Type 1 diabetes in adults: supporting self management

Clinical Review Type 1 diabetes in adults: supporting self management BMJ 2016; 352 doi: http://dx.doi.org/10.1136/bmj.i998 (Published 10 March 2016) Cite this as: BMJ 2016;352:i998 Article Related content Metrics Responses Monika Reddy, specialist registrar, diabetes and endocrinology1 2, Sian Rilstone, diabetes specialist dietitian2, Philippa Cooper, has type 1 diabetes3, Nick S Oliver, consultant diabetologist1 2 Author affiliations 1Department of Diabetes, Endocrinology and Metabolism, Imperial College London, St Mary’s Hospital Campus, London W2 1PG, UK 2Diabetes and Endocrinology, Imperial Healthcare NHS Trust, London 3London Correspondence to: N S Oliver [email protected] What you need to know Glucose concentrations in type 1 diabetes are affected by multiple interacting and independent complex factors Structured education programmes support effective self management and should be available to everyone with an established diagnosis of type 1 diabetes Long term self-management of type 1 diabetes is challenging and requires ongoing support from an expert multidisciplinary team Insulin dose adjustment involves carbohydrate estimation and mental arithmetic, which can be supported with technology Healthcare professionals should be alert to signs of depression or distress in people with type 1 diabetes, and access to psychosocial support is critical Type 1 diabetes affects 300 000 people in the United Kingdom.1 2 Despite regular specialist multidisciplinary input, responsibility for glucose monitoring and insulin administration is devolved to the person with diabetes, or their care giver. Empowering effective self management of type 1 diabetes is critical to achieve HbA1c targets, minimise hypoglycaemia and optimise quality of life. Structured education programmes for diabetes self management should be offered to everyone with type 1 diabetes. It is important for healthcare providers to understand what structured education involves before referral. This review examines the meaning and evidence for self management, and provides advice on how general physicians and non-specialists can support and enable people with type 1 diabetes to self manage their condition

Green revolution vaccines, edible vaccines

Edible vaccines are sub-unit vaccines where the selected genes are introduced into the plants and the transgenic plant is then induced to manufacture the encoded protein. Edible vaccines are mucosal-targeted vaccines where stimulation of both systematic and mucosal immune network takes place. Foods under study include potatoes, bananas, lettuce, rice, wheat, soybean, corn and legumes. Edible vaccines for various diseases such as measles, cholera, hepatitis-B, and many more are in the process of development. Food vaccines may also help to suppress autoimmunity disorders such as Type-1 Diabetes. Key words: Edible vaccines, oral vaccines, antigen expression, food vaccines. African Journal of Biotechnology Vol. 2 (12), pp. 679-683, December 200

Study of Prevalence and Stages of diabetic nephropathy in a rural tertiary care centre - Southern India (2011-12)

Type 2 diabetes mellitus (T2DM) is an alarming health care concern the world over affecting more-than 220 million people worldwide according to World Health Organization. Kidney disease in diabetic patients is clinically characterized by increasing rates of urinary albumin excretion (UAE), starting from normoalbuminuria, which progresses to microalbuminuria, macroalbuminuria and eventually to End-Stage Renal Disease. Diabetic nephropathy has been categorized into stages based on the values of urinary albumin excretion and estimated glomerular filtration (eGFR). There is accumulating evidence suggesting that the risk for developing diabetes nephropathy and cardiovascular disease starts when UAE values are still within normoalbuminic range. Objective: To study the prevalence and stages of nephropathy in T2DM patients and to compare albumin levels with glycemic control in rural population. Methodology: Cross-sectional study was carried out from January 2011 to April 2012 among diabetic patients attending General Medicine department in RL Jalappa Hospital. Random blood sample and spot urine sample was collected for analysis and the data was collected in a predesigned, pretested semi-structured questionnaire. Results: The prevalence of diabetic nephropathy in our study was 37.02%. The prevalence microalbuminuria was 30.79% in males and 24.46% in females. The prevalence of overt nephropathy was 9.27% in males and 6.73% in females. Around 62.97% were in microalbuminuric range. 75.76% of the patients had poor glycemic control, but among patients with poor glycemic control 79.78% had overt nephropathy and 86.80% had microalbuminuria. Among patients with good glycemic control 20.28% had overt nephropathy and 13.19% had microalbuminuria. Conclusion: Microalbuminuria was earliest sign in Diabetic Nephropathy (DN). Progression of DN can be prevented on early detection. Poor glycemic control and duration of diabetes was associated with increase in UAE level and progression of Chronic Kidney Disease. Screening for DN at the time of diagnosis in T2DM and measures to reduce albuminuria at earliest could prevent further progression of DN in patients with T2D

