is Cardiomyopathy ("weak heart muscle"),and How it is Classified

The cardiomyopathies are a group of diseases in which the primary feature is direct involvement and weakening of the heart muscle (myocardium only). Cardiomyopathies are increasing in incidence and are a significant cause of death. Dilated cardiomyopathy, the most common type of cardiomyopathy, is reported to occur in 5 to 8 people per 100,000 population per year.

Cardiomyopathies occur more frequently in blacks than whites and more commonly in men than women. Factors that are associated with increased death rates in cardiomyopathy patients include the following:

Weak heart function (left ventricular ejection fraction:

• Aging (age greater than 55 years)

• Reduced functional capacity

• Electrical abnormalities

• Low blood sodium level (hyponatremia)

• Worsening kidney function.

Cardiomyopathy can be classified as primary, which is heart muscle disease of unknown cause, or secondary, which is heart muscle disease due to specific causes (such as narrowing of the heart arteries [coronary artery disease], heart valve disease, high blood pressure).

The World Health Organization (WHO) classifies cardiomyopathy into 3 major groups:

• Dilated

• Hypertrophic

• Restrictive.

What are the features and causes of dilated cardiomyopathy (DCM)?

Dilated cardiomyopathy (DCM) is typically characterized by significant enlargement of the 2 pumping chambers of the heart—the left ventricle (which pumps blood to the body) and the right ventricle (which pumps blood to the lungs). As a result of the chamber enlargement, there is some degree of reduction in the pumping power of the ventricle (reduced ejection fraction).

While there are many causes of DCM (nearly 80 specific diseases have been associated with DCM), a clear cause is often not identified in many individuals, and these cases are described as idiopathic. Alcohol abuse is a common cause of DCM, as long-term ingestion leads to cardiac cell (myocyte) damage with subsequent heart dysfunction. Many patients can see significant improvement if they stop drinking. Cocaine abuse can lead to DCM in some individuals; in 1 large study, more than 10% of cocaine users had at least mild left ventricular dysfunction.

Infectious causes can also lead to DCM. Viral infections can attack the heart muscle and lead to significant cardiac dysfunction; in many cases, the damage can be irreversible and severe. In young adults, severe viral-related DCM is the top reason to be "listed" for heart transplantation. Human immunodeficiency virus (HIV), the cause of AIDS, can also lead to DCM in a minority of causes. Vitamin deficiencies (such as thiamine) can lead to DCM, though such cases occur more commonly in Third World countries.

Metabolic disorders can lead to DCM. A relatively common example is hemochromatosis, a disease of iron metabolism, which is often familial and more common in men, in whom iron is deposited in the liver and heart muscle.
Peripartum cardiomyopathy is a form of DCM that typically occurs during the last 3 months of pregnancy and up to 6 months after delivery. It occurs in about 1 in every 5,000 pregnancies. The incidence is higher in women older than 30 years old and those with high blood pressure, multiple previous pregnancies, and twin pregnancies. Note that those who experience this condition are strongly discouraged from subsequent pregnancies, as the recurrence rate is high and death can even occur due to heart failure.

Chemotherapy drugs can lead to DCM in some individuals.
Drugs most commonly associated with DCM are doxorubicin, cyclophosphamide, amsacrine, and interferon. Neuromuscular disorders (disorders of the muscles and nervous system) are also associated with DCM.

Does therapy for DCM differ from that for congestive heart failure due to coronary artery disease (narrowing of the heart arteries)?

Treatment is similar for heart failure due to either DCM or coronary artery disease and includes:

• Salt restriction and diuretics (drugs that reduce lung and leg fluid via increased urine output)

• Beta-blockers (drugs that slow the heart rate and take stress off the heart)

• Angiotensin-converting enzyme (ACE) inhibitors (drugs that reduce the load on the heart by relaxing the body's major blood vessels)

• A combination of hydralazine and isosorbide nitrates (a drug option in those who cannot tolerate ACE inhibitors due to kidney function problems)

• Digoxin (a drug that helps improve the squeezing power of the heart).

What is hypertrophic cardiomyopathy (HCM)?

Hypertrophic cardiomyopathy (HCM) is a primary disorder of the heart muscle characterized by inappropriate hypertrophy (excessive growth) of the left ventricle, which is the chamber that pumps blood to the body's organs and tissues. In many individuals, hypertrophy predominantly involves the septum, which is the intracardiac wall that separates the left ventricle and right ventricle.

In at least one-quarter of cases, this variant leads to obstruction of blood flow out of the left ventricle and into the aorta and, hence, is called hypertrophic obstructive cardiomyopathy (HOCM). Overall annual death rates in HCM individuals are approximately 3% per year in adults, while the rates are higher in those with HOCM.

What are the causes of hypertrophic cardiomyopathy (HCM)?

In more than 50% of cases, HCM is genetically transmitted.

