Low risk drinking is defined as 2 or less drinks per day, with 9 or less drinks weekly for women and 14 or less weekly for men.
20-50% of hospital admissions, 10& of premature death, 30% of suicides, and 50% of traffic fatalities in Canada arealcohol-related.
Alcohol withdrawal can be significant and life threatening, and can be treated with benzodiazepines. A massive increase in NADH results, and this diverts pyruvate and OAA away from gluconeogenesis.
This, accompanied by potential reduced dietary intake and depletion of the liver's glycogen stores, can result in hypoglycemia. Many of the behavoiurs associated with alcohol intoxication - agitation, impared judgement, and combativeness - can be produced by hypoglycemia.
The acute depressive effects of alcohol are thought to be due to changes in the fluiditiy of membrane phospholipids and altered signal transduction. Alcohol causes acute, reversible fatty liver, which in chronic alcoholics can lead to palpable hepatomegaly. In chronic ethanol use, 10-15% of alcoholics develop cirrhosis, characterized by a hard, shrunken liver.
Chronic thiamine deficiency is common in alcoholics and leads to nerve cell degeneration, reactive gliosis, and cerebellar and nerve atrophy.
Chronic alcohol use can cause cardiomyopathy, and while the mechanism is unknown, direct toxicity is likely involved. Ethanol toxicity can lead to acute gastritis, and chronic users can develop acute and chronic pancreatitis. Chronic alcoholism often leads to reduced availability of vitamins due to dietary and liver insufficiency. Ethanol can be toxic to skeletal muscle, leading to muscle weakness, pain, and breakdown of myoglobin. Alcohol is associated with cancers of the mouth, pharynx, esophagus, liver, and possibly the breast.
Methanol is metabolized into formaldehyde, resulting in metabolic acidosis, dizziness, vomiting, blurred vision and blindness, and respiratory depression. Drinking above low-risk levels, but with no alcohol-related physical or social problems, puts people at risk. A positive response on any one of the RAPS4 items or both of the QF items is considered positive on the RAPS4-QF.
During the last year has a friend or family member ever told you about things you said or did while you were drinking that you could not remember? During the last year have you failed to do what was normally expected from you because of drinking? False positives can occur when the individual uses drugs (such as barbiturates) that induce GGT. With treatment, 60-70% of people with jobs and families have an imprived quality of life after one year. Our personalised weight loss & diabetes lifestyle programs are medically supervised to help you achieve and maintain a healthy weight - for life. The reason our programs achieve such fantastic long-term results is the focus on creating effective positive life habits, for each client.
With over 150,000 hours of consulting experience, our clinical team have the experience and know-how to support you with a wide-range of dietetic, exercise, and health issues. Standard drinks are a simple and effective way of keeping track of how much alcohol you’re consuming.
If you want to lose weight however, or if your triglyceride levels are high, you have poor glucose control or high blood pressure; try to drink alcohol on special occasions only. Hypoglycemia (low blood glucose levels) Alcohol in large amounts and particularly when consumed on an empty stomach, stops the liver from releasing glucose.
Raised triglyceride levels Alcohol can increase the levels of triglycerides (a type of ‘bad’ fat) in your blood.
Some research has suggested that there may be a cardiovascular benefit from drinking moderate amounts of alcohol, particularly red wine. The Australian Government has recently put together a report addressing national guidelines for alcohol consumption, which can be viewed here.
Certain information about the patient’s past medical history and current heath status should be obtained with every patient contact. Occasionally when Paramedics ask a patient if he has any medical problems, some patients will tell the Paramedic that there are not any, even though there is a history of a chronic disease. The Paramedic should ask the patient about any medication use and inquire about prescription, over the counter, and homeopathic or nutritional substances. The Paramedic can face difficulty in obtaining an accurate medical history in some situations. It is often imperative to question the patient about topics that may be embarrassing or socially sensitive in order to learn more about factors which may have contributed to the illness. Whenever confronted with unexpected silence, the Paramedic should be alert for nonverbal clues of distress and try to determine if anything in his interview technique might be responsible for them. It is easy to become impatient with an overly talkative patient when time is of the essence.
