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Psoriasis

2012-02-10T18:26:00.000-08:00

What Is Psoriasis?

Psoriasis (pronunciation: "sor-eye-sis") is a common long term (chronic) condition that causes thick red marks and flaky white patches that look like scales to form on the skin. Skin cells grow deep in the skin and slowly rise to the surface. This process is called cell turnover, and it takes about a month. With psoriasis, it can happen in just a few days because the cells rise too fast and pile up on the surface.
Most psoriasis causes patches of thick, red skin with silvery scales. These patches can itch or feel sore. They are often found on the elbows, knees, other parts of the legs, scalp, lower back, face, palms, and soles of the feet. But they can show up other places such as fingernails, toenails, genitals, and inside the mouth.

Who Gets Psoriasis?
What Causes Psoriasis?
How Is Psoriasis Diagnosed?
How Is Psoriasis Treated?

Who Gets Psoriasis?

Anyone can get psoriasis, but it occurs more often in adults. In many cases, there is a family history of psoriasis. Certain genes have been linked to the disease. Men and women get psoriasis at about the same rate.

Is psoriasis contagious?

No, you cannot catch psoriasis from another person or give it to someone by touching them. You also cannot spread it to other parts of your body

Symptoms

What are the symptoms of psoriasis?

The symptoms of psoriasis may include:

Pink or red, raised patches of scaly skin
Dry, cracked or flaky skin (it may also bleed at times)
Skin that burns, is itchy or sore
Thick, pitted fingernails
Pus-filled blisters on the red patches of skin (in more severe cases)

The symptoms most often appear on the skin of the knees and elbows, although psoriasis may occur anywhere on the body (including the scalp, palms of the hands, soles of the feet, mouth and skin on the joints).

What Causes Psoriasis?

Psoriasis starts with the immune system. Your immune system usually protects the body against infection and disease by attacking bacteria and viruses. However, when you have psoriasis, your T cells, a kind of white blood cells that are part of the immune system, mistakenly attack your skin cells instead. Your body then produces other immune system responses, leading to swelling and fast turnover of skin cells. Psoriasis tends to run in families and it usually appears between 10 and 45 years of age.

People with psoriasis may notice that sometimes the skin gets better and sometimes gets worse. Certain things that can cause the psoriasis to get worse include:

Infections (such as sore throat and the common cold)
Diseases that weaken the immune system
Stress
Certain medicines (such as beta-blockers for high blood pressure and other mediciness used to prevent malaria)
Skin irritations
Cold weather
Smoking

How Is Psoriasis Diagnosed?

Psoriasis is diagnosed by looking on the rash, however sometimes it may be hard to diagnose because it can look like other skin diseases.

How Is Psoriasis Treated?

Treatment depends on:

How serious the disease is
The size of the psoriasis patches
The type of psoriasis
How the patient reacts to certain treatments.

All treatments don't work the same for everyone. Doctors may switch treatments if one doesn't work, if there is a bad reaction, or if the treatment stops working. There are a number of treatments for psoriasis. Your doctor will help you decide which one is best for you. Keeping your skin moisturized with an over-the-counter product is a good first step. Body lotion can help keep skin from getting too dry and cracking. It can also help remove some of the scales. Bathing daily in Dead Sea salts, bath oil or oatmeal can calm redness and remove scales.
Prescription creams, ointments, lotions and gels (also called topical medicines) that you put on the affected areas are often used to treat psoriasis. To help the medicine stay on the skin, you might apply it and then cover the areas with plastic wrap. Options include corticosteroids, a type of vitamin D and pine tar. Special shampoos are used for psoriasis on the scalp.
For more severe cases of psoriasis, your doctor may prescribe antibiotics or other medicines in pill form. Some of these medicines can cause side effects, so your doctor may prescribe these for only a short period of time before returning to another type of treatment.
Sunlight also can help psoriasis, but be careful not to stay in the sun too long. A sunburn can actually make your psoriasis worse. Talk to your doctor about how to safely try sunlight exposure as a psoriasis treatment. Light therapy may be another option for treatment of psoriasis. With this treatment, the affected skin is exposed to controlled forms of artificial sunlight, usually after using Psoralen, a light-sensitizing medicine. This is called "PUVA" treatment. Talk to your doctor about this option.

Topical Treatment:

Treatments applied right on the skin (creams, ointments) may help. These treatments can:

Help reduce inflammation and skin cell turnover
Suppress the immune system
Help the skin peel and unclog pores
Soothe the skin.

Light Therapy:

Natural ultraviolet light from the sun and artificial ultraviolet light are used to treat psoriasis. One treatment, called PUVA, uses a combination of a medicine that makes skin more sensitive to light and ultraviolet A light.

Systemic Treatment:

If the psoriasis is severe, doctors might prescribe medicine through a shot. This is called systemic treatment. Antibiotics are not used to treat psoriasis unless bacteria make the psoriasis worse.

Combination Therapy:

When you combine topical (put on the skin), light, and systemic treatments, you can often use lower doses of each. Combination therapy can also lead to better results.

Will psoriasis go away with treatment?

While psoriasis will typically improve with treatment, it may not ever completely go away. The scales of psoriasis should improve after you begin treatment. It may take 2 to 6 weeks for the affected areas of your skin to return to a more normal thickness, and the redness may take several months to improve. Sometimes, certain scaly spots will get better at the same time that other spots get worse.
After you've been using a certain type of medicine for a while, your psoriasis may "get used to" the treatment. If this happens, your medicine may not be as effective as it once was. Your doctor may change your medicine. Sometimes you may need a stronger dose of medicine. Talk to your doctor if your psoriasis doesn't seem to be getting better with treatment.

What Are Some Promising Areas of Psoriasis Research?

Doctors are learning more about psoriasis by studying:

Genes
New treatments that help skin not react to the immune system
The association of psoriasis with other conditions such as obesity, high blood pressure, and diabetes.

Questions to Ask Your Doctor

What treatment is best for me?
Will I have to change medicines often?
Is there anything I can do at home to relieve the pain and itching?
If my symptoms get worse, when should I call my doctor?
Is there a special shampoo I should use?
Could you recommend a good lotion?
Will I have to be on medicine the rest of my life?
I have psoriasis. Will my children have it?
Should I make any changes to my skin care routine?
Are there any support groups in my area?

FEVER

2012-01-26T11:39:00.000-08:00

A fever is usually a sign that something out of the ordinary is going on in your body. For an adult, a fever may be uncomfortable, but fever usually isn't dangerous unless it reaches 103 F or higher. For very young children and infants, a slightly elevated temperature may indicate a serious infection.
But the degree of fever doesn't necessarily indicate the seriousness of the underlying condition. A minor illness may cause a high fever, and a more serious illness may cause a low fever.
Usually a fever goes away within a few days. A number of over-the-counter medications lower a fever, but sometimes it's better left untreated. Fever seems to play a key role in helping your body fight off a number of infections.

Symptoms

You have a fever when your temperature rises above its normal range. What's normal for you may be a little higher or lower than the average normal temperature of 98.6 F.
Depending on what's causing your fever, additional fever signs and symptoms may include:

Sweating
Shivering
Headache
Muscle aches
Loss of appetite
Dehydration
General weakness

High fevers between 103 F and 106 F may cause:

Hallucinations
Confusion
Irritability
Fits
Dehydration

When to see a doctor
Fevers by themselves may not be a cause for alarm — or a reason to call a doctor. Yet there are some circumstances when you should seek medical advice for your baby, your child or yourself.
Taking a temperature
To check your or your child's temperature, you can choose from several types of thermometers, including oral, rectal and ear thermometers.
Although it's not the most accurate way to take a temperature, you can use an oral thermometer for an armpit reading:

Place the thermometer in the armpit and cross your arms or your child's arms over the chest.
Wait four to five minutes. The armpit temperature is slightly lower than an oral temperature.
If you call your doctor, report the actual number on the thermometer and where on the body you took the temperature.

Infants
An unexplained fever is greater cause for concern in infants and in children than in adults. Call your baby's doctor if your baby has a fever of 101 F or higher. Also call your baby's doctor if your baby:

Has a fever and is younger than 3 months of age.
Refuses to eat or drink.
Has a fever and unexplained irritability, such as marked crying during a diaper change or when moved.
Has a fever and seems lethargic and unresponsive. In infants and children younger than age 2, these may be signs of meningitis. If you're worried that your baby might have meningitis, take your baby to the doctor right away.
Is a newborn and has a lower than normal temperature — less than 97 F. Very young babies may not regulate their body temperature well when they are ill and may become cold rather than hot.

Children
There's probably no cause for alarm if your child has a fever but is responsive — making eye contact with you and responding to your facial expressions and to your voice — and is drinking fluids and playing.

Call your child's doctor if your child:

Is listless or irritable, vomits repeatedly, has a severe headache or stomach ache, or has any other symptoms causing significant discomfort.
Has a fever after being left in a hot car. Seek medical care immediately.
Has a fever that persists longer than a day (in children younger than age 2) or longer than three days (in children ages 2 and older).

Ask your child's doctor for guidance in special circumstances, such as a child with immune system problems or with a pre-existing illness. Your child's doctor also may recommend precautions if your child has just started taking a new prescription medicine.
Adults
Call your doctor if:

Your temperature is more than 103 F
You've had a fever for more than three days

In addition, seek immediate medical attention if any of these signs or symptoms accompanies a fever:

Severe headache
Severe throat swelling
Unusual skin rash, especially if the rash rapidly worsens
Unusual sensitivity to bright light
Stiff neck and pain when you bend your head forward
Mental confusion
Persistent vomiting
Difficulty breathing or chest pain
Extreme listlessness or irritability
Abdominal pain or pain when urinating
Any other unexplained signs or symptoms

Causes

Your normal body temperature varies throughout the day — it's lower in the morning and higher in the late afternoon and evening. In fact, your normal temperature can range from about 97 F to 99 F. Although most people consider 98.6 F normal, your temperature may vary by a degree or more. Other factors, such as your menstrual cycle or heavy exercise, can affect your temperature.
A fever might be caused by:

A virus
A bacterial infection
Heat exhaustion
Extreme sunburn
Certain inflammatory conditions such as rheumatoid arthritis
Overdressing
A malignant tumor
Some medications, such as antibiotics and drugs used to treat high blood pressure or seizures
Some immunizations, such as the diphtheria, tetanus

Sometimes it's not possible to identify the cause of a fever. If you have a temperature of 101 F or higher for more than three weeks and your doctor isn't able to find the cause after extensive evaluation, the diagnosis may be fever of unknown origin.

