Why insulin is given in diabetes?

Diabetes is a state of insulin deficiency. In adult diabetes is treated with either oral anti diabetic tablets or with insulin. 

Insulin has got the following advantages

1. To stop the severe catabolic state & regain lean body mass.

2. Decreases frequent infections.

3. Reduce  fetal & maternal complications  in pregnancy.

4. Prevent & delay complications of diabetes.

5. Eliminate symptoms of hypoglycemia.

6. Prevent DKA(diabetic ketoacidosis).

Principles of insulin therapy

1. To supply  sufficient insulin throughout 24 h to cover the  basal requirements

2. To provide higher boluses of insulin to match the high glucose levels  following meals .

Treatment strategies

Appropriate insulin regimen is planned based on

1. Patient’s lifestyle.

2. Age.

3. Motivation.

4. General health.

5. Self management skills.

6. Goals of treatment.
Before initiating insulin patient should be given appropriate education & support about the care & use of insulin, detection & management of  hypoglycemia.

Treatment strategies in type 1

1. Multiple Daily Injections.

2. Twice daily injections are not recommended in Type 1 DM.

3. Complementary education & support.

4. Most newly diagnosed patients with type 1 diabetes may be started on a total daily dose of 0.2 to .0.4 u/ kg / day, most will ultimately require 0.6 to 0.7 u/ kg / day.

6. During puberty > 1 IU/kg per day insulin is given

Type 2 DM (Diabetes mellitus) 

1. Initial management does not include insulin.

2. Given for patients unable to achieve good blood sugar  control with a combination of diet, exercise and OHA.

3. Goals of insulin treatment is  similar to Type1 DM

Achronym's used
DM - Diabetes mellitus.
IU/kg - Units of Drug per Kilogram of body weight.
OHA - oral hypoglycemic agents.
DKA - diabetic ketoacidosis.

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How to overcome tiredness

Increased tiredness is one of the most common health problem that is experienced by many people in their day to day life. Cause of tiredness vary. 

The most common causes are

1.Lifestyle changes.

2.Distressing hard work.

3.Competition and stress in the professional field.

4.Lack of sleep .

If you have excessive tiredness consult a doctor make sure that the tiredness is not due to any physical illness,then make some change in the lifestyle,that will help you to become energetic.

Here are few tips that will help you to become more energetic

1.Ensure adequate sleep,on an average 6 to 8 hours sleep is required.Both excessive and reduced sleep causes tiredness.

2.Eat food that is balanced and nutritious,it should contain adequate vegetables and fruits.Avoid fatty food and fried foods.

3.During menstruation,pregnancy and lactation special attention should be given.

4.Adequate water intake is necessary,during summer season drink 2 liter of water daily.Avoid carbonated drinks.

5.Regular exercise will make you energetic.

6.Reduce the time spent for for watching television and computer.

7.Avoid alcohol and smoking.

8.Control coffee intake,

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Food sources of vitamin C

All fresh fruit and vegetables  contain Vitamin C. Unfortunately, vitamin c is easily leached out of vegetables if they are placed in water and is also easily destroyed  during cooking or exposure to copper or alkali. So fresh fruit and juices and salads are encouraged. Also advised to cook vegetables lightly and quickly. Vitamin  is lost during storage. About  40% of the U.S. population consumes vitamin C as a dietary supplement in which “natural forms” are no more bio available than synthetic forms.

The recommended  nutrient intake for adults

90 mg/day for males  in the United States - for healthy people.

75 mg/d for females

Following  are the rich sources of vitamin C.

1. Blackcurrants, guavas.

2. Rosehip syrup, green peppers.

3. Oranges, other citrus fruit, strawberries.

4. Cauliflower, broccoli.

5. Sprouts, cabbage, watercress.

6. Potatoes.

7. Liver and milk.

Absorption  of vitamin C

If the dose of vitamin C administered in a single dose is < 100 mg,  complete absorption occurs. At doses more than  1 g less than 50% is absorbed, this is because of increased degradation and fecal and urinary excretion of vitamin C at higher doses. As already mentioned above good dietary sources of vitamin C include citrus fruits, green vegetables (especially broccoli), tomatoes, and potatoes. People get recommended daily allowance by consuming five servings of fruits and vegetables a day. There are several drugs that interfere and cause vitamin C deficiency such as  corticosteroids, aspirin, indomethacin, phenylbutazone, and tetracycline. As the requirement of vitamin C increase during major surgery it is advisable to supplement vitamin C upto 250 mg  a day to cover major surgery. Bottlefed infants are advised to give orange juice. In the elderly scurvy can be avoided by consuming adequate  fruits and vegetables. Careful observation is required  in the elderly people who live alone. Rarely vitamin C supplementation is required.

Vitamin C requirements increase in the following situations.

