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Diabetic Problems

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Concurrent Illnesses

Frequently more insulin than normal is needed during any infection, whatever its nature. Insulin must not be stopped merely because the person is probably eating less. This could lead to hypoglycaemic attacks, or the more serious complications of coma or ketosis.

Local Reactions

Some patients react locally to insulin injections. These may be painful, causing red, swollen lumps that may persist for 24 – 36 hours or more. They seem to be a local allergic reaction. Changing to another brand may give relief.

Insulin Resistance

Some patients develop antibodies to insulin and may require abnormally large doses, in the vicinity of 1000 units a day or even more, to control the disease. Sometimes steroids may be necessary to control the reaction and suppress the antibodies.

Steroids Resistance

On the other hand, some patients who are taking steroids (cortisone like preparations) for other purposes may suddenly develop diabetes. It may be the unmasking of latent diabetes. Usually the degree is not severe, and oral medication may soon control the diabetes.

Ketosis Resistance

In some patients a metabolic disorder called ketosis might occur. This may be shown up by the appearance of ketone bodies in the urine, which can be detected with some of the simple dip tests. This calls for immediate, vigorous treatment, for it shows that the patient is not being adequately controlled, and the condition is getting out of hand. Mild cases may be treated at home, but the dose of insulin must be increased at once by one-quarter to one-third. Anything more serious must be treated in hospital, where full facilities are available. Soluble insulin gives the quickest and best results and regular, supervised measured amounts of glucose or carbohydrate are given.

Surgical Operations

Most well-controlled diabetics are able to undergo surgical operations if these become necessary. However, precautions are necessary, and for the period of the operation the insulin may be altered to soluble forms that give greater control.

However, although the mother does well, infants do not share the improved mortality rate. The prenatal death rate, and that from obstetrical complications, has always been high. Not long ago it fluctuated around the 40 per cent mark. With greater care, and more prenatal skill, this has been brought down in some centers to 10 – 14 per cent, still very high in relation to the normal perinatal figure.

Diabetic women are best advised to discuss the matter fully with their obstetrician before embarking on pregnancy, to ascertain the full risk factors and to have clearly in mind the course their antenatal care should take. Strict control of the diabetes is essential, and close supervision with the doctors throughout is imperative. The insulin needs vary quite a lot, and as the pregnancy progresses, they tend to increase considerably.

Sweating

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The skin is liberally supplied with intricate network of sweat glands. They are referred to as the Eccrine Sweat Glands, and there are several million them all over the body. Although all parts of the skin are copiously supplied, they are concentrated mainly on the forehead, in the armpits on the palms of the hands and soles of feet.

The sweat glands are part of system’s heat regulatory mechanism: They react almost immediately to the stimulus of heat, which operates via the brain. It is essential that the body temperature be maintained between certain critical boundaries. Any rise above normal is quickly compensated through the sweating system. When these glands are stimulated fluids pour onto the skin surface where they dry almost instantly. This immediately draws heat from the body, and the temperature falls. A very delicate balance exists to keep body temperatures operatic, within the prescribed limits in this manner.

The fluid excreted is mainly water, however, it contains some salt (sodium chloride) and other chemicals called electrolytes. The volume of fluid that is perspired can reach high levels. On an average two hour period this can reach 10,000 ml. To give an indication of the amount, 5 ml approximately equals one teaspoonful so 500 ml is roughly equal to one glass, and 10,000 ml is about equal to 20 pints! On extremely hot days, or if prolonged hard physical activity is being undertaken, the daily volume can rise still further.

In areas where the humidity is high the sweat does not tend to evaporate from the skin surface. Therefore very uncomfortable feeling occurs. The feeling is sticky as salty water accumulates. Sweat may trickle down the face, under the arms and promote greater discomfort. It is not so common in hot, dry regions such as inland regions where humidity is appreciably lower than most coastal locations. Cramps commonly follow if sweating has been very profuse. This is due to the excessive loss of sodium chloride from the system, and is often relieved by an increased intake of salt in the diet.

A serious Sebaceous (oil-secreting) gland, Dermi Gland cells that secrete sweat cross-sections through the sweat gland known as cystic fibrosis, is often diagnosed by the excessive salt content of the patient’s sweat. There is a defect in sweat-gland function, but this is only an outward sign of an internal disorder. Many people are troubled by excessive sweating. It can be triggered by hot weather or emotional stress. Even in cool weather, many people perspire abnormally. Some find their feet sweat so heavily that new footwear is required every few weeks, because shoes fall apart so quickly with the continuing moisture! For these persons, abnormal sweating becomes a major problem.