Is it a Fever?

A gentle kiss on the forehead or a hand placed lightly on the skin is often enough to give you a hint that your child has a fever. However, this method of taking a temperature is dependent on the person feeling the temperature and doesn't give an accurate measure of temperature.

Use a reliable thermometer to confirm a fever (which is when a child's temperature is at or above one of these levels):

100.4° F measured rectally (in the bottom)
99.5° F measured orally (in the mouth)
99° F measured in an axillary position (under the arm)

But how high a fever is doesn't tell you much about how sick your child is. A simple cold or other viral infection can sometimes cause a rather high fever (in the 102°-104° F range), but this doesn't usually indicate a serious problem. And serious infections might cause no fever or even an abnormally low body temperature, especially in infants.

Because fevers can rise and fall, a child might have chills as the body tries to generate additional heat as its temperature begins to rise. The child may sweat as the body releases extra heat when the temperature starts to drop.

Sometimes kids with a fever breathe faster than usual and may have a higher heart rate. You should call the doctor if your child is having difficulty breathing, is breathing faster than normal, or continues to breathe fast after the fever comes down.

Complications

Complications of a fever may include:

Severe dehydration
Hallucinations
Fever-induced seizure, in a small number of children ages 6 months to 5 years

Fever induced seizures
Febrile seizures usually involve loss of consciousness and shaking of limbs on both sides of the body. Although alarming for parents, the vast majority of febrile seizures cause no lasting effects.
If a seizure occurs:

Lay your child on his or her side or stomach on the floor or ground
Remove any sharp objects that are near your child
Loosen tight clothing
Hold your child to prevent injury
Don't place anything in your child's mouth or try to stop the seizure

Most seizures stop on their own. Take your child to the doctor as soon as possible after the seizure to determine the cause of the fever.
Call for emergency medical assistance if a seizure lasts longer than 10 minutes.

Preparing for your appointment

After you make an appointment with your family doctor, general practitioner or pediatrician, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from the doctor.

What you can do

Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
Write down information about the fever, such as when it started, how and where you measured it (orally for example) and any other symptoms. Note whether you or your child has been around anyone who's been ill.
Write down key personal information, including any major stresses, recent life changes or recent travel out of the country.
Make a list of all medications, vitamins and supplements that you or your child is taking.
Write down questions to ask the doctor.

Preparing a list of questions ahead of time will help you make the most of your time together. List your questions from most important to least important. For fever, some basic questions to ask include:

What is causing the fever?
What else could be causing it?
What kinds of tests are needed?
What is the best course of action?
What are the alternatives to the primary approach you're suggesting?
Is medicine necessary to lower the fever?
Are there any restrictions that I need to follow?
Is there a alternative to the medicine you're prescribing?
Are there any brochures or other printed material that I can take home with me? What websites do you recommend?

In addition to the questions that you've prepared, don't hesitate to ask questions during your appointment anytime that you don't understand something.
What to expect from your doctor
Be prepared to answer questions your doctor is likely to ask you, including:

When did the symptoms first occur?
What method did you use to take your or your child's temperature?
Have you or your child taken any fever-lowering medication?
What other symptoms are you or your child experiencing? How severe are they?
Do you or your child have any chronic health conditions?
What medications do you or your child regularly take?
Have you or your child been around anyone who's ill?
Have you or your child recently undergone surgery?
Have you or your child recently traveled outside the country?
What, if anything, seems to improve the symptoms?
What, if anything, appears to worsen the symptoms?

Tests and diagnosis

Your doctor will look for an infection or noninfectious cause of your fever based on your other symptoms and a physical exam. You may need tests, such as blood tests, to confirm a diagnosis.
If you have a low-grade fever that persists for three weeks or more, but have no other symptoms, your doctor may recommend a variety of tests to help find the cause. These may include blood tests and X-rays.

Treatments and drugs

With low-grade fever, doctors don't always recommend trying to lower the body temperature. Doing so may prolong the illness or mask symptoms and make it harder to determine the cause.
Some experts believe that aggressively treating a fever interferes with the body's immune response. Viruses that cause colds and other respiratory infections thrive at normal body temperature. By producing a low-grade fever, your body may be helping to eliminate a virus.
Over-the-counter medications
In the case of a high fever, your doctor may recommend an over-the-counter medication, such as:

Paracetamol (Crocin) or ibuprofen (Brufen). Use these medications according to the label instructions or as recommended by your doctor. Be careful to avoid taking too much. High doses or long-term use of paracetamol may cause liver or kidney damage, and acute overdoses can be fatal. If your child's fever remains high after a dose, don't give more medication; call your doctor instead. For temperatures below 102 F, don't use fever-lowering drugs unless advised by your doctor.
Aspirin, for adults only. Don't give aspirin to children, because it may trigger a rare, but potentially fatal.

Prescription medications
Depending on the cause of your fever, your doctor may prescribe an antibiotic, especially if he or she suspects a bacterial infection, such as pneumonia or throat infection.
Antibiotics don't treat viral infections. There are a few antiviral drugs used to treat some specific viral infections. However, the best treatment for most viruses is often rest and plenty of fluids.

Lifestyle and home remedies

You can try a number of things to make yourself or your child more comfortable during a fever:

Drink plenty of fluids. Fever can cause fluid loss and dehydration, so drink water, juices or broth. For a child under age 1, use an oral rehydration solution. These solutions contain water and salts proportioned to replenish fluids and electrolytes.
Rest. It's necessary for recovery, and activity can raise your body temperature.
Stay cool. Dress in light clothing, keep the room temperature cool and sleep with only a sheet or light blanket.
Soak in lukewarm water. Especially for high temperatures, a lukewarm five- to 10-minute soak or a sponge bath can be cooling. If the bath causes shivering, stop the bath and dry off. Shivering raises the body's internal temperature — shaking muscles generate heat.

Prevention

The best way to prevent fevers is to reduce your exposure to infectious diseases. One of the most effective ways to do that is also one of the simplest — frequent hand-washing.
Teach your children to wash their hands often, especially before they eat, after using the toilet, after spending time in a crowd or around someone who's sick, and after petting animals. Show them how to wash their hands vigorously, covering both the front and back of each hand with soap, and rinsing thoroughly under running water. Carry moist towelettes or hand sanitizer with you for times when you don't have access to soap and water. When possible, teach your kids not to touch their noses, mouths or eyes — the main way viral infections are transmitted.
In addition, teach your children to turn away from others and to cover their mouths when coughing and their noses when sneezing.

You've probably experienced waking in the middle of the night to find your child flushed, hot, and sweaty. Your little one's forehead feels warm. You immediately suspect a fever, but are unsure of what to do next. Should you get out the thermometer? Call the doctor?

In healthy kids, fevers usually don't indicate anything serious. Although it can be frightening when your child's temperature rises, fever itself causes no harm and can actually be a good thing — it's often the body's way of fighting infections. And not all fevers need to be treated. High fever, however, can make a child uncomfortable and worsen problems such as dehydration.

Types of Thermometers

Whatever thermometer you choose, be sure you know how to use it correctly to get an accurate reading. Keep and follow the manufacturer's recommendations for any thermometer.

Digital thermometers usually provide the quickest, most accurate readings. They come in many sizes and shapes and are available at most pharmacies. You should read the manufacturer's instructions to determine what the thermometer is designed for and how it signals that the reading is complete. Overall, digital thermometers usually can be used for these temperature-taking methods:

oral (in the mouth)
rectal (in the bottom)
axillary (under the arm)

Turn on the thermometer and make sure the screen is clear of any old readings. Digital thermometers usually have a plastic, flexible probe with a temperature sensor at the tip and an easy-to-read digital display on the opposite end. If your thermometer uses disposable plastic sleeves or covers, put one on according to the manufacturer's instructions. Remember to discard the sleeve after each use and to clean the thermometer according to the manufacturer's instructions before putting it back in its case.

Electronic ear thermometers measure the tympanic temperature — the temperature inside the ear canal.

Plastic strip thermometers (small plastic strips that you press against the forehead) may be able to tell you whether your child has a fever, but aren't reliable for taking an exact measurement, especially in infants and very young children.

Forehead thermometers also may be able to tell you if your child has a fever, but are not as accurate as oral or rectal digital thermometers.

Pacifier thermometers may seem convenient, but again, their readings are less reliable than rectal temperatures and shouldn't be used in infants younger than 3 months. They also require kids to keep the pacifier in their mouth for several minutes without moving, which is a nearly impossible task for most babies and toddlers.

Glass mercury thermometers were once common, but now they should not be used because of concerns about possible exposure to mercury, which is an environmental toxin.

Tips for Taking Temperatures

As any parent knows, taking a squirming child's temperature can be challenging. But it's one of the most important tools doctors have to determine if a child has an illness or infection. The best method will depend on a child's age and temperament.

For kids younger than 3 months, you'll get the most reliable reading by using a digital thermometer to take a rectal temperature. Electronic ear thermometers aren't recommended for infants younger than 3 months because their ear canals are usually too small.

For kids between 3 months to 4 years old, you can use a digital thermometer to take a rectal temperature or an electronic ear thermometer to take the temperature inside the ear canal. You could also use a digital thermometer to take an axillary temperature, although this is a less accurate method.

For kids 4 years or older, you can usually use a digital thermometer to take an oral temperature if your child will cooperate. However, kids who have frequent coughs or are breathing through their mouths because of stuffy noses might not be able to keep their mouths closed long enough for an accurate oral reading. In these cases, you can use the tympanic method (with an electronic ear thermometer) or axillary method (with a digital thermometer).

To take a rectal temperature: Before becoming parents, most people cringe at the thought of taking a rectal temperature. But don't worry — it's a simple process:

1. Lubricate the tip of the thermometer with a lubricant, such as petroleum jelly.

2. Place your child:
- belly-down across your lap or on a firm, flat surface and keep your palm along the lower back
- or face-up with legs bent toward the chest with your hand against the back of the thighs

3. With your other hand, insert the lubricated thermometer into the anal opening about ½ inch to 1 inch (about 1.25 to 2.5 centimeters). Stop if you feel any resistance.

4. Steady the thermometer between your second and third fingers as you cup your hand against your baby's bottom. Soothe your child and speak quietly as you hold the thermometer in place.

5. Wait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. Write down the number on the screen, noting the time of day that you took the reading.

To take an oral temperature: This process is easy in an older, cooperative child.

1. Wait 20 to 30 minutes after your child finishes eating or drinking to take an oral temperature, and make sure there's no candy in your child's mouth.

