The Diagnosis of Diabetes
Although the diagnosis of diabetes may be anticipated when classical
symptoms and signs are present; weight loss, fatigue, a history of
polydipsia (excessive
thirst) and polyuria (excessive urinating), the diagnosis should not rely
only on the presence of glycosuria (sugar in the urine). The diagnosis must
be
confirmed by demonstrating the presence of fasting hyperglycaemia (raised
blood sugar) and following an oral glucose tolerance test.2
Diabetic Retinopathy and Blindness
Twenty years after the onset of diabetes nearly all patients with type I
diabetes (insulin-dependent) and more than 60% of those with type II
diabetes (non
insulin-dependent) will have retinopathy.3 Diabetic retinopathy is the
leading cause of blindness amongst people of working age in industrialised
countries.4
It is estimated that there are 20 million diabetics in the Middle East (WHO
Eastern Mediterranean Region), of which 800,000 will require treatment for
retinopathy, and 116,000 new patients will present for treatment each year.5
In Singapore, 8.6% of the population between 15 and 69 years is diabetic,
that is, 165,000 diabetics and at least 16,500 of these will have
retinopathy.6
Ricky Sharma writes in this issue of his experience at Aravind Eye Hospital,
South India. In a six month period, 1,863 new eye patients had a diagnosis
(either previously known or unknown) of diabetes mellitus. Of these, 684
(37%) were found to have diabetic retinopathy. Further, 987 (53%) had either
immature
or mature cataracts and so some retinopathy will have been obscured.
Thylefors, Negrel, Pararajasegaram and Dadzie, in their analysis of the WHO
Global Data Bank on Blindness, said that the survey data on diabetic
retinopathy
as a cause of blindness is too limited to reach an accurate figure.7
However, it does seem likely that blinding diabetic eye disease is now the
fourth
major cause of blindness worldwide, after cataract, the glaucomas and
trachoma.
Philip Hykin, in his review article, describes the clinical features and
management of diabetic retinopathy. The new descriptive terms used by the
Early
Treatment of Diabetic Retinopathy Study (ETDRS) should be understood by us
Screening and Treatment
Lyn Jenkins and Valerie Mayon-White address the difficult question of
screening for diabetic retinopathy. Although the 'ideal screening method
does not
exist' and many in developing countries will not have available
sophisticated equipment for screening, all eye care workers should be aware
if diabetes
is a public health problem in their region and make sure that diabetic
patients have regular, dilated view ophthalmoscopy
Old Descriptive Term
New Term (ETDRS)
Background
Mild Non-Proliferative
Moderate Non-Proliferative
Pre-Proliferative
Severe Non-Proliferative
Very Severe Non-Proliferative
Proliferative
Proliferative (the same)
Maculopathy ('Diffuse'; 'Exudative'; 'Ischaemic')
Maculopathy (focal laser therapy based on whether 'Clinically Significant
Macular Oedema')
It is understood that adding retinal photography to direct or indirect
ophthalmoscopy greatly improves sensitivity and specificity (
) in identifying diabetic retinopathy.5,7,8 However, Yeo, Lim and colleagues
rightly point out that 'primary health care and other practitioners should
... be encouraged to attempt direct ophthalmoscopy ... and refer diabetics
for further examination if the fundal state cannot be adequately assessed by
them.'6
Early treatment using laser photocoagulation has been shown to reduce
blindness due to diabetic retinopathy by at least 60% and the figure will
improve
further as patients at risk are identified early:3 the earlier the better.
Recognition of the increasing problem of diabetes mellitus and its danger to
sight, training in ophthalmoscopy (and other diagnostic methods, if
possible),
early identification of the stages of retinopathy in patients at risk and
referral for expert opinion and treatment, will prevent blindness for many
individuals
Dr.vijeta
----original message
From: "Muralidhar R" <[EMAIL PROTECTED]>
To: "K Ramkrishna" <[EMAIL PROTECTED]>;
<accessindia@accessindia.org.in>
Sent: Sunday, September 24, 2006 11:43 AM
Subject: Re: [AI] diabetes
> Friends,
>
> One should be very careful with diabetes as it is one main reason for
> causing blindness. Further information on how diabetes affects retina and
> how to prevent will be highly appreciatted.
>
> With regards,
>
> Muralidhar R
> ----- Original Message -----
> From: "K Ramkrishna" <[EMAIL PROTECTED]>
> To: <accessindia@accessindia.org.in>
> Sent: Saturday, September 23, 2006 10:03 AM
> Subject: Re: [AI] diabetes
>
>
> : Dear Bhawani and other members of the list,
> :
> : On account of relative physical inaction & inability to go for a swift
> walk,
> : the visually impaired persons have a higher probability of diabetes
> attack.