1. Smoking,

2. Hemodialysis,

3. Pregnancy,

4. Stress

5. Infection

6. Trauma

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Diet for Heart disease - A must read for every one

Coronary artery disease (Heart attack) is  a multi factorial disease. Here the strongest environmental factor is diet. Basic abnormality that lead to coronary artery disease is  is atherosclerosis. Major constituent of atherosclerosis is cholesterol esters,which  are carried by LDL (Law Density Lipoproteins ) in the blood. LDL cholesterol is affected by the type of  dietary fat.
Saturated fatty acid raise the blood cholesterol,while polyunsaturated fatty acid decreases the cholesterol. Cholesterol is found only in  animal food.

Following are the dietary recommendation in patients with coronary artery disease.

• Balanced diet is recommended.
• High fiber content (Complex carbohydrates) - Effect is determined by the type of dietary fiber. Soluble fibers such as pectin, guar and oat fibers can produce moderate reduction of cholesterol. Wheat fibers (wholemeal breads or bran) wont reduce the plasma cholesterol, but those who consume more wheat fibers and whole grain food the incidence of CAD  is decreased.
• Weight reduction to achieve optimal BMI (Body Mass Index) - Overweight, especially abdominal obesity is an independent risk factor for CAD. Weight reduction will reduce the cholesterol.
• More vegetables and fruits - Soya protein if included in the diet help to reduce the total and LDL cholesterol. Vegetables and fruits are law in fat and contain pectin other dietary fibers ,flavanoids and antioxidants. Five servings of different vegetables and fruit per day (400 g/day average weight)  is recommended.
• Avoid excessive caffeine intake - Coffee contains small amounts of diterpenes (lipids), cafestol and kahweol - not caffeine - it raise plasma total and LDL cholesterol. Since the diterpenes are removed  filtered or instant coffee does not raise the cholesterol.
• Avoid junk food.
• Avoid  foods with high fat content especially MUFA, excess salt ,cholesterol.
• Fish oil (omega 3 PUFA), garlic, plant sterols, antioxidants all help in reducing the cholesterol.
• Salt (NaCl)   should be restricted to 6 gram/day for the general population this is more important for CAD  patients.
• Fish  at least twice a week preferably fatty fish is recommended, it should not be fried in saturated fat. EPA (eicosapentanoic acid) help in reducing  CAD.
• Alcohol one or two drinks per day may be beneficial in middle aged people at risk for CAD, because of complications of over intake not recommended in general population.
• The following dietary components reduce the risk of coronary heart disease. Fruits and vegetables, cereal fiber,  PUFA, linolenic  acid, alcohol and fish, nuts, vitamin E, folate.

Glossary

1. BMI - Body mass index
2. CAD - Coronary artery disease
3. LDL - Law density lipoproteins
4. MUFA - Monounsaturated fatty acids, plant-based fats found in avocado, nuts and seeds, oils, olives, and dark chocolate
5. PUFA - Cutting off all vegetable oils except coconut oil, olive oil and palm oil. 

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Drugs used for treatment of heart attack patients.

Heart attack occurs when there is reduced blood supply to heart. It is an emergency situation and immediate medical care is required. Here in this article we will tell you some of the drugs and their aims. It is always good to have these in your mind

Following are the aims of treatment.

1.Immediate stabilization of patient.

2.longterm symptom control.

3.Cure of the condition if possible.

Drugs used for the treatment are given below.

1. Antiplatelet drugs –Aspirin and Clopidogrel, it is a group of powerful drugs that will prevent the blood clotting.

2. Nitrates will help to reduce the pain

3. Betablockers decrease the heart rate, blood pressure and improve the oxygen supply to heart.

4. Statin will reduce the blood cholesterol. Stabilize the plaque so prevent further attack.

5. ACE Inhibitors- role is to reduce the blood pressure, dilate the blood vessels and increases the blood supply.

6. Angiotensin II Receptor Blockers will increase the blood supply to heart.

7. Clot lysis with streptokinase give immediate improvement.

8. Diuretics remove excess salt and water from the body so help the heart to work properly.

9. Digoxin improve the function of heart.

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Statin a cholesterol lowering agent - Reduce cholesterol in 4 weeks

The problem of high cholesterol is increasing in the society. This will lead to atherosclerosis and increased risk for heart attack and stroke. Statin's will help to reduce the cholesterol level and thus will help to reduce heart attack and stroke in the community. Statin's are the most efficacious and best tolerated lipid lowering drug. They will reduce both primary and secondary hypercholesterolemia. Statin's can reduce the total cholesterol in 4 to 6 weeks. All the statin's are given at bedtime to get maximum effect.

Statins include the following

1. Atorvastatin­ dose 10 to 80 mg/day.

2. Lovastatin­ 10 to 40 mg/day,this is the first used statin.

3. Simvastatin ­5 to 20 mg/day.

4. Fluvastatin.

5. Pravastatin.

Adverse effects of statins

1. Headache.

2. Nausea and bowel upset.

3. Rash.

4. Sleep disturbance.

5. Muscle pain and rise in CPK level.

6. Increase in serum transaminase,but liver damage is not seen.

Uses of Statins

1.Reduce  cholesterol level.

2.Decrease heart attack rate

3.Decrease  stroke rate.

4.Help in plaque stabilization in atherosclerosis.

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