Type 2 Diabetes And Managing It

Diabetes is a life-long disease that affects the way your body handles glucose in your blood.


Causes

Insulin, a hormone produced by the pancreas, facilitates the movement of glucose absorbed from food in blood into cells.

Patients with Type II diabetes have insulin resistance and the normal metabolism involving insulin becomes disrupted. .

In the initial phase, the pancreas will compensate by making more insulin to maintain normal metabolism but eventually, due to inadequate compensation, sugar will build up in the blood.

Causes of type 2 diabetes include:

• Genes. Certain individuals have a genetic predisposition to develop type 2 diabetes
• Obesity. Obesity causes insulin resistance.
• Metabolic syndrome. People with insulin resistance often have a group of conditions including high blood glucose, extra fat around the waist, high blood pressure, and high cholesterol and triglycerides.
• Hepatic Causes. Liver abnormalities can cause abnormally high blood sugars
• Abnormal beta cells. Abnormal pancreatic beta cells (the cells that produce insulin) can cause Diabetes Type II

Risk Factors and Prevention

• Age: 45 or older
• Family members with Diabetes
• Ethnicity: African-American, Alaska Native, Native American, Asian-American, Hispanic or Latino, or Pacific Islander-American are all predisposed to develop Diabetes Type 2
• Heart and blood vessel disease
• High blood pressure, even if it's treated and under control
• Low HDL ("good") cholesterol
• High triglycerides
• Being overweight or obese
• Gestational Pregnancy
• Polycystic ovary syndrome (PCOS)
• Depression
• A sedentary lifestyle
• Smoking
• Stress
• Insufficient or excessive amounts of sleep

What Can You Do?

• Lose weight. 7% to 10% of weight loss can cut your risk of type 2 diabetes by half.
• Exercise. Moving muscles use insulin. Thirty minutes of brisk walking a day will cut your risk by almost a third.
• Eat right. Avoid highly processed carbs, sugary drinks, and trans and saturated fats. Limit red and processed meats.
• Quit smoking.

Symptoms

• Excessive thirst
• Excessive amounts of urine
• Blurry vision
• Increased irritability
• Tingling or numbness in your hands or feet
• Feeling tired all the time
• Poor wound healing
• Recurrent yeast infections

Getting a Diagnosis

Blood tests can be performed to determine diabetic statuses.

A1C: This gives an indication of the sugar control over the last 3 months from the point of blood evaluation.

Fasting plasma glucose: This gives a direct measure of the blood glucose level at the point of blood evaluation. .

Oral glucose tolerance test (OGTT): This evaluates how your body handles excessive sugar.


Long-Term Effects

Over time, high blood sugar can damage and cause problems with your:

• Heart and blood vessels
• Kidneys
• Eyes
• Nerves, which can lead to trouble with digestion, the feeling in your feet, and your sexual response
• Wound healing
• Pregnancy

The best way to avoid these complications is to manage your diabetes well.

• Take your diabetes medications or insulin on time.
• Check your blood glucose.
• Eat right, and don't skip meals.
• See your doctor regularly to check for early signs of trouble.

About The Author

Dr Lau Tzun Hon is a resident housecall doctor at CMY Medical. He received his MBBS (Hons) from Sydney University in 2001 and has served in the both private and government restructured hospitals prior to commencing his practice in Home Care.

While in the Government Restructured Hospitals, Dr Lau served primarily in the Department of Accident & Emergency Medicine and Anaesthesia. Upon entering the Private sector, Dr Lau worked in both public and private A&E departments before venturing into Home Care.

Over the years, he has developed a strong passion to maintain and  enhance the quality of life for patients under his care.  A strong believer that healthcare does not need to be financially straining, Dr Lau often delivers more value beyond expectations.

What is Roseola

Roseola, a common infection affecting children less than 2 years of age, is a mild infection characterised by fever, rash, and generalized irritability in infants.

Two common strains of herpes virus cause roseola. Duration of disease can last beyond a week in some cases.

Roseola typically isn't serious. However, in some cases, uncontrolled high fevers can result in complications.

Treatment of roseola includes bed rest, fluids and anti-pyretic medications.