2. Place the tip of the thermometer under the tongue and ask your child to close his or her lips around it. Remind your child not to bite down or talk, and to relax and breathe normally through the nose.

3. Wait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. Write down the number on the screen, noting the time of day that you took the reading.

To take an axillary temperature: This is a convenient way to take a child's temperature. Although not as accurate as a rectal or oral temperature in a cooperative child, some parents prefer to take an axillary temperature, especially for kids who can't hold a thermometer in their mouths.

1. Remove your child's shirt and undershirt, and place the thermometer under an armpit (it must be touching skin only, not clothing).

2. Fold your child's arm across the chest to hold the thermometer in place.

3. Wait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. Write down the number on the screen, noting the time of day that you took the reading.

Whatever method you choose, keep these additional tips in mind:

Never take a child's temperature right after a bath or if he or she has been bundled tightly for a while — this can affect the temperature reading.
Never leave a child unattended while taking a temperature.

CHICKEN POX

2012-01-26T10:06:00.000-08:00

Chickenpox is a common illness among kids, particularly those under age 12. An itchy rash of spots that look like blisters can appear all over the body and be accompanied by flu-like symptoms. Symptoms usually go away without treatment, but because it is very contagious, an infected child should stay home and rest until the symptoms are gone.

Chickenpox is caused by the varicella-zoster virus (VZV). Kids can be protected from VZV by getting the chickenpox (varicella) vaccine, usually between the ages of 12 to 15 months. Medical bodies recommend a booster shot at 4 to 6 years old for further protection. It is also recommended that people 13 years of age and older who have never had chickenpox or received the chickenpox vaccine get two doses of the vaccine at least 28 days apart.

A person usually has only one episode of chickenpox, but VZV can lie dormant within the body and cause a different type of skin eruption later in life called shingles or herpes zoster. Getting the chickenpox vaccine significantly lowers kids' chances of getting chickenpox, but they might still develop shingles later in life.

Symptoms

Chickenpox causes a red, itchy skin rash that usually appears first on the abdomen or back and face, and then spreads to almost everywhere else on the body, including the scalp, mouth, nose, ears, and genitals.

The rash begins as multiple small red bumps that look like pimples or insect bites. They develop into thin-walled blisters filled with clear fluid, which becomes cloudy. The blister wall breaks, leaving open sores, which finally become dry, brown scabs.

Chickenpox blisters are usually less than a quarter of an inch wide, have a reddish base, and appear in crops over 2 to 4 days. The rash may be more extensive or severe in kids who have skin disorders such as eczema.

Some kids have a fever, abdominal pain, sore throat, headache, or a vague sick feeling a day or 2 before the rash appears. These symptoms may last for a few days, and fever stays in the range of 100°-102° F, though in rare cases may be higher. Younger kids often have milder symptoms and fewer blisters than older children or adults.

Chickenpox is usually a mild illness, but can affect some infants, teens, adults, and people with weak immune systems more severely. Some people can develop serious bacterial infections involving the skin, lungs, bones, joints, and the brain. Even kids with normal immune systems can occasionally develop complications, most commonly a skin infection near the blisters.

Anyone who has had chickenpox (or the chickenpox vaccine) as a child is at risk for developing zoster later in life, and up to 20% do develop. After an infection, VZV can remain inactive in nerve cells near the spinal cord and reactivate later as zoster, which can cause tingling, itching, or pain followed by a rash with red bumps and blisters. Zoster is sometimes treated with antiviral drugs, steroids, and pain medications, and there's now a shingles vaccine for people 60 and older.

Contagiousness

Chickenpox is contagious from about 2 days before the rash appears until all the blisters develop scabs. A child with chickenpox should be kept out of school until all blisters have dried, usually about 1 week. If you're unsure about whether your child is ready to return to school, ask your doctor.

Chickenpox is very contagious — most kids with a sibling who's been infected will get it as well (if they haven't already had the disease or the vaccine), showing symptoms about 2 weeks after the first child does. To help keep the virus from spreading, make sure your kids wash their hands frequently, particularly before eating and after using the bathroom. And keep a child with chickenpox away from unvaccinated siblings as much as possible.

People who haven't had chickenpox or the vaccine also can catch it from someone with zoster, but they cannot catch zoster itself. That's because zoster can only develop from a reactivation of VZV in someone who has previously had chickenpox.

Chickenpox and Pregnancy

Pregnant women and anyone with immune system problems should not be near a person with chickenpox. If a pregnant woman who hasn't had chickenpox in the past contracts it (especially in the first 20 weeks of pregnancy), the fetus is at risk for birth defects and she is at risk for more health complications than if she'd been infected when she wasn't pregnant. If she develops chickenpox just before or after the child is born, the newborn is at risk for serious health complications. There is no risk to the developing baby if the woman develops zoster during the pregnancy.

If a pregnant woman has had chickenpox before the pregnancy, the baby will be protected from infection for the first few months of life, since the mother's immunity gets passed on to the baby through the placenta and breast milk.

Those at risk for severe disease or serious complications — such as newborns whose mothers had chickenpox at the time of delivery, patients with blood cancer or immune deficiencies — may be given varicella zoster immune globulin after exposure to chickenpox to reduce its severity.

Prevention

Doctors recommend that kids receive the chickenpox vaccine when they're 12 to 15 months old and a booster shot at 4 to 6 years old. The vaccine is about 70% to 85% effective at preventing mild infection, and more than 95% effective in preventing moderate to severe forms of the infection. Therefore, although some kids who are immunized still will get chickenpox, the symptoms are usually much milder than those of kids who haven't had the vaccine and become infected.

Healthy kids who have had chickenpox do not need the vaccine — they usually have lifelong protection against the illness.

Treatment

A virus causes chickenpox, so the doctor won't prescribe antibiotics. However, antibiotics may be required if the sores become infected by bacteria. This is pretty common among kids because they often scratch and pick at the blisters.

The antiviral medicine acyclovir may be prescribed for people with chickenpox who are at risk for complications. The drug, which can make the infection less severe, must be given within the first 24 hours after the rash appears. Acyclovir can have significant side effects, so it is only given when necessary. Your doctor can tell you if the medication is right for your child.

Dealing With Discomfort

To help relieve the itchiness, fever, and discomfort of chickenpox:

Use cool wet compresses or give baths in cool or lukewarm water every 3 to 4 hours for the first few days. Baths do not spread the rash, in fact they help removing bacteria from the body hence it reduces the chances of bacterial infection and subsequent complications and scarring.
Pat (don't rub) the body dry.
Serve foods that are cold, soft, and bland because blisters in the mouth may make drinking or eating difficult. Avoid feeding your child anything highly acidic or especially salty, like orange juice.
Give your child paracetamol regularly to help relieve pain if your child has mouth blisters.
Ask the doctor about using over-the-counter medication for itching.

Never use aspirin to reduce pain or fever in kids with chickenpox because aspirin has been associated with the serious disease Reye syndrome, which can lead to liver failure and even death.

As much as possible, discourage kids from scratching. This can be difficult for them, so consider putting gloves or socks on your child's hands to prevent scratching during sleep. In addition, trim fingernails and keep them clean to help lessen the effects of scratching, including broken blisters and infection.

Most chickenpox infections require no special medical treatment. But sometimes, there are problems. Call the doctor if your child:

has fever that lasts for more than 4 days or rises above 102° F (38.8° C)
has a severe cough or trouble breathing
has an area of rash that leaks pus (thick, discolored fluid) or becomes red, warm, swollen, or sore
has a severe headache
is unusually drowsy or has trouble waking up
has trouble looking at bright lights
has difficulty walking
seems confused
seems very ill or is vomiting
has a stiff neck

Call your doctor if you think your child has chickenpox and you have a question or are concerned about a possible complication. The doctor can guide you in watching for complications and in choosing medication to relieve itching.

If taking your child to the doctor, let the office know in advance that your child might have chickenpox. It's important to try to avoid exposing others in the office — for some of them, a chickenpox infection could cause severe complications.

ATOPIC DERMATITIS

2012-01-25T00:31:00.000-08:00

What Is Atopic Dermatitis?

Atopic dermatitis is a long-term skin disease. "Atopic" refers to a tendency to develop allergy conditions. "Dermatitis" means swelling of the skin. Atopic eczema is sometimes called ‘infantile’ or ‘childhood’ eczema. You may also hear eczema called ‘dermatitis’ – they are both the same thing.

Atopy, or any atopic condition, is where the body’s immune system over-reacts to things that would not normally do any harm – often due to common environmental factors that are all around us.

Eczema improves for most children as they get older, but they may be left with dry and sensitive skin. Some children continue to have problematic eczema throughout life while others may find that their eczema goes away sometime during their childhood, only to come back in adulthood. There is no way we can predict the natural course of your child’s eczema – the important thing is to take and keep control of it.

The most common symptoms of atopic dermatitis are:

Dry and itchy skin
Rashes on the face, inside the elbows, behind the knees, and on the hands and feet.

Scratching the skin can cause:

Redness
Swelling
Cracking
"Weeping" clear fluid
Crusting
Thick skin
Scaling.

Often, the skin gets worse (flares), then it improves or clears up (remissions).

Who Gets Atopic Dermatitis?

Atopic dermatitis is most common in babies and children. But it can happen to anyone. People who live in cities and dry climates may be more likely to get this disease. When children with atopic dermatitis grow older, this problem can improve or go away. But the skin may stay dry and easy to irritate. At other times, atopic dermatitis is a problem in adulthood. You can't "catch" the disease or give it to other people.

What Causes Atopic Dermatitis?

The cause of atopic dermatitis is not known. It is likely caused by both genetic (runs in the family) and environmental factors. People with atopic dermatitis may go on to develop hay fever and asthma.

How Is Atopic Dermatitis Diagnosed?

Diagnosis is based on the symptoms. Each person has his or her own mix of symptoms that can change over time. Doctors will ask for a medical history to:

Learn about your symptoms
Know when symptoms occur
Rule out other diseases
Look for causes of symptoms.

There no certain test that can be used to check for this disease. But you may be tested for allergies by a dermatologist (skin doctor).

Things That Make Atopic Dermatitis Worse

Irritants and allergens can make atopic dermatitis worse.

Irritants are things that may cause the skin to be red and itchy or to burn. They include:

Wool or synthetic fibers
Soaps and cleansers
Some perfumes and makeup
Substances such as chlorine, mineral oil, or solvents
Dust or sand
Cigarette smoke.

