Nhs diabetes type 2 statistics books,diabetes insipidus is caused by hypersecretion of,medication error prevention a shared responsibility strategy - Review


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I am a New Zealand registered nurse and nutritionist (Grad Cert Sci: nutrition, Massey Univ). Apparently, if you’re cooking for a diabetic, no foods are to be avoided and you should give them plenty of starchy carbohydrates (potatoes, pasta etc) and vegetables. I had hoped that nutritionists would have come to their senses about diabetes in the 10 years since I started ignoring them, but it seems dogma still holds sway. Diabetes, whether type 1 or type 2, essentially means the body is no longer able to handle glucose in the blood properly.
The body gets glucose from food, and some foods are turned into glucose by the digestive system much more rapidly than others.
Given the fact that Type 1 diabetes is an auto-immune disease, I recommend that if you have it you follow the paleo diet – Why? It is startling to me that Diabetes New Zealand are not even yet following recommendations of on of the most prestigious diabetes clinics recommend. When I first started my own nutrition practice I exclusively taught the Zone diet, because this was the plan that radically changed my own health (I’ve since evolved to teaching paleo and lower carb principals). The decrease in each of the risk factors indicates the Zone Nutritional Program has significant potential in reducing the cardiovascular risk that is elevated in Type 2 diabetics. The main result was that the blood sugar rise in response to carbohydrate intake was markedly lower after 12 weeks in the Paleolithic group (–26%), while it barely changed in the Mediterranean group (–7%).
The improved glucose tolerance in the Paleolithic group was unrelated to changes in weight or waist circumference, although waist decreased slightly more in that group. Low-carbohydrate diets, due to their potent antihyperglycemic effect, are an intuitively attractive approach to the management of obese patients with type 2 diabetes. Of the 23 patients who have used a low-carbohydrate diet and for whom we have long-term data, two have suffered a cardiovascular event while four of the six controls who never changed diet have suffered several cardiovascular events. Advice to obese patients with type 2 diabetes to follow a 20% carbohydrate diet with some caloric restriction has lasting effects on bodyweight and glycemic control. So it looks like what works best for type 2 diabetics who wish to control blood glucose and reverse the symptoms diabetes is a low – moderate carbohydrate, paleo eating plan. Other supplements are also useful; magnesium, chromium and alpha lipoic acid, and of course a very high nutrient, high anti-oxidant diet.
Yes, you are right, point taken, reversing the symptoms of type 2 diabetes is more accurate – text has been changed. There are reasons that some people with diabetes are advised to avoid high protein food plans (such as Atkins). Also, I think that scare tactics are nasty, don’t work and, when what is being said is wrong, can be damaging. I have personally seen people reverse symptoms of type 2 diabetes and manage it in such a way as to show no measurements of diabetes.
Some methods of debridement require a lower level of skill to perform and are available to generalist nurses. WHEN IS REFERRAL NECESSARY?If any doubt exists as to the diagnosis or treatment pathway, referral for assessment and advice from the specialist wound care or tissue viability team should occur prior to debridement.
Patients with inflammatory conditions such as pyoderma gangrenosum where active debridement may lead  to wound deterioration. Wounds that are associated with congenital malformation or when malignancy is suspected or the normal anatomy is changed.
Patients with a prosthetic implant in the region of the wound require a review and advice from the appropriate surgical team.
Early appropriate wound debridement facilitates healing, reduces risk of infection and improves patient quality of life.
Debridement is frequently an ongoing process and will involve the integration of a number of debridement methods if healing is to be optimised.
Bahr S, Mustafi N, Hattig P, et al (2011) Clinical efficacy of a new monofilament fibre-containing wound debridement product.
Gray D, Acton C, Chadwick P, et al (2011) Consensus guidance for the use of debridement techniques in the UK. A blood glucose test measures the amount of a type of sugar, called glucose, in your blood.