> : In my opinion any discussion on diabetes is very pertinent to visually
> : impaired persons in general and to this site in particular. Actually
> when I
> : saw Vijeta's mail, which in my opinion was very informative and
> interesting
> : I was only hoping that one of us should not blow the whistle in the
> context
> : of the topical importance. Before blowing the whistle, we should put the
> : general interest of the site before our personal interests, tastes &
> : preferences. e.g. we had an extended & perhaps interminable discussion
> on
> : stray dogs and many of us shared our experience on the site on the way
> they
> : were kissed and bit by dogs. While this many not be pertinent to some of
> us
> : on an individual basis, it is of common interest. I request that before
> : blowing the whistle, which in my opinion should be best left to the
> : moderator let us ask ourselves whether the topic under discussion is of
> : common importance pertaining to visually impaired. Some of us raised an
> : objection when an incident involving an IT professional in Bangalore was
> : posted. I also feel that we should not recommend any of our members to
> post
> : their messages in any other specific site. I hope this is appreciated.
> :
> : Rgds,
> :
> : (K. Ramkrishna)
> : 23.9.06
> : ----- Original Message -----
> : From: "BHAWANI SHANKAR VERMA" <[EMAIL PROTECTED]>
> : To: <accessindia@accessindia.org.in>
> : Sent: Friday, September 22, 2006 10:40 AM
> : Subject: Re: [AI] diabetes
> :
> :
> : > please discuss such matter in another group called "say everything".
> this
> : > is
> : > not an appropriate forum for such discussion. thanks.
> : >
> : > ----- Original Message -----
> : > From: "vijeta" <[EMAIL PROTECTED]>
> : > To: <accessindia@accessindia.org.in>
> : > Sent: Thursday, September 21, 2006 5:22 PM
> : > Subject: [AI] diabetes
> : >
> : >
> : >>
> : >> Diabetes
> : >>
> : >> Diabetes
> : >>
> : >> Diabetes is classified into four catagories with slightly varied
> : > therapeutic protocols that our customers have seen phenomenal results
> : > with.
> : >>
> : >> Diabetes is a major health concern globally. According to the
> National
> : > Daibetes Association, 16 million people in the U.S. have diabetes and
> less
> : > than 1/2
> : >> aren' t even aware that they have it.
> : >>
> : >> Diabetes ranks as the number 4 cause death in America with 178,000
> : > assocaited deaths annually. 18 - 24,000 people lose their eyesight and
> : > more
> : > than 20,000
> : >> diabetics are treated for renal disease. Diabetes is the most
> frequent
> : > cause of non- traumatic loss of limbs each year.
> : >>
> : >> The protocol for Brittle diabetes, Diabetes Insipidus, Diabetes
> Mellitus
> : > Type I, Diabetes Mellitus Type II are excellent specific complementary
> : > therapies.
> : >>
> : >> Central to all kits is the DNA insulin product that is
> homeopathically
> : > proven to re-teach the pancreas optimal insulin production thereby
> : > correcting hereditary
> : >> diabetic predispositions.* DNA insulin contains energetic imprints
> from
> : > optimally working pancreatic tissues, non-diabetic DNA and Insulin and
> : > serves to
> : >> remind the body of correct pancreatic function. When taken over a
> period
> : > of time the body begins to relearn insulin production. DNA Insulin
> : > manufactured
> : >> exclusively by PHP labs is truly a breakthrough in Diabetes therapies
> and
> : > resonance homeopathy. It is not neccesary to continue taking DNA
> Insulin
> : > past
> : >> a 3 or 6 month adaptation period. We believe in addressing root
> causes
> : >> and
> : > not just supressing symptoms.
> : >>
> : >> The kits all also contain PROZN-GL
> : >> US Patent # 5,834,032(Cyclo his-pro plus Zinc)
> : >> which showed improvements in biochemical measures of glucose
> metabolism
> : >> in
> : > double-blind studies at UCLA. Cyclo (his-pro) is a naturally occurring
> : > cyclic
> : >> dipeptide consisting of histidyl and proline. Concentrations of cyclo
> : > (his-pro) have been found in the blood, cerebrospinal fluid (CSF),
> semen,
> : > brain,
> : >> spinal cord, and gastrointestinal tract of humans. Studies suggest
> that
> : > cyclo (his-pro) is one of numerous compounds in the prostate gland
> that
> : > regulate
> : >> the intestinal absorption of zinc.Both animals and humans with
> diabetes
> : > have altered zinc metabolism and zinc is known to play a key role in
> : > synthesis,
> : >> storage, and secretion of insulin. Zinc is also required for proper
> : > glucose utilization by muscle and fat cells. PROZN_GL enhances both
> zinc
> : > absorption
> : >> and glucose utilization, which results in a significant decline in
> both
> : > blood and urine glucose levels of diabetic patients.* It appears that
> : > cyclo
> : > (his-pro)
> : >> is an important new agent that can help improve glucose metabolism in
> : > patients with type diabetes.
