AN INTERESTING NEWS FOR DIABETICS

New drugs, treatment make diabetes management easier

TNN | Apr 13, 2016, 01.10 AM IST

Chennai: Many people with diabetes have to suffer several needle pricks a day- they have to get their fingers jabbed for routine blood tests and take insulin shots to keep their sugar level under control.

Scientists are now trying to reduce the daily discomfort and pain for people with diabetes by advising them to use sensors and devices to check their sugar levels. One such solution is the ambulatory glucose profiler, which works on a coin-sized sensor, and gives 1,400 readings. "You stick it on your upper arm for 15 days. The doctor can remove the sensor and pass it through a reader to get the readings and graphs," said diabetologist Dr V Mohan. He said technology was changing healthcare, and an example is how a device like Google Glass can give readings by scanning iris.

It is not just monitoring, even drug delivery can be non-invasive. Insulin pumps, in existence for about three decades as an alternative to multiple daily injections of insulin, are being improved. "Monitoring devices can be attached to these pumps to switch them on and off automatically. Prototypes of pumps that can manage high and low blood sugar levels have been developed," Dr Mohan said.

On Tuesday, a company announced in Chennai an injectible drug that can delay a diabetic's switchover from tablets to insulin shots. Edgard Olaizola, MD, Lilly India, said the drug is the first injectible when a patient is not able to keep the sugar under control with oral medication. "It has a molecule that mimics the effects of GLP-1, a hormone that helps keep the sugar level normal by helping the body release its insulin," he said. India has around 65 million diabetics. A paper published recently in Lancet found that 15.3% of adults with diabetes are from India. The paper, based on data from 751 studies, involving 4.4 million adults from 200 countries, showed that the prevalence of diabetes has increased 80% in women and more than doubled in men in the country.

PAINFULL MENSES PERIODS AND RELIEVES

DYSMENORRHEA

Some women are experiencing painful periods during the end gap of one cycle for a period several days to start another cycle.The condition is known as dysmenorrhea.

Menses  

It is a cyclic periodical discharge of blood and other physiological wastes through the vagina of a non pregnant woman in order clean the system at the end of one period with the duration of some days to start the next period.

Dysmenorrhea is of two types 1.Primary 2.Secondary

Primary Dysmenorrhea is a painfull mensturation with prostaglandin discharge in the absence of any identifiable pelvic disorder

Secondary Dysmenorrhea is associated with any identifyable pelvic disorders.

Symptoms 

Nausea,vomiting,diarrhea,headache,dizziness,and lower abdominal cramping which may some times spread to back and legs.

Treatments

Treatments should be based on the degree of pain experienced by an individual.Usually the pain associated with dysmenorrhea may hardly last for two three days only.If the pain continue for longer periods it must be referred to your physician as it may be due to some underlying causes.

Treatments in the beginning may start with aspirin or paracetamol.Naproxen may be a drug of choice among the NSAIDs followed by Ibuprofen.The dosage recipe can be started one or two days before the menses starts followed by another two to three days to be continued within ihe cycle duration.

The Dosage for Naproxen is mentioned in the PDR is start with 550 mg followed by 275 mg for every 6 to 8 hrs.and not to exceed 1375mg per day.

Naproxen is available on the pharmacy OTC as Aleve,Naprosyn etc with each ablet contain 220 mg of Naprosyn Sodium for women's self treatment.The label comes with the packing reads 1 tablet every 8 to 12 hrs.But a woman can follow the optional regimen of take 2 caplet at the start followed by 1 caplet every  12 hrs if pain persists.Do not exceed 12 tablets per day.

In case of Ibuprove which is also said to be effective in releiving menstural cramps is available with perfect formulation in the pharmacy OTC as Cramp Releiving Midol-IB,Cramp End Tablets,Halran,Midol-200,Pamprin and Trendar.

But a 400 mg Brufen 1 tablets 2 imes daily or a single dosage of 600 mg can solve the problem.

Mensural Migrains are also an another annoying experience during the periods are common to some women

Conclusion

See pains are symptoms of body language to express he underlying serious causes such as ovarian or endometrial disorders.Hence simply aking painkillers for a limitless periods may result into disaster.

