Archive for the 'Diabetes' Category
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LIPIDS/LIPOPROTEINS: A CONSENSUS FOR INTENSIVE MANAGEMENT OF LIPIDS AND LIPOPROTEINS IN TYPE 2 DIABETESType 2 diabetes has long been known to be associated with accelerated coronary heart disease. Typically, people with type 2 diabetes have an atherogenic lipid profile, characterized by elevated plasma triglycerides, low plasma HDL cholesterol levels, and increased population of small, dense LDL particles. An important consideration is that these alterations are frequently seen in the very early stages of type 2 diabetes, during the stage of impaired glucose tolerance or metabolic syndrome. Thus, even before the appearance of fasting hyperglycemia and a definitive diagnosis of diabetes, patients are at high risk for cardiovascular events due, at least in part, to persistent dyslipidemia. Fortunately, clinical trial evidence has rapidly accumulated to support aggressive lipid-lowerjng treatment strategies in type 2 diabetes.The ADA and the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) have now joined forces in recommending that diabetic patients be treated for lipid alterations with the same intensity as nondiabetics with established coronary heart disease. This is a major policy shift for NCEP(ATP III). In its recent report, this group recognized that people with diabetes or metabolic syndrome have extremely high cardiovascular risks. The new features of this important report are as follows:1. Focus on multiple risk factors• Raises persons with diabetes without CHD, mostof whom display multiple risk factors, to the risk level of CHD risk equivalent.• Uses Framingham projections of 10-year absolute CHD risk (i.e., the percent probability of having a CHD event in 10 years) to identify certain patients with multiple (2+) risk factors for more intensive treatment.• Identifies persons with multiple metabolic risk factors (metabolic syndrome) as candidates for intensified therapeutic lifestyle changes.2. Modifications of lipid and lipoprotein classification• Identifies LDL cholesterol <100 mg/dl as optimal.• Raises categorical low HDL cholesterol from < 35mg/dl to < 40 mg/dL (men) because the latter value is a better measure of depressed HDL.• Lowers the triglyceride classification outpoints to give more attention to moderate elevations (>150 mg/dl).3. Support for implementation• Recommends a complete lipoprotein profile every 5 years in patients > 20 years of age. Fasting levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides as the preferred initial test.• Encourages use of plant stanols/sterols and viscous (soluble) fiber as therapeutic dietary options to enhance lowering of LDL cholesterol.• Presents strategies for promoting adherence to therapeutic lifestyle changes and drug therapies.• Recommends treatment beyond LDL-lowering for persons with triglycerides >= 200 mg/dl.*168\357\8*
Most of the world’s population eat a high carbohydrate diet based on staples such as rice, maize (corn), millet and wheat-based foods like pasta or bread. In developing countries, carbohydrate may form 70 to 80 per cent of a person’s kilojoule intake. In developed countries the intake may be half this. In the United States and Canada, the United Kingdom, Australia and New Zealand, carbohydrate typically contributes only 40 to 45 per cent of kilojoule intake. In these countries, carbohydrate, the body’s vital energy source, tends to be crowded out by fat.
Current recommendations suggest that we take at least 50 to 60 per cent of our total kilojoules as carbohydrate. To do this we need to consume 150 grams of carbohydrate for every 4200 kilojoules (1000 Calories). For a low kilojoule diet (5000 kilojoules/1200 Calories) it means eating about 175 grams of carbohydrate per day (equivalent to about 12 slices of bread). A young, active person with higher energy requirements, say in the order of 8400 kilojoules (2000 Calories) would require 300 grams of carbohydrate (equivalent to about 20 slices of bread). As an example of what this looks like we have calculated a sample carbohydrate intake for small eaters and bigger eaters.
The number of kilojoules and hence the amount of carbohydrate needed varies greatly between people. Your kilojoule requirements depend on your age, sex, activity level and body size. It is not possible to publish standard figures that will apply to every reader. If you want more information on your own specific kilojoule and carbohydrate needs, we suggest that you consult a dietitian. Dietitians can help you assess your kilojoule requirements and calculate exactly how much carbohydrate you need. Most of us don’t need to keep count of the number of grams of carbohydrate we eat every day. But for some people, like athletes, it may be necessary to keep a watch to make sure that they are eating enough carbohydrate.
However, if you are looking at ways to improve your own diet there are two important things to remember:
1. Identify the sources of fat and look at ways you can reduce it. Don’t go overboard-the body needs some fat in the diet
2. Check whether you need to add more carbohydrate to your diet and eat more. Most people don’t eat enough.
Note: A low-fat diet is not appropriate for children under five years of age. They need the extra energy provided by fat for normal growth and development.
