WPADE.org

Thanks to all of you who have already contributed diabetes supplies for Malawi, Africa. If you have items on your shelves that you cannot use, please consider a donation to this third world country. There is a sustained need for insulin, oral agents, monitoring strips, insulin and lancets. (We cannot send used meters or expired items.)

This effort is affiliated with the Pittsburgh Presbytery Partnership Committee, which provides support to churches in Malawi. Malawi, Central Africa, is about the size of the state of Pennsylvania. Diabetes care is virtually non-existent in Malawi. Diabetes is not frequently diagnosed and when it is diagnosed, there is virtually no treatment. Previous donations were gratefully accepted at Queen Elizabeth Hospital in Malawi, with insulin in coolers, hand-carried on the plane.

Please contact me for more information:
Jean Betschart Roemer
Children’s Hospital of Pittsburgh
412 257-8756
Jeanwrites4U@comcast.net

LuAnn Berry

It is hard to believe that it is July already and my 2 year president/co-president term has ended. Time flies when you are having fun. Reflecting upon our goals for the 2002/2003 year, it has been another successful year.

WPADE. Org is up and running, and I can’t thank my partner, Louise, enough for all of her hard work in seeing that project through. If you have any ideas regarding the Website, please contact us.

One goal for the year included continuing education programs. WPADE has provided four informative programs this year but, the board has decided on a new direction for WPADE education programs. There will be two programs a year, fall and spring, both offering continuing education credits. Keep your eyes open for notification of those opportunities. This will allow the board to focus on offering the members excellent education programs.

We are still working on achieving another goal of acting as a voice for Senator Orie’s Training of School Employee’s legislation. We still need your help. Please check the website for updates. The senate is in recess for the summer, but will be starting again in fall when our grass roots effort will begin again.

Another goal we are still working on is increasing member participation. We hope our new continuing education programs schedule will help to achieve this. WPADE’s mission includes not only continuing education programs, but also providing a network and resources for diabetes educators. The board of directors would like WPADE to promote a positive atmosphere in which this can occur.

I want to thank my co-president and the entire WPADE board, past and present, and those members who volunteered. The success of this organization is a result of your commitment and hard work.

Louise DeRiso

I agree with LuAnn, the time has flown by. I have enjoyed my year as co-president of WPADE, and want to thank my “partner” LuAnn Berry. Because of her previous year’s experience as president, it was easy for me to learn the role of president. I also want to thank our hard working board members who provided the management of programs, scholarships, memberships, legislative issues, budgets, newsletters, and web site assistance. I would encourage WPADE members to consider a position as an officer or board member; it is a very rewarding experience and it is a great way to get to know other members.

I am happy that WPADE.org is up and running; I think it will help make our organization more efficient and will allow for timely news regarding programs and legislative issues to reach the members quickly. I have to thank Deb Kulbacki for her assistance with the web site development, but most of the credit goes to our webmaster, Ellie Heidingsfelder. Ellie graduated from Woodland Hills High School this year, and is off to Duquesne for college. She has agreed to continue to be our webmaster, and we all appreciate her hard work throughout this past year.

Best wishes to the new officers and board of directors of WPADE!

The demand for obesity surgery has skyrocketed. More than 63,000 such operations were performed in 2002 compared to only 16,000 observations that found weight loss in patients who had part of their stomach removed for cancer treatment or ulcer resolver. Today’s surgery is less invasive, safer, more refined, more effective and has better outcomes and fewer risks.

A normal stomach that can stretch to the size of a football can be reduced to the size of an egg that can hold only a few tablespoons of food. Staples or a plastic band is used close off the stomach and the smaller pouch is able to accommodate only tiny, well-chewed bites, eaten slowly.

Over time, a staple stomch still has the potential to stretch and if old eating habits resume, lost weight can be found. A Roux-en-Y (ROO-en-Y) technique combines stomach reduction and closing off a part of the small intestine, forcing food to by-pass part of that organ. The diameter of the intestine, forcing food to by-pass part of that organ. The diameter of the intestines is made more narrow, allowing food to pass slower, making one feel fuller longer.

Surgery can also be performed laparoscopically, which requires 6 small cuts, less that 1/2 inch long, to insert a tiny camera, which allows the physician to observe the procedure on a T.V. monitor as surgical instruments are moved about. The smaller insicions mean less pain, less infection and only a 3 day hospital stay, but is not without risk. Blood clots, heart attacks, respiratory failure and even death can result from intestinal fluid leaking into the abdominal cavity post operatively.

