin if it is really not feasible. Insulin therapy is more intense and will affect life. Because there are many kinds of oral diabetes drugs, each of which has a different mechanism of action, you must discuss with your doctor before taking them to make sure that you can take them safely. The following lists a variety of oral diabetes drugs, and briefly describes the mechanism of action of each drug: sulfonylureas-stimulate the pancreas to secrete more insulin.
Biguanidine drugs-reduce the glucose produced by the liver and enhance the sensitivity of muscle tissue to insulin.
Chloroacetic acid drugs-stimulate the pancreas to secrete more insulin.
Thiazolidinedione-reduces the glucose produced by the liver and enhances the sensitivity of muscle and adipose tissue to insulin.
DPP-4 (Dipeptidyl Peptidase 4) Inhibitor —— Preventing the short-term disintegration of chemical mechanism for regulating blood sugar level.
SGLT2 (sodium glucose transporter 2) inhibitor-absorbs blood sugar in the kidney.
α -glucosidase inhibitor-prevents starch decomposition in small intestine, thus reducing glucose level. In addition, it can slow down the decomposition of glucose.
Cholic acid chelating agent-lowers cholesterol, but also lowers glucose level (the mechanism is not clear at present).
4. Consider supplementing other drugs. The above-mentioned drugs for treating diabetes are not the only drugs prescribed by doctors for patients. Doctors may also prescribe a series of drugs, from aspirin to flu vaccine, to help patients control diabetes. Although these drugs are not as "serious" or powerful as the above-mentioned diabetes drugs, it is best to consult a doctor before supplementing these drugs just in case. Here are some auxiliary drugs: aspirin-doctors sometimes prescribe aspirin to reduce the risk of heart attack in diabetic patients. The mechanism of action is not clear, but aspirin can inhibit the adhesion of red blood cells.
Influenza vaccine-Like many diseases, influenza can cause blood sugar levels to fluctuate, making diabetes more difficult to control. Therefore, doctors often advise patients to get flu shots every year to reduce the possibility of getting flu.
Herbal supplements-Scientific research cannot determine whether most "homeopathic" supplements are effective, but some diabetics claim that they are effective (anecdotal evidence, no research support).
It is suggested that once the symptoms of hyperglycemia are changed (abnormal signs), please seek medical attention immediately. Diabetes is a serious disease, which will cause lasting or irreversible effects and need immediate and continuous medical care. Scientists have not discovered all the causes of diabetes.
At first, the beta cells responsible for insulin secretion in the pancreas were damaged, which led to diabetes. Cells also began to "resist insulin", increasing the burden on the pancreas. The food we eat will be converted into glucose, which provides the energy needed by the body. Once there is no β cell secreting insulin, glucose cannot enter cells (muscle, fat, etc.). ), but can only stay in the blood and then excrete urine, so the body can't make good use of glucose (insulin deficiency). If not controlled, glucose will damage the kidneys, lead to renal failure, and also damage organs such as liver, heart, nerves and eyes before it is excreted with urine.
If there are signs of diabetes, please see a doctor immediately and let the doctor make an appropriate analysis. Patients with type 2 diabetes will eventually have symptoms of 1 diabetes, which are mild at first, and will become more and more serious if they are not well controlled. Common symptoms of diabetes include abnormal appetite.
dehydrate
pollakiuria
Weight loss is obvious
be down in spirits
Skin xerosis
An unhealed wound
Continue to get sick
Gastrointestinal problems
Organs begin to weaken, and if the disease cannot be controlled, organs will fail.
Diabetes is an incurable disease caused by the body's inability to secrete insulin. Scientists are constantly trying to find ways to treat diabetes, such as promoting pancreatic growth, islet transplantation, pancreatic transplantation, gene therapy and so on. These methods must go through a series of experiments and analysis, such as preventing insulin resistance, finding ways to secrete enough insulin, and keeping the pancreas function sound.
If you have diabetes, you have three choices to avoid many problems in the future: avoid raising blood sugar.
Relieve symptoms
Seek treatment for diabetes. China Diabetes Association has provided a lot of research information about 1 and the treatment of type 2 diabetes.
When the pancreas can't secrete enzymes and hormones (including insulin and glucagon), if it is not treated, the body can't use the food it eats, which will lead to hunger and death. Under normal circumstances, digestive enzymes will be activated to digest food after entering the small intestine. If digestive enzymes are activated in the damaged pancreas, they will attack, digest and destroy the pancreas, leading to pancreatitis. The induced causes of pancreatitis include alcoholism, genetic diseases, injuries, infections caused by diseases (such as Reye's syndrome, mumps, Coxsackie B virus, Mycoplasma pneumoniae and Campylobacter) and cancer. People can ingest substances extracted from mashed and dried pancreases of pigs and cattle, as well as other highly purified enzymes and hormones.
Warning not to control diabetes alone will make you feel angry and tired and finally give up your efforts. Seek the help of the medical team. Once you get into the habit, you will feel better and control diabetes more easily.
If diabetes is not controlled, it will lead to heart disease, renal failure, dry skin, nerve damage, blindness, lower limb infection, amputation and even death.