Taking the drugs used to treat diabetes, particularly insulin, may be difficult for some older people. For those with vision problems or other problems that make accurately filling a syringe difficult, a caregiver can prepare the syringes ahead of time and store them in the refrigerator. People whose insulin dose is stable may purchase pre-filled syringes. Prefilled insulin pen devices may be easier for people with physical limitations. Some of these devices have large numbers and easy-to-turn dials.
^ Jump up to: a b Petzold A, Solimena M, Knoch KP (October 2015). "Mechanisms of Beta Cell Dysfunction Associated With Viral Infection". Current Diabetes Reports (Review). 15 (10): 73. doi:10.1007/s11892-015-0654-x. PMC 4539350. PMID 26280364. So far, none of the hypotheses accounting for virus-induced beta cell autoimmunity has been supported by stringent evidence in humans, and the involvement of several mechanisms rather than just one is also plausible.
Some patients with type 2 DM can control their disease with a calorically restricted diet (for instance 1600 to 1800 cal/day), regular aerobic exercise, and weight loss. Most patients, however, require the addition of some form of oral hypoglycemic drug or insulin. Oral agents to control DM include sulfonylurea drugs (such as glipizide), which increase pancreatic secretion of insulin; biguanides or thiazolidinediones (such as metformin or pioglitazone), which increase cellular sensitivity to insulin; or a-glucosidase inhibitors (such as acarbose), which decrease the absorption of carbohydrates from the gastrointestinal tract. Both types of diabetics also may be prescribed pramlintide (Symlin), a synthetic analog of human amylin, a hormone manufactured in the pancreatic beta cells. It enhances postprandial glucose control by slowing gastric emptying, decreasing postprandial glucagon concentrations, and regulating appetite and food intake; thus pramlintide is helpful for patients who do not achieve optimal glucose control with insulin and/or oral antidiabetic agents. When combinations of these agents fail to normalize blood glucose levels, insulin injections are added. Tight glucose control can reduce the patient’s risk of many of the complications of the disease. See: illustration
Good metabolic control can delay the onset and progression of diabetic retinopathy. Loss of vision and blindness in persons with diabetes can be prevented by early detection and treatment of vision-threatening retinopathy: regular eye examinations and timely intervention with laser treatment, or through surgery in cases of advanced retinopathy. There is evidence that, even in developed countries, a large proportion of those in need is not receiving such care due to lack of public and professional awareness, as well as an absence of treatment facilities. In developing countries, in many of which diabetes is now common, such care is inaccessible to the majority of the population.
Diabetes has been coined the “silent killer” because the symptoms are so easy to miss. Over 24 million people in America have diabetes, so this is no tiny issue. Kids years ago hardly ever knew another child with diabetes, but such is no longer the case. Approximately 1.25 million children in the United States living with diabetes, which is very telling for state of health in America in 2016 when children are having to endure a medical lifestyle at such a young age.
Adult and pediatric endocrinologists, specialists in treating hormone imbalances and disorders of the endocrine system, are experts in helping patients with diabetes manage their disease. People with the disease also may be cared for by a number of primary care providers including family or internal medicine practitioners, naturopathic doctors, or nurse practitioners. When complications arise, these patients often consult other specialists, including neurologists, gastroenterologists, ophthalmologists, acupuncturists, surgeons, and cardiologists. Nutritionists, integrative and functional medicine doctors, and physical activity experts such as personal trainers are also important members of a diabetes treatment team. It is important to interview a new health care professional about their experience, expertise, and credentials to make sure they are well qualified to help you.
Type 2 diabetes: Type 2 diabetes affects the way the body uses insulin. While the body still makes insulin, unlike in type I, the cells in the body do not respond to it as effectively as they once did. This is the most common type of diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases, and it has strong links with obesity.
