Neil Young

Young reformed Crazy Horse as his backup band, this time with Frank Sampedro on guitar for 1975's Zuma. Among the major risks of the disorder are chronic problems affecting multiple organ systems which will eventually arise in patients with poor glycemic control. [1] (http://www.independent.com/a&e/soundfury904.htm) The mood of these albums was reflected in the tour for Tonight's the Night, a drunken and frequently shambolic affair that divides fans to this day. Longstanding hypoglycemia may require hospital admission to allow supervised recovery and adjustment of diabetic medications. A review by Derek Svennungsen of the 2004 CD re-release calls it "mesmerizing, harrowing, lucid, and bleary". In most cases, recovery is rapid and troublefree. By the time Tonight's the Night was released, Young had also recorded On the Beach (1974), another blues-influenced record but more focused, based loosely around the theme of the downside of fame and the Californian lifestyle. Like Tonight's the Night it sold poorly, but both would become critical favourites and may represent Young's most original work. Oral or intravenous dextrose can also be given.

The album received mixed reviews at the time, but is now generally well regarded by critics and seen by some as a precursor to punk rock. Other ways of treating hypoglycemia include an injection of glucagon which causes the liver to convert its internal stores of glycogen to be released as glucose into the blood. Deeply affected by the drug-induced deaths of Whitten and roadie Bruce Berry, they recorded Tonight's the Night in 1973, a dark, maudlin record of unhinged blues and out-of-tune ballads that Reprise did not see fit to release until two years later. In the case of children, this can be a type of candy disliked by the patient, to prevent concerns about unnecessary use. In the second half of 1973, Young formed The Santa Monica Flyers, with Crazy Horse's rhythm section augmented by Lofgren on guitar. Experienced diabetics can often recognise the symptoms early on - all diabetics should always carry something sugary to eat or drink as these symptoms can be rapidly reduced if treated early enough. On November 18, 1972, shortly after he was fired from the tour preparations, Whitten was found dead of a heroin overdose. Consciousness can be altered, or even lost, in extreme cases, leading to coma and/or seizures or even death and brain damage.

During the rehearsals for the tour that would produce the Time Fades Away live album, it became evident that Danny Whitten could not function as a musician due to his drug abuse. If blood glucose levels are low enough, the patient may become agitated, sweaty, and have many symptoms of sympathetic activation of the autonomic nervous system - they may experience feelings similar to dread and immobilized panic. The relationship with Snodgress lasted until 1975. Hypoglycemia in diabetic patients almost always arises as a result of poor management of the disease either from too much or poorly timed insulin or oral hypoglycemics or too much exercise, not enough food, or poor timing of either. The boy, Zeke Young, would later be diagnosed with cerebral palsy. As with DKA, urgent medical treatment is necessary. This is the diabetic coma to which type 2 diabetics are prone; it is less common in type 1 diabetics. On September 8, 1972 Academy Award nominated actress Carrie Snodgress gave birth to Neil Young's first child. This combination of changes, especially if prolonged, will result in symptoms similar to ketoacidosis, including loss of consciousness.

A rougher ride but I saw more interesting people there.". Electrolyte imbalances are also common. Travelling there soon became a bore so I headed for the ditch. The osmotic effect of high glucose levels combined with the loss of water will eventually result in such a high serum osmolality that the body's cells may become directly affected as water is drawn out from them. He would later write that "Heart of Gold put me in the middle of the road. The kidneys will also be "dumping" glucose into the urine, resulting in concomitant loss of water, causing an increase in blood osmolality. The album's success caught Young off guard and his first instinct was to back away from stardom. In anyone with very high blood glucose levels (usually considered to be above 300 mg/dl) water will be osmotically driven out of cells into the blood.

Other songs returned to some usual Young themes: "Alabama" was an inferior rehash of "Southern Man"; "Words" featured a lengthy guitar workout with the band; and "The Needle and the Damage Done" chronicled Danny Whitten's descent into heroin addiction. It has some symptoms in common with DKA, but a different cause, and requires different treatment. After the supergroup split up, he recruited a new group of country-music session musicians, whom he christened The Stray Gators, and recorded a country rock record in Harvest (1972). Catching the mood that would soon lift The Eagles to superstardom, Harvest was a massive hit, producing the US number one single "Heart of Gold". Hyperosmotic diabetic coma is another acute problem associated with improper management of diabetes mellitus. The song was used frequently during anti-war rallies in the 1970s, and Young was still performing it 20 years later, by which time he often dedicated it to the Chinese students who had been killed at Tiananmen Square protests of 1989. Treatment usually results in full recovery, though death can result from inadequate treatment or a variety of complications. Young's song "Ohio", a single released shortly after the Deja Vu album, was written following the Kent State University killings that happened on May 4, 1970. The basic principles of DKA treatment are.

