gout

Out with gout

Your Health
DR GITA MATHAI

“Them that can eat have no meat and them that have meat cannot eat!” said Henry VIII who suffered from gout. Gout was then considered a disease of aristocrats, as they were the only people who could afford red meat and alcohol. Excessive consumption of the two was for centuries considered to be precipitating factors for the disease. Today, we know that it is due to high uric acid levels in the blood (more than 7 mg /dl). The incidence of gout is increasing, with the highest rates of change being in India, China and Thailand. Gout now affects 0.3 per cent of the Indian population.

Uric acid is a product of purine metabolism found in all living cells with high concentrations in protein rich foods such as red meat, fish, yeast, broccoli, cabbage, cauliflower and some beans. Beer too has a high purine content while other liquors elevate uric acid levels in the blood as they are metabolised.

The levels of uric acid can increase despite a normal diet if there is increased cell destruction in the body as in leukaemia and sickle cell disease. The levels may also go up as a side effect of certain medications.

Typical gout starts abruptly — in the middle of the night when the temperature dips. Sharp shooting pains appear in the big toe, ankle or knee. The joint becomes red and swollen. There may be fever. This may initially lead to a mistaken diagnosis of inflammatory arthritis.

With or without treatment, the pain may subside 48-72 hours later, and then disappear forever in a lucky few. In others, it re-appears after months or years. Eventually, if left untreated, it may progress to chronic gout, with swollen and deformed joints. Crystallised uric acid may be deposited under the skin as visible “gouty tophi” on the ear, fingers and toes. These appear as movable lumps which eventually grow larger, become painful and interfere with joint movement. The kidney tries to excrete the excess uric acid, which may precipitate there to form stones. It can eventually lead to kidney failure.

Uric acid levels may increase if the body has a problem with eliminating normal quantities of uric acid. This occurs in the obese, the diabetic and those with abnormal lipid levels. Genetically predisposed males develop gout in the forties. Women are protected till menopause, after which their uric acid levels can go up.

Not everyone with high uric acid levels exhibits symptoms. Some people remain asymptomatic all through life.

The diagnosis of gout is confirmed by blood tests to estimate blood uric acid levels, aspiration of fluid from the joints to demonstrate crystals, X-rays or a synovial biopsy.

During an acute attack of gout, the pain can be relieved with medication. Some non steroidal anti-inflammatory agents work better in some people than others. Indomethecin and Nalidixic are particularly effective. Injections of steroids into the affected joints may also be needed. Later, once the acute attack has subsided, drugs like allopurinol may have to be taken regularly to lower blood uric acid levels.

Although medication is the mainstay of gout treatment, for faster pain relief soak the affected joint in hot water with rock salt in it. Then apply ice.

Lifestyle modifications can help to reduce the severity and frequency of attacks.

• Maintain ideal body weight. Although a BMI (body mass index) of 23 is ideal, gout is precipitated when BMI goes above 35.

• Reduce alcohol intake. Beer and binge drinking increase the likelihood of attacks.

• Increase your consumption of carbohydrates. Reduce red meat. If you are vegetarian, remember that some vegetables too contain a lot of purine.

• Coffee reduces blood uric acid levels.

• Vitamin C reduces uric acid. Eating more than 500mg a day as tablets can cause side effects. It is better to get your requirements by squeezing half a lime into every glass of water.

• Eat 2-3 bananas a day.

• Drink 4 litres of water a day. This will help wash out the uric acid and prevent it forming stones in the kidney.

• Exercise for an hour a day. It will correct obesity, metabolic derangements in sugar and lipid levels and help to maintain ideal body weight.

The chance of developing diseases is radically reduced by maintaining ideal body weight and exercising daily. Just putting one foot in front of the other and walking on the road for 40 minutes a day will increase your longevity and keep you healthy.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