Sweating Treatment

When facetious remarks are made about the disability it does little to assist people with this problem, and little help is available. The following ideas may be of some assistance:

Temperature control: working in an area subject to regular air-conditioning may assist, but this is not the answer to the problem on a permanent basis.

Frequent bathing: this gives temporary relief, and helps to avert body odor that may be a common and embarrassing problem. But the sweating usually recommences soon afterwards, and this is a temporary measure only.

Antiperspirants: these are aimed at narrowing the ducts of sweat glands by chemical means. They assist mild cases only. They are of little value for the excessive perspiration.

Vitamin C: some find that large daily doses of vitamin C (ascorbic acid)-1,000 mg once or twice dailysometimes helps.

Further Treatment

Simple remedies rarely (if ever) cure this disorder. Most finally arrive at the doctor’s surgery for advice.

The professional lines available are:

Sympathectomy: this is a form of treatment offering a complete and permanent result. The nerve that supplies the sweat glands is surgically severed. The result is a complete absence of sweating in the offending part(s) supplied from that time forth. Some believe this is a radical measure for a simple symptom, but patients treated often prefer this. Some complain of being “too dry” following the operation. This operation is performed by a surgeon or neurosurgeon. Surgical removal of the skin and sweat glands is also being successfully used in some suitable patients.

Removal of sweat glands: Surgical removal of a triangular area of skin in the armpit is often effective. The application of Aluminium Chloride Hexahydrate (if available) periodically painted on locally is recommended. The daily washing of the armpits with a rough rag for at least five minutes helps.

Other methods

There are IT medicaments of value for this. The anticholinergics and others expected on theoretical grounds to cure must be given as too high for convenience. They produce side reactions that may be unacceptable and they are not generally used for this purpose. Relaxation is often successful in the long-term.

Of course, if you want to learn much more about the skin diseases as well as most other body illnesses, we can only advise you to check with some of the other information we have prepared. Probably the best reference guide of all is Volumes 3-5 of Family Medical Care, which covers the whole spectrum of conditions and medical care of family illnesses. These are available from the same publishers of this book.

Sunburn

We have already dealt with sunburn, but I think it should have a further brief mention here. Agreed?

Agreed, for it is very important and may be classified as an accident. In Chapter 13, “Strange Conditions of the Skin” we set out the salient items about sunburn and the treatment. I wish to reemphasize that children’s skin is prone to burning, so take adequate precautions against sunburn. Many children brown up quickly also, but when it is soft and tender and lilywhite, it may burn rapidly, often within minutes of exposure to the hot sun. Never leave a baby or child in the sun unattended. Sun kicks are great for babies, but do remember that while they are kicking away probably in a birthday suit, they could be silently and stealthily sustaining sunburn. Also, remember that the ultraviolet rays of the sun bounce back from large masses of light-colored expanses, such as clouds, beaches, open paddocks and fields. Sunburn may occur in any of these situations, often when the child is oblivious to it all.

What’s the best treatment?

Apart from avoidance in the first case, application of cool packs is the best starting point. Repeat these often, using small folded towels placed in icy water wrung out, then placed over the burnt places. Plenty of fluids, ideally fresh fruit juices, will replace fluid loss. Add some vitamins. Paracetamol elixir is best for fevers and pain reduction. The dose will usually be printed on the label. Do not place skin applications on sunburn, for they may sensitize it, and seldom help. Avoid them, despite what your friends may say. Apply ultraviolet screeners to protect against sunburn, but after the event, they are useless.

Using Cushions

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Cushions are the quickest and least expensive way of changing the mood and style of a room, so it is surprising that we don’t all have cupboards(closets) bursting with alternative covers awaiting their chance to be the main feature in response to our prevailing mood. It is difficult to imagine having too many cushions because each one adds to the atmosphere of comfort and relaxation, which is a priority in any living space.

Use the colour, texture, shape and size of cushions to add interest to a room. The same room with a plain sofa, carpet and neutral wall colour can be transformed by an arrangement of Chinese embroidered and tasselled satin cushions, rough homespun earthy-coloured bolsters or frilled red gingham squares mixed with patchworks and cotton lace. The mood each time will be entirely different. Just a few other options to consider are Provencal prints, Indian hand-blocked cottons, rich brocades, velvets and satins, or tactile velvets.

Cushions with borders (Oxford pleated or gathered), edges adorned with colourful piping or braids, appliquéd patterns and pictures created from embroidery or fabric paint and patchwork covers: the ways that cushions can he adorned are limitless. Mix similar patterns but with different colours, or similar colours but a variety of patterns. Look at the many textured fabrics that add a tactile pleasure to the visual: cottons, suede, leather, velvet, silk, wool; each has a place in the sitting room.

