When will you give insulin in type 2 diabetes.

The term diabetes means there is increased blood sugar level above the normal range.
There are mainly two type of diabetes .
Type 1 diabetes - Which is due to reduced insulin level in the body
Type 2 diabetes - Where the basic defect is not the reduction of insulin but due to reduced action of insulin.
In Type 1 diabetes treatment of choice is only insulin.
In Type 2 diabetes initial treatment of choice is anti diabetic tablets. Insulin is given only in the following situations

(a) Newly diagnosed symptomatic type 2 diabetes with severe hyperglycemia.
(b) Poor glucose control while taking maximal doses of a combination of oral medications.
(c) Intercurrent illness (eg - myocardial infarction, infection) or operation.
(d) Pregnancy.
(e) Kidney disease.
(f) Liver disease.
(g) Allergy to or inability to tolerate oral antidiabetic medication.

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Home Remedies - How to get pink beautiful lips by natural method ?

Pink and beautiful lips will make your smile pretty and attractive , that make your personality more impressive. Natural remedies give long lasting effect. It is without any side effects. If you wish to have pink and soft lips you can try these easily at home and they are cheap also.

Why lips need special care?

Lips are the only part of face that cant produce oil itself to moisturize it. So dryness and chapping occur easily and if you fail to treat it at right time it causes pigmentation and darkness. So you need to apply moisturizer and give special care to keep it pink and soft. Pink lips also is an indicator of good health. Here are the most effective ways to get pink soft lips.

Basic things you need are 

Exfoliation with lip scrubs make it soft

Exfoliation means removing dead cells from the lips that will make it soft and supple.It should be done at least 2 times a week.

How to do scrub

(a) Honey and  sugar lip scrub - Dip finger in a mixture made of one teaspoon of honey two teaspoon of sugar and one teaspoon of olive oil. Rub it on your lips in circular movements and leave it there for sometime then wipe off with damp cloth or cotton.

(b) Take a toothbrush with smooth bristle with a bit of toothpaste, remove the dead cells with gentle rubbing in circular movements on lip, and wash the lips.
Moisturization of the lips hydration external and internal 

Since lips cant produce oil itself it will become dry easily, dryness take away all its beauty. To avoid dryness you need to apply moisturizer. Dryness can lead to dark lips. Following are the best lip moisturizers. Well hydrated lip has juicy appearance,while dry lip appears dull.

(a) Apply glycerin on your lips before you go to bed at night. Glycerin help to keep the lip hydrated. It will prevent darkness.

(b) Adequately hydrate your body, drink 8-10 glass of water daily.

(c) Application of Vitamin E to the lip also keep it soft.

(d) Lip balm also help to maintain hydration. Avoid Petroleum containing Lip balms. It is better to use lip balm containing Natural Beeswax, Cadillac Wax, Almond Oil and Vitamin E,  glycerin.
Lightening agents-Remove the darkness and give pink colour to your lips.

(a) Lemon honey lip serum - Mix  equal amount of lemon juice and honey and coat it  on your lips, keep it for 1 hour and wipe off with soft wet cloth. Do it daily to remove the tan from lips. This lip serum can be kept in refrigerator and used for 1 week. 

(b) Take the slice of beetroot and rub gently on your lips.

(c) Almond oil application at bedtime lighten the lips.

(d) Cucumber juice if applied daily removes tan from your lips.
Protection from harmful things

(a) Avoid lip products that are cheap and allergic

(b) Avoid excessive sun exposure

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Foods that keep you young

Most beautiful phase of human life is youth. While you are young you will have fit body beautiful skin, and a healthy mind. It is the most energetic phase of life. Even then we don't realize its significance and value. We rapidly loss this phase due to wrong diet and lifestyle. If you want to prolong this you should follow healthy food habits.

Experience the change, your food can cause magic. There are several foods that prevent ageing. To avoid fat accumulation eat low calorie foods. Do not eat up to a level that your stomach is completely filled.

1. Antioxidants - Food that contain antioxidants are the strongest anti ageing agents. Fruits that are dark colored and vegetables are rich in antioxidants. Consume vegetables and fruits of different color. Examples are apple, orange, papaya, beetroot, grapes, mango, capsicum. This food habit is called rainbow food.Weekly fruits and vegetables of 3 different colors are advised.

2. Vitamin C - Vitamin C rich foods help to prevent pigmentation of skin. Citrus fruits are rich in vitamin C. Drink lime juice daily. Eat a gooseberry daily.

