Exercise guidelines for patients with diabetes

Source morgantraining.co.uk

 

 

 

At a glance

    * Exercise has demonstrable benefits for cardiovascular risk factors of concern in type 2 diabetes mellitus.
    * Standard exercise stress testing is recommended before initiating a vigorous fitness program.
    * Physical activity should be initiated gradually in previously sedentary individuals.
    * Active people are less prone to foot ulceration.

The increasing prevalence of type 2 diabetes mellitus (T2DM) and the threat of an epidemic of its complications have led the American Heart Association to issue a scientific statement on a key but often overlooked element of T2DM management: exercise.


"We want to emphasize that exercise is just as important, if not more important, as giving antihypertensive medication, hypoglycemic medication, or a statin," says Roger S. Blumenthal, MD, director of the Johns Hopkins Ciccarone Preventive Cardiology Center in Baltimore and an author of the statement.


Regular exercise has been shown to improve glycemic control, presumably through reduced body fat, heightened insulin sensitivity, and enhanced glucose transporter function. Gains in muscle mass and blood flow may also play a role, the guidelines suggest. More generally, exercise has demonstrable benefits for cardiovascular risk factors of concern in T2DM, such as hypertension, hyperlipidemia, and obesity. 


The authors advocate the inclusion of exercise in prevention counseling as part of every clinical encounter with T2DM patients and suggest that the primary-care setting is "the logical first location for education" in this area. 


The guidelines address exercise training in terms of duration, frequency, and intensity as well as such ancillary concerns as cardiovascular and other risks and adherence. One often misunderstood issue that deserves special attention, Dr. Blumenthal notes, is preparticipation testing. 

When and how to test 


While major cardiac events during exercise are generally rare, the imposition of screening for occult coronary artery disease may pose a barrier to exercise, particularly in obese and out-of-shape individuals. "The overall balance of benefit in exercise substantially exceeds the risk in unselected subjects," the guidelines state.


The presence of T2DM does not change that equation. "Many clinicians, especially in private practice, think that if a patient has diabetes, you have to do stress nuclear testing," explains Dr. Blumenthal. "There's no basis for that at all."


Standard exercise stress testing (with echocardiography, if imaging is indicated) is more broadly useful, and the guidelines recommend this before initiating a vigorous fitness program. When more moderate exercise is planned, testing may be more selective, generally targeting individuals with stable coronary artery disease who have not been tested for two years, those who experience chest discomfort or dyspnea, or those exhibiting an abnormal ECG or clinical or laboratory evidence of peripheral artery disease or cerebrovascular disease.


Treadmill testing is most useful. Results can be used to help design an exercise program. For example, a patient with ischemia at a high workload might be prescribed a protocol that maintains a heart rate at least 10 beats/minute below the ischemic threshold. Stress imaging and pharmacologic stress testing are indicated in specified circumstances.


Via : clinicaladvisor.com

The various aspects of the Polycystic Ovarian Syndrome

Source : dawn.com

 

 

 

Infertility was once thought to be a disease itself and other primary factors were never identified. But now things have changed and many factors leading to infertility have come to the fore.

 

One of the most common endocrine disorders in females that is evidently linked with infertility is Polycystic Ovarian Syndrome (PCOS) - a hormonal anomaly in which females develop small multiple cysts in their ovaries that restrict the ovaries to function normally. Due to the presence of multiple cysts, the ovaries are termed as polycystic ovaries. These cysts are small fluid-filled sacs that are nourished and developed in the ovaries. However, women may possess different kinds of cysts in the ovaries during their child bearing age that may be harmless and benign but the symptoms can further classify whether it is PCOS or just a normal cyst.

PCOS occurs in 5-10 per cent of women of child bearing age and the symptoms may begin in the early teens, a youthful time where there is no focus on the gynecological issues of a girl. In our society, females generally only visit gynecologists after marriage when they are trying to conceive or deliver a baby. The symptoms of PCOS are related to elevated male hormones (androgens) and irregularities in menstruation cycle. Other symptoms may include obesity, hirsutism, female scalp hair loss, elevated insulin levels, infertility, acne, high cholesterol levels and elevated blood pressure. All the symptoms may not appear in the same individual and may vary from person to person.
Andaleeb, a teenager, was utterly unconfident due to the excessive facial hair, increased weight and irregular menstrual cycle. She never used to socialize and isolated herself in her room after school. Her mother didn’t even pay attention as the concept of visiting a gynecologist is not common in our society before marriage. She spent all her teenage years in remoteness and was never found at the forefront of any activity. Thus, in the age of utmost exuberance, she chose the path of isolation and alienation for herself.



With PCOS, women do not regularly ovulate and the release of an egg is delayed – a factor which can lead to infertility. Women with PCOS have a greater chance of having Diabetes Mellitus at the age of 40 and above, along with coronary atherosclerosis (arteries become clogged with cholesterol, calcium, and cellular waste) and endometrial carcinoma (cancer of the lining of uterus).

The cause of this syndrome is unidentified until date but is understood that it is due to hereditary and environmental factors. If the mother or grandmother had it so the chances increase for their daughters to develop PCOS. This is not something that has suddenly evolved, however, it has been there for years but definitely the occurrence has augmented quite fast; maybe because of our eating habits, lifestyle changes, or devastating environmental pollution. With the advent of fast food drenched with oil, speedily grown chicken that has been induced various hormones and complex carbohydrate diets; conditions like these are likely to develop.

Once PCOS is diagnosed, it should be smartly managed. After consulting an experienced gynecologist or endocrinologist, the focus should be diverted on lowering the insulin levels, restoration of fertility and menstrual cycle, and treatment of hirsutism and acne.

Diet plays an integral part in PCOS. Change of lifestyle with adapting healthy eating habits, exercise at regular intervals throughout the week and stress reduction has been the major recommendation by the physicians for women with PCOS. By watching their weight, patients can lower the risks of developing diabetes and heart disease. There are many success stories where obese women have shed a lot of weight by sticking to a proper medication and high fiber diet. After losing those extra pounds, they were able to conceive and found regularity in their menstrual cycle.

It is a misconception that woman with PCOS cannot conceive. Ovulation could be a problem in most of the women but for those who are obese, weight loss and proper medication could fulfill their desire of having a child. As for the treatment of acne and hirsutism, it could be treated with an anti-androgen drug that restricts the production of male hormones in the body, eradicating the male pattern hair growth and acne. Other remedies may include electrolysis and laser, which may sound a little hard on the pocket but can be good alternative to get rid of such a nuisance.

I still remember when I was in grade six in the early 90s, there was a girl in the college next to our school who used to always cover her chin. One day when she was drinking water, I spotted a trace of what would be considered a manly stubble. I walked away abruptly feeling very confused. 

The prospect for PCOS patients is still challenging. Physicians are in a continuous quest for identifying undercover problems and introducing solutions for this endocrinal disorder. In the recent years, PCOS is being much talked about on different talk shows, forums, chat-rooms, email lists, and websites. Moreover, with the influx of many interactive forums on the internet, women can communicate with other women on different platforms and share their experiences and be more aware of their health issues.

 

What is diabetes and how to detect it?

Source : topnews.in

What is diabetes?
Diabetes mellitus is a silent chronic disorder characterized by elevated blood sugar levels either due to defective insulin secretion or action or both. It is associated with altered metabolism of carbohydrates, fats and proteins. 

There are two major types of diabetes, type 1 and type 2 diabetes. Type 1 diabetes (earlier called juvenile-onset or insulin-dependent diabetes), usually develops in children or young adults. In this type the body completely stops producing insulin, the hormone that enables the body to use glucose found in food into energy, due to damage to insulin producing cells (beta cells) of the pancreas. 

In type 2 diabetes (earlier called adult-onset or non insulin-dependent diabetes), the body produces some insulin, but it is not enough and moreover there is insulin resistance, which means that the available insulin does not work properly. This type is mostly seen in adults, although it is being increasingly detected in younger age groups also. Type 2 diabetes is believed to have a strong genetic component and this type of diabetes is usually seen in people with a family history of diabetes. Compared to Type 2 diabetes, which accounts for 95% of cases globally, frequency of Type 1 diabetes is relatively low (<5%). In both types of diabetes, the signs and symptoms are similar.

Symptoms of diabetes
The symptoms of diabetes may begin gradually and can be difficult to identify at first. Thus, diabetes is, most of the times, undiagnosed.

The symptoms include:

    * Being very thirsty
    * Frequent urination
    * Weight loss
    * Excessive hunger
    * Blurry vision
    * Irritability
    * Tingling or numbness in the hands or feet
    * Frequent skin, bladder or gum infections
    * Delay in healing of wounds
    * Itching in the genital areas
    * Extreme unexplained fatigue

The primary symptoms exhibited in type 1 diabetes could be nausea and vomiting. These symptoms are due to diabetes ketoacidosis which leads to breaking down of energy giving muscles and tissues, thus resulting in loss of weight. This leads to severe electrolyte disturbances and dehydration, which may have a poor prognosis and could even lead to coma and death. 

The symptoms observed in diabetes are quickly relieved once it is diagnosed and treated and also reduces the chance of developing serious complications. It must be remembered however that up to 50% of patients with diabetes may not have any symptoms at all! Such patients are detected on routine investigations such as the pre-employment master health checkup or because of a family history of diabetes. In this case, people can live for months, even years without knowing they have the disease. Often diabetes comes on so gradually that symptoms may not even be recognized; hence the term `silent killer` is used to describe diabetes.

Diagnosis of diabetes
Approximately 50% of people with type 2 diabetes are undiagnosed. As there may not be any apparent symptoms, the diagnosis is usually made during an annual medical checkup. Type 2 diabetes may remain undetected for several years, and by the time of its diagnosis, many people unfortunately have one or more complications of diabetes. Hence the high-risk group for developing diabetes should be screened for diabetes at regular intervals.

Who are at high risk of Type 2 diabetes?
People who

    * Are overweight
    * Are over 35 years old
    * Have a family history of diabetes
    * Are physically inactive
    * Are on steroids
    * Are under a lot of stress
    * Have hypertension
    * Have had diabetes during pregnancy or gave birth to at least one baby weighing over 4.5 Kgs

Read More @ food.sify.com

Doctor claims non-invasive treatment for spine problems

A leading Canada-based orthopaedic surgeon has claimed to have developed a technology using sound waves for an effective, non-invasive and painless treatment for spinal ailments including injuries.

“The treatment helps in gentle repositioning of vertebrae, functional restoration of the central nervous system and cellular bio-synthesis which is responsible for restoring and regenerating worn or damaged disks,” said Dr. Aslam Khan.

Called as the Khan Kinetic Treatment (KKT), the new technology, the Indian-origin doctor said, allows people with spine injuries due to accidents, sports injuries, sudden falls, repetitive activity-related injuries, postural abnormalities, stress, genetic pre-disposition to reduce or completely eliminate their pain.

Following this treatment, muscles, blood vessels and neural communication are stimulated and cellular bio-synthesis is triggered, initiating the body’s self-healing process, said 46-year-old Khan who claimed to have developed the KKT technology after 20 years of research.

The special technology device for the treatment has been approved by the USFDA, he said.

Research papers by Khan, Chairman and CEO of KKT International Centre for Spine which opened its first centre here recently, and his colleagues are published in peer reviewed journals such as American Journal of pain management (January 2007) and Journal of Musculoskeletal pain (November 2007).

Asked about the technique, Dr. Pradeep Bhosle, Head of Orthopaedic Department of King Edward Memorial (KEM) hospital said, “Yes, we keep hearing about these techniques expecting some magical thing to happen. Personally I do not have any experience“.

These developments have no role in medical text books or exams, he added.

“We are looking at stem cells to play a major role in joint pains,” Bhosle said.

In India, according experts, 50 per cent of the population suffers from backache at some point of time in their life with the incidence being as high as 70 per cent in the geriatric population.

Degenerative changes in the lower back constitute a normal feature of ageing and in young people, back pain is caused more often due to distortion of the gel like disc sandwiched between the vertebrae.


Via : thehindu.com

Marijuana Can Reduce Nerve Pain

New research shows that smoking marijuana can reduce pain in patients with nerve pain stemming from injuries or surgical complications.

The study was led by Dr. Mark Ware, director of research at the Alan Edwards Pain Management Unit of the McGill University Health Centre in Canada. Ware and his team studied the pain-relieving effects of smoking cannabis in 21 people with “chronic neuropathic pain”: those who had constant nerve pain, caused by trauma or surgery.

“We found that 25 mg herbal cannabis with 9.4 per cent THC, administered as a single smoked inhalation three times daily for five days, significantly reduces average pain intensity compared with a zero per cent THC cannabis placebo in adult subjects with chronic post traumatic/post surgical neuropathic pain,” the study’s authors concluded in Monday’s online issue of the Canadian Medical Association Journal. Approximately 1 to 2% of people have chronic neuropathic pain - pain due to problems with signalling between nerves - but effective treatments are lacking. They also reported that they slept better, and were less anxious and depressed than when they were on the placebo.

The team also noted that those who smoked marijuana with 9.4 percent of the active ingredient tetrahydrocannabinol (THC) also reported sleeping better.

California was the first state to pass a medicinal marijuana law (Proposition 15, 1996), one that was later repeated by more than a dozen other states.

No serious harmful effects were reported during the trial. The most common adverse effects of smoking marijuana — found to be negligible — were headaches, dry eyes, a burning sensation in areas of neuropathic pain, dizziness, numbness and coughing.

Via : healthjackal.com

Factors that make marijuana addictive

The Cannabis Sativa or most commonly known as marijuana, is one of the most widely used illegal substances in the planet these days.

Marijuana use in America has already been rampant for about four decades. In America alone, there are around 5 million users of marijuana. Although there are numerous bills and laws that prohibit marijuana use, there are still a lot of people using it regardless of the consequences.

This is because the penalties are quite lenient for those who are caught using it. Moreover, the availability of marijuana has been very difficult to bar for drug enforcers as more suppliers continue to spread marijuana for public consumption.

Numerous factors make marijuana addictive. However, the addiction is quite more inclined in the psychological aspect of a user. First factor that makes marijuana addictive is the presence of the substance called delta-9 tetrahydrocannabinol or more commonly known as the THC. This substance makes marijuana addictive as it causes the feeling of euphoria, which the users commonly crave.

Another factor that makes marijuana addictive is the feeling of an improved well-being. As a user smokes marijuana, he or she feels more confident of him or herself. The user tends to become more talkative and easier to socialize with. As this effect continues to surface among users, people tend to become closer with the users and the users tend to use marijuana more frequently to get the sense of improved confidence.

The feeling of relaxation is also a factor that makes marijuana addictive. As the user smokes marijuana, the user tends to feel more relaxed. For people who are stressed out, marijuana may be addictive as it gives relaxation not only to the mind but to the muscles as well.

In addition, it can be used to mitigate chronic pain making marijuana addictive. For those who are experiencing chronic pain, marijuana may be necessity as it brings relief that the chronic pain causes. In a recent study conducted by researchers at the Alan Edwards Pain Management Unit of McGill University’s Health Centre, it showed that marijuana have affected the increased relief from chronic pain. The study involved 21 people with chronic neuropathic pain.

This type of condition involves pain in the nerves due to trauma or surgery. The researchers led by Dr. Mark Ware administered THC, which was smoked on pipes on one group and a placebo substance to the other. The result showed that the group who smoked THC had a significant decline in their pain averages compared to those who smoked the placebo.

Via : seerpress.com

Osteoporosis drugs may heighten esophageal cancer risk

Findings of a new study have established a link between consumption of bisphosphonates, a commonly used class of osteoporosis drugs, 

and development of esophagus, the cancer [abnormal cells that divide without control, which can invade nearby tissues or spread through the bloodstream and lymphatic system to other parts of the body. ]  of the gullet.

The study researchers aver that the findings are worrisome since this class of osteoporosis drugs are routinely prescribed to old people for strengthening feeble bones.

Merck & Co's Fosamax, Roche's Boniva, and Novartis's Reclast are all bisphosphonates prescribed to prevent bone fractures and make up for bone weakness linked with menopause and osteoporosis. 

Need to evaluate risks and benefits

However, the results should not prompt doctors or patients to instantaneously stop prescribing or taking bisphosphonates, claim the scientists.

"We have to be concerned, but this is the first large study with long-term follow up that has found this effect, and it is just one observational study," lead author of the study, Jane Green of Oxford University's Cancer Epidemiology Unit, said.

"Also, because esophageal cancer [abnormal cells that divide without control, which can invade nearby tissues or spread through the bloodstream and lymphatic system to other parts of the body. ] is uncommon, even a doubled risk is still a low risk," noted Green.

"It's important to see our findings as part of a wider picture. These are very commonly prescribed drugs and we don't have enough information about the long-term risks and benefits," Green added.

The study

For the purpose of the study, Green and her colleagues examined 3000 cases taken from the UK General Practice Research database on men and women aged over 40.

The participants in the study had one of the following cancers diagnosed between 1995 and 2005: esophageal, stomach, or colorectal.

The study established that people with 10 or more prescriptions
for bisphosphonates, or with prescriptions over about five years, were twice more susceptible to contracting esophageal cancer vis-à-vis their counterparts who had no bisphosphonate prescriptions.

"In Europe and North America, the incidence of esophageal cancer at age 60-79 is typically 1 per 1,000 population over five years, and this is estimated to increase to about 2 per 1,000 with five years' use of oral bisphosphonates," declared the study authors.

The study found no relation between bisphosphonate prescriptions and stomach or bowel cancer.

The National Osteoporosis Society said of the findings, "It is a case of balancing the reduced risk of fractures against the side effects of treatment.”

"When you consider the fact that there are 230,000 osteoporotic fractures every year in the UK and 1,150 hip-fracture-related deaths every month, the case for treatment is strong," stated the society.

The findings of the study have been published in the British Medical Journal.

Via : themedguru.com