Sugar Low's and High's

Hypoglycemia

Insulin is a hormone which is secreted from the pancreas, when blood sugar levels rise to high. Hypoglycemia occurs when there is an abnormal amount of glucose in the blood; it is most common in diabetes. The term literally means ‘low blood sugar’, the level depends on the person but the average level for Hypoglycemia is when the blood glucose level is below 4mmol/L or 70mg/dL. Hypoglycaemia can be the result of too much insulin being secreted, or alternatively the cause is due to glucose being secreted into the blood stream too slowly, or the glucose which is supplied is used up too quickly.

Although hypoglycemia is most common in diabetics, babies with diabetic mothers may experience low blood sugars or due to some weight loss surgery, alcohol, serious heart or kidney failure, hormone deficiency or insulioma. (tumors of the pancreas that produce too much insulin are called insulinomas. Insulinomas keep making insulin, even when your blood sugar drops too low.)

There are many symptoms: dysphoria, dizziness, unconsciousness and seizures are due to a lack of glucose being supplied to the brain this is known as neuroglycopenia.  Other symptoms: include blurry vision, fast pounding heartbeat, feeling nervous, shaking, hunger, sleeping difficulty, tiredness, tingling or shaking. In serious cases, blood sugar cannot rise so patients will end up in faint, have a seizure or end up in a coma. 

Treatment: Effectively it is essential to raise the blood sugar level; the low blood sugar level can be measured by a glucose monitor. Diabetics have to treat it by eating quick release food or drink such as coca-cola or sweets. Although if it is consistent due to insulinoma, the best treatment is to have the tumour remove to prevent too much insulin being secreted.

Hyperglycemia

It is the opposite of the condition I just explained, where there is too much glucose in the blood, and it builds up in blood plasma. The average level for Hyperglycemia is when blood sugar levels raise above 11.1mmol/L, however symptoms are often not seen to above 15mmol/L. It is a common condition for people with diabetes, and they can reduce the glucose level by exercising or injecting on insulin (unless ketones are in the urine.) The symptoms are increased urination (with lots of sugar in urine) and thirst. If the condition is untreated it can lead to ketoacidosis also known as a diabetic coma, which is a result of the body not producing enough insulin and so fat stores are broken down and ketones are a waste product which cause this. Ketoacidosis is distinguished by shortness of breath, fruity smelling breath and very dry mouth.

In this post I have frequently talked about blood glucose level, so I have found a key describing the measurements: (my source: http://www.news-medical.net/health/What-is-Hyperglycemia.aspx)

Glucose levels are measured in either:

Milligrams per decilitre (mg/dl), in the United States and other countries (e.g., Japan, France, Egypt, Colombia); or

Millimoles per litre (mmol/l), which can be acquired by dividing (mg/dl) by factor of 18.

Scientific journals are moving towards using mmol/l; some journals now use mmol/l as

the primary unit but quote mg/dl in parentheses.

Comparatively:

72 mg/dl = 4 mmol/l

90 mg/dl = 5 mmol/l

108 mg/dl = 6 mmol/l

126 mg/dl = 7 mmol/l

144 mg/dl = 8 mmol/l

180 mg/dl = 10 mmol/l

270 mg/dl = 15 mmol/l

288 mg/dl = 16 mmol/l

360 mg/dl = 20 mmol/l

396 mg/dl = 22 mmol/l

594 mg/dl = 33 mmol/l

Cause of Type 1 Diabetes

I have a great interest in sport along with medicine, one of my favourite being running so last night I entered myself for the Bristol 10 kilometre race. I’m running on behalf of diabetes UK and hopeful to raise over £250. I decided on this charity because my younger sister has Diabetes Mellitus Type 1, this has encouraged a great interest into the research for a cure, or prevention against the Auto immune disease.

The structure of a pancreas consists of Alpha Cells, Beta Cells, Delta Cells and (Capillaries). These cells are all found in areas within the pancreas called the islets of Langerhans. Alpha cells make and release glucagon, which raises the level of glucose (sugar) in the blood. The primary function of a beta cell is to store and release insulin. Insulin is a hormone that brings about effects which reduce blood glucose concentration. Beta cells can respond quickly to spikes in blood glucose concentrations by secreting some of its stored insulin while simultaneously producing more. Delta cells make somatisation, a hormone that inhibits the release of numerous hormones in the body.