Symptoms

Roseola can be dormant in the child up to a week or 10 days. Once the disease erupts, the symptoms include:

• Fever. Roseola typically starts with a sudden, high fever greater than 39.4 C. Other symptoms experienced include a sore throat, runny nose or cough. Swollen lymph nodes can also occur. The fever usually lasts 3-5 days. 
• Rash. Once the fever subsides, a rash typically appears — but not always. The rash consists of many small pink spots or patches, are generally flat, and usually has a global distribution all over the body. The rash, which isn't itchy or uncomfortable, can last from several hours to several days before fading.

Other signs and symptoms of roseola may include:

• Irritability in infants and children
• Mild diarrhea
• Decreased appetite
• Swollen eyelids

When To See A Doctor

Seek immediate medical care if the child has a seizure due to uncontrolled fevers.


Call your child's doctor if:

• The fever is uncontrolled. 
• The illness is prolonged and unresolving after a week

Call your doctor

If immunocompromised, contact your doctor. Monitoring for a possible infection will be necessary.


Causes

The most common cause of roseola is the human herpes virus 6, and in rare cases, herpes 7.

It is spread via respiratory secretions or saliva. Hence children in close contact with other children become infected easily.

Roseola is contagious even if no rash is present. Hence the disease can spread insidiously.


Risk Factors

Older infants are at greatest risk of acquiring roseola because their immune system is still developing. Newborn babies receive antibodies from their mothers that protect them in the first 6 months of life. Hence, the most common age of infection is between 6 to 15 months.


Complications

1.  Seizures in children

Uncontrolled fevers can result in seizures in children. This often presents as a brief loss of consciousness, jerking of limbs, and or temporary loss of bladder or bowel control.

Although frightening, febrile seizures in otherwise healthy children are generally short-lived and are rarely harmful. However, seek medical care if unsure.


Complications from roseola are rare. The vast majority of otherwise healthy children and adults with roseola recover quickly and completely.

2.  Concerns for immunocompromised individuals
Immunocompromised individuals, for example, those who have recently received a bone marrow or organ transplant, may contract roseola as a new infection or due to reactivation of the dormant virus in their body.

These patients may experience potentially serious complications from the infection, such as
pneumonia or encephalitis.


Preparing For Your Appointment

Prior to seeing the doctor, encourage your child to rest and drink lots of fluids.


Tests and Diagnosis

Diagnosis is usually clinical though a blood test can be done to check for antibodies.


Treatments and Drugs

Most children spontaneously recover within a week of the onset of the fever.

Medications to control fever can be used for symptom control.


Prevention

Avoid exposing your child to an infected child. If your child is sick with roseola, keep him or her home and away from other children until the fever subsides.

Most patients are immune by the time they are of schooling age. However, basic hand washing is recommended to prevent the spread of the disease.

Adults who never contracted roseola as children can become infected later in life, though the disease tends to be mild in healthy adults. Infected adults however can pass the disease to children.

About The Author

Dr Lau Tzun Hon is a resident housecall doctor at CMY Medical. He received his MBBS (Hons) from Sydney University in 2001 and has served in the both private and government restructured hospitals prior to commencing his practice in Home Care.

While in the Government Restructured Hospitals, Dr Lau served primarily in the Department of Accident & Emergency Medicine and Anaesthesia. Upon entering the Private sector, Dr Lau worked in both public and private A&E departments before venturing into Home Care.

Over the years, he has developed a strong passion to maintain and  enhance the quality of life for patients under his care.  A strong believer that healthcare does not need to be financially straining, Dr Lau often delivers more value beyond expectations.

What is Constipation

When bowel movements are difficult or happen less often than normal, constipation has developed. Everyone will experience it at some point in life and it is usually harmless.

The normal length of time between bowel movements varies widely from person to person, ranging from bowel movements three times a day to once or twice a week.

However, having no bowel movement for three or more days will usually result in stool becoming hard and difficult to pass.


