TRAVELS OF PEOPLE WITH DIABETES: TIME ZONES

June 3rd, 2010
Adjustment from home time to foreign time is complicated. If you are taking oral hypoglycaemicpills, work out the total dose of pills you take in twenty-four hours. Next consider the actual number of hours between breakfast on the day you leave home and the first breakfast in the country you are visiting. By breakfast, I mean the meal eaten on getting up in the morning, whatever it is called locally. If there are twenty-four hours or more between these two breakfasts take your total twenty-four hour dose of pills split at appropriate intervals. Do not take more than this, but wait until your first breakfast in your new country before you start taking your pills during the day as you would at home. If there are less than twenty-four hours between your breakfast at home and your first breakfast in your new country, take fewer pills. Thus, if there are twelve hours, take half your pills, eighteen hours, two-thirds of your pills and so on. You will need to use a bit of common sense to arrive at a practical division. Follow a similar process on the way home.
If you are taking insulin you can use the same calculation if you wish, but their type of insulin and its duration of action have to be considered. The main concern is not to have a hypoglycemic attack in some remote corner of a foreign airport. This is not a hypothetical worry. You are tired and the food on the aero-plane was indigestible; you may have had a couple of free drinks, you have lugged two suitcases, a shoulder bag, two carriers of duty free wine and a souvenir from Barcelona through endless miles of corridors; your next flight has just been delayed for four hours and the restaurant is shut. As always, check your blood glucose and do not care if anyone sees you.
How do you calculate your insulin? If you are on one injection of very long-acting insulin a day and two or more injections of rapid-acting insulin: Calculate the number of actual hours between breakfast at home and your first breakfast in the new country. If this is twenty-four hours or more, take your usual dose of very long-acting insulin; if less than this, take an appropriate proportion (for example, for twelve hours half the dose, twenty hours 80 per cent of the dose and so on). Take your usual short-acting insulin before breakfast at home and then check your blood glucose levels before each meal you have until the first breakfast. If they are 7 mmol/1 or more (126 mg/dl) take 2 to 4 units of rapid-acting insulin to cover each meal. If they are below 4 mmol/1 (72 mg/dl), eat a bigger meal and start it with some fast-acting carbohydrate. Before breakfast in the new country have your usual insulin and continue this, with frequent blood glucose measurements and adjustments as necessary, until you come home. Then follow a similar process when you arrive home.
If you are on two injections of medium-acting or long-acting insulin with short-acting insulin a day: twenty-four hours or more between your home breakfast and your next breakfast, take your usual insulin before breakfast at home and twelve hours later (or at the meal nearest to twelve hours later) take your ‘evening’ dose. It may be wise to reduce each dose by a small proportion, for example, 10 per cent, to make sure that you do not go hypoglycemic. Then have your usual insulin before the next breakfast as above.
Less than twenty-four hours between the two breakfasts, take your usual insulin before breakfast at home (reduced a little if you wish). Then take no more long-acting or medium-acting insulin until the next breakfast. Check your blood glucose level before each main meal and give 2 to 4 units of insulin if it is 7 mmol/1 or more. Have your usual medium-acting or long-acting insulin before your first breakfast in the new country. Reverse the process for your return trip.
This advice can be modified by your personal experience. If you make regular trips across a particular time zone, you should be able to work out your best insulin dose from experience. What I have suggested may cause you to run your blood glucose level a little high for the first few days, but that is better than going hypoglycemic in a strange country.
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DIABETES
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TRAVELS OF PEOPLE WITH DIABETES: BUS, RAIL, SEA AND AIR

