Smoking and Diabetes
Written by Doc Team Monday, 08 March 2010 09:20
Approximately 30 percent of teenagers show evidence of recent nicotine exposure and the prevalence in adolescent with diabetes does not differ.
Diabetes education needs to address the following issues; (a) Smoking is deleterious to the health of all person at any age, (b) Medical evidence indicates that smoking is and additional risk factor for the appearance and progression of microvascular disease and macrovascular disease, (c) Smoking is also associated with Hypertension, Poorer glycaemic control, Excess general morbidity, Additional risk in pregnancy.
Smoking should be actively discouraged in diabetes and the education process should be commenced in paediatric service.
Medicine Interaction
Written by Doc Team Friday, 05 March 2010 16:46
Many reports of medicine interactions in man are anecdotal and bear little scientific weight. There are other reports of animal and test-tube studies that are not reproducible in man. Some interactions have little clinical significance because the medicines involved do not have major effects alone or in combination, or the increase or decrease in effects is relatively insignificant on a flat dose-response curve.
There are so many possibilities for medicine interaction that it is perhaps surprising and fortunate that relatively few have major clinical significance. The major clinical interactions probably involve alterations in the rate of metabolism of one medicine by another and the additive effect of a number of medicines with similar properties. A medicine may interfere with the renal clearance of another medicine or may compete with another medicine at receptor sites.
Metabolic Acidosis in Diabetes Mellitus
Written by Doc Team Thursday, 04 March 2010 10:45
Diabetes mellitus is a common disorder characterized by an insufficient secretion of insulin or insulin-resistance by the major target tissues (skeletal muscle, liver, and adipocytes). A severe metabolic acidosis may develop in uncontrolled diabetes mellitus.
Acidosis occurs because insulin deficiency leads to decreased glucose utilization, a diversion of metabolism toward the utilization of fatty acids, and an overproduction of ketone body acids (acetoacetic acid and _-hydroxybutyric acids). Ketone body acids are fairly strong acids (pKa 4 to 5); they are neutralized in the body by HCO3_ and other buffers. Increased production of these acids leads to a fall n plasma [HCO3 _], an increase in plasma anion gap, and a fall in blood pH (acidemia).
Insulin Injection Technique
Written by Doc Team Monday, 01 March 2010 10:23
Injection should be given into the deep subcutaneous tissue through a broad pinch of skin at a 450 angle or at a 900 where the subcutaneous layer is thicker than the needle length.
Intra muscular insulin ijection should be avoide as absorption is far too rapid and the injection may be painful. Standard insulin syringes have a 12.7 mm needle. Short (8 mm) needle disposable syringes are now available.
These minimize the risk of administering the insulin intra musculary. They allow 900 angle of injection routinely in all sites in most adolescent, but care still needs to be taken with children and very lean individuals who may require a 450 angle. Insulin pens have 8 mm-length needles. There are no data on mean distances between the skin and the muscle layer in children.
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