The body obtains glucose from three main sources: the intestinal absorption of food; the breakdown of glycogen (glycogenolysis), the storage form of glucose found in the liver; and gluconeogenesis, the generation of glucose from non-carbohydrate substrates in the body.[60] Insulin plays a critical role in balancing glucose levels in the body. Insulin can inhibit the breakdown of glycogen or the process of gluconeogenesis, it can stimulate the transport of glucose into fat and muscle cells, and it can stimulate the storage of glucose in the form of glycogen.[60]
Hypoglycemia. Hypoglycemia or “insulin shock” is a common concern in DM management. It typically develops when a diabetic patient takes his or her normal dose of insulin without eating normally. As a result, the administered insulin can push the blood sugar to potentially dangerously low levels. Initially the patient may experience, sweating, nervousness, hunger and weakness. If the hypoglycemic patient is not promptly given sugar (sugar, cola, cake icing), he or she may lose consciousness and even lapse into coma. Questions and Answers about Diabetes and Your Mouth Q: If I have diabetes, will I develop the oral complications that were mentioned? A: It depends. There is a two-way relationship between your oral health and how well your blood sugar is controlled (glycemic control). Poor control of your blood sugar increases your risk of developing the multitude of complications associated with diabetes, including oral complications. Conversely, poor oral health interferes with proper glucose stabilization. Indeed, recent research has shown that diabetic patients who improve their oral health experience a modest improvement in their blood sugar levels. In essence, “Healthy mouths mean healthy bodies.” Q: What are the complications of diabetes therapy that can impact my oral health? A: One of the most worrisome urgent complications associated with diabetes management is the previously described hypoglycemia or insulin shock. In addition, many of the medications prescribed to treat diabetes and its complications, such as hypertension and heart disease, may induce adverse side effects affecting the mouth. Common side effects include dry mouth, taste aberrations, and mouth sores. Q: I have type-2 diabetes. Are my dental problems different than those experienced by people with type-1 diabetes? A: No. All patients with diabetes are at increased risk for the development of dental disease. What is different is that type-2 disease tends to progress more slowly than type-1 disease. Thus, most type-2 diabetes patients are diagnosed later in life, a time in which they are likely to already have existing dental problems. Remember, there is no dental disease unique to diabetes. Uncontrolled or poorly controlled diabetes simply compromises your body’s ability to control the existing disease.
A fingerstick glucose test is most often used to monitor blood glucose. Most blood glucose monitoring devices (glucose meters) use a drop of blood obtained by pricking the tip of the finger with a small lancet. The lancet holds a tiny needle that can be jabbed into the finger or placed in a spring-loaded device that easily and quickly pierces the skin. Most people find that the pricking causes only minimal discomfort. Then, a drop of blood is placed on a reagent strip. The strip contains chemicals that undergo changes depending on the glucose level. The glucose meter reads the changes in the test strip and reports the result on a digital display. Some devices allow the blood sample to be obtained from other sites, such as the palm, forearm, upper arm, thigh, or calf. Home glucose meters are smaller than a deck of cards.
DM affects at least 16 million U.S. residents, ranks seventh as a cause of death in the United States, and costs the national economy over $100 billion yearly. The striking increase in the prevalence of DM in the U.S. during recent years has been linked to a rise in the prevalence of obesity. About 95% of those with DM have Type 2, in which the pancreatic beta cells retain some insulin-producing potential, and the rest have Type 1, in which exogenous insulin is required for long-term survival. In Type 1 DM, which typically causes symptoms before age 25, an autoimmune process is responsible for beta cell destruction. Type 2 DM is characterized by insulin resistance in peripheral tissues as well as a defect in insulin secretion by beta cells. Insulin regulates carbohydrate metabolism by mediating the rapid transport of glucose and amino acids from the circulation into muscle and other tissue cells, by promoting the storage of glucose in liver cells as glycogen, and by inhibiting gluconeogenesis. The normal stimulus for the release of insulin from the pancreas is a rise in the concentration of glucose in circulating blood, which typically occurs within a few minutes after a meal. When such a rise elicits an appropriate insulin response, so that the blood level of glucose falls again as it is taken into cells, glucose tolerance is said to be normal. The central fact in DM is an impairment of glucose tolerance of such a degree as to threaten or impair health. Long recognized as an independent risk factor for cardiovascular disease, DM is often associated with other risk factors, including disorders