Although not ideal, the Paramedic may have to lower expectations and accept a less comprehensive history. Providing reassurance to patients can be both beneficial and harmful depending on the way it is provided. It is not unusual for patients to exhibit anger toward healthcare personnel for a variety of reasons, including feeling unwell, suffering anxiety, or developing a feeling they have lost control over their lives. Acutely intoxicated patients who are belligerent, angry, or uncooperative can be some of the most difficult patients to interview.
Crying is an important clue to emotions.27-29 The Paramedic should be supportive and wait for the patient to recover. Occasionally, despite best efforts, the patient’s history does not appear to make sense and the Paramedic may feel baffled or confused.
Most patients with even moderately limited intelligence can usually give adequate histories.
However, the Paramedic should be careful about making assumptions about the patient’s level of functioning.
When confronted with a patient-provider language barrier, the Paramedic should make every effort to obtain a translator. In many regions and cultures, it is disrespectful for children to question their elders, especially in personal matters.
Patients with hearing impairments may present as many issues as those with language barriers.
When talking to a patient with limited vision, the Paramedic should make sure to identify herself, alert the patient to her location, and explain what is being done. Paramedic should avoid making any sudden movements that may increase the patient’s anxiety in what is likely already a stressful situation.
The novice Paramedic must master the skill of history taking in order to be effective at providing care to the vast array of patients encountered during one’s career. The Worksite Wellness Committee is sponsoring a blood pressure self-monitoring program for DHSS employees.
Each kit has a blood pressure cuff, self-tracking cards, and information about blood pressure and how to manage or prevent high blood pressure. Many of us often ignore our blood pressure but carefully monitoring it could help save your life. Untreated high blood pressure, also called hypertension or HBP, can lead to serious health conditions including heart attack and heart failure, stroke and kidney failure.
Wait at least 30 minutes after having consumed caffeine, alcohol, medicine, or herbal remedies.
Follow the recommended procedure for taking your blood pressure based on the type of device you're using (digital blood pressure monitor or manual blood pressure methods). For more information about blood pressure, visit the Mayo Clinic and the American Heart Association. Intensive control of blood glucose and keeping glycosylated hemoglobin (HbA1c) levels below 7%. Diabetic ketoacidosis (DKA) is a life-threatening complication caused by insulin deficiency. The process is usually triggered in insulin-deficient patients by a stressful event, most often pneumonia or urinary tract infections. Severely low insulin levels cause excessive amounts of glucose in the bloodstream (hyperglycemia). These fatty acids are converted into chemicals called ketone bodies, which are toxic at high levels. Cerebral edema, or brain swelling, is a rare but very dangerous complication that occurs in 1% of ketoacidosis cases and results in coma, brain damage, or death in many cases.
Other serious complications from DKA include aspiration pneumonia and adult respiratory distress syndrome. If the condition persists, coma and eventually death may occur, although over the past 20 years, death from DKA has decreased to about 2% of all cases.
Life-saving treatment uses rapid replacement of fluids with a salt (saline) solution followed by low-dose insulin and potassium replacement. Patients with type 1 diabetes are 10 times more at risk for heart disease than healthy patients. Both type 1 and 2 diabetes accelerate the progression of atherosclerosis (hardening of the arteries). In type 1 diabetes, high blood pressure (hypertension) usually develops if the kidneys become damaged. Impaired nerve function (neuropathy) associated with diabetes also causes heart abnormalities. Atherosclerosis is a disease of the arteries in which fatty material is deposited in the vessel wall, resulting in narrowing and eventual impairment of blood flow.