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sleep

Good night, sleep tight YOUR HEALTH Dr. Gita Mathai “I just can’t sleep.” At a conservative estimate, 10 per cent of the population voices this complaint to friends, relatives or busy practitioners. But the condition is seldom taken seriously, especially by those who sleep soundly, and sleeping tablets are prescribed as a temporary panacea. The sleep requirements of individuals vary, with infants and children sleeping 16 to 20 hours a day, adults (till 60) seven to eight hours and senior citizens approximately six hours. Some people get by on just four hours a day. The deepest and most refreshing kind of sleep diminishes with age, with the result that sleep in people over 60 becomes fragmented, with brief awakenings. A common misconception is that constant daytime drowsiness or early-morning awakening is a part of aging. Actually, older adults sleep less because of an inability to sleep, and not because their sleep requirement is reduced. Insomnia is present if there is difficulty in falling asleep, frequent or early awakening, daytime drowsiness, inability to function efficiently, absenteeism, inadequate performance, poor concentration and dysfunction in the workplace. Other symptoms are tension headaches, stomach upsets and constant worry about not getting enough sleep. It can be acute or chronic. Everyone has a normal sleep-wake rhythm, and this may become disturbed with “shift” work, frequent late nights, or travel to different time zones. Medical conditions like hyperthyroidism, the restless leg syndrome, bronchial asthma and hot flushes (menopause) can disturb sleep. An urinary tract infection or an enlarged prostrate can necessitate frequent trips to the toilet, particularly at night. Pain because of arthritis or a peptic ulcer can keep a person awake. Many prescription drugs, antidepressants, heart and blood pressure medications, allergy medications, stimulants (Ritalin) and corticosteroids cause insomnia. Some of these medications are prescribed. Others, (like cough suppressants containing pseudoephedrine) are over-the-counter (OTC) medications. Some herbal weight loss products contain thyroid extract, ephedrine or caffeine. They too can keep a person awake. Antihistamines may initially sedate, but they can increase your night-time loo visits. An alcoholic beverage before bedtime may appear to lead to good sleep, but it produces early awakening and reduces restful sleep. Caffeine, present in tea, coffee, chocolate and cola, is a stimulant that produces mild exhilaration and prevents sleep. Do not drink coffee or tea after lunch if you find sleeping difficult. Colas have a similar effect. Nicotine is a central nervous system stimulant found in cigarettes, beedis, chewing tobacco and snuff. Using these products within an hour of bedtime will compromise sleep. Psychological problems like grief, anxiety, depression and unresolved stress prevent sleep. The unsettled conflicts and images prey on the mind, preventing sleep. Exercise will contribute to good sleep but only if done 3-4 hours before bedtime. Exercise releases stimulatory chemicals from the leg muscles and it takes 3-4 hours for the chemicals to be removed from the body. Hunger can keep you awake. So having a light snack with warm milk (which contains the sleep inducer tryptophan) at bedtime is a good idea. A heavy meal on the other hand will make you feel bloated, uncomfortable and may cause acid regurgitation. All this contributes to insomnia. To tackle insomnia, try correcting all these factors. Exercise regularly for 40 minutes a day and combine it with yoga and meditation. Try to visualise your problems (financial, familial) as images instead of figures. Remove all distractions (computer, television) from the bedroom. If you cannot fall sleep in 30 minutes, get up and read a book. If nothing works, you can go to a sleep laboratory to rule out sleep apnea and do a test called a polysomnography (overnight sleep study). This is expensive and offered only at a few centres. Popping pills should be the last resort. Many sleeping tablets are addictive and habituating, requiring higher doses for the same effect. They can produce severe allergic reactions, or cause confusion, memory loss and bizarre behaviour. If the insomnia is due to depression, psychiatric help and antidepressants may cure it. If you’re having trouble falling asleep, wake frequently once you do fall asleep, or wake up earlier than you want to, try acupressure. Just maintain the pressure for a minute on the spirit gate, which is below the little finger at the wrist or the inner gate, which is two-and-a-half finger widths below the wrist at the centre. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