3. Daily drink at least 8 glass of water. Body should be adequately hydrated.

4. Green tea - Green tea is a rich source of antioxidants. If you drink it daily, it will increase the antioxidants level in the blood. Green tea is more effective if it is mixed with a teaspoon of lemon juice.

5. Garlic improve the immunity of the body. Can be consumed with or food or can be chewed.

6. Red wine helps to prevent ageing. It enhance the absorption of food. Daily consumption of grape wine 15 ml will give good result.

7.Include nuts(almond, cashew nut, ground nuts ) in daily menu. Consume one spoon (30 gm) of nuts daily. This will keep the skin tight by maintaining the collagen level.

8. Broccoli the magic food prevent ageing. This will give you good mood.

9. Wheatgerm in whole wheat Prevent ageing of skin.

10. As the salads and soups are poor in protein, to get adequate protein consume skimmed milk,low fat meat, soya beans and fish.

11. To protect your heart omega 3 fatty acids are essential. Include omega 3 rich foods mackerel, sardines and tuna twice weekly.

12. Avoid white poison that is sugar, trans fatty acid example vanaspathy, oily foods and sauce.

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Most effective ways to strengthen your bone

Osteoporosis is one of the most disabling problem in elderly, especially in females. In osteoporosis there is weakness of bone strength. Inorder to escape from osteoporosis you should take care of your bones from childhood itself. 

Following tips will help you to strengthen your bone.

1. Growing phase of bone is up to 21 years, you should consume foods with maximum calcium content this phase. Here are some foods that are rich in calcium.

(a) Milk and milk products.

(b) Green leafy vegetables.

(c) Foods with high vitamin C will help in calcium absorption.

(d) Orange.

(e) Gooseberry.

2. Consumption of foods that's rich in calcium is better than consuming calcium supplements, take calcium supplements if prescribed by doctor and ensure balanced diet.

3. For strong and healthy bones regular physical exercise is essential. Walking and swimming are best for bone strengthening.

4. Give more attention in bone strengthening from 30 years onward.

5. In females postmenopausal osteoporosis is common, estrogen replacement help to reduce it. Hormone replacement therapy contains phytoestrogen, which functions as estrogen in the body.

6. Reduce the salt intake, excessive salt causes weakening of bone strength.

7. Avoid excess sugar, carbonated drinks and coffee. The phosphoric acid in them cause loss of calcium through urine.

8. Avoid physical activities that create over burden to bones after 45 years.

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Lower your cholesterol without drugs

Health problems due to high cholesterol is on rise due to change in lifestyle and food habit.

To lower your cholesterol the following measures are available 

Dietary changes

Regular exercise

Drug

Here are few tips that will help to lower your cholesterol without drugs.

1. Reduce the intake of fried food especially fried meat and fish.

2. Do not reuse the oil that is once used to fry the food.

3. Reduce the oil intake as far as possible.It is better to use olive oil or sunflower oil for cooking.

4. Vegetables and fruits contain large amount of dietary fibers, that will inhibit the cholesterol absorption.Increase the daily intake of vegetables and fruits.

5. Oats.barley,cashew nuts also help to lower cholesterol.

6. Daily intake of Green tea will help to control cholesterol.

7. Fish such as sardine contain omega three fattyacid which can lower the cholesterol level.

8. Eating curry leaves ,and garlic are also useful.

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Why exercise is advised in diabetic patients

Diabetes mellitus is a condition characterized by elevated blood sugar value. Apart from that there is alterations in blood lipid value and blood pressure. In diabetic patients exercise will help to decrease the blood sugar and also increases the sensitivity to insulin.

Other positive effect of exercise in diabetic patients

1. Decrease the heart attack risk

2. Decrease the blood pressure.

3. Exercise will help to reduce the muscle mass.

4. Reduce the body fat.

5. Produce weight loss.

Recommend exercise in diabetes

Diabetic people are advised exercise 150 minutes/week that is distributed at least over 3 days, moderate aerobic physical activity and resistance training.

Precaution before starting exercise in diabetic patients.

Since  diabetic patients are at high risk for heart disease without pain exercise tolerance test may be done in the following situations.

1. Age  more than 35 yrs

2. Duration of diabetes more than 15 yrs in type 1 diabetes and more than 10 yrs in type 2 diabetes.

3. If the patient has complications of diabetes such as kidney disease ,eye disease

4. Blood vessel occlusion in limbs.

5. Other risk factors for heart disease.

Those patients who have proliferative diabetic retinopathy should avoid vigorous exercise because of the chance of bleeding in to eye. 