Diabetic nephropathy, the leading cause of end-stage renal disease (ESRD), occurs in about 20 - 40% of patients with diabetes. Diabetes is responsible for more than half of all lower limb amputations performed in the U.S. People with diabetes who are overweight, smokers, and have a long history of diabetes tend to be at most risk. In general, foot ulcers develop from infections, such as those resulting from blood vessel injury.
Charcot foot is initially treated with strict immobilization of the foot and ankle; some centers use a cast that allows the patient to move and still protects the foot.
Diabetes accounts for thousands of new cases of blindness annually and is the leading cause of new cases of blindness in adults ages 20 - 74.
The early and more common type of this disorder is called nonproliferative or background retinopathy. If the capillaries become blocked and blood flow is cut off, soft, "woolly" areas may develop in the retina's nerve layer. Type 1 diabetes is associated with a slightly reduced bone density, putting patients at risk for osteoporosis and possibly fractures. Women with diabetes should also be aware that certain types of medication can affect their blood glucose levels.
It is also important for women to closely monitor their blood sugar levels during pregnancy. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Breakdown of peripheral fat stores leads to increased free fatty acids in the liver, and lipid biosynthesis is increased due to excess NADH production. Thiamine insufficiency (wernicke-Korsakoff Syndrome) is common, leading to peripheral vasodilation and myelin degeneration. Upper GI cancers may result from the reduction in detoxification of carcinogens such as nitrates and nitrites. The condition of the conjunctival tissue is evaluated on the basis of the extent of capillary engorgement and scleral jaundice.
This should be estimated with the arms extended anteriorly, half bent at the elbows, with the hands rotated toward the midline. This should be evaluated with the tongue protruding a short distance beyond the lips, but not too excessively. Its buildup leads to flushing, headache, nausea, and hypotension if alcohol is ingested, discourages alcohol abuse. Do not base any decision or action on this site's contents, either for yourself or someone else, without first consulting with a health care professional. When alcohol is consumed, our bodies use this nutrient firstly as the fuel source, causing other nutrients (fat, carbohydrates and protein) to be stored. However, there are many aspects of one’s medical history, most of which are not necessary to obtain during a medical emergency.
Most patients should be specifically asked about heart problems, hypertension, breathing problems, and diabetes. If an allergy is reported by the patient, the Paramedic should inquire what type of reaction the patient had to the medication. The Paramedic should also determine if the patient is compliant with medication use and how long the patient has been taking each medicine. Forming this impression will allow the Paramedic to decide which other questions she should ask and which physical exams she should perform to confirm the Paramedic’s conclusion.
Application of several simple techniques can assist the Paramedic in obtaining a history in these situations. These topics might include such issues as drug and alcohol use, physical abuse, and sexual history.
It may be helpful for the Paramedic to allow the patient free reign for the first few minutes and then directly question the patient about the most important details.
If necessary, he should explain to the patient that time is short and that the current discussion will be continued later. For some patients, anxiety has significant implications in their reaction to their illness or even may have contributed to their illness.
In an emergency situation, many patients worry not only about their condition, but also how it affects others they care for or love.
Paramedics should use a calm, direct voice and simple directions to encourage the patient to allow himself to be assessed and treated. Quiet acceptance or a supportive comment may assist the patient in composing herself and continuing the interview. The Paramedic should always maintain a high index of suspicion for depression in patients complaining of multiple, vague symptoms. If the Paramedic becomes aware of such feelings, one should realize that these thoughts are normal responses.
While many of these situations involve an emotional component, the Paramedic should avoid dismissing the patient’s concerns and instead attempt to focus in on a single chief concern.
When patients suffer from severe mental impairment, however, most of the history will have to be derived from other sources, such as family, friends, or medical charts.
The best technique, just as with any other patient, is to establish a relationship first with the patient and then, if necessary, seek other sources for history. She should remember to always respond vocally to the patient and avoid raising her voice while speaking. With practice and by observing other experienced healthcare providers obtain a history from a patient, the novice Paramedic will soon develop and refine her skill. However, it is often not used in emergent situations due to the extensive amount of data it collects and time required. The mnemonic SAMPLE is used to remember the different historical components of a focused history. This approach can help prevent complications due to vascular (blood vessel) abnormalities and nerve damage (neuropathy) that can cause major damage to organs, including the eyes, kidneys, and heart. Blood glucose control helps the heart, but it is also very important that people with diabetes control blood pressure, cholesterol levels, and other factors associated with heart disease.
Other triggers include alcohol abuse, physical injury, pulmonary embolism, heart attacks, or other illnesses. Among young patients, the youngest children and boys of any age are at higher risk for hypoglycemia. Hypoglycemia unawareness is a condition in which people become accustomed to hypoglycemic symptoms. Mild symptoms usually occur at moderately low and easily correctable levels of blood glucose. Heart attacks account for 60% of deaths in patients with diabetes, while strokes account for 25% of such deaths. Severely restricted blood flow in the arteries to the heart muscle leads to symptoms such as chest pain. With this condition, the tiny filters in the kidney (called glomeruli) become damaged and leak protein into the urine. Patients with ESRD have 13 times the risk of death compared to other patients with type 1 diabetes. It is a common complication that affects nearly half of people with type 1 or type 2 diabetes after 25 years.
Studies show that tight control of blood glucose levels delays the onset and slows progression of neuropathy. People who have the disease for more than 20 years and are insulin-dependent are at the highest risk. Numbness from nerve damage, which is common in diabetes, compounds the danger since the patient may not be aware of injuries.
Charcot foot or Charcot joint (medically referred to as neuropathic arthropathy) occurs in up to 2.5% of people with diabetes. When the acute phase has passed, patients usually need lifelong protection of the foot using a brace initially and custom footwear. Patients with no signs of retinal damage or low risk factors for retinopathy may only require screening every 2 - 3 years. People with diabetes face a higher risk for influenza and its complications, including pneumonia, possibly because the disorder neutralizes the effects of protective proteins on the surface of the lungs. Women with diabetes face a significantly higher risk for urinary tract infections, which are likely to be more complicated and difficult to treat than in the general population. Depression, in turn, may increase the risk for hyperglycemia and complications of diabetes. The changes in estrogen and other hormonal levels that occur during perimenopause can cause major fluctuations in blood glucose levels.
Up to a third of young women with type 1 diabetes have eating disorders and under-use insulin to lose weight.
A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Ethanol and its metabolites are directly toxic to hepatocytes, leading to necrosis and fibrosis. Cirrhosis is a serious, potentially fatal disease accompanied by weakness, muscle wasting, ascites, GI hemorrhage, and coma.
Thiamine is involved in the oxidative decarboxylation of pyruvate and alpha-ketoglutarate, two important molecules in energy metabolism. Examination is best conducted in clear daylight by asking the patient to direct his gaze upward and then downward while pulling back the upper and lower eye-lids. However, it will inactivative prescription opioids as well, and can trigger opioid witdrawal. The key is to focus on significant historical information or those aspects necessary to determine the nature and potential severity of the patient’s illness or injury.
Much of the difficulty in asking sensitive questions lies with our own biases, embarrassment, or perceptions with these topics.