Nutritional Status And Its Association With Diabetes Mellitus In School Children, India

Background: Poor health and nutrition may impair both the growth and intellectual development of school children. Incidence of malnutrition related childhood diabetes mellitus has increased and continues to be on the rise.Objectives: To assess the nutritional status by anthropometry and to screen for diabetes by capillary blood examination of school children. Design: Longitudinal study Setting: The study was carried out at Sri R.L.Jalappa Central School, Kolar from August 2008 to December 2009. Methods: All the school children were interviewed with pre-designed and pre-tested proforma. Height, Weight was measured by standard procedures. The nutritional status was analysed by Body Mass Index (BMI) for age. The school children were also screened for diabetes mellitus by Finger stick capillary random plasma glucose testing. The children were followed up for any major medical problems during the study period.Participants: All the students studying in the school during study period.Results: Mean height and weight of children were found comparable to the ICMR pooled data. However, compared to NCHS standards and affluent Indian children the mean height and weight were found to be much inferior at all ages. According to BMI for age as per NCHS most of the children were undernourished (79.2%) and 3 children (0.6%) were overweight. Out of 495 children screened for diabetes 14 children had hyperglycaemia (>160mg/dl). These 14 children were further tested by oral glucose tolerance test and found to have normal blood sugars levels. During the follow up two undernourished children developed diabetes mellitus. Conclusion: The magnitude of malnutrition among school going children was found to be 79%. During the follow up two undernourished children developed diabetes mellitus, hence under nutrition was associated with diabetes mellitus

Antidiabetic, Antihyperlipidemic and Antioxidant Activities of Buchanania lanzan Spreng Methanol Leaf Extract in Streptozotocin-Induced Types I and II Diabetic Rats

Purpose: To evaluate the antidiabetic, antihyperlipidemic and antioxidant activities of Buchanania lanzan.Methods: Wistar rats were divided into nine groups of six animals each, and 40 mg/kg of streptozotocin or streptozotocin + nicotinamide was administered intraperitonially to induce types I and II diabetes. Those with blood glucose levels > 190 ± 8 mg/dl were administered the methanol leaf extract of Buchanania lanzan (MEBL, 100 or 200 mg/kg, p.o.) or positive control for 21 days. Blood glucose, lipid profile, antioxidant enzymes and oxidative stress markers were evaluated.Results: Following induction, blood glucose level rose to 327.7 ± 47.4 mg/dl, compared to the normal value of 910 ± 3.2 mg/dl. Administration of MEBL (100 or 200 mg/kg) significantly (p < 0.05) decreased blood glucose level, serum lipid profile, and significantly (p < 0.05) increased antioxidant activity as evidenced by increase in super oxide dismutase (SOD), catalas, glutathione (GSH), and decrease in the activity of lipid peroxidation (LPO).Conclusion: MEBL exhibits antidiabetic, antihyperlipidemic and antioxidant activities in diabetic rat and needs to be further investigated for the treatment of both types I and II diabetes mellitus.Keywords: Antidiabetic, Antihyperlipidemic, Antioxidant, Buchanania lanzan

Validation of Potential Fishing Zone (PFZ) Advisories (2006 – 2007)

The Potential Fishing Zone (PFZ) Advisories are being generated and disseminated by Indian National Centre for Ocean Information Services (INCOIS). The methodology used for generation of these advisories and the scientific basis behind the identification of the PFZ locations was described. With a view to validate these PFZ Advisories and to assess the potential benefits to the fishing community, INCOIS had undertaken PFZ validation experiments at various places under the leadership of fishery experts. Simultaneous fishing operations have been conducted within the PFZ Areas and outside PFZ Areas using identical vessels. The quantitative results of the experiments were described

