Diabetes

ALL ABOUT DIABETES

Diabetes (diabetes mellitus) is classed as a metabolism disorder. Metabolism refers to the way our bodies use digested food for energy and growth. Most of what we eat is broken down into glucose. Glucose is a form of sugar in the blood - it is the principal source of fuel for our bodies.

Diabetes comes from Greek, and it means a siphon. Aretus the Cappadocian, a Greek physician during the second century A.D., named the condition diabainein. He described patients who were passing too much water (polyuria) - like a siphon. The word became "diabetes" from the English adoption of the Medieval Latin diabetes. 

SYMPTOMS OF DIABETES

Frequent urination                Increased fatigue

Disproportionate thirst         Irritability

Intense hunger                      Blurred vision

Weight gain                             Cuts and bruises don't heal properly or quickly

Unusual weight loss             more skin and/or yeast infections

Itchy skin                                Gums are red and/or swollen

Frequent gum disease         Sexual dysfunction among men

Numbness or tingling, especially in your feet and hands

Diabetes can often be detected by carrying out a urine test, which finds out whether excess glucose is present. This is normally backed up by a blood test, which measures blood glucose levels and can confirm if the cause of your symptoms is diabetes.

THREE MAIN TYPES OF DIABETES

Diabetes Type 1 - You produce no insulin at all.

Diabetes Type 2 - You don't produce enough insulin, or your insulin is not working properly.
 

Gestational Diabetes - You develop diabetes just during your pregnancy. 

5 ESSENTIALS DIABETES TIPS

• READ UP ON DIABETES
• TEST AND RECORDS YOUR BLOOD SUGAR
• PICK A GOOD DIET FOR YOUR DIABETES
• INCLUDE SOME ACTIVITY EACH DAY
• TALK ABOUT YOUR DIABETES 

TREATMENT

The major goal in treating diabetes is to minimize any elevation of blood sugar (glucose) without causing abnormally low levels of blood sugar.

Type 1 diabetes is treated with insulin, exercise, and a diabetic diet.

Type 2 diabetes is treated first with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugars, oral medications are used. If oral medications are still insufficient, treatment with insulin is considered.

Weight reduction and exercise are important treatments for diabetes. Weight reduction and exercise increase the body's sensitivity to insulin, thus helping to control blood sugar elevations.

 R. Y. MANABAT, R.N.

For reading references, visit Free Diabetes E-books.

Depression

Feeling sad, or what we may call "depressed", happens to all of us. The sensation usually passes after a while. However, a person with a depressive disorder - clinical depression - finds that his state interferes with his daily life. His normal functioning is undermined to such an extent that both he and those who care about him are affected by it. 

 What is DEPRESSION ?

Depression is "a mental state or chronic mental disorder characterized by feelings of sadness, loneliness, despair, low self-esteem, and self-reproach; accompanying signs include psychomotor retardation (or less frequently agitation), withdrawal from social contact, and vegetative states such as loss of appetite and insomnia."

Different Types of Depression

Major depressive disorder (major depression)

Major depressive disorder is also known as major depression. The patient suffers from a combination of symptoms that undermine his ability to sleep, study, work, eat, and enjoy activities he used to find pleasurable.

Dysthymic disorder (dysthymia)

Dysthymic disorder is also known as dysthymia, or mild chronic depression. The patient will suffer symptoms for a long time, perhaps as long as a couple of years, and often longer. However, the symptoms are not as severe as in major depression, and the patient is not disabled by it.

Psychotic depression

When severe depressive illness includes hallucinations, delusions, and/or withdrawing from reality, the patient may be diagnosed with psychotic depression.

Postpartum depression (postnatal depression)

Postpartum depression is also known as postnatal depression or PND. This is not to be confused with 'baby blues' which a mother may feel for a very short period after giving birth. If a mother develops a major depressive episode within a few weeks of giving birth it is most likely she has developed PND.

SIGNS and SYMPTOMS

Depression varies from person to person, but there are some common signs and symptoms. It’s important to remember that these symptoms can be part of life’s normal lows.

Feelings of helplessness and hopelessness. A bleak outlook—nothing will ever get better and there’s nothing you can do to improve your situation.

Loss of interest in daily activities. No interest in former hobbies, pastimes, social activities, or sex. You’ve lost your ability to feel joy and pleasure.

Appetite or weight changes. Significant weight loss or weight gain—a change of more than 5% of body weight in a month.

Sleep changes. Either insomnia, especially waking in the early hours of the morning, or oversleeping (also known as hypersomnia).