praying hands

Reading the hand Your Health DR GITA MATHAI Praying Hands (see pic) is a famous pen-and-ink drawing by Albrecht Dürer. A close look at the drawing makes several medical assumptions possible.  The person is middle-aged or older.  The hands have been used to manual labour.  The person is diabetic or will shortly become so. Diabetes produces changes in the structure of the hands so that when they are folded, as in prayer, a small gap is visible between the two little fingers. As people walk, they unconsciously move their arms. Watch to see the position of the thumb. If it is rotated inwards, the person has a body mass index (BMI) over 29 and is already obese or heading there. The creases and lines on our palms, formed when the foetus is 12 weeks old, are genetically determined. Normally, three lines are formed. If there are only two lines (single palmar crease), the child must be followed up for Down’s syndrome, or other genetic abnormalities. It is rare for normal people to have a single palmar crease but some do have it only on one palm, a trait shared by many in the family. Some people are prone to chronic infectious diseases such as tuberculosis. They too tend to have only two lines but their single abnormal line is situated just above the thumb. Hormone levels in the uterus influence finger length. A person (irrespective of sex) whose index finger is shorter than the ring finger will have had more testosterone (male hormone) in the womb and a person with an index finger longer than the ring finger will have had more estrogen (female hormone). The difference in the lengths can as little as two or three per cent but is important. Professional women and female scientists tend to have higher levels of testosterone relative to their oestrogen level, while the converse is true of men in the fine arts and social sciences. Marfan’s syndrome is a genetic disease in which the person has abnormally long fingers (arachnodactly), like that of a spider. Congenital hypothyroidism, certain renal diseases and some forms of dwarfism are associated with a tripartiate hand where the index, middle and ring fingers are of the same length. Palmar creases, tripartate hands and archnodactly can be picked up on ultrasound examination after the 12th week. All of five fingers are essential for the hand to function properly. The thumb is the most important as it helps us to grasp something securely. If there are extra fingers, they need to be surgically removed. They may be associated with internal organ abnormalities, particularly of the kidney. The tips of the fingers have loops and whorls, some closed and circular, others open ended. No two individuals have identical fingerprints. Strangely, people with mental illnesses have more open loops and fewer whorls. Smokers have yellowish brown nails. In chronic respiratory ailments or congenital heart disease, nails bulge with a convex parrot beak appearance and are blue in colour. The skin of the palm may be yellow. Jaundice causes this. It can also occur because of excessive consumption of yellow vegetables and fruits. Hard labour can make the fingers gnarled and knotted; housework, which involves dealing with harsh detergents, makes the skin rough. Office work makes the hands soft and smooth. Regular manicures keep the hands looking good. The occupation and financial status of a person can be determined by looking at the hands. Fingers may get fixed in the flex position with sudden painful release, the “trigger finger”. The tissues of the hand may get thickened, causing them to contract. These conditions need to be seen by an orthopaedic surgeon. Osteoarthritis sets in with age and is commoner in women. The fingers become painful and work becomes difficult. This is a localised condition and other body systems are not affected. Rheumatoid arthritis occurs in younger people. The joint deformities give the fingers a spindle shaped appearance. This disease can affect other organs as well. Treatment is long drawn and includes medication, physiotherapy and regular exercise. Most joint pains, whatever the cause, respond well to immersion in hot salted water and underwater exercises. Involuntary shaking movements called tremors can be first seen in the hands and may be associated with tingling. Sometimes these are familial and harmless. Tremors can also be the result of too much coffee, medication induced or the manifestation of a neurological disease like Parkinson’s. Tremors need to be evaluated by a physician. Hands reveal a great deal if observed carefully. No wonder palmistry is a successful profession! Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