June 3rd, 2010
Travel by bus or rail
The main problem with bus journeys is keeping comfortable. Otherwise, once you have got on to a bus all you have to do is sit down until you reach your destination. Not all buses have lavatories so it is a good idea to make sure your blood glucose is below your renal threshold during the journey. You will, of course need your diabetes travel pack.
Most trains in the developed countries have lavatories but there may be none in Third World countries. Again you will need to make sure your blood glucose is below your renal threshold. If you are travelling in an out of the way place, you will also need a far larger food and fluid reserve, and should plan your trip more as I described for mountain expeditions.
Travel by sea
If you know you are a bad sailor, take a motion sickness pill before you step on board ship and keep taking them at the interval stated on the package until you are safely on dry land again. These pills, of which a range is available from pharmacies, drugstores or doctors, will not upset your diabetes, but sea sickness might. The pills may make you drowsy, though, and so you should not take them if, for example, you are planning to drive your car off the ferry.
What should you do if sea sickness strikes? Try to find somewhere to he down with some fresh air. Ask a steward for a motion sickness pill if you do not have any. Check your blood glucose level every couple of hours and suck some glucose tablets or have a glucose drink such as Lucozade if it is low. Take a few units of rapid-acting insulin every four hours if your blood glucose level is high. This is unlikely because motion sickness is not usually related to a generalized infection, like gastroenteritis, and so there is no increase in insulin resistance. Your glucose level will tend to go down in most cases. You may feel as if you want to die while you are sea sick, but you will recover quickly when you are back on land.
Travel by air
Air travel has several special problems for the person with insulin-treated (and, to some extent, the non-insulin-treated) diabetes:
1.   You are at the mercy of the airline and their timetable
2.   Your luggage is restricted
3.   You are more likely to have trouble with customs checks
4.   You may travel rapidly through time zones.
Unpredictability
The first problem is simply that of the unpredictability of air travel. Your diabetes travel pack and extra food should see you through this, and besides you will usually be able to buy food and drink at the airport. Your main luggage will be taken from you and put in the hold, where it may be frozen in flight. You must, therefore, have all your insulin with you inside the passenger compartment as it is destroyed by freezing. You must keep your diabetes travel pack with you.
Customs
Customs officers and airline officials using x-ray scanners frequently stop people with diabetes because syringes and needles show up on their screens. This is why you need your diabetic card and an explanation of it in the language of the country you are visiting. There should be no problem, once you have explained the situation, so do not get angry or upset.
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DIABETES
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YOUR CHILD’S HEALTH/ASTHMA: OTHER FORMS OF MANAGEMENT

May 21st, 2009

Drugs form the mainstay of the modern treatment of asthma. Most other forms of treatment are unproven and have a limited place, if any, in the treatment of asthma in children. While allergens probably have a role in the triggering of asthma attacks, there is very little evidence that desensitisation (a series of injections designed to make the child less allergic to certain substances) makes any difference either to the frequency or the severity of attacks. Physiotherapy may occasionally have a role to play for some children with asthma, but generally the child is better off participating in regular exercise and sporting activities.

Consideration should be given to factors which may trigger attacks of asthma. Cigarette smoke should be avoided. Exposure to animals that cause symptoms (often household pets) should be minimised or avoided, and the child may be better with non-allergenic bedding if he is affected by goose-down or feathers. In some selected cases, carpets may need to be removed to minimise dust, but this is not usually necessary.

These measures should be balanced with the need to minimise drastic changes to the child’s and family’s living conditions. Change in environment of any significant degree may not be indicated in children with mild or minimal symptoms.

Some of these precipitating factors can and should be avoided. However, most trigger factors cannot be identified, let alone avoided. This means that the mainstay of management of asthma is pharmacological — the appropriate use of medications to prevent and treat symptoms.