Most experts think that some if not all of the sporadic forms of HCM are due to spontaneous mutations (a sudden change in the genetic code of the developing fetus). At least 8 different genes have been associated with HCM. Note that genetic testing is not currently indicated (except in research settings), even in families in which HCM occurs, because knowing the type of gene defect does not impact subsequent treatment.

What are the most frequent symptoms in patients with HCM?

Shortness of breath (dyspnea) occurs in approximately 90% of symptomatic individuals with HCM. It occurs due to a combination of abnormalities, including poor relaxation of the stiff, thickened heart muscle (diastolic dysfunction), reduced blood flow into the main heart pumping chamber (impaired ventricular filling), and increased pressures in the left atrium and pulmonary veins.

Fainting and near-fainting (syncope and near-syncope) can occur in HCM patients due to inadequate cardiac output during times of increased demand (such as physical exertion or severe stress). Serious arrhythmias can also result in fainting episodes; in fact, such arrhythmias are a top cause of sudden death in otherwise healthy children and young adults.

Chest pain (angina pectoris) occurs in up to three-fourths of symptomatic patients.The discomfort is a result of an imbalance between a reduced oxygen supply to the heart (because of thickened and narrowed heart arteries) and increased demand (due to greater heart muscle).
What noninvasive testing can be used to evaluate patients with suspected DCM or HCM?


Useful tests include electrocardiography (ECG), chest x-ray, and ultrasound (echocardiography).
In symptomatic individuals, the ECG is usually abnormal, but no specific findings are diagnostic of either DCM or HCM.

A chest x-ray will demonstrate an enlarged cardiac silhouette in DCM patients and in some HCM patients.

An echocardiogram provides the most useful and specific information. In DCM patients, severe dilatation of the ventricles is demonstrated, and an accurate estimation can be made of the impairment of heart function. In HCM patients, thickening of the left ventricle is the cardinal feature. Other findings include narrowing of the outflow tract through which blood flows from the left ventricle and out through the aortic valve and into the aorta, a small left ventricular cavity size, and abnormal motion of the mitral valve.

What medical and invasive therapies are available to treat HCM patients?

Beta-blockers (examples include metoprolol and atenolol), which are drugs that slow down the heart rate, are the cornerstone of medical therapy for HCM. In up to two-thirds of patients, they reduce the frequency of chest pain, shortness of breath, and near fainting.
Calcium channel blockers, such as verapamil, have also been utilized with good success; they appear to help the thick heart muscle relax better (decreased diastolic dysfunction) and can reduce the outflow tract obstruction.

Insertion of a pacemaker may be useful in some patients with an outflow gradient and severe symptoms.

In high-risk patients, especially in those who have had serious ventricular arrhythmias or aborted sudden death, an implantable cardiac defibrillator (ICD) should be inserted.

Surgical and invasive options exist for severely symptomatic patients. A surgical myomectomy, or excision of excess heart muscle, has a mortality rate of 3% or less in large centers. Surgery results in long-term improvement in symptoms and exercise capacity in most patients.

A nonsurgical invasive approach involves injection of alcohol into 1 of the arteries supplying the excessively thickened septal wall; this is done via left catheterization (a small incision is made in a leg or arm artery to allow delivery of a catheter into the specific artery under x-ray guidance). Short-term results in experienced centers have been promising, but long-term results are still not available.

What is restrictive cardiomyopathy (RCM), and what are the most common forms?

Restrictive cardiomyopathy (RCM)—the least common of the cardiomyopathies—is characterized by abnormal relaxation of the heart muscle in the presence of normal ejection fraction. RCM is often classified into myocardial (throughout the heart muscle) and endocardial (from inside the ventricle).

The most common myocardial forms are amyloidosis and sarcoidosis (infiltrative diseases); scleroderma or idiopathic (noninfiltrative diseases); and hemochromatosis, glycogen storage diseases, and Fabry's disease (storage diseases).

Infiltrative diseases refer to abnormal proteins and cells generated by certain disease states that penetrate the heart muscle. Noninfiltrative diseases are typically diseases related to activation of the autoimmune system or due to a genetic abnormality that activates abnormal cardiac muscle growth, where the storage diseases refer to genetic abnormalities that lead to abnormal storage of sugars and other substances inside the heart muscle cells.

The most common endocardial forms of RCM are carcinoid, metastatic malignancy (spread of cancer), and endomyocardial fibrosis.

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The Use of Antibiotics To Pregnant Women

Health - Antibiotics to pregnant women may harm babies

Antibiotics administered indiscriminately to pregnant women to delay premature birth may cause long-term harm to babies, a research has suggested.

The study, published in The Lancet, found that among women whose waters had not broken, giving antibiotics was associated with increased risk of cerebral palsy in the children and problems such as poor eyesight or hearing not only at birth but for decades beyond.
Britain has issued a warning about the indiscriminate prescribing of antibiotics to pregnant women to delay premature labour after research revealed that the practice may cause long-term harm to their babies, the Independent newspaper said today.



