Information on popular complementary and alternative medical topics » Diabetes

EPISODES OFTEN MISTAKEN FOR SEIZURES: “PALLID BREATHHOLDING SPELLS”

admin — Mon, 20 Dec 2010 15:09:59 +0000

Sometimes these breathholding spells can be aborted or prevented by diverting the child’s attention. Also, since the crying and frustration that cause these spells are reinforced by parental overprotection in fear that a spell will reoccur, behavioral modification should be taught to the family by the physician or by a behavioral psychologist. Parents should learn to ignore the crying and reward the child’s good behavior, and not reward the tantrum and breathholding with attention and concern. The spells will probably then decrease in frequency and the child will outgrow them without long-term consequences as the central nervous system matures.
There is a second form of these spells that is misnamed “pallid breathholding spells,” usually occurring after trauma such as a bump on the head. The child suddenly stops what he has been doing, turns pale, and may fall down. Occasionally the child will then arch his back and rarely experience jerking movements. Such spells are not preceded by crying, breathholding, or turning blue. They are caused by “vasovagal syncope,” that is, fainting because of overactivity of the normal reflex that slows the heart rate. If the heart beat slows sufficiently, not enough blood is pumped to the brain and the child loses consciousness and stiffens. These “pallid breathholding spells” are the infancy and childhood counterpart of fainting when blood is drawn. The slowing of the heart rate can often be reproduced in the physician’s office by pressing on the child’s closed eye. If a child has an overactive vagal nerve reflex, the physician will hear a dramatic slowing of the heart rate, at times even a brief pause between heart beats. If an EKG (electrocardiogram) is running at the time, the increasingly longer interval between heart beats can be documented.
Although they are frightening, pallid spells are usually benign and will be outgrown. Only rarely, when the spells are quite frequent, is it necessary to consider treatment, but not with anticonvulsants since these spells are not seizures. The appropriate medications are those that block the action of the vagus nerve and prevent the slowing of the heart.
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DIABETES MELLITUS: ESSENTIALS OF TREATMENT AND DIET PRESCRIPTION

admin — Mon, 13 Dec 2010 15:09:25 +0000

Essentials of treatment
The goals of treatment are (1) to relieve symptoms; (2) to enable the patient to lead a normal life; and (3) to prevent or delay the onset of complications. The following are crucial requirements if these goals are to be met: (1) maintenance of normal weight; (2) regular spacing of meals; (3) normal nutritional requirements with normal proportions of carbohydrate, fat, and protein; (4) usually restriction of cholesterol and modification of the type of fat; (5) use of oral compounds or insulin, if not controlled by diet alone; (6) regulation of physical activity; and (7) attention to body hygiene. For children two additional requirements are maintenance of normal rate of growth and emotional well-being.

Diet prescription
Energy. Weight control is the single most important objective of dietary management. An overweight patient is initially placed on a diet that permits a loss of 3/4 to 1 kg (1 1/2 to 2 lb) each week. From 1000 to 1200 kcal is suitable for obese women and 1200 to 1500 kcal for obese men. The diets described on p. 345 are suitable without further calculations of the diet for protein, fat, and carbohydrate.
Individuals of normal weight are given sufficient calories to maintain weight:
In bed           25 kcal per kg (11 kcal per lb)
Sedentary       30 kcal per kg (14 kcal per lb)
Moderately active   35 kcal per kg (16 kcal per lb)
Protein. About 15 to 20 per cent of total calories are provided by protein. This corresponds to about 1 to 1.5 gm per kg body weight, an allowance that is typical of American diets.
Carbohydrate. Approximately 50 to 55 per cent of calories are furnished by carbohydrate. Severe restriction of carbohydrate is no longer recommended. Diets that provide more liberal intake of carbohydrate do not proportionately increase the hyperglycemia or the need for insulin or oral compounds.
Fat. The remaining calories (30 to 35 per cent) are furnished by fat-Most physicians recommend that saturated fats should be kept at a minimum (about 10 per cent of total calories) and that polyunsaturated fats should be increased to at least 10 per cent of total calories. Cholesterol is preferably restricted to 300 mg daily. These limitations on the kinds and amounts of fat are intended to maintain blood cholesterol levels at a lower level and thus to prevent or delay the onset of cardiovascular complications.
Let us suppose that a diet is being planned for a sedentary individual weighing 60 kg who needs 1800 kcal.
0.20 X 1800 kcal = 360 kcal from protein
360: 4 = 90 gm protein
0.50 X 1800 kcal = 900 kcal from carbohydrate
900 kcal: 4 = 225 gm carbohydrate
0.30 X 1800 kcal = 540 kcal from fat
540:9 = 60 gm fat
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NUTRITION RECOMMENDATIONS FOR PATIENTS WITH DIABETES

admin — Wed, 08 Dec 2010 15:08:43 +0000

Calories
Sufficient to attain and/or maintain a reasonable body weight for adults, normal growth and development for children and adolescents, and increased to meet needs during pregnancy and lactation or for recovery from catabolic illness.
Reasonable body weight is defined as the weight an individual and health care provider acknowledges as achievable and maintainable, both short term and long term.
Calorie requirements are 25 calories per kilogram of the ideal body weight (IBW):
Moderate activity = 30 kcal/kg/IBW
Underweight = T 5-10 kcal/kg/IBW
Overweight = I 5-10 kcal/kg/IBW
Calories to be divided into three major meals and 2-3 snacks.