Diabetes is an autoimmune disease, where your body produces antibodies to attack your own tissue; in this case the antibodies are produced against the pancreas. It involves the destruction of Beta Cells within the Pancreas; therefore the pancreas can no longer secrete insulin, or store insulin. There is not a greatly known understanding what causes the destruction of Beta Cells, a major factor is believed to be Inflammation. This inflammation is caused by lipids which are secreted by protein based enzymes (12 LO) within the Cells. Recent scientific investigations have identified the removal of this enzyme in mice, can prevent Type 1 Diabetes. Different research is investigating the possibility to differentiate Stem Cells into Beta Cells to replace the destroyed pancreatic cells.

However Diabetes is known as a polygenic disease, which means there are many factors which contribute to its onset. This means it is difficult to find a cure of prevention, it is believed that there’s a genetic higher risk. The risk of a child developing type 1 diabetes is about 10% if the father has it, about 10% if a sibling has it, about 4% if the mother has type 1 diabetes and was aged 25 or younger when the child was born, and about 1% if the mother was over 25 years old when the child was born. In the UK, around 2.9 million people are affected by diabetes. There are also thought to be around 850,000 with undiagnosed diabetes.

The symptoms for type 1 diabetes are increased thirst, increased urination and weight loss. Weight loss is the main factor because with the beta cells being destroyed there is no secretion of glucose, therefore there is no glucose in the blood, and cells receive no glucose to make energy. This leads to the body breaking down its own fat supply to provide enough energy, leading to a huge loss of muscle. The glucose deficient blood can lead to a temporary condition where the blood becomes acidic, known as diabetic ketoacidosis which is the cause of dehydration.

The treatment for diabetes is daily injections of insulin, or there are other means such as an insulin pump. Left untreated, diabetes can cause many different health problems. Large amounts of glucose can damage blood vessels, nerves and organs. Even a mildly raised glucose level that does not cause any symptoms can have damaging effects in the long term.

Kwashiorkor

On the news today has been the main problem in Africa being poverty, this huge issue has led to many health issues. One of the main diseases, which affects most young people, is Kwashiorkor.

This disease is very common in very poor countries, due to famine, lack of education (regarding diet) and the limit of food supply. It can also be very common after natural disasters. It is a form of malnutrition, where essentially someone does not have enough protein in their diet. The main symptom is a protruding belly; however there are many other symptoms such as decreased muscle mass, failure to gain weight, fatigue, enlarged fatty liver and infections due to weak immune system and Oedema. Oedema is swelling caused by fluid retention, excess fluid is trapped in the body’s tissues, commonly arms, hands, ankles, legs and feet.

In kwashiorkor the body cannot synthesize the proteins it needs. Body proteins, including blood proteins, are broken down to supply the body with energy. Proteins function in the blood to help keep blood from leaking out of the blood vessels into body tissues and cavities. This loss of proteins from the blood increases its water potential. This means that less water is removed from the body tissues into the blood by osmosis, causing the body tissues to swell. The bloated stomach of a starving child with kwashiorkor is caused by this process, as well as a swollen liver.

Therefore the diagnosis, other than physical examination, can be by taking a blood test, total protein levels or urinalysis. Treatment:  Getting more calories and protein will correct kwashiorkor, if treatment is started early enough. However, children who have had this condition will never reach their full potential for height and growth. Treatment depends on the severity of the condition. People who are in shock need immediate treatment to restore blood volume and maintain blood pressure. Calories are given first in the form of carbohydrates, simple sugars, and fats. Proteins are started after other sources of calories have already provided energy. Vitamin and mineral supplements are essential. Since the person will have been without much food for a long period of time, eating can cause problems, especially if the calories are too high at first. Food must be reintroduced slowly. Carbohydrates are given first to supply energy, followed by protein foods.

Pertussis

Thirteen new born babies have died in the recent outbreak of whooping Cough; this has led to the campaign to vaccinate pregnant women. New born immune systems are so vulnerable and it’s too early to give them vaccinations these are given at 2, 3 and 4 Months of Age (and then again before school at around 3 years and 4 months.) The new campaign to help the new born babies is to vaccinate the pregnant mothers around 28-30 weeks old. The vaccinate will increase the number of antibodies in the mother, these should move from the mother to the baby and hopefully vaccinate the new born. The vaccination are recommended because although most babies are infected against most infections through breast-feeding, they are not protected against whooping cough. 

