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Treatment of Diabetes in Type II Diabetes Mellitus

Treatment of Diabetes in Type II Diabetes MellitusTreatment of diabetes starts with educating patient about this disease. He is also educated about symptoms related to low and high sugar levels so that he can recognise these. He is encouraged to carry a diabetes card with his medication, and the name of his doctor written on it. He is also encouraged to carry with him sugar candies etc near him to treat hypoglycemia. Home blood glucose monitoring can be taught to nearly all patients. The various risk factors are noted and the complications if any are studied. The goal of treatment is to reduce the sugar to near normal levels to ward off complications of diabetes and reduce risk to life, vital organs while permitting a good quality of life. Non-pharmacologic measures To reduce risk of heart disease and stroke, weight should be reduced to normal levels. If a person is overweight (BMI ie Wt in kgs/ ht in meters squared) and BMI is between 25 to 29.9 wt can be reduced gradually to with i…

Dialysers

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Dialysers Dialysers are small plastic cylinders. These have an inlet for blood entry and outlet for blood exit. It also has an entry opening for dialysate and exit for the fluid. Its main body has hundreds of small tubes all connected to a common plate at the top and bottom portion of the dialyser. Blood enters at the entry point and flows through these tubes. These tubes are again joined at the exit and then blood goes out through a common tube back to the patient. These tubes are nowadays made of synthetic material of different types. Some common types are polysulfone, polymethamethyl acrylate, poly acrylonitrile and polyamide. Earlier cellular or semisynthetic membranes were also in use (hemophane, cuprophane, cellulose etc. ) These membranes are now gradually being replaced by synthetic membranes. Synthetic membranes are comparatively inert and produce fewer reactions. These are easy to clean and sterilise. The large no of tubes (called capillariesin medical parlance) increase the…

Diabetes Mellitus

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Diabetes Mellitus Diabetes is a condition where a person either does not produce required amounts of insulin or is unable to utilise insulin appropriately. It is a common (about 10% of the population), complex disease. It can cause complications if not treated and controlled well. Types of Diabetes: There are 2 common types of diabetes Type I and Type II. There are other rare varieties due to pancreatic diseases, hormonal disorders, in pregnancy, after drugs and even rarer genetic disorders. Type I is the cause in about 10 % of cases, onset is in childhood or young age and insulin is required for treatment. Type II is the common variety, onset is usually around 50 Yrs of age, often associated with overweight and the risk is high if one parent is diabetic (30 %) and if both parents are diabetic (50 %). During initial stages, diet modification and oral drugs may control sugars but later insulin may be required. Symptoms: Classically symptoms in diabetes are polyuria (more urine), polydy…

Dialysis Water

Dialysis water During hemo-dialysis about 500 ml (range 50-800 ml) of dialysate flows through the dialyer (The plastic casing that contains dialysis membrane and which partitions blood on one side and dialysate on the other). Water treatment is an essential requisite for safe dialysis. In a 4 to 5 hrs session about 120 to 150 liters of water thus comes into contact with blood. A very small impurity in this water thus can get magnified and produce serious consequences in the renal failure patient. If dialysis water is unfit, it results in recurrent fever, poor health and nutrition of patient, electrolyte abnormalities etc. High aluminium levels can produce brain disorder called dementia and aluminium related bone disease. High chlorine levels can cause severe reactions. Water treatment is done for ensuring safe dialysis water. If ground or municipal supply provides hard water it is softened by machine. Particulate matter is removed by filters consisting of pebbles, sand and other mate…

Treatment of Hypertension

Treatment of Hypertension Why should hypertension be treated ? The following are the benefits of treating hypertension:- 50 % reduction in risk of heart failure30-40% reduction of risk of strokes of brain20-30 % reduction in risk of heart attacks. The benefit occurs in all age groups including elderly. If a cause has been found (as happens in very few cases) treatment of underlying cause is useful e.g. treating kidney disease, removing adrenal tumours, stopping steroids, analgesics, contraceptive pills, certain anti depressants etc. In the majority of cases, no cause is found. In these, we suggest non-pharmacologic ways as well as medicines to lower blood pressure. Non-pharmacological methods may reduce blood pressure by 5- 10 mm on their own. These include Reduction of weight if overweight Reduction of salt in diet (avoid pickles, salted foods, preserved foods). Do not take salt substitutes if there is associated kidney disease. Dash diet ( dietary approaches to stop hypertension diet…