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How to make your Eyes most beautiful and attractive

The most beautiful part of our face is eyes, with make up you can make it more bigger and attractive and you need not spend much time for it, this will create wonder to your face.

For Eye make up you need the following.

1. Deep colors eyeshadow

2. Kajal

3. Brush 

4. Mascara 

5. Ice cubes 

6. Translucent powder

7. Rose-water

8. Cotton ball

9. Foundation / concealer

How to do it?

1. With ice cubes gently massage around the eyes - This will reduce the puffiness around the eyes and decrease the dark circles.

2. Dip the cotton ball in the rosewater, then clean the area around the eye. This removes dirt and gives a glow. 

3. Apply some moisturizer around the eye.

4. Apply the creamy concealer to area around the eye, the concealer should be one or two shade lighter than the skin tone. With fingertip or brush, gently blend it around the eye in circular movements.

5. If you apply some translucent powder on the top of concealer that will give smooth finish and help to keep the concealer for long time.

6. Apply eye shadow, better color are deep brown or burgundy. First apply the eye shadow on your eyelid then extend to the creases and outer part of creases. "V" area of the eye is covered with an eye shadow that is one shade darker. This will give you glamorous look. 

7. Line the upper eyelid with a black pencil or liquid eyeliner.

8. Use gel black eye shadow or kajal to line lower eyelid slightly extend the line upward.

9. Curl your eyelashes with eyelash curler.

10. Apply mascara on to  eyelashes to  thickens your eyelashes.

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How to get glowing radiant skin with Honey

Glowing skin is a dream of every women and it is a sign of beauty. Honey is the delicious golden liquid that will help you to get a glowing awesome skin with minimum efforts. This is why it is a content of many skincare products.

Contents of Honey

A rich source of fructose and glucose. 

Essential vitamins. 

Minerals.

Antioxidants.

Honey can produce wonders to your skin why?

1. Moisturizing effect honey can absorb water from air and retain it in the skin layers so skin become soft and supple which help to give better appearance to dry skin.

2. Help to fight acne due to its antibacterial effect.

3. Honey is a great anti ageing that reduces the fine lines and age spots which give young and radiant  appearance to skin.

4. Honey protect skin from harmful UV rays.

5. Help the skin to rejuvenate.

6. It act as a facial cleanser, Honey can unplug the skin pores.

7. Because of the anti-inflammatory action it helps to treat sunburn.

8. Honey has skin lightening effect that help to reduce the skin pigmentation.

9. Honey reduces the scars.

Honey is cheap and easily available, preparation of honey mask doesn't require much time

Lemon honey facial mask for glowing youthful skin 

1 teaspoon honey.

1 teaspoon fuller’s earth (multanimitti).

1 teaspoon lemon juice.

Mix the above contents and make a paste apply it to the face wash after 20 minute with lukewarm water.

You will get glowing  radiant skin 

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Do you have acidity ? Omeprazole to reduce acidity.

Omeprazole Proton pump inhibitor is a common drug used for acidity and ulcer disease. Ulcer occur in that part of gut exposed to acid from stomach. Omeprazole inhibit the last stage of acid secretion. Depending upon the dose the strength of action vary. It can even completely stop the acid secretion from stomach. Omeprazole does not inhibit the mobility of stomach.

It is orally given and 50% is absorbed, excretion from the body is through  liver and kidney. No dose reduction is required in elderly and in renal impairment.

After intake, action start in 1 hour and reach maximum in 2 hours and last for 3 days.

Dosage

Available as 10 mg and 20 mg capsules.Capsules should not be opened or chewed.It should be taken before meals.

Side effects

Side effects are minimal

Following side effects are seen in 3 to 5 percentage of people.

1. Nausea (a tendency to vomit)

2. Loose stool

3. Headache.

4. Abdominal pain.

5. Dizziness.

Rare side effects

1. Rash

2. Liver function changes.

3. Low blood count

4. On prolonged treatment atrophic gastritis occurs.

Precaution should be taken by patients who are on the following drug.

1. Diazepam

2. Phenytoin

3. Warfarin.

Uses of Omeprazole

1. Ulcer disease-it produce fast pain relief. Fast healing is seen  at dose 40 mg per day. Stomach ulcer require treatment for 4 to 8 weeks. But ulcer in the intestine need only 2 weeks.

