Oral medications for diabetes mellitus journal,jan 10 2011,newly diagnosed type 2 diabetes medications review - PDF Books


Science, Technology and Medicine open access publisher.Publish, read and share novel research. Effectiveness of Fenugreek for Lowering Hemoglobin (HbA1c) in Patients with Self-Management of Type 2 Diabetes: A Randomized Controlled TrialRashid Ansari1 and Saiqaa Ansari2[1] School of Public Health, University of New England, Australia[2] School of Population Health, University of Queensland, Australia1. Cold SoresAlso called fever blisters, you don't get cold sores from fevers or colds but they can be triggered by them. When candida albicans attack certain parts of the body, white curd-like sores or patches may appear on the affected area and this is usually seen on the mucous membrane of the oral cavity. The course of treatment often depends on the infected individual’s overall health, causal pathogen, age and severity of the infection.
Refrain from using mouth sprays and mouthwashes when suffering from yeast infection in mouth. Add more yeast free foods to the diet and avoid the consumption of beer, bread, wine, sweets and other types of foods that can favor the growth and development of the fungus. People who smoke cigarettes or chew tobacco are at high risk of developing oral yeast infection.
For the symptoms of yeast infection in mouth, your physician might suggest inculcating a yeast infection diet. Note that individuals suffering with pre-diabetes or diabetes will always be at risk of contracting the infection. Other products that can be considered as yeast infection cures include Candidate, which is an herbal product, coconut oil, oregano oil and cinnamon oil. Bear in mind that it is equally important to be familiar with the symptoms of yeast infection in mouth.
Yeast Infection Sufferer Reveals Complete System That Will Show you How To Permanently Cure Your Yeast Infection. To treat thrush naturally limit consumption of sugar, milk, starchy vegetables, processed meat, alcohol, nuts, mushrooms and food products containing yeast.
The Lactobacillus strains present in probiotic food products and supplements can fight Candida growth in the mouth and tongue. People on antibiotics or medications that suppress the immune system can reduce their risks of developing oral Candida infection by taking probiotic supplements. To boost your body’s resistance against oral fungus, take vitamins and minerals that help to strengthen the immune system. Vitamins A, C, D and E are especially recommended for improving immune response. Grapefruit seed extract contains antifungal compounds. It also helps to stimulate the immune system, enhancing its ability to prevent growth of the Candida fungi.
On May 27th The Nigeria Diabetes online Community conducted it’s monthly chat dedicated to children living with diabetes in Africa.
The chat that coincides with Children’s day in Nigeria drew participants from Nigeria, UK, South Africa and Ghana.
The children’s day chat reflects the reality that faces us as a nation and africa as a continent on the need for a vibrant healthcare sector to combat the scourge of diabetes. All our participants have wards living with diabetes (we encourage parents and guardians to get their wards involved in social peer support chats online).
Most wards view living with diabetes as a burden (stressful,frustrating, depressive and expensive – in the words of pearl who has young relatives living with diabetes) with a few having a good insight of the condition.
Large percentage of our wards living with diabetes seemingly initially have a feeling of being the only ones with such condition in the world.
It was also noted that there’s a constant battle of emotions as the children hit their teens with their tendencies to want to fit in like their friends. In cases when their emotions are really all over the place, a constant show of love, mentoring and continuous education about diabetes has been noted to be very helpful.
We graciously call on the minister of health in all african countries to emulate the South Africa government who is said to provide free medications to include insulin and glucose strips.
The international diabetes federation life for a child has been commended for their active support in resource poor settings where insulin, glucometers and teststrips are provided for free. Wouldn’t it be great to see life saving medications donated for free exempted from import tax which could be enormous?
We wish to thank all our participants for their contributions and commitments to ensuring an healthy life with diabetes is achievable by our children. High grief when mere number set to a higher than normal level by regulatory defects in the body is allowed to hold the body hostage for too long. A high sugar effectively beaten down and kept so keeps the diabetic away from diabetes : diabetes sans diabetes. Diabetologists are the sugar experts but any clinician unable or unwilling to offer tangible help with the management of diabetes in its most general sense is likely to come to grief at some point in his career. Uncontrolled sugar over a long enough period raids virtually every tissue of the victim, none less so than the blood vessels. Increasing deterioration in calibre and reflex performance of the blood vessels lead to progressive interference in the circulatory status of the tissues, gradually compromising the nutritional transactions at the tissue interfaces. The ultimate compound effect is a sore, which no matter how small it started can fester into a huge crater, as deep as it is wide.
When a bad leg ulcer presents itself to the surgical clinic, what is often required to heal it can involve far more ?sacrifices than what is required to amputate the leg. An ulcer is any break in the skin lining; But it can very rapidly progress to well beyond the skin to involve underlying fat, muscles and bones. For any ulcer to heal,the strategic aim is reverse the very process or processes that led to it in the first instance. In others, fixed damages to the support system in the particular part, like the blood vessels and nerves prevent reversibility ?. Luckily the body is getting to yield more and more of its secrets to those researchers who relentlessly knock at its many doors. And through these unlocked secrets, the applied science at the bed sideis ?getting richly and confidently relevant . One thing is clear ; biologically nothing ever happens in the body unless pulled or pushed. Every cell is responding to something under a complex but well ordained set of traffic rules ?. But the pushers of growth( growth factors) are unable to push if the cell to be pushedhas no handles that can be engaged by pushers’ hands. So growth factors to be fully relevant must have growth receptors granting a hole into which reciprocal key can fit to unlock the handle to the transaction. The pusher ( growth factor) engages the ?handle ( growth receptor) on the pushed then the cell grows. And like mortar filling up a hole in the floor, the new cells can fill up the hole in say the leg. HerbeprotP is drug formulation composed of epidermal growth factor ; the growth pusher that can stimulate cell production at depleted sites causing tissue defects to fill up and stave off amputation.