According to the British daily, Liam Donaldson, UK's chief medical officer, warned that the antibiotics should "not routinely be given" to women in premature labour where there was no sign of infection and whose waters had not broken, in line with "existing good clinical practice".

A clinical trial involving 12,000 women in the UK and around the world, published in 2001, found antibiotics delayed labour and improved outcomes for mother and babies at risk of giving birth prematurely.

According to the UK medical journal, a follow-up study seven years later of more than 8,000 of the women in the UK showed that among women whose waters had not broken, giving antibiotics was associated with up to a threefold rise in cerebral palsy, from 1.6 per cent in those given placebo to 4.4 per cent in those on two antibiotics, and a small increase in "mild" functional impairment such as poor co-ordination and poor eyesight.

However, among women whose waters had broken, giving antibiotics caused no long-term benefit or harm to their children, despite the improved outcome at birth revealed in the first study, the study showed.


Antibiotic Use in Pregnant Women Increases Risk of Functional Impairment in Their Children NEW YORK -- September 17, 2008 -- Long-term follow-up data on a trial to assess the effects of antibiotics given to pregnant women experiencing premature labour, with intact membranes and no obvious infection, has revealed an unexpected increased risk of functional impairment and/or cerebral palsy in some children.

This is among the conclusions of the Overview of the Role of Antibiotics in Curtailing Labour and Early Delivery (ORACLE) Children's Study, published early online in 2 articles and in an upcoming edition of The Lancet.

Both studies are authored by Sara Kenyon, MD, University of Leicester, Leicester, United Kingdom, and colleagues from the ORACLE study group.
The ORACLE Children Study I and II were carried out in the UK to discover whether erythromycin and co-amoxiclav had any long-term effects on the children at 7 years of age born to these mothers.

The ORACLE Children Study II looked at mothers in spontaneous premature labour with intact membranes surrounding their unborn child and no obvious sign of infection.

The children were born to the 4,221 women who had completed the study, and were followed-up after 7 years using a structured parental questionnaire to assess the child's health status. Data for 3,196 (71%) of eligible children was available.

The researchers found that functional impairment was increased in children of mothers who received erythromycin (42.3%, 658 children) compared with no erythromycin (38.3%, 574 children) -- an increase in relative risk of 18% for receiving erythromycin. Co-amoxiclav (with or without erythromycin) had no effect of the proportion of children with any functional impairment.

The researchers also made the unexpected discovery that more children whose mothers had received the antibiotics developed cerebral palsy than those who did not.

For mothers receiving erythromycin (with or without co-amoxiclav), 53 (3.3%) children had cerebral palsy compared with 27 (1.7%) receiving no erythromycin. For mothers given co-amoxiclav (with or without erythromycin), 50 (3.2%) children had cerebral palsy versus 30 (1.9%) receiving no co-amoxiclav.

The risk was clearest for mothers given both antibiotics: 35 (4.4%) of children had cerebral palsy compared with 12 (1.6%) of mothers receiving double placebo.
No effects were seen with either antibiotic on the number of deaths, other medical conditions, behavioural patterns, or educational attainment.

"The prescription of erythromycin for women in spontaneous preterm labour with intact membranes was associated with an increase in functional impairment among their children at 7 years of age. The risk of cerebral palsy was increased by either antibiotic, although the overall risk of this condition was low," the authors concluded.

The ORACLE Children Study I followed up 4,148 eligible children whose mothers joined the trial with preterm rupture of the membranes without obvious signs of infection.

The original trial reported that prescription of erythromycin to these women resulted in reductions in short-term neonatal morbidity and erythromycin is now recommended treatment.

The Children Study, which assessed data from 3,298 (75%) eligible children, found no differences in functional impairment with either antibiotic, and no differences in behavioural difficulties, medical conditions, or educational achievement.

In relation to this part of the study, the authors said that "the prescription of antibiotics for women with preterm rupture of the membranes seems to have little effect on the health of children at 7 years of age."

In an accompanying comment, Philip J. Steer, Chelsea and Westminster Hospital, London, United Kingdom, and Alison Bedford Russell, Warwick Medical School, Coventry, and Heart of England NHS Trust, Birmingham, United Kingdom said: "The lessons to be learned seem clear; contrary to popular opinion, antibiotics are not risk-free. There are good reasons not to give them in association with threatened preterm labour unless there is clear evidence of infection. It is vital the practice is not extended by stealth beyond that which is justified by the evidence, and interventions given in pregnancy should always be evaluated with proper long-term follow-up."

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Honey as Medicine Benefits

Ayurvedic as well as Yunani medicine have been using honey as a vital medicine for centuries.

Today’s western scientists also accept honey as a "Ram Ban" (very effective) medicine for all kinds of diseases without producing any side effects. Today, honey is produced in most of the countries of the world and is therefore available worldwide. Modern science maintains that although honey is sweet, if ingested in the right dosages as a medication, diabetic patients will also be able to intake it.