saving lives in emergencies

Saving lives in emergencies YOUR HEALTH DR GITA MATHAI A few days ago while driving, my grandson suddenly shouted, “Stop, stop! Look at all the blood on the road.” I pulled up to the side, and saw a dazed, 75-year-old man fast losing consciousness. A motorbike had knocked him down and sped away. There was a gaping hole in the side of his leg and he was exsanguinating rapidly from a cut artery. We had no first aid equipment but we ripped off his shirt and applied sufficient pressure to reduce the bleeding till we got him to hospital. Most of the bystanders did nothing while a few clicked snaps on their cell phones. India has only one per cent of the world’s motor vehicles but accounts for six per cent of global road traffic accident (RTA) deaths. Over 1,20,000 people die on the roads every year (one every two minutes), and a majority of them is pedestrians. Twenty per cent of the accidents are the result of alcohol consumption. The majority of the workforce in India is males under 45. This means that the greatest number of deaths also occur in this age group. Of those who survive, most are bedridden or confined to a wheel chair. Usually, they are the sole bread earners for their families. Stop and take charge as people are looking for leadership. Check if the person is bleeding. Apply pressure over the site to stop the bleeding. Get the person to the nearest hospital. Maintaining heartbeat and breathing is very important. If necessary, perform cardio-pulmonary resuscitation (CPR). Learn it as 15 per cent of people will have the opportunity to perform CPR sometime in their lives. Basic resuscitation can be remembered as ABC. A. Clear the airway because if it is blocked with blood, mucous, a foreign body (bones, nuts) or water, air cannot enter. Then perform the Heimlich manoeuvre. Stand behind the person and wrap your arms around the waist. Make a fist and place the thumb side of your fist against the victim’s upper abdomen, below the ribcage and above the navel. Grasp your fist with your other hand and press into their upper abdomen with a quick upward thrust. Do not squeeze the ribcage; confine the force of the thrust to your hands. Repeat until the object is expelled. If the victim is pregnant or obese, it is difficult to wrap the arms all the way around. Then stand behind the victim, move your arms up into the victims armpits, and make a fist in the centre of the chest, over the sternum, before proceeding with swift inward movements. If the person is unconscious or unable to stand, place the victim on his or her back. Kneel astride the victim’s hips. Place one hand on top of the other. Place the heel of your bottom hand on the upper abdomen below the rib cage and above the navel. Use your body weight to press into the upper abdomen with a quick upward thrust. Repeat until the object is expelled B. Once the airway is clear, listen and look for breathing by watching for the rise and fall of the abdomen. If the person is not breathing Pinch the victim’s nostrils firmly Place your mouth over the victim’s mouth Blow air in forcefully at the rate of one breath per second. If the mouth is full of vomited material or blood, administering chest compressions alone will help. C. Circulation has to be maintained. If there is no heart beat: Place the heel of one hand over the lower half of the sternum. Place the heel of the second hand on top of the first. Keep the arms straight. Rhythmically depress the sternum 2-5cm at the rate of 100 compressions a minute. In children use the thumbs one on top of the other and press down only 1-2 cm. It is easier if two people work in tandem, with 15 chest compressions to two breaths (15:2) ratio. There is a so called “golden hour,” the first hour after trauma, when the person has the best chance of survival provided he reaches the emergency department of a hospital geared to deal with accidents. By following these steps, you too might save a life. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

thirst and rehydration

Beat the heat, correctly DR GITA MATHAI Summer is here in full force and advertisements for fizzy drinks, colas, sports drinks, beer (surrogate advertising) and even plain glucose have started flooding prime time television. They claim to quench your thirst, give a much needed energy boost and improve flagging sports performance. Everyone needs adequate fluid and electrolytes in summer, to replace the visible amounts lost as sweat and the unseen lost as evaporation from the body. In hot and humid climates, the fluid loss may go unnoticed till the body signals dehydration with thirst, a parched mouth, headache, nausea and muscle cramps. Urine may become scanty and darker. If these symptoms are ignored, dehydration can proceed to heat exhaustion or heat stroke, with the temperature rising to 104°F or more, dry flushed skin with no sweating, delirium, loss of consciousness and even seizures and death. Healthy adults recognise the symptoms of thirst and proceed to drink water. Those over 65 may not recognise the symptoms or ignore them. They may also be more vulnerable if they are on medication like beta blockers or anti depressants. These affect the body’s ability to stay hydrated. Infants are unable to express themselves when they are thirsty. They also lose more fluid as their exposed body surface is greater than in adults. Some, though not all, may stick out their tongue in a serpentine movement if they are thirsty. Parents and caregivers need to recognise their need and offer fluids at frequent intervals. A child that is not thirsty will refuse the fluid. School going children may become engrossed in play and ignore thirst. They need to carry at least a litre of water with them to school. Even while playing in the compound, they should carry water. Fluids that are “isotonic” and contain water and electrolytes in the correct proportions replenish body fluids. Many advertised fruit drinks, colas and reconstituted powders are “hypertonic”. The body loses fluid from its cells into the stomach as it tries to make them isotonic and utilisable. Thirst is aggravated instead of being quenched. Sugar or plain glucose is often added to drinks. Since the body requires glucose for metabolism, this should in theory provide the body with an instant energy boost and quench thirst. If the drink is isotonic (some sports drinks are), the extra glucose will provide a temporary energy boost. After an hour, in some people there is a rebound effect with increased thirst, fatigue and drowsiness. The instant calories also prevent the body from efficiently breaking down its fat stores, negating the effect of exercise on weight loss. Although ice water may appear refreshing, the body has to expend energy to bring the water to room temperature before it is absorbed. Fluid at room temperature is absorbed faster. Fluids should be drunk before thirst sets in so that you never become dehydrated. Adult men need around three litres of water a day and women around 2.5. Children need 100ml/kg until they are 10kg. Over 20kg they need 1,000ml (1 litre) plus 50 ml/kg. This is the baseline requirement. Activity requires additional fluid; adults need 300ml for every 20 minutes and children 200ml. Fluid needs do not stop when the activity is over. Around 500-600ml needs to be drunk after activity. A mouthful of liquid for an adult is roughly 30ml and a child’s 15ml. If you are rarely thirsty and pass around 1.5 litres of urine a day, your hydration is probably adequate. Plain water is best for rehydration. Lightly salted butter milk, lime juice or coconut water are also effective. Ready mix drinks and sports drinks should be either avoided (unless you are an endurance athlete) or used judiciously. If a person has heat exhaustion: nBring them indoors to a shady place and switch on the fan Give them fluids Place ice in the armpits and groin Swab them with a towel soaked in water at room temperature. Allow the water to evaporate Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

