Managing Diabetes In The Elderly Patients

managing diabetes in elderly patientsAs the medical care is advancing and the life expectancy is increasing there are now more people who are now elderly and are patients of type 2 diabetes mellitus. Although the pharmacological treatment options are almost the same for the older patients as those in the younger adults but the elderly need some specific care and management if they have diabetes. Also it is important to take note of the fact that diabetes is not the only disease that may be affecting the patient because elderly people above the age of 70 have more than one chronic diseases that are present at the same time.

The overall goal of management of diabetes in the elderly patients includes maintaining optimal glycemic control as well as managing the associated risk factors due to advanced age.

1. Educating about the disease: Studies have shown that patients who know their diseases well are able to manage it more properly than those who are not educated about the disease. This is especially very important in case of diabetes. Elderly patients may not be able to remember properly about their drugs and doses or may forget about the nutritional care. It is important to educate them as well as their primary care givers.

2. Preventing and Recognizing  Hypoglycemia: The risk of hypoglycemia is much more in the older adults and the symptoms may be missed or confused and so the hypoglycemic episodes are not properly reported in the elderly patients. Even a mild hypoglycemia that caused dizziness may lead do major problems like a fall and resulting fracture that is very difficult to heal due to the age factor. Thus it is important to take care and prevent hypoglycemia to occur at the first place.

3. Care for Proper Nutrition: Senior patients with diabetes should always be helped by a proper dietitian for the nutrition care. They should be advised to take protein rich food as protein slows sugar absorption.

4. Choosing the Medications: It is important to consider different factors like weight, mobility, kidney function, risk of hypoglycemia, and other co-morbidity before prescribing a medication to an elderly diabetic patient.

  • Metformin may be the initial therapy for patients who do not have a renal impairment or severe heart failure.
  • A short acting sulfonylurea like glipizide may be used for patients who have contraindication for metformin.
  • Repaglinide a drug distinct from sulfonylureas maybe used in patients who are allergic to sulfonyureas and also it has possibly a lower risk of hypoglycemia.
  • Insulin is usually avoided to be used in older patients but sometimes if required a long acting insulin with one or two daily doses can be used after proper assessment and explanation to the care giver.

5. Monitoring Of Blood Glucose: Monitoring is necessary to achieve glycemic controls and prevent the complications. It is usually advised to monitor HbA1c levels twice in a year for elderly patients who are meeting the treatment goals and are stable.  Blood glucose concentrations can also be checked regularly at home by the patient or the care giver.  Continue reading “Managing Diabetes In The Elderly Patients”

ECG Findings In Different Types Of Heart Block.

heart block ECGHeart Block is an abnormality in the electrical rhythm of the heart and it occurs when the electrical signals that moves through the heart are slowed or disrupted. There are different types of heart blocks that are mostly diagnosed by the finding on the ECG.

Normal Electrical Activity Of the Heart:

A normal heartbeat is initiated when the heart’s natural pacemaker in the sino-atrial node located at the top of the right atrium creates the electrical signal which then travel through the atrium and reaches the atrio-ventricular node. After crossing the AV node these signals pass through the bundle of His. This bundle then divides into thin structures called as bundle branches which then extend into the right and the left ventricles. Through these bundle branches the signals finally reach within the muscle cells of the ventricles causing them to contract. In this way the ventricular muscles contracts as a whole and pumps the blood to the body. If this normal electrical passage is interrupted anywhere it leads to a condition known as heart block.

1. First Degree Heart Block:

In the first degree heart block the electrical impulses are slowed as they move from the atria to the ventricles, but they all reach successfully to the ventricles. This condition rarely causes any symptoms and usually do not require any treatment. On ECG patients with a first degree heart block will have a longer , flatter line between the P and the R wave. In other words the PR interval is prolonged.

2. Second Degree Mobitz type I:

In this type of heart block the electrical impulses are gradually delayed more and more with each heart beat until an impulse fails to reach the ventricles entirely resulting in a skipped beat. This condition sometimes may cause dizziness and usually does not require treatment. On ECG patients with Second degree Mobitz type I heart block shows a characteristic gradual prolongation of the PR interval until a dropped beat with an absent QRS complex.

3. Second Degree Mobitz type II:

In this type of heart block some of the electrical impulses don’t reach the ventricles but the pattern is less regular as compared to Mobitz type I. This condition is less common but more serious than Mobitz type I and may need a pace maker as it may progress into a third degree complete block. On ECG patients with this condition shows QRS wave follows the P wave at a normal speed but some of the QRS waves are missing that indicates a block.  Continue reading “ECG Findings In Different Types Of Heart Block.”