of lipid metabolism (elevation of very-low-density lipoprotein cholesterol and triglycerides and depression of high-density lipoprotein cholesterol), obesity, hypertension, and impairment of renal function. Sustained elevation of serum glucose and triglycerides aggravates the biochemical defect inherent in DM by impairing insulin secretion, insulin-mediated glucose uptake by cells, and hepatic regulation of glucose output. Long-term consequences of the diabetic state include macrovascular complications (premature or accelerated atherosclerosis with resulting coronary, cerebral, and peripheral vascular insufficiency) and microvascular complications (retinopathy, nephropathy, and neuropathy). It is estimated that half those with DM already have some complications when the diagnosis is made. The American Diabetes Association (ADA) recommends screening for DM for people with risk factors such as obesity, age 45 years or older, family history of DM, or history of gestational diabetes. If screening yields normal results, it should be repeated every 3 years. The diagnosis of DM depends on measurement of plasma glucose concentration. The diagnosis is confirmed when any two measurements of plasma glucose performed on different days yield levels at or above established thresholds: in the fasting state, 126 mg/dL (7 mmol/L); 2 hours postprandially (after a 75-g oral glucose load) or at random, 200 mg/dL (11.1 mmol/L). A fasting plasma glucose of 100-125 mg/dL (5.5-6.9 mmol/L) or a 2-hour postprandial glucose of 140-199 mg/dL (7.8-11 mmol/L) is defined as impaired glucose tolerance. People with impaired glucose tolerance are at higher risk of developing DM within 10 years. For such people, lifestyle modification such as weight reduction and exercise may prevent or postpone the onset of frank DM. Current recommendations for the management of DM emphasize education and individualization of therapy. Controlled studies have shown that rigorous maintenance of plasma glucose levels as near to normal as possible at all times substantially reduces the incidence and severity of long-term complications, particularly microvascular complications. Such control involves limitation of dietary carbohydrate and saturated fat; monitoring of blood glucose, including self-testing by the patient and periodic determination of glycosylated hemoglobin; and administration of insulin (particularly in Type 1 DM), drugs that stimulate endogenous insulin production (in Type 2 DM), or both. The ADA recommends inclusion of healthful carbohydrate-containing foods such as whole grains, fruits, vegetables, and low-fat milk in a diabetic diet. Restriction of dietary fat to less than 10% of total calories is recommended for people with diabetes, as for the general population. Further restriction may be appropriate for those with heart disease or elevated cholesterol or triglyceride levels. The ADA advises that high-protein, low-carbohydrate diets have no particular merit in long-term weight control or in maintenance of a normal plasma glucose level in DM. Pharmaceutical agents developed during the 1990s improve control of DM by enhancing responsiveness of cells to insulin, counteracting insulin resistance, and reducing postprandial carbohydrate absorption. Tailor-made insulin analogues produced by recombinant DNA technology (for example, lispro, aspart, and glargine insulins) have broadened the range of pharmacologic properties and treatment options available. Their use improves both short-term and long-term control of plasma glucose and is associated with fewer episodes of hypoglycemia. SEE ALSO insulin resistance
Type 2 diabetes can be prevented with lifestyle changes. People who are overweight and lose as little as 7 percent of their body weight and who increase physical activity (for example, walking 30 minutes per day) can decrease their risk of diabetes mellitus by more than 50%. Metformin and acarbose, drugs that are used to treat diabetes, may reduce the risk of diabetes in people with impaired glucose regulation.
An article published in November 2012 in the journal Global Public Health found that countries with more access to HFCS tended to have higher rates of the disease. Though it’s likely that these countries’ overall eating habits play a role in their populations’ diabetes risk, a study published in February 2013 in the journal PLoS One found limiting access to HFCS in particular may help reduce rates of the diagnosis.

Managing your blood glucose, blood pressure, and cholesterol, and quitting smoking if you smoke, are important ways to manage your type 2 diabetes. Lifestyle changes that include planning healthy meals, limiting calories if you are overweight, and being physically active are also part of managing your diabetes. So is taking any prescribed medicines. Work with your health care team to create a diabetes care plan that works for you.


Yet carbs are processed differently in the body based on their type: While simple carbs are digested and metabolized quickly, complex carbs take longer to go through this system, resulting in more stable blood sugar. “It comes down to their chemical forms: A simple carbohydrate has a simpler chemical makeup, so it doesn’t take as much for it to be digested, whereas the complex ones take a little longer,” Grieger explains.