Allergens are allergy-causing substances from foods, plants, animals, or the air. Common allergens are:

Eggs, peanuts, milk, fish, soy products, and wheat
Dust mites
Mold
Pollen
Dog or cat hair

Stress, anger, and frustration can make atopic dermatitis worse, but they haven't been shown to cause it. Skin infections, temperature, and climate can also lead to skin flares. Other things that can lead to flares are:

Not using enough moisturiser after a bath
Low humidity in winter
Dry climate
Long or hot baths and showers
Going from sweating to being chilled
Bacterial infections.

How Is Atopic Dermatitis Treated?

Atopic eczema is a dry skin condition. The skin does not produce enough oil and loses too much water, so it becomes dry and cracked. Replace the oil and treat dry skin with emollients on an ongoing basis. Eczema flares can be treated with prescribed topical treatments, which will be used to reduce the inflammation.

Treatment works best when the patient, family members, and doctor work together. Treatment plans are based on:

Age
Symptoms
General health.

You need to carefully follow the treatment plan. Try to notice what is or isn't helpful. Symptoms usually improve with the right skin care and lifestyle changes.

Atopic dermatitis treatment goals are to heal the skin and prevent flares. Your doctor will help you:

Develop a good skin care routine
Avoid things that lead to flares
Treat symptoms when they occur.

You and your family members should watch for changes in the skin to find out what treatments help the most.

Medicines for atopic dermatitis include:

Skin creams or ointments that control swelling and lower allergic reactions
Corticosteroids
Antibiotics to treat infections caused by bacteria
Antihistamines that make people sleepy to help stop nighttime scratching
Medicines that suppress the immune system.

Other treatments include:

Light therapy
A mix of light therapy and a drug called psoralen
Skin care that helps heal the skin and keep it healthy
Protection from allergens.

Emollients

Emollients are an essential treatment for all children with atopic eczema to moisturize the skin by soothing and softening. There is a wide range of emollients to choose from and you mayneed to try quite a few until you find the right ones for your child. Emollients come in various forms, including lotions, gels, creams, ointments and sprays (known as leave-on emollients).Some leave-on emollients can be used as soap substitutes. Emollient washes, bath and shower products are available for washing and cleansing. When you find one that suits your child, ask them to prescribe it in large amounts – for example, a 500-g tube and 200-ml bottle. Try to use a new emollient for at least a month, unless you can see it is making the eczema worse. Remember that a stinging sensation is always likely when applying emollients to very dry skin. However, if irritation occurs, consider using a different one.

Bath oils

Bathing your child every day is good practice, as this can prevent infection, but find a bathing routine that suits your child’s skin and your daily routine. Some bath oils have an ingredient that helps with itching or that can help to deal with infection. Avoid using bubble bath and ordinary baby oil as they dry out the skin.

Soap substitutes

Ordinary soaps should not be used as they can dry the skin. Some wash, bath and shower products are especially designed for eczema skin. Remember to ask the pharmacist if a product is designed for eczema, as some products may appear eczema friendly but contain detergent and are not suitable. You can also use most leave-on emollients as soap substitutes. Getting used to is essential as they do not foam like ordinary soaps but are just as good at getting you clean. Apply a soap substitute onto your child’s skin before they get into the bath, or whilst they are sitting in the bath, and simply let the child soak in the water. After washing, bathing or showering, rinse off the emollient, pat the skin dry and then re-apply the leave-on emollient.

Leave-on emollients (lotions, gels, creams and ointments)

The best way to put on emollients is to rub them directly onto the skin in the direction that the hairs grow. You can use as much emollient as you wish – even if you can still see the emollient on the skin, it will soon sink in. The most important thing is to use an emollient that your child likes and use it several times a day. If your child will not use an ointment but will happily put on a cream, then choose the cream or gel. Creams are good for using during the day as they are easy to put on and sink into the skin. As creams and lotions contain water, they also have preservatives, and these can cause skin reactions in some people. If you feel that this may be the case with your child, stop using the cream and try an ointment. Ointments are the best thing to use on very dry skin, though they can be difficult to put on and can look greasy on the skin. They can be good to use last thing at night and first thing in the morning. Ointments can seal the skin but may block hair follicles causing red bumps, especially in hot weather. Some newer creams contain natural moisturising factors, producing similar hydrating qualities to ointments with the same consistency as creams. Lotions are the ‘lightest’ emollient. They are good for areas of ‘wet’ eczema, or for veryhairy areas. Remember to keep your leave-on emollients clean – pump dispensers are very helpful. If you use a tub, do not put fingers in the pot – use a spoon to decant and apply what you need. If you need more advice on the differences between the formulations of leave-on emollients, it is best to ask a dermatologist. A few handy tips for emollient use include:

• Apply in a smooth, stroking action, rather than rubbing in, to prevent blockage of hair follicles and irritation.

• If you use pots, decant before application, so fingers are not constantly in pots, which will cause contamination. A good way to prevent this is to use pumps.

• Ask for emollients in large quantities (200 ml for bath oils / wash products and 500 g for leave-on emollients). Small dispensers or tubes are useful for taking to school.

• Mix and match different types of emollients (creams, ointments and gels) depending on skin dryness, seasons, activity and lifestyle.

• Bandages and clothing in contact with ointments (paraffin based products) can easily catch fire with a naked flame or cigarette. So please take care near naked flames.

• Baths and showers will require daily cleaning to prevent slipping and build-up of oil.

• In some situations – like cold weather or feeding time for babies and small children – eczema can get much worse on the face and hands, so apply plenty of emollient to protect the skin before feeding or going out in the cold.

• Apply emollients before swimming, and shower and reapply after swimming.

Topical steroids

When something is ‘topical’ it means that it is applied to the skin. The human body produces its own steroids and these keep down any swelling, redness and inflammation. The steroids that are used to treat eczema are very like the ones that the body produces. Topical steroids come in creams, ointments, gels and in different strengths, and the chance of any side effect increases as the steroid gets stronger. For example, hydrocortisone is mild, Eumosone is moderate and Betnovate is a potent strength. Be aware that topical steroids have a generic (drug) name and product name. The potency is indicated in the patient information leaflet and not on the packaging. Your doctor will choose the appropriate potency steroid depending on how severe the eczema is, how long it will be used for, the age of the child and areas of skin affected. Dermatologists will normally use the lowest strength that they can, but sometimes a short course of a stronger one may be needed to bring the eczema under control. Always follow the instructions. You should always apply steroids in small amounts, usually just once or twice a day and enough so that you can see a sheen on the skin. Topical steroids have been used to treat atopic eczema for 40 years and, although you need to use them carefully, they can be very safe and effective for treating eczema flares. Always apply topical steroids and emollients separately. It does not really matter which you put on first – you will find what suits your child best – but try to leave about half an hour in between an emollient and prescribed treatment. Never apply an emollient and prescribed treatment at the same time or dilute a topical steroid with an emollient.

Practical management

There are many other things that you can do to make your child more comfortable and less itchy. Here are a few tips:

• Try not to tell them to stop scratching – instead, use play as a distraction technique.

• Keep their nails short and hand gloves or socks on hands or all-in-one sleepsuits at night.

• Keep your home (and especially the child’s bedroom) cool as overheating makes the itching worse.

• Use cotton clothing as much as you can as it is cool and comfortable. Wool can make the skin itch.

• Avoid substances that can affect the skin, such as soap and detergents. Some people find non-biological products cause fewer problems than biological ones.

Doctor may prescribe antihistamines for your child to help them sleep at night. These are meant to be used for a short time when the eczema has flared up and not as a longterm measure. In some situations – like cold weather or feeding time for babies and small children – eczema can get much worse on the face and hands, so apply plenty of emollient.

Avoiding allergens

Atopic eczema seems to be linked to certain things that can cause an allergic reaction. These are called allergens. Children with atopic eczema may have allergy to any number of things in our environment. Allergy testing is generally not helpful and high-street allergy tests should be avoided. A common sense approach to minimising your child’s exposure to some of the more common allergens known in atopic eczema is probably the best course of action. The house-dust mite is a common allergen, or rather its droppings are. It lives in all our homes, and – because it loves warm,damp conditions – it is most at home in our mattresses and carpets, where it feeds on our dead skin. Regular vacuuming, dusting with a damp cloth and using special anti-house-dust-mite bedding covers can help to cut down their numbers. Pets can be a problem for children with eczema. If you do not have a pet, do not get a pet that has fur, hair or feathers. Goldfish are all right! If you already have a family pet, you should try to cut down the contact between the pet and your child, and keep pets out of the bedroom. Allergy to food in children with atopic eczema is a very difficult subject. There has been a lot of research published about it and for a long time there were no real answers. However, it now seems that food allergy can affect a small number of young children, but is usually less of a problem over one year of age. Some foods also cause irritation around children’s mouths, rather than allergic reactions. You should not try to change a child’s diet without first seeing a specialist (doctor) and dietitian – you need to be very sure of a link between food and eczema before considering it as part of your child’s treatment.

Infection

Infection in eczema can be a common problem and can be the reason why eczema flares up. Once your child has broken the skin by scratching, it is very easy for germs to get into the broken areas. Infection can cause the skin to change, making it look more red, itchy and swollen and may even cause it to weep and form a yellow covering. The skin may also feel hot to the touch and may be more difficult to control with your usual treatments. This may indicate a bacterial infection. Other skin infections include viral infections, such as eczema herpeticum and molluscum. Eczema herpeticum can be caused by the cold sore virusand spread very quickly in atopic eczema. If you think your child has this, you should seek medical advice urgently. If you think your child’s eczema may be infected, you should see your doctor as soon as possible. If your child has several infections in a short period of time, a skin swab may be taken to identify the bacterium or virus that may be causing the problem and to ensure that they receive the correct treatment.

Other treatments

There are other specialist treatments for eczema that can be safely used for babies and small children. These include bandaging, wet wraps and therapeutic clothing. Other topical treatments, such as topical calcineurin inhibitors, can be used as alternatives to topical steroids or can be used in conjunction with topical steroids, with specialist guidance. There are a number of other treatments available for more severe eczema that seem to have some success in managing eczema. Generally, these treatments will be started by a dermatologist.

Eczema can be managed but even in a mild form requires time and commitment. It is important to use a good skin-care routine. It is also essential that children with eczema are not made to feel that they are different. Brothers and sisters need to be involved as much as possible in the care of the child with eczema. It can be hard to find a balance between giving too much attention and too little to both the child with eczema and any of their brothers or sisters. You may begin to feel like your child’s eczema is taking over your family life, especially if everyone is losing sleep. However, you can manage it well if you approach it in a positive way. By talking to your doctor.