Proteins
12-15% of daily calories – should be from proteins – not less than adult recommended dietary allowance (RDA). Adjust to
0.8 g/kg/day with evidence of macroalbuminuria: 0.6 g/kg/day for reduced glomular filtration rate (GFR), adjust for very young children, pregnant and lactating women, and some elderly people.

Fats
Individualized, based on the nutrition assessment and treatment goals for those more than 2 years old.
•   Total fat varies with treatment goals.
15-30% Energy percent for normal weight and normal lipids.
< 20% for obese; elevated low-density lipoproteins.
•   Saturated fat < 10% of daily calories; < 7% with elevated low-density lipoproteins.
•   Polyunsaturated fat: up to 10% of total calories.
•   Monounsaturated fat: 10% and as carbohydrate substitutes.

Cholesterol: <300 mg/day

Carbohydrates
It is individualized, based on the patient’s eating habits.
• 55-60% Energy.
• Distribution vary with insulin regimens and treatment goals.

Fibre
35-40 g/day, same as general population. Generally, not beneficial to glycemic control at lesser amounts.

Sodium
•   < 3000 mg/day, same as general population.
•   < 2400 mg/day in mi Id-to-moderate hypertension.
•   < 2000 mg/day with nephropathy, hypertension and oedema.

Alcohol
Moderate usage (i.e., <2 alcoholic drink daily for adult men and one alcoholic drink for women, one drink being 30 ml of whisky, gin, vodka or 250 ml of beer unless otherwise indicated) (e.g., alcohol abuse, hypertriglyceridaemia).

Vitamins/Minerals
Same as for general population.
Magnesium replacement possibly needed if at high risk glycosuria, ketoacidosis.
If at high risk, determine if replacement is necessary with laboratory test.
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DIABETES: SOME THINGS YOU CAN DO TO PREVENT DISEASE

admin — Thu, 23 Apr 2009 08:04:21 +0000

Just lose the weight. Low-fat? High-carbohydrate? Sprout-and-spinach-shake regimen? Don’t worry about how you shed those extra pounds-at least as far as diabetes is concerned. Just shed them. “We don’t really know if any specific diet works best for preventing type II diabetes,” says Eli Ipp, M.D., head of the diabetes section at Harbor-UCLA Medical Center’s division of endocrinology in Torrance, California. “The issue is to lose the weight and keep it off.”

Exercise. Physical activity actually helps your body process glucose, so it helps prevent diabetic complications as well as the disease itself. In fact, medical researchers have actually taken disembodied human muscles, “exercised” them with electric stimulation, and then measured their insulin action. It works.

“Exercise can improve your insulin sensitivity a great deal no matter what your weight is,” Dr. King says. “And the effects can last for two or three days.”

Mix it up. Aerobic exercise is what’s usually emphasized in the prevention of diabetes and its complications because that’s what the subjects did in the studies that first made the connection. But new evidence shows that strength training and even offbeat activities such as tai chi can also improve insulin action, according to Aaron Vinik, M.D., Ph.D., director of research at the Diabetes Institute in Norfolk, Virginia. “All forms of activity have been shown to reduce the likelihood of complications once you have the disease,” he says. “It doesn’t have to be just aerobic exercise.”

A caveat, though: Diabetics with nerve damage or eye disease should stay away from weight training because the strain of lifting weights can cause damaged blood vessels in the eyes to rupture and bleed, according to Dr. Vinik. And if you have nerve damage, you may not be able to sense the damage in your eyes.

Feel your oats. In a 1996 study, Canadian researchers fed four men bread made from oat bran for six months, while another four ate white bread. The oat bran-eaters showed better glucose levels. This finding is consistent with a 1997 study suggesting that diets that emphasize high-fiber whole grains (of which oat bran is one) over refined grains reduces your risk for type II diabetes.

Eliminate it with E. Free radicals- those pesky, tissue-damaging molecules-thrive on diabetes but succumb to antioxidants such as vitamin E.

Also, says Dr. King, vitamin E might help decrease complications for those with diabetes. “Since doses of 100 to 400 International Units are associated with a decrease in heart disease, I would certainly take that much,” he says.

Take your vitamin C. Vitamin C, another antioxidant plentiful in many fruits, may also do the trick. A 1995 study by an Italian research team linked vitamin Ñ to improved glucose metabolism in type II diabetics.

Cool it with the booze. Tee-totaling isn’t required to fight diabetes, but anything more than one shot of liquor or one glass of wine or beer a day is asking for trouble, according to Dr. King. “If you drink too much, you can damage your pancreas,” he warns. “And that’s where the insulin comes from in the first place.”

Watch for the warning signs. Forewarned is forearmed. According to the American Diabetes Association, the following are worth seeing a doctor about: increased thirst; increased need to urinate; an edgy, tired, and sick-to-the-stomach feeling; repeated or hard-to-heal infections of your skin, gums, or bladder; blurred vision; tingling or loss of feeling in your hands or feet; dry, itchy skin.

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