 

 

A COMPREHENSIVE STUDY OF FRUIT JUICES

FRUIT JUICES

Summer started.More sunny days with dryness and sweatings are ahead.Fruit Juice Malls,Juice shops are now itself started with packed crowds.Hyper Markets and Grocery shops are preparing and getting ready with their racks fillied with colourfull pakets and tins of various preserved and processed juices  and nonpreserved the so called fresh juices.On the otherhand there are big big tins and bottles of preserved and processed artificial juices both in liquid and powedered forms.

First thing we must learn how to protect our body from dehydration by this pricky summer heat.Our body is comprised of 90% water to maintain our health such as blood circulation tissue metabolism digestion absorption assimilation and excretion etc.etc.For this consuming water is very important.People likes to take water in delicious way.That is why mostly they prefer fruit juices,tender coconut water etc.etc.rather to take plain water.

There is no doubt that liquids such as fruit juices  solve our thirsty and dehydration immediately than the fruits itself.But one thing keep in your mind in general all fruits are having active sugars in various proportions.Eventhough sugar in the form of glucose is body's daily need as energy there are limitations.These limitations are provided in naturally occuring fresh fruits by the Almighty Allah as Fibers, Vitamins, Antioxidents and various natural Additives.Sugar when you take along with these additives especially fibers provided by God is totally harmless more especially for Diabetics.This is possible only by taking raw fruits as they are, rather than by juices.Because in juice shops when you order a mango juice or an apple juice or an orange juice they would prepare them in electronic juicers which would automatically remove all the healthy additives by filteration and leave a clear attractive juice with only sugar and will be given to you in a colourfull juice glass with matching coloured beautifull straw.Ofcourse by drinking this you get an immediate releif from your striking thirsty and dehydration but at the same time you  harm your body with a heavy load of sugar into your blood and an unnecessary over stimulation to your pancreas.

But still you are craving for juice bring the fresh fruits from the market and prepare juice with sufficient water and without sugar without filtering and drink it in a cloudy form.This is better than the clear juice.

Now comes to the preserved and processed juices.They all contains artificially added additives such as sodium benzoate a preservative in common practice which nowadays said to cause Leukimia,the blood cancer.

There are some packed fresh juices with a labelling of "No preservatives";"No Artificial Flavouring" and "No Additives" are available on the shelves of the Malls.Beware of these products in spite of there "No" labellings they may still contains many hidden invisible chemical additives to keep their product atleast for three days from expiry.Everythings are now commercial.So cheating is common.Hence beware of that.

FRUITS THAT CAN BE SAFELY COSUMED BY DIABETICS

A delicious and safe way of eating Fruits by Diabetics are given below:- See the video https://www.youtu.be/1CSG439DQUI

(If any difficult to load the above link please copy and paste it at your Google or any other search browsers)

GUAVA IS CONTAINING LOW SUGAR LEVEL AS ITS GLYCEMIC INDEX IS VERY LOW. IT HAS BEEN PROVED THAT EATING GUAVA WITHOUT SKIN WILL REDUCE SUGAR ABSORPTION ACCORDING TO I-SHOVE UNIVERSITY STUDY

GUAVA IS GOOD FOR PREVENTING PROSTATE CANCER

GUAVA IS FIBER RICH HENCE IT IS GOOD TO RELIEVE CONSTIPATION COMMON IN DIABETES AND PREVENT TO GET DM TYPE 2

1/2 CUP OF GUAVA CONTAINS 7gms OF ACTIVE NET CARBOHYDRATES,4.5gms OF FIBER AND 61 calories

EVEN THOUGH ITS GLYCEMIC INDEX IS NOT SCIENTIFICALLY ESTABLISHED IT IS VERY SAFE TO DIABETICS AS IT'S GLYCEMIC LOAD IS VERY LOW AS 2 FOR ONE 1

