WPADE.org

By Annette Karnash

The European Agency for the Evaluation of Medicinal Products (EMEA) issued a public warning on May 21 2003 NOT to use the combination of PRANDIN(repaglinide), a drug to lower blood sugar in type 2 diabetics, and the cholesterol drug LOPID (gemfibrozil). EMEA serves a function within the European Union similar to that of the FDA in the United States.

The basis for the warning was a recent publication in the March, 2003 issue of the medical journal Diabetologia that found the use of these two drugs in combination can enhance the blood sugar lowering effects of PRANDIN (repaglinide) and can result in severe hypoglycemia. The Europeans have received 5 reports of serious hypoglycemia associated with the use of LOPID and PRANDIN.

By Annette Karnash

It’s always a good idea to watch what you eat, and it is even more important to pay attention to the latest diet fads. The current, popular low carbohydrate, high-protein diets may result in rapid weight loss, but they may also pose serious health problems, such as possible higher risk of bone loss and kidney stones. Significant factors related to the increased risk of kidney stones are the acidic content of animal meat and the lack of alkaline foods in the diet. According to a research report at the University of Texas Southwestern Medical Center, while individuals were on diets that severely restricted carbohydrates, acid excretion, a marker for the acid load in the blood, increased as much as 90%.

The body needs a certain source of energy and a quick source is obtained from carbohydrates, which are readily available when a normal diet pattern is consumed. When no carbohydrates are available, the body then turns to other sources to obtain energy, one of which is fat. Restricting carbohydrates leads to ketoacidosis. Ketone bodies are formed when the body is forced to burn fat for energy, which may result in ketoacidosis.

Ketoacidosis is a condition resulting from an accumulation of ketone bodies in the blood and increased blood acidity. Osteoporosis is going to be a major issue as the population ages and if people are to consume this type of diet on a long term basis, it is unknown what the implications will be for the bones. Researches are studying the effects of this protein and fat heavy diet on bones and are developing methods to counteract the higher risk of kidney stones. No one is questioning the value of this diet in the producing weight loss, but the side effects may be long term in surfacing.

The aging of skin is a gradual and natural result of growing older. However, the process is greatly accelerated by as much as 0 to 15 years for the maturing diabetic adult. The difference between regular chronological aging and premature diabetic aging is the increase in symptoms. The skin, being the largest organ in the body, is dramatically affected by this degenerative, metabolic disorder. Youthful skin can regenerate itself in less than 30 days, whereas mature and diabetic skin can require 45 or more days to regenerate. Often the skin can change form a healthy appearance to chronic, dull, dry skin; from smooth, supple skin to wrinkled, thinning skin with the appearance of tiny blood vessels and aging spots.

The areas of the skin most affected are the collagen and its elastic fibers found in the dermis, which keeps the skin firm and strong. Chronological aging causes deterioration in elastic fibers, and collagen, which is genetic and occurs at different levels depending upon each individual’s biological clock. The aging process of the skin of a diabetic is greatly accelerated. Their skin is thinner and the epidermis loses moisture more rapidly, causing this dehydrated skin to become dry, flaky, wrinkled and irritated, leading to cracks, cuts, scratches and ultimately infection. Internally, the fatty layers that normally support the skin are lost, causing sagging.

A daily skin regime is advised, consisting of examining the feet for corns, cuts, calluses, blisters, redness, and swelling. In addition, moisturizing extremities and bony prominences is also important, but you should avoid skin care products that contain fragrances, alcohol, perfumes and dyes as these can further dry the skin. A foot cream, a hand and body cream and a daytime moisturizer with ultraviolet (UV) sun protection should be included. Do not walk barefooted or use chemical agents for the removal of corns and calluses. When bathing, no more than once a day, use warm water (not hot) and pat dry. In winter it is advised to bathe less frequently, followed by moisturizing cream. Bathing further dries the skin and robs it of its natural oils. Elevated blood sugars further dry the skin and increase the risk of nerve damage and infection. Fresh fruits, vegetables, greens and 8 glasses of water (unless contraindicated) daily will help to hydrate the skin. Thirty minutes of exercise, 3 to 5 times a week promotes good circulation to the skin. Smoking and tobacco products will reduce blood flow to the skin and injure the heart. Aging also correlates to over-exposure to the elements such as wind, cold and sun, in addition to drinking and stress. These all cause the skin to become dry and dehydrated.

If a better understanding, recognition and treatment for skin care exists, many problems can be averted by taking these extra precautions.

Taken from DIABETIC WELLNESS NEWS, Vol.9, Nos.5, May, 2003.

Hello everyone. It’s hard to believe that it’s November already and Thanksgiving is just around the corner. I can’t believe how this year has flown by. One minute, I’m learning about my new position from LuAnn Berry and Louise DeRiso and now they’re “gone” and I’m it. I learned a great deal from them both and appreciate all of their help and guidance. I would like to extend a heartfelt thank you to them both. They put a lot of time and effort into WPADE in order to continue the mission of WPADE. During their tenure, we have had excellent educational offerings and have a new website that will serve as a communication tool for the latest and greatest information WPADE and AADE have to offer.

I hope in the coming year to work with the board to continue to provide two continuing education offerings per year. We have some ideas for upcoming offerings, but would love your input. Our most recent program on obesity management was well received and attended by over 50 clinicians. Speaking of our education programs, I would like to send a special thanks to Linda Fevrier and Janet Krulia for their efforts towards making our programs a success. Another goal for the year is to continue working on the website, WPADE.org, with Ellie Heidinsfelder’s help. Again, our aim is to make the website a communication tool. So, if you have information to share with other educator’s in the area, please do so by emailing your questions/concerns/queries to Diane Harbaugh or Terri Yeager. They will forward the information to Ellie for placement on the website.

On the national diabetes education front, don’t forget to check out the AADE website, new address www.diabeteseducator.org. The AADE website has information available to the healthcare professional and the general public. You can update your member profile on the web site. The process takes very little time. Also, applications for the AADE Awards Program are available on the web site. There are seven awards available, so take a look and nominate yourselves or a fellow educator.

Finally, if you are interested in volunteering for a committee or would like to serve on the board, we are always looking for enthusiastic members. Please give us a call or send an email if you would like to get involved. Have a wonderful holiday season.