Post traumatic Stress Disorder

Post traumatic Stress DisorderDefinition:  Post traumatic stress disorder may be defined as a mental health condition that follows a traumatic or a terrifying experience in life. It is characterized by feelings of stress and being frightened even though they are no longer in a danger situation.

Many people who go through a traumatic event have a difficulty adjusting and coping with normal life for a while but they do not necessarily have post traumatic stress disorder. If the symptoms get worse, may last for months or years and interfere with normal functioning then it is an illness known as post traumatic stress disorder (PTSD)

Physiology Behind PTSD: When a person is in danger or is experiencing a traumatic event like death of a loved one it is natural to feel afraid and stressed out. This fear triggers changes in the body that can help oneself to defend or avoid the danger situation. This ‘fight or flight’ response is a normal healthy physiological response of the human body but in PTSD this response gets changed or damaged. The person with PTSD may have suffered a harm to oneself or have seen a harm done to a loved one or even strangers but now when he/she is no more in the danger situation still they have feelings of being stressed and frightened.

How Was This Condition known in Medical Science: PTSD was first brought in and discovered in relation to the condition of war veterans who have been in the war or in a prison and then could not recover the feelings of fright and stress they have been through. Now it is known that it can occur following a variety of traumatic events like mugging, rape, torture, kidnapping, car accidents, bombings, plane crashes, earthquakes etc.

Signs And Symptoms: A patient suffering from a post traumatic stress disorder may experience:

  •  Flash backs of the event again and again
  • Physical symptoms of racing heart and sweating with the flash backs.
  • Nightmare and upsetting dreams
  • Severe emotional distress.
  • Frightening thoughts
  • Staying away from places or persons that may remind of that event.
  • Feelings of strong guilt and depression
  • Inability to have positive feelings.
  • Trouble sleeping
  • Always being on guard for a coming danger
  • Easily startled.

Continue reading “Post traumatic Stress Disorder”

Acetaminophen- A Brief Introduction

acetaminophenWhat Is Acetaminophen?

A widely used medicine that almost every one knows also known as Paracetamol or Tylenol. It is a pain reliever and fever reducer. It is classified as a mild analgesic drug.

Medical Uses:

Acetaminophen is commonly used for a wide variety of conditions like :

  • Headaches
  • Backache
  • Muscle ache
  • Toothache
  • Arthritis
  • Common cold
  • Fever
  • Pain due to menstrual periods
  • Prevention of pain and fever in reaction to vaccinations. etc

How To Use It ?

Acetaminophen comes in the form of tablets, chewable tablets, solution, suspension, suppositories and is available easily over the counter without a need for prescription. While giving it to children it is important to calculate the dose according to the weight of the child. The usual dose for an average adult is 500 mg every 8 hrs but it may vary depending on the condition for it is prescribed. It is also available in various combinations like used for severe pain or post surgical pain in combination with opioid analgesics or in combination with an antihistamine for symptoms of cold and fever.

Mechanism Of Action:

The exact mechanism of action is not known but it is believed that acetaminophen works by inhibition of cyclooxygenase. Pharmacologically it is classified as a centrally acting antipyretic and analgesic drug. Some studies also show that the analgesic effect of acetaminophen is due to increased threshold of pain.

Side Effects: Although considered a safe drug like any other medicine it can have certain side effects like:

  • Allergic reactions like skin rash, itching, or difficulty breathing if severe.
  • Liver damage
  • Nausea, vomiting may indicate an over dose.

Over Dose Or Toxicity:

Since it is an easily available drug overdose is common either intentionally or accidentally. Continue reading “Acetaminophen- A Brief Introduction”

Raynaud’s disease

raynauds_diseaseOne of several primary arteriospastic disorders, Raynaud’s disease is characterized by episodic vasospasm in the small peripheral arteries and arterioles, precipitated by exposure to cold or stress. This condition occurs bilaterally and usually affects the hands or, less often, the feet.
Raynaud’s disease is most prevalent in women, particularly between puberty and age 40. A benign condition, it requires no specific treatment and has no serious aftereffects.
Raynaud’s phenomenon, however, a condition often associated with several connective tissue disorders—such as scleroderma, systemic lupus erythematosus, and polymyositis—has a progressive course, leading to ischemia, gangrene, and amputation. Differentiating the two disorders is difficult because some patients who experience mild symptoms of Raynaud’s disease for several years may later develop overt connective tissue disease—most commonly, scleroderma.
Causes
Although the cause is unknown, several theories account for the reduced digital blood flow: intrinsic vascular wall hyperactivity to cold, increased vasomotor tone resulting from sympathetic stimulation, and antigen-antibody immune response (the most probable theory, because abnormal immunologic test results accompany Raynaud’s phenomenon).
Signs and symptoms
After exposure to cold or stress, the skin on the fingers typically blanches, then becomes cyanotic before changing to red and before changing from cold to normal temperature. Numbness and Continue reading “Raynaud’s disease”

Brief Summary Of Benzodiazepines

benzodiazepinesIntroduction:

Benzodiazepines are a class of drugs also know as tranquilizers that acts on the central nervous system and are mainly used to treat different anxiety disorders.