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SEXUALITY, ILLNESS, AND HEALTH: ALCOHOLISM AND SEX – OUR SOCIETY’S EMPHASIS ON THE DRINKING/ SEXUALITY CONNECTION IS STRONG

May 19th, 2009

We must recognize that our society’s emphasis on the drinking/ sexuality connection is strong. “A few drinks and I can really get it on,” was one wife’s report. She means that she experiences sufficient anxiety and insecurity that a chemical is needed to facilitate sexual interaction. The natural chemicals from our own brains are available to us if we will learn to relax, to share, to give a priority to intimacy so that we do not need “quick drugs” to depress us just enough that we can have sex. There is no human activity that is helped by drinking, and if you doubt that, you may be taking very early steps toward a drinking problem yourself. Drinking is ingesting small doses of a toxic substance that affects our nutrition, judgment, speech, perception, coordination, and ability to be truly intimate. It is one of our society’s most serious problems, and the emphasis on the war against drugs should include alcohol as one of the major enemies.

During the treatment program for the couples, all alcohol was prohibited. Every one of the couples found that sex improved once

they were free of their “habit.” Our brains are preprogrammed to “get high,” but our own bodies and brains provide the natural internal chemicals for that high. We seem to have a natural reflex, a joy response, and this joy response is blocked by alcohol, not enhanced by it. The couples found an immediate improvement in communication without alcohol, although at first some couples were awkward, actually in a type of mutual withdrawal state.

“It was like a first date. We just always used to have a drink or two before sex. It was kind of frightening at first, but we really rediscovered each other.” This wife spoke for other spouses who at first resisted the sanction against drinking and then learned what it was like to respond drug-free in a sexual relationship.

If you have a drinking problem, even if you suspect one, get help now. You will not be able to stop alone later, and the earlier you get the help, the less suffering for all concerned. If you are drinking to change how you feel, you have a drinking problem. If you are fighting this issue as you read this material, you probably have a problem with alcohol.

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YOUR MARILAL HEALTH/THE SUPER SEX RESPONSE MODEL: AFTERGLOW

May 18th, 2009

The old term for this phase was resolution. One wife referred to it as “restitution.” Prior sexual perspectives saw this phase as essentially a complete reversal of the whole process of the sexual response. Masters and Johnson saw this as “phase-specific ,” a retreat of all prior physiological changes occurring only at the end of the cycle.

The thousand couples did not substantiate this phase. Sometimes the “sex flush,” the reddening of the skin in the facial cheeks and upper chest, would go away quickly and sometimes it would linger on. Instead of a feeling of settling down, some spouses reported a “glowing,” almost a “suspension in time” preceding a readiness for another experience. If we expect “resolution,” a resolving of all of this energy buildup that was talked about so much in the first perspectives, we will probably experience it. If we expect to

“glow,” to enjoy, to share, following a physical or psychological orgasm or at any time in our interaction, then we will be free to do so.

“I never thought of sharing too much after we came. It was a whole new thing. We would lie together and glow. It was like E.T., but the light was not just a heart light. It was all over. We learned to really enjoy this period instead of lying there waiting for it to pass so we could go to sleep,” reported one of the husbands at five-year follow-up. His comments illustrate the importance of not being “phase-specific,” of turning in instead of out for our sexual reference points. Enjoying the full-body response of our partner during intimate relationships does not have to be-preparatory; it can happen at any time.

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THE JOY OF PERFECT HEALTH: HOW WE DEVELOP DISEASES

May 18th, 2009

So we have a perfect body, capable of automatic self-repair, without even bothering us with any mundane details of its repair jobs. A program embedded in our DNA and the subconscious mind, developed through billions of years of existence of various lifeforms, automatically manages all repairs to optimise our comfort and performance.

However, there is one very important condition.

As we noticed from the example in the previous chapter, the repair is carried out perfectly and effortlessly, only when the extent of the damage to the body is limited

Let us try to explore the limits to the extent of such damage.

The key question is this :

How much abuse can our body withstand, before it fails to function perfectly ?

It is quite difficult to answer this question without additional information and analysis.

Let us start by examining the ways by which we could possibly abuse our mind-body system during our life. A short list of possible means of abuse is presented below. 1 poisoning.