Anger or irritability. Feeling agitated, restless, or even violent. Your tolerance level is low, your temper short, and everything and everyone gets on your nerves.

Loss of energy. Feeling fatigued, sluggish, and physically drained. Your whole body may feel heavy, and even small tasks are exhausting or take longer to complete.

Self-loathing. Strong feelings of worthlessness or guilt. You harshly criticize yourself for perceived faults and mistakes.

Reckless behavior. You engage in escapist behavior such as substance abuse, compulsive gambling, reckless driving, or dangerous sports.

Unexplained aches and pains. An increase in physical complaints such as headaches, back pain, aching muscles, and stomach pain.

TREATMENT

Antidepressant medications

Selective serotonin reuptake inhibitors (SSRIs) are medications that increase the amount of the neurochemical serotonin in the brain.

Electroconvulsive therapy (ECT)

In the ECT procedure, an electric current is passed through the brain to produce controlled convulsions (seizures). ECT is useful for certain patients, particularly for those who cannot take or have not responded to a number of antidepressants, have severe depression, and/or are at a high risk for suicide.

Psychotherapies

Many forms of psychotherapy are effectively used to help depressed individuals, including some short-term (10 to 20 weeks) therapies. Talking therapies (psychotherapies) help patients gain insight into their problems and resolve them through verbal give-and-take with the therapist.

HOW TO AVOID BEING DEPRESSED:

1.    Offer goodwill to others.
2.    Learn to Detach from Thoughts
3.    Keep Busy.
4.    Avoid Feelings of guilt.
5.    Live a Balanced Life.
6.    Don’t Base your Happiness solely on other people.
7.    Share Problems
8.    Cultivate Happiness.
9.    Have Low Expectations.
10.  Don’t Dwell On the Negative.

"Happiness will follow you if your heart remains Undisturbed by trifles." (Sri Chimoy)

R. Y. MANABAT, R.N. 



For references, visit Anxiety and Depression.

ALCOHOL ABUSE

Drinking is woven into the fabric of many societies—sharing a bottle of wine over a meal, going out for drinks with friends, celebrating special occasions with champagne. But because alcohol is such a common, popular element in many activities, it can be hard to see when your drinking has crossed the line from moderate or social use to problem drinking.

If you consume alcohol simply to feel good, or to avoid feeling bad, your drinking could become problematic. Alcoholism and alcohol abuse can sneak up on you, so it’s important to be aware of the warning signs and take steps to cut back if you recognize them. Understanding the problem is the first step to overcoming it.

 Understanding Alcoholism and Alcohol Abuse

Alcoholism and alcohol abuse are due to many interconnected factors, including genetics, how you were raised, your social environment, and your emotional health. Some racial groups, such as American Indians and Native Alaskans, are more at risk than others of developing alcohol addiction. People who have a family history of alcoholism or who associate closely with heavy drinkers are more likely to develop drinking problems. Finally, those who suffer from a mental health problem such as anxiety, depression, or bipolar disorder are also particularly at risk, because alcohol may be used to self-medicate.

SYMPTOMS

Alcohol affects the central nervous system as a depressant. This leads to a decrease in:

·                 Activity

·                 Anxiety

·                 Inhibitions

·                 Tension

Even a few drinks can change behavior, slow motor skills, and decrease the ability to think clearly. Alcohol can impair concentration and judgment. Drinking a lot of alcohol can cause drunkenness (intoxication).

Some of the symptoms of alcoholism include:

•                  Abdominal pain
•                  Confusion
•                  Drinking alone
•                  Episodes of violence with drinking
•                  Hostility when confronted about drinking
•                  Lack of control over drinking -- being unable to stop or reduce alcohol intake
•                  Making excuses to drink
•                  Nausea and vomiting
•                  Need for daily or regular alcohol use to function
•                  Neglecting to eat
•                  Not caring for physical appearance
•                  Numbness and tingling
•                  Secretive behavior to hide alcohol use
•                  Shaking in the morning

TREATMENT

Three general steps are involved in treatment once the disorder has been diagnosed:

·                 Intervention

·                 Detoxification

·                 Rehabilitation

  

Medications are sometimes prescribed to prevent relapses.

• Acamprosate is a new drug that has been shown to lower relapse rates in those who are alcohol dependent.
• Disulfiram (Antabuse) produces very unpleasant side effects if you drink even a small amount of alcohol within 2 weeks after taking the drug.
• Naltrexone (Vivitrol) decreases alcohol cravings. It is available in an injected form.