> : >>
> : >> It is important to monitor your blood sugar and insulin and eat a
> proper
> : > diet while on these complementary protocols. These products are not a
> : > substitute
> : >> for any pharmaceuticals that your Dr. may have prescribed.
> : >> Hypoglycemics and Borderline Diabetes
> : >>
> : >>
> : >> Hypoglycemics and Borderline Diabetes:
> : >>
> : >>
> : >> The kit for hypoglycemics and borderline diabetics contains ProZnGL,
> DNA
> : > Insulin and Glucogen Complex
> : >>
> : >> ProZn GL US Patent # 5,834,032. PROZN_GL enhances both zinc
> absorption
> : > and glucose utilization, which results in a significant decline in
> both
> : > blood and
> : >> urine glucose levels of diabetic patients.*
> : >>
> : >> C19 DNA - Aids in correcting hereditary diabetes by re-teaching the
> body
> : > insulin production
> : >>
> : >> SGC Glucogen Complex 120 capsules. Is a metabolic product that helps
> to
> : > regulate sugar levels and insulin.
> : >>
> : >> Dr. vijeta
> : >> To unsubscribe send a message to
> [EMAIL PROTECTED]
> : > with the subject unsubscribe.
> : >>
> : >> To change your subscription to digest mode or make any other changes,
> : > please visit the list home page at
> : >>
> : >
> http://accessindia.org.in/mailman/listinfo/accessindia_accessindia.org.in
> : >>
> : >
> : >
> : > DISCLAIMER:
> : > The Information transmitted in this email is solely for the addressee.
> It
> : > is confidential and may be legally privileged. Access to this email by
> : > anyone else is unauthorized. Any disclosure, copying, distribution or
> any
> : > action taken by anyone other than by the intended recipient is
> prohibited
> : > and may be unlawful. If you are not the intended recipient then kindly
> : > delete the mail from your system. Any opinion or views expressed in
> this
> : > mail may not necessarily reflect that of Punjab National Bank. The
> bank
> : > considers unencrypted email as an insecure mode of communication.
> : >
> : > To unsubscribe send a message to
> [EMAIL PROTECTED]
> : > with the subject unsubscribe.
> : >
> : > To change your subscription to digest mode or make any other changes,
> : > please visit the list home page at
> : >
> http://accessindia.org.in/mailman/listinfo/accessindia_accessindia.org.in
> : >
> :
> :
> :
> ---------------------------------------------------------------------------------------------------------------------
> : This e-mail contains privileged information or information belonging to
> : IDBI Ltd. and is intended solely for the addressee/s. Access to this
> : email by anyone else is unauthorized. Any copying (whole or partial)
> or
> : further distribution beyond the original recipient is not intended,
> and
> : may be unlawful. The recipient acknowledges that IDBI Ltd. is unable
> to
> : exercise control or ensure or guarantee the integrity of the contents
> of
> : the information contained in e-mail transmissions and further
> : acknowledges that any views expressed in this message are those of the
> : individual sender and are not binding on IDBI Ltd. E-mails are
> : susceptible to alteration and their integrity cannot be guaranteed.
> IDBI
> : Ltd. does not accept any liability for damages caused on account of
> this
> : e-mail. If you have received this email in error, please contact the
> : sender and delete the material from your computer.
> :
> ---------------------------------------------------------------------------------------------------------------------
> :
> :
> : To unsubscribe send a message to [EMAIL PROTECTED]
> with the subject unsubscribe.
> :
> : To change your subscription to digest mode or make any other changes,
> please visit the list home page at
> :
> http://accessindia.org.in/mailman/listinfo/accessindia_accessindia.org.in
>
> To unsubscribe send a message to [EMAIL PROTECTED]
> with the subject unsubscribe.
>
> To change your subscription to digest mode or make any other changes,
> please visit the list home page at
> http://accessindia.org.in/mailman/listinfo/accessindia_accessindia.org.in
To unsubscribe send a message to [EMAIL PROTECTED] with the subject unsubscribe.
To change your subscription to digest mode or make any other changes, please
visit the list home page at
http://accessindia.org.in/mailman/listinfo/accessindia_accessindia.org.in