Fasting blood sugar (FBS) measures blood glucose after you have not eaten for at least 8 hours. Pour reussir, pour que ce soit le meilleur regime pour vous, le programme pour perdre du poids doit se concentrer sur votre sante en general et pas uniquement sur ce que vous mangez. Est-ce que ce programme offre des cours de groupe ou des conseils personnalises en direct pour m’aider a prendre de bonnes habitudes ? Si le programme comporte des aliments speciaux, puis-je l’amenager en fonction de mes gouts ou en cas d’allergies alimentaires ? Ce programme comprend-il un plan pour m’aider a maintenir mon poids une fois que j’aurai maigri ? Quels diplomes possede le personnel concernant le controle du poids, l’education, l’experience et la formation dans ce domaine ? Le personnel ou le medecin du programme peut-il se mettre en relation avec mon medecin pour preciser comment le programme peut interferer avec mes problemes medicaux ? Y a-t-il un suivi possible d’un personnel medical pour s’assurer que tout se passe bien pendant que je suis le programme ? Y a-t-il des couts supplementaires (frais d’adhesion, contacts ou visites hebdomadaires, frais d’aliments ou de substituts de repas, supplements ou autres produits) ? Souvenez-vous que les methodes pour perdre du poids ou mincir vite ne fournissent pas de resultats durables.
Les methodes pour perdre du poids qui s’appuient sur des « aides au regime » comme des boissons, des aliments preemballes, des pilules amaigrissantes ne fonctionnent pas a long terme. Si vous perdez du poids vous-meme ou avec un groupe, souvenez-vous que les changements les plus importants sont a long terme. Peu importe combien vous avez de poids a perdre, vous devez utiliser le meilleur regime avec des objectifs modestes et un parcours lent qui augmenteront vos chances de conserver votre nouveau poids. Our New BMJ website does not support IE6 please upgrade your browser to the latest version or use alternative browsers suggested below. Objective: To determine whether tight control of blood pressure prevents macrovascular and microvascular complications in patients with type 2 diabetes.
Main outcome measures: Predefined clinical end points, fatal and non-fatal, related to diabetes, deaths related to diabetes, and all cause mortality. Conclusion: Tight blood pressure control in patients with hypertension and type 2 diabetes achieves a clinically important reduction in the risk of deaths related to diabetes, complications related to diabetes, progression of diabetic retinopathy, and deterioration in visual acuity. Members of the study group are given at the end of the paper.Editorials by Orchard and Mogensen Papers pp 713, 720This paper was prepared for publication by Robert Turner, Rury Holman, Irene Stratton, Carole Cull, Valeria Frighi, Susan Manley, David Matthews, Andrew Neil, Heather McElroy, Eva Kohner, Charles Fox, David Hadden, and David Wright. In the general population treatment to lower blood pressure reduces the incidence of stroke and myocardial infarction, 14 15 particularly in elderly people.
We studied hypertensive patients with type 2 diabetes who had been recruited to the UK prospective diabetes study.
Of the 4297 patients recruited to the 20 centres participating in the hypertension in diabetes study, 243 had either died or were lost to follow up before the start of the hypertension study in 1987 (fig 1). TABLE I Characteristics of patients allocated to tight and less tight control of blood pressure. Randomisation stratified for those with or without previous treatment for hypertension was performed by the coordinating centre. Captopril was usually started at a dose of 25 mg twice daily, increasing to 50 mg twice daily, and atenolol at a daily dose of 50 mg, increasing to 100 mg if required.


Blood pressure (diastolic phase 5) while the patient was sitting and had rested for at least five minutes was measured by a trained nurse with a Copal UA-251 or a Takeda UA-751 electronic auscultatory blood pressure reading machine (Andrew Stephens, Brighouse, West Yorkshire) or with a Hawksley random zero sphygmomanometer (Hawksley, Lancing, Sussex) in patients with atrial fibrillation. At entry to the UK prospective diabetes study and subsequently every three years all patients had a clinical examination which included retinal colour photography, ophthalmoscopy, measurement of visual acuity, assessment of peripheral and autonomic neuropathy, chest radiography, electrocardiography, and measurement of brachial and posterior tibial blood pressure using Doppler techniques. Visual acuity was measured with Snellen charts until 1989, after which ETDRS (early treatment of diabetic retinopathy study) charts22 were used to assess best corrected vision, with current refraction or through a pinhole.
Twenty one clinical end points were predefined in the study protocol.22 All available clinical information was gathered for possible end points—for example, copies of admission notes, operation records, death certificates, and necropsy reports. Secondary outcome analyses of four additional aggregates of clinical end points were used to assess the effect of treatments on different types of vascular disease. Since a patient could in sequence have different end points, he or she could be included in more than one end point category.
Analysis was on an intention to treat basis, comparing patients allocated to tight and less tight blood pressure control. Hypoglycaemia was determined from the number of patients allocated to a treatment and continuing with it who had one or more minor or major hypoglycaemic episodes each year.
Both the UK prospective diabetes study and hypertension in diabetes study received ethical approval from the appropriate committee in each centre and conformed with the guidelines of the Declarations of Helsinki (1975 and 1983).