Before blood glucose levels rise, the body of a person destined for type 2 becomes resistant to insulin, much as bacteria can become resistant to antibiotics. Insulin is the signal for the muscles, fat, and liver to absorb glucose from the blood. As the body becomes resistant to insulin, the beta cells in the pancreas must pump out more of the hormone to compensate. People with beta cells that can't keep up with insulin resistance develop the high blood glucose of type 2 diabetes.
Jump up ^ Pignone M, Alberts MJ, Colwell JA, Cushman M, Inzucchi SE, Mukherjee D, Rosenson RS, Williams CD, Wilson PW, Kirkman MS (June 2010). "Aspirin for primary prevention of cardiovascular events in people with diabetes: a position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation". Diabetes Care. 33 (6): 1395–402. doi:10.2337/dc10-0555. PMC 2875463. PMID 20508233.
People with Type 1 diabetes are usually totally dependent on insulin injections for survival. Such people require daily administration of insulin. The majority of people suffering from diabetes have the Type 2 form. Although they do not depend on insulin for survival, about one third of sufferers needs insulin for reducing their blood glucose levels.
Monogenic diabetes is caused by mutations, or changes, in a single gene. These changes are usually passed through families, but sometimes the gene mutation happens on its own. Most of these gene mutations cause diabetes by making the pancreas less able to make insulin. The most common types of monogenic diabetes are neonatal diabetes and maturity-onset diabetes of the young (MODY). Neonatal diabetes occurs in the first 6 months of life. Doctors usually diagnose MODY during adolescence or early adulthood, but sometimes the disease is not diagnosed until later in life.
Low blood sugar (hypoglycemia), is common in people with type 1 and type 2 DM. Most cases are mild and are not considered medical emergencies. Effects can range from feelings of unease, sweating, trembling, and increased appetite in mild cases to more serious effects such as confusion, changes in behavior such as aggressiveness, seizures, unconsciousness, and (rarely) permanent brain damage or death in severe cases.[24][25] Moderately low blood sugar may easily be mistaken for drunkenness;[26] rapid breathing and sweating, cold, pale skin are characteristic of low blood sugar but not definitive.[27] Mild to moderate cases are self-treated by eating or drinking something high in sugar. Severe cases can lead to unconsciousness and must be treated with intravenous glucose or injections with glucagon.[28]
A neck lump or nodule is the most common symptom of thyroid cancer. You may feel a lump, notice one side of your neck appears to be different, or your doctor may find it during a routine examination. If the tumor is large, it may cause neck or facial pain, shortness of breath, difficulty swallowing, cough unrelated to a cold, hoarseness or voice change.
Inhalable insulin has been developed.[125] The original products were withdrawn due to side effects.[125] Afrezza, under development by the pharmaceuticals company MannKind Corporation, was approved by the United States Food and Drug Administration (FDA) for general sale in June 2014.[126] An advantage to inhaled insulin is that it may be more convenient and easy to use.[127]
Patients with type 2 diabetes can still make insulin, but not enough to control their glucose levels. Type 2 diabetes is therefore initially treated with a combination of lifestyle changes (diet and exercise) which reduce the need for insulin and therefore lower glucose levels. If this is insufficient to achieve good glucose control, a range of tablets are available. These include metformin and pioglitazone, which, like diet and exercise, reduce insulin requirements; sulphonylureas (e.g. gliclazide), which stimulate insulin secretion; DPP4 inhibitors (e.g sitagliptin) and GLP-1 agonists (e.g. liraglutide), which stimulate insulin production and reduce appetite; and SGLT2 inhibitors (e.g. dapagliflozin), which lower blood sugar levels by causing sugar to pass out of the body in the urine. In many patients, particularly after several years of treatment, insulin production is so low or so insufficient compared with the patient's needs that patients with type 2 diabetes have to be treated with insulin injections, either alone or in combination with tablets.
Diabetes develops when the body can't make any or enough insulin, and/or when it can't properly use the insulin it makes. For some people with diabetes, the body becomes resistant to insulin. In these cases, insulin is still produced, but the body does not respond to the effects of insulin as it should. This is called insulin resistance. Whether from not enough insulin or the inability to use insulin properly, the result is high levels of glucose in the blood, or hyperglycemia.