Young spent a year with CSN&Y, recording the classic Deja Vu (1970) and the live Four Way Street (1971). At this point the patient is urgently in need of intravenous fluids. After the Gold Rush was certified gold, but that success was minor compared with what came next. Many other tests can be affected. Single "Only Love Can Break Your Heart" was a minor hit. Laboratory tests typically show hyperglycemia, metabolic acidosis, normal or elevated potassium, and severe ketosis. The album contains some of his best work, covering subjects from the environmental concerns of the title track, redneck racism on "Southern Man" (which, along with the later song "Alabama", prompted the reply "Sweet Home Alabama" from Lynyrd Skynyrd) to the acoustic love songs of "Tell Me Why" and "I Believe in You". The dehydration can become severe enough to cause shock.

The album was a commercial breakthrough, aided by his new-found fame as a member of the supergroup Crosby, Stills, Nash and Young (CSN&Y, with whom he performed at Woodstock), having been invited to join as a foil for Stills. The level of consciousness is normal until late in the process, when obtundation may progress to coma. Crazy Horse, and Whitten in particular, were also in evidence on Young's next album, After the Gold Rush (1970), (which also featured the young Nils Lofgren). Abdominal pain is common and may be severe. Danny Whitten, guitar; Billy Talbot, bass guitar and Ralph Molina, drums from "The Rockets" took the name "Crazy Horse". Their album Everybody Knows This Is Nowhere (May 1969) -- credited to "Neil Young and Crazy Horse" -- was recorded in just two weeks, and is dominated by two lengthy jams, "Cowgirl in the Sand" and "Down by the River", both of which showcased the understanding between the musicians and Young's idiosyncratic guitar soloing. On presentation to hospital, the patient in DKA is typically dehydrated and breathing both fast and deeply. While a promising debut -- the track "The Loner" is still a staple of his live shows -- it remains a relatively weak set of songs compared to his later output. Wanting a harder rock sound for his next record, Young recruited a few members of the band "The Rockets" who had released a self titled album in 1968. As the metabolic acidosis worsens, it induces obvious hyperventilation (termed Kussmaul respiration).

Neil Young (January 1969), which contained a mix of songs similar to his Buffalo Springfield contributions, and received mixed reviews. Reduced fluid intake from vomiting combined with amplified urination produce dehydration. Young and Nitzsche immediately began work on Young's first solo record. The high volume of urination (polyuria) also produces increased losses of electrolytes, especially sodium, potassium, chloride, phosphate, and magnesium. Along with country music, Young's solo career would tend to flit among these disparate forms. The rising level of glucose increases the volume of urine produced by the kidneys (an osmolar diuresis). "Broken Arrow" was a lushly produced ballad, with a string arrangement of the kind Young's producer, Jack Nitzsche, would dub "symphonic pop". As the ketosis worsens, it produces a metabolic acidosis, with anorexia, abdominal distress, and eventually vomiting.

On the other hand "Mr Soul" was pure rock and roll driven by a fat guitar riff that owed more than a little to the Rolling Stones' "Satisfaction". The rise of fatty acid levels is accompanied by a rise of ketones (acetone, acetoacetate and beta-hydroxybutyrate). "Expecting to Fly" was a piece of confessional folk-rock, of a kind with many other records that emerged from the singer-songwriter movement. Muscle is degraded to release amino acids for gluconeogenesis. Young's three songs on Buffalo Springfield Again can be seen as a model for his solo records. Fat in adipose tissue is reduced to triglycerides and fatty acids by lipolysis. By that time the group had officially split, and Young had signed a solo deal with Reprise records (home of his compatriot, Joni Mitchell, with whom he shared a manager named Elliot Roberts). The liver becomes a net producer of glucose by way of gluconeogenesis and glycogenolysis.