The data monitoring and ethics committee examined the end points every six months to consider halting or modifying the study according to predetermined guidelines. The median follow up to death, the last known date at which vital status was known, or to the end of the trial was 8.4 years. In the group assigned to tight control of blood pressure patients took their allocated treatment for 77% of the total person years and did not take antihypertensive treatments for 6% of the total person years. Figure 3 shows the increasing number of antihypertensive agents required to maintain blood pressure lower than target levels. Patients allocated to tight compared with less tight control of blood pressure had a 24% reduction in risk of developing any end point related to diabetes, (P=0.0046) (figs 4 and 5). Patients in the group assigned to tight blood pressure control compared with those in the other group had a 32% reduction in risk of mortality from diseases substantially increased by diabetes (P=0.019), two thirds of which were cardiovascular diseases. The group assigned to tight blood pressure control had a non-significant reduction in risk of 21% in the aggregate end point for myocardial infarction (table 2 and fig 7). When all macrovascular diseases were combined, including myocardial infarction, sudden death, stroke, and peripheral vascular disease, the group assigned to tight blood pressure control had a 34% reduction in risk compared with the group assigned to less tight control (P=0.019). The group assigned to tight blood pressure control had a 37% reduction in risk of microvascular disease compared with the less tight group (P=0.0092) (figs 4 and 7). There was a 56% reduction in risk of heart failure (P=0.0043) (fig 8) in the tight control group compared with the less tight control group.
Neuropathy—The surrogate indices of neuropathy and autonomic neuropathy were not significantly different between the two groups. There was no significant difference between the groups in the proportion of patients who developed surrogate indices for macrovascular disease.
This paper reports that patients with hypertension and type 2 diabetes assigned to tight control of blood pressure achieved a significant reduction in risk of 24% for any end points related to diabetes, 32% for death related to diabetes, 44% for stroke, and 37% for microvascular disease. Retinopathy —The was a 34% reduction in the rate of progression of retinopathy by two or more steps using the modified ETDRS final scale.
I am a Certified Zone Instructor, and have worked teaching Zone diet principles to hundreds of clients over the last 10 years.
I went and had a look at Diabetes UK and their food recommendations for diabetics are horrifying.
So it seems clear that nutritionists will be a big help to diabetics, because they can tell diabetics which kinds of foods will quickly raise blood glucose and should be avoided, right?
Well, not if that diabetic is listening to professional nutritional advice, which actively warns them off the foods that won’t raise blood glucose rapidly and actively encourages them to scoff down the foods that will. It reduces the auto-immune reactions caused by agricultural foods; grains, legumes and dairy. In those days Sears recommendations were very paleo and meals usually ended up being lower carb than the 40% calories prescribed. All patients had increased blood sugar after carbohydrate intake (glucose intolerance), and most of them had overt diabetes type 2. Hence, the research group concludes that something more than caloric intake and weight loss was responsible for the improved handling of dietary carbohydrate. Both groups received group meetings, nutritional supplementation, and an exercise recommendation. Both interventions led to improvements in hemoglobin A1c, fasting glucose, fasting insulin, and weight loss. We previously reported that a 20% carbohydrate diet was significantly superior to a 55–60% carbohydrate diet with regard to bodyweight and glycemic control in 2 groups of obese diabetes patients observed closely over 6 months (intervention group, n = 16; controls, n = 15) and we reported maintenance of these gains after 22 months. So it may have gone into remission, but the potential for it to come back would probably be a few bad meals away.
So many people are erroneously being given the message that biology is destiny when they can do something constructive about it e.g. The decision to debride a wound can be complex and may require the multidisciplinary team involvement. These include autolytic methods, biosurgical therapy and the recently introduced mechanical method, Debrisoft® (Activa Healthcare).
New techniques of mechanical debridement provide the generalist practitioner with more rapid options for debridement when used in conjunction with autolytic techniques.
Maintaining a healthy wound bed following initial debridement of a chronic wound can be performed using non-specialist methods. This increase causes your pancreas to release insulin so that your blood glucose levels do not get too high. Ce type de regime necessite une surveillance medicale etroite par des consultations et des tests medicaux frequents (pour plus de conseils sur ce type de regime, lisez l’article sur les regimes a tres basses calories).
Mais quand on y regarde de plus pres (ou de plus loin) le surpoids est la 5eme cause de mortalite au niveau mondial et la troisieme dans les pays occidentaux.