The medical name for Whooping Cough is Pertussis; the name whooping cough comes from the distinctive ‘whooping’ noise in a persistent bout of coughing, after the first symptoms of dry throat. The coughing attacks occur on average 15 times a day, and the infection can last up to 12 weeks. There are other symptoms like high temperature, runny nose and vomiting after coughing. It is highly contagious which means it can be passed from person to person through the air when people sneeze or cough. It can take 5-15 days to see the symptoms after the disease is contracted, this is known as the ‘incubation period.’  The infection is caused by the Bordetella Pertussis which affects the lungs and airways.

Diagnosis: It’s usually formed from symptoms and family recent history; however it can also be diagnosed by analysing a swab taken from nose and mouth (results take about five days) and Blood tests are usually avoided. There is a new surveillance test which involves taking a specimen by brushing along the gum line with a saliva-collecting device. It’s used to estimate antibody levels directed against a toxin produced by the bacterium and is suitable for assisting in the diagnosis of those patients who have been coughing for more than two weeks and are suspected of having whooping cough.

Vaccination is the best prevention; however the body creates immunity after having the infection. Although most cases of whooping cough don’t need treatment and in a lot of cases in older people the infection is not diagnosed. In newborns and young children with asthma they usually have to monitored in hospital, and the only other treatment is antibiotics. 

Celiac Disease

My sister Laura (aged 13) has been diagnosed with celiac disease, along with diabetes a couple of years ago. She has to change what she eats to gluten free equivalents of most foods, apart from fruit, vegetables, rice, potato’s and other foods, which don’t contain gluten.

In the Small intestine there are villi, which absorb nutrients from food, however when someone with celiac disease eats gluten, the immune system responds by damaging these villi. Therefore the disease is described as ‘autoimmune’, the damage is due to the consumption of gluten that is found in wheat, barley, rye and possibly oats. The consequence of the villi being damaged is that the body does not absorb all the nutrients it needs and therefore the person becomes malnourished.

There is no known cause of celiac disease, but it can be developed at any point in life and there is an increased risk if a family member has it (sadly for myself.) As well as it being common in families, it is more common if you have Type 1 Diabetes therefore when my sister was diagnosed with type 1, she was put at a higher risk. It is also more common for people with Down syndrome, Intestinal Cancer, Lactose intolerance, Addison’s disease and thyroid disease.

There are many symptoms for celiac disease and they do vary for different aged people.  The main symptoms are abdominal pain, constipation, decreased appetite, diarrhoea, lactose intolerance (until disease is treated), nausea and vomiting, unexplained weight loss. In children symptoms could be slowed growth, delayed puberty, poor weight gain and effects on tooth enamel. Due to the lack of nutrients other symptoms can include bruising easily, depression, hair loss, itchy/irritated skin, nosebleeds, tingling in hands and feet.

Sadly for my sister, there is currently no cure: however I hope one day there is one, (along with the cure for diabetes.) Therefore the only way for patients with celiac disease to help is to have a gluten free diet, which can be quite challenging. 

Blood Doping

Lance’ Armstrong’s recent confession of using drugs and blood transfusions to win his 7 tour de France titles, has encouraged me to put research into Blood Doping.

Blood doping is a way of enhancing the performance of athletes. Several months before the event the athlete would be competing in, around 1dm of blood is taken from athlete and frozen. As the athlete continues to train, the blood removed from the body would be replaced as the body makes more. A few hours before the event, the red blood cells from the athlete’s blood would be transferred back into the blood stream of the athlete.

Blood doping enhances the performance because after the transfusion of red blood cells, the body would contain a higher concentration than it usually would. Therefore the quantity of haemoglobin would increase, and so more oxygen would be able to travel around the body.  With more oxygen in the body, cells could carry out more aerobic respiration.

More recently since 1998, like lance Armstrong- the same effect of blood doping can be achieved by using the hormone erythropoietin (EPO). It is a natural hormone in the body, which is secreted by the kidneys and increases the rate of production of red blood cells. 

Parkinson's Disease

Today, 17^th January 2013 is Mohammad Ali’s seventy-second birthday. Mohammed Ali who is an American Former Boxer and Civil rights leader, was diagnosed with Parkinson’s disease in 1984 which is caused by head trauma from activities such as boxing. It is said to believe that the Holmes fight, contributed majorly to the Parkinson’s syndrome.

Parkinson’s is most common in men; around the age of 60 but 1 in 20 cases develop around the age of 50 and on average 1 out of 500 people are affected by the disease. Parkinson’s is caused by a reduction in dopamine in the brain because it is vital job is to control movement in the body. The reduction in dopamine is caused when nerve cells die.