POMEGRANATE (Punica Granatum Linn) HAS BEEN PROVED AS IT IS GOOD FOR THE HEART OF A DIABETIC PATIENT PROTECTING IT FROM DEVELOPMENT OF ATHEROSCLEROSIS.
POMEGRANATE IS MOSTLY ACTIVE AGAINST DIABETES NOT BY THE PULP OR JUICE BUT BY THE SEEDS, PEELS, AND ITS FLOWERS. ITS MECHANISMS OF ACTION AGAINST DIABETES MELLITUS IS BY REDUCING OXIDATIVE STRESS AND LIPID PEROXIDATION.
POMEGRANATE CONTAINS PUNICALAGIN, ELLAGIC ACID, GALLIC ACID, OLEANOLIC ACID, URSOLIC AND UALLIC ACIDS WHICH ARE ALL BELIEVED TO BE ANTIDIABETIC.MOREOVER, THE PULP AND JUICE ALSO CONTAINS ANTIOXIDANTS. BUT BEWARE THAT JUICE ARE TO BE AVOIDED AS THEY NOT CONTAIN FIBERS
SINCE THIS FRUIT CONTAINS A LITTLE BIT MORE SUGAR AND LESS FIBER BUT ITS GLYCEMIC INDEX IS 58 WHICH IS SAFER AND BELOW THE UPPER LEVEL OF 77 AND GLYCEMIC LOAD IS 10 THE FRUIT SHOULD BE CONSUMED WITH A DAILY LIMIT OF 5oz (150gms) MAXIMUM FOR SAFETY. BUT ITS SEEDS AND PEELS ARE HAVING HIGH VALUE FOR DIABETICS 

APPLES, ON THE OTHER HAND, IS UNDOUBTEDLY GOOD FOR DIABETICS. THEY ARE RICH IN SOLUBLE FIBERS WHICH HELPS THE BODY TO ABSORB SUGAR GRADUALLY AND IN A REDUCED MANNER INTO THE BLOOD. SOLUBLE FIBERS ALSO BOOST IMMUNITY AND HELPS DIABETIC WOUNDS TO HEAL FASTER.
APPLE CONTAINS QUERCETIN A POLYPHENOL WHICH BY RESEARCH HAS BEEN PROVED THAT IT IMPROVES GLUCOSE METABOLISM IN LIVER AND SKELETAL MUSCLES IN VITRO BY MICE AND TEST TUBES.
APPLE'S GLYCEMIC INDEX RANGES FROM 28 TO 44 FROM UNRIPEN TO RIPEN FRUIT WELL BELOW THE UPPER LIMIT 77. BUT BECAUSE OF ITS SOLUBLE FIBER CONTENT A DIABETIC CAN TAKE ONE APPLE PER DAY SAFELY

GRAPES RED, GREEN, AND BLACK ALL CONTAIN SUGAR AND FIBERS. BUT THE RICH IN FIBER CONTENT WOULD LIMIT THE ABSORPTION OF SUGAR TO MINIMAL LEVEL. HENCE TAKING THESE FRUITS IN LIMITED QUANTITY MAY NOT SPIKE THE BLOOD SUGAR LEVEL SUDDENLY BECAUSE OF THE SOLUBLE FIBER. HALF Half a cup of red grapes for diabetics contain only 52 calories. This serving of red grapes also contains about 11.69 grams of sugar. Of this, 0.11 grams is sucrose, 5.43 grams glucose, and 6.14 grams of fructose. These also contain a small amount of fiber that can help your health. Diabetic Association also recommends Grapes for diabetes as they do not cause a sudden spike in blood sugar levels. Green grapes are more in fiber contents than its black and red varieties    
GRAPES ARE RICH IN FRUCTOSE WHICH WOULD NOT INCREASE CALORIES AND DO NOT NEED INSULIN TO METABOLISE. THREE SERVINGS OF HALF A CUP EACH MAY BE THE PERFECT DAILY LIMIT. GRAPES ARE HIGHLY NUTRITIOUS

AVOCADO IS ALSO A FRUIT WHICH IS GOOD FOR DIABETICS BECAUSE OF ITS LOW GLYCEMIC INDEX. AN AVERAGE SIZE OF THE FRUIT WILL YIELD SUGAR AS AVAILABLE CARBOHYDRATE ONLY 3 TO 6 GMS TO OUR BLOOD OUT OF TOTAL CARBOHYDRATE  CONTENT OF THE FRUIT SUCH AS 30 GMS. A DIABETIC PATIENT GENERALLY CAN TAKE SUGAR UPTO 45 GMS  AVOCADO IS SAFER. SINCE AVOCADO IS LOW IN GLYCEMIC LOAD AND RICH IN FIBER IT IS SAFER THAN ANY OTHER FRUIT FOR DIABETICS. IT IS RICH IN MONOHYDRICUNSATURATED FATS. HENCE IT IS GOOD FOR REDUCING BAD CHOLESTEROL.
AVOCADO IS RICH IN VITAMINS SUCH AS K, B6, PANTOTHENIC ACID, FOLIC ACID, AND POTASSIUM.

