Screening of Diabetes

The prevalence of diabetes mellitus is increasing as well as incidence of diabetes throughout the world; especially in some countries it is becoming alarming. The incidence of diabetes is increasing throughout the world, in some countries it is fast becoming sort of endemic and in some countries the increase in incidence is not much. Within a country also the rate of increase and prevalence is not same; in some regions it is highly prevalent whereas in some regions its prevalence is less. Because of the high prevalence of diabetes, the screening of diabetes is recommended.

The following are the reason why diabetes screening should be conducted routinely:

1. A large percentage of individuals who meet the current criteria for DM (diabetes mellitus) are not symptomatic and they are unaware that they have diabetes.

2. Many epidemiologic studies suggest that type 2 diabetes may be present for up to a decade before diagnosis is made and till that time they are asymptomatic and slowly develop complication without their knowledge.

3. Up to 50% of individuals with type 2 diabetes have one or more diabetes-specific complications at the time of diagnosis of diabetes.

4. With appropriate treatment of type 2 diabetes it is possible to favorably alter the natural history of diabetes. So screening is helpful.

Fasting plasma glucose (FPG) level should be strongly recommended if an individual has any of the following factors:

1. Family history of diabetes, especially any first degree relative (parents or sibling) with type 2 diabetes.

2. Obesity with a BMI (body mass index) of more than 25.

3. Previously identified IFG (impaired fasting glucose) or IGT (impaired glucose tolerance).

4. Race/ethnicity like African American, Latino, Native American, Asian American, Pacific Islander etc. are more prone to develop diabetes.

5. Habitual physical inactivity.

6. If individual is hypertensive and have high HDL cholesterol and/or a triglyceride level.

7. Birth weight more than 4 kg or 9 lb.

Online Pharmacy

Going online is a new trend. Every field is going online or already online. Pharmacy is such a field which is using internet to promote business since very long time. There are many advantages of online pharmacy, like anyone can buy a medicine which he/she may need. You need not to go out to buy the medicine with a prescription which is time consuming and may be expensive (sometimes more expensive than online purchase). You can also chose the medicine from a good reputed company, to be sure of the quality of the medicine.

There is no end to the list of medicines you can buy online. Some of the popular online medicines are nutritional supplements, antibiotics for common infections like Keflex online (for treatment of gonorrhea, staphylococcal skin infection, streptococcal infection), vitamins, antioxidants to name only a few. Best selling medical products online are diet and nutritional supplements, laxatives etc.

But you should be careful in choosing the company or website from where you buy your required medications. The most important aspect of medicine is the quality of the product (best quality is the one which contain what it is supposed to contain in right quantity and right quality). To ensure the quality of you online medicines, you should always stick to the best companies and trusted websites. You should not go for the cheaper medicine to save some bucks, which may be the cause of your harm in terms of health as well as in terms of draining your pocket. You should buy medicines online from the same site everytime.

Lose Weight by Acai Berry Diet

Acai berry can be considered as the wonder diet of this century, which is gaining popularity only recently, thanks to the internet. Acai berry grows naturally in the flood plains of Amazon River basin in Brazil and its neighboring countries. The acai berry is part of staple diet among some of the Amazonian tribes, which contributes up to 40% of their diet. These tribes whose diet consists of acai berry are very healthy in general, compared to many of the communities of the world including industrialized countries. The good health of these tribes can be attributed to the acai berry. The good qualities of acai berry can be obtained by anybody by regularly consuming acai berry diet, which can be purchased from your nearest grocery store as well as it can be purchased online with a click of a mouse.

Acai berry has many qualities which are not found in other food in such quality and quantity. Some of the qualities of acai berry are:

1. Acai berry can reduce weight in a natural way, unlike many other weight loss products.
2. It is the richest natural source of anti oxidants. Anti oxidants are the chemicals which fight free radicals and prevent our body from damage, cancer and ageing.
3. Acai berry is very good in cleansing and detoxification.
4. It provides energy to fight lethargy and weakness.
5. The acai berry is a rich source of protein as well as dietary fiber, in addition to high levels of both omega-6 and omega-9 fatty acids, which are protective on the heart and cardiovascular system.