Patients may use silence to collect their thoughts or remember details about their concerns. If necessary, he should interrupt the patient as gently as possible and summarize the history as succinctly as possible.
The Paramedic should refocus the patient on one concern by asking the patient about the most important concern, for example, "You told me many concerns. The Paramedic should be conscious of nonverbal clues to the patient’s anxiety and, when he senses anxiety, encourage the patient to talk about his or her feelings.
By providing reassurance, the Paramedic can help calm the patient down, allowing him to make appropriate medical decisions or be more cooperative with the assessment and treatment.
They can attempt to defuse the patient’s anger by identifying that, although they understand he is angry, you are there to help him. The Paramedic should try to avoid talking to the patient in a confined area, as the patient may feel trapped and react with hostility.
If the patient is depressed, one should be concerned for the possibility of self-harm and question the patient directly about suicidal thoughts.30 Any patient with the potential for self-harm must be transported to an emergency department for further evaluation. However, one must prevent these feelings from affecting her professional interaction with the patient. The Paramedic should use simple language when interviewing the patient and listen closely as the patient describes tests or other elements of his medical history. Using a family member often leads to distorted meanings and may present a confidentiality problem.31,32 The Paramedic should look at the patient when talking, and not the translator.
If it is necessary to use children as translators, one should ask as few questions as possible and alert the staff at the hospital so that a more thorough and accurate history can be obtained. Often the patient is able to read lips well enough to answer the Paramedic’s questions. The Paramedic may need to explain procedures and actions in more detail than is needed for patients with normal vision.
It may also occur in a person with type 1 diabetes who is not consistent with insulin therapy, or who has an acute illness or infection that makes their diabetes difficult to control. The most serious consequences of neuropathy occur in the legs and feet and pose a risk for ulcers and, in unusually severe cases, amputation.
Patients with diabetes should be aware of other warning signs of a heart attack, including sudden fatigue, sweating, shortness of breath, nausea, and vomiting. The consequences of both poor circulation and peripheral neuropathy make this a common and serious problem for all patients with diabetes.
About 85% of amputations start with foot ulcers, which develop in about 12% of people with diabetes. Related conditions that put people at risk include peripheral neuropathy, peripheral artery disease, foot deformities, and a history of ulcers.
Early changes appear similar to an infection, with the foot becoming swollen, red, and warm. People with diabetes are also at higher risk for developing cataracts and certain types of glaucoma. The two primary abnormalities that occur are a weakening of the blood vessels in the retina and the obstruction in the capillaries -- probably from very tiny blood clots. Patients beginning a new or vigorous exercise program should have their eyes examined, as well as all patients planning pregnancy.
Everyone with diabetes should have annual influenza vaccinations and a vaccination against pneumococcal pneumonia.
In terms of sexual health, diabetes may cause decreased vaginal lubrication, which can lead to pain or discomfort during intercourse. Long-term use (more than 2 years) of birth control pills may increase the risk of health complications.
Studies indicate that high blood sugar levels (hyperglycemia) can affect the developing fetus during the critical first 6 weeks of organ development. Women with diabetes also face an increased risk of premature menopause, which can lead to higher risk of heart disease.
Adolescents with diabetes are at higher risk than adults for ketoacidosis resulting from noncompliance. Anorexia and bulimia pose significant health risks in any young person, but they can be especially dangerous for people with diabetes.
Other signs of chronic alcohol ingestion include the appearance of 'goose-flesh" on the neck and yellowish blotches on the skin. All patients should be questioned about chronic illnesses, medications taken, allergies, and tobacco, alcohol, or other drug use.
If related to the chief concern, such as a bee sting, the Paramedic should inquire about environmental allergies. Silence may be the result of insensitivity by the Paramedic in asking questions, or the patient may be taking some time to decide whether or not to trust the Paramedic.