ORANGES ARE HAVING LOW GLYCEMIC INDEX AND LOW GLYCEMIC LOAD OF ABOUT 5 GMS AND ALSO FIBER RICH AND VIT.C IT IS GOOD FOR A DIABETIC PATIENT.
MOREOVER, CITRU FRUITS LIKE ORANGES AND GRAPE FRUITS ARE RICH IN VITAMIN C WHICH IS GOOD FOR FOR VARIOUS PROBLEMS IN DIABETIC PATIENTS. FOR EXAMPLE OPHTHALMIC RETINOPATHY, AND PAINFUL PERIPHERAL NEUROPATHY ARE ALL CAUSED BY THE INCREASED SORBITOL LEVEL IN THE EYES AND NEURONS. VITAMIN C IS SAID TO BE REDUCING THE SORBITOL LEVEL IN ALL THE WAYS.
CITRUS FRUITS ARE HAVING FLAVONOIDS WHICH IS IMPROVING TISSUE INSULIN UPTAKE BY REDUCING THE PERIPHERAL RESISTANCE. THEY ARE REGULATING LIVER ENZYMES TO IMPROVE GLUCOSE UPTAKE.
CAUTION TO BE TAKEN WHILE TAKING OTHER MEDICATIONS ALONG WITH CITRUS FRUITS SUCH AS GRAPEFRUIT AS THESE FRUITS ALSO HAVING FURANOCOUMARINS WHICH IS LIVER CYTOCHROME 450 INHIBITOR WHICH MAY CAUSE SERIOUS SIDE EFFECTS WITH ..STATINS, CALCIUM CHANNEL BLOCKERS, AND BENZODIAZEPINES SUCH AS DIAZEPAM, ALPRAZOLAM, AND TRIAZOLAM.

OLIVE FRUIT IT HAS BEEN PROVED THAT A DIET RICH IN OLIVE FRUITS AND OIL NOT ONLY CURE DIABETES ALSO PREVENT THE ONSET OF THE DISEASE BY ITS SUGAR LESS CONTENT AND FIBER RICHNESS. THE HYPOTHESIS OF THE BENEFITS OLIVE OIL IS ITS EFFECT ON RENIN-ANGIOTENSIN-ALDOSTERON SYSTEM IN AN HEALTHY WAY TO PREVENT THE COMPLICATION OF DIABETIC DAMAGES OF KIDNEYS AND CARDIOVASCULAR SYSTEMS SUCH AS ATHEROSCLEROSIS, THE MAI FACTOR OF CORONARY ARTERY DISEASE AND ANGINA ALTHOUGH THE GLYCEMIC INDEX OF THE FRUIT IS WELL ESTABLISHED THE GLYCEMIC LOAD IS FOR 1oz(30gms) =0; AND FOR 100 gms =1.HENCE IT IS HEALTHIEST FRUIT FOR DIABETICS

JAMUN FRUIT (நாவற்பழம்)  IS ALSO A KIND OF FRUIT WITH A LITTLE ACIDIC AND ASTRINGENT TASTE IS GOOD FOR DIABETES. ALSO, ITS POWDERED SEEDS CAN BE TAKEN AS DICOTION. BECAUSE THIS FRUIT IS ENRICHED WITH FRUCTOSE A KIND OF SUGAR WHICH DOES NOT NEED INSULIN TO METABOLIZE IT IS GOOD FOR DIABETICS.
WONDERFULLY JAMUN FRUIT IS TOTALLY FREE FROM SUCROSE THE DISACHCHARIDE WHICH IS A DANGEROUS SUGAR WHICH CAUSES  SPIKES IN THE BLOOD SUGAR LEVEL
JAMUN FRUITS ALSO HAVING VITAMINS AND MINERALS.
.LOWER GLYCEMIC INDEX.AN AVERAGE SIZE OF PEACH WILL GIVE MERELY 2GMS OF AVAILABLE CARBOHYDRATE IT CAN BE TAKEN BY A DIABETIC PATIENTS SAFELY ONE FRUIT PER DAY.ALSO, IT IS RICH IN VITAMINS AND FIBERS.