There are also many benefits of acai berry and its products.

There are many products of acai berry which are available. Some examples of acai berry products are acai berry weight loss, acai burn, acai pure, acai pure cleanse etc.

How to Diagnose Diabetes Mellitus

The world health organization (WHO) and National Diabetes Data Group (of USA) have issued diagnostic criteria for diabetes mellitus. These are based on the following:

1. The spectrum of fasting plasma glucose (FPG) and the response to an oral glucose load (oral glucose tolerance test) varies among normal individuals.
2. Diabetes mellitus is defined as the level of glycemia at which diabetes-specific complications occur rather than on deviations from a population-based mean.

Criteria for diagnosis of diabetes mellitus:

Based on the above two the world health organization (WHO) has given the following criteria for diagnosis of diabetes mellitus-

1. Symptoms of diabetes plus random blood glucose concentration of more than 200 mg/100 ml of blood or
2. Fasting plasma glucose 126 mg/100 ml of blood or
3. Two-hour plasma glucose 200 mg/100 ml of blood during an oral glucose tolerance test.

Random blood sugar is defined as “blood (plasma) sugar level without regard to time since the last meal”. Fasting is defined as “no caloric intake for at least 8 hours”. Oral glucose tolerance test should be performed using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water, but this test is not recommended for routine clinical use.

The above criteria for diagnosis of diabetes are accepted by ADA (American Diabetes Association).

Brain Training: an Introduction

A new subject is slowly gaining popularity in the field of medicine, which is brain training and various companies are promoting this brain training by developing sophisticated software. These neurotechnology companies develop software for brain training and market them. The brain training software train in brain fitness (keep the brain healthy as well as sharp in terms of memory power, peak performance, academic skills, mind concentrating ability etc.). The new brain training software are meant for optimal brain health, better memory power, better attentiveness, peak performance, good academic skills etc.

Many websites as well as many companies are marketing the brain training programs and internet has made this job much easier for these companies. Many brain training programs are available in the internet, which is regarded as gymnasium of the mind and brain (as we keep our body fit by training in the gym, by doing brain training we keep our brain and mind fit). The websites which provide brain training, can make your brain function more efficiently and also can help your mind to process information very quickly.

Benefits of brain training:

There are many benefits of training your brain at brain training sites or with brain training software. You will be able to do multiple tasks at a time after brain training, your efficiency improves, your concentration ability improves, your memory become better as well your attention. You can become a smarter person with brain training. These are just few benefits of brain training, as there are many more benefits.

Hyperglycemic Hyperosmolar State of Diabetes

Hyperglycemic Hyperosmolar State (HHS) is another acute complication of diabetes mellitus generally seen in type2 diabetes. The patient of hyperglycemic hyperosmolar state is usually an elderly person with type2 diabetes with several week histories of polyuria (excess urination), weight loss, and diminished oral intake of food that leads to mental confusion, lethargy and/or coma. On examination there is severe dehydration, hypotension (low blood pressure), hyperosmolality, high pulse rate and altered mental status. But symptoms of diabetic ketoacidosis (nausea, vomiting, and abdominal pain and the Kussmaul respirations) are absent.

Precipitating factors: Precipitating factors hyperglycemic hyperosmolar state is, serious illness like stroke and MI (myocardial infarction or cardiac attack), pneumonia, generalized sepsis or any serious infection. So in a patient with HHS, any of the above condition should be sought. In social/religious ceremonies (like Ramadan or Muslim fasting) where water intake is prohibited or compromised can also cause development of HHS.

Pathophysiology: The main underlying cause of development of hyperglycemic hyperosmolar state is relative insulin deficiency and inadequate fluid/water intake. Insulin deficiency causes increase glucose production in liver (gluconeogenesis and glycogenolysis) and reduced use of glucose in skeletal muscles. Hyperglycemia causes increase in diuresis (increase urine production) which reduces blood volume, which is exacerbated by reduced intake of water.