pressure can be fatal

This pressure can kill

Your Health
DR GITA MATHAI

High blood pressure sneaks up on you like a thief in the night with practically no warning. Symptoms like giddiness, headache, nose bleeds and convulsions occur very late in the disease, when the blood pressure has already spiralled out of control. The only way to ensure early detection is by getting your blood pressure checked every two years, starting when you turn 18.

Blood pressure measurements have two values, an upper or systolic and a lower or diastolic. As long as the upper value is 120 or less and the lower value is 80, you are safe. If it creeps up to 139/89 you are in the pre-hypertension stage, which requires frequent evaluation and perhaps, medication. Once you have reached 140/90 you require treatment to prevent progression and side effects. Blood pressure varies from day to day. At least three values are needed before a diagnosis is made.

Primary hypertension has no known cause. It tends to run in families. Several genes have been identified in its inheritance. A person with a genetic predisposition to hypertension is more likely to develop it if they are also obese and inactive.

Secondary hypertension occurs when there is kidney disease, congenital abnormalities in blood vessels, sometimes during pregnancy or as a side effect of certain medication. The pressure returns to normal if the precipitating factor is removed.

The risk of developing blood pressure increases with age. This is because blood vessels become rigid and less compliant as you age. Obesity increases the risk. It is also more likely to eventually occur in diabetics.

Tobacco (smoked, chewed or snorted) releases certain chemicals into the body. These cause an immediate transient elevation in blood pressure. Over a period of time, the inner lining of the blood vessels become permanently damaged and narrowed, causing a permanent elevation of the blood pressure. Passive inhalation of second hand smoke causes the same effects.

Alcohol increases the heart rate. As it is metabolised, certain chemicals are released that elevate the blood pressure. It also damages the heart, making it more vulnerable to the effects of hypertension.

Salt adds flavour to food but too much of it can cause the body to retain fluid and elevate blood pressure. The requirement is 6gm a day (1 teaspoon = 5gm). Most people take around 9gm a day. Potassium balances salt in the blood, and the requirement is 1.5gm to 2gm a day. It is present in bananas and some nuts. Most people get too little potassium, causing salt to accumulate.

Deficiency of vitamin D affects some kidney enzymes that regulate blood pressure, aggravating hypertension.

High blood pressure can affect children and teenagers too. Most often it is aggravated by obesity, lack of exercise and excessive consumption of high salt snacks.

Uncontrolled hypertension silently damages the body. It can cause the heart to work hard to pump blood against resistance. The heart can become enlarged, weakened and eventually fail. The blood vessels in the body can be damaged and weakened. They may give way, causing a bulge called an aneurysm. This can suddenly rupture. If this occurs in the eyes, it can result in blindness.

Blood supply to the brain can become compromised. Initially this can result in loss of memory, forgetfulness or confusion. It can eventually result in a stroke. Blood vessels to the kidneys can get damaged, causing them to fail.

There is no universal medication for high blood pressure. Some people do well with a single drug. Others require frequent dosing with as many as four or more drugs. The important thing is to remember to take your medication regularly and not skip doses. Fasting, rearranging schedules or switching to alternate medication should not be done without consulting a doctor. Drugs can react with one another. So it is better to stay with a single physician who will be able to monitor your medication and response. Low dose aspirin may be needed to prevent strokes and heart attacks.