PLUMS ARE FIBER RICH FRUITS WITH SUGAR AND NUTRIENTS BE AS AN HEALTHY DIET FOR DIABETICS. DAILY MAXIMUM 3 FRESH FRUITS UNSWEETENED AND NOT ARTIFICIALLY CANNED IN HEAVY SYRUP CAN BE TAKEN SAFELY BY DIABETICS. THOUGH PLUMS CONTAIN SUGAR IT WOULD BE SLOWLY AND GRADUALLY ABSORBED BY OUR BODY DUE TO ITS RICH FIBER CONTENT. SLOW AND GRADUAL ABSORPTION OF SUGAR FROM FOOD IS GOOD AND HEALTHY FOR DIABETICS
CARB CONTENT AND GLYCEMIC VALUES OF PLUMS:
1/2 CUP SLICED PLUMS CONTAINS 8 gms ACTIVE CARBOHYDRATES,1gm FIBER, AND 38 CAL.ENERGY
1 MEDIUM SIZED PLUM (2.5" DIAMETER AND 2.3 oz) CONTAINS 8 gms ACTIVE CARB ,1 gm. FIBER AND 30 CAL ENERGY.
AVERAGE GLYCEMIC INDEX IS = 39 (<77,SAFE)
GLYCEMIC LOAD IS =2 (<10,SAFE)

BLUEBERRIES ( அவுரி நெல்லி ) SIMILAR TO THE PINEAPPLE BLUEBERRIES WITH DAILY HALF A SERVING CUP CONSUMPTION WOULD NOT SPIKE THE BLOOD   GLUCOSE LEVEL IMMEDIATELY BECAUSE, OF ITS RICHNESS IN FIBER,LOW GLYCEMIC INDEX AND LOW GLYCEMIC LOAD.75 GM CONSUMPTION WOULD YIELD A 10 GM CARBOHYDRATE TO THE BLOOD GRADUALLY INCREASE THE BLOOD SUGAR LEVEL WHICH IS GOOD FOR DIABETICS FOR THEIR DAILY CALORIE NEEDS. BLUEBERRIES GLYCEMIC INDEX IS 53 BLUEBERRIES CONTAINS A CHEMICAL KNOWN AS ANTHOCYANINS WHICH ARE PROVED TO IMPROVE THE GLUCOSE UPTAKE IN MICE.BLUE BERRIES ARE RICH IN FIBERS WHICH ALSO BENEFICIAL FOR SLOW YIELD OF CARBOHYDRATES INTO THE BLOOD.A 3/4 CUP SERVING OF BLUE BERRIES DAILY IS ENOUGH.

PEARS ARE THE FIBER RICH FRUITS AND BECAUSE OF ITS FIBER CONTENT, ITS GLYCEMIC INDEX IS LOW. A MEDIUM SIZE PEAR CONTAINS ABOUT 7 GMS OF FIBER CONTENT A 25% OF OUR BODY NEEDS. PEAR IS A GOOD SOURCE OF VITAMIN C WHICH HELP TO CONTROL BLOOD SUGAR. THOUGH PEAR CONTAINS SUGAR IT WILL ABSORB GRADUALLY AND SLOWLY BY OUR BLOOD WHICH IS GOOD FOR DIABETICS. EVERY diabetic NEEDS 10 TO 15 GM YIELDED CARBOHYDRATE FOR THEIR DAILY ENERGY NEEDS AND THIS WILL BE PROVIDED BY 75 GMS OF PEAR
CARB CONTENTS OF PEARS:- 120 gms OF PEAR CONTAINS 8 gms OF AVAILABLE CARBOHYDRATES AND 7 GRAMS OF FIBERS
GLYCEMIC INDEX IS =41 (<77,SAFE)
GLYCEMIC LOAD IS =3.8 (<10,SAFE)

INDIAN GOOSEBERRY(நெல்லிக்காய் )
THIS FRUIT IS PROOVED AS THE BEST FRUIT IN PREVENTING ARTHRITIS, DIABETES, HEART DISEASES, INFLAMMATIONS, CANCER, LIVER DISEASES AND REDUCING BAD CHOLESTEROL WITHOUT AFFECTING GOOD CHOLESTEROL, BECAUSE OF ITS HIGH CONTENTS OF ANTIOXIDANTS LIKE VITAMIN C VITAMIN E ETC.ANTI OXIDANTS ARE PREVENTING OXIDATION OF FREE RADICALS TO FORM TOXIC MOLECULES WHICH CAUSE VARIOUS ILLNESSES LIKE DIABETES MELLITUS CANCER ETC. IN OUR BODY.
MOREOVER, THIS FRUIT CONTAINS VERY LOW SUGAR ALMOST TO ZERO.

