WPADE.org

By Annette R. Karnash, R.N., M.N.

In PAD, arteries supplying blood to the legs become clogged or partially blocked. The supply of blood is unable to keep up with the demands so when walking, the deficiency manifest itself with pain in the calf muscle. This is known as intermittent claudication, caused by PAD. Individuals with type 2 diabetes increase the risk of developing PAD. It affects 1 in 20 over the age of 50 and may go unrecognized.

The cause is normally due to hardening of the arteries (arteriosclerosis) or narrowing of the arteries (atherosclerosis) due to accumulation of cholesterol containing fatty deposits (plaque) on the inner walls of the vessel. However, it can be caused by blood clots, limb trauma or radiation exposure. The increase of developing PAD may be due to obesity, smoking, hypertension, lack of exercise, and aging. If blockage causes this condition, a graft from a vessel in another part of the body can be used to bypass blood flow. A tube made of a synthetic fabric may also be used to surgically by pass the blockage.

By Annette R. Karnash, R.N., M.N.

Americans continue to become bigger and bigger over the last several decade and this includes our children. And as the saying goes, an overweight or obese child will become an overweight or obese adult. This places them at risk for diabetes, hypertension, asthma, sleep apnea, cardiovascular disease and many other chronic diseases. Children in the 85th percentile are considered overweight and those in the 95th percentile are obese. Psychological factors will also enter the picture.

Due to the many technological advances we tend to spend more time in front of the TV and computer, resulting in less physical exercise. While engaged in these sedentary activities they consume snack foods which are high in fat and calories. More fast foods are consumed today than ever before and in larger portions – often due to working mothers who don’t always have time to cook the more nutritious foods. Fortunately, schools who often supplied machines where chips, cookies, soda and crackers were stacked are now taking measures to remove these and concentrate on more nutritious lunches with milk.

Low calorie food should be encouraged such a fruits and vegetable and yogurt. Increased amount of water should be offered, perhaps with a wedge of lemon or lime. Allowing everyone to participate in meal planning and preparation will give a better understanding of a healthy diet. Limits should be placed on watching television and using the computer. Participation in sports such as skating, skiing, and hiking, the use of bikes, wagons, scooters, and active games are involved such as tag, hop-scotch, jumping rope, soccer. These will also allow them to become involved with others rather than solitary play or games. Surprisingly these activities will allow them to drop these added pounds and become healthier.

By Annette R. Karnash, R.N., M.N.

These individuals with diabetes who have relied on insulin injections to balance their blood sugars may now be offered new controls without needles. The US Food and Drug Administration (FDA) approved inhalable insulin in January of 2006.

This fine powder which comes in small foil packets is placed into a small inhaler requiring no electricity or batteries. The packet is punctured when activated, created a spray of insulin that shoots into a small holding chamber. The user inhales the insulin by breathing through their mouth and then the insulin enters the lungs where it is absorbed into the bloodstream.

The insulin used in the inhaler is rapid acting, taken 10-15 minutes prior to a meal. Those with type 1 diabetes may use this in lew of mealtime rapid acting insulin injections, but will still need to use long acting injected insulin. However, not everyone is a candidate for inhalable insulin. It has not been approved for those younger than age 18 or for smokers, those who have stopped smoking within the last 6 months, those with lung disease such as asthma, emphysema or chronic obstructive lung disease (COLD).

Prior to writing a prescription for inhalable insulin, the doctor will probably want to monitor the patient’s lung prior to and after beginning the use of inhaled insulin. Needless to say it is imperative that blood glucose monitoring accompanies this form of treatment.

By Annette R. Karnash, R.N., M.N.

A study at Columbia University and the University of Rochester found that patients taking clozapine for severe mental disorders are at a significant risk for developing type 2 diabetes. Additional research is needed to determine the cause of the correlation between diabetes and clozapine and to determine a risk associated with diabetes and other antipsychotic medications

By Annette R. Karnash, R.N., M.N.

A recent study from Campbell University, North Carolina found that approximately one third of the patients with diabetes were unaware of the ADA guidelines regarding the benefits of aspirin therapy. Therefore it behooves us as educators to make our patients aware of these recommendations.