What Research Is Being Done on Atopic Dermatitis?

Research is being done into what causes atopic dermatitis, and how it can be managed, treated, and prevented.

Research includes:

Genetics
Biochemical changes in skin and white blood cells
Immune factors
Light therapy
New medications
Supplements, herbs, and plant extracts.

DIABETES - Part 2

2012-01-23T01:03:00.000-08:00

Check Your Blood Glucose as Recommended

You'll want to know how well you're taking care of your diabetes. One way to find out is to check your blood to see how much glucose is in it. If your blood has too much or too little glucose, you may need a change in your meal plan, physical activity plan, or medicines.

Checking your blood glucose will help you see if your diabetes treatment plan is working. Ask your doctor how often you should check your blood glucose. Some people check their blood glucose once a day. Others do it three or four times a day. You may check before and after eating, before bed, and sometimes in the middle of the night. Your doctor or diabetes educator will show you how to check your blood using a blood glucose meter. Your health care team should also check your blood glucose levels with a lab test called the Hb A1C test. Contact us for more information about the A1C test.

Take Other Tests for Your Diabetes

Tests for Ketones

You may need to check your blood or urine for ketones if you're sick or if your blood glucose is above 240. Your body makes ketones when you burn fat instead of glucose for energy. Ketones can make you very sick. If you have ketones, you are at risk for having a serious condition called ketoacidosis. If ketoacidosis isn't treated, it can cause death. Signs of ketoacidosis are vomiting, weakness, fast breathing, and a sweet smell on the breath. Ketoacidosis is more likely to develop in people with type 1 diabetes.
Your doctor or diabetes educator will show you how to test for ketones.

The A1C test

Another test for blood glucose, the A1C, also called the hemoglobin A1C test, shows what your average blood glucose was for the past 2 to 3 months. The doctor does this test to see what your blood glucose is most of the time. Have this test done at least twice a year.
Ask your doctor what your A1C test showed. A result of below 7 usually means that your diabetes treatment is working well and your blood glucose is under control. If your A1C is higher, your blood glucose may be too high. You'll then have a greater risk of having diabetes problems, like kidney damage. You may need a change in your meal plan, physical activity plan, or diabetes medicines.
Talk with your doctor about what your target should be. Your personal target may be lower or higher than the target shown below. Even if your A1C is higher than your target, remember that every step toward your goal helps reduce your risk of diabetes problems.

A1C results
Target for most people with diabetes	below 7
Time to change my diabetes care plan	8 or above
My last result	__________
My target	below __________

Keep Daily Records

Write down the results of your blood glucose checks every day. You may also want to write down what you ate, how you felt, and whether you exercised.
By keeping daily records of your blood glucose checks, you can tell how well you're taking care of your diabetes. Show your blood glucose records to your health care team. They can use your records to see whether you need changes in your diabetes medicines or your meal plan. If you don't know what your results mean, ask your health care team.
Steps
If You Use Insulin

Keep a daily record of

your blood glucose numbers
the times of the day you took insulin
the amount and type of insulin you took
whether you had ketones in your blood or urine
your diabetes medicines: times and amounts taken
if your blood glucose was very low
if you ate more or less food than you usually do
if you were sick
what kind of physical activity you did and for how long

Action Steps
If You Don't Use Insulin

Keep a daily record of

your blood glucose numbers
the times of the day you took your diabetes medicines
your physical activity

DAILY DIABETES RECORD PAGE Week starting Dec 20, 2011

	Other Blood Glucose	Breakfast Blood Glucose	Medicine	Lunch Blood Glucose	Medicine	Dinner Blood Glucose	Medicine	Bed Time Blood Glucose	Notes :Special events, sick days, physical activities
Mon		104				128		114
Tue				103				155	Missed Evening walk
Wed		120		144		132		120
Thu		110		126		124		248	Sick with Cold
Fri		128		114		102		150
Sat		127				164			Had extra Big snack in afternoon
Sun		115		120				140

When Your Blood Glucose Is Too High or Too Low

Sometimes, no matter how hard you try to keep your blood glucose in your target range, it will be too high or too low. Blood glucose that's too high or too low can make you feel sick. Learn how to handle these emergencies.

What You Need to Know about High Blood Glucose

If your blood glucose stays above 180, it may be too high. See the Blood Glucose Targets table. High blood glucose means you don't have enough insulin in your body. High blood glucose, also called hyperglycemia, can happen if you miss taking your diabetes medicines, eat too much, or don't get enough exercise. Sometimes, the medicines you take for other problems cause high blood glucose. Be sure to tell your doctor about other medicines you take.

Having an infection, being sick, or being under stress can also make your blood glucose too high. When you're sick, be sure to check your blood glucose and keep taking your diabetes medicines. For more about how to take care of yourself when you're sick, see "When You're Sick."

If you're very thirsty and tired, have blurry vision, and have to go to the bathroom often, your blood glucose may be too high. Very high blood glucose may also make you feel sick to your stomach.

If your blood glucose is high much of the time, or if you have symptoms of high blood glucose, call your doctor. You may need a change in your diabetes medicines or your meal plan.

What You Need to Know About Low Blood Glucose

Low blood glucose, also called hypoglycemia, happens if your blood glucose drops too low. It can come on fast. Low blood glucose can be caused by taking too much diabetes medicine, missing a meal, delaying a meal, exercising more than usual, or drinking alcoholic beverages. Sometimes, medicines you take for other health problems can cause blood glucose to drop.

Low blood glucose can make you feel weak, confused, irritable, hungry, or tired. You may sweat a lot or get a headache. You may feel shaky. If your blood glucose drops lower, you could pass out or have a seizure.

If you have any of these symptoms, check your blood glucose. If the level is below 70, have one of the following right away:

3 or 4 glucose tablets
1 serving of glucose gel-the amount equal to 15 grams of carbohydrate
1/2 cup, or 4 ounces, of any fruit juice
1/2 cup, or 4 ounces, of a regular-not diet-soft drink
1 cup, or 8 ounces, of milk
5 or 6 pieces of hard candy
1 tablespoon of sugar or honey

Have one of these "quick fix" foods when your blood glucose is low.

After 15 minutes, check your blood glucose again to make sure your level is 70 or above. Repeat these steps until your blood glucose level is 70 or above. Once your blood glucose is stable, if it will be at least an hour before your next meal, have a snack.

If you take diabetes medicines that can cause low blood glucose, always carry food for emergencies. You should also wear a medical identification bracelet or necklace.

If you take insulin, keep a glucagon kit at home and at other places where you often go. Glucagon is given as an injection with a syringe and quickly raises blood glucose. Show your family, friends, and co-workers how to give you a glucagon injection if you pass out because of low blood glucose.

Action steps if you use Insulin

When you have low blood glucose, have a snack to bring your blood glucose back to normal. You can prevent low blood glucose by eating regular meals, taking your diabetes medicines, and checking your blood glucose often. Checking will tell you whether your glucose level is going down. You can then take steps, like drinking fruit juice, to raise your blood glucose.

Action steps if you Don't use Insulin

Tell your doctor if you have low blood glucose often, especially at the same time of the day or night sevral times in a row. Be sure to tell your doctor about other medicines you are taking.Some diabetes pills can cause low blood glucose. Ask your doctor whether your tablets can cause low blood glucose.

Why Taking Care of Your Diabetes Is Important

Diabetes and Your Heart and Blood Vessels
Diabetes and Your Eyes
Diabetes and Your Kidneys
Diabetes and Your Nerves
Foot Care Tips
Diabetes and Your Gums and Teeth

Taking care of your diabetes every day will help keep your blood glucose, blood pressure, and cholesterol in your target range and help prevent other health problems that diabetes can cause over the years. You can do a lot to prevent diabetes problems.

Follow your meal plan every day.

Take your diabetes medicines every day.

Be physically active every day.

Check your blood glucose as recommended.

Diabetes and Your Heart and Blood Vessels

The biggest problem for people with diabetes is heart and blood vessel disease. Heart and blood vessel disease can lead to heart attacks and strokes. It also causes poor blood flow, also called circulation, in the legs and feet.

To check for heart and blood vessel disease, your health care team will do some tests. At least once a year, have a blood test to see how much cholesterol is in your blood. Your health care provider should take your blood pressure at every visit. Your provider may also check the circulation in your legs, feet, and neck.

The best way to prevent heart and blood vessel disease is to take good care of yourself and your diabetes.

· Eat foods that are low in sodium (salt). Check the amount of sodium by looking at the Nutrition Facts on food packages. Limit the amount of salt you use when you cook. Choose foods naturally low in sodium, such as vegetables, fruits, dry beans and peas, and unprocessed meats, poultry, and fish.

· Limit how much you have of these kinds of fat:

saturated fat, such as bacon, butter, cream, lard, and high-fat dairy products such as whole milk
trans fat, found in processed foods with partially hydrogenated or hydrogenated oil
cholesterol, found in high-fat dairy products, high-fat meats and poultry, egg yolks, and liver

· Keep your blood glucose on track. Know your A1C. The target for most people is
below 7.

· Keep your blood pressure on track. The target for most people is below 130/80. If
needed, take medicine to control your blood pressure.

· Keep your cholesterol level on track. The target for LDL cholesterol for most people
is below 100. If needed, take medicine to control your blood fat levels.

· If you smoke, quit.

· Be physically active.

· Lose weight if you need to.

· Ask your health care team whether you should take an aspirin every day.

What's a desirable blood pressure level?

Blood pressure levels tell how hard your blood is pushing against the walls of your blood vessels. Your pressure is given as two numbers: The first is the pressure as your heart pushes blood out into your blood vessels and the second is the pressure as your heart rests. If your blood pressure is higher than your target, talk with your health care team about changing your meal plan, exercising, or taking medicine.

Blood Pressure Results
Target for most people with diabetes		below 130/80
My last result		____________
My target		below ____________

What are desirable blood fat levels?

Cholesterol, a fat found in the body, appears in several forms. If your LDL cholesterol, also called "bad" cholesterol, is 100 or above, you are at increased risk of heart disease and may need treatment. A high level of total cholesterol also means a greater risk of heart disease. But HDL cholesterol, also called "good" cholesterol, protects you from heart disease, so the higher it is, the better. You should keep your triglyceride-another type of fat-levels below 150. All of these target numbers are important for preventing heart disease. But the most important target to reach first is for your LDL cholesterol.