The embargo is preventing the drug from getting out of Cuba to be tested for claimed impact on the wider market. Diplomatic talks between Washington and the Castro government on issues such as immigration, travel and commercial ventures are scheduled to start next week. At a briefing today on Obama’s normalization plans, administration officials were asked about the status of Heberprot but were noncommittal.
A proven drug that will thwart flesh-destroying diabetic wounds is desperately sought by physicians throughout the world, according to Dr.
Diabetes researchers at Umea University in Sweden reported in 2013 that worldwide, a limb is lost every 20 seconds because of a foot ulcer that doesn’t heal. Each year, he and his team at the Tucson medical center spend hours in operating rooms trying to save the lower limbs of more than 11,000 patients from around the world. Untreated or poorly treated, diabetes often interferes with blood flow to the extremities, causing vascular disease, a failure in anti-bacterial defenses and nerve damage.
Because of this loss of protective sensation, diabetic ulcers form but often go undetected. Hyperbaric oxygen treatment is sometimes useful, say diabetes specialists, but surgical removal of the dead flesh is the typical treatment.
Building walls between nations, the type Cruz and Trump want to do retard intellectual and scientific diffusion of knowledge and skills ; those of us who know this too well have no choice but fight against a Republican victory by any means. This gesture according to Sola Giwa is part of his commitments at ensuring the deliverance of democracy.
The public health screening will strictly be on diabetes and high blood pressure issues which will afford participants to be aware of its symptoms, damages and preventions to avert any health havoc. Importantly, this program aims to improve health awareness as well as overall wellbeing of the people in his constituency through a 4-day public enlightenment and screening in 4 different locations. Its intended target audience daily is between 500 making it 2,000 ground total target audience. It is with a heavy heart that I share the tragic story of a promising young boy with type 1 diabetes. I met Durojaiye Bola through the Pediatric Endocrinologist of The Olabisi Onabanjo University Teaching Hospital (OOUTH) a year ago. Although Durojaiye was diagnosed with Type1 diabetes his family was without the means to support the expense of his treatment and medication.
Right now Durojaiye has been referred to a plastic surgeon in a bigger hospital with the possibility of amputation. 4) An advocacy plan to ensure liable children with diabetes have access to insulin and other essential consumables. GlucoTrack uses ultrasonic, electromagnetic and thermal technologies to non-invasively measure glucose levels in the blood. The device is battery-operated and includes a Main Unit (UMU), which contains display and control features, as well as transmitter, receiver and processor, and a Personal Ear Clip (PEC), which contains sensors and calibration electronics, and is clipped to the earlobe. The equipment which is still in registration process will relieve the pressure of needle pricks and jabs. On the 29th of January,2016 The Nigeria Diabetes Online Community coordinated its monthly tweetchat centered around creating a platform for People living with diabetes in Nigeria to interact with an overall aim of creating a social peer support. The monthly #diabetes tweetchat – first of its kind in Africa has participants from all over Nigeria and Africa. Sometimes ago we got an email from someone explaining the health benefits of probiotics in diabetes reversal. He claimed probiotics when combined with other essential components can cause a reversal of diabetes. In as much as we know that a cure or reversal of diabetes isn’t established yet, we still decided to dig further into verifying his claims. Probiotics are live bacteria that naturally occur in certain foods—from fermented vegetables, to live-cultured yogurt.
The pathogenesis of diabetes mellitus is complex and one of the factors implemented is the oxidative stress. Although the research highlighted will not provide an immediate cure for people living with Type 1 or Type 2 diabetes, but it’s very interesting nevertheless. The study was focused on rats, and at that stage it is too early to say if the probiotic used would have the same benefits in humans, or if it could become a routine treatment for diabetes in humans. Years of further research using animal models and clinical trials in humans will be needed before we will know if this treatment could benefit people living with diabetes. Without further research, we do not know if this approach could potentially replace or work in combination with existing therapies for people living with diabetes.
It is important to note that, in people with Type 1 diabetes, insulin-producing cells in the pancreas are targeted and destroyed by an immune attack. According to this article on Diabetes UK page until further research has been completed, the best way to manage diabetes is by taking existing medications prescribed by your doctor, and maintaining a healthy weight by following a healthy balanced diet and taking regular exercise.
Although claims of cure has been a major influencer of late presentations at hospitals and increased complication in Nigeria, we believe that Africa has been endowed with natural remedies that if researched into may provide outstanding breakthroughs. We hope government, corporate organizations and individuals will invest in such researches. It is with great joy I congratulate us all on a successful out gone year and anticipate a greater and fulfilling 2016 ahead.
Looking at the achievements we had in the past years, we can’t but extend our profound gratitude to our partners,directors and our over 30 amiable volunteers whose activities pro-buono keeps us going.