Young rejoined in time to help record a final, disappointing, album -- Last Time Around -- released in 1968. Insulin deficiency switches many aspects of metabolic balance in a catabolic direction. Despite that, the album was well received. When a person is known to have diabetes and is being adequately treated, DKA usually results from omission of insulin, mismanagement of acute gastroenteritis (the "flu"), or an overwhelming new health problem (e.g., bacterial infection, myocardial infarction). By then, Palmer had been arrested for possession of drugs and deported back to Canada, and Young had all but left the group; his compositions "Mr Soul", "Expecting to Fly" and the adventurous "Broken Arrow" are solo recordings in all but name. This can occur at the onset of type 2 diabetes as well, especially in young people. The tensions led to the abandonment of the record, provisionally titled Stampede, although some of the songs reappeared on Buffalo Springfield Again (1967). In about a quarter of young people who develop type 1 diabetes, the insulin deficiency and hyperglycemia lead to ketoacidosis before the disease is recognized and treated.

During sessions for the follow-up, relations between the band deteriorated, with Stills and Young, the de facto leaders of the group, pulling in opposite directions. DKA occurs more commonly in type 1 diabetes because the insulin deficiency is more severe, though it can occur rarely in type 2 diabetes. Playing a mixture of folk, country, psychedelia and rock, and given a hard edge by the twin lead guitars of Stills and Young, the Springfield were a critical success, and the first record Buffalo Springfield (1967) sold well, supported by a hit single in Stills' political "For What It's Worth". Without prompt proper treatment, diabetic ketoacidosis leads to death. With the American Richie Furay they formed the Buffalo Springfield, taking their name from a popular brand of tractor. Diabetic ketoacidosis (DKA) is an acute, dangerous complication and is always a medical emergency. In 1966, after an aborted record deal with the Rick James-fronted Mynah Birds, he and bass player Bruce Palmer relocated to Los Angeles, where he again met Stills. See also the more detailed articles diabetic ketoacidosis and diabetic coma.

Having first played in high school instrumental rock bands in Winnipeg (one of whom, the Squires, had a local hit with "The Sultan") he began to work the folk clubs of Toronto, where he befriended guitarist Stephen Stills. While not used for diagnosis, an elevated glucose bound to hemoglobin, HbA1c, of 6.0% or higher (2003 revised US standard); is a screening and treatment-tracking test reflecting average blood glucose levels over the preceding 90 days (approximately). Young was born in Toronto; his father is sportswriter and novelist Scott Young. Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is diagnosed by demonstrating any one of. In addition to electric and acoustic guitars, he has occasionally performed on piano and organ, and frequently complements singing with harmonica playing. The most common are (1) health screening, (2) detection of hyperglycemia when a doctor is investigating a complication of longstanding, unrecognized diabetes, and less commonly (3) new signs and symptoms attributable to the diabetes. Young is recognizable for his distinct high-pitched, nasal voice. The diagnosis of other types of diabetes is made in many other ways.

He retains a core audience of devoted followers. These symptoms typically worsen over days to weeks; about 25% of people with new type 1 diabetes have developed a degree of diabetic ketoacidosis by the time the diabetes is recognized. His back catalogue includes folk and country, hard rock, rockabilly, garage rock (which saw him tagged "The Godfather of Grunge") and electronica. The diagnosis of type 1 diabetes and many cases of type 2 is usually prompted by recent-onset symptoms of excessive urination (polyuria) and excessive thirst (polydipsia), often accompanied by weight loss. Coming to prominence with pop band Buffalo Springfield, and reaching his commercial peak during the singer songwriter boom of the early 1970s, his career is marked by experimentation and frequent stylistic changes that have often left critics, audiences, and (in one notable case) his record label, baffled. Early symptoms of impending diabetic coma include polyuria, nausea, vomiting and abdominal pain, with lethargy and somnolence a later development, progressing to unconsciousness and death if untreated. Neil Young (born November 12, 1945) is a Canadian musician and filmmaker. The most dangerous form of altered consciousness is the so-called "diabetic coma" which produces unconsciousness.