Mechanism of action:

Although the exact mechanism of action is not known these drugs effect the GABA neurotransmitter in the brain. The response to this inhibitory neurotransmitter is enhanced and thus it becomes resistant to excitation.

Common Drugs In this Group:

All benzodiazepines are similar in pharmacological action but have different potencies, and some bezodiazepines work better in the treatment of certain conditions than the other. They are used mainly as sedatives, hypnotics, muscle relaxants, anxiolytics and anticonvulsants. Common drugs in this group include:

  • Alpralzolam
  • Lorazepam
  • Midazolam
  • Bromazepam
  • Diazepam  etc

Medical Uses: Benzodiazepines may be prescribed for one of these conditions:

  • Anxiety
  • Insomnia
  • Alcohol Withdrawal
  • Seizures
  • Depression
  • Sedation prior to surgery or any diagnostic procedure
  • Panic disorders
  • Muscle spasms

Side Effects: The common side effects may include:

  • Drowsiness
  • Dizziness
  • Decreased alertness and concentration
  • Confusion
  • Memory impairment
  • Improper body balance
  • Nausea and vomiting
  • Weight gain
  • Dry mouth
  • Fatigue

Continue reading “Brief Summary Of Benzodiazepines”

Sleep Disorders

sleep-disordersIntroduction: 

Sleep disorders may be defined as any condition that prevents a person from getting a restful sleep. Good sleep is necessary for optimal health and normal functioning of the human body. Some sleep disorders may be serious enough to impair the physical and mental functioning of the person.

Normal Sleep:

Before different sleep disorders are summarized here it is important to know what is the normal sleep pattern. The amount of sleep a person requires depends on many factors like age, gender, pregnancy etc

  • Infants require 14-15 hrs of sleep a day
  • Teenagers need an average of 8-9 hrs of sleep daily.
  • Most adults need 7- 9 hrs sleep at night but some may need as few as 6 hrs or some may be satisfied after 10 hrs of sleep.
  • Women in the first 3 months of pregnancy need some extra hours of sleep than usual.

Sleep Disorders: A few of the sleep disorders are summarized here :

  1. Insomnia: a hard time falling or staying asleep.
  2. Sleep apnea: a condition in which breathing difficulty interrupts sleep.
  3. Delayed sleep phase disorder: the patient feels really difficult to wake up in the morning and the biological clock is disturbed. It becomes impossible to wake up even with a loud alarm clock or a person waking the patient up.
  4. Restless leg syndrome: a tingling or prickly sensation in the legs with a strong desire to keep the legs moving and interfering with sleep.
  5. Nacrolepsy: a condition in which patient has attacks of daytime sleep.
  6. Bruxism: a condition in which there is involuntary clenching and grinding of teeth while sleeping.
  7. Nocturia: a frequent desire to wake up and urinate at night. it may be associated with underlying disease like diabetes.
  8. Jet lag: a condition that effects a person travelling which leads to disturbance of biological clock due to changes in time zone.
  9. Night terror: a disorder with sudden wakening up at night from sleep and a behavior consistent with terror.
  10. Rapid eye movement sleep behavior disorder: sudden acting out violently when in rapid eye movement sleep. sometimes may lead to self injury or injury to the bed partner.
  11. Sleep paralysis: a condition characterized by temporary paralysis of body shortly before or after sleep. It may be accompanied by visual, auditory or tactile hallucinations.
  12. Non 24 hr sleep wake syndrome: a condition that sets the biological clock to 25 hours and usually seen in blind individuals who cannot have sleep awake light clues.
  13. Sleep walking: a condition that mainly effects children. the brain continues to sleep but the body acts as though it is awake. Sleep walking is often linked to fever, stress, medications etc.

 

Managing Patients After A Suicidal Attempt

Managing Patients After A Suicidal AttemptUrgent Psychiatric help and assessment is required for patients who are revived from a suicidal attempt. Attempted suicide is one of the greatest risk factor for a future completed suicide. Despite the known risk little is known about the effective methods and treatment to prevent a suicide to occur.

Some Statistics: 

  • Suicide attempters have 66 times more risk of a completed suicide than the annual risk of suicide in the general population.
  • Approximately 15% of those who have attempted a suicide will re attempt it.
  • Suicide attempts and other forms of self injury without intent to die are estimated to occur at a rate of 300 persons per 100,000 per year.