Dialysis Access

Dialysis Access Blood flows on one side of membrane while dialysate flows on the other side. To ensure effective dialysis a high blood flow is required for taking blood from the body to the dialysis machine. The blood flow required is about 5ml/kg body weight /min. Usually 250 ml to as much as 500-600 ml if tolerated. The way to achieve this is through creation of dialysis access. This may be temporary or permanent. A temporary access is made in those patients who will require dialysis for a few days to few weeks as in acute kidney injury ( also called earlier as ARF or acute renal failure), while awaiting creation of a permanent access. Temporary access is obtained by inserting a tube in neck veins (Int Jugular Vein) usually on right but sometimes on left side. It is uncommon nowadays to use subclavian (behind collar bone ) or upper thigh veins. The advantage of this is that it is ready to use immediately however it often gets infected and may cause clot formation in the vein in whic…

Hypertension

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HypertensionThe heart pumps blood so that it can reach various parts of the body and supply these parts with oxygen and nutrients. The pressure generated by the heart forces the blood to go from the heart to various organs and return from there to be sent again. There is about 5 liters of blood in average adult and heart pumps about 70 ml in each heart beat. The force generated by heart results in pressure which can be measured. Hypertension is said to occur when the recorded blood pressure is higher than expected for the particular age. Children have lower BP, it gradually rises to adult levels and continues to increase with age in most cases. BP is measured by sphygmomanometer which was earlier mercury based but are now aneroid or electronic. BP is measured as Systolic ( higher value of the two ) and diastolic (lower reading) and written as systolic/diastolic BP in mm of Hg. e.g. 120/80 mm Hg. Blood pressure at birth is about 70 to 85 /30 to 45 , at 5 yrs 90-110/50-66 , at 10 yr 100-1…

Dialysis

DialysisWhen the kidneys fail to maintain the body in a healthy state, the condition is called chronic renal failure. In advanced stages of chronic renal failiure, symptoms arise. These are called uremic symptoms and may consist of one or more of the following:- Weakness, decreased appetite, nausea, vomiting, hiccups, breathlessness, swelling of the body, decreased amount of urine etc. Later on a person may develop fits or increasing drowsiness, unconsciousness, extreme weakness, muscle paralysis etc. Initially these symptoms are mild but later on they do not allow a person to live a normal life and still later they will kill a person unless treated. The process of taking over of failed kidney functions by treatment is called Renal Replacement Therapy (RRT). This mainly comprises of Dialysis and Renal Transplant. Dialysis is the process through which the accumulated waste products are removed. It also removes extra water salt, potassium, acid, phosphorus and molecules of middle size.  T…

Functions of the Kidney

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Functions of the KidneyThe main function of the kidney is the maintenance of the interior composition of the body. Due to continued digestion and utilisation of food in the body, construction and destruction of the various body tissues, waste products are generated daily. Excretion of waste productsIf allowed to collect in the body, the function of the body is affected. These waste products are thrown out from the body by liver and intestines, lungs, skin and kidneys. Kidneys excrete urea, creatinine and similar products in a concentrated form in urine. The amount of excretion closely balances the amount of production of these materials.  Water and salt balanceKidneys maintain salt and water balance in the body. When healthy, a person may drink upto 10 liters of water or as low as ½ litre in a day. The kidneys increase and decrease urine appropriately to maintain the total body water. About 1 litre of blood flows through kidney. Of this about 180 litres of water, some salts and small part…

Structure of the Kidney

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Structure of the Kidney
There are 2 kidneys in the human body. Each weighs about  125 gms. These are located one on each side of the spine in the abdomen. These are


covered and protected in their upper part by ribs. These are bean shaped and beans are said to be kidney shaped.


Each kidney has about 1 million filtering units. These are called renal corpuscles and can be seen by microscope. The ball like portion where the formation of urine begins by filtering from blood is called glomerulus. The filtered fluid gets modified while passing through tube like structures. Kidneys are very rich in blood supply. It gets more blood per 100 gms of tissue than any other organ except the heart.  About one fifth of the total blood pumped by heart goes to the kidneys. After the urine is formed in the kidneys, it comes to the urinary bladder by two tubes called ureters. The urine can be stored in bladder till voided at will. Various valve like structures prevent urine from flowing backwards and leakage …