The Faber Encyclopedia of Rock, Phil Hardy, Dave Laing (editors). Especially dangerous symptoms in diabetics include the smell of acetone on the patient's breath (a sign of ketoacidosis), Kussmaul breathing (a rapid, deep breathing), and any altered state of consciousness or arousal (hostility and mania are both possible, as is confusion and lethargy). Hyperrust Never Sleeps : The Unofficial Neil Young Pages, http://hyperrust.org/. These are now quick (less than 5 minutes total), inexpensive (materials less than US$1), and can be safely performed by almost anyone with trivial training. Shakey: Neil Young's Biography, Jimmy McDonough,. All unexplained quick changes in eyesight should force a fasting blood glucose test. Neil Young, Sylvie Simmons, published by MOJO Books in 2001, ISBN 184195084. Prolonged high blood glucose causes changes in the shape of the lens in the eye, leading to blurred vision and, perhaps, a visit to an optometrist.

A Dreamer of Pictures, David Downing, published by Bloomsbury in 1994, ISBN 0747518815. Another common presenting symptom is altered vision. Neil Young, the Rolling Stones Files: the Ultimate Compendium of Interviews, Articles, Facts, and Opinions from the Files of Rolling Stone, published by Rolling Stone Press in 1994, ISBN 0786880430. The lost blood volume will be replaced from water held inside body cells, causing dehydration. Neil and Me, Scott Young, published by McClelland and Stewart in 1997, ISBN 0771090994. Thirst develops because of osmotic effects — sufficiently high glucose (above the 'renal threshold') in the blood is excreted by the kidneys but this requires water to carry it and causes increased fluid loss, which must be replaced. Neil Young: Zero to Sixty: A Critical Biography, Johnny Rogan, published by Omnibus Press in 2000, ISBN 0952954044. These symptoms may also manifest in Type 2 diabetes in patients who present with frank poorly controlled diabetes.

Shakey: Neil Young's Biography, Jimmy McDonough, published by Random House in 2002, ISBN 0679427724. There may also be weight loss (despite normal or increased eating), increased appetite, and irreduceable fatigue. 2005 Untitled, yet-to-be released album. Early symptoms of type 1 diabetes are often polyuria (frequent urination) and polydipsia (increased thirst, and consequent increased fluid intake). 2004 Greatest Hits. Type 2 diabetes almost always has a slow onset (often years), but in type 1, particularly in children, onset may be quite fast (weeks or months). 2003 Greendale (with Crazy Horse). The exact reasons for these connections are unknown.

1999 Looking Forward (CSN&Y). However, even in those who have inherited the susceptibility, type 1 diabetes mellitus seems to require an environmental trigger. 1997 Year of the Horse (live album with Crazy Horse). genetic "self" identifiers used by the immune system). 1996 Broken Arrow (with Crazy Horse). There is a genetic element in the susceptibility of individuals to some of these triggers which has been traced to particular HLA genotypes (i.e. 1996 Dead Man (soundtrack album). exposure to a causative agent).

1995 Mirror Ball (with Pearl Jam). Type 1 diabetes appears to be triggered by infection, stress, or environmental factors (e.g. 1994 Sleeps With Angels (with Crazy Horse). Both type 1 and type 2 diabetes are at least partly inherited. 1993 Unplugged. In addition, about 20-50% of these women go on to develop type 2 diabetes. 1993 Lucky Thirteen. It requires careful medical supervision during the pregnancy.

1992 Harvest Moon. It is temporary and fully treatable, but if untreated it may cause problems with the pregnancy, including macrosomia (high birth weight) of the child. 1991 Arc (live with Crazy Horse). Type 4 or gestational diabetes mellitus appears in about 2-5% of all pregnancies. 1991 Weld (live with Crazy Horse). Main article: Gestational diabetes mellitus. 1990 Ragged Glory (with Crazy Horse). All other specific forms of diabetes, accounting for up to 5% of all diagnosed cases of diabetes, are termed Type 3:.

1989 Freedom. When these have failed, insulin therapy may be necessary to maintain normal glucose levels. 1988 American Dream (CSN&Y). The next step, if necessary, is treatment with oral antidiabetic drugs: the sulphonylureas, metformin, or (if these are insufficient) thiazolidinediones. 1988 This Note's For You (with The Bluenotes). around 5 kg (10 to 15 lb). 1987 Life (with Crazy Horse). Type 2 is initially treated by changes in diet and through weight loss. This can restore insulin sensitivity, even when the weight lost is modest e.g.