Management:

1. Talking may prevent repeat suicide attempts: In studies done to prevent the repeated suicide attempts it shows that talking helps. The main goal of the talk therapy is to identify the thoughts and beliefs behind the attempt. It also helps in addressing the issues that lead to suicide attempt and the therapist may help the patient to adapt to and cope with the stress. Studies also show that the severity of depression decreases if the person talks and the feelings of hopelessness reduces.

2. Developing a strong supporting network: It is important to have a supportive network of friends and family that can help a person recover and protect from any future attempt for suicide.

3. Help the patient Take care of himself: Taking care of one own self both physically and mentally is very important. help the patient discover his hidden skills and use them. let the patient know that he is worth living and that it is important for him to live this life.

4. Cognitive behavioral therapy: is also very helpful for these patients and as the name suggests this form of psychotherapy address the problems, behavior and thoughts that are linked to committing a suicide. It aims to teach a suicidal person other ways to cope up with the stress he is facing and help them learn new ways to think about themselves and the world around them.  Continue reading “Managing Patients After A Suicidal Attempt”

Angina And Its Treatment

anginapectorisAngina is a pain that comes from the heart usually as a result of narrowing of the coronary arteries and as a result the heart muscle does not get as much blood and oxygen supply as needed. The pain of angina is described as an uncomfortable pressure, discomfort and squeezing in the center of the chest. Sometimes the pain may be felt in the arm, neck, jaw or shoulder. A number of medications and treatment options are available for managing angina.

Non-Pharmacological Treatment:

  • If the patient smokes it is important to make every possible effort to stop him smoking.
  • The blood pressure should be checked regularly and if high should be manged accordingly.
  • If the patient is over weight , loosing weight is advised.
  • Avoid inactivity and the aim should be a moderate physical activity on most of the days of the week for at least 30 minutes daily.
  • If blood cholesterol is high it should be treated
  • The patient should eat a healthy diet and avoid fatty foods.
  • Avid drinking alcohol.
  • Avoid taking large heavy meals that may trigger an attack of angina.
  • Patients are advised to slow down or take rest if physical activity triggers an attack of angina.
  • Some patients may get an angina due to a emotional stress so try to avoid the situations that causes stress.

Pharmacological Treatment:

1. Nitrates: are the most common drugs used for the angina treatment. Among the nitrates Nitroglycerin is the most commonly used medicine. Nitrates act by relaxing and dilating the blood vessels. This allows more blood to flow to the heart and also decreases the work load of the heart. Nitroglycerin or glyceryl trinitrate medicine comes in the form of a tablet or a spray and the dose is given under the tongue when the pain of angina develops. The medicine is absorbed quickly into the blood stream and acts within minutes to relieve the pain. The patients with a history of angina or those who are at risk are advised to carry the medicine with them all the time and use it as soon as needed. The most common side effect with this drug is a headache which usually improves with continued use. Continue reading “Angina And Its Treatment”

Managing High Blood Pressure

Managing High Blood PressureIntroduction:

Millions of people around the globe have been diagnosed with high blood pressure or hypertension and it is one of the most common risk factor for stroke and heart attack. High blood pressure can also lead to damage to the blood vessels leading to kidney problems, aneurysms as well as damage to the eyes. It is very important to prevent, control and treat hypertension appropriately.

Guidelines For Target Blood Pressure:

The new guidelines recommend the following target for controlling high blood pressure:

  • among adults age 60 and older with high blood pressure, aim for a target blood pressure under 150/90.
  • among adults age 30 to 59 with high blood pressure, aim for a target blood pressure under 140/90
  • among adults with diabetes or chronic kidney disease, aim for a target blood pressure under 130/80.

Management:

Managing high blood pressure involves diet changes, exercise, life style changes and if requires certain medications.

1. Loosing extra weight: Blood pressure often increases as weight increases. Loosing just 10 pounds helps reduces the blood pressure. Beside just loosing weight it is important to keep an eye on the waistline since carrying too much weight around the waistline leads to an increase in blood pressure.

2. Regular Exercise: Exercising regularly has a great impact on preventing and controlling high blood pressure. Even moderate activity for 10 minutes at a time or just walking may alos help a lot.

3. Eating A healthy diet: Aim to eat a diet rich in fruits, vegetables, whole grains and high fiber food. avoid fatty foods and also limit sugar intake.

4. Reduce Sodium In the diet: Even a small reduction of sodium in the diet can help reduce blood pressure greatly. Avoid eating processed food like chips and fast food items that are high in sodium content.

5. Manage Stress:  Stress or anxiety can temporary lead to a high blood pressure. Try to figure out what is stressing you out and try to cope up with the stressor in a healthier way.

6. Cut Back On Caffeine, Avoid Alcohol and Tobacco Products:  Continue reading “Managing High Blood Pressure”