Tag Archives: Insulin

Not All Surgery

Shock was writ all over her face and her husband’s. “How can I have diabetes,” asked the young woman. “When I saw the result of the blood sugar test, I thought it was a mistake. No one in my family has diabetes!” Well, that may be true, but it is also a fact that 2 per cent of the Indian population has diabetes and 15 per cent of pregnant women have abnormal blood glucose values.

Despite the epidemic of diabetes in our young urban adults, statistics about the exact prevalence of the disease in pregnancy are difficult to obtain. Many pregnant women are not tested. In centres offering antenatal care, the presence or absence of “sugar” in the urine — an unreliable test at best — is used to diagnose diabetes.

Blood should be tested as part of routine antenatal care. A fasting glucose level of more than 126mg/dL or 7mmols/L in pregnancy is considered abnormal. A blood sample can also be drawn one hour after ingesting 50g of glucose. A normal value is less than 140mg/dL or 7.8mmols/L. If it is higher, it needs to be followed by a three-hour OGTT (oral glucose tolerance test) with a 100g glucose load. A positive diagnosis is made if the fasting value is 105mg/dl, the one-hour value 190 mg/dL, the two-hour value 165mg/dL and the three-hour value 145 mg/dL or more.

Some of the women with these values are diabetics who are asymptomatic and unaware of their condition. Others have relative insulin insufficiency, or MODY (maturity onset diabetes of the young), and are already on oral diabetic medications. Women with polycystic ovarian syndrome may be on the oral diabetic drug metformin. They may become overtly diabetic during pregnancy.

Others with abnormal blood sugar levels have gestational diabetes mellitus (GDM), a peculiar type of glucose intolerance which first appears during pregnancy in an otherwise normal woman. It can occur at any time during the pregnancy, though it is more likely to occur after 24 weeks. The exact reason for gestational diabetes is not known.

Women at risk are those who:-

* Have a family history of diabetes,

* Have a BMI (body mass index — that is, weight in kilogram divided by height in metre squared) of more than 30,

* Are older than 25,

* Have previously had large babies (more than 4kg) or still births.

The glucose in the mother’s blood crosses over via the placenta to the baby. The excess sugar supplied makes the baby grow rapidly. The baby’s pancreas starts to work overtime to lower the sugar to normal by secreting insulin. The excess calories are stored as fat. This gives rise to a large baby (macrosomia) weighing more than 4kg. This in itself increases mortality by 50 per cent. The size may cause the baby to get stuck in the birth canal. Forceful extraction can result in fractures of the collarbone or paralysis of the nerves to the arm. After birth, the baby’s pancreas continues to produce high levels of insulin as it is acclimatised to do so. This may cause the blood sugar levels in the baby to drop precipitously. The baby may then have seizures. In addition, it may develop other problems such as low blood levels of calcium and magnesium. Many babies also die (that is, are still born) while others (up to 50 per cent) may have breathing difficulties.

About 33 per cent may have polycythemia (excess blood) and 16 per cent develop jaundice at birth or soon after.

Mothers with GDM are also prone to develop other complications during the pregnancy such as hypertension. Almost 60 per cent of these women develop GDM in subsequent pregnancies, particularly if there has been maternal weight gain between the two pregnancies. Around 35 per cent will go on to develop diabetes in the next 15 years. The blood sugar in mothers with GDM should be well controlled to prevent complications in her as well as the baby. Diet regulation is needed to keep the sugars under control. Since not all women with GDM are obese, the diet has to be adjusted in accordance with the mother’s BMI. The diet should consist of 40 per cent carbohydrate, 20 per cent protein and 40 per cent fat.

Pregnant women do not really “have to eat for two”. The calorie requirements are

*35kcal/kg/ 24hour for a woman of normal weight (BMI 25).

* 24kcal/kg/ 24hour for overweight women (BMI 25-30).

* 12 to 15 kcal/kg/24hour for morbidly obese women (BMI 30-40).

* 40kcal/kg/24hour for underweight women (BMI less than 25).

A combination of diet control and aerobic exercise such as brisk walking for 45 minutes every day usually keeps the blood sugars normal. If the sugars remain high, insulin therapy may have to be started. Many of the oral diabetic medications cross the placenta and cause hypoglycaemia in the baby. Some of them are, however, used under supervision.