Thank you all for investing your excellent spirits in ensuring a better life for people living with diabetes.
In a chaotic world marred by  religious extremism, wars, gender inequalities, natural and man-made disasters, communicable diseases, we at NGdoc remain resolute at making the world a better place for people living with diabetes one step at a time. Through the wonderful support of our partners and commitment of our volunteers we have become one of the foremost youth led diabetes organizations locally and globally.
As we start the new year I wish us all a more fulfilling and rewarding year ahead in all our endeavors. Your continual support, partnership and encouragement is highly solicited as we unveil our activities for the new year. 2016 is a year of more social peer support engagements with more national influence on policies and diabetes care. My Co-Founder and I have personally committed as part of our new year resolution to raise funds to support diabetes awareness and care for NGdoc and T1International – a non governmental organization whose charity activities have influenced advocacy and T1 care in resource poor settings. This fund will be committed to advocacy, access to essential medicine, diabetes awareness and care in resource poor settings, and importantly locally inspired diabetes research works.
So when we come to your door for your support ; please let us join hands in saving the world together. The Nigeria Diabetes Online Community in collaboration with The Pediatric Endocrinology department of the Olabisi Onabanjo University Teaching Hospital partnered with Penpals United – an organization that offers online support groups and pen-pal opportunities to people with type one diabetes around the globe towards the first online social peer support group for children living with diabetes in Nigeria.
The partnership ushers in the first online social support group for children living with diabetes in Nigeria with the aim of creating a platform for the empowerment of the children and support for their diabetes management and care through help with insulin access, mentoring and penpal. If you know any child living with diabetes and wish to join our subsequent periodic meetings , please feel free to reach on thengdoc(at)gmail(dot)com.
If you’re interested in partnering with us to ensure steady supplies of insulin, consumables and glucometers are available to our CWDs please do reach us.
A huge thanks to the medical team of the Olabisi Onabanjo University Teaching Hospital, Penpals United, T1International, Access Alliance, Marjorie Funds, Cajsa Lindberg and Cherise Shockley for the support towards making this a reality.
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Monoject Oral Medication Syringe with Tip Cap, manufactured by Kendall, is used to administer medication and to assist feeding in liquid diets.
IntroductionThe incidence of type 2 diabetes is increasing worldwide, resulting in large measure from the increasing prevalence of obesity (Yale, 2000).
The virus that causes cold sores is usually passed via a kiss, shared utensils, or other close contact. It is intended for general informational purposes only and does not address individual circumstances.
Candida refers to a large group of fungi and one of its specie is considered as the primary cause of the condition known as candidiasis or yeast infection. Oral yeast infection, also known as oral candidiasis or oral thrush, can also affect the tongue, gums, palate, tonsils and throat. It is necessary to brush the teeth using a toothbrush with soft bristles at least three times per day, once after each meal. These types of products can disrupt the balance of microorganisms inside the mouth and worsen the infection.
Reduced consumption of the mentioned products can hamper the development of infection and prevent its recurrence in the future.
If you want to protect yourself against such condition, then it would be best to avoid these vices to reduce the frequency of yeast infection outbreaks.


That is why these individuals have to be very careful with the foods that they are consuming and they should put extra effort when it comes to maintaining normal levels of blood sugar by following a diet that is both yeast and sugar free. Administration of these is proven effective against the infection and in preventing its recurrence. The most noticeable symptoms of the condition include the presence of white, cream or yellow-colored, raised patches inside the mouth or around the oral cavity. You might be required to undergo thorough diagnosis to determine the primary cause of infection.
It could affect a lot of things, your eating and your nutrition making you vulnerable to other ailments.
Just type in the keyword and the search box will help you go through our article archive easily. Also known as, oral Candida infection, thrush occurs when the balance of the microorganisms in the mouth is disrupted owing to certain diseases, medications or stress. Supplements and herbal remedies are frequently used for strengthening the immune system and inhibiting growth of the fungi.
They work by restoring the normal microbial balance in the mouth and stimulating the immune system. The antifungal property of garlic is attributed to ajoene and other sulfur containing compounds.
We are here to support and assist through education providing online platform for interactions. When they smell luck, they rush to the spot, and their feeding frenzy only expedites the rate at which tissue is lost and the system beyond poisoned. David Armstrong, professor of surgery and director of the University of Arizona’s Southern Arizona Limb Salvage Alliance. Georges Benjamin, executive director of the American Public Health Association, said that “there is politics in everything” but putting public health before politics is of prime importance to his organization, which just last month signed a agreement to work more closely with its Cuban counterparts. Without a proper blood supply, the tissue around the ulcer becomes infected, continues to die and the wound grows. And at a certain point, amputation becomes the only option to save the life of the patient.
Elof Eriksson, a Harvard University professor and chief of plastic surgery and a wound care expert at Boston’s Brigham and Women’s Hospital, last month returned from an international meeting of hundreds of wound specialists near Havana. This meeting coincided with our peer support program for children living with diabetes at the same institution where we met online with Jack Terschluse of Penpals United.
He was on our list for support, next in line to Omolade who, thanks to T1International through its diabetes warrior initiative underwent a vocational training to help her pay for her insulin needs and later a partner NGO called Priceless Jewel, now supports with her insulin and university education from a kind philanthropist. Last Friday I followed a friend to the ER of the teaching hospital and found him with burn scars on all of his limbs. In a bid to bring him back to life, his digits were burnt badly in fire by the religious members.