The cost of surgery is between $17,000 to $25,000 and insurance covers much of the cost. A morbidly obese individual must be able to document what previous weight loss methods were tried and for what length of time. An individual classified as “morbidly obese” means at least 100 pounds overweight or having a body mass index (BMI) of 40 or more. This qualifies them for surgery. In addition, the candidates must be prepared and capable of committing to a life long, different eating pattern and screened by a physician, a nutritionist and a psychologist. They must stop smoking, attend healthy eating classes and even lose some weight and be free of life stressors prior to surgery. Procedures will differ among physicians and hospitals.

To learn more about this condition, plan on attending the next scheduled seminar on Tuesday, Sept., 23, 2003 from 8am-4pm at the Holiday Inn on McKnight Road in the North Hills entitled “Management of Obesity: Surgical and Non-Surgical Approaches”. A panel of guests who have had this surgery will share with you their experiences.

On May 13th, a dinner program on “Herbal Medicine/Supplements” was presented at the Holiday Inn East in Forest Hills, by Dr. Petrow pharmacist from UPMC - Passavant Hospital. He noted that today, more alternative medicine is surfacing in the U.S., despite the fact that other countries have been using herbs for years. Germany has 70% of their physicians prescribing over 700 herbs, the government of China has endorsed herbs and now the U.S. has 500 different herbs available. Surveys show that more women and more individuals over the age of 35 use herbs. Most of the costs were paid out-of-pocket and the higher the socio-economic level, the more the use. There is no proof that natural products are of no value. Consider that one third of the drugs that are currently being used in this country are of plant origin (Belladonna is Atropine, Foxglove is Digitails, etc.). However, herbs are expensive, they are not approved, they are not pattented products, there is variation in purity and source and side effects (anxiety, depression, fatigue, insomnia, back pain, arthritis and G.I. problems) do occur. Especially important for diabetics to know is that green tea, chromium, ginseng, dandelion and myrr can cause hypoglycemia. Bee Pollen, Glucosamine, Royal Jelly and Gotu Kola can cause hyperglycemia. Patients must be informed of the lack of a body of evidence for herbs. Individuals must disclose all medications that they are taking to avoid interactions and caution must be exercised by monitoring while taking herbs. The program was hosted by Med-Press, Diabetes Management Support Services.

Two life threatening acute metabolic complications of Diabetes, Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Non-ketotic Syndrome (HHNS), require immediate medical attention. Diabetic Ketoacidosis (DKA) is an acute complication of hyperglycemia that occurs most often in patients with type I diabetes and may be the fist evidence of disease. Acute insulin deficiency precipitates this condition, which can be caused by illness, infection - most often viral such as rubella, mumps, CMV and adenovirus, physical or emotional stress, which can cause prolonged elevation in stress hormone levels of cortisol, glucagon, epinephrine, and GH, which in turn raises the blood glucose and increases demands on the pancreas.

Hyperosmolar Hyperglycemic Nonketotic Syndrome occurs most often with type II diabetes, but can occur in those whose insulin tolerance is stressed and in those who have undergone certain procedures such as peritoneal dialysis, tube feedings or total parenteral nutrition (TPN). Acute insulin deficiency precipitates this condition as well and is caused by illness, infection and stress.

Inadequate insulin hinders the uptake of glucose by fat and muscle cells, resulthing in the accumulation of glucose by fat and muscle cells, resulting in the accumulation of glucose by fat and blood. The liver then responds to the demands of the energy-starved cells by converting glycogen to glucose and releasing it into the bloodstream. Consequently, the blood glucose level rises even further and when it exceeds the renal threshold, glycosuria results.

Because the insulin deprived cells are unable to utilize the glucose, protein is rapidly metabolized.

Intracellular potassium, phosphorus and excess liberation of amino acids, which are converted into glucose and urea by the liver, are lost. Glucose levels in the blood become grossly elevated causing an increased serum osmolarity and glucosuria, leading to osmotic diuresis. Because blood glucose is higher in HHNS than in DKA, glucosuria is higher in HHNS.

Fluids and electrolyte imbalance and dehydration can occur due to the vast volume loss of fluid from osmotic diuresis. Water loss, being far greater than the loss of glucose and electrolytes, contribute to hyperosmolarity, which perpetuates dehydration, reducing the amount of glucose excreted in the urine and decreasing the rate of glomerular filtration. This leads to a deadly cycle. A decreased excretion of glucose then raises the blood glucose, producing dehydration, hyperosmolarity, resulting in shock, coma and even death.

The absolute insulin deficiency found in DKA cause a further complication by converting the fat cells into glycerol and fatty acids to obtain energy. The fatty acids accumulate in the liver where they are converted into ketones because the can’t be metabolized as rapidly as they are released. Acidosis, which results in the accumulation of ketones in the blood and urine, lead to further tissue breakdown, additional acidosis and ketones and eventually shock, come and death.