Unlike other forms of diabetes, which are permanent, GDM disappears after delivery. It, however, acts as a warning. Exercise for 45 minutes or more a day, reduce your weight and maintain your BMI at 23. That way, diabetes may not plague you in your later years.
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Source: The Telkegraph (Kolkata, India)

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A Grapefruit Pill to Fight Obesity

Tart and tangy with an underlying sweetness, grapefruit has a juiciness which rivals that of the ever popular orange and sparkles with many  of the same health promoting benefits.


And, now researchers are on track to develop a pill from a chemical compound in grapefruit, which they claim would help obese people shed the flab and diabetics control their blood sugar levels.

Researchers at University of Western Ontario have found that naringenin, the chemical compound that gives grapefruit its bitter taste, has revolutionary effect on the liver making it burn fat instead of storing it after a meal.

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According to them, this means that without having to change diets or cut out particular foods, a dose of naringenin could prevent weight gain and even help to lose it as well as help those having diabetes to control blood sugar levels.

Lead researcher Murray Huff said: “The study shows naringenin, through its insulin-like properties, corrects many of the metabolic disturbances linked to insulin resistance and represents a promising approach for metabolic syndrome.”

They have based their findings on an analysis of tests which were carried out on mice — two groups of rodents were both fed the equivalent of a Western diet to speed up their “metabolic syndrome”, the process leading to Type 2 diabetes.

Source:    The Times Of India

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Less Carbs Slow Prostate Tumour Growth

Cutting down on carbohydrates may slow prostate tumour growth, according to a study conducted on animals.

“Researchers believe that insulin and insulin-like growth factor contribute to the proliferation of

prostate cancer,” said Stephen Freedland, urologist at the Duke Prostate Centre and lead investigator on this study.

“Previous work here and elsewhere has shown that a diet light in carbohydrates could slow tumour growth. But the animals in those studies also lost weight and because we know that weight loss can restrict the amount of energy feeding tumours. We weren’t able to tell just how big an impact the pure carbohydrate restriction was having until now,” Freedland added.

Animals in the study were fed one of three diets: a very high fat/no carbohydrate diet, a low-fat/high carbohydrate diet and a high fat/moderate-carbohydrate diet, which is most similar to the diet most Americans eat, Freedland said.

They were then injected with prostate tumours at the same time.

“The mice that were fed a no-carbohydrate diet experienced a 40-50 percent prolonged survival over the other mice,” Freedland said.

Mice on the no-carbohydrate diet consumed more calories in order to keep body weights consistent with mice on the other study arms. “We found that carbohydrate restriction without energy restriction – or weight loss – does indeed result in tumour growth delay,” he said.

Patients are likely to be recruited by Duke and California (Los Angeles) Universities, for further clinical trials within a few weeks, said a Duke release.

Sources: The Times Of India

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Fructose Worse Than Glucose for Human Health

While too much sugar is bad for health, scientists have found that over-consumption fructose is more dangerous than that of glucose.

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YOU MAY CLICK TO SEE:->Fructose: Sweet, But Dangerous

Peter Havel and colleagues, at the University of California at Davis, Davis, conducted the 10-week study.

It was found that human consumption of fructose-sweetened but not glucose-sweetened beverages could adversely affect both sensitivity to the hormone insulin and how the body handles fats, creating medical conditions that increase susceptibility to heart attack and stroke.

In the study, overweight and obese individuals consumed glucose or fructose-sweetened beverages that provided 25% their energy requirements for 10 weeks.

During this period, individuals in both groups put on about the same amount of weight, but only those consuming fructose-sweetened beverages exhibited an increase in intra-abdominal fat.

In addition, only these individuals became less sensitive to the hormone insulin (which controls glucose levels in the blood) and showed signs of dyslipidemia (increased levels of fat-soluble molecules known as lipids in the blood).

The researcher said that although these are signs of the metabolic syndrome, which increases an individual’s risk of heart attack, the long-term affects of fructose over-consumption on susceptibility to heart attack remain unknown.

Sources: The Times Of India

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Pancreas Transplant

Region of pancreas

Image via Wikipedia

Alternative Names:Transplant – pancreas

Introduction:
A pancreas transplant is surgery to implant a healthy pancreas(one that can produce insulin) from a donor into a patient who usually has diabetes. Pancreas transplants give the patient a chance to become independent of insulin injections.
Because the pancreas is a vital organ, performing functions necessary in the digestion process, the recipient’s native pancreas is left in place, and the donated pancreas is attached in a different location. In the event of rejection of the new pancreas which would quickly cause life-threatening diabetes, the recipient could not survive without the native pancreas still in place.

