The old guidelines didn't take race and ethnicity into account, suggesting all adults with a body mass index, or BMI, of 25 (considered overweight) be tested for diabetes. The ADA's recommendations come from a review of five meta-analyses that looked at 156 studies. The ADA's Chiang says the new guidelines will help increase early detection of diabetes in Asian-Americans and enable more preventive measures. A BMI calculator (like this one from the National Institutes of Health) is a good place to start figuring diabetes risk. Watch for acute complications of diabetic therapy, especially hypoglycemia (vagueness, slow cerebration, dizziness, weakness, pallor, tachycardia, diaphoresis, seizures, and coma).
Be alert for signs and symptoms of ketoacidosis (acetone breath, dehydration, weak and rapid pulse, Kussmaul's respirations) and hyperosmolar coma (polyuria, thirst, neurologic abnormalities, stupor).
Watch for diabetic effects on the cardiovascular system, such as cerebrovascular, coronary artery, and peripheral vascular impairment, and on the peripheral and autonomic nervous systems. Assess for signs of diabetic neuropathy (numbness or pain in the hands and feet, footdrop, neurogenic bladder).
Teach the patient to care for his feet by washing them daily, drying carefully between the toes, and inspecting for corns, calluses, redness, swelling, bruises, and breaks in the skin. Teach the patient how to manage his diabetes when he has a minor illness such as a cold, flu, or upset stomach.
To delay the clinical onset of diabetes, teach persons at high risk to have good weight control, exercise regularly, increase the whole grains, fruits, and vegetables in their diet, and employ stress management techniques. As 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. 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. 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. Diabetes mellitus is a clinical syndrome characterized by chronic hyperglycemia and disturbances in carbohydrate,lipid and protein metabolism. Palpate all the peripheral pulses that includes femoral, popliteal, posterior tibial, dorsalis pedis. Do the neurological assessment by checking the sensations including those of dorsal column.
Reflexes may be diminished due to neuropathy and also look for any signs of proximal muscle wasting.
It is one of the most common gynecologic complaints in young women who present to clinicians. Primary (spasmodic): Primary dysmenorrhea is defined as menstrual pain not associated with macroscopic pelvic pathology (ie, absence of pelvic disease). Secondary (congestive): Secondary dysmenorrhea is diagnosed when symptoms are attributable to an underlying disease, disorder, or structural abnormality either within or outside the uterus. It is thought to be due to a release of prostaglandins and leukotrienes in the menstrual fluid, which in turn produces vasoconstriction in the uterine vessels, causing the uterine contractions which produce the pain. Obesity and alcohol consumption were found to be associated with dysmenorrhea in some (not all) studies. Physical activity and the duration of the menstrual cycle do not appear to be associated with increased menstrual pain.
Dysmenorrhea may affect more than half of menstruating women, and its reported prevalence has been highly variable.
Primary dysmenorrhea peaks in late adolescence and the early 20s. The incidence falls with increasing age and with increasing parity.
Pancreatitis is an inflammatory process in which pancreatic enzymes autodigest the gland. Acute pancreatitis is sudden swelling and inflammation of the pancreas. The pancreas is an organ located behind the stomach that produces chemicals called enzymes, as well as the hormones insulin and glucagon. When these enzymes somehow become active inside the pancreas, they eat (and digest) the tissue of the pancreas.
The condition is most often caused by alcoholism and alcohol abuse (70% of cases in the United States). This may be the case for many Asian-Americans who look slim, but actually face a higher risk of diabetes than people belonging to other ethnic groups. Even Asian-Americans who aren't considered overweight by standard measures (a BMI of 25 to 30) are still at risk for diabetes.
The studies looked at Asian-American populations to consider the effects of an American lifestyle and environment. But doctors must beware the trap of treating all Asian-Americans, or people of any race or ethnicity the same. Stress the need for personal safety precautions; explain that decreased sensation can mask injuries.
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.
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. 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.
Care for Proper Nutrition: Senior patients with diabetes should always be helped by a proper dietitian for the nutrition care.
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. Monitoring Of Blood Glucose: Monitoring is necessary to achieve glycemic controls and prevent the complications.
Retinopathy: The prevalence of retinopathy increases with the increased duration of diabetes and regular eye examinations are extremely important for older diabetic patients. Care for the Foot: The foot problems are at much higher risk in patients who are old and have diabetes. Physical Activity: Although many elderly patients have limited physical activity due to many associated factors like lack of interest in exercise plans, arthritis, nerve damage or vision problems but the primary care physician can guide each individual for the proper physical activity and exercise program that may be helpful. Preventing Osteoporosis and Fractures: Diabetes is a known risk factor for osteoporosis and appropriate majors should be taken to prevent the complications associated with it more so in the elderly patients. Managing the Associated problems: Elderly patients with diabetes are more prone to suffer from depression, urinary incontinence , urinary tract infections, sudden falls and problems with taking the medicine. A patient with diabetes need a complete physical examination to look for any related complications and to manage accordingly.
The prostaglandin release may also be responsible for gastrointestinal disturbance which may occur in association with dysmenorrhoea.
In acute cases the gland heals without any impairment of function or any morphologic changes. Most of the time, the enzymes are only active after they reach the small intestine, where they are needed to digest food.
This causes swelling, bleeding (hemorrhage), and damage to the pancreas and its blood vessels. Asian-Americans typically gain their fat around the waist, rather than the thighs or other parts of the body.
Chiang says Asian-Americans with a BMI around 23 or 24, particularly those with a family history of diabetes, should ask their doctor about getting tested.
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.
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.
It is usually advised to monitor HbA1c levels twice in a year for elderly patients who are meeting the treatment goals and are stable. The eye examination not only screens for retinopathy but also checks for the cataract and glaucoma that is more common in diabetes as well as with aging. With advanced age neuropathy increases and the old patients do not take care of the feet as they used to take care at their younger age. Elderly patients may not be able to remember properly about their drugs and doses or may forget about the nutritional care.
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