We must support community based organizations centered around caring for people with diabetes, encourage social peer support and help make the lives of children living with diabetes a meaningful one. If this approach were used to engineer new insulin-producing gut cells in people with Type 1, these cells could also be targeted by the immune system – so this would need to be monitored closely. Fetuga (Head of department of the pediatric department at the University and Consultant Pediatric Endocrinology), Doctors Adekoya, Obadina and Adebola from the teaching hospital in attendance. Diabetes mellitus is a pandemic disease and is one of the main threats to human health (Narayan, 2005).
It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. The most probable cause being linked to oral yeast infection is low count of white blood cell, low count of IgA and IgA deficiency. If the infected infant is generally healthy, the condition can be managed by giving the infant plain yogurt and acidophilus supplements. Wearing dentures and having diabetes calls for regular checkups with a physician, as individuals with either of the two are more susceptible to oral infections.
As already stated above, reduced intake of sugar is proven effective for the treatment of yeast infection and in preventing its symptoms.
Recurrent yeast infection can be an early sign of HIV or STD, and so proper diagnosis is necessary to rule out these conditions. Learn how to treat and deal with the condition by reading our articles and gain more knowledge about yeast infection through our website.
People with weakened immune system or diabetes have a higher risk of developing Candida infection in the mouth and tongue. The ideal diet for a person suffering from yeast infection should contain non-starchy fiber-rich vegetables, lean meat, fish and whole grains that do not contain gluten such as brown rice, millet and oat. You can also take supplements containing lactobacillus acidophilus or bifidobacterium to treat thrush. To treat Candida infection, you can eat fresh garlic or garlic supplements and apply garlic oil or paste to the affected areas.
How many young boys and girls in Africa must go through the same traumatic experience before our community takes action? The syringes have clear, polypropylene barrels that permit easy visual inspection of content, and the dual graduation markings in milliliters and teaspoons provide accurate dosage measurements.
Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site.
The fungus affects children, as they have vulnerable immune systems and adults with metabolic disturbances or diabetes, denture users, drug users, individuals undergoing antibiotic course for treatment of a certain medical condition, chemotherapy patients and individuals with poor nutrition and immune system.
Individuals with vulnerable immune system are recommended to consume prescribed antifungal medications. If the level of sugar into the body is low, none will favor the growth of yeast and this can suppress infection. However, once these areas are scraped or irritated, extreme pain sensation can be felt along with bleeding.
Reducing the sugar content in the diet deprives the Candida fungus of its main energy source, which helps to reduce fungal growth. In addition to taking caprylic acid supplement, consider applying coconut oil to the tongue and mouth. The NGdoc submitted a project proposal 2 years ago to a foundation for support of such an education initiative but unfortunately we never got the funding. Disposable and designed for single-use, these syringes are latex-free and have separate ribbed tip caps for a better grip. It is projected that this number will be increased by 72% to 333 million by 2025, and nearly 80% of these cases will be in the poorer industrialized countries (IDF, 2003).
Aside from medications, there are home remedies and self-care methods that should be adopted to hasten the recovery from the infection.
There are times when the condition is not responsive to medications and this is because the root cause of the problem is not treated with proper medications. According to a 2005 US Government estimate, approximately 21 million people in the United States have diabetes (Gerich, 2005). In 2002, diabetes was the sixth leading cause of death and had an estimated total cost of $132 billion (Hogan et al.
But a weakened immune system, antibiotics, diabetes, or certain medications -- such as  inhaled corticosteroids -- can give candida a chance to grow wild. Type 2 diabetes is a disease characterized by a dual defect: 1) by insulin resistance which prevents cells from using insulin properly, and 2) degrees of reduced pancreatic insulin secretion. A quarter of the population of Pakistan would be classified as overweight or obese with the use of Indo-Asian-specific BMI cutoff values. Black Hairy TongueThis painless condition occurs when the little bumps on your tongue grow long and trap bacteria that live in your mouth -- making the tongue look black and hairy.
Jafar et al (2006) have reported that prevalence of overweight was 25% and obesity was 10% in a large population-based sample of people over the age of 15 years in Pakistan.
Causes can include antibiotic use, poor oral hygiene, smoking, drinking a lot of tea or coffee, and not producing enough saliva.
On the age-specific prevalence of overweight and obesity, they found that more than 40% of women and 30% of men aged 35–54 years were classified as overweight or obese. Brushing the tongue and using a tongue scraper is usually all you need to treat it, though sometimes medication is necessary. It has been suggested in a variety of observational and epidemiological studies that physical activity may play a significant role in the prevention of type 2 diabetes mellitus.
The relationships between physical activity and overweight are only beginning to be understood for the adult population, sedentary behaviours, particularly watching television (TV) and videos, surfing the internet have been found to be related to higher body mass index (BMI) for adult’s population (Struber, 2004). Triggers include hypersensitivity, infection, hormones, stress, and not getting enough of some vitamins.