Target Blood Fat Levels for People with Diabetes
	My Last Result	My Target

Total cholesterol below 200	___________	below _____
LDL cholesterol below 100	___________	below _____
HDL cholesterol above 40 (men)	___________	above _____
above 50 (women)	___________	above _____
Triglycerides below 150	___________	below _____

Diabetes and Your Eyes

Have your eyes checked once a year. You could have eye problems that you haven't noticed yet. Yearly exams may catch eye problems early so problems can be treated. Treating eye problems early can help prevent blindness.

High blood glucose can make the blood vessels in the eyes bleed. This bleeding can lead to blindness. You can help prevent eye damage by keeping your blood glucose and blood pressure as close to normal as possible. If you already have eye problems, your eye doctor may be able to suggest treatments that can help.

The best way to prevent eye disease is to have a yearly eye check up. In this check up, the eye doctor puts drops in your eyes to dilate your pupils. When the pupils are dilated, or big, the doctor can see into the back of the eye. This type of exam is called a dilated eye exam and it doesn't hurt. If you've never had this kind of eye exam before, you should have one now, even if you haven't had any trouble with your eyes. Be sure to tell your eye doctor that you have diabetes.

Follow these tips to take care of your eyes:

For adults and adolescents-10 years old and older-with type 1 diabetes: Have your eyes examined within 5 years of being diagnosed with diabetes. Then have an exam every year.
For people with type 2 diabetes: Have an eye exam every year.
Have an eye exam before becoming pregnant or as soon as possible after becoming pregnant.
If you smoke, quit.
Keep your blood glucose and blood pressure as close to normal as possible.

See your eye doctor for a dilated eye exam every year. Early treatment of eye problems can help save your sight.

Tell your eye doctor right away if you have any problems like blurry vision or seeing dark spots, flashing lights, or rings around lights.

Diabetes and Your Kidneys

Your kidneys help clean waste products from your blood. They also work to keep the right balance of sodium and fluid in your body.

Too much glucose in your blood is hard on your kidneys. After a number of years, high blood glucose can cause the kidneys to stop working, a condition called kidney failure. If your kidneys stop working, you'll need dialysis-a treatment that does some of the work your kidneys used to do-or a kidney transplant.

Make sure you have the following tests at least once a year to make sure your kidneys are working well:

a urine test for protein, called the microalbumin test
a blood test for creatinine, a waste product made by your body

Some types of blood pressure medicines can help prevent kidney damage. Ask your doctor whether these medicines could help you. You can also help prevent kidney problems by

taking your medicine if you have high blood pressure
asking your doctor or your dietitian whether you should eat less high-protein foods, such as meat, poultry, cheese, milk, fish, and eggs
keeping your blood glucose and blood pressure as close to normal as possible
quitting smoking

You should visit your doctor right away if you get a bladder or kidney infection. Signs of bladder or kidney infections are cloudy or bloody appearance of urine, pain or burning when you urinate, and having to urinate often or in a hurry. Back pain, chills, and fever are also signs of kidney infection.

Diabetes and Your Nerves

Over time, high blood glucose can harm the nerves in your body. Nerve damage can cause you to lose the feeling in your feet or to have painful, burning feet. You may not feel pain from injuries or sore spots on your feet. If you have poor circulation because of blood vessel problems in your legs, the sores on your feet can't heal and might become infected. If the infection isn't treated, it could lead to amputation.

Nerve damage can also cause pain in your legs, arms, or hands or cause problems with digesting food, going to the bathroom, or having sex.

Nerve damage can happen slowly. You may not even realize you have nerve problems. Your doctor should check the nerves in your feet at least once a year. Your doctor should check your sense of feeling and the pulses in your feet.

Tell the doctor about any problems with your feet, legs, hands, or arms. Also, tell the doctor if you have trouble digesting food, going to the bathroom, or having sex, or if you sometimes feel dizzy.

Ask your doctor whether you already have nerve damage in your feet. If you do, you should take good care of your feet. To help prevent complications from nerve damage, check your feet every day. See Foot Care Tips.

You can prevent nerve problems by

keeping your blood glucose and blood pressure as close to normal as possible
limiting the amount of alcohol you drink
checking your feet every day
quitting smoking

Foot Care Tips

You can do a lot to prevent problems with your feet. Keep your blood glucose in your target range and follow these tips to take care of your feet and help protect them.

·
Check your bare feet every day. Look for cuts, sores, bumps, or red spots. Use a mirror or ask a family member for help if you have trouble seeing the bottoms of your feet.

· Wash your feet in warm-not hot-water every day, but don't soak them. Use mild soap. Dry your feet with a soft towel, and dry carefully between your toes. After washing your feet, cover them with lotion before putting your shoes and socks on. Don't put lotion or cream between your toes.

· File your toenails straight across with an emery board. Don't leave sharp edges that could cut into your toe. Don't try to cut hardened skin or corns off with a razor blade or knife, and don't use wart removers on your feet. If you have warts or painful corns or calluses, see a podiatrist, a doctor who treats foot problems.

· Wear thick, soft socks. Don't wear mended socks or socks with holes or seams that might rub against your feet.

· Check your shoes before you put them on to be sure they have no sharp edges or objects in them.

· Wear shoes that fit well and let your toes move. Break new shoes in slowly. Don't wear flip-flops, shoes with pointed toes, or plastic shoes. Never go barefoot.

· Wear socks if your feet get cold at night. Don't use heating pads or hot water bottles on your feet.

· Have your doctor check your feet at every visit. Take your shoes and socks off when you go into the examining room to remind the doctor to check your feet.

· See a podiatrist for help if you can't take care of your feet yourself.

Diabetes and Your Gums and Teeth

Diabetes can lead to infections in your gums and the bones that hold your teeth in place. Like all infections, gum infections can cause blood glucose to rise. Without treatment, teeth may become loose and fall out.

Help prevent damage to your gums and teeth by

seeing your dentist twice a year
brushing and flossing your teeth at least twice a day
quitting smoking
keeping your blood glucose as close to normal as possible
having regular checkups with your dentist

Be sure to tell your dentist that you have diabetes.

Taking Care of Your Diabetes at Special Times

Diabetes is part of your life. You can learn how to take care of yourself and your diabetes when you're sick, when you're at work or school, when you travel, when you're thinking about having a baby or are pregnant, or when there's an emergency or natural disaster.

When You're Sick
When You're at School or Work
When You're Away from Home
When There's an Emergency or Natural Disaster
When You're Planning a Pregnancy

When You're Sick

Having a cold, the flu, or an infection can raise your blood glucose levels. You can have serious health problems leading to a coma if your blood glucose levels are very high.

Be prepared for illness. Make a plan ahead of time for sick days. Ask your health care team

how often to check your blood glucose levels
whether you should check for ketones in your blood or urine
whether you should change your usual dose of your diabetes medicines
what to eat and drink
when to call your health care provider

Action Steps
If You Use Insulin

Take your insulin, even if you are sick and have been throwing up. Ask your doctor about how to adjust your insulin dose based on your blood glucose test results.

Your doctor may recommend the following:

· Check your blood glucose level at least four times a day and write down the results in your record book. Keep your results handy so you can report results to your health care team.

· Keep taking your diabetes medicines, even if you're not able to eat.

· Drink at least 1 cup of water or other calorie-free, caffeine-free liquid every hour while you're awake.

If you can't eat your usual food, try eating or drinking any of the following:

juice
saltine crackers
dry toast
soup
broth
popsicles or sherbet
regular-not sugar-free-gelatin
milk
yogurt
regular-not sugar-free-soda

Action Steps
If You Don't Use Insulin

Keep taking your diabetes medicines, even if you're sick and have been vomiting

Your doctor may say you should call right away if

your blood glucose levels are above 240 even though you've taken your diabetes medicines
your urine or blood ketone levels are above normal
you vomit more than once
you have diarrhea for more than 6 hours
you have trouble breathing
you have a high fever
you can't think clearly or you feel sleepier than usual

You should call your doctor if you have questions about taking care of yourself.

When You're at School or Work

Take care of your diabetes when you're at school or at work:

Follow your meal plan.
Take your medicines and check your blood glucose as usual.
Tell your teachers, friends, or close co-workers about the signs of low blood glucose. You may need their help if your blood glucose drops too low.
Keep snacks nearby and carry some with you at all times to treat low blood glucose.
Tell your company nurse or school nurse that you have diabetes.

When You're Away From Home

These tips can help you take care of yourself when you're away from home:

· Follow your meal plan as much as possible when you eat out. Always carry a snack with you in case you have to wait to be served.

· Limit your drinking of beer, wine, or other alcoholic beverages. Ask your diabetes educator how much alcohol you can safely drink. Eat something when you drink to prevent low blood glucose.

· If you're taking a long trip by car, check your blood glucose before driving. Stop and check your blood glucose every 2 hours. Always carry snacks like fruit, crackers, juice, or soft drinks in the car in case your blood glucose drops too low.

· Bring food for meals and snacks with you if you're traveling by plane.

· Carry your diabetes medicines and your blood testing supplies with you. Never put them in your checked baggage.

· Ask your doctor how to adjust your medicines, especially your insulin, if you're traveling across time zones.

· Take comfortable, well-fitting shoes on vacation. You'll probably be walking more than usual, so you should take good care of your feet.

· If you're going to be away for a long time, ask your doctor for a written prescription for your diabetes medicines and the name of a doctor in the place you're going to visit.

· Don't count on buying extra supplies when you're traveling, especially if you're going to another country. Different countries use different kinds of diabetes medicines.

Action Steps
If You Use Insulin

When you travel,

take a special insulated bag to carry your insulin to keep it from freezing or getting too hot
bring extra supplies for taking insulin and testing your blood glucose in case of loss or breakage
ask your doctor for a letter saying that you have diabetes and need to carry supplies for taking insulin and testing blood glucose

When There's an Emergency or Natural Disaster

Everyone with diabetes should be prepared for emergencies and natural disasters, such as power outages or hurricanes. Always have your disaster kit ready. Include everything you need to take care of your diabetes, such as

a blood glucose meter, lancets, and testing strips
your diabetes medicines
a list of your prescription numbers
if you take insulin-some insulin, syringes, and an insulated bag to keep insulin cool
if you take insulin or if recommended by your doctor-a glucagon kit
glucose tablets and other foods or drinks to treat low blood glucose
antibiotic cream or ointment
a copy of your medical information, including a list of your conditions, medicines, and recent lab test results
phone numbers for the Hospitals, Red Cross and other disaster relief organizations

You also might want to include some nonperishable food, such as canned or dried food, along with bottled water.

Check and update your kit at least twice a year.