How to find a dietitian. If you want to consult a dietitian about your kilojoule requirements and how much carbohydrate you need, look in the Yellow Pages under Dietitians. Make sure that the person you choose has the letters APD after their name (Accredited Practising Dietitian).
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At what age should my child be giving his own injections?
As soon as he expresses a wish to do so. Some doctors like children to give injections to themselves at as young an age as possible, and certainly many children have been known to give their own needles at the age of 4 or 5. There is very little point, however, in coercing your child to give his own injections too early. By the age of 10 or 11 years he will very probably want to be responsible for his own injections, particularly as he may want to go away camping or stay with friends by himself.
Some children find that they want help from their parents with injecting until they are even older, but at all events by the time a child is a teenager he should be encouraged to do his own injections. Parents’ anxiety to help their child may prove not to be in his best interests if it prevents him becoming self-reliant in his adolescent years. Sometimes it is hard for parents to teach their own child to give the injection. Allowing your child to attend a Diabetic Camp where he can be taught by trained nurses and follow the example of other children can be one way of overcoming this. Perhaps you will wish his doctor or nurse to teach your child to give his own injections.
Are automatic injectors a good idea?
For a few people they are helpful. It is wise to learn first to give the injection by hand, partly because it will give you confidence in handling the syringe, and partly because the injector is just one more thing to learn about. Also it is wise to be able to give an injection by hand in case an injector goes wrong. Many people prefer to give an injection by hand because they find that the extra time taken setting up an automatic injector can be a nuisance. It all depends on the individual, and it is particularly helpful for a nervous person who has trouble plucking up the courage to plunge the needle through the skin. If after giving the ordinary method of injection a fair trial you feel that the plunging of the needle through the skin is a tremendous ordeal, you should discuss the question of an automatic injector with your doctor or nurse.
If the insulin dose has to be increased does this mean that the diabetes is getting worse?
No, not necessarily at all. Insulin dose will have to be increased with time, both because your child is getting bigger (and the requirement for insulin grows with her), and because, with the passage of time, the pancreas produces less and less insulin. There is, after all, very little difference in having to have, say 10 units, than having to have 20 or 30 units of insulin a day. In each case it merely represents your child’s need for insulin rather than anything to do with the severity of the diabetes.
How do you store insulin in very hot weather?
It is important that insulin should be kept in a cool place. If the weather is very hot, it may be wise to keep it in the door of the refrigerator but be sure that it does not freeze. It is better not to keep the bottle that you are actually using in the refrigerator but to keep it in a cool part of the house. When travelling in hot weather keep the insulin well insulated and not in the hot part of a car. A wide necked thermos flask with a little ice can be used. Insulin is quite a stable substance and lasts well at normal room temperature.
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TRAVEL OF PEOPLE WITH DIABETES
Author: admin
People with diabetes can – and do – travel anywhere. Usually this will not involve much change in the usual routine, but if you are travelling long distances overseas by plane, there will be some necessary adjustment to cope with the time differences between countries.
There is some preparation and planning you should consider before your trip. Although you will receive advice from your physician there are some general suggestions you may find useful.
General advice
1. Take extra supplies of insulin and syringes with you, carrying them in two separate items of luggage. This means that if a piece of luggage is lost you still have spare insulin and equipment.
2. Carry essential equipment in hand luggage and then it is always to hand.
3. In very hot climates make sure insulin is kept cool. You may need to take insulated food or drinks pack or make arrangements for the use of a refrigerator. Hotel rooms are usually quite cool enough for keeping insulin, but cars can get very hot.
4. If your child is liable to get travel sickness, it may be wise to use an anti-travel sickness tablet. Discuss this with your doctor.
Advanced planning for overseas trips
Ask your travel agent well in advance to give you the following information:
1. Departure time.
2. AH stops – arrival and departure times.
3. Flying hours between stops.
4. Arrival at destination – local time.
5. Meal times on flight.
Get your supplies together using the check list and get prescription items in plenty of time.
Tell your doctor. Make an appointment one or two weeks before departure to discuss details. Warn him that you will need two letters – see the check list.
Check with the travel agent if the airline requires a medical certificate. Most don’t, but if they do, you will need to take it to your doctor. Ensure you have adequate health insurance cover – hospital care can be very expensive in some countries.
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