You cannot take these medications if you are pregnant or have certain medical conditions. Long-term treatment with counseling or support groups is often necessary. The effectiveness of medication and counseling varies.

R. Y. MANABAT, R.N.

Burn Prevention

A burn is a type of injury to the skin caused by heat, electricity, chemicals, or radiation (an example of the latter is sunburn).

Sunburn

A sunburn is a radiation burn to the skin produced by overexposure to ultraviolet (UV) light, commonly from the sun's rays. Exposure of the skin to lesser amounts of UV will often produce a suntan. Usual mild symptoms are red or reddish skin that's hot to the touch, a washed out feeling, and mild dizziness. Sunburn can be life-threatening and is a leading cause of cancer.

Sunburn can easily be prevented through the use of sunscreen, clothing (and hats), and by limiting solar exposure, especially during the middle of the day.

The only cure for skin burn is slow healing, although skin creams can help.

 TYPES OF BURN INJURIES:

Thermal Burn Injuries

The most common type of burn injury — are the result of contact with heat sources such as fire, steam, hot liquids, hot metals and hot objects. Forty-three percent of burn center admissions are fire/flame related, 23 percent are related to scalding, and 8 percent are linked to contact with a hot object.

Chemical Burns

Chemical burns represent approximately 3 percent of all burn center admissions.  Chemical burns occur when certain acids, alkaloids and other caustic chemicals come into contact with the skin.

Possible causes of chemical burns at home or in the workplace include:

• Industrial products, tar, gasoline and wet pavement
• Household cleaners that contain lye (paint cleaners), sulfuric acid (toilet bowl cleaners), phenol (deodorizers), or sodium hypochlorite (disinfectants and bleaches)
• Cosmetic products such as nail polish remover and hair dye
• Explosions and spills 

Electrical Burns

Electrical burns represent 4 percent of burn center admissions.  Electrical burns occur when electric current passes through the body, causing both external and internal injuries.  Most of the damage from electric current occurs beneath the surface of the skin.  Factors affecting the extent of injury include the intensity and type of current, duration of exposure, the amount of moisture on the patient and the area of the body that the current passed through. 

How to Treat a Burn

The treatment of burns caused by heat or electricity starts with the application of cold water in order to cool destroyed tissues and to minimize damage to them.

This treatment is not administered in extensive or third-degree burns, as cold water may aggravate the state of shock.

· If the patient has suffered burns in the face or has inhaled smoke or hot air in a burning building, the burn is regarded as an inhalation burn that requires assessment by a physician. 

· We immerse the burned area immediately in cold running water. We place it under a tap or in a bucket of water, or we apply cold-water compresses (but not ice) to the burned area. 

·  We continue to cool the burned area with cold water for about 5 minutes or until the pain diminishes. We then dry the area gently with a clean towel and dress it with a sterile or clean, dry cloth. 

·  We do not prick blisters or otherwise interfere with the burned area. 

·  We do not remove clothing adhering to the wound. We remove any watches, bracelets, rings, belts, or constricting clothing from the affected area before it begins to swell. 

·  We do not apply butter, oil, or creams to the wound. We use analgesic drugs, ointments, or sprays only in first-degree burns or according to medical instructions. 

·  We do not press the burned area. 

·  In electrical burns, we look for the entrance and exit points of the electric current. 

·  In chemical burns, we do not use other materials to neutralize the chemicals without detailed medical instructions. However:

• we remove contaminated clothing and the patient’s shoes and socks;
• we douse the victim with cold water and keep washing off the burned area with running water for at least 5 minutes;
• we relieve pain with cold-water compresses;
• we cover wounds with a damp bandage;
• we require evaluation by a physician even when the burn is not extensive. 

·  In extensive burns, the victim is wrapped in a clean sheet and transferred to hospital.

• ·  In face burns, extensive first-degree burns, second-degree burns in the limbs or perineum, burns in more than 10-15% TBSA, and all third-degree burns, we require evaluation by a physician.

 R. Y. MANABAT, R.N.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a painful condition caused by compression of a key nerve in the wrist.   It occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist.

 

You should know what’s causing your Carpal Tunnel Syndrome (CTS); it’s the result of overworking your hands - performing repetitive (motion) task all day long.