Uncommon cause for anterior knee pain - Aggressive aneurysmal bone cyst of the patella

A 56-year-old man presented with a two month history of increasing anterior knee pain without previous trauma. As usual we recommended physiotherapy with stretching exercises of the quadriceps muscle. Since symptoms did not improve after 6 weeks MRI was performed. Surprisingly a hyperintense lobulated mass of the patella with small fluid-filled cavities at the inferior pole was revealed. We performed an open biopsy to exclude any malignancy and diagnosed an aneurysmal bone cyst. Further examination with CT scans showed an aggressive behaviour with cortical breakthrough

Comparison of the sensitivity of a 24 h-shell vial assay, and conventional tube culture, in the isolation of Herpes simplex virus – 1 from corneal scrapings

BACKGROUND: Herpes simplex keratitis is a sight threatening ocular infection. A rapid and specific diagnosis is essential for the institution of specific antiviral therapy and to avoid complications that can arise from misdiagnosis and inappropriate treatment. Though a variety of techniques are available, isolation of Herpes simplex virus 1 (HSV-1) in culture provides the most reliable and specific method, and is considered as the gold standard in laboratory diagnosis of herpes simplex keratitis. We report a comparative study of the sensitivity of a 24 h-shell vial assay and conventional tube culture in the isolation of HSV-1 from corneal scrapings. METHODS: A total of 74 corneal scrapings obtained from 74 patients with a clinical suspicion of herpes simplex keratitis submitted for the isolation of HSV-1, were simultaneously inoculated into shell vial and tube cultures employing the vero cell line. Shell vial and tube cultures were terminated at 24 h and fifth day respectively. Isolation of HSV-1 was confirmed employing an indirect immunofluorescence assay. RESULTS: HSV-1 was isolated from 24/74 (32.4%) specimens employing both the methods. Sensitivity of both the techniques were found to be similar (20/24, 83.3%) (P = 1.0). CONCLUSION: A 24 h-shell vial assay is a rapid alternative technique in comparison to the time consuming conventional tube cultures for the isolation of HSV-1, especially from corneal scrapings for the laboratory diagnosis of herpes simplex keratitis

Predominant constitutive CFTR conductance in small airways

BACKGROUND: The pathological hallmarks of chronic obstructive pulmonary disease (COPD) are inflammation of the small airways (bronchiolitis) and destruction of lung parenchyma (emphysema). These forms of disease arise from chronic prolonged infections, which are usually never present in the normal lung. Despite the fact that primary hygiene and defense of the airways presumably requires a well controlled fluid environment on the surface of the bronchiolar airway, very little is known of the fluid and electrolyte transport properties of airways of less than a few mm diameter. METHODS: We introduce a novel approach to examine some of these properties in a preparation of minimally traumatized porcine bronchioles of about 1 mm diameter by microperfusing the intact bronchiole. RESULTS: In bilateral isotonic NaCl Ringer solutions, the spontaneous transepithelial potential (TEP; lumen to bath) of the bronchiole was small (mean ± sem: -3 ± 1 mV; n = 25), but when gluconate replaced luminal Cl(-), the bionic Cl(- )diffusion potentials (-58 ± 3 mV; n = 25) were as large as -90 mV. TEP diffusion potentials from 2:1 NaCl dilution showed that epithelial Cl(- )permeability was at least 5 times greater than Na(+ )permeability. The anion selectivity sequence was similar to that of CFTR. The bionic TEP became more electronegative with stimulation by luminal forskolin (5 μM)+IBMX (100 μM), ATP (100 μM), or adenosine (100 μM), but not by ionomycin. The TEP was partially inhibited by NPPB (100 μM), GlyH-101* (5–50 μM), and CFTR(Inh)-172* (5 μM). RT-PCR gave identifying products for CFTR, α-, β-, and γ-ENaC and NKCC1. Antibodies to CFTR localized specifically to the epithelial cells lining the lumen of the small airways. CONCLUSION: These results indicate that the small airway of the pig is characterized by a constitutively active Cl(- )conductance that is most likely due to CFTR