According to Ayurvedic medicine, a mixture of Honey and Cinnamon can be beneficial to many ailments and diseases and on 17th January 1995, ‘Weekly World News’ - Canada, published a list of ailments/diseases that can be helped / treated with a Honey/Cinnamon mixture. Some of the important details of that information are as below:

* HEART DISEASES

Make a paste of honey and cinnamon powder, spread it on bread or chapatti instead of jelly and jam and eat it regularly for breakfast. This can help to reduce the cholesterol in the arteries and maybe reduce the possibility of a heart patient from suffering a heart attack. Patients, who have already suffered attacks, are also advised to ingest the honey/cinnamon mixture to ward off further attacks.

Regular use of the mixture relieves loss of breath and strengthens the heartbeat. In USA and Canada, various nursing homes have treated patients successfully and have found that due to increasing age, the arteries and veins, which lose their flexibility and become clogged, are revitalized.

* ARTHRITIS

Mix one part honey to two parts of lukewarm water and add a small level teaspoon of cinnamon powder. Make a paste and massage slowly onto the itching area of the body. It has been found that the pain can recede within a minute or two. Arthritic patients can also benefit from the daily intake morning and evening, of one cup of hot water with two spoons of honey and one small teaspoon of cinnamon powder mixed together. In a recent research program conducted at Copenhagen University, it was found that when the doctors treated their patients with a mixture of one tablespoon honey and half a teaspoon cinnamon powder before breakfast; within a week, out of 200 patients who underwent the treatment, 73 patients were relieved of pain, and within a month most of the patients who could not walk or who had limited mobility due to their arthritis, started walking without pain.

* HAIR LOSS

For people suffering from hair loss or baldness the following paste has been found to be effective: In warm olive oil, mix one tablespoon of honey, one teaspoon cinnamon powder, make a paste and apply before taking a bath. Leave on the scalp /hair for around 5 ―15 minutes, and then wash the hair.

* BLADDER INFECTIONS

Stir two tablespoons of cinnamon powder and one teaspoon of honey in a glass of lukewarm water and ingest. This can destroy the bacteria in the bladder that are the cause of the infection.

* TOOTHACHE

Make a paste of one teaspoon of cinnamon powder and five teaspoons of honey and apply to the aching tooth. This may be applied 3 times a day until the tooth stops aching.

* CHOLESTEROL

Two tablespoons of honey and three teaspoons of cinnamon powder mixed into 16 ounces of tea water, can aid in the reduction of cholesterol levels in the blood by 10% within a two hour period. As mentioned above for arthritic patients, if this mixture is ingested 3 times day, chronic cholesterol can be lowered. Pure honey, also ingested daily without cinnamon, taken together with food, is an aid in lowering cholesterol levels.

* COLDS

Those suffering from common or severe colds should take one tablespoon lukewarm honey mixed with 1/4 spoon cinnamon powder daily for 3 days. This will cure most chronic coughs, colds and clear the sinuses.

* INFERTILITY

Yunani and Ayurvedic medicine have been using honey for thousands of years to strengthen the semen of men and improve impotence. Through the regular ingestion of two tablespoons of honey, prior to sleep, impotence can be greatly reduced. In China, Japan and Far-Eastern countries, women, who do not conceive and need to strengthen the uterus, have been taking cinnamon powder for centuries. Women, who are unable to conceive, may take a pinch of cinnamon powder in half teaspoon of honey and apply it on the gums frequently throughout the day, so that it slowly mixes with the saliva and can therefore enter the body. There is a story about a couple in Maryland, USA who were unable to produce children for 14 years and had lost hope of having a child of their own. When told about the honey cinnamon mixture both the husband and wife started ingesting the mixture and the wife conceived after a few months, giving birth to healthy twins.

* UPSET STOMACH

Honey taken with cinnamon powder cures stomachache and can also clear stomach ulcers.

* GAS

According to studies done in India & Japan, honey, taken together with cinnamon powder can relieve the stomach of gas.

* IMMUNE SYSTEM

Daily use of honey and cinnamon powder strengthens the immune system and protects the body from bacteria and viral attacks. Scientists have found that honey has various vitamins and iron in large amounts. Constant use of honey strengthens the white blood corpuscles to fight bacteria and viral diseases.

INDIGESTION Cinnamon powder sprinkled onto two tablespoons of honey taken before eating, relieves acidity and aids in the digestion of the heaviest of meals.

INFLUENZA A scientist in Spain has proven that honey contains a natural ingredient, which kills influenza germs.

* LONGEVITY

Tea made with honey and cinnamon powder, when taken regularly, arrests the ravages of old age. Take 4 spoons of honey, 1 spoon of cinnamon powder and 3 cups of water and boil as if making tea. Drink 1/4cup, 3 to 4 times a day. It keeps the skin fresh and soft and arrests old age. Life spans also increases and even a 100 year old, starts performing the chores of a 20-year-old.