STRAWBERRIES ARE ALSO LIKE OTHER BERRIES LIKE BLUEBERRIES,GOOSEBERRIES,BLACKBERRIES
 ARE GOOD FOR DIABETICS BECAUSE OF ITS DIABETIC FRIENDLY CONTENT OF LOW CARBOHYDRATE LEVEL ALONG WITH FIBERS.A 1 CUP SERVING SIZE OF STRAWBERRY CONTAINS APPROXIMATELY ABOUT 8 gms OF ACTIVE CARB AND 3 gms OF FIBERS. BECAUSE OF THIS FIBER RICHNESS CONSUMING DAILY 1 CUP STRAWBERRY WOULD NOT PRODUCE SPIKES AND IMMEDIATE HIGH RISES IN BLOOD SUGAR LEVELS.
ALSO STRAWBERRY CONTAINS ANTIOXIDANTS WHICH ARE GOOD FOR DIABETICS.
FOR 120 GRAMS STRAWBERRY ITS GLYCEMIC INDEX (THE AMOUNT OF CARBOHYDRATE THAT IS AVAILABLE FOR ABSORPTION BY THE GUT) =40 (<77 SAFE)
THE GLYCEMIC LOAD (THE AMOUNT OF CARB ADDED TO THE BLOOD) = 1(<10,SAFE)

URIC ACID AND GOUT

URIC ACID AND GOUT

GOUT AND URIC ACID

Gout is nowadays very common due to our modern purine rich foods
Gout is very painfull and it is due to an increase in the levels of blood Uric Acid (Hyperuricemia) But Hyperuricemia always may not result in Gout but Gout is due to Hyperuricemia only.The reason is not well defined.
In general whenever we take proteins they would be converted in the blood as nitrogen wastes such as Urea and Creatinine and excreted by the kidneys.
Purine is a kind of Aminoacids a nitrogen compound .When we took Purine rich foods like Red Meats (Mutton,Beef,Pork etc) heavy alcoholic drinks,and chocholates the ingested purines would be coverted by an enzyme Xanthine oxidase into Uric Acid and should be excreted by the kidneys.But due to some known or unknown reasons this will not happen and eventually the uricacid levels in the blood rises to hyperglycemia.The elevated Uric Acid would react with Sodium ions to form Sodium Urate crystals which are as sharp as the broken glass pieces and deposited into joint gaps to produce gouty pain.
Gout which may be caused by idiopathic unknown reasons is known as Primary Gout.90% of the cases fall into this
Gout which may due to some pathological reasons such as Kidney diseases,Cancer is known as Secondary Gout
Primary Gout is again classified into 1.Acute Gout;2.Chronic Gout.
Treatments: ACUTE GOUT :-1.Phenylbutazone;2.Indomethacin (Indocid);3.Colchicine;4.Most of the NSAIDs except Aspirin
Aspirin should not be taken for gout as it is a weak acid weaker than uric acid and hence it would block the excretion of uric acid by kidneys.
Phenylbutazone:-This medicine is because of its serious side effects now totally out of use in humen but still use as a vetarinary medicine for horses.
Its side effects are same like that of NSAIDs such as ulcer,GI tract bleedings,Kidney Damages ,mouth ulcers etc.etc.
Indomethacin also carries the same side effects but to a lesser extent and hence can be used causiously with the advice of a Doctor.
CHRONIC GOUT :-1.Probenecid 2.Sulfinpyrazone
Both the above mentioned uricosuric agents are also weak acids similar to aspirin but at the therapeutic dosage they become stronger than uric acid and promote its excretion.Hence Doctor has to device their dosages
Allopurinol (Zyloric) is a xanthine oxidase inhibitor.This medicine is more preferable and safe.
Xanthine Oxidase is an enzyme which is converting purune into uric acid.Allopurinol act by inhibit this enzyme.

Insulin degludec: No hint of added benefit in children and adolescents

Insulin degludec: No hint of added benefit in children and adolescents: With regard to insulin degludec, no added benefit for adolescents and children with diabetes mellitus can be derived from the drug manufacturer dossier. In girls with type 1 diabetes, severe side effects were more frequent.

