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From the SLMA:
Health educating you on diabetes
The Sri Lanka Medical Association under its new president Prof. Rezvi
Sheriff and the new Committee had decided to health educate the public
through the media on important health issues relating to the people.
Here we are leading the page with the first article on Diabetes by
Dr. Sarath Gamini de Silva (Consultant Physician National Hospital,
Diabetes - insulin or tablets?
Controlling the diet
Diabetes mellitus is a disorder where the blood glucose level rises
due to either the quantitative or qualitative failure of insulin
secretion or the inability of the peripheral tissues to utilize insulin.
Thus in the former, commonly called type 1 diabetes, patients needs
administration of insulin while in the latter, type 2 diabetes, oral
drugs are given to lower blood sugar levels. As the deficiency of
insulin gets worse progressively, those who are initially controlled on
oral drugs will eventually need insulin therapy.
Also during acute illness like infection or during surgery, pregnancy
etc. even those on oral drugs will need insulin temporarily to tide over
the acute crisis.
Controlling the diet
In whatever form of diabetes, first step in the management is always
the control of the diet.
Although details of the diet is beyond the scope of this article, it
has to be stressed that all forms of refined sugar should be avoided,
encouraging the use of complex carbohydrates such as unpolished rice
together with reduced fat intake. Amount of calories for a 24 hour
period depends on the amount of physical activity the person undertakes.
Maintaining blood sugar level
Thus drugs used to treat diabetes are of two main groups, insulin and
oral hypoglycaemic agents (OHAs). The doctor considering above facts
will prescribe the most appropriate drugs to control diabetes.
The main aims of treatment is to maintain the blood sugar levels as
close as possible to the normal levels seen in non diabetic people.
When this is done the patient is relieved of the troublesome symptoms
like passing excessive urine, excessive thirst, weight loss and induces
a general feeling of well-being. More importantly, adequate control of
blood sugar levels has been proven beyond any doubt to prevent the long
term life threatening complications like kidney failure, loss of vision,
heart attacks, strokes etc.
When near normal blood sugar levels are achieved there is a slightly
increased risk of hypoglycaemic attacks where the patient feels hungry
faintish or even become unconscious. These can be easily prevented by
Insulin being a protein, will be digested if taken by mouth. As such
it has to be given by injection under the skin. Depending on the source,
it is labelled human, bovine, porcine etc. There are short and rapid
acting insulins which have to be given usually before every meal.
Longer acting insulins may be given once or twice daily before the
morning and evening meal. Combination of short and long acting insulins
may be used to achieve adequate control of blood sugars. Occasionally
those on OHAs may be given a dose of insulin at night to control night
time blood sugars.
Monitoring blood sugar at home
It is useful for patients on insulin to monitor their blood sugars at
home. This is done with a Glucometer, a simple device that tests a drop
of blood, obtained by finger prick, on a strip of paper. As various
brands are available, make sure that what you choose has a regular
supply of the testing strips.
Following should be noted.
1. Generally insulin should be taken before meals.
2. Once insulin is injected, the meal should be taken within 15 to 30
3. If the blood sugar levels are outside normal limits, the dose of
insulin may be adjusted provided the patient has received instructions
from the doctor on how this should be done.
4. The blood sugar level at a given time depends on the preceding
dose of insulin, eg. the fasting blood sugar level depends on the dose
of insulin given the previous evening or night: the lunch time or
evening blood sugar depends on the insulin given in the morning.
Oral Antidiabetic Agents
There are several main groups.
* Biguanides such as metformin, which improves peripheral utilization
* Sulphonylureas, like tolbutamide, glibenclamide, gliclazide,
* Glitazones like pioglitazone, rosiglitazone
*Alpha glucosidase inhibitors like acarbose
There are newer drugs which are not in common use.
Biguanides like metformin are taken 15 to 30 minutes after a meal,
acarbose is taken with the meal and all other drugs are taken before
meals. All except metformin are given once or twice daily, usually
before breakfast and dinner. Usually, the patient is started on a small
Depending on the blood sugar reports, the dose is adjusted by the
Irrespective of insulin or tablets taken by mouth, the patient has to
follow standard guidelines.
The appropriate diabetic diet should be taken at the regular times.
Delaying the meal leads to low sugar levels.
The quantity of the meal too cannot vary beyond limits. As an example
one cannot suddenly decide to have a light lunch and a heavy dinner.
An excessive meal taken cannot be covered by taking a higher dose of
the drug. However if one has to undergo more exertion than usual, he may
have to take an extra quantity of food to cover that.
the best Medicine
At the gates of Heaven:
After a lifetime of suffering, a 70 year old man decided to finally
enjoy life, so he went for a crash course of health supplements, gym
sessions and plastic surgery.
Looking 20 years younger, he found himself a young bride, but on the
day of the wedding, a meteorite crashed into his house and killed him.
At the gates of heaven, the man complained to Saint Peter “How can
you do this to me, and now of all times?”