* PIMPLES

Make a paste from three tablespoons of honey and one teaspoon of cinnamon powder. Apply this paste on the pimples before sleep and wash it off the next morning with warm water. If applied daily for two weeks, the paste can remove pimples.

* SKIN INFECTIONS

Applying honey and cinnamon powder in equal parts on the affected parts can cure eczema, ringworm and all types of skin infections.

* WEIGHT LOSS

Drink daily in the morning on an empty stomach, 1/2 hour before breakfast and at night before sleeping, a honey and cinnamon powder mixture boiled in one cup of water. If taken regularly, it is said to reduce the weight of even the most obese person. Also by drinking this mixture regularly, fat does not accumulate in the body even though the person maybe eating a high calorie diet.

* CANCER

Recent research in Japan and Australia has reveled that advanced cancer of the stomach and bones have been cured successfully. Patients suffering from these kinds of cancer should take one tablespoon of honey with one teaspoon of cinnamon powder, 3 times a day for one month.

* FATIGUE

Recent studies have shown that the sugar content of honey is more helpful than detrimental to the strength of the body. Senior citizens, who take honey and cinnamon power in equal parts, are more alert and flexible. Half a tablespoon of honey stirred into in a glass of water and sprinkled with cinnamon powder, taken daily n the afternoon at about 3.00PM when the vitality of the body starts to decrease, can help the body to have more vitality within a week.

* BAD BREATH

In order to maintain fresh breath throughout the day, the people of South America, gargle with one teaspoon of honey and cinnamon powder mixed in hot water first thing upon awakening.

* HEARING LOSS

Taken daily, morning and evening, honey and cinnamon powder taken in equal parts can restore hearing.

I hope honey can be utilized for the overall health

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and prevention of diabetes complications

Danger of diabetes is very large and can enable people with weak kidneys, become blind, suffering from the disease and the foot of the many serious complications and cause a high mortality rate. Diabetes patients at risk every day because of blood sugar is not controlled. Blood glucose level that can change throughout the day, especially when eating,conduct activities, and even if you are drinking diabetes drugs. Medical research proves that when the blood glucose level is very high - be in the danger zone - so many people who will suffer the disease diabetes heart disease. Research shows eight of the 10 people who contract the disease diabetes affected heart attack.

They have a high risk of diabetes is infected with a family history a disease with diabetes. This is common when someone enters the age above 40 years, the overweight, is exposed to high blood pressure, in addition, of course, eating the wrong use patterns.An estimated one out of eight people in urban areas can have a diabetes. The high number of people in urban areas, was caused by changes in lifestyle its community.

I do not want to frighten them, but how good you are its all you can to prevent that, starting from the tips:

• Diabetes complications can kill

Diabetes is a disease that has complications (cause other diseases) the most. This is related to the blood sugar level constant, so that result in damage to blood vessel, nerve and other internal structures.

Complex substance consisting of sugar in the blood vessel walls, causing blood vessel leakage and experienced thick. This result thick occur in the region the blood flow will be reduced, especially for the skin and nerves.
Blood sugar is not controlled rate also tends to cause the fatty substances in the blood increases, so the speed of a aterosklerosis (plaque storehouse of fat in the blood vessel). Aterosklerosis is 2-6 times more common in diabetics.
Poor circulation of blood through the blood vessel is large (macro) can harm the brain, heart, and blood vessel foot (makroangiopati), whereas blood vessel small (micro) can harm the eyes, kidneys, nerves and skin and slow healing of wounds.

People with diabetes may experience a variety of long-term complications if diabetes is not managed well.

Complications that occur more often and turn off the heart attack and stroke.

Blood vessel damage to the eyes can cause disturbances of vision due to damage to the retina eye (retinopati diabetikum). Deviation kidney function can cause kidney failure, so people have to wash the blood (dialisa).Interference on the nerves can learn some manifestation in the form of. If you have a nerve aberration function (mononeuropati), then an arm or leg in a normal suddenly become weak.

If the nerves that go to the hand, leg and foot were damaged (polineuropati diabetikum), then on the arm and leg can be perceived as pain or pins and burned weakness.
Cause damage to the nerves of the skin more often due to injury can not ease pressure and temperature changes. The reduced flow of blood to the skin can also cause ulkus (ulcer) and all running slow wound healing. Ulkus in the foot and can be experienced in infection and the old so it must be part of the leg be amputated.