The literature linking physical activity levels with risk of overweight in adults is not consistent but physical activity is an important component of effective obesity treatments (Saelens, 2003). Also called aphthous ulcers, canker sores can show up on the tongue, cheek, even your gums. The main health promotion intervention here is the public health education which highlights the importance of physical activity for the prevention of type 2 diabetes in the middle-aged population of sub-continent and particularly Pakistan, which is experiencing a rapid and substantial decline of physical activity levels as a result of poor eating habits, unhealthy food supply, expansion of television, computerization, and mechanization, more prevalent car ownership and sedentary behaviour. In parallel with decreasing levels of physical activity, the prevalence of overweight and obesity has increased significantly in Pakistan and as a consequence, diabetes mellitus has become a major public health issue.
Persistent, severe canker sores can be treated with numbing creams, prescription drugs, or dental lasers. Therefore, promoting an active lifestyle or regular exercise has become the highest public health priority in that country to overcome the onslaught of type 2 diabetes. LeukoplakiaLeukoplakia is a reaction to an irritant, like rough teeth, badly fitting dentures, smoking, and smokeless tobacco. Also, the search for dietary adjuncts along with usual medical care to treat this life altering disease has become more important and dietary supplements that can modulate glucose homeostasis and potentially improve lipid parameters would be desirable. It can show up as white patches or plaques in the mouth, is usually painless, and can't be scraped off. Fenugreek (Trigonella foenum-graecum Linn) is a dietary supplement that may hold promise in this regard and is one of the oldest medicinal plants, originating in India and Northern Africa and dating back to ancient Egyptian times (Jensen, 1992).In Pakistan and India, fenugreek is commonly consumed as a condiment (Yoshikawa et al. Lichen PlanusA rare rash that shows up as lacy, white patches or red shiny bumps on the inside of the cheeks or tongue could be lichen planus. Fenugreek seeds also lower serum triglycerides, total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) (Al-Habori and Raman, 1998). The lipid-lowering effect of fenugreek might also be attributed to its estrogenic constituent, indirectly increasing thyroid hormones (Basch, 2003). The plant protein in fenugreek is 26%, so it might exert a lipid lowering effect (Sharma, 1986). Since a high proportion of diabetic patients in sub-continent suffer from malnutrition, the use of fenugreek which is rich in protein and fiber (48%), has a distinct advantage in these patients (Sharma, 1986). This chapter addresses the effectiveness of fenugreek for lowering hemoglobin (HbA1c) in this randomized controlled trial and determines whether the intervention of taking fenugreek in combination of usual medical care lowers HbA1c in patients with type 2 diabetes.
Effectiveness trials such as this are critical in determining if the interventions are effective in the practical world in which patients live. Geographic TongueWhen parts of your tongue are missing some of their small bumps, you end up with raised and lowered spots, giving your tongue a map-like appearance.
This randomized control trial addresses the research question “Is Fenugreek treatment with medical care for patients with type 2 diabetes more effective than usual medical care and can it help to lower the haemoglobin in patients with poorly controlled type 2 diabetes”? Characteristics of type 2 diabetesType 2 diabetes is associated with certain ethnic groups, obesity, family history of diabetes, and physical inactivity, among other factors. If there's pain, over-the-counter pain relievers and anti-inflammatory medications can help. Chronic, untreated hyperglycemia can lead to serious complications that include cardiovascular diseases, blindness, kidney failure, and stroke.
Furthermore, very low values of blood glucose (hypoglycemia) for even a short duration can result in loss of consciousness and coma.
The figure 1 shows the complications of type 2 diabetes which is a syndrome characterized by insulin deficiency, insulin resistance, and increased hepatic glucose production.
These metabolic abnormalities are treated by use of various medications which are designed to correct one or more of these metabolic abnormalities (Saltiel & Olefsky, 2001).
Type 2 diabetes is most common in adults, although younger people are also developing this type of disease. Causes can include smoking cigarettes and using smokeless tobacco, drinking heavily, overexposure to the sun, and a family history of cancer. It starts with a slow onset with thirst, frequent urination, weight loss developing over weeks to months. It is also considered to run in families but it may happen with a person without a family history of diabetes as well.
Don't let fear keep you from the doctor -- oral cancer that is caught early is treatable and curable. TMJA problem with the jaw called temporomandibular joint syndrome can cause  severe pain in the jaw, face, ear, or neck. Clenching, tooth grinding, or injury can all cause TMJ syndrome, but the results are often the same: pain, headaches, dizziness, even trouble swallowing. In its early stages, many people with type 2 diabetes can control their blood glucose levels by losing weight, eating properly and exercising. Many may subsequently need oral medication, and some people with type 2 diabetes may eventually need insulin shots to control their diabetes and avoid the disease's serious complications (Saltiel & Olefsky, 2001). Chipped TeethMunching on ice or hard candies, grinding or clenching teeth, even exposing teeth to heat and cold can lead to chips, cracks, and breaks in your teeth. Even though there is no cure for diabetes, proper treatment and glucose control enable people with type 2 diabetes to live normal, productive lives. A major advance for people at risk of developing type 2 diabetes - such as family members of those with the condition - occurred recently when it was shown that diet and exercise can prevent or delay type 2 diabetes. Your dentist can offer dental bonding, tooth contouring, porcelain veneers, and crowns to fix badly damaged teeth.