Carpal Tunnel Syndrome Signs and Symptoms:

With CTS, there will be pain and/or tingling, burning, and numbness in the hand along the distribution of the median nerve in one or both hands.  Patients often complain of the hand "going to sleep" or a feeling of "needles and pins" in the thumb, index, long, and ring fingers.  The symptoms are usually most marked in the early morning hours and often awaken sufferers from sleep.  They may also experience pain in the elbow or shoulder, as fibers of the median nerve originate from the spinal cord in the neck and travel through the shoulder and elbow areas.  Repetitive use activities involving the hands often initiate or worsen the symptoms.  Such activities often reported by patients as initiating the symptoms include:  keyboarding, driving, talking on the phone, crocheting, and other activities which involve maintaining a certain wrist position for prolonged time periods.  The hand will most often look normal; however, if the process is long-standing, there may be some atrophy (loss of mass) in the thenar muscles (group of muscles at the base of the thumb).

 

Possible Cause?

Anything which increases the pressure within the carpal tunnel may bring on Carpal Tunnel Syndrome (CTS).  The most commonly thought of factor is repetitive trauma to the contents of the tunnel, caused by repetitive movements at the wrist due to jobs or hobbies which involve these movements (keyboarding, playing a musical instrument, etc.). 

Carpal Tunnel Syndrome Treatment Options

There are many different treatment options for Carpal Tunnel Syndrome.  Which option is employed is based on your physician's clinical judgment.  Options include:

Steroid/Anesthetic injection into the carpal tunnel - A mix of a steroid (a drug which decreases inflammation) and a local anesthetic (numbs the area after the injection) are injected directly into the canal in an attempt to decrease the inflammation and swelling in the canal.

Night Splinting - The wrist is splinted in a straight or slightly extended position to prevent flexing the wrist which can compress the canal and bring on symptoms.
 

Open decompression - An incision is made in the palm under local (only the area involved is numbed) or general anesthesia (patient sleeping), the transverse carpal ligament (the roof of the carpal tunnel) is visualized and cut.

Endoscopic decompression - Two smaller incisions are made in the wrist and palm, and an endoscope (a small lighted tube containing a camera) is passed through the carpal tunnel through these incisions.  The surgeon then visualizes the transverse carpal ligament (the roof of the carpal tunnel) and cuts it, freeing the contents of the carpal tunnel from the compression.

R. Y. MANABAT, R.N.

Tuberculosis

Tuberculosis (TB) is an infection, primarily in the lungs (a pneumonia), caused by bacteria called Mycobacterium tuberculosis. It is spread usually from person to person by breathing infected air during close contact.

How does a person get TB?
A person can become infected with tuberculosis bacteria when he or she inhales minute particles of infected sputum from the air. The bacteria get into the air when someone who has a tuberculosis lung infection coughs, sneezes, shouts, or spits (which is common in some cultures). People who are nearby can then possibly breathe the bacteria into their lungs. You don't get TB by just touching the clothes or shaking the hands of someone who is infected. Tuberculosis is spread (transmitted) primarily from person to person by breathing infected air during close contact.

• Cough
• Unexplained weight loss
• Fatigue
• Fever
• Night sweats
• Chills
• Loss of appetite

What organs are affected?

Tuberculosis usually attacks your lungs. Signs and symptoms of TB of the lungs include:

• Coughing that lasts three or more weeks
• Coughing up blood
• Chest pain, or pain with breathing or coughing

Treatment

With treatment, the chances of full recovery are good. Although several treatment protocols for active TB are in wide use by specialists, and protocols sometimes change due to advanced in our understanding of optimal therapy, they generally share three principles: 

1.    The regimen must include several drugs to which the organisms are susceptible.

2.      The patient must take the medication on a regular basis.

3.      Therapy must continue for a sufficient time. 

Also, treatment recommendations are subject to change depending upon both the characteristics of the particular organism being treated and newer advances in therapeutic agents. Thus, consultation on treatment strategies with local public health and infectious disease experts is always advisable.

Isoniazid (INH) is one of the most common drugs used for TB. Inexpensive, effective and easy to take, it can prevent most cases of TB and, when used in conjunction with other drugs, cure most TB. INH preventive treatment is recommended for individuals who have:

• close contact with a person with infectious TB
• positive tuberculin skin test reaction and an abnormal chest x-ray that suggests inactive TB
• a tuberculin skin test that converted from negative to positive within the past two years
• a positive skin test reaction and a special medical condition (for example, AIDS or HIV infection or diabetes) or who are on corticosteroid therapy  
• a positive skin test reaction, even with none of the above risk factors (in those under 35

Questions to Ask Your Doctor About Tuberculosis:

• Should a TB test be done?
• What medications will you prescribe?
• Is my case of TB contagious?
• What precautions can be taken to minimize the exposure to TB?
• Are there any lasting effects after treatment?

R. Y. Manabat, R.N.