1986 Landing on Water. Other research shows that type 2 diabetes causes obesity.¹². 1985 Old Ways. The majority of patients with type 2 diabetes mellitus are obese - chronic obesity leads to increased insulin resistance that can develop into diabetes, most likely because adipose tissue is a (recently identified) source of chemical signals (hormones and cytokines). 1983 Everybody's Rockin' (with Shocking Pinks). There is also a strong inheritable genetic connection in type 2 diabetes: having relatives (especially first degree) with type 2 is a considerable risk factor for developing type 2 diabetes. 1982 Trans. The fraction of type 2 diabetics in other parts of the world varies substantially, almost certainly for environmental and lifestyle reasons.

1981 Re-ac-tor (with Crazy Horse). About 90-95% of all North American cases of diabetes are type 2, and about 20% of the population over the age of 65 is a type 2 diabetic. 1980 Hawks and Doves. long-term steroid use). 1980 Where the Buffalo Roam. It may be caused by a number of diseases, such as hemochromatosis and polycystic ovary syndrome, and can also be caused by certain types of medications (e.g. 1979 Live Rust (old songs live, with Crazy Horse). Type 2 diabetes was formerly known by a variety of partially misleading names, including "adult-onset diabetes", "obesity-related diabetes", "insulin-resistant diabetes", or "non-insulin-dependent diabetes" (NIDDM).

1979 Rust Never Sleeps (with Crazy Horse, new songs played live). However, severe complications can result from unnoticed type 2 diabetes, including renal failure, and coronary artery disease. 1978 Comes A Time. Type 2 may go unnoticed for years in a patient before diagnosis, since the symptoms are typically milder (no ketoacidosis) and can be sporadic. 1977 Decade. This is a more complex problem than type 1, but is sometimes easier to treat, since insulin is still produced, especially in the initial years. 1977 American Stars'n'Bars. Type 2 diabetes is characterized by "insulin resistance" as body cells do not respond appropriately when insulin is present.

1976 Long May You Run (with Stephen Stills, the "Stills-Young Band"). Each term is a misnomer, especially since the obesity epidemic in recent years has led to increased incidence of type 2 diabetes in children and adolescents in the USA, and insulin is used in some type 2 cases. 1975 Zuma (with Crazy Horse). Formerly, type 1 diabetes was called "childhood" or "juvenile" diabetes or "insulin dependent" diabetes. 1974 On the Beach. Most of this difference is not currently understood. 1973 Tonight's The Night (with The Santa Monica Flyers, release delayed until 1975). The fraction of type 1 diabetics in other parts of the world differs; this is likely due to both differences in the rate of type 1 and differences in the rate of other types, most prominently type 2.

1973 Time Fades Away (with The Stray Gators). About 5-10% of all North American cases of diabetes are Type 1 diabetics. 1972 Journey Through the Past. Experimental replacement of beta cells (by transplant) is being investigated in several research programs and may become clinically available in the future. 1972 Harvest (with The Stray Gators). The treatment must be continued indefinitely. 1971 Four Way Street (live CSN&Y). Insulin delivery is also available by an insulin pump, which allows the infusion of insulin 24 hours a day at preset levels, and the ability to program push doses (bolus) of insulin as needed at meal times.

1970 Deja Vu (Crosby, Stills, Nash & Young). Currently, type 1 is treated with insulin injections, lifestyle adjustments, and careful monitoring of blood glucose levels using blood test kits. 1970 After the Gold Rush (with Crazy Horse). Other pancreatic problems including trauma, pancreatitis or tumors (either malignant or benign) can also lead to loss of insulin production. 1969 Everbody Knows This Is Nowhere (with Crazy Horse). certain rat poisons) work by selectively destroying certain types of cells, including pancreatic beta cells, thus producing "artificial" type 1 diabetes. 1969 Neil Young. Some poisons (e.g.

2001 Box Set. In addition, a small proportion of type 1 cases has the hereditary condition maturity onset diabetes of the young (MODY). 1973 Buffalo Springfield (2 LP compilation). A subtype of type 1 (identifiable by the presence of antibodies against beta cells) develops slowly and so is often confused with Type 2. 1968 Last Time Around. The autoimmune attack may be triggered by reaction to an infection, for example by one of the viruses of the Coxsackie virus family. 1967 Buffalo Springfield Again. It is an autoimmune disorder, in which the body's own immune system attacks the beta cells in the Islets of Langerhans of the pancreas, destroying them or damaging them sufficiently to reduce insulin production.

