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A prick of life for diabetics
Menopausal problem: Is hormone replacement a panacea?
What to do when there’s leg pain?
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A prick of life for diabetics
Treatment for diabetes revolves around various modalities classified as oral drugs or injections in the skin. The therapy option depends on various factors such as the type of diabetes, duration of diabetes, age, associated diseases such as hypertension, obesity, etc. In Type 1 diabetes, the natural insulin secretion is lacking and needs lifelong replacement from the external route. In Type 2 diabetes also, the majority of the patients require insulin at some stage. In this situation, most of the doctors prescribe insulin only when oral drugs are no longer effective or are required at higher doses at which side-effects supersede benefits. The discovery of insulin in 1921 by Banting and Best, for which the Nobel Prize was also awarded, revolutionised the treatment of millions of diabetics. Insulin is of various types and can be prescribed in different combinations to provide 24-hour control of blood sugar levels. A combination of rapid/short acting insulin and long/intermediate acting insulin is ideal for lowering the blood glucose levels for both Type 1 and Type 2 diabetes. The purpose of Premix Insulin Therapy for people with diabetes is to provide optimal sugar control, using the minimum number of injections possible. Oral drugs can also be given along with insulin. Do not keep your insulin in the freezer compartment of the refrigerator. Any insulin once frozen must not be used. Some preparations like premix insulin and NPH insulin need to be shaken before use for even distribution. Various methods are available for insulin delivery such as the syringe, reusable or disposable insulin pen, insulin pump and via-jet injector. Though many other modes are being developed—for example, inhalation, buccal (inside cheeks) spray, oral routes, etc. — none of them have yet provided a practical alternative. Insulin injection can be given externally just beneath the skin. The most common and appropriate sites for injection are abdomen, thighs and arms. The angle for injection depends upon a person's body weight, injection site and the length of the needle. The site of injection must be changed after each injection to avoid skin irritation. Hot bath, exercise and massage at the injection site increase the speed of insulin absorption whereas smoking and a large dose of insulin reduces it. The needles and syringes for injection are meant for single use, only. On repeated use, there are higher chances of injection site infection. Moreover, the tip of the needle can become blunt, causing more pain and discomfort. The amount of insulin delivered with each dose can vary and may lead to unpredictability in insulin action leading to hypoglycemia. This is especially important in the case of children and old age patients. Weight gain and increased appetite are also observed with insulin. Vials and syringes are conventional and the cheapest method of insulin injection. But this method is associated with various drawbacks, including pain, inaccuracy and inconvenient technique. On the other hand, insulin pens are accurate, easy to handle, portable, discreet devices with virtually painless needles. Some insulin pens have different colour coding for different types of insulin preparations avoiding confusion. The maximum dose dialled by the insulin pens vary from 21 to 80 units. The technique of injection with insulin pen is simple and easy to learn. These pens can be stored in the refrigerator for four-six weeks depending on the insulin preparation. The only major disadvantage with the insulin pen is the higher cost. But the associated advantages with these devices make them the preferred method for injecting insulin. Some new drugs have also entered the Indian market known as GLP-1 analogues. The first drug in this category was Exenatide which need to be given by twice daily injections. Another drug in this category is Liraglutide which is approved in many European countries, the US, Japan, etc, and is currently awaiting approval in India. The weight loss in obese patients is an added advantage but nausea, vomiting and very rarely pancreatitis may occur with these new drugs. These are not recommended for type 1 diabetics and during pregnancy. The writer is Senior Consultant, Endocrinology, Fortis Hospital, Mohali. Email: k.singh@fortishealthcare.com
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Menopausal problem: Is hormone replacement a panacea?