Surrogate measures of microvascular disease included urinary albumin excretion and retinal photography.
16 17 In patients with type 1 diabetes who have microalbuminuria or overt nephropathy strict control of blood pressure reduces urinary albumin excretion and deterioration in renal function.
22 23 General practitioners were asked to refer patients aged 25-65 with newly diagnosed diabetes to 23 participating centres.
Other agents were added if the control criteria were not met in the group assigned to tight control despite maximum allocated treatment or in the group assigned to less tight control without drug treatment. At each visit plasma glucose concentration, blood pressure, and body weight were measured, and treatments to control blood pressure and blood glucose concentration were noted and adjusted if target values were not met. The first reading was discarded and the mean of the next three consecutive readings with a coefficient of variation below 15% was used in the study, with additional readings if required.
Retinal colour photographs of four standard 30° fields per eye (nasal, disc, macula, and temporal to macular fields) were taken plus stereophotographs of the macula. Copies of these, without reference to the patient's allocated or actual treatment, were formally presented to two independent physicians who allocated an appropriate code from the ninth revision of the international classification of diseases (ICD-9) if the criteria for any particular clinical end point had been met. These were myocardial infarction (fatal or non-fatal myocardial infarction or sudden death), stroke (fatal or non-fatal stroke), amputation or death from peripheral vascular disease, and microvascular complications (retinopathy requiring photocoagulation, vitreous haemorrhage, and fatal or non-fatal renal failure). Patients allocated to tight control with angiotensin converting enzyme inhibitors or ? blockers were pooled in this paper for analysis.
These included a difference of three or more standard deviations by log rank test in the rate of deaths related to diabetes or deaths related to diabetes and major illness between the group assigned to tight control and that assigned to less tight control or between the group given captopril and that given atenolol.22 One of the stopping criteria was attained immediately before the scheduled end of the study. The vital status was known at the end of the trial in all patients except 14 (1%) who had emigrated and a further 33 patients (3%) who could not be contacted in the last year of the study for assessment of clinical end points.


In the other group patients did not take any antihypertensive treatments for 43% of the total person years; they took an angiotensin converting enzyme inhibitor for 11% of the total person years and a ? blocker for 9%. At nine years 29% of those assigned to tight blood pressure control required three or more agents in comparison with 11% of patients in the other group.
This group also had a 44% reduction in risk of stroke, fatal and non-fatal, compared with the group assigned to less tight blood pressure control (P=0.013). This was partly because fewer patients required retinal photocoagulation, but the risk was still significantly reduced when retinal photocoagulation was excluded (data not shown). The cause of death in one patient in the group assigned to less tight control of blood pressure was attibuted to hypoglycaemia. More recently after finding that eating Paleo food choices was the "icing on the cake" health wise, I have become a Paleo enthusiast and teacher. If your blood has high glucose levels over the long term, you can look forward to blindness, impotence, kidney failure, amputated limbs and an early death, so the diabetic’s task is to keep those blood glucose levels down as close to normal as possible. It burns me up that these imbeciles are encouraging people to sabotage their chances of surviving diabetes. Why would professional nutritionists instruct diabetics to eat mostly foods that are going to turn them into broken-down pieces of shit?
The main difference between the groups was a much lower intake of grains and dairy products and a higher fruit intake in the Paleolithic group. The risk of diabetes complications increase when BGs are elevated over long periods of time. I have also heard others like yourself say that they can manage their T1 diabetes with a controlled amount of carbs (carb counting) and careful insulin dosage. This made easy section looks at the reasons for debridement, the methods available and the skills required to manage the wound effectively.What is debridement? Once the decision to debride a wound is made and the method confirmed, clinicians should consider their own skills to perform the task. New additions to existing options may demonstrate a reduced need for more advanced debridement treatments. Autolytic debridement and biosurgical (larval) therapy, combined with the use of new products (such as Debrisoft®)may make the process of debridement more universally available. Blood glucose levels that remain high over time can damage your eyes, kidneys, nerves, and blood vessels. 18 19 Lowering blood pressure also decreases albuminuria in type 2 diabetes,20 but whether it also reduces the risk of end stage renal disease or of cardiac disease is not known. Patients were enrolled on the basis of the mean of three blood pressure measurements taken at consecutive clinic visits. The suggested sequence was frusemide 20 mg daily (maximum 40 mg twice daily), slow release nifedipine 10 mg (maximum 40 mg) twice daily, methyldopa 250 mg (maximum 500 mg) twice daily, and prazosin 1 mg (maximum 5 mg) thrice daily. If treatments and target blood pressures were not in accord with the protocol, the coordinating centre sent letters about affected patients to the clinical centres requesting appropriate action. Monthly quality assurance measurements have shown the mean difference between Takeda and Hawksley machines to be 1 (4) mm Hg or less.