1967 Buffalo Springfield. Type 1 diabetes is most commonly diagnosed in children and adolescents, but can occur in adults as well. The net effect is persistent high levels of blood glucose, poor protein synthesis, and other metabolic derangements. If the amount of insulin produced is insufficient, if cells respond poorly to the effects of insulin (insulin insensitivity or resistance), or if the insulin itself is defective, glucose is not handled properly by body cells (about 2/3 require it) nor stored appropriately in the liver and muscles. Higher insulin level increase many anabolic ("building up") processes such as cell growth, cellular protein synthesis, and fat storage. Insulin is the principal signal in converting many of the bidirectional processes of metabolism from a catabolic to an anabolic direction.

Lowered insulin levels result in the reverse conversion of glycogen to glucose when glucose levels fall -- though only in the liver not muscle tissue. Insulin is also the principal control signal for conversion of glucose (the basic sugar unit) to glycogen for storage in liver and muscle cells. Insulin makes it possible for most body tissues to remove glucose from the blood for use as fuel, for conversion to other needed molecules, or for storage. Insulin is produced by beta cells in the pancreas in response to rising levels of glucose in the blood, as occurs after a meal.

Most of the carbohydrates in food are rapidly digested to glucose, the principal sugar in blood. Since insulin is the principal hormone that regulates uptake of glucose into cells (primarily muscle and fat cells) from the blood, deficiency of insulin or its action plays a central role in all forms of diabetes. The National Diabetes Information Clearinghouse estimates that diabetes costs $132 billion in the United States alone every year. The Centers for Disease Control has termed the change an epidemic.

In 2002 there were about 18.2 million diabetics in the United States alone. For at least 20 years, diabetes rates in North America have been increasing substantially. Diabetes is in the top 10, and perhaps the top 5, of the most significant diseases in the developed world, and is gaining in significance (see big killers). The increase in incidence of diabetes in the developing countries follows the trend of urbanisation and life style changes.

The greatest increase in prevalence rate is, however, expected to occur in Asia and Africa, where most of the diabetic patients will be seen by 2025. Diabetes mellitus occurs throughout the world, but is more common (especially type 2) in the more developed countries. Its incidence is increasing rapidly, and it is estimated that by the year 2025 this number will double. In 2004, according to the World Health Organization, more than 150 million people worldwide suffer from diabetes.

Other risk factors that can require addressing to reduce complications are: cessation of smoking, optimizing cholesterol levels, maintaining a stable body weight, controlling high blood pressure and engaging in regular exercise. Patient understanding and participation is vital as blood glucose levels change continuously, while successfully keeping blood sugar within normal limits has been compellingly shown to reduce or prevent development of some of the complications of diabetes. The former requires insulin injections, while the latter is generally managed with oral medication and only requires insulin if the tablets are ineffective. The most important forms of diabetes are due to decreased production of insulin (diabetes mellitus type 1, the first recognized form), or decreased sensitivity of body tissues to insulin (diabetes mellitus type 2, the more common form).

Longer-term complications include cardiovascular disease (doubled risk), chronic renal failure (it is the main cause for dialysis), retinal damage with eventual blindness, nerve damage and eventual gangrene with risk of amputation of toes, feet, and even legs. Hyperglycemia itself can lead to dehydration and ketoacidosis. All types of diabetes mellitus share similar symptoms and complications at advanced stages. Diabetes mellitus is a medical disorder characterized by varying or persistent hyperglycemia (elevated blood sugar levels), especially after eating.

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Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001;344:1343-50. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, Keinanen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M. PMID 12814710. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet 2003;361(9374):2005-16.

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PMID 9742976. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998;352:837-53. UK Prospective Diabetes Study Group. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Geneva: WHO, 1999 (PDF (http://whqlibdoc.who.int/hq/1999/WHO_NCD_NCS_99.2.pdf)).

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Diabetes Control and Complications Trial Research Group. identification of thiazolidinediones as effective antidiabetics in the 1990s. Reaven's introduction of the metabolic syndrome in 1988. the radioimmunoassay for insulin, as discovered by Rosalyn Yalow and Solomon Berson (gaining Yalow the 1977 Nobel Prize in Physiology or Medicine);.

identification of sulfonylureas in 1942. peripheral vascular disease which contributes to foot ulcers and the risk of amputation. stroke. ischemic heart disease caused by both large and small vessel disease.

Large vessel disease complications: