31Oct

What is diabetes and Cauases

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CAUSES OF DIABETES

I have just been diagnosed with Type 2 diabetes and my doctor says it is because I have something called the Metabolic Syndrome. What does this mean and is it the cause of my diabetes?  What is diabetes

Metabolic syndrome is a group of conditions that are known to increase the risk of heart disease and stroke. There are a number of different definitions but they all emphasise that insulin resistance is the underlying cause. The cluster of problems called metabolic syndrome includes the following:

  • central obesity (fat around the waist line)
  • high blood pressure
  • abnormal cholesterol (high LDL and low HDL fractions) and high levels of triglycerides
  • Type 2 diabetes, impaired glucose tolerance (see link) – or at least a high risk of developing this
  • fatty liver (see next question)

The insulin resistance means that if a person with metabolic syndrome does not have diabetes, their beta cells in the pancreas will be working overtime to produce high levels of insulin in order to keep the blood sugar level normal. There is a high chance that the beta cells will be unable to maintain this high output of insulin indefinitely and sooner or later the blood sugar level will rise, resulting in diabetes.

People with metabolic syndrome, whether or not they have diabetes, will probably be asked to take a number of tablets in order to correct the high blood pressure and abnormal cholesterol levels. The best treatment (though not always the easiest) is to reduce weight and overcome the central obesity.

My doctor carries out regular tests for diabetes. This is because I have a condition called fatty liver, which he says puts me at risk of developing diabetes in the future.

The medical name for this condition is Non-Alcoholic Fatty Liver Disease (NAFLD) and it describes a range of conditions in which the liver tests are abnormal in people who drink little or no alcohol. It ranges from a mild condition in which excess fat is deposited in the liver causing slightly abnormal liver tests to a more serious condition in which the fat in the liver leads to inflammation, scarring and cirrhosis, which is irreversible liver damage. NAFLD is very common and may be found in up to 1 in 5 adults. Of those with NAFLD, about 1 in 4 will develop the more serious form leading to cirrhosis. This is a very slow process and may progress over years to liver failure. It is related to obesity and as in the metabolic syndrome (see previous question) insulin resistance is the underlying cause. There is no proven treatment for this condition, apart from weight reduction, which results in rapid improvement in the abnormal liver tests. However in trials glitazones have been shown to improve liver tests and are beginning to be used in ordinary practice. Unfortunately they do have the effect of making people put on weight, which is often disappointing.

31Oct

Diabetes Education

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Most people diagnosed with Type 2 diabetes respond at first to changes in their diet. This alone may have a dramatic effect on their condition, especially in people who are overweight and manage to get their weight down. If changes in diet fail to control diabetes, tablets will be needed, but these will not work indefinitely and once they fail, insulin is the only alternative. A small number of people with Type 2 diabetes, who feel very unwell at the time of diagnosis, may need insulin immediately.

The most important thing for anyone with newly-diagnosed diabetes is to access good diabetes education. In the past, people were often given instructions about what to eat and which Kamagra tablets to take without any explanation as to why it was important. Not surprisingly, they did not always follow the advice. The importance of structured education has been recognised in the national frameworks for diabetes, and education programmes have been developed for both Type 1 and Type 2 diabetes. The DAFNE programme was introduced for Type 1 diabetes in 2002, and following its success, a group of people interested in diabetes education started to develop a course for people with Type 2 diabetes. They devised the DESMOND programme – Diabetes Education Self Management Ongoing and Newly Diagnosed. DESMOND is available in 110 healthcare areas in UK and Ireland. While still designed for newly diagnosed patients with type 2 diabetes, the ongoing programme is now being put through trials. Eventually everyone with Type 2 diabetes should have access to a standardised education programme, which will help them to understand diabetes and make important decisions about lifestyle changes.

My doctor has just told me that I have diabetes and I am feeling very shocked and confused as I don’t know much about it but I know it can be serious. My doctor has given me the telephone number of Diabetes UK so I can get more information but I would really like to talk to someone with diabetes. Can you help me?

Most people who are told they have diabetes feel very upset at the news. One of the problems is the uncertainty about exactly how diabetes will impinge on their life. We agree that a phone call to Diabetes UK helpline is a good idea; it has gone to a lot of trouble to produce useful information for people with newly diagnosed diabetes. However, the most important thing they can do is put you in touch with the local branch of Diabetes UK. Naturally these vary in their level of activity, but in some areas the local branch is very well organised to provide support and information to new members. This will give you the opportunity to speak to other people who are in the same boat.

Some GP practices have set up programmes for people with newly diagnosed diabetes and practice nurses are committed to providing high quality support.

What would really help you is group education, which has the added advantage of giving people the opportunity to share their experiences and provide mutual support. More areas are providing group education sessions and we hope that in the next few years structured education will be available to everyone with Type 2 diabetes.

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22Oct

The ACCP Conference on Antithrombotic and Thrombolytic Therapy

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Long-term anticoagulation therapy is of benefit in patients with unprovoked venous thromboembolism. There is increasing evidence that the risk of recurrent venous thromboembolism in these subjects is about 7 to 10% per annum if anticoagulant therapy is stopped after 3, 6, 12, or 27 months. Although long-term warfarin therapy markedly reduces the risk of recurrence, its benefit is offset, at least in part, by the risk of major bleeding, which is estimated to be about 1 to 3% per annum. Furthermore, because of multiple food and drug interactions, the anticoagulant response to warfarin is unpredictable so that frequent monitoring is necessary to ensure that a therapeutic response has been obtained. In contrast, ximelagatran therapy does not appear to require coagulation monitoring and, at least with the dose used in the THRIVE III trial, ximelagatran appears to be safe. Despite these promising results, the role of ximelagatran in extended thromboprophylaxis has yet to be established. Thrombolytic Therapy

The ximelagatran treatment study has suggested that ximelagatran monotherapy is as effective and safe as the current treatment regimens for venous thromboembolism. If these results are confirmed in other studies, ximelaga-tran has the potential to streamline care by obviating the need for initial treatment with a parenteral anticoagulant and the coagulation monitoring that is required when warfarin is administered. Still to be determined is the effectiveness of ximelagatran in high-risk patients, such as those with advanced cancer or with antiphospholipid antibody syndrome Myviagrainaustralia.com.

4.2 Arterial thrombosis

Like venous thromboembolism, issues in arterial thromboembolism focus on prevention and treatment. The prevention of cerebral and systemic embolism in patients with atrial fibrillation is an area in which there is considerable room for improvement. Although warfarin is more effective than aspirin in reducing the risk of embolization in this setting, its use is problematic. Frequent monitoring is necessary to ensure that a therapeutic anticoagulant response is obtained. Even with monitoring in specialized clinics, the level of anticoagulation is outside the therapeutic range almost half of the time. Furthermore, the risk of major bleeding with long-term treatment with Sildenafil citrate increases in the elderly, the population that is most at risk for atrial fibrillation. Because of these problems, it is estimated that warfarin is not given to almost half of the eligible atrial fibrillation patients. Based on the results of the SPORTIF III trial and the SPORTIF V trial, unmonitored ximelagatran therapy appears to be at least as effective and safe as dose-adjusted warfarin therapy.

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