The healthy pancreas comes from a donor who has just died or who has suffered brain-death, but remains on life-support. The donor pancreas must meet numerous criteria to make sure it is suitable.it may be a partial pancreas from a living donor. Whole pancreas transplants from living donors are not possible, again because the pancreas is a necessary organ for digestion. At present, pancreas transplants are usually performed in persons with insulin-dependent diabetes, who have severe complications that are usually of a renal nature. Patients with pancreatic cancer are not eligible for valuable pancreatic transplantations, since the condition has a very high mortality rate and the disease, being highly .

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In addition to insulin, the pancreas produces other secretions, such as digestive enzymes, which drain through the pancreatic duct into the duodenum. Therefore, a portion of the duodenum is removed with the donor pancreas. The healthy pancreas is transported in a cooled solution that preserves the organ for up to 20 hours.

The patient’s diseased pancreas is not removed during the operation. The donor pancreas is usually inserted in the right lower portion of the patient’s abdomen and attachments are made to the patient’s blood vessels. The donor duodenum is attached to the patient’s intestine or bladder to drain pancreatic secretions.

The operation is usually done at the same time as a kidney transplant in diabetic patients with kidney disease.

Why the Procedure is Performed?
A pancreas transplant may be recommended for people with pancreatic disease, especially if they have type 1 diabetes and poor kidney function.

Pancreas transplant surgery is not recommended for patients who have:

*Heart or lung disease
*Other life-threatening diseases
*Solitary pancreas transplant for diabetes, without simultaneous kidney transplant, remains controversial.

History
The first pancreas transplantation was performed in 1966 by the team of Dr. Kelly, Dr. Lillehei, Dr.Merkel, Dr.Idezuki Y, & Dr. Goetz, three years after the first kidney transplantation. A pancreas along with kidney and duodenum was transplanted into a 28-year-old woman and her blood sugar levels decreased immediately after transplantation, but eventually she died three months later from pulmonary embolism. In 1979 the first living-related partial pancreas transplantation was done.

Types:-
There are three main types of pancreas transplantation:

*Simultaneous pancreas-kidney transplant (SPK), when the pancreas and kidney are transplanted simultaneously from the same deceased donor.

*Pancreas-after-kidney transplant (PAK), when a cadaveric, or deceased, donor pancreas transplant is performed after a previous, and different, living or deceased donor kidney transplant.

*Pancreas transplant alone, for the patient with type 1 diabetes who usually has severe, frequent hypoglycemia, but adequate kidney function.

Indications:-
In most cases, pancreas transplantation is performed on individuals with type 1 diabetes with end-stage renal disease The majority of pancreas transplantations (>90%) are simultaneous pancreas-kidney transplantions.

Preservation until implantation:-
The donor’s blood in the pancreatic tissue will be replaced by an ice-cold organ storage solution, such as UW (Viaspan) or HTK until the allograft pancreatic tissue is implanted.

Complications & Risk Factors:-
Complications immediately after surgery include rejection, thrombosis, pancreatitis and infection.

The risks for any anesthesia are:

*Heart attack
*Reactions to medications
*Problems breathing

The risks for any surgery are:
*Bleeding
*Infection
*Scar formation

The body’s immune system considers the transplanted organ foreign, and fights it accordingly. Thus, to prevent rejection, organ transplant patients must take drugs (such as cyclosporine and corticosteroids) that suppress the immune response of the body. The disadvantage of these drugs is that they weaken the body’s natural defense against various infections.

Prognosis:-
The prognosis after pancreas transplantation is very good. Over the recent years, long-term success has improved and risks have decreased. One year after transplantation more than 95% of all patients are still alive and 80-85% of all pancreases are still functional. After transplantation patients need lifelong immunosuppression. Immunosuppression increases the risk for a number of different kinds of infection and cancer.

The main problem, as with other transplants, is graft rejection. Immunosuppressive drugs, which weaken your body’s ability to fight infections, must be taken indefinitely. Normal activities can resume as soon as you are strong enough, and after consulting with the doctor. It is possible to have children after a transplant.

The major problems with all organ transplants are:

*Finding a donor
*Preventing rejection
*Long-term immunosuppression

Recovery:
It usually takes about 3 weeks to recover. Move your legs often to reduce the risk of blood clots or deep vein thrombosis. The sutures or clips are removed about two to three weeks after surgery. Resume normal activity as soon as possible, after consulting with the physician. A diet will be prescribed.

Resources:
http://en.wikipedia.org/wiki/Pancreas_transplantation
http://www.nlm.nih.gov/medlineplus/ency/article/003007.htm

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