Amalgam TattooEver notice a small blue-gray "stain" in a soft part of your mouth after dental work? Called amalgam tattoos, they occur when a tiny piece of amalgam filling gets embedded in your cheek or gum. The silver in the amalgam leaches into your mouth's soft tissue, resulting in what looks a bit like a tiny tattoo. 2004), however, population-based data on the prevalence of diabetic retinopathy in Pakistan and on the visual impairment due to diabetic retinopathy is lacking and only the hospital-based data is available (Kayani et al. But if the blue-gray spot grows or changes color, there is a good possibility it may not be an amalgam tattoo. Diabetic nephropathy is present in 18% of people diagnosed with diabetes (DSG, 1993) and is a leading cause of end-stage renal disease (Molitch et al. 2003)Stroke: diabetes is associated with a 2- to 4-fold increase in cardiovascular mortality and stroke (Kannel et al. Gum DiseaseWhen periodontal (gum) disease develops, bacteria in plaque accumulate along the gum line.
Therefore, early detection and treatment of diabetes is essential in order to reduce the impact of its serious complications.
Development of type 2 diabetesDevelopment of type 2 diabetes is the result of multifactorial influences that include lifestyle, environment and genetics. The disease arises when insulin resistance-induced compensatory insulin secretion is exhausted.
Increased inflammation causes the gums to recede, forming pockets between the teeth and gums.


A high-caloric diet coupled with a sedentary lifestyle is one of the major contributing factors in the development of the insulin resistance and pancreatic ?-cell dysfunction as shown in Figure 2. These pockets trap tartar, plaque, and food debris that eventually lead to infection and abscesses.
However, a predisposing genetic background has long been suspected in playing a contributing role in the development of type 2 diabetes. Advanced gum disease damages the bone that supports teeth and is one of the leading causes of tooth loss in adults. The metabolic syndrome is defined as a clustering of atherosclerotic cardiovascular disease risk factors that include visceral adiposity (obesity), insulin resistance, low levels of HDLs and a systemic proinflammatory state.
There are key components to the metabolic syndrome which include in addition to insulin resistance (the hallmark feature of the syndrome), hypertension, dyslipidemia, chronic inflammation, impaired fibrinolysis, procoagulation and most telling central obesity.3. While you may hope this relieves pain faster, instead the acid in the aspirin burns a white, rough lesion into your gums or cheek.
Randomized controlled trials with fenugreekThe multiple trials in the past have shown conflicting results of the effect of fenugreek on the patients of type 2 diabetes. These studies showed some positive results on fasting serum glucose but did not examine hemoglobin (HbA1c) levels. Gupta et al (2001) reported the results of a small randomized, controlled, double-blind trial to evaluate the effects of fenugreek seeds on glycemic control. Simple burns should heal in about two weeks.  Cavities, Abscesses, DiscolorationFlossing, brushing, and rinsing daily and regular dental checkups help prevent problems like cavities, abscesses, and tooth discoloration. The authors reported that there were no significant differences between groups in mean glucose tolerance test values at the study's end.
However, the trial may have been too small or brief to detect significant mean differences between groups.
See your dentist as soon as possible if your tooth aches or if you have a fever, earache, or pain when you open your mouth wide.
Raghuram et al (1994) reported the results of a randomized, controlled, crossover trial of fenugreek seeds in 10 patients with type 2 diabetes. Bad BreathUnbrushed teeth have food particles around them that promote bacteria and cause bad breath.
In the fenugreek-treated patients, statistically significant mean improvements were reported for glucose-tolerance test scores and serum-clearance rates of glucose. Persistent bad breath or a bad taste in your mouth may be from continuous breathing through your mouth, dry mouth, tooth decay, a sign of gum disease, or even diabetes. Fight bad breath by brushing your teeth and tongue, flossing and rinsing with an antiseptic mouthwash daily, drinking water, and avoiding food triggers.
Sharma and Raghuram (1990) conducted two randomized, controlled, crossover studies in patients with type 2 diabetes. Significant mean improvements in fasting blood-glucose levels and glucose-tolerance test results were described in the fenugreek-treated patients. Moosa et al (2006) conducted study to evaluate the effect of fenugreek on serum lipid profile in hypercholesteremic type 2 diabetic patients and concluded that fenugreek seeds powder significantly reduced serum total cholesterol, triglyceride and LDL-cholesterol but serum HDL-cholesterol level elevation was not significant.
So-called "lie bumps" or transient lingual papillitis are common even if you tell only the truth. Neeraja and Rajyalakshmi (1996) presented a case series including six men with type 2 diabetes and six without diabetes. These small, harmless bumps go away on their own after a few days, but they may be uncomfortable.
The cases suggested fenugreek reduced postprandial hyperglycemia primarily in subjects with diabetes, but less so in subjects without diabetes. Their cause is a mystery -- it could be a reaction to a food or a minor trauma like biting the tongue. The studies conducted to date have been methodologically weak, lacking adequate descriptions of blinding, randomization, baseline patient characteristics, statistical analysis, and standardization data for the therapy used.
Demonstrating the efficacy of fenugreek has also been confounded by inconsistencies in the preparations, dosing regimens, and outcome measures used in the trials.
Moreover, none of the investigations have been conducted over the longer period (Basch, 2003). Method of patient selectionThe patients were recruited from the diabetic medical centre in rural area of Peshawar conducting the study of management of type 2 diabetes among the population aged 30-65 years.
Patients having coexisting liver, kidney or thyroid disorder were not included in the study.