2. Wrong diet.

3. Overeating.

4. Not enough sleep or rest

5. Accumulation of stress and anxiety

6. Bad hygiene

7. Excessive physical activity

8. Exposure to radiation

9. Exposure to noise

10. Exposure to dust

Note, that in many cases, our limited knowledge does not allow us to predict the extend of the damage and therefore we could easily underestimate the consequences of our actions.

In some cases we can be aware, that we are abusing our body, and I would like to exclude such cases from further consideration. Simply speaking, we should be prepared for facing the consequences of any such abuse, whatever their extent might be.

It is the abuse, which we are not aware of, which is actually the most important. The main reason for such importance is the fact, that without our knowledge and consent such abuse can continue over one’s lifetime. This especially applies to situations, when there is a significant delay in symptoms. As a result we could face problems, without ever realising the reason for them.

Some of the means of abuse listed above are sporadic, while others continue over an entire lifetime. Simple logic dictates that the latter should deserve our special attention, because their source is basically in our ignorance and/or misinformation.

Now, let us go back to our list of possible means of abuse and examine in which areas our ignorance (or pride that we know best) could lead to slow, but more or less continuous damage to our body without our consent.

With respect to radiation the situation is different. We have to use scientific instruments to assess the danger. Japanese had to use Geiger counters to examine their food after World War 2. I have not heard about anyone opposing the view that we should avoid radiation as much as possible, so I will not dispute this either.

The first three items on the list of means of abuse should deserve our special attention.

1.    Poisoning.

2.    Wrong diet.

3.    Overeating.

All three are not clear and objective: it is not clear what exactly is a “poison”, it is questionable just what represents a “wrong” diet and just how much food is actually too much.

As a result, all three forms of abuse may co-exist over an entire lifetime, only because we are misinformed.

Notice, that all three relate closely to our diet (food and beverage consumption).

With regard to exposure to dust and noise, excessive physical activity, bad hygiene, stress and lack of sleep, our conscious mind is notified almost immediately – we feel uncomfortable. It is therefore our responsibility to avoid continuing and repeating such experiences.

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LAW AND MEDICINE – MALPRACTICE SUITS AGAINST DOCTORS

May 15th, 2009

This would appear not to be so in the U.S., where malpractice suits against doctors have reached epidemic proportions, and where judgments of more than $1 million are given against doctors quite frequently.

To protect himself under these circumstances, the doctor has to take out adequate insurance, and in many states in the U.S. the cost of such insurance has become prohibitive, amounting in some instances to a third of the doctor’s income.

Some lawyers specialise in malpractice suits, agreeing to take a specified percentage of any amount awarded.

In losing cases the fee is either very small or non-existent.

It is now reported that many doctors have decided to cope with this problem by not insuring at all and prominently advertising that fact.

Should a patient wish to sue, he has to obtain his judgement from the personal assets of the doctor, which may not be great and not worth the effort of a civil action.

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BETA BLOCKERS – INTRODUCTION

May 15th, 2009

The lifespan of any drug in modern medicine is short.

What seems like a miracle drug soon becomes “old hat” as others with claims of fewer side-effects come on the market.

One group maintaining their usefulness are the beta blockers, the term applied to those drugs with wide-ranging effects on the body and for which new uses keep appearing.

To understand how these drugs work, it is necessary to have some knowledge of the body’s autonomic nervous system.

This is what governs those functions of our bodies which are not under voluntary control. Our heart beats, we breathe, digest and absorb our food and our kidneys eliminate waste products, all independently of our wills.

These actions are under the control of the autonomic nervous system. The sympathetic part of this system, when stimulated, is what makes us get up and go.

The heart beats faster, the blood pressure rises, the breathing becomes deeper and digestion ceases.

The actions of the parasympathetic part of the autonomic nervous system are usually the reverse of those of the sympathetic.

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DIAGNOSTIC PROCEDURES FOR DETECTING ENDOMETRIOSIS: ULTRASOUND

May 8th, 2009

Nature provided the whale and the bat with the miracle of an innate sonar system. Scientists studied the process, pretty much duplicating it for its original technological intent—wartime vigilance. During world War II, navy submarines negotiated their way through deepest waters using sonar to detect the location of enemy vessels unseen by peritcopic sighting.

