DIABETES MELLITUS: MISCONCEPTIONS

Are you making frequent trips to the bathroom at night? Experiencing extreme thirst, excessive eating, overwhelming fatigue, or blurry vision; or noticing that you keep getting infections, ask your doctor for a diabetes test. It could be diabetes mellitus; an early diagnosis can help prevent complications.

I have put this piece together as pre awareness for the world diabetes day 2015 which comes up on Saturday 14^th November 2015. 

My pastor gave a talk last Sunday in church on effective communication, he used the story of a man who was attending a conference out of town, The man was said to be satisfied with the service at the hotel and wrote and sent a mail to the wife, the mail read as follow ’’ Dear, the venue of the conference was superb, the lodging was fantastic and above all the female receptionist was pleasant, i wish you were her’’

The wife was said to be furious and suspicious of his husband having clandestine move with the receptionist. The man later read his mail over again, he had written i wish you were her instead of i wish you were here.

Many health workers, doctors, nurses, pharmacists, health educators and other health workers have at one time or the other given the kind of information in the story above to diabetics living a lot of them slightly confused without even knowing.

Diabetes is contagious

Truth: Diabetes is categorised as being a non-communicable illness meaning it cannot be passed on by sneezing, through touch, nor via blood or any other person to person means.
The only way in which diabetes can be passed on is from parents to their own children but even this is only a genetic likelihood of diabetes and not the condition itself.
Diabetes is not that serious:
Truth: In fact, diabetes causes more deaths than breast cancer and HIV/AIDS in the western world. There are conditions called diabetes emergencies which may lead to death.
Eating too much sugar causes diabetes:
Truth: Eating too much sugar does not cause diabetes. It is advisable to be moderate in all things; eating less sugar is beneficial to all.
People with diabetes have to eat a carbohydrate-free diet:

Truth: People with diabetes need to eat a diet that is balanced; They are not to abstain from carbohydrates completely as they are the chief source of energy. The amount or portion is to be reduced.

They are advised to avoid food items that are directly absorbed with little or no digestion like carbonated soft drinks and artificial juice, table sugar, etc as they tend to shoot up blood glucose rapidly.

Being overweight causes diabetes.
Truth: Just because a person gains weight doesn't mean she's going to get diabetes. There are many overweight people who don't ever get the disease. Around 20% of people with type 2 diabetes are of a normal weight, or underweight.

People with diabetes go blind and lose their legs

Truth: Diabetes is a leading cause of blindness and also causes many amputations each year. However, those people with diabetes that control blood pressure, glucose, weight and quit smoking all increase their chances of remaining complication free.
Blindness and amputation are therefore preventable and the vast majority of people with diabetes will avoid blindness and amputation, by doing diabetic (blood glucose) checks periodically.

People with diabetes are more likely to be ill

Truth: People with diabetes are not more likely to have colds or other illnesses. The significance of illness for people with diabetes is that it can make the management of blood glucose levels more difficult which can increase the severity of an illness or infection.
Having diabetes means you must eat foods that are different from everyone else's.
Truth: People with diabetes don't need to follow a totally restricted diet but instead should try to follow the same healthful eating guidelines as everyone else, including choosing foods that are lower in fat, higher in nutrients, and contain an appropriate amount of calories,
Only older people get diabetes.
Truth: These days, children as young as age 5,children and adolescent are being diagnosed with type 2 diabetes but some years back children or adolescent were diagnosed with Type 1 diabetes also known as insulin-dependent diabetes or juvenile diabetes.
To help prevent diabetes in children, parents should try to encourage good habits for the entire family. That means less video game and TV time, more physical activity, less junk food, and smaller portions.

In conclusion, diet is a major form of diabetic treatment and should be adhered to, this is supported by Hipocrates, the father of modern medicine who said ‘’Let food be thy medicine and medicine be thy food’’

Dietary Regimen: Diabetics are to take their breakfast between 7am-8:30am , lunch between  1:30-2:30PM and dinner between  6:00-7:30PM. In-between Meals 11am-12noon.

Diabetics are not to skip meals! if you're skipping meals. Missing meals, especially if you take insulin or an oral medication, can raise the risk of developing low blood sugar.

All vegetables, cucumber, garden eggs are very healthy and can be freely taken by diabetics.

No pineapple, sugarcane, mangoes & banana. Pounded Yam, Garri and Fufu if taken should be with extreme caution.