Diabetes Criteria for patientsThe well known standard screening test for diabetes, the fasting plasma glucose (FPG), is also a component of diagnostic testing. The FPG test and the 75-g oral glucose tolerance test (OGTT) are both suitable tests for diabetes; however, the FPG test is preferred in clinical settings because it is easier and faster to perform, more convenient and acceptable to patients, and less expensive.
When it was found necessary, plasma glucose testing was also performed on individuals who have taken food or drink shortly before testing. Such tests are referred to as casual plasma glucose measurements and are given without regard to time of last meal.
A confirmatory FPG test or OGTT was also completed on such patients on a different day if the clinical condition of the patient permits.
Laboratory measurement of plasma glucose concentration is performed on venous samples with enzymatic assay techniques, and the above-mentioned values are based on the use of such methods. The A1C test values remain a valuable tool for monitoring glycemia, but it is not currently recommended for the screening or diagnosis of diabetes. Pencil and paper tests, such as the American Diabetes Association’s risk test, may be useful for educational purposes but do not perform well as stand-alone tests.
Capillary blood glucose testing using a reflectance blood glucose meter has also been used but because of the imprecision of this method, it is better used for self-monitoring rather than as a screening tool.
Determination of study sample size The study sample size was determined based on the assumption of the estimation of Standard Deviation (SD).
Therefore, the study design was selected to detect an effect size of 0.5 SD lowering of HbA1c.
It was assumed that 15% patients might be lost to follow-up in control group over the period of three months and only 5 % patients will be lost to follow-up in intervention group. This assumption was based on the popularity of fenugreek seeds used by diabetic patients in sub-continent to manage their glycemic control. Study population and randomizationInitially 325 patients with type 2 diabetes were invited to pre-randomized interview, out of which only 210 patients were included in the actual trial. Out of the 325 patients, 93 patients did not meet the inclusion criteria and 22 patients refused to participate in the trial. Finally, two hundred and ten (210) patients agreed to participate and signed informed consent documents at the clinic where they used to visit for their usual medical care for diabetes.
Therefore, 102 patients were randomized to intervention group (fenugreek supplements) and 108 to the control group (usual medical care). The randomization code was developed using a computer random number generator in a block size of eight patients. That helped to allocate patients to the intervention and control groups equally in each block – that is each patient would have an equal chance of allocation to either group. Once the randomization phase was completed, all patients were instructed to follow-up the usual medical care for their diabetes for the duration of the 90 days trial.
The patients were allowed to adjust their usual medications as recommended by their doctors.
In addition, each patient was asked to go for blood test for HbA1c on day 1 and then return to give blood sample after 90 days.
In addition, participants were advised not to take any other new treatments for the management of type 2 diabetes during the trial periods. The control group in randomized controlled trial received medical care from a physician-coordinated team. This team included physicians, nurses, dietitians, and mental health professionals with expertise and a special interest in diabetes. It is essential in this collaborative and integrated team approach that individuals with diabetes assume an active role in their care.
The management plan in that group was based on individualized therapeutic alliance among the patient and family, the physician, and other members of the health care team. This plan has recognized diabetes self-management education as an integral component of care and in developing the plan, consideration was given to the patient’s age, work schedule and conditions, physical activity, eating patterns, social situation and personality, cultural factors, and presence of complications of diabetes or other medical conditions. Patient self-management was emphasized, and the plan emphasized the involvement of the patient in problem-solving as much as possible. A variety of strategies and techniques were employed to provide adequate education and development of problem-solving skills in the various aspects of diabetes management. During the implementation of the management plan it was assured that each aspect of diabetes management was understood and agreed on by the patient and the care providers and that the goals and treatment plan were reasonable. Those patients randomized to take fenugreek (intervention group) received 100 gms fenugreek seeds powder from the pharmacy in the clinic.
They were instructed to take 50 gms doses twice a day at lunch and dinner time in addition to their normal medications for diabetes. Those patients randomized to usual medical care (control group) were instructed to take their normal medicines and follow-up with their doctor as per their normal schedule. All participants were contacted again after 90 days (3-months) to give their blood sample for HbA1c testing. At that time, a questionnaire was sent via e-mail to participants in both intervention and control groups to assess the progress of the fenugreek treatment and clinical care without fenugreek. The clinical and demographic characteristics of the patients in the two groups were well balanced at randomization.
A demographic measure included age, gender, weight, ethnicity, religion, marital status, previous episodes of glycemic control, previous and current treatments of type 2 diabetes.
The table 3 gives baseline characteristics of intervention and control groups in RCT trial. Diabetes treatment with medicationsThe treatment options of type 2 diabetes is shown in figure 4 suggesting the specific areas of actions using medications which influence the various organs of the body to correct the metabolic abnormalities such as reducing the liver glucose production, slowing down absorption of sugars from the gut and reducing the insulin resistance. There are currently six distinct classes of hypoglycemic agents available to treat type 2 diabetes. The patients in both the groups in RCT trials received medications recommended by their physicians.
The most common combinations among both the groups were Meglitinide (repaglinide) with Thiazolidendiones and Sulfonylurea with Biguanides. Details of hypoglycaemic medications used in RCT trialThe diabetes medications mentioned in table 4 work in different ways but the main function of all these medications include lowering blood sugar levels; help improve the body’s use of glucose, decrease the symptoms of high blood sugar, help keeping patients with diabetes functioning normally and may prevent the complications, organ-damaging effects and premature deaths diabetes can cause.