HIGH BLOOD PRESSURE OR HYPERTENSION

HYPERTENTION OR HIGH BLOOD PRESSURE

 

Hypertension or high blood pressure is no doubt one of the major causes for cardiac diseases,stroke,and kidney damage.But there are contraversies regarding to the measurement of blood pressure as whether they are truely representing your body health at the right time at which it is measured at the Doctor's room.Because the movement when you entered inside the hospital, your already elevated B.P by the travel movement either by walk or vehicle from your home to hospital,would elevate further and the B.P would reach its peak level when you are called by the doctor to get in.
The Blood Pressure is always said to be the basic and funtamental information with regarding to the physiology of our body.An ordinary mild fever may be some times undetected by a thermometer but a proper measurement of a spygmomanometer would reveal that.Hence measurement of blood pressure should be made by giving sufficient time to the patient to relax by the time when he arrived at the hospital.
There are BP home measurement kits are available in the market.There are many brands in various price ranges.There are electronic and nonelectronic(Aneroid) BP kits.

An aneroid BP apparatus is the one which has a rectangular bladder on one side of the cuff embedded with a calibrated dial known as the aneroid gauge with a movable pointer,a stethoscope embedded in the cuff bladder,and a bulb pump to inflate the air.The figure is shown above.This is very simple and give more accurate measurement very close to the Doctor's mercury manometer but need experience of detecting the various pulse sounds.

Measuring BP with Aneroid BP Kit

Insert all the detachable parts like the bulb,the gauge dial,and the stethoscope armed earpieces into the respective tubes.Relax by sitting in a convenient chair for five minutes.

Place the bladder on your right or left arm by putting the stethoscopic dial exactly on the brachial artery which is right around the elbowwhere the fold is formed when you bent the arm.Wrap the cuff around the arm not too tight and not too loose such that after the wrap a pointer finger can be inserted.Place the ear pieces of the steth,into your ears.Put your wrapped arm on the table with a height exactly in a line with your heart.Relax.Inflat the bulb a little high above 150 mm/Hg and slowly deflate it.watch the pulse sound carefully.

PHASES OF PULSE SOUNDS WHEN MEASURING WITH ANEROID KITS

Phase-1 After inflate the cuff more sufficiently just 5 mm/Hg above your preveously measured or assumed BP slowly deflate by releasing the bulb valve and carefully hear the faint clear murmuring and tapping sound,the point at which this sound start is the systolic pressure

Phase-2 On continue deflation at the end of the Phase-1,a murmur nd swishing sound follows.This sound is longer than the phase-1 sound. This is the Phase-2 sound and continue deflating

Phase-3 At the end of the Phase-2,the sounds are more crisp,loud and increase in intensity
Phase-4 At the end of the phase-3 the sounds become less distinct,muffled and faint like blowing.This is phase-4.
Phase-5 At the end of the phase -4 watch the disappearence of the last sound that indicate the exact beginning of the Phase-5 which should be noted down as your diastolic pressure.Then deflate the gauge commpletely.
The procedure should be repeated two or more times daily until you become familiar with the pulse sounds.Aneroid methods are as accurate as Mercury meters,less expensive,and more convenient.

MEASUREMENT WITH ELECTRONIC METERS

 

Electronic meters are available in variety of models some are manual, semi automatic (auto deflation only),some are fully automatic (Both inflate and deflate automatically) and some with printers.All are automatically measuring the pulse and pressure and will display the values digitally at the end of the measurements in an electronically calibrated dial.Most of them are working in both battery and direct current operation.

 There are various different types such as arm model to measure by arm which are fuzzy logic,wrist watch model to measure in the wrist and finger model to measure by the finger.But measuring the BP by the arm is the reliable method.Procedures are discribed in the manufacturers instruction manual comes along with the products.The testers for Consumer Reports gave brands such as Omron and Marshalls top rating for reliability and ease of use.
Blood Pressure can be defined as the product between stroke volume and heart rate multiplied by systamic vascular resistance and can be conveniently read by the following equation:-
(stroke volume x heart rate) x systamic vascular resistance

  Altering any of the above factors would result in a change in the blood pressure.

Blood Pressure composed of two parts like the pressure at which the left ventricle empties a large chunk of blood into the aorta against the systamic resistance in the aotra during the contraction of the left portion of the heart(the sound is specific as Lub) the pressure raises in the arteries is known as SystolicPressure.

When the left side relax,by the cotraction of the right side of the heart the (sound is specific as Dup) left ventricle relax,and receive a chunk of blood from the right venricle,and the pressure in the aorta lowers and is known as Diastolic Pressure.