Terapi For Diabetes Mellitus

The main objective of diabetes treatment is to maintain blood sugar in the normal range. However, the blood sugar is really hard to be normal.
However, the approach the normal range, then the possibility of the occurrence of complications and the long-term becomes increasingly reduced. It is necessary to monitor blood sugar regularly both independently conducted tests with an own blood sugar at home or done in a laboratory near you.
Treatment of diabetes include weight loss, exercise and diet.Obesity and someone who suffered from type 2 diabetes will not need treatment if they lose weight and doing sports regularly.
However, most patients had difficulty lose weight and doing sports regularly. Therefore, insulin therapy is usually given drug or hipoglikemik (in its blood sugar lowering) per-oral.
Type 1 diabetes can only be treated with insulin, but type 2 can be treated with oral medication. If weight control and exercise do not work then the doctor and then give the medicine that can be drunk (oral = mouth) or use insulin.

Following the division of farmakologi therapy for diabetes, namely:

• Oral medications Hipoglikemik (OHO)

• Insulin therapy

1. Hipoglikemik oral medicine

Group sulfonilurea can often reduce the blood sugar in diabetics type II, but not effective in diabetes type I. Examples are glipizid, gliburid, tolbutamid and klorpropamid. The medicine down the blood sugar in a way to stimulate insulin release by pancreas and increase effectiveness.
Other drugs, namely metformin, does not affect insulin release, but increase the body's response to the insulin to its own. Akarbos works by delaying glucose absorption in the intestine.
Drugs hipoglikemik per-oral usually given on the type II diabetics and if the diet fails to decrease by sport sugar with enough blood.
This medicine can sometimes given only one time (morning), although some patients require 2-3 times the.
If the drug per-oral hipoglikemik can not control your blood sugar well, may need insulin injections are given.

2. Insulin therapy Sulih

In the type 1 diabetes, pancreas can not produce insulin, so insulin must be given a replacement. The provision of insulin can only be done through injection, insulin was destroyed in the stomach so that it can not be per-oral (swallowed).
A new form of insulin (nose spray) are in the research. At this time, a new form of insulin is not able to work well as a different rate its absorption cause problems in determining the dose.
Insulin injected under the skin into the fat layer, usually in the arm, thigh or stomach wall. The needle used is very small so do not feel too painful.

Insulin is available in 3 basic forms, each with its own speed and duration of work is different:

• Insulin work fast.

Examples are regular insulin, which work most quickly and most briefly.
Insulin is often started down the sugar in 20 minutes, peak within 2-4 hours and work for 6-8 hours.
Insulin work fast often used by patients who undergo injections several times each day and Inject the 15-20 minutes before eating.

• Insulin are working.

Examples are Suspensi zinc insulin or insulin Suspensi isofan.
Start work within 1-3 hours, reaches peak maksimun within 6-10 hours and work for 18-26 hours.
Insulin can be injected in the morning to meet the needs for a day and can be injected in the night to meet the needs throughout the night.

• Insulin working slowly.

Examples are insulin Suspensi zinc that have been developed.
New effects arise after 6 hours of work for 28-36 hours.
insulin in the packaging room temperature for months so that the stable can be taken to go everywhere.

Elections insulin that will be used depends on:

• The desire to control the diabetes is

• The desire to monitor the patients blood sugar and adjust the dose

• Summary of daily

• Dexterity in patients learn and understand the disease

• Stability of blood sugar throughout the day and from day to day.

packaging that is most easy to use injections of insulin once a day at work. But blood sugar control package provides the most minimal.

A more stringent control can be obtained by combining 2 types of insulin, the insulin work faster and insulin are working. Second injection is given at the dinner, or when trying to sleep at night.

The most stringent control obtained with injected insulin work faster and insulin are working on morning and evening insulin injection, along with additional work quickly in the afternoon.
Some people with old age requires the same amount of insulin each day, other people need to adjust the dose depending on the insulin food, exercise and blood sugar pattern. Insulin needs will vary according to changes in food and exercise.
Some patients experience resistance to insulin. Insulin is not entirely the same as the insulin produced by the body, so the body can be formed antibody against insulin replacement. This antibody activity affect insulin, so patients with resistansi of the need to increase the insulin dose.

insulin can affect the skin and tissue underneath at the injection site.Sometimes the allergic reaction occurs that causes pain and feeling burnt, followed by redness, itching and swelling around the injection site used for several hours. Its form injections often cause deposition of fat (so the skin looks a lump) or damage the fat (so that the skin grooved). Complications can be prevented by changing the way and change the type of insulin. On the use of synthetic human insulin resistance and rare allergy.

The diet is very important. Usually people can not eat too much sweet food and must eat in a regular schedule. People with diabetes tend to have a high cholesterol level, therefore, recommended to limit the amount of saturated fat in food. But the best way to lower the cholesterol level is to control blood sugar and body weight.
All people should understand how a diet and exercise to control the disease. They must understand how to avoid the occurrence of complications.
People also need to give special attention to the infection so that the feet must be cut his nails regularly. It is important to be examined so that the eye changes in blood vessel in the eye.