The blood glucose levels in hyperglycemic hyperosmolar state is very high (much more than diabetic ketoacidosis) at 600-1200 mgs per 100 ml (in diabetic ketoacidosis it is 250-600 mgs per 100 ml), osmolality is more than 350 mosmol per liter. Systemic acidosis is mild or absent.

Prompt treatment should be initiated to get the patient out of danger.

Diabetic Ketoacidosis: Laboratory Abnormalities

Diabetic ketoacidosis (DKA) is a serious medical emergency and prompt confirmed diagnosis is essential in the initiation of treatment to save the life of the patient.

Hyperglycemia, ketosis, and increased anion gap due to metabolic acidosis are the characteristic findings of diabetic ketoacidosis. Blood glucose is usually from 250 mgs to 600 mgs per 100 ml, but sometimes it may be only slightly elevated. The arterial blood pH is 6.8- 7.3 (normal blood pH is 7.42) depending on severity of acidosis (the severe the acidosis the lesser is the pH). Serum bicarbonate is generally less than 10 mmol per liter (due to excess use of bicarbonate in trying to neutralize the acids).

Serum potassium at presentation may be mildly elevated, despite a total-body potassium deficit, which is due to the acidosis. Sodium, chloride, phosphorous, and magnesium levels are reduced in diabetic ketoacidosis. But these are not reflected correctly due to dehydration and excess blood glucose. Blood urea nitrogen (BUN) and serum creatinine are elevated which suggest dehydration. But increase serum creatinine may be due to interference of aceto acetic acid.

Serum sodium concentration is reduced due to high blood sugar (for increase of each 100 mgs per 100 ml of glucose there is reduction of 1.6 mmol per liter of serum sodium). So, normal serum sodium at the beginning indicates a more severe dehydration.

Among the ketone bodies the β hydroxybutyrate is produced three times more than aceto acetic acid, but the conventional tests detect the aceto acetic acid. The normal tests for aceto acetic acid may give false positive results due to drugs like captopril or penicillamine. Serum or plasma assays for β-hydroxybutyrate more accurately reflect the true ketone body level.

Serum amylase level is elevated in DKA, which may mislead the diagnosis in favor of acute pancreatitis in presence of pain in abdomen. But in DKA the amylase is usually of salivary origin and thus is not diagnostic of pancreatitis (where amylase is of pancreatic origin). Serum lipase level should be tested if pancreatitis is suspected.

How Diabetic Ketoacidosis Develop

Diabetic ketoacidosis is a medical emergency and treatment  should be given promptly to save the life of the patient.

Diabetic ketoacidosis develop due to absolute or relative deficiency of insulin along with excess production of hormones which causes increase blood glucose level like glucagons, growth hormone, catecholamines and cortisol. Insulin deficiency along with glucagon excess is required to produce diabetic ketoacidosis. When insulin ratio falls in compare to glucagons it causes gluconeogenesis (production of glucose from non carbohydrate like protein and fat, and usually take place in liver), glycogenolysis (breakdown of glycogen to glucose and increase blood glucose) and increase formation of ketone bodies (which is responsible for the acidosis) in liver. The increase in glucagons and deficiency of insulin also cause delivery free fatty acids and amino acids from fat and muscle to the liver which in turn cause increase glucose production and rise in blood glucose level through gluconeogenesis.

Insulin deficiency and hyperglycemia reduces the hepatic level of fructose-2,6-phosphate. This in turn alters the activity of phosphofructokinase and fructose-1,6-bisphosphatase. Glucagon excess reduces the pyruvate kinase activity and insulin deficiency increases phosphoenolpyruvate carboxykinase activity. These causes pyruvate to synthesize glucose instead of glycolysis (breakdown or metabolism of glucose) in liver. Increase glucagon and catecholamines along with insulin deficiency promote glycogenolysis in liver and there is excess of glucose in blood. Insulin deficiency impairs glucose uptake into skeletal muscle and fat and reduces glucose metabolism.