Every year a fasting blood sample was taken to measure glycated haemoglobin (haemoglobin A1c), plasma creatinine concentration, and concentrations of urea, immunoreactive insulin, and insulin antibodies; random urine samples were taken for measurement of albumin concentration.
They are compared in the accompanying paper.29 Life table analyses were performed with log rank tests, and hazard ratios were obtained from Cox's proportional hazards models and used to estimate relative risks. Change in diabetic retinopathy was defined as a change of two steps (one step in both eyes or two or more steps in one eye) with a scale from the worse eye to the better eye that included retinal photocoagulation or vitreous haemorrhage as the most serious grade.
The mean differences in systolic and diastolic pressures were 10 (95% confidence interval 9 to 12) mm Hg and 5 (4 to 6) mm Hg respectively. The proportion of patients taking nifedipine was 32% in the group assigned to less tight blood pressure control and 31% and 40% in the group assigned to tight blood pressure control taking captopril and atenolol respectively. The trend to protection against microvascular disease and death related to diabetes became evident within the first three years of allocation to tight control (figs 4–7). The trend for reduced risk of fatal and non-fatal renal failure was non-significant (fig 8).
At nine years of follow up the group assigned to tight blood pressure control had a 47% reduction in risk of a decrease in vision by three or more lines in both eyes measured with an ETDRS chart (P=0.004) (fig 9). There was no significant difference in plasma creatinine concentration or in the proportion of patients who had a twofold increase in plasma creatinine concentration between the two groups. There was no difference between the allocations for other surrogate indices of macrovascular disease. Patients in the Paleolithic group were recommended to eat lean meat, fish, fruit, vegetables, root vegetables and nuts, and to avoid grains, dairy foods and salt.
In my opinion, the best information for people with T1 diabetes is to learn to carb count, dose insulin accordingly and eat from a wide variety of foods. Debridement is the removal of non-viable tissue (see Box 1) from the wound bed to encourage wound healing.
Further staff training or specialist referral may be a necessary consideration to provide safe and effective care.
16 25 26 Randomisation produced balanced numbers of patients allocated to the various glucose and blood pressure treatment combinations for the UK prospective diabetes study and hypertension in diabetes study. Retinal photographs were assessed at a central grading centre by two independent assessors for the presence or absence of diabetic retinopathy. If agreement was not possible the information was submitted to a panel of two further independent assessors for final arbitration. Visual loss was defined as the best vision in either eye, deteriorating by three lines on an ETDRS chart. Cross sectional blood pressure in patients with data at each year were similar to the data in patients with nine years of follow up. There was no significant difference in the incidence of death from accidents, cancer, other specified causes or unknown causes. Of the sixteen patients, five have retained or reduced bodyweight since the 22 month point and all but one have lower weight at 44 months than at start. After nine years of follow up 29% of patients in the group assigned to tight control required three or more treatments to lower blood pressure to achieve target blood pressures.
Of the 1544 hypertensive patients, 252 were excluded and 144 patients did not enter the study.
In the text relative risks are quoted as risk reductions and significance tests were two sided.
I have in all seriousness been given medical advice that I should eat a high-carb diet that will wreck my blood sugar control because low-carb diets involve lots of fat, and diabetics have an increased risk of heart attack. Physicians recorded hypoglycaemic episodes as minor if the patient was able to treat the symptoms unaided and as major if third party or medical intervention was necessary. For aggregate end points 95% confidence intervals are quoted, whereas for single end points 99% confidence intervals are quoted to allow for potential type 1 errors. Similarly, 99% confidence intervals were used to assess surrogate end points that were measured at triennial visits. Mean (SD), geometric mean (1 SD interval), or median (interquartile range) values are quoted for the biometric and biochemical variables, with values from Wilcoxon, t, or ?2 tests for comparisons.
The overall values for blood pressure during a period were assessed for each patient as the mean during that period and for each allocation as the mean of patients with data in the allocation. Control of blood pressure was assessed in patients allocated to the two groups who had data at nine years of follow up.



January goodreads 2015
Natural treatment for diabetes control




Comments

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