Tag Archives: health

Suckers: how alternative medicine makes fools of us all – Rose Shapiro

This is an eye-opening and well-researched book. Very readable, but at the same time shocking to consider that so much money has been spent on treatments that don’t work – just because they’re trendy and people like them. In fact, what I found was the most disturbing was that the people who lay into Western medicine as being ‘artificial’ and dangerous are precisely the same people who reject the scientific approach of randomised controlled trials (the most rigorous form of evidence) because they ‘don’t work’ on complementary therapy. That’s probably all you need to know…

Treating Severe Hypoglycaemia

Patient is unable to self-treat. If conscious, and able to swallow safely, patient should be given one of the following:

  • 100ml Lucozade
  • 150ml non-diet fizzy drink
  • 200ml smooth orange juice
  • 5-6 dextrose tablets
  • 4 jelly babies
  • 7 jelly beans
  • 2 tubes glucose gel

Repeat as required and stay with patient until recovered.

If patient is unconscious, he should be put in recovery position, glucagon can be injected if trained to do so. Otherwise dial 999 for ambulance.

Symptoms of Diabetes

(Guide only, type 2 diabetes can be asymptomatic for years)

Symptoms Type 1 Diabetes Type 2 Diabetes
Onset Fast (days/weeks) Slow (months/years)
Thirst √ often profound √
Polyuria/nocturia √ √
Bedwetting in children √  -
Lethargy/tiredness √ √
Mood changes/irritability √ √
Weight loss √++ √+/-
Visual disturbances √ √
Thrush infections (genital) - √
Recurrent infections (boils/ulcers) - √
Hunger √ √
Tingling/pain/numbness in extremities - √
Occasionally abdominal pain √ -
Confusion If advanced √ Especially in the elderly
Incontinence - √ Especially in the elderly
Glucosuria √ May be absent especially in the elderly or if there is a high renal threshold
Ketones in urine or blood May be present (ketoacidosis) Likely to be present

Thanks to Practice Nurse 41 8

Symptoms of TIA

Definite Probably Not Alarm symptoms (may require admission)
Slurring Dizziness Known AF; or high stroke risk
Clumsiness Confusion Recurrent TIAs; more than 2 in last 2 weeks
Tingling/numbness General weakness Patient on anticoagulant. May need brain scan
Visual disturbance ABCD2 score of 4 or more

Thanks to Practice Nurse 41 8

Treating Mild Hypoglycaemia

To raise blood glucose, take one of the following:

  • 100ml Lucozade
  • 150ml non-diet fizzy drink
  • 200ml smooth orange juice
  • 5-6 dextrose tablets
  • 4 jelly babies
  • 7 jelly beans
  • 2 tubes glucose gel

If blood glucose is still below 4mmol/l after 10 mins, or if patient doesn’t feel better, repeat one of the above treatments.

When feeling better, eat some starchy food such as a sandwich or a banana, monitoring blood glucose afterwards.

Coeliac Disease

This is an autoimmune condition triggered by the consumption of gluten found in wheat, barley, rye and occasionally oats. Frequently there is confusion of a patient’s symptoms, sometimes leading to a diagnosis of IBS or wheat intolerance. Untreated celiac disease can lead to increased risk of osteoporosis and small bowel cancer.

Symptoms of celiac disease include:

  • Nausea
  • Bloating
  • Flatulence
  • Constipation
  • Diarrhoea
  • Weight loss
  • Fatigue
  • Joint or bone pain
  • Mouth ulcers
  • Dematitis herpetiformis (a skin condition associated with coeliac disease)

Coeliac disease is diagnosed first of all with a blood test for immunoglobulin A or tissue transglutaminase amtonpdoes (tTGA). If this proves inconclusive. Endomysial antibodies may also be tested for, and later with an endoscopy and biopsy of the duodenum.

Gluten-free food including pasta, flour, biscuits, crackers and even breads and pizza bases are available on prescription.

Interpretation of ABPI

  • 1.3 or above may indicate arterial disease or calcification. Seek advice from tissue viability nurse
  • 1.0-1.3 normal arterial flow. Regular compression is probably safe, if not otherwise contraindicated
  • 0.8-1.0 Mild arterial disease, but sufficient for compression if not otherwise contraindicated
  • 0.5-0.8 Moderate arterial insufficiency. Seek advice from tissue viability nurse; reduced compression may be appropriate following specialist advice

Korotkoff Sounds

  • Phase I – the initial appeance of faint, repetitive tapping sounds that grandually increase in intensity for at least two consecutive beats (the systolic blood pressure)
  • Phase II – a brief period during which the sounds soften and acquire a swishing quality. In some patients the sounds may even disappear briefly. This is known as an auscultatory gap
  • Phase III – the return of sharper sounds, which may even be stronger than those in Phase I
  • Phase IV – distinct, abrupt muffling sounds that become soft and blowing in quality
  • Phase V – all sounds finally disappearing (the point of diastolic blood pressure)

Thanks to Nursing in Practice 62 (2011)

Medical Research Council Dyspnoea Scale

  • Grade 1 – not troubled by breathlessness except during strenuous exercise
  • Grade 2 – short of breath when hurrying or walking up a slight hill
  • Grade 3 – walks slower than contemporaries on the level because of breathlessness, or has to stop for breath when walking at own pace
  • Grade 4 – stops for breath after walking about 100m or after a few minutes on the level
  • Grade 5 – too breathless to leave the house, or breathless when dressing or undressing

Type I Diabetes

Type I diabetes occurs when there is a loss of insulin secretion ability due to automimmune destruction of the beta cells in pancreatic tissue. Patients generally present with the symptoms of hyperglycaemia including ketoacidosis.

Type I diabetes is the most common form in young people (affecting aout 0.5% of the population); bringing with it the potential for problems such as retinopathy, neuropathy, nephropathy and vascular disease.

Small amounts of insulin are produced by the pancreas throughout the day to ensure cells have access to glucose, and suppress the release of stored glucose from the liver. During fasting periods, glucagon is released to ensure glucose supplies for brain function.

Carbohydrates are digested in order to provide glucose, which results in the release of insulin titrated to the supply of glucose to use and store glucose in suitable quantities.

Insulin needs to be replaced in type I diabetes patients to ensure 24 hour cover. Boluses may also need to be prescribd to match carbohydrate intake at mealtimes. Often this can be suitably treated with a twice daily insulin if the patient’s daily routine is predictable, for patients whose lifestyle is more varied, titrated insulin may be required perhaps involving a pump or more frequent injections.

Carbohydrate awareness is important for those with type I diabetes because it is carbohydrates that affect blood glucose levels, and therefore patients need to be aware of the carbohydrate values of the foods they consume. This is particularly important for those titrating their insulin.

One of the ways insulin titration is done is through ‘dose adjustment for normal eating’ (DAFNE) which was designed for those with type I diabetes and can contribute to an improved quality of life and satisfaction for patients. Research shows that patients on DAFNE treatment are less likely to be admitted to hospital with ketoacidosis or hypoglycaemia, and also the treatment can make huge cost savings for providers. It consists of a 38 hour training course delivered in a group session based around competency skills. The scheme is successful in promoting understanding of diabetes, awareness of implications regarding diet, and the skills and knowledge required to count carbohydrates and titrate insulin accordingly with the use of DAFNE algorithms.