Since the drugs work in different ways, these are sometimes used in combination to enhance the effectiveness of treatment. In this RCT trial Sulfonylurea was used in combination with Biguanide (metformin) and Meglitinide was used in combination with Thiazolidinedione.
The main function of Sulfonylurea is to bind and inhibit the pancreatic ATP-dependent potassium channel that is normally involved in glucose-mediated insulin secretion. Like the sulfonylurea, meglitinide therapy results in significant reduction in fasting glucose as well as HbA1c. The mechanism of action of the meglitinide is initiated by binding to a receptor on the pancreatic ?-cell that is distinct from the receptors for the sulfonylurea. Metformin is a member of this class and is currently the most widely prescribed insulin-sensitizing drug in current clinical use.
Metformin administration does not lead to increased insulin release from the pancreas and as such the risk of hypoglycemia is minimal. Because the major site of action for metformin is the liver its use can be contraindicated in patients with liver dysfunction. Thiazolidinedione: The thiazolidinedione (pioglitazone) has proven useful in treating the hyperglycemia associated with insulin-resistance in both type 2 diabetes and non-diabetic conditions. The net effect of the thiazolidinedione is a potentiation of the actions of insulin in liver, adipose tissue and skeletal muscle, increased peripheral glucose disposal and a decrease in glucose output by the liver. Diabetes treatment with diet and exerciseThe normal diabetes treatment addresses the issues related to unhealthy lifestyles, such as lack of physical activity and excessive eating, which are the main causes to initiate and propagate the majority of type 2 diabetes (Michael, 2007). Studies have demonstrated strong relationship between excess weight and the risk of developing type 2 diabetes, hypertension, and hyperlipidemia.
Therefore, the objective of physicians is to motivate patients to lose weight and exercise to improve the control of diabetes and slow down or even reverse the natural course of the disease (Michael, 2007).However, it is difficult to overstate the importance of the relationship between lifestyle and the risk of developing type 2 diabetes. There are prospective studies which have demonstrated that lifestyle modification in the form of diet and regular moderate exercise sharply decrease the likelihood of developing type 2 diabetes in high-risk individuals who have impaired glucose tolerance or impaired fasting glucose. The effectiveness of this intervention superseded that of metformin therapy (Knowler et al. In this RCT trial, physicians compiled the flow scheme shown in Figure 5 which represents the method of treatment of type 2 diabetes by the combination of diet, exercise and medication for diabetes monitoring and control. It has been divided into two segments: for obese and normal weight patients and the combination of medication for both the groups of patients. Dietary consideration for patients (intervention and control group)It has been recommended that carbohydrate and monosaturated fat consumption for the patients with type 2 diabetes should comprise 60-70% of total calories. However, there is some concern that increased unsaturated fat consumption may promote weight gain in obese patients with type 2 diabetes and therefore may cause in reduction of insulin sensitivity (Bantle et al. The “glycemic index” is an attempt to compare the glycemic effects of various foods to a standard, such as white bread. Although several authors have proposed its clinical usefulness in controlling postprandial hyperglycemia, prospective studies have not demonstrated a clear improvement in hemoglobin (HbA1c) in patients using low-glycemic index diets (Michael, 2007).
The physicians in this trial have recommended the best mix of carbohydrate, protein, and fat that was adjusted to meet the metabolic goals and individual preference of the patients with diabetes in both the intervention and control groups. It has been recommended for individuals with diabetes, that the use of the glycemic index and glycemic load may provide a modest additional benefit for glycemic control over that observed when total carbohydrate is considered alone (ADA, 2011). Monitoring carbohydrate, whether by carbohydrate counting, choices, or experience-based estimation, remain a key strategy in achieving glycemic control.
Physical activity consideration for patients (intervention and control group)Physical activity is a key component of lifestyle modification that can help individuals prevent or control type 2 diabetes. It is considered that diet is probably more important in the initial phases of weight loss, incorporating exercise as part of a weight loss regimen helps maintain weight and prevent weight regain (Klein et al. In this trial, the message was given to both the groups that as little as 30 minutes of moderate physical activity daily may offer greater benefits to these patients in managing their diabetes. It has also been reported that in patients with type 2 diabetes, structured regimens of physical activity for 8 weeks or longer improved HbA1c independent of changes in body mass (Sigal et al. The evidence supports the contention that controlling blood glucose through modification of diet and lifestyle should be mainstay of diabetes therapy.
It was found in this RCT that despite being one of the most time-consuming discussions with the patients in both the groups, this is probably the most important patient-physician discussion in regard to diabetes control and prevention of disease progression and complications.
Statistical analysisWe analysed the primary outcome by an un-paired sample t-test (mean difference between baseline and final HbA1c).
The statistical analysis was carried out on an intention to treat basis and that was subject to the availability of data at follow up as well as at entry level for individual patients. The differences between mean changes were tested by unpaired t tests, and ?2 tests (chi-squared test) were used to test for differences in proportions between the fenugreek treatment and clinical based treatment groups.



Pw50 2005
Umhs management of type 2 diabetes mellitus may 2014 online
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Comments

  1. Samirka

    The wrong food item unhealthy Food and lifestyle and certain ketosis can be triggered.

    29.12.2014

  2. alishka

    American dietetic association, as well as other governmental and.

    29.12.2014