2. Gastroesophageal reflux (heartburn) - 20 to 60 mg per day.

3. Zollinger Ellison syndrome-60 to 120 mg per day.

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Association of age and sex with osteoarthritis

Age and osteoarthritis : Osteoarthritis is a common problem in the community. It has several important risk factors of which one of the most important risk factor is age. Association between age and osteoarthritis is as below.

1. Osteoarthritis is less prevalent in people below 45 years. Type of osteoarthritis seen in this group usually affect single joint. The most common cause  of this is trauma and injury.

2. As the age advances the chance of getting osteoarthritis also increases this is seen up to 65 years .

3. In elderly more joints are involved compared to young people who predominantly show affection of single joint.

4. Radiological evidence of osteoarthritis is seen  in people under 40 years even if they do not have symptom.

5. In people aged over 70 years more than 50 percentage will have osteoarthritis of hand.

6. Joint are protected from osteoarthritis by several mechanism, these protectors fails with age.

7. One of the important protective mechanism is cartilage in the joint, as age advances there is thinning of cartilage in the joint. So the joint experience increased stress with load.

8. Muscle that bridge the joint protect the joint from increasing stress, as age advances there is weakening of the muscle strength.

9. As a part of  ageing ligaments stretch, so they cannot absorb the stress.

Sex difference in osteoarthritis

1. In mild osteoarthritis there is no gender difference

2. Female predilection is seen in severe grades of osteoarthritis

3. Severe disease is seen in older age groups in knee and hand osteoarthritis.

4. Older women are at increased risk for osteoarthritis of all joints ,it is seen in sixth decade,this is due to loss of female sex hormone after menopause.

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Need of patient education about osteoarthritis.

Helping the patient to understand about osteoarthritis is important. It is a progressive wear and tear disease of old age. Poor understanding of the disease will lead to negative attitude in patients. For example ignorance about the disease may lead to lack of activity which further aggravate the disease. Patient education is an essential component of  treatment due to the following reasons.

Psychological and social factors will alter the effect of disease, proper education of the patient regarding the disease and effect will reduce the pain, distress, disability and it will improve the treatment compliance.

To protect the affected joint from excessive loading

1. Reduce the weight.

2. Patient should consume low fat, carbohydrate rich low calorie food for weight reduction.

3. Avoid inappropriate daily and occupational activities example knee lifts.

4. Use walking sticks.

5. Wear shock absorbing footwear.

6. Correct the disparity in leg length with shoe rise.

7. Tubular loose knee support may reduce the pain.

8. Use wedge insoles.

9. Proper advice should be given to maintain the normal joint function.

10.Advice aerobic fitness such as walking and swimming to maintain the joint motion and stability.

11. Do muscle strengthening exercise.

12. Regular physical activity.

13. Avoid over activity on good days because that may increase the pain and reduction of activities on subsequent days.

Proper modification of work place and home activities are required.

Advice regarding sexual activities should be given to the patient and the partner with hip osteoarthritis.

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Diagnosis of Ebola fever

Ebola viral fever is a dreaded fever with high mortality  rate, Early diagnosis of the disease is important for initiation of treatment. Following are the laboratory features. 

Laboratory findings

1. Decreased blood count initially.

2. Increase in neutrophil count later.

3.Fall in Platelet counts (sometimes much below) 50,000/µL.

4. Laboratory evidence of DIC is present but its clinical significance not known.

5. Increased  liver enzymes  alanine and aspartate aminotransferases.

7. Elevation of serum bilirubin.

8. The serum amylase level may be increased  indicating pancreatitis.

9. Deterioration of renal function can occur especially with low blood pressure .

Diagram of Ebola virus

Diagnosis

Most of the acutely sick patients will have high levels of viral load in the blood.

Methods of detection of virus include

1. ELISA is a sensitive diagnostic test.

2. Virus isolation and reverse-transcription PCR is useful.

3. Recovering patients develop antibody to ebola virus ( IgM and IgG antibodies ) that are detected by ELISA test.

4. The indirect fluorescent antibody test with paired sera is an effective test.

5. Quarantine or geographic spread is detected by Real-time PCR.

6. Skin biopsies is useful for postmortem diagnosis.

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Beneficial effect of exercise in osteoporosis

Osteoporosis is characterized by low bone strength. This condition is more common in females after cessation of periods (postmenopausal). The disease is associated with increased risk of fracture in various sites of body.

The main aim of treatment is strengthening of bone and muscles, prevent fall and fracture. The beneficial effects of exercise in osteoporosis patients are discussed below.