An embarrassed St. Peter replies “We are sorry we didn’t recognise
Sent by Dr. Viraj Peramuna
(taken from the article Humour you
can use anytime by Edmund Tan in RD June 2005)
Health news summary
Following is a summary of current health news briefs.
Could lice prevent asthma?
Could lice be the secret to preventing asthma? Research on mice shows
that those carrying the most lice had calmer immune systems than
uninfested rodents, and they said their finding may have implications
for studying the causes of asthma and allergies in people.
Want to reduce breast cancer risk?
By eating walnuts, women could reduce their risk of breast cancer,
researchers said on Tuesday. Researchers at Marshall University School
of Medicine in Huntington, West Virginia, found that lab mice bred to
develop breast cancer had a significantly lower risk of breast cancer if
fed the human equivalent of a handful of walnuts a day.
Drug seen useful in preventing
A drug used to reduce sugar levels in diabetics appears to be useful
in delaying or even preventing the disease in people predisposed to
developing diabetes, a study in Japan has found.
The study, published in The Lancet, found that fewer people who were
given the generic drug voglibose went on to develop diabetes compared to
those who received placebo, or dummy lookalike pills with no therapeutic
Burned meat linked to pancreatic
People who regularly eat burned or charred red meat, like that cooked
on a grill, have a 60 percent higher risk of pancreatic cancer, U.S.
The finding is one of the strongest yet linking very well-done meat,
especially red meat, to cancer.
Need a heart defibrillator? Call a
Heart patients who get a defibrillator from doctors who specialize in
the heart’s electrical system fare better than those whose devices are
implanted by other types of doctors, U.S. researchers said on Tuesday.
They also are more likely to get a newer device that is harder to
implant but that treats heart failure, they said.
Health educating mothers in
Detecting deafness of children
HealthWatch had an interview last week with Dr. Devanand Jaha
(Consultant ENT, Head and Neck Surgery) at the Colombo Apollo Hospital
who did the second Baha ear implant surgery on two children born with
sensorineural deafness, which if not detected early, would have led to
more complications affecting the future of the two kids.
Here Dr. Jaha who has been with us in our health education panel,
wants to emphasise the important role the parents, specially the mother
has to play in detecting the hearing problems of their growing children
at the early stage.
Dr. Devanand Jaha. Picture by Ruwan de Silva
One day program
In this connection HealtHwatch in collaboration with the Apollo
Hospital, will be organising a one day program for parents in detecting
hearing defects of children shortly, with Dr. Jaha conducting the
program. Dr. Jaha also gave this release on this hearing defect which
helps the parents to understand this defect and the needed implantation
When you or your child can no longer take part in conversations, it
may be time to meet with your hearing health professional. You’ll
discover hearing aids are not your only option. There are ways to hear
again, or in some cases, hear for the very first time.
You may break through the sound barrier and re-connect with the world
around you. A world in which you’ll enjoy all the things that others
take for granted.
Like taking part in school, pursuing a career or enjoying time with
family and friends. And young children get back far more than their
Learning to speak is almost entirely dependent on the ability to hear
a full range of speech sounds. So they won’t simply follow
conversations, they’ll be part of them.
You are not alone
Globally, hundreds of millions of people experience some form of
hearing loss. While the majority can be helped with hearing aids, for
many even the most powerful hearing aids are inadequate. This article
explains the different types of hearing loss, as well as some proven
technology that may help when hearing aids are no longer enough.
How do we hear?
1. Ear canal: Sound waves move through the ear canal and strike the
2. Eardrum and bones: Sound waves cause the eardrum to vibrate,
sending the bones in the middle ear into motion.
3. Inner ear: This motion causes the fluid inside the inner ear
(cochlea) to move the hair cells.
4. Hearing nerve: Hair cells change the movement into electric
impulses, which are sent to the hearing nerve up to the brain; you hear
Types of hearing loss
Hearing loss can be categorised according to which part of the
auditory system is damaged. There are three basic types of hearing
conditions where Cochlear’s technology may help transform lives.
Sensorineural hearing loss:
Sensorineural hearing loss is often referred to as nerve deafness. It
occurs when there is damage to the inner ear (cochlea) or to the nerve
pathways from the inner ear to the brain. A sensorineural hearing loss
is permanent and there is rarely any medical treatment available. Causes
of sensorineural hearing loss include:
* Inherited hearing loss
* Viral infections such as rubella, measles, mumps and
* Drugs which damage the hearing system
* Birth trauma
* Complications from prematurity
* Trauma due to long term exposure to extremely loud noise, commonly
referred to as industrial deafness
* Previous surgery such as the removal of an acoustic neuroma tumour.
Conductive hearing loss:
Conductive hearing loss occurs when sound is not conducted
efficiently through the outer ear canal to the eardrum and the tiny
bones, or ossicles, of the middle ear. A conductive hearing loss may
often be helped by medical or surgical treatment. Some causes of
conductive hearing loss include:
* Inherited (congenital) hearing loss where the outer or middle ear
do not develop as expected
* Excess wax or foreign object in the ear canal
* Outer ear infection
* Chronic ‘glue ear’ or middle ear infection, called Otitis Media
* A hole in the eardrum.