Moderate exercise at least 30 minutes in a day, 3 times weekly is good measure for controlling diabetes.

DIETARY CONTROL OF DIABETES  MELLITUS

TIMING OF MENU

Breakfast  7am -8:30am

Lunch  1:30-2:30PM

Dinner  6:00-7:30PM

In-between Meals : First  11am-12noon

FOODS TO BE TAKEN AS IN BETWEEN MEALS

• Carrots (2-3 pcs finger-sized)
• Apple (1 small size, costs about 50 naira)
• 1 or half grape fruit orange
• Pawpaw (hard one, 1 cup chopped)
• Watermelon (1 cup chopped)
• Orange (1 small size…costs about 20 naira)
• Walnut (Asala) 4-6 pcs…costs about 50 naira
• Kemos cracker biscuits 2pcs

NORMAL DIET

• Bread (2 slices of normal bread or 3 slices of wheat bread or 1/3 of Senegal bread…costs about 120 naira )
• Cornflakes (3/4 cup…dry portion)
• Swallows: Amala, Semo, Semolina – 1 cup ; Wheat, plantain flour 11/4 cup (1.25 cup)
• Eko (agidi) 1 wrap…costs about 20 naira + 1-2 moimoi (1 wrap + vegetables)
• Guineacorn pap – 1 cup + 1-2 moimoi (1.5-2 cups + milk)
• Unripe plantain – 1 moderate size + vegetable
• Yam 1.5 slices; Water yam 2-3 slices; Irish potatoes 2-3 pcs moderate size

FOODS THAT CAN BE FREELY TAKEN

• Cucumber
• Garden eggs
• All vegetables

FOODS TO BE TAKEN IN MODERATION

• Meat (lean meat)…1-5pcs per week
• Chicken or turkey (remove the skin)
• Fish (scaly fish…dried or fresh fish, stockfish/okporoko, kote, shawa, mackerel)
• Boiled Eggs…remove yolk(1-2 per week)
• Milk (skimmed milk e.g danoslim or marvel, soyabean powdered milk 2 tablespoon levelled/day.
• Tea (lipton, toptea, Eby’s tea, etc)
• Low cholesterol Vegetable oil

FOODS NOT ALLOWED

• Sugar, honey, pies, cake, sausages, Gala & pastries
• Fried foods (akara, dodo, fried meat, fried fish, etc)
• Beverages (milo, bournvita, ovaltine, chocolate drinks, carbonated soft drinks and alcoholic beverages)
• Melon (Egusi) and apon
• Fatty meat & fish

CAUTION !

• No pineapple, sugarcane, mangoes & banana
• No eba, fufu, lafun & iyan
• Do not skip meals!

Exercise at least 3-5 times a week for 30-45 mins .

This diet list above is a research work of  Dr Emma O'brien ,he can be reached via www.medicalpings.com

Blood, mucous in stools need urgent attention

Bose is a 13-month-old female toddler who is being taken care of by grandma due to the busy nature of her mom’s job. The grandma is a very observant woman who pays attention to little details.

She had rushed the toddler to the hospital one morning after an uneventful night of bouts of diarrhoea, repeated vomiting and blood in the stool.

Bose was my first patient for the day. After taking the medical history and examining the child, I placed her on admission and commenced the drips. Her blood sample was also taken for investigations.

I did not waste time making impressions of acute abdomen pain in order to rule out intussusception – a medical emergency that needs the attention of a paediatric surgeon.

The paediatric surgeon was called, the baby was operated on and she was fine within 72 hours after the surgery. The surgeon’s findings showed that one part of her intestine had entered the other.

The surgeon also found that the appendix was inflamed; consequently, he simultaneously removed it – a surgery called incidental appendicectomy.

After the surgery, the surgeon congratulated the parents and explained to them that the surgery was fine. On a lighter mood, he teased the parents that they would pay extra for the appendectomy, since it was an additional surgery.

He informed them that the child no longer carries an appendix and that they should not allow her to be misdiagnosed of appendicitis in the future. Bose is fine now and she has grown from a toddler to the pre-school age.

Intussusception is the invagination of a proximal segment of the bowel (intestine) into the distal bowel (intestinal) lumen. The commonest occurrence is a segment of ileum moving into the colon through the ileo-caecal valve.

It may occur at any age, but it commonly occurs in the two-month to two-year age groups. It also occurs in adults.