Also, he should ensure that the translator asks the patient the question and is not just answering the question for the patient. He should avoid shouting or raising his voice unless the patient indicates it helps her hear the questions. If walking with a patient with vision impairment, the patient should grasp the Paramedic’s arm rather than the Paramedic grasping his or hers.
Longer survival rates are probably due to improvements in monitoring and tighter control of blood glucose.
Other contributing factors are lack of health insurance and intentionally reducing insulin doses in order to lose weight, which occurs with adolescent girls in an effort to keep weight down.
It affects about 25% of patients who use insulin, nearly always people with type 1 diabetes. Urine tests showing microalbuminuria (small amounts of protein in the urine) are important markers for kidney damage. Symptoms of kidney failure may include swelling in the feet and ankles, itching, fatigue, and pale skin color. Peripheral neuropathy usually starts in the fingers and toes and moves up to the arms and legs (called a stocking-glove distribution).
Lowering triglycerides, losing weight, reducing blood pressure, and quitting smoking may help prevent the onset of neuropathy.
If these processes affect the central portion of the retina, swelling may occur, causing reduced or blurred vision. In this more severe condition, new abnormal blood vessels form and grow on the surface of the retina. Therefore, it is important that women with pre-existing diabetes (both type 1 and type 2) who are planning on becoming pregnant strive to maintain good glucose control for 3 - 6 months before pregnancy. Young people who do not control glucose are also at high risk for permanent damage in small vessels, such as those in the eyes.
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In contrast, capillary engorgement is reflected in the appearance of burgundy-coloured vascular elements and the appearance of a greenish-yellow tinge to the sclera. Signs of clinical intoxication include slurred speech, disorganized thinking, inappropriate responses to your questions, combativeness, and staggering gait.
Paramedics need to make clear to these patients that the relationship with them is purely professional.
Usually the condition is manageable, but, occasionally, it can be severe or even life threatening, particularly if the patient fails to recognize the symptoms, especially while continuing to take insulin or other hypoglycemic drugs. In such cases, hypoglycemia appears suddenly, without warning, and can escalate to a severe level.
The outlook of end-stage renal disease has greatly improved during the last four decades for patients with type 1 diabetes, and fewer people with type 1 diabetes are developing ESRD. The bones may crack, splinter, and erode, and the joints may shift, change shape, and become unstable.
It is often helpful for each individual Paramedic to observe more seasoned providers obtaining this information and then develop an effective method which works.
It is more appropriate to acknowledge that there are factors that are of concern, but state that it is better to focus on getting well first and take it a step at a time. A Paramedic may need to enlist the aid of local law enforcement to assist in bringing the patient to the emergency department for evaluation if the patient refuses to go.
Communication through written notes, although time-consuming, may be the only solution to obtaining an adequate history. Even a single recent episode of hypoglycemia may make it more difficult to detect the next episode. It typically develops in people who have neuropathy to the extent that they cannot feel sensation in the foot and are not aware of an existing injury. Major hemorrhage or retinal detachment can result, causing severe visual loss or blindness.
Any duplication or distribution of the information contained herein is strictly prohibited. Reassurance that the patient is in good hands or going to see a good physician can also help the Paramedic provide positive reassurance to the patient without creating a false expectation. With vigilant monitoring and by rigorously avoiding low blood glucose levels, patients can often regain the ability to sense the symptoms.
Instead of resting an injured foot or seeking medical help, the patient often continues normal activity, causing further damage. However, even very careful testing may fail to detect a problem, particularly one that occurs during sleep.




Blood test that measures glucose level after not eating breakfast
Good foods to control blood sugar levels low


Comments

  1. 01.08.2014 at 14:16:50


    Diabetic have a similar reaction, but.

    Author: mp4
  2. 01.08.2014 at 17:37:41


    Four hours for the first 24 hours you should stop.

    Author: FREEMAN
  3. 01.08.2014 at 23:33:48


    Can lead to confusion , coma for most people without the potential to maintain the.

    Author: ISABELLA
  4. 01.08.2014 at 10:40:59


    And skin for ulcers and wounds.

    Author: RENOCKA