Large, square cushions mixed with smaller, rectangular or round ones can be piled very successfully one on top of the other. Bolsters, too, can be used as the base for a luxurious mix of cushions. The secret is to use them to fill the angle between a sofa sear and back or bed mattress and head. Then pile other cushions on top to make a gentle slope at the perfect angle for an afternoon cup of tea or a long and absorbing hook. Wrap a bolster in a lace-edged tablecloth, tying up the ends with ribbon, Christmas-cracker style, so that they spill out over the edge of the sofa, or use velvet-edged ribbons, fancy cords and tassels for flamboyant Renaissance look.

A comfortable cross between a bolster and loose cushions can be made by stitching together a row of same-sized cushions. Use cushions covered in the same fabric or choose a mixture of plain covers and co-ordinating prints. Using a strong thread, sew one edge of each cushion together to make a single long, jointed cushion that is the same width as the sofa or bed.

Look out for fabric-remnant bins because they usually contain a wealth of short lengths that arc ideal for cushion covers. It is also worth looking in haberdashery (notions) departments for dressmaker’s trimmings such as fringing, lace, braids, ribbons and beadwork borders. These are not as hard for caring as upholsterer’s trimmings but cost a fraction of the price and are perfectly adequate for cushions. Don’t despair if you don’t like sewing as covers can be made just as effectively using iron-on hemming tape, double-sided carpet tape or pins and knots.

Few things immediately suggest luxury and comfort as easily as white linen cushions do, and they are well worth the investment.

If you have always thought that cushions just belonged in the living room and pillows were only for sleeping on, then perhaps it is time to consider giving cushions a bit of bed space too. A cushion can be merely decorative and it can be highly pleasing to dress up your bed during the day, particularly if it is going to be on show, and then removed at night. This sort of bed dressing is fun when decorating, because there will be periods when the room stands empty but still needs to look welcoming.

In addition to the essential equipment needed for creating any form of soft furnishing, there are specific items to help make cushions:

Corner turner: this tool is useful for turning points and corners of cushions. Embroidery hoop: this consists of two hoops that fit snugly inside each other. Made of wood or plastic, with a spring closure, it is used for both hand and machine embroidery.

Fabric dyes: hot and cold dyes are available. Fabrics with natural fibres, such as cotton and linen, can be dyed most successfully.

Fabric paints: there is a wide range of easy-to-use products. Choose water-based paints that can be fixed (set) with an iron. The paints can be mixed and applied with a brush to create an unlimited number of colours.

Pair of compasses: use these for drawing circles. If you do not have your own compasses, draw around cups for small circles; to draw larger circles use plates or bowls.

First Aid in Drowning

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Treatment prolonged lack of oxygen from being submerged under water leads to cardiac arrest, so it is important that rescue breathing or CPR (either mouth-to-mouth or mouth-to-nose ventilation) be started immediately – even in the water if necessary.

  • Call 911 for medical assistance and a quick transfer to the nearest emergency center.
  • If you know what happened prior to the accident, tell the rescue workers, particularly if head and neck injuries are likely (as would be the case if the child was diving when the accident occurred). Keep the child warm, especially if he was in cold water. Wrap him in towels or a blanket until medical personnel arrive.

Drowning Prevention

Studies show that 70 percent of drowning accidents could be avoided if self-closing, self-latching doors were installed in homes and on gates in the fences around pools. Sturdy, childproof pool covers and alarms on doors leading to the pool area – or even an alarm that sounds when someone enters the water – are also appropriate safety measures. Parents need to teach their children the importance of swimming only when supervised and the necessity of life jackets when boating. Older children and adolescents should be warned explicitly of the risks of alcohol and/or drug consumption while swimming.

When young children are around water, they must always be supervised by an adult. Parents and teens should strongly consider becoming certified in CPR. Poolside telephones are helpful because they allow adults to answer the phone while continuing supervision. They also can speed the process of calling for help if an accident occurs.

Chances of Surviving Drowning

The chances of surviving submersion are not significantly affected by the type of water (salt, fresh, or pool water with chemicals). How long a child can survive without oxygen depends on many other factors, including age, previous health, the water temperature, and the speed and effectiveness of the rescue effort. Children under age five have an advantage because of a nerve reflex that causes the heart to slow down and blood to be directed to the brain and heart. Younger children usually survive if submersion lasts less than 3 minutes and may survive a submersion lasting up to 10 minutes if the water temperature is 50° to 60°F (10° to 15°C). In general, cold water temperatures improve survival chances.


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