Exercise in young individuals help to attain maximum bone mass and strength.In elderly weight bearing exercise help to prevent the bone loss, but it wont increase the bone mass. The benefits decreases if they stop excise. There will be better effects if the exercise is done for longer period. Exercise should be done at least 3 times a month.

Exercise also help to improve the following

The strength of nerves and muscles.

Improve the coordination.

Improve the balance 

Thus help to reduce the fall.

Various exercise programs for osteoporosis
Selection of exercise program depends on the  physical condition and preference of the patient.

1. Walking program

5. Use of gym equipment.

2. Dancing

3. Racquet sports.

4. Cross country skiing

If the patient cannot do the above mentioned ones swimming and water sports are advised, but this has low effect on bone. This will help to strengthen the muscles.

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Causes of low back pain and alarming features in lowback pain

Low back pain is a common compliant in the population. At one time or another many of us experience low back pain. It may persist for few days or last for few months. Common causes of low back pain vary according to age.

15 to 30 years

Poor posture

Disc prolapse

Trauma

Fracture

Ankylosing spondylitis

30 to 50 years

Poor posture

Degenerative disc disease

Disc prolapse

Discitis

More than 50 years

Postural causes

Degenerative disc

Osteoporotic fracture

Cancer

Multiple myeloma

Following are the dangerous features in low back pain

Less than 20 years and more than 55 years

Non mechanical pain

Chest pain

Past history of cancer

HIV infection

Patients on steroids

Weight loss

Weakness of legs

Structural deformities.

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Serum cholesterol testing and its interpretation

Incidence of high serum cholesterol is increasing worldwide. This is due to alterations in lifestyle and food habits. High serum cholesterol is a risk factor for many disease. It increase the risk for heart disease and stroke.The interesting factor is that it is a controllable risk factor. 

Normal value

Total serum cholesterol

Desirable level ­<200mg/dl

Borderline­ level 200 to ­239mg/dl

High risk level > 240mg/dl

Fasting stating is preferred for LDL cholesterol checking. HDL and total cholesterol can be measured non fasting state. Cholesterol level is determined by lipid metabolism. Which in turn is affected by heredity, diet,liver kidney and thyroid disease.

Conditions where you get high serum cholesterol

1. Primary disorders of cholesterol metabolism.

• Polygenic hypercholesterolemia
• Familial hyperlipidemia.

2. Secondary causes of elevated cholesterol.

• Uncontrolled diabetes mellitus
• Hypothyroidism
• Biliary obstruction
• Anorexia nervosa
• Nephrotic syndrome
• Drugs ­corticosteroid
• Conditions with low serum cholesterol
• Severe liver disease
• Hyperthyroidism
• Severe acute and chronic illnesses
• Malnutrition and malabsorption
• Familial causes

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Causes of Loss of Appetite (anorexia)

Loss of appetite is called anorexia. A variety of disease can cause anorexia. It may be associated with significant weight loss. Anorexia should be differentiated from early satiety or painful swallowing. 

Following are the important cause of anorexia

Depression : Patients will have depressed mood ,disturbed sleep and inertia

Drugs : Certain drugs are well known to produce anorexia following are the common agents Digoxin, narcotics, diuretics, amphetamines, antidepressants (SSRIs), and antihypertensives (especially ACE inhibitors)

Anorexia nervosa : Patients usually avoid food than anorexia due to alteration in body perception. Seen in females they are usually very thin, hypothermic and will have constipation.

Congestive heart failure : Occur only in advanced heart failure. Patient will have leg edema and breathlessness.

Hepatitis : In patients with hepatitis anorexia occur prior to clinical jaundice. Patient will have associated right sided abdominal pain.

Cancer : Prominent in gastric and pancreatic cancer and in cancer with liver metastases. In these patients weight loss is out of proportion to anorexia.

HIV infection : Anorexia occur as a part of disease or due to opportunistic infection or due to side effects of drugs.

Uremia : Waxy oedema  sallow colour and  decreased urine output are seen.

Addison disease : It is due to deficiency of hormone cortisol. Patients will also have fatigue or tiredness low blood pressure increased skin pigmentation especially of palmar creases and buccal mucosa.

Mesenteric ischemia : patients will develop abdominal pain after food intake due to poor blood supply to intestine, so they avoid eating. Features of systemic vascular disease is found.

Hypothalamic lesion : Certain lesions of hypothalamus such as tumors can cause visual field defect and anorexia .

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