Also can be overcome with the herbs as medicine for a nutritious Diabetes

Since antiquity, diabetes has been treated with plant medicines. Scientific investigation has recently confirmed the benefits of this much preparation, some really effective. Only plants that appear most effective, relatively not toxic and has many benefits include:

• Pterocarpus marsupium (Indian Kino, Malabar Kino, Pitasara, Venga)

Tree is the source of the Kino pharmacopeas Europe. Gum resin that looks like dried blood (Dragon blood), widely used in Indian medicine. This herb has a long history of use in India as a treatment for diabetes. The flavonoid, (-)-epicatechin, extracted from the bark of this plant has been shown to prevent alloxan-induced damage to beta cells in mice.

Both epicatechin and crude alcohol extract of Pterocarpus marsupium have actually have been shown to regenerate functional pancreatic beta cells. No other drug or natural agent has been shown for this event.

• Bitter Melon (Momordica charantia)

Bitter melon, also known as balsam pear, is a tropical vegetable widely cultivated in Asia, Africa and South America, and has been used extensively in folk medicine as a cure for diabetes. Blood sugar lowering action of the extract or juice of fresh raw fruit has been clearly defined in both experiments and clinical studies.

Bitter melon consist of several compounds with confirmed anti-diabetic properties. Charantin, taken by the alcohol, consisting of a hypoglycaemic agent mixed steroids that are stronger than the drug tolbutamide which is often used in diabetes care. Momordica also contains insulin-like polypeptide, polypeptide-P, the lower the level of blood sugar when injected subcutaneously into type 1 diabetes patients. Oral administration of 50-60 ml of juice that has shown good results in clinical trial.

Excessively high doses of bitter melon juice can cause abdominal pain and diarrhea. Young children or anyone with hypoglycemia should not take bitter melon, since this herb could theoretically trigger or worsen low blood sugar, or hypoglycemia. In addition, diabetics taking hypoglycemic drugs (such as chlorpropamide, glyburide, or phenformin) or insulin should use bitter melon with caution, as they may potentiate the effectiveness of drugs, leading to severe hypoglycemia.

• Gymnema Sylvestre (Gurmar, Meshasringi, Cherukurinja)

Gymnema assist in the pancreas produce insulin in type 2 diabetes. Gymnema also improve insulin to lower blood sugar in both Type 1 and Type 2 diabetes. He came down for the sweet cravings. This herb can be an excellent substitute for oral blood sugar lowering drugs in Type 2 diabetes. Some people take 500 mg per day of gymnema extract.
Garlic and onion (Allium CEPA and Allium sativum)

Onion and garlic with significant blood sugar lowering action. Principal active ingredients are believed to be allyl propyl disulphide (APDS) and diallyl disulphide oxide (allicin), although other constitutents such as flavonoids also play a role in May.

Experiment and clinical evidence indicates that the APDS lower glucose levels by competing with insulin for insulin-inactivating sites in the heart. This result increases free insulin. APDS administrative dose of 125 mg / kg to fasting humans found cause marked fall in blood sugar levels and increased serum insulin. Allicin doses of 100 mg / kg produced similar effects.

Garlic extract found to reduce blood sugar levels during oral glucose tolerance and blood. Effect increased as the dose increased, but the effect is observed even for beneficial low level used in diet (eg, 25 to 200 grams). Effect is the same in both raw and boiled onion extracts. Hepatic onion influence of sugar metabolism and / or increase insulin release, and / or prevent insulin's destruction.

Additional benefits from the use of garlic and onions that they beneficial cardiovascular effects. They found lower lipid levels, inhibit platelet aggregation and antihypertensive. So, liberal use of onion and garlic are recommended for diabetes patients.

• Fenugreek (Trigonella foenum-graecum)

Experiment and clinical studies have shown antidiabetic properties of fenugreek seeds. Active ingredients responsible for the antidiabetic properties of defatted fenugreek seed that contains the alkaloid trogonelline, nicotinic acid and coumarin.

• Blueberry leaves (Vaccinium myrtillus)

A decoction of leaves of blueberry has a long history of use in the treatment of diabetes. Complex myrtillin (an anthocyanoside) is apparently the most active material. After the injection is rather weak compared to insulin, but less toxic, even at 50 times 1 g per day therapeutic dose. One dose can produce beneficial effects for several months.

Blueberry anthocyanosides also increase capillary integrity, prevent free radical damage and improve the tone of the vascular system. In Europe, it is used as an anti-haemorrhagic agent in the treatment eye, including diabetic retinopathy disease.
Asian Ginseng

Asian ginseng is generally used in traditional Chinese medicine to treat diabetes. Has been shown to increase the release of insulin from the pancreas and to increase the number of insulin receptors. It also has a direct effect of lowering blood sugar.
A study found that 200 mg of ginseng extract per day to improve control of blood sugar and energy levels in Type 2 diabetes (NIDDM).

• Bilberry

Bilberry may lower the risk of some diabetes complications such as cataracts and diabetic retinopathy.