For three years, Maya, 45, tried all the usual remedies to manage her hot flashes — exercise, soy foods, herbal supplements, calcium, magnesium, vitamins, tranquilizers, sedatives and so on. She was having sleepless nights and miserable days ever since her periods became scanty and then stopped after she entered the menopausal zone. Exhausted and desperate, she talked to her doctor about hormone therapy while disclosing her own personal risks: a family history of breast cancer and an elevated platelet blood count, which put her at an increased risk of blood clots and stroke. She was advised a battery of tests to rule out any coexisting ailments. When her mammography revealed a normal study and blood tests a normal platelet count, she decided to get relief. Within a few weeks of starting hormone replacement therapy (HRT), her hot flashes and unexplained sweating ceased and her night sleep returned. Now, she had restful nights and cheerful days. Use of local hormonal cream helped in her vaginal dryness. Zest had again returned to her life. Women like Maya have been frightened away from HRT ever since a report of a study called the Women’s Health Initiative (WHI) found in 2002 that the HRT treatment raised the risk of breast cancer, heart disease and strokes. Prescriptions for estrogen and progesterone — a combination regimen that protects against uterine cancer, which can result from taking estrogen alone — quickly dropped. Since then doctors no longer prescribed hormones as they once did to prevent osteoporosis, clogged arteries and dementia. However, that decision of doctors all over the world was more out of panic than based on logic. Now many experts advocate the use of HRT under supervision if menopause sets in early and the symptoms like hot flashes or bone loss are severe. The pendulum has swung back in favour of HRT. Hot flushes, sweats, poor sleep, anxiety, lethargy and dry skin are a short list of the symptoms women can experience as they pass through menopause. Many experts now contend that the pendulum has swung back in favour of HRT, an effective remedy for severe menopausal symptoms. In fact, the WHI study was designed to test whether the long-term use of hormone therapy could prevent age-related illnesses, and “was never meant to test the effectiveness of hormones for symptoms,” says Nanette Santoro, Director of Institute for Reproductive Medicine. More so, the average age of the participants in WHI study was 63 — more than 15 years beyond the average age of menopause in India. By such late age symptoms like hot flashes subside spontaneously and a palliative like HRT is not required. There is a definite role for HRT for women in their 40’s and 50’s to ward off the unpleasant symptoms and to protect at least bones, if not the heart and the brain. So now, after trying unhappily to go without, many of the 40 per cent of menopausal women who suffer from severe hot flashes and night sweats are turning to a new way of using hormones — an ultra-low dose for as short a time as possible. What’s more, a study published in the Journal of the American Medical Association in March 2008 indicates that the small increase in the likelihood of having a heart attack, stroke or dangerous blood clots associated with taking estrogen and progesterone disappears soon after women go off the hormones. So, the hormones should be withdrawn as soon as symptoms subside. However, HRT can be safely used for women suffering from severe symptoms like hot flashes, under the supervision of a gynaecologist. Hormones should be taken in the smallest dose and for a minimum of time. In addition, the doctor may add Bisphosphonates for bone health and low dose anti-depressants whereever the symptoms so demand. The writer is a Chandigarh-based senior gynaecologist.
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What to do when there’s leg pain?