Parkinson’s is a progressive neurological disease, the main and first symptoms are physical which include shaking, muscle stiffness and movement becomes very slow. Other symptoms not related to movement would be difficulty swallowing, daytime tiredness and depression.  There is currently not any treatment, but there is medication such as Levodopa which relieves these symptoms.

Dementia

I’m applying for a Care Assistant position, in an elderly care home where 26 out of the 28 residents have some form of dementia. Therefore on the BBC website this morning, the headline “Uneven dementia care ‘disgraceful’” caught my attention.

800,000 people in the UK have some form of dementia; most of these people have not been diagnosed. In the UK there has been a rise from 43% in 2011, to 46% in 2012. The article talks about the major problem being that with late diagnosis, people are left to suffer unnecessarily. 

Dementia is associated as an on-going syndrome where, progressively the brain loses less and less of it abilities, Including memory, mental speed, understanding, judgement, language. The care home has different extents of people with dementia, some only forgotten memories and others who can no longer talk due to extensive brain loss abilities. People with dementia can become uninterested, have difficulty controlling emotions and also lose social manners. The manager at the care home described one of the qualities of a care assistant as ‘thick skinned’ because in order to carry out the job you need to be aware of the rude and unpleasant things people with the syndrome may say.

Dementia can be diagnosed by brain scans, blood tests accessing the amount of Vitamin B, and mental and physical assessment. The tests can be carried out at the GP; however CT scans have to be done by a specialist. 

Plastic Surgery is an Art

A Plastic Surgeon in Bristol, came to talk to my schools medical society about her speciality today. She described her career not as a 'job' but as a 'passion.' She combined her love for sculpting and medicine together to give her the perfect career choice: Plastic Surgery. 

Typically plastic surgery is surgery to reconstruct damaged skin and tissue usually after illness or injury, 
the first aim is to restore the skin or tissue function back as close to normal, and secondary aim to improve the appearance of the skin.Plastic surgery can be used to repair damage caused by:

• illnesses or defects from birth
• an illness affected a particular part of the body
• damage from fire (burns), car accidents or other serious injury

Cosmetic surgery is a recent branch into plastic surgery, however instead of repairing compulsory function, its to improve the physical appearance of someone. For example liposuction (fat removal) 

An Important and Emerging Field

One of the most interesting things in the news this week, is the advancement for diagnosis of Cancer and Asthma. It's seen as such a big advancement, because it will reduce the time of diagnosis from 'weeks to minutes.' This is because, the traditional way is to take a sample of bacteria and see how it responds to antibiotics which can be a long process.  

Using mice which have Pseudomonas aeruginosa and Staphylococcus aureu, infections like these release compounds which are exhaled. Scientists have discovered 'chemical fingerprints' given of by certain bacteria which could allow the advancement of diagnosis to a breath test. 

UK First Hand Transplant

Mark Cahill developed gout in his toes and feet 20 years ago, and five years ago spread to his hand making him unable to move his fingers. Gout is a build of a uric acid with in the blood; it’s a waste product of the body and excreted through the kidneys in urine.  However if you create too much uric acid, or not enough is excreted in urine then it builds up as crystals around joints. These crystals can cause pain and inflammation around joint and also the crystals can build up and progressively cause problems to joints and bone.

The surgery took 8 hours, and carried out at Leeds Royal Infirmary. As well as being the first UK hand plant, it was the first time a limb was amputated to attack the donor limb. It was amputated where the watch would be worn at the end of the forearm, then the bone, blood vessels were all attached to the donor hand. The bones were connected by metal plates. 

Mark Cahill talks about the great success:

http://www.youtube.com/watch?v=7VlrzUohMWo

Medlink

I attended the ‘medicine taster’ course at Nottingham University during my Christmas break, where I spent 5 days of lectures and practical sessions, and stayed in the halls of residents. I found it very independent staying on my own, however was good to make new friends with the other people on the course, and people with the same career interests as myself. It was very enjoyable and rewarding and showed me new medical areas which I hadn’t previously known.

I was particularly interested in HEMS (Helicopter Emergency Medical Services): pre-medical care for severe medical problems In need of urgent response. The prime job in severe cases is to keep the patient stable, until hospital care can be given. I was very interested by typical cases HEMS doctors deal with on a daily basis, along with unique cases which occurred in major disasters. HEMS is fully run on donations due to the cut in government spending on health care, so if not enough money is available the services are unable to run which is a great shame.

Generally the course gave me a good insight into what studying medicine at university would be like, and I really enjoyed my days there. It may persuade me to do another course such as Medsim which is more interactive, in the summer! The course will also help me to complete my gold duke of Edinburgh.