Causes

The causes of intussusceptions are not fully known, although some viral and bacterial infections of the intestine may possibly contribute to intussusceptions in infancy.

Signs and symptoms

The child appears to have intermittent pain which is colicky, severe and may be associated with the child drawing up the legs. Pain occurs two to three times per hour and may increase over the next 12-24 hours

During these episodes of crying, the child may look pale, compared to many other causes of infant crying which are associated with facial redness rather than paleness.

Vomiting is usually a prominent feature, while bloody and mucous stools (like classic red currant jelly stool) are also a sign.

Weakness, (lethargy) and diarrhoea are also common symptoms.

 

source : jama.jamanetwork.com

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Examination

The doctor looks for the following signs to confirm his suspicion of intussusceptions: pallor, lethargy, abdominal swelling, and distended abdomen later in the course of the illness.

Bloody stool/occult blood is positive, rectal examination is done but may be unnecessary if good evidence of intussusceptions is present.

Investigations

The doctor requests for abdominal X-rays, abdominal ultrasound scan, series of blood tests for infections, for kidney status, blood glucose, blood groups/levels, as well as urine tests are among the numerous tests to be done.

Treatment

Treatment is surgery; this is usually done by a paediatric or general surgeon. The use of air enema is diagnostic and therapeutic.

Prevention

There is no particular prevention, since the exact cause is not known.

In conclusion, blood in stools of children with diarhoea is called dysentary and is mainly caused by bacteria.

When next a child is crying, rolling on the floor, weak, pale, gripping in pain, vomiting, and passing stools with blood and mucous, seek medical attention immediately, as it could be intussusceptions.

MANAGING APPENDICITES

A reporter with this newspaper featured a report on Saturday, August 8, 2015, entitled “A community where nine out of every 10 villagers have appendicitis.” He wondered what could be the reason for a situation whereby almost nine out of 10 persons in a particular community had undergone surgery as a result of the illness.

The youths informed the reporter that appendicitis and hernia were common among members of their community. They disclosed that several persons have died as a result of the conditions.

The reporter deduced that this could be attributed to the villagers’ travails on hardship, hard work, farming and absence of potable water in the community.

The import of this piece is to shed light on the medical condition called appendicitis, being one of the commonest abdominal emergencies seen anywhere in the world.

To start with, appendicitis is more common in females than in males. It used to be thought of as a cosmopolitan disease; but in the last two decades or so, evidence has suggested that this is not necessarily true. Indeed, there is no hospital, large or small, that does not have to deal with this condition in all parts of Nigeria, whether in the urban areas or in the hinterland.

The appendix is a small, thin pouch about five to 10cm long. It’s connected to the large intestine, where faeces (stools) are formed. No one knows exactly why we have an appendix; and removing it is not harmful.

Appendicitis is a painful swelling of the appendix, which causes pain in the abdomen. There are four types of appendicitis: acute appendicitis, sub-acute appendicitis, recurrent appendicitis, and chronic appendicitis

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Acute appendicitis is the commonest surgical condition of the abdomen. Acute appendicitis may occur at all ages, while sub-acute appendicitis may resolve with medications.

Signs and symptoms

Appendicitis typically starts with a pain in the middle of the abdomen (tummy). The pain may come and go. Within hours, the pain travels to the lower right-hand side, where the appendix usually lies, and becomes constant and severe.

Other symptoms are anorexia, nausea, and low grade fever. Pressing on this area, coughing or walking may all make the pain worse. The patient may lose appetite, feel sick and occasionally experience diarrhoea.

The single most important physical finding by the doctor is right lower abdominal pain on palpation of the abdomen. Other findings include low-grade fever, peritoneal signs, and guardedness.

Causes

It’s not exactly clear what the causes of appendicitis are, although most cases are thought to occur when something, usually a small piece of seed, stone, faeces (stool) or a swollen lymph node within the wall of the bowel blocks the entrance of the appendix. This obstruction leads to the development of inflammation and swelling.

Diagnosis

The overall diagnostic accuracy achieved by history, physical examination, and laboratory tests has been approximately 80 per cent.

The ease and accuracy of diagnosis varies by the patient’s sex and age, and is more difficult in women, children, elderly persons and women of childbearing age because acute gynaecologic conditions (e.g., pelvic inflammatory disease) may cause symptoms similar to appendicitis.

If the diagnosis of appendicitis is clear from the patient’s history and physical examination, no further testing is needed, and prompt surgical referral is warranted.