The mean calculation of these two parts of the B.P is measured by the various spygmomanometers as we have seen above.
If the systolic raises above 120 mm/Hg and the diastolic above 80mm/Hg we should be careful about we may have the preliminary conditions of hypertension. 

Table

No  ----        category        ----                             sytolic/diastolic       

  1.   ---         High normal -----                             130/85 to 139/89

  2..   ---        Mild               ----                              140/90 to 149/99

  3.   ----       Moderate       ---                              160/100 to 179/109

  4.   ---        Severe            ---                            180/110  to  209/119

  5.  ----        Very severe   -----                          >210/120 
In the olden days the physicians did not start to worry unless the pressure reached 150/95.At present the medical field is more aggressive in assessing the patient's model condition to be normal or above the normal with a base of 120/80mm/Hg.Because blood pressure is any way is varying environementally flexuating here and there according to the emotinal feelings,situation and sorroundings of our daily routine life.A patient is said to be having high pressure only if his repeated readings show an high persistant value.First the medical field considered only the high persisting diastolic pressure as a base.But now they consider both systolic and diastolic  if above 130/90 .
But if you are above forty it is normal and not to be panic if the pressure readings are systolic 130-140 and diastolic is 90 to 100.
There are some conditions in whic care should be taken in altering the pressure by treatments.For example some studies shows that lowering the diastolic below 90mm/Hg may produce adverse effects in patients with coronary insufficiency. 

Non-Drug Therapies For Hypertension

1.Weight Reduction:-It is of no doubt that obesity plays an important role in hypertension and cardiac overload.Food control especially fat restricted and fiber rich foods are recommended and reduced intake of food with minimum excercise may certainely have an benificial impact on overweight.

Use of tobacco,and alcohol may put on overweight by depositting fats.Avoid to take more saturated fatty meals such as redmeats like mutton beaf and like meats,adulterated cooking oils,daldas etc.

Drink a tablespoon of pure honey mixed with a cup of lukewarm water in the morning wakeup on empty stomach daily is assumed to be good extra fat remover.Similary daily morning have a drink of smooth light dicoction of fresh tea is said to have beneficiary effect.

2.Helping Minerals Foods with extra calcium,megnesium,and potassium also helping to reduce blood pressure.Apricots,avocados,bananas,cocoa,dates,figs,fish,molasses,dried peaches,peanuts,peacans,potatos,raisins,sunflower seeds,wheatgerm and brewer's yeast are potassium rich.
3.Excercise Non aggressive aerobic excercises such as morning and evening walkings,cyclings,swimmings are of benificial to help blood pressure. 

Drugs Therapy

Many people are thinking that helping blood pressure to ease down  simply by taking proper medications and enjoy the freedom from diet restriction and excercises are good thing.But a trial known as Multiple Riskfactor Intervension Trial (MRFIT), was conducted for 10 years at a cost of $100 million with 12000 recruits.The results are unexpected and it explained that those who are taking medicines are dying faster than those who are not taking medicines.

Further detailed studies by The New England Journal of Medicines  based on the MRFIT findings revealed that treatments of coronary artery disease with aggressive thiazide dosing may increase the major cause of sudden deaths by heart attack.The main reason is diuretics generally causes dipletion of the major important minerals potassium and magnesium which leads to cardiac arrhythmias and cardiac arrest.
Reserpine and guanethidine(Ismelin),as they are indirectly working by blocking the secretion of the main adrenergic transmitter norepinephring from the adrenergic nerve endings they often produce unpleasant side effects such as Orthostatic hypotension and sexual dysfunction as in the case of guanethidine,CNS depression and bradycardia as in the case of reserpine.Hence these medicines are now minimised by the doctors.
Then came the betablockers.They are non selective like propranolol(Inderal),selective such as metaprolol(Lopressor),atenolol(Tenormin,Aten),betablockers with little alpha blocking capacity such as carvedilol(Coreg)and labetalol,betablockers selective at beta-1 receptor with an partial sympathetic agonism such as acebutol(Secral).These medicines are especially the beta one selective blockers are advantageous more to youngsters with minimal side effects.But people sometimes complains fatigue.cold hands,sexual difficulties,and problem controlling sugar and cholesterol.
Then came the calcium channel blockers such as Nifedypine(Adalat),Diltiazem(Dilzem) are introduced with further minimal side effects. 
Conclusively different people responded to different medicines and should be thoroughly subjected to proper evaluation. 
For a full reference ANENCYCLOPAEDIA OF HYPERTENSION