Metformin is generally recommended as a first line treatment for type 2 diabetes, as there is good evidence that it decreases mortality.[6] It works by decreasing the liver's production of glucose.[87] Several other groups of drugs, mostly given by mouth, may also decrease blood sugar in type II DM. These include agents that increase insulin release, agents that decrease absorption of sugar from the intestines, and agents that make the body more sensitive to insulin.[87] When insulin is used in type 2 diabetes, a long-acting formulation is usually added initially, while continuing oral medications.[6] Doses of insulin are then increased to effect.[6][88]
Diabetes mellitus (DM) is best defined as a syndrome characterized by inappropriate fasting or postprandial hyperglycemia, caused by absolute or relative insulin deficiency and its metabolic consequences, which include disturbed metabolism of protein and fat. This syndrome results from a combination of deficiency of insulin secretion and its action. Diabetes mellitus occurs when the normal constant of the product of insulin secretion times insulin sensitivity, a parabolic function termed the “disposition index” (Figure 19-1), is inadequate to prevent hyperglycemia and its clinical consequences of polyuria, polydipsia, and weight loss. At high degrees of insulin sensitivity, small declines in the ability to secrete insulin cause only mild, clinically imperceptible defects in glucose metabolism. However, irrespective of insulin sensitivity, a minimum amount of insulin is necessary for normal metabolism. Thus, near absolute deficiency of insulin must result in severe metabolic disturbance as occurs in type 1 diabetes mellitus (T1DM). By contrast, with decreasing sensitivity to its action, higher amounts of insulin secretion are required for a normal disposition index. At a critical point in the disposition index curve (see Figure 19-1), a further small decrement in insulin sensitivity requires a large increase in insulin secretion; those who can mount these higher rates of insulin secretion retain normal glucose metabolism, whereas those who cannot increase their insulin secretion because of genetic or acquired defects now manifest clinical diabetes as occurs in type 2 diabetes (T2DM).
Jump up ^ McBrien, K; Rabi, DM; Campbell, N; Barnieh, L; Clement, F; Hemmelgarn, BR; Tonelli, M; Leiter, LA; Klarenbach, SW; Manns, BJ (6 August 2012). "Intensive and Standard Blood Pressure Targets in Patients With Type 2 Diabetes Mellitus: Systematic Review and Meta-analysis". Archives of Internal Medicine. 172 (17): 1–8. doi:10.1001/archinternmed.2012.3147. PMID 22868819.
They may need to take medications in order to keep glucose levels within a healthy range. Medications for type 2 diabetes are usually taken by mouth in the form of tablets and should always be taken around meal times and as prescribed by the doctor. However, if blood glucose is not controlled by oral medications, a doctor may recommend insulin injections.

The pain of diabetic nerve damage may respond to traditional treatments with certain medications such as gabapentin (Neurontin), phenytoin (Dilantin), and carbamazepine (Tegretol) that are traditionally used in the treatment of seizure disorders. Amitriptyline (Elavil, Endep) and desipramine (Norpraminine) are medications that are traditionally used for depression. While many of these medications are not indicated specifically for the treatment of diabetes related nerve pain, they are used by physicians commonly.
Type 2 diabetes is partly preventable by staying a normal weight, exercising regularly, and eating properly.[1] Treatment involves exercise and dietary changes.[1] If blood sugar levels are not adequately lowered, the medication metformin is typically recommended.[7][14] Many people may eventually also require insulin injections.[9] In those on insulin, routinely checking blood sugar levels is advised; however, this may not be needed in those taking pills.[15] Bariatric surgery often improves diabetes in those who are obese.[8][16]
Type 1 diabetes has some connection to your family genes, but that doesn't mean you'll get it if one of your parents had it. "Since not all identical twins get diabetes, we do think that exposure to an additional environmental factor may trigger an immune response that ultimately causes destruction of the insulin-producing cells of the pancreas," says Dr. Sarah R. Rettinger, an endocrinologist with Providence Saint John's Health Center in Santa Monica, California.

Diabetes mellitus is a chronic disease caused by inherited and/or acquired deficiency in production of insulin by the pancreas, or by the ineffectiveness of the insulin produced. Such a deficiency results in increased concentrations of glucose in the blood, which in turn damage many of the body's systems, in particular the blood vessels and nerves.