Leg pain is a very common problem and everyone suffers quite often in one’s life. It may involve your leg from the hip to the toe and affect the whole leg or a localised area. The causes run in pages, but basically it can involve any of the structures constituting your leg — skin, muscle, tendons, nerves, arteries, veins or bones. That makes the diagnosis all the more difficult. Like in chest pain, the most feared constituent is the heart because it can endanger your life. In leg pain, too, vascular causes must be excluded because they could lead to the limb loss or loss of life. When to consult a doctor
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Call for immediate help if the following happens: l
There is leg injury with a deep cut or the bone is exposed. l
Unable to walk or put weight on your leg. l
Have a red, swollen, tender and hot area of leg. l
Hear a breaking sound at the time of the injury. l
Sudden cold, numb leg with reduced power and movement. See a doctor as soon as possible in the case of the following: l
Infection - red, hot, tender with fever > 100 F l
Swelling of leg with breathing problems l
Serious leg symptoms that develop for no apparent cause l
Calf or leg swelling after a prolonged car journey or flight. Do see a doctor when possible in the following situations: l
Pain during or after walking l
Swelling in both legs l Leg pain gets worse l
Painful varicose veins l Pain worsens after a week’s treatment at home Self care at home: Minor pains often respond well to home treatment. Preventing cramps in the legs l
Stretch your leg muscles often l
Drink plenty or water l Include a lot of high potassium foods in your diet — coconut water (Dab), bananas, etc. To relieve mild pain and swelling l
Stay off your legs as much as possible l
Apply cold (ice) compresses to the affected area for 15-20 minutes thrice daily l
Elevate your legs whenever you sit of lie l
For best results, start these measures within 48 hours of injury l
Once swelling subsides, mostly within two-three days, apply moist heat to get full range of movement and flexibility. One of the most dangerous causes of leg pain which could lead to limb loss or loss of life is vascular. So, consult a vascular surgeon at the earliest. The writer is a senior consultant and vascular surgeon, Batra Hospital, New Delhi. |
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Health Notes In the new study, scientists from The Scripps Research Institute have shown for the first time that the same molecular mechanisms that drive people into drug addiction are behind the compulsion to overeat, pushing people into obesity. The study has demonstrated clearly that in rat models the development of obesity coincides with a progressively deteriorating chemical balance in reward brain circuitries. As these pleasure centers in the brain became less and less responsive, rats quickly developed compulsive overeating habits, consuming larger quantities of high-calorie, high-fat foods until they become obese. — ANI
Revolutionary capsule offers hope to diabetics London: A revolutionary technique that has been found to successfully treat the symptoms of gout could result in a new form of therapy for a range of other medical conditions such as diabetes and obesity, say experts. Gout is caused by a build-up of uric acid in the bloodstream, which results in the crystals of uric acid being deposited in the kidneys and joints, leading to bouts of extreme pain. Professor Martin Fussenegger of the Swiss Federal Institute of Technology in Zurich designed a “molecular prosthesis” to treat gout, which is made from human cells designed to detect an increase in the levels of uric acid and to respond by secreting an enzyme called urate oxydase, which destroys uric acid. —
ANI
Antibiotics may act as ‘lifeline’ for HIV patients London: Providing antibiotics to some newly diagnosed HIV patients could save tens of thousands of patients, but researchers are missing this opportunity, say researchers. According to a major study in The Lancet, the simple, cheap, drug treatment halved mortality. The World Health Organization already endorses the treatment, but specialists say many people are not given the drug. In the battle against HIV, the researchers have long been focussing on antiretroviral drugs, which can greatly extend life. However, many patients are at greatest risk in the first weeks after diagnosis, with a variety of infections ready to take advantage of their weakened immune systems. —
ANI
London: A single half-hour “shot” treatment for breast cancer can now do away with a six-week course of tumour-destroying therapy, according to British doctors. The radiotherapy treatment, which is for use in patients with early breast cancer after they have undergone surgery on the tumour, is showing positive results in early trials in patients. The novel therapy is designed to kill the remaining cancerous cells with a concentrated beam of radiation. Currently, women with breast cancer undergo a five-to-six-week course of radiotherapy treatment after surgery, involving about 20 hospital visits. —
ANI
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Treatment for diabetes revolves around various modalities classified as oral drugs or injections in the skin. The therapy option depends on various factors such as the type of diabetes, duration of diabetes, age, associated diseases such as hypertension, obesity, etc.
In Type 1 diabetes, the natural insulin secretion is lacking and needs lifelong replacement from the external route. In Type 2 diabetes also, the majority of the patients require insulin at some stage. In this situation, most of the doctors prescribe insulin only when oral drugs are no longer effective or are required at higher doses at which side-effects supersede benefits.
London: Pigging out on junk food is as addictive as taking heroin and cocaine, according to a new research.