Mixed hearing loss:
This is a hearing loss where there is a problem with both the
conductive pathway (outer and middle ear) and the inner ear (cochlea) or
Why aren’t hearing aids enough for
While the majority of people who suffer from hearing loss may be
helped with hearing aids, for some, hearing aids do not provide the
benefits they need. Why is this? Simply stated, hearing aids only
For people with a moderate-to-profound hearing loss, even the most
advanced hearing aids may not work because making sounds louder does not
make them clearer.
You may be able to hear sound with hearing aids, but understanding
speech and other sounds may still be very difficult.
Using a hearing aid with a moderate-to-profound hearing loss can be
likened to listening to a loud, badly tuned radio program. You
experience only fragments of the program, but at full volume. And in
some cases hearing aids may not provide audibility.
If hearing aids can’t help what are
Many people believe that when hearing aids are no longer benefiting
them or their children, there are no other options.
Thankfully, with continued advances in implantable hearing technology
there are solutions.
For you to know:
Bathroom scale is a liar
* It does not tell us whether we are over-weight or have extra fat.
* It only indicates how much we are contributing to the total weight
of the earth.
* Knowing about the weight of fat, muscles and bones in our body is
far more important than the total weight.
* Bath room scale is a very commonly used method. Because it is
easier to measure total body weight than body fat. Having extra body fat
is far more dangerous than having more muscles. In fact, having extra
muscles is a healthy sign.
* On any crash diet, our kidneys work overtime and we may find
ourselves going to bathroom frequently. We need to lose two glasses of
water to lose one kg of weight on the scale.
* We do not loose body fat: we lose water. We trust the scale when it
seems to say “Congratulation, you have lost weight”. In face, we lose
water weight and as such the scale is a liar.
* Generally, the body weight measured in the morning is less by, as
much as 2 kg, than the weight measured in the evening. This is because
of food and water taken during the day...making the bathroom scale
* It’s important to remember that weight is not the only indicator of
overall body fitness and health. Muscle weighs more than fat so the
numbers on the scale can be misleading. Other indicators, such as, Body
Mass Index (BMI), Body Fat Percentage, Waist Circumference, weight: hip
ratio, weight: height ratio and Lean Body Mass should be taken into
account as well.
From: Slim Life
Sent by Mrs. Chrissy Aloysius
(President Doctors’ Wives Association)
Tips for a healthy heart
Whole grains, good fats, and colorful fruit and vegetables, along
with exercise and stress reduction, are the building blocks to a healthy
Medically Reviewed By Rosalyn Carson-Dewitt, MD
An everyday health special report
The good news is that for most people, heart disease doesn’t just
happen. “Of all heart disease we experience, 80 percent is preventable,”
says Dr. C. Noel Bairey Merz, director of the Women’s Heart Center and
the Preventive and Rehabilitative Cardiac Center at Cedars-Sinai Medical
Center in Los Angeles.
Fiber-rich whole grains a pillar of every heart-healthy diet.
The most effective way to protect your heart is to consume a
heart-healthy diet, combined with moderate exercise, stress relief, and
not smoking. More good news: While starting these habits young is best,
it’s never too late to make heart-friendly lifestyle changes.
Fiber is essential
Fiber-rich whole grains are a pillar of every heart-healthy diet.
Whole grains can help reduce heart disease risk in a number of ways:
They help to lower “bad” LDL cholesterol and triglycerides, regulate
blood sugar, normalize blood pressure, and control weight.
Most of us already know that eating insoluble fiber, which comes from
sources like whole wheat, seeds, nuts, green leafy vegetables, and fruit
skins, promotes regularity and the quick removal of waste products.
The less well known soluble fiber also plays a positive role in
metabolism, by assisting the regulation of insulin, boosting “good” HDL
cholesterol, and lowering “bad” LDL cholesterol. Sources of soluble
fiber include oats, barley, flaxseeds, carrots, and oranges.
Substituting whole wheat, oats, brown rice, barley, or buckwheat for
food you may currently eat, like white bread or white rice, is an easy
way to add whole grains that are rich in vitamins, minerals, and fiber
to your diet.
“When people have borderline cholesterol, we recommend eating soluble
fiber,” says Dr. Eleanor Levin, who for 15 years was chief of Cardiology
at Kaiser Permanente in Santa Clara, California, and who continues to
practice at the managed care organization.
The Institute of Medicine recommends a total daily fiber intake of 38
grams for men and 25 grams for women aged 50 and under. For men and
women over 50, the recommendation is for 30 and 21 grams per day,
Fruit and Vegetables
Fruit and vegetables also lower blood pressure, moderate blood sugar
levels, and cut the risk for heart disease. Doctors recommend nine
servings a day — or almost five cups, at a minimum.
The more eye-catching the vegetable, the better it is for you. Go for
dark leafy greens, and produce that is bright yellow, orange, or red in