Cataracts and glaucoma are also more common among diabetics. It is also important to note that since the lens of the eye lets water through, if blood sugar concentrations vary a lot, the lens of the eye will shrink and swell with fluid accordingly. As a result, blurry vision is very common in poorly controlled diabetes. Patients are usually discouraged from getting a new eyeglass prescription until their blood sugar is controlled. This allows for a more accurate assessment of what kind of glasses prescription is required.
On behalf of the millions of Americans who live with or are at risk for diabetes, we are committed to helping you understand this chronic disease. Help us set the record straight and educate the world about diabetes and its risk factors by sharing the common questions and answers below. If you're new to type 2 diabetes, join our Living With Type 2 Diabetes program to get more facts.

Type 1 DM is caused by autoimmune destruction of the insulin-secreting beta cells of the pancreas. The loss of these cells results in nearly complete insulin deficiency; without exogenous insulin, type 1 DM is rapidly fatal. Type 2 DM results partly from a decreased sensitivity of muscle cells to insulin-mediated glucose uptake and partly from a relative decrease in pancreatic insulin secretion.

A. Diabetes is the inability of the body to ‘produce insulin - type 1 diabetes’ or ‘proper use of insulin - type 2 diabetes, gestational diabetes and pre-diabetes’. Diabetes is often goes undiagnosed because many of the symptoms of diabetes seems harmless. The causes of diabetes continues to be a mystery, pancreas it the organ whose defect causes diabetes.
If sugars in general are not associated with increased diabetes risk, but sodas are, it suggests the possibility that something other than sugar explains this relationship.16 Sodas are often accompanied by cheeseburgers, chicken nuggets, and other unhealthful foods. That is, soda consumption can be a sign of a diet focusing on fast foods or an overall unhealthful diet and lifestyle. And sugary snack foods (e.g., cookies and snack pastries) are often high in fat; the sugar lures us in to the fat calories hiding inside. Some, but not all, observational trials have sought to control for these confounding variables. 
Exercise is very important if you have this health condition. Exercise makes cells more insulin sensitive, pulling glucose out of the blood. This brings down blood sugar, and more importantly, gives you better energy because the glucose is being transferred to the cells. Any type of exercise will do this, but extra benefit is gained when the activity helps build muscle, such as weight training or using resistance bands. The benefits of exercise on blood sugar last about 48-72 hours, so it is important for you to be physically active almost every day.
The earliest surviving work with a detailed reference to diabetes is that of Aretaeus of Cappadocia (2nd or early 3rd century CE). He described the symptoms and the course of the disease, which he attributed to the moisture and coldness, reflecting the beliefs of the "Pneumatic School". He hypothesized a correlation of diabetes with other diseases, and he discussed differential diagnosis from the snakebite which also provokes excessive thirst. His work remained unknown in the West until 1552, when the first Latin edition was published in Venice.[110]
The blood vessels and blood are the highways that transport sugar from where it is either taken in (the stomach) or manufactured (in the liver) to the cells where it is used (muscles) or where it is stored (fat). Sugar cannot go into the cells by itself. The pancreas releases insulin into the blood, which serves as the helper, or the "key," that lets sugar into the cells for use as energy.
Screening for undiagnosed T2DM is recommended at the first prenatal visit in women with above risk factors, using standard diagnostic method criteria. Screening for gestational diabetes (GDM) at 24-28 wk of gestation is recommended in women who do not have previous history of diabetes, as GDM remains asymptomatic11. A history of GDM carries a high risk for developing diabetes.
Low blood sugar (hypoglycemia), is common in people with type 1 and type 2 DM. Most cases are mild and are not considered medical emergencies. Effects can range from feelings of unease, sweating, trembling, and increased appetite in mild cases to more serious effects such as confusion, changes in behavior such as aggressiveness, seizures, unconsciousness, and (rarely) permanent brain damage or death in severe cases.[24][25] Moderately low blood sugar may easily be mistaken for drunkenness;[26] rapid breathing and sweating, cold, pale skin are characteristic of low blood sugar but not definitive.[27] Mild to moderate cases are self-treated by eating or drinking something high in sugar. Severe cases can lead to unconsciousness and must be treated with intravenous glucose or injections with glucagon.[28]
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