When You're Planning a Pregnancy

Keeping your blood glucose near normal before and during pregnancy helps protect both you and your baby. Even before you become pregnant, your blood glucose should be close to the normal range.

Your health care team can work with you to get your blood glucose under control before you try to get pregnant. If you're already pregnant, see your doctor right away. It's not too late to bring your blood glucose close to normal so that you'll stay healthy during the rest of your pregnancy.

Your insulin needs may change when you're pregnant. Your doctor may want you to take more insulin and check your blood glucose more often. If you take diabetes pills, you'll take insulin instead when you're pregnant.

If you plan to have a baby,

work with your health care team to get your blood glucose as close to the normal range as possible before you get pregnant
see a doctor who has experience in taking care of pregnant women with diabetes
don't smoke, drink alcohol, or use harmful drugs
follow the meal plan you get from your dietitian or diabetes educator to make sure you and your unborn baby have a healthy diet.
Be sure to have your eyes, heart and blood vessels, blood pressure, and kidneys checked. Your doctor should also check for nerve damage. Pregnancy can make some health problems worse.

Where to Get More Help with Your Diabetes

People Who Can Help You
Organizations That Can Help You

People Who Can Help You

· Your doctor. You may see your regular doctor for diabetes care or someone who has special training in caring for people with diabetes. A doctor with special training in diabetes is called an endocrinologist or diabetologist.

You'll talk with your doctor about what kind of medicines you need and how much you should take. You'll also agree on a target blood glucose range and blood pressure and cholesterol targets. Your doctor will do tests to be sure your blood glucose, blood pressure, and cholesterol are staying on track and you're staying healthy. Ask your doctor if you should take aspirin every day to help prevent heart disease.

· Your diabetes educator. A diabetes educator may be a nurse, a dietitian, or another kind of health care worker. Diabetes educators teach you about meal planning, diabetes medicines, physical activity, how to check your blood glucose, and how to fit diabetes care into your everyday life. Be sure to ask questions if you don't understand something.

· Your family and friends. Taking care of your diabetes is a daily job. You may need help or support from your family or friends. You may want to bring a family member or close friend with you when you visit your doctor or diabetes educator. Taking good care of your diabetes can be a family affair!

· A counselor or mental health worker. You might feel sad about having diabetes or get tired of taking care of yourself. Or you might be having problems because of work, school, or family. If diabetes makes you feel sad or angry, or if you have other problems that worry you, you can talk with a counselor or mental health worker. Your doctor or diabetes educator can help you find a counselor.

Organizations That Can Help You

To find a doctor / diabetes educator or dietitian contact a government hospital / private hospital near your area.

How to Find a Dietitian

To find a dietitian near you, contact a government hospital / private hospital near your area.

Pronunciation Guide

A1C (A-VUN-SEE)

beta cells (BEE-ta) (selz)

cholesterol (koh-LESS-ter-ol)

diabetologist (DY-beh-TOL-o-jist)

endocrinologist (EN-doh-krih-NOL-o-jist)

gestational (jess-TAY-shuhn-uhl)

glucagon (GLOO-kuh-gon)

glucose (GLOO-koz)

hemoglobin (HEE-mo-GLO-bin)

hyperglycemia (HY-per-gly-SEE-mia)

hypoglycemia (HY-po-gly-SEE-mia)

immune (e-MYOON)

injection (in-JEK-shun)

insulin (IN-su-lin)

ketoacidosis (KEE-toh-ASS-e-DO-siss)

ketones (KEE-ton-z)

pancreas (PAN-kree-ASS)

podiatrist (poh-DY-a-trist)

syringe (suh-RINJ)

triglyceride (try-GLISS-r-eyed)

DIABETES - Part 1

2012-01-22T02:26:00.000-08:00

Diabetes means your blood glucose, also called blood sugar, is too high. Your blood always has some glucose in it because your body needs glucose for energy to keep you going. But too much glucose in the blood isn't good for your health.

How do you get high blood glucose?

Glucose comes from the food you eat and is also made in your liver and muscles. Your blood carries the glucose to all the cells in your body. Insulin is a chemical, also called a hormone, made by the pancreas. The pancreas releases insulin into the blood. Insulin helps the glucose from food get into your cells. If your body doesn't make enough insulin, or if the insulin doesn't work the way it should, glucose can't get into your cells. It stays in your blood instead. Your blood glucose level then gets too high, causing pre-diabetes or diabetes.

What is pre-diabetes?

Pre-diabetes is a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. People with pre-diabetes are at increased risk for developing type 2 diabetes and for heart disease and stroke. The good news is, if you have pre-diabetes, you can reduce your risk of getting diabetes. With modest weight loss and moderate physical activity, you can delay or prevent type 2 diabetes and even return to normal glucose levels.

What are the signs of diabetes?

The signs of diabetes are

being very thirsty
urinating often
feeling very hungry or tired
losing weight without trying
having wounds that heal slowly
having dry, itchy skin
losing the feeling in your feet or having tingling in your feet
having blurry eyesight

You may have had one or more of these signs before you found out you had diabetes. Or you may have had no signs at all. A blood test to check your glucose levels will show if you have pre-diabetes or diabetes.

What kind of diabetes do you have?

People can get diabetes at any age. Type 1, type 2, and gestational diabetes are the three main kinds.

Type 1 diabetes, formerly called juvenile diabetes or insulin-dependent diabetes, is usually first diagnosed in children, teenagers, or young adults. With this form of diabetes, the beta cells of the pancreas no longer make insulin because the body's immune system has attacked and destroyed them. Treatment for type 1 diabetes includes taking insulin and possibly another injectable medicine, making wise food choices, being physically active, taking aspirin daily-for some-and controlling blood pressure and cholesterol.

Type 2 diabetes, formerly called adult-onset diabetes or noninsulin-dependent diabetes, is the most common form of diabetes. People can develop type 2 diabetes at any age-even during childhood. This form of diabetes usually begins with insulin resistance, a condition in which fat, muscle, and liver cells do not use insulin properly. At first, the pancreas keeps up with the added demand by producing more insulin. In time, however, it loses the ability to secrete enough insulin in response to meals. Being overweight and inactive increases the chances of developing type 2 diabetes. Treatment includes using diabetes medicines, making wise food choices, being physically active, taking aspirin daily-for some-and controlling blood pressure and cholesterol.

Some women develop gestational diabetes during the late stages of pregnancy. Although this form of diabetes usually goes away after the baby is born, a woman who has had it is more likely to develop type 2 diabetes later in life. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin.

Why do you need to take care of your diabetes?

After many years, diabetes can lead to serious problems with your eyes, kidneys, nerves, and gums and teeth. But the most serious problem caused by diabetes is heart disease. When you have diabetes, you are more than twice as likely as people without diabetes to have heart disease or a stroke.
If you have diabetes, your risk of a heart attack is the same as someone who has already had a heart attack. Both women and men with diabetes are at risk. You may not even have the typical signs of a heart attack.
You can reduce your risk of developing heart disease by controlling your blood pressure and blood fat levels. If you smoke, talk with your doctor about quitting. Remember that every step toward your goals helps!

What's a desirable blood glucose level?

Everyone's blood has some glucose in it. In people who don't have diabetes, the normal range is about 70 to 120. Blood glucose goes up after eating but 1 or 2 hours later returns to the normal range.
Ask your health care team when you should check your blood glucose with a meter. Talk about whether the blood glucose targets listed below are best for you. Then write in your own targets.

Blood Glucose Targets for Most People with Diabetes
When	Target levels	My target levels
Before meals	70 to 130	______ to _____
1 to 2 hours after the start of a meal	below 180	below ______

It may be hard to reach your target range all of the time. But the closer you get to your goal, the more you will reduce your risk of diabetes-related problems and the better you will feel. Every step helps.

Taking Care of Your Diabetes Every Day

Do four things every day to take care of your diabetes:

Follow your meal plan.
Be physically active.
Take your diabetes medicines every day.
Check your blood glucose as recommended.
Take other tests for your diabetes.
Keep daily records.

Experts say most people with diabetes should try to keep their blood glucose level as close as possible to the level of someone who doesn't have diabetes. The closer to normal your blood glucose is, the lower your chances are of developing serious health problems.
Check with your doctor about the right range for you. The Blood Glucose Targets table shows target blood glucose ranges.
Your health care team will help you learn how to reach your target blood glucose range. Your team may include a doctor, a nurse, a dietitian, and others.

When you see your doctor, ask lots of questions. Before you leave, be sure you understand everything you need to know about taking care of your diabetes.
A diabetes educator is a health worker who teaches people how to manage their diabetes. Your educator may also be a nurse, a dietitian, or other kind of health care worker.
A dietitian is someone who's specially trained to help people plan their meals.

Follow your meal plan

You should have your own meal plan. Ask your doctor to give you the name of a dietitian who can work with you to develop a meal plan. Your dietitian can help you plan meals that include foods that you and your family like to eat and that are good for you too. Ask your dietitian to include foods that are heart-healthy to reduce your risk of heart disease.
Your diabetes meal plan will include breads, cereals, rice, and grains; fruits and vegetables; meat and meat substitutes; dairy products; and fats. People with diabetes don't need to eat special foods. The foods on your meal plan are good for everyone in your family! Making wise food choices will help you

reach and stay at a weight that's good for your body
keep your blood glucose, blood pressure, and cholesterol under control
prevent heart and blood vessel disease

Action Steps
If You Use Insulin

Follow your meal plan.
Don't skip meals, especially if you've already taken your insulin, because your blood glucose may go too low. Email us for information about how to handle low blood glucose, also called hypoglycemia.

Action Steps
If You Don't Use Insulin

Follow your meal plan.

Don't skip meals, especially if you take diabetes medicines, because your blood glucose may go too low. Eat several small meals during the day instead of one or two big meals.

Be Physically Active

Physical activity helps you stay healthy. Try walking, swimming, dancing, riding a bicycle, playing baseball, or bowling. You can even get exercise when you clean your house or work in your yard. Physical activity is especially good for people with diabetes because it

helps keep weight down
helps insulin work better to lower blood glucose
is good for your heart and lungs
gives you more energy

You may be able to stop taking diabetes pills if you lose weight. Always check with your doctor before you stop taking your diabetes pills. Losing 5 or 10 Kgs can help you reach your target blood glucose levels.
Before you begin exercising, talk with your doctor. Your doctor may check your heart and your feet to be sure you have no special problems. If you have high blood pressure or eye problems, some exercises like weightlifting may not be safe. Your health care team can help you find safe exercises.