Lifestyle changes are necessary to eventually reduce the dosage, number of drugs and the long-term effects of high blood pressure.

lMaintain ideal body weight. This can be calculated by multiplying height in metre squared by 23.

lTry adding more fruits, vegetables and fibre rich food to your diet. Reduce the fat content.

lReduce salt intake to 1.5gm (one-fourth tsp) a day. Remember to take into account the salt in pickles, and ready-to-eat soups and sauces.

lDo not smoke or use tobacco in any form.

lAvoid alcohol. If that is not possible, remember the allowance is 2 drinks a day for men and one for women.

lGet moving. You can reap huge benefits by walking as little as 30 minutes a day. Every step counts!

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

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diabetes

he other diabetes

Your Health
DR GITA MATHAI

Diabetes, which affects eight to nine per cent of the urban population in India, is perceived to be a lifestyle disease of overweight, sedentary and middle-aged people. These patients do not require insulin injections. In this type of diabetes, the body either loses its sensitivity to insulin (the natural hormone needed to reduce blood sugar) or the pancreas (which produces insulin) fails to produce enough of the stuff. A judicious combination of restricted diet, exercise and tablets are usually enough to keep the sugar level in check and complications at bay.

Few people, however, realise that one per cent of newly diagnosed diabetics are thin and young. They have type 1 diabetes. The disease was previously called juvenile diabetes as sufferers were usually young but now the nomenclature has been changed to “insulin dependent diabetes”. In these patients, the pancreas fails to produce insulin. It can occur at any age, from infancy, childhood, and adolescence to adults, as both genetic factors and environmental triggers are involved. Once it has set in, it cannot be prevented, delayed or cured, it can only be treated.

Type 1 diabetes may be inherited or occur suddenly after an infection. The mumps, Epstein-Barr and coxsackie virus in particular have been implicated. The body itself may also produce antibodies to the islet cells (which produce insulin) in the pancreas, destroying them. A relative deficiency of vitamin D has been linked to an increased risk of type 1 diabetes. Drinking water contaminated with nitrates may also increase the risk. Early weaning (before the recommended 4-6 months) increases the risk. Exclusive breast feeding until the age of one reduces the risk.

Diagnosing insulin dependent diabetes in a child is difficult. There has to be a high index of suspicion on the part of the parent and the doctor. The typical symptoms of increased thirst, frequent urination, a relapse of bedwetting after successful toilet training, voracious appetite and overeating with loss of weight or fatigue may be accepted and dismissed as a “normal” part of childhood. Often the diagnosis is only made by accident or after uncontrolled infections or other complications set in.

Blood tests are needed to confirm the diagnosis. A random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher, Glycated hemoglobin (A1C) of 6.5 per cent or more, a fasting blood sugar of 126 mg/dL indicates diabetes.

Treatment for insulin dependent diabetes requires a judicious combination of diet, exercise and insulin. The diet should be nutritious with plenty of fresh fruits and vegetables. The total calories required depends on the age and level of physical activity. Blood sugar levels should be checked three times a day (with a glucometer) before meals so that the quantity of food eaten can be adjusted. Some young people do well if food is split into six mini meals instead of three big ones. Control is often difficult for parents when the children are fussy eaters.

Unfortunately there is no oral medication or miracle drug as yet which can replace insulin. So insulin has to be given as injections — often several times a day — depending on blood sugar values and the quantity of food about to be eaten. It becomes difficult for parents when the child refuses to eat after the calculated dose of insulin has been given, or the child vomits. Flexibility in the diet and dosage of insulin has to be maintained.

Low blood sugar can be dangerous. It can cause sweating, shivering, hunger, giddiness, tiredness, headache, irritability, palpitations, tremors, sweating, convulsions and loss of consciousness. Some form of sugar should be given as soon as such symptoms occur. Affected children need to always carry sweets. Blood sugar can become low at night and cause sweating and morning headache.

In the absence of insulin, even when blood sugar levels are high, cells are unable to process the sugar and face starvation. The body begins to break down fat stores. This leads to a dangerous condition called ketoacidosis. There may be nausea, vomiting, abdominal pain, a fruity odour and eventually loss of consciousness or seizures.

Uncontrolled high blood sugar can over the years cause complications in the eyes, heart, kidney, skin, and nerves. Infections become difficult to control and wounds may not heal. In later life, dementia and Alzheimer’s can set in.

If the sugars are controlled with diet, exercise and insulin, patients can lead normal lives and have standard life expectancy.



Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in