When the diagnosis is not clear, management options for suspected appendicitis include observation in a hospital, diagnostic imaging to clarify the diagnosis, laparoscopy, and appendectomy.

In atypical cases, ultrasonography and computed tomography (CT) may help lower the rate of false-negative appendicitis diagnoses, and reduce morbidity from perforation.

Complications

It may rupture with the escape of faecal material and various bacteria into the abdomen, thus causing more severe disease called peritonitis.

An abscess cavity forms around the appendix, with the development of severe illness, high-grade fever and considerable discomfort.

A mass is formed by a combination of certain structures within the abdomen, the intestines and the appendix itself, called an appendix mass.

Treatment

In most cases of appendicitis, the appendix will need to be surgically removed as soon as possible. Removal of the appendix, known as an appendectomy or appendicectomy, has an excellent success rate.

Most people make a full recovery from an appendectomy in a couple of weeks, although strenuous activities may need to be avoided for up to six weeks after open surgery.

Prevention

As the causes are not fully understood, there’s no guaranteed way of preventing appendicitis. The risk of the disease may be reduced by the increasing consumption of high fibre diets and vegetables, since such foods make bowel movements regular and shorten the digestion transit time.

How to manage constipation in Infants

My daughter is three weeks old and she did not have a bowel movement for five days. She was miserable! I called my paediatrician and she told me this was normal for breastfed babies when they were going through a growth spurt.

“She proceeded to tell me that if my baby seemed distraught by it, I should give her half of an infant glycerin suppository. Within 10 minutes of giving the suppository to her, she filled up the diaper with faeces and has been happy since.” — A concerned mother.

I have also seen several mothers of neonates and infants with the same complaint of their babies’ inability to move bowel for up to 10 days. The babies are without any abnormality and they will start moving their bowels after rectal examination.

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This is partly due to the stimulation of the nerves innervating the rectum and they will not need any medication; while very few (about two per cent) may have an underlying medical condition and may need to be sent for further tests such as X-ray and ultrasound scan of the abdomen.

It is advisable for mothers of newborns with constipation to contact their doctors for advice and not assume all is right.

Constipation in infants less than one year of age is common, but it can be a source of concern for parents. Sometimes, the baby is not really constipated, but must be given time to set his own schedule for having a bowel movement.

Infant constipation is the passage of hard, dry bowel movements — not necessarily the absence of daily bowel movements. Infant constipation may begin when a baby transitions from breast milk to formula or begins eating solid foods.

In rare cases, constipation may be caused by a lack of nerves or by structural problems in the lower large intestine.

Signs and symptoms

•An infant who is constipated usually strains more than other babies to have a bowel movement.

•The stool may be formed and hard like small pebbles, or it may be soft and mushy. Stool may even be wide and large.

•Sometimes, solid stool stays inside and liquid stool (like diarrhoea) may pass out around it.

•Other signs of constipation are infrequent stools that are difficult to pass.

•The child’s abdomen can become swollen with gas, and painful cramps can result from constipation.

•The child may be restless and cranky.

Investigations

•Digital rectal examination: In this procedure, a doctor or other health care provider inserts a gloved finger into the rectum to feel for anything unusual or abnormal.

•Abdominal X-ray: This is a diagnostic test to evaluate the amount of stool in the large intestine.

•Abdominal scan may be helpful in some cases.

Treatment

•You may give fruit juices (prune, pear, cherry, orange or apple). If the stool becomes too loose, just give less juice to your baby.

•If the baby is eating rice cereal, it may help to switch to oatmeal or barley cereal. Rice cereal can cause constipation in some children.

•To ease the passage of hard stools, consider applying a small amount of water-based lubricant to your baby’s anus.

•It might help to place an infant glycerin suppository into your baby’s anus. Glycerin suppositories are available without a prescription. They are only meant for occasional use when dietary changes are not effective.

•If your baby is old enough to eat strained foods, you may give him fruits and vegetables.

•A warm bath at least once a day can help relax his rectum. This can make it easier for him to have a bowel movement.

•Proper toilet training/bowel habits for older infants: Have your child sit on the potty at least twice a day for at least 10 minutes, preferably shortly after a meal.

The treatment listed above is applicable to infants above three months only. Those that are less will need a doctor’s review.

In conclusion, most of the time, constipation is a temporary situation. However, some children may have diseases of the intestine, such as Hirschsprung’s disease. All cases should be referred to a competent medical practitioner.