Being active helps you stay healthy. Try to be active almost every day for a total of about 30 minutes. If you haven't been very active lately, begin slowly. Start with 5 to 10 minutes, and then add more time. Or exercise for 10 minutes, three times a day. If you use insulin or take diabetes pills that help your body make insulin, you may need to eat a snack before you exercise. Check your blood glucose before you exercise. If your blood glucose is below 100, have a snack before you exercise.

Action Steps
If You Use Insulin

See your doctor before starting a physical activity program.
Check your blood glucose before, during, and after exercising. Don't exercise when your blood glucose is high and you have ketones in your blood or urine. Email us for information about ketones.
Don't exercise right before you go to sleep because it could cause low blood glucose during the night.

Action Steps
If You Don't Use Insulin

See your doctor before starting a physical activity program.
Ask your doctor whether you need to eat before you exercise.

When you exercise, carry glucose or a carbohydrate snack with you in case you have low blood glucose. Wear or carry an identification tag or card that says you have diabetes.

Take Your Diabetes Medicines Every Day

Three kinds of diabetes medicines can help you reach your blood glucose targets: pills, insulin, and other injections. Many people with type 2 diabetes take pills to help keep blood glucose in their target range.

If You Take Diabetes Pills

If your body makes insulin but the insulin doesn't lower your blood glucose enough, you may need diabetes pills. Some pills are taken once a day, and others are taken more often. Ask your health care team when you should take your pills. Be sure to tell your doctor if your pills make you feel sick or if you have any other problems.
Sometimes, people who take diabetes pills may need insulin for a while. If you get sick or have surgery, the diabetes pills may no longer work to lower your blood glucose.

If You Use Insulin

You need insulin if your body has stopped making insulin or if it doesn't make enough. Everyone with type 1 diabetes needs insulin, and many people with type 2 diabetes do too. Some women with gestational diabetes also need to take insulin.

You may need insulin to control your blood glucose.
Your doctor can tell you which of these ways to take insulin is best for you.

· Taking injections. You'll use a needle attached to a syringe-a hollow tube with a plunger-that you fill with a dose of insulin. Some people use an insulin pen, a pen-like device with a needle and a cartridge of insulin.

· Using an insulin pump. A pump is a small device, worn on a belt or in a pocket, that holds insulin. The pump connects to a small plastic tube and a very small needle. The needle is inserted under the skin and stays in for several days.

· Using an insulin jet injector. This device sends a fine spray of insulin through the skin with high-pressure air instead of a needle.

· Using an insulin infuser. A small tube is inserted just beneath the skin and remains in place for several days. Insulin is injected into the end of the tube instead of through the skin.

If You Use Other Injectable Medicines

Some people with diabetes use other injectable medicines to reach their blood glucose targets. These medicines are not substitutes for insulin.

If You Don't Use Pills, Insulin, or Other Injectable Medicines

Many people with type 2 diabetes don't need diabetes medicines. They can take care of their diabetes by using a meal plan and exercising regularly.

PIMPLES

2012-01-22T02:06:00.000-08:00

What Is Acne / Pimple?
Acne is a disease that affects the skin’s oil producing glands. The small holes in your skin (pores) connect to oil glands under the skin. These glands make an oily substance called sebum. The pores connect to the glands by a canal called a follicle. Inside the follicles, oil carries dead skin cells to the surface of the skin. A thin hair also grows through the follicle and out onto the skin. When the follicle of a skin gland clogs up, a (Acne) pimple grows.

Most pimples are found on the face, neck, back, chest, and shoulders. Although acne is not a serious health threat, but it can cause scars.

How Does Acne Develop?

Acne occurs when sebum is not able to pass through the hair root (follicle). Sometimes, the hair, sebum, and dead skin cells in the follicle clump together to form a plug. The bacteria in the plug may cause inflammation and hence swelling. When it can no longer hold the contents it bursts and spills the sebum, dead skin cells and bacteria onto the skin surface.
There are many types of pimples. The most common types are:

Whiteheads (Closed Comedones) - These are pimples that stay under the surface of the skin.
Blackheads (Open comedones) - These pimples rise to the skin’s surface and look black once they open up and drain the sebum. The black color is not from dirt.
Papules - These are small pink bumps that can be tender.
Pustules - These pimples are red at the bottom and have pus on top.
Nodules - These are large, painful, solid pimples that are deep in the skin.
Cysts - These are deep, painful, pus-filled pimples that can cause scars.

Who Gets Acne?

Acne is the most common skin condition. People of all races and ages get acne. But it is most common in teenagers and young adults. An estimated 80 percent of all people between the ages of 11 and 30 have acne outbreaks at some point. Some people in their forties and fifties also acne.

What Causes Acne?

The cause of acne is unknown. Doctors think certain factors might cause it:

The hormone increase in teenage years (this can cause the oil glands to plug up more often)
Hormone changes during pregnancy
Starting or stopping birth control pills
Heredity (if your parents had acne, you might get it, too)
Some types of medicines
Greasy /oily makeup.

How Is Acne Treated?

Acne is treated by doctors who work with skin problems (dermatologists). Treatment tries to:

Heal pimples
Stop new pimples from forming
Prevent scarring
Help reduce the embarrassment of having acne.

Early treatment is the best way to prevent scars. Your doctor may suggest over-the-counter (OTC) or prescription drugs. Some acne medicines are put right on the skin (topical). Other medicines are pills that you swallow (oral). Sometimes you may have to use more than one medicine.

How Should People With Acne Care for Their Skin?

Here are some ways to care for skin if you have acne:

Clean skin gently. Use a soap cleanser in the morning, evening, and after heavy workouts. Scrubbing the skin does not stop acne. It can even make the problem worse.
Try not to touch your skin. People who squeeze, pinch, or pick their pimples can get scars or dark spots on their skin.
Shave carefully. If you shave, you can try both electric and safety razors to see which works best. With safety razors, use a sharp blade. Also, it helps to soften your beard with soap and water before putting on shaving cream. Shave lightly and only when you have to.
Stay out of the sun. Many acne medicines can make people more likely to sunburn. Being in the sun a lot can also make skin wrinkle.
Choose makeup carefully. All makeup should be oil free. Look for the word “non-comedogenic” on the label. This means that the makeup will not clog up your pores. But some people still get acne even if they use these products.
Shampoo your hair regularly. If your hair is oily, you may want to shampoo daily.

What Things Can Make Acne Worse?

Some things can make acne worse:

Changing hormone levels in teenage girls and adult women 2 to 7 days before their period starts
Pressure from bike helmets, backpacks, or tight collars
Pollution and high humidity
Squeezing or picking at pimples
Hard scrubbing of the skin.

What Are Some Myths About the Causes of Acne?

There are many myths about what causes acne. Dirty skin and stress do not cause acne. Also, chocolate and greasy foods do not cause acne in most people.

What Research Is Being Done on Acne?

Scientists are looking at new ways to treat acne. Current research includes:

Working on new drugs to treat acne, including new topical antibiotics
Looking at ways to prevent plugs
Looking at ways to stop the hormone testosterone from causing acne
Understanding more about bacteria on the skin.

In some patients, acne medications cause side effects such as irritation on skin, burning or redness. These side effects are usually mild and stop after sometime. Severe side effects should be brought to the notice of the doctor.

It may take 4-8 weeks before improvement is noticed by the patient.

Some common topical medications used for acne are :

· Benzoyl peroxide

· Clindamycin

· Erythromycin

· Tetracycline

· Tretinoin

· Adapalene

Other treatments for acne include :

· Hormonal treatment

· Low – dose corticosteroids

· Anti androgen medicines

· Removal of comedones by dermatologists

· Steroid injections in the acne

· Skin peeling therapy for uneven skin

· Cosmetic surgery for scar improvement.

swaasthya-healing

Psoriasis

What Is Psoriasis?

Who Gets Psoriasis?

Is psoriasis contagious?

Symptoms

What are the symptoms of psoriasis?

What Causes Psoriasis?

How Is Psoriasis Diagnosed?

How Is Psoriasis Treated?

Topical Treatment:

Light Therapy:

Systemic Treatment:

Combination Therapy:

Will psoriasis go away with treatment?

What Are Some Promising Areas of Psoriasis Research?

Questions to Ask Your Doctor

FEVER

Symptoms

Causes

Complications

Preparing for your appointment

Tests and diagnosis

Treatments and drugs

Lifestyle and home remedies

Prevention

CHICKEN POX

ATOPIC DERMATITIS

What Is Atopic Dermatitis?

Who Gets Atopic Dermatitis?

Other Types of Skin Problems

What Causes Atopic Dermatitis?

How Is Atopic Dermatitis Diagnosed?

Things That Make Atopic Dermatitis Worse

How Is Atopic Dermatitis Treated?

What Research Is Being Done on Atopic Dermatitis?

DIABETES - Part 2

Check Your Blood Glucose as Recommended

Take Other Tests for Your Diabetes

Tests for Ketones

The A1C test

A1C results

Keep Daily Records

When Your Blood Glucose Is Too High or Too Low

What You Need to Know about High Blood Glucose

What You Need to Know About Low Blood Glucose

Why Taking Care of Your Diabetes Is Important

Diabetes and Your Heart and Blood Vessels

What's a desirable blood pressure level?

Blood Pressure Results

What are desirable blood fat levels?

Target Blood Fat Levels for People with Diabetes

Diabetes and Your Nerves

Foot Care Tips

Diabetes and Your Gums and Teeth

Taking Care of Your Diabetes at Special Times

When You're Sick

Action Steps If You Use Insulin

Action Steps If You Don't Use Insulin

Keep taking your diabetes medicines, even if you're sick and have been vomiting

When You're Away From Home

Action Steps If You Use Insulin

When There's an Emergency or Natural Disaster

When You're Planning a Pregnancy

People Who Can Help You

Organizations That Can Help You

How to Find a Dietitian

Pronunciation Guide

DIABETES - Part 1

How do you get high blood glucose?

What is pre-diabetes?

What are the signs of diabetes?

What kind of diabetes do you have?

Why do you need to take care of your diabetes?

What's a desirable blood glucose level?

Blood Glucose Targets for Most People with Diabetes

Taking Care of Your Diabetes Every Day

Follow your meal plan

Action Steps If You Use Insulin

Action Steps If You Don't Use Insulin

Action Steps
If You Use Insulin

Action Steps
If You Don't Use Insulin

Action Steps
If You Use Insulin

Action Steps
If You Use Insulin

Action Steps
If You Don't Use Insulin

Action Steps
If You Use Insulin

Action Steps
If You Don't Use Insulin