Ketosis (excess ketone bodies which are acidic and cause acidosis) is due to increase Free Fatty Acid (FFA) release from fat cells and also due to increase synthesis of ketones in liver. Normally FFA are converted to triglycerides and VLDL (very low density lipoprotien) in liver, but due to insulin deficiency and excess growth hormone and cathecholamines there is increase in lypolysis (breakdown of fat to form free fatty acids) and release of FFA. Ketone bodies exist as ketoacids, which are neutralized by bicarbonate and as bicarbonate stores are depleted, metabolic acidosis develops.

Diabetic ketoacidosis develops as a result of inadequate plasma insulin. Diabetic ketoacidosis is seen in illness or infections when requirement of insulin increases. If insulin production does not increase as in type1 diabetes due to destruction of insulin secreting β cells of pancreas, diabetic ketoacidosis can be precipitated. This is the reason diabetic ketoacidosis is generally seen in type1 diabetes not in type2 diabetes (due to presence of insulin secreting β cells in pancreas).

Sometimes diabetic ketoacidosis is seen if patient forgets to take insulin injection and if short acting insulin preparations are used. With short acting preparations a brief interruption in insulin supply can cause severe insulin deficiency and precipitate diabetic ketoacidosis.

Chillies: The Red Hot Medicine

Chilli is one of the commonest of spices used in cooking specially in tropical countries. One in four humans worldwide consumes chillies daily. Chillies have many properties one of which is antibacterial property. Chillies add taste to the food and are integral part of food in many countries.

Chemical capsaicin is the reason why chillies are hot to taste. It is the main ingredient from chillies that is used in cooking. In one of the study Jennifer Billing, at Cornell University, scanned dozens of cookbooks and compiled a list of more than 4,500 recipes from across the world (36 countries) mainly meat-based cuisines. Then Billing and Paul Sherman, a professor of neurobiology and behavior at Cornell, analyzed temperature and rainfall patterns, anti bacterial properties of 43 spice plants in each of those countries. There was a distinct pattern on the map. The world has a hot zone (India, Thailand and Malaysia) a band on both side of the equator where temperatures are high and the food is spicy hot and non hot zone (Sweden, Finland and Norway) with the least spicy food.

The scientists found that spices were microbe killers. Garlic and onion were the most efficient in wiping out virtually all bacteria, followed by cinnamon, cumin and thyme that kill 80 per cent of bacteria. Capsicum and chillies eliminate about 75 per cent of bacteria. People who enjoy food with anti bacterial spices are healthier, especially in hot climates.

The chilli plants are attacked by a fungus named Fusarium and the plant protects them by producing more of capsaicin. It was found that the more capsaicin in the plant the better is the protection from Fusarium. The studies also showed that a high level of capsaicin is associated with lower seed mortality from fungal attack. The study also suggests that the capsaicin in chillies may have protected early humans from microbial infections.

So if you like chillies in food have lots of chillies and live a longer and healthier life.

Good Qualities of Pomegranate and Goji Berry

There are many fruits in nature which have many good qualities including some medicinal values and healing properties. Pomegranate and goji berry are two such fruits that has healing properties and medicinal value. Pomegranate is a shrub which can grow up to 5 meters tall and produce fruit bearing sprouts upon them. Pomegranate grows in very warm and humid climate. In the United States pomegranate plant grows naturally in gardens only in the state of California and in other states it is grown in greenhouse or artificial gardens.

Pomegranate is one of the first cultivated fruits known to men. It is documented in art and literature of olden times. Since olden days it was used for treatment of dysentery and worm infestation (tape worm). It is also used for treatment of certain bowel problems. Pomegranate has very high levels of vitamins, minerals and antioxidants and these qualities are used for fighting illness and disease. Pomegranate rind and roots are also used for various medicinal purposes. Medicinal properties of pomegranate can be traced back to thousands of years in traditional Chinese medicine where it was being used for treatment of infertility.

Goji berry (fruit) is used for its medicinal properties. Goji berry originated from China. Goji berry is used for treating cancer, skin pain, productivity troubles and reduced vision. Goji berry leaves can be used as antiseptic and used in wound healing by rubbing it on the wound. In many studies it is seen that Goji berry can increase longevity of life. Many people are using goji berry juice for longevity of their life and also making their married life better.