• Stevia

Stevia has been used traditionally to treat diabetes. Early reports that stevia may be useful for glucose tolerance (and therefore potentially help with diabetes), although not all reports that confirmed this. Stevia does not even have direct antidiabetic effects, its use as a sweetener that can be reduced in patients Feed sugars.

• Biloba ginkgo

Ginkgo biloba extract in May prove useful for prevention and early treatment diabetic neuropathy.

Cinnamon - Triples insulin's efficiency

Barberry - One of the mildest and liver tonics known.
Dosage: tincture, 10-30 drops; or standard decoction 3-9 g.
Preventing Complications of diabetes Danger
Monitoring blood sugar is an important part of treatment of diabetes. The existence of glucose can be water from urine; still chew water proofing is not a good way to monitor or adjust the dose of medication.
At this time the blood sugar can be measured easily by its own people at home using a gauge of blood glucose. People with diabetes should record their blood sugar and report them to the doctor so that the dose of insulin or drugs hipoglikemik can be adjusted.
Insulin and drugs hipoglikemik per-oral too many can lower the blood sugar increase hipoglikemia. Hipoglikemia (low sugar in the blood) can also occur if people eat less or not eating on time or do the exercise without eating too heavy.
If blood sugar is too low, the first organ affected is the impact the brain. To protect the brain, the body begin to make glucose from glikogen stored in the liver.
This process involves the release epinefrin (adrenalin), which tends to cause hunger, fear, increased shivering. The reduced level of blood glucose to the brain can cause headaches.
Hipoglikemia must be overcome because in a few minutes can be a serious, sometimes causing coma and brain injury settle. If there are signs hipoglikemia, people should be eating sugar.
Therefore, diabetics should always carry candy, sugar, or glucose tablets to face attacks hipoglikemia. Immediately or people drinking a glass of milk, sugar water or fruit juice, piece cake, fruit or other sweet foods.
People with type I diabetes must always take glukagon, which can be injected if they can not eat foods that contain sugar.

Symptoms of low blood sugar:

• Pain that arises is hungry all of a sudden

• Headache

• Worries arise that the sudden

• Body tremor

• Sweating

• Confused

• The decline in awareness, coma.

Ketoasidosis diabetikum is an emergency. Without the proper treatment and quick, coma can occur even in death. People must be treated in the intensive care unit. Given a large amount of fluid and electrolyte intravena (natrium, potassium, klorida, phosphate) to replace the water lost through the urine excessive.
Insulin is given via intravena so to be able to work immediately and dose adjusted. Glucose level, electrolyte and blood keton measured every few hours, so that treatment can be adjusted.
Example of arterial blood was taken for the its acidity.Controlling blood sugar and electrolyte replacement can usually restore the balance of acid basa, but sometimes need additional treatment is given to edit the blood acidity.
Treatment for hiperglikemik comma-hiperosmolar non-ketotik with the same treatment for ketoasidosis diabetikum given the fluid and electrolyte replacement. Blood sugar must be returned in stages to prevent fluid movement into the brain. Blood sugar tend to be more easily controlled blood acidity and not too heavy.
If blood sugar is not controlled, the majority of long-term complications develop progressive. Retinopati diabetik can be treated directly with laser surgery to plug the leakage of blood vessel so that it can prevent damage to the retina settled. Laser therapy early can help prevent or slow vision loss.

Recent research shows that diabetes complications can be prevented, delayed or slowed by control of blood sugar. Controlling blood sugar can be done with therapy, for example wieldy take medicine.

Avoid with Diabetes Lifestyle Change
The descendants of whether someone has diabetes can be affected or not. Besides children, lifestyle also large. Type 2 diabetes often occurs in people who have experienced Obesity. Obesity or overweight is the most important causes of diabetes triggered.
Obesity means excess body weight at least as much as 20% of ideal body weight. The index also means the body more than 25 kg/m2. Excess fat that will cause resistance to insulin. This explains why diet and sports is a method for type 2 diabetes.

With lower body weight and increase muscle mass, reduces the amount of fat so that helps the body utilize insulin better. In fact there is a connection between type 2 diabetes with the most fat stack location. When the pile of fat found in the most stomach is exposed to the risk of diabetes higher.

The researchers also believe that the genes that bring nature Obesity had a role in causing diabetes. Gen gen obes named this set the weight of protein through our news whether we are hungry or not. In the experiments with mice, these genes mutation when the mouse will become a obes and type 2 diabetes.

Research shows that obesity-related time spent in front of the TV and computer. Watching TV will also cause the move does not affect the eating patterns.

How do I overcome obesity to avoid diabetes?

How easy, cheap and effective, including:

1. Habituate themselves to live healthy

2. Familiarize exercise regularly

3. Avoid watching TV or playing computer too long

4. Do not consume candy, chocolate, or a snack with a high salt contents.

5. Avoid dishes with the contents of fat and carbohydrate content is high.

6. Consumption of vegetables and fruits.

Hopefully you can help with various efforts to live healthy

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