Sonar is the simple process of bouncing high-frequency acoustical vibrations off solid masses. The waves then bounce back in echo patterns that appear as a picture on a specially devised screen. Sonar is the mother of sonography, or ultrasonography, known familiarly as ultrasound—a relatively new and popular diagnostic technique, gaining ever increasing acceptance for confirmation of pelvic abnormalities. It is a convenient way to diagnose both pelvic masses and fetal size (sometimes, too, the sex of the unborn child) during pregnancy. Doctors are choosing sonography over X rays for a variety of diagnoses, especially since ultrasound is completely harmless to the body.

When these high-frequency sounds are projected into the body, the reflected “echo” on the screen indicates the size and location of a tumor. Doctors can freeze the picture of a growth on the screen and measure it. The technique is especially useful in locating uterine fibroids and ovarian cysts, although occasionally, there is difficulty in sonographic diagnosis in defining the precise location of a tumor—is it growing on the side of the uterus or on the ovary? Since ovarian tumors are a more serious matter than uterine masses, laparoscopy might be necessary if sonography proves ineffective as a confirming diagnostic tool.

As with laparoscopy, sonography facilitates an accurate diagnosis when pelvic organs are lifted from view. The “lifting” here is done not with gas, but with water. That is, women prepare for ultrasound testing before coming to the doctor’s office by drinking six to eight glasses of water, thus filling their bladders. The amply filled bladder moves organs up just enough so that the doctor can see the uterus and ovaries more clearly. A practiced ultrasonographer can usually detect a cyst and identify its type (and its contents) by the echo pattern on the screen and determine if the cyst is endometriotic in nature.

Ultrasound has its benefits, but in my opinion, this technique cannot pick up endometriosis in its early stages, when many women really need help in managing the disease and when it is most adroitly treated.

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SKIN CARE: TUBERCULOSIS OF THE SKIN

May 8th, 2009

This used to be a very common and disfiguring disease in western countries. It still occurs in some underdeveloped countries and atypical forms still appear in western communities. The declining incidence may be largely attributed to better hygiene, less malnutrition, improving living standards, elimination of infected milk herds, and BCG vaccinations.

The disease is caused by the bacillus Mycobacterium tuberculosis. It affects other animals as well as man, and may occur in most organs of the body, particularly the lungs. The type of skin infection depends on the person’s resistance to the germ. When a person with good immunity is infected, the host resistance may be sufficient to confine the infection to fairly localized nodules. If immunity is less effective in localizing the infection, multiple chronic nodules will appear.

There are various forms of tuberculosis. One of these, warty tuberculosis, may begin as a lump, nodule or pustule, which becomes warty. There are no associated enlarged lymph glands, and spontaneous healing of the disease usually occurs.

Another form, primary inoculation tuberculosis, typically takes the form of a raised red lump or ulcer, with associated enlargement of the nearby lymph glands. This may spontaneously heal or may proceed to Lupus vulgaris, the chronic progressive form of tuberculosis.

Lupus vulgaris is the commonest tuberculosis of the skin, and is the chronic progressive form. It usually begins as a brown mark on the face, which becomes lumpy and translucent. It progresses slowly, with resultant scarring and ulceration, leading to severe mutilation. The name lupus’ (Latin for ‘wolf’) is a reference to the wolf-like ugly appearance of the advanced, and fortunately rare, case.

Other rarer forms of skin tuberculosis also exist. The treatment of all forms is as for tuberculosis elsewhere, together with plastic surgery where necessary. The drugs most frequently used are Isoniazid, Paraminosalicylic acid and Streptomycin, either singly or in combination. In certain cases Rifampidn may be used. Treatment is for two to three months. Plastic surgery may be necessary for the rehabilitation of those with disfiguring scarring.

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