DIABETES MELLITUS-OBESITY-STROKE

DIABETES MELLITUS

Diabetes mellitus (DM) is coming up as one of the commonest diseases in the society. This is partly because people are getting more food and due to the fact that high carbohydrate diet is fast becoming part of our daily diet. Foods like cold drinks, juices, cakes, sweets, jams and jellies are responsible for this increase in this disease of the pancreas. The pancreas is almost completely destroyed by the time patient has symptoms in the insulin dependant diabetes mellitus (IDDM). In the other type called non-insulin dependant diabetes (NIDDM) usually the patient is obese (fat).
Symptoms and Signs: In both the symptoms and signs are almost the same. Patient has excessive thirst (polydipsia), excessive urination (polyuria), with a normal or increased appetite. Even then patient has loss of weight as he loses sugar in his urine. Also patient is susceptible to infections like urinary tract infections, recurrent boils, delay in healing of the wounds etc. As DM continues to be uncontrolled for a long time patient develops acute or chronic complications. The chronic complications involve almost all systems of the body. Thus patient has damage to the nerves (neuropathy) which leads to weakness of hands and legs with impaired sensations, impotence etc. When the eyes are affected it produces cataracts, decrease in vision, or later blindness (retinopathy). Involvement of the kidneys (nephropathy) leads to proteinuria, and later kidney failure.
Diagnosis is clinical and by laboratory tests. Blood is tested for sugar in a fasting as well as after food. Urine is also tested for sugar. High blood sugar and sugar in urine help in confirming the diagnosis. For Fasting Blood Sugar (FBS) patient should be fasting for a period of 12-14 hours. In addition protein in urine, level of cholesterol in blood, the kidney function tests, the liver function tests, an ECG and an eye consultation is a must for all new cases of DM.
Course of the disease: DM is a chronic disease which means that patient is almost with the disease throughout his or her life. Thus I recommend that patient should try to understand DM as much as possible. This will help him or her to make DM a slave rather the master.
Treatment: Lifestyle modification, weight reduction to a Body Mass Index of lower limit of normal, regular exercises, is a must. Whether patient needs Insulin or Oral Tablets for DM is best decided by the doctor.
Advise: Know what is hypoglycemia and its treatment.


OVERWEIGHT AND OBESITY

Every extra morsel of food eaten is as if you dig your own grave with your teeth (Moroccan proverb).
Overweight and obesity means patients weight is more than normal. Ideal weight is calculated as per a persons height and weight. The result is called Body Mass Index (BMI). Normal BMI is from 21-25. Overweight is a person whose BMI is 26-29. BMI of 30 or more is obesity. More and more children and adolescents are seen these days with obesity. Lack of outdoor games, getting glued to TV or computer, eating fast foods, and cold drinks are some of the causes. Same is true of adults especially Kashmiri females more than forty. This is certainly harmful to the heart, lungs, knees, back, etc. Many develop diabetes mellitus and hypertension.
Symptoms and Signs: Morbid obesity can come with hypertension, diabetes, osteoarthritis of the knees, low backache, and heart disease.
Diagnosis: Measurement of height, weight and calculation of BMI is a must. Patients should be told about their ideal weight and if obese should be advised to attain that. Battery of tests are needed to know the cause of obesity and its possible complications.
Course of the disease: As mentioned obesity leads to many systemic disorders. Unless corrected it continues to be a risk factor for these illnesses.
Treatment: Walking, rather brisk walking is the best exercise. Make it a habit to walk for at least half an hour daily. Be content and eat less. Depression leads to overeating. Hence avoid it. Fat rich diets are carcinogenic too, hence avoid these. Weight reduction is a challenge to the physician and proper guidance and encouragement to obese patient is a must. Hence do not live to eat but eat to live.
Advise: Know how much you should weigh. Get a check up if you are fat.

STROKE
What is a stroke?
A stroke happens when there is a problem with the blood supply to a part of the brain. The area of the brain that does not get enough blood becomes damaged. A stroke can happen when a blood clot blocks an artery in the brain. A stroke also can happen when the wall of an artery bursts. Depending on which part of the brain has poor blood supply, a stroke can be mild to severe. Here are some problems strokes can cause
1. Problems with moving (including paralysis)
2. Problems with feeling
3. Loss of vision
4. Problems with thinking, understanding, or communicating (that is, problems with speaking, reading, or writing)
5. Changes in emotion or behavior
What increases my risk of having a stroke?
Strokes can happen in anyone, but they tend to be more common in older men, black people, and Asian people. Although we cannot change our age, gender, or race, we can control the following risk factors for stroke
1. Tobacco use
2. High cholesterol levels
3. Inactive lifestyle
4. High blood pressure
5. Diabetes
6. Heavy alcohol use
7. Atrial fibrillation, which is an unsteady heart rhythm (say: ay-tree-all fib-rill-ay-shun)
What can I do to lower my risk of having a stroke?
Here are some things everyone can do to lower their chances of having a stroke--these things will also lower your risk of having a heart attack. Get your blood pressure checked regularly and get treatment if it is high. High blood pressure is a silent illness with no warning signs.
If you smoke--stop! Ask your family doctor for ways to help you quit.
Eat low-fat foods, and have your cholesterol levels checked by your family doctor.
Exercise regularly--for at least 30 minutes on most days of the week.
Keep your weight under control. If you are overweight, lose weight.
If you have diabetes, control your blood sugar levels. Controlling your diabetes will help your heart, kidneys, eyes, and brain.
Can medicine help lower my risk of stroke?
Medicines can help prevent strokes in some people. If you need one of these medicines, your family doctor will prescribe it for you. If you have high blood pressure, and diet, exercise, and weight loss do not control it, you may need to take medicine to lower your blood pressure. Lowering blood pressure in people who have hypertension is the most important way to prevent stroke. If your cholesterol level is high and exercise and diet do not lower it, you may need to take a cholesterol-lowering medicine. If you have atrial fibrillation, you may need to take a blood thinner such as warfarin (brand name: Coumadin). Aspirin can lower the risk of stroke in some people. However, aspirin is not for everyone. There are risks associated with taking aspirin every day.