Symptoms

• Fewer bowel movements than usual
• Straining to evacuate stool
• Hard and/or small stools
• Experiencing Tenesmus - a sensation of incomplete evacuation
• Abdominal swelling and tenderness
• Vomiting with reduced appetite

Causes

• Medications containing calcium or aluminum
• Dietary changes
• Colon cancer
• Excessive consumption of dairy products
• Eating disorders
• Irritable bowel syndrome
• Neurological conditions such as Parkinson's disease or multiple sclerosis
• Physical inactivity
• Dehydration
• Laxative abuse
• Pregnancy
• Haemorrhoids
• Narcotics, anti-depressants, and iron supplements
• Stress
• Hypothyroidism

Diagnosis

Doctors can order certain investigations to find the cause for constipation. For example:

• Blood tests to check hormone levels 
• Imaging studies like Barium studies to look for any blockages in your colon
• Colonoscopy 

What Should I Do If I Am Constipated?

• Unless instructed otherwise, drink two to four extra glasses of water a day 
• Warm fluids in the morning
• Increase fruits and vegetable intake
• Prunes, bran and cereal can help

When Should I Call My Doctor?

Call your doctor if:

• Constipation is a new problem for you
• Bloody stools develop
• Unexplained loss of weight associated with constipation
• Painful bowel movement
• Constipation beyond 2 weeks
• Pencil thin stools

Can I Prevent Constipation?

• Eat a well-balanced diet with plenty of fiber. 
• Drink lots of water
• Avoid caffeine
• Avoid milk if it causes constipation in you
• Exercise regularly.
• Be prompt to evacuate. Go to the bathroom when you feel the urge.

About The Author

Dr Lau Tzun Hon is a resident housecall doctor at CMY Medical. He received his MBBS (Hons) from Sydney University in 2001 and has served in the both private and government restructured hospitals prior to commencing his practice in Home Care.

While in the Government Restructured Hospitals, Dr Lau served primarily in the Department of Accident & Emergency Medicine and Anaesthesia. Upon entering the Private sector, Dr Lau worked in both public and private A&E departments before venturing into Home Care.

Over the years, he has developed a strong passion to maintain and  enhance the quality of life for patients under his care.  A strong believer that healthcare does not need to be financially straining, Dr Lau often delivers more value beyond expectations.

Influenza

Overview

Influenza is a viral infection that attacks your respiratory system — your nose, throat and lungs. Influenza, “the flu”, is a viral infection that attacks your nose, throat, and lungs.

In most cases, influenza resolves spontaneously. However, severe complications occur in certain people.

These high risk populations include:

• Children under 5
• Adults older than 65
• Nursing home Residents
• Pregnant women 
• Immunocompromised People
• Chronically ill Patients
• The Obese (BMI >40)

The best defense against influenza is to be vaccinated against it.


Symptoms

Runny nose, sneezing and sore throat. The difference between colds and the flu, however are marked. Colds usually develop slowly while flus are sudden.

Common signs and symptoms of the flu include:

• Fever over 38 Deg C
• Generalized aches and pains
• Rigors and Chills
• Headache
• Dry, persistent cough
• Fatigue and weakness
• Nasal congestion
• Sore throat

When To See A Doctor

If you have flu symptoms and are at risk of complications, see your doctor right away. 

Consumption of antiviral drugs within the first 48 hours can reduce the length of your illness and help prevent complications.

Causes

Flu viruses are transmitted via directly through the air. Carried by droplets of water in the breath, whenever an infected individual coughs, sneezes, or even talk, the virus spreads. Inhalation of these infected droplets results in infection. 

Infected individuals are contagious for about a week to 10 days after symptoms appear. 

Understand that the viruses are constantly evolving and changing. Hence, previous infections do not fully protect against new strains of the influenza virus.

Risk Factors

Factors that may increase your risk of developing influenza or its complications include:

• Age. The very young and very old are at increased risk. 
• Living conditions. Patients in facilities that recycle air or have other occupants in close proximity are at increased risk. 
• Weakened immune system. Cancer treatments, anti-rejection drugs, corticosteroids and HIV/AIDS all weaken your immune system making it easier to be susceptible to the flu.
• Chronic illnesses. Chronic conditions, such as asthma, diabetes or heart problems, may increases your risk of influenza complications.
• Pregnancy. Pregnant women, especially in the second and third trimesters and 2 weeks after delivery are at a higher risk. 
• Obesity.

Complications

These include:

• Pneumonia
• Bronchitis
• Asthma flare-ups
• Heart problems
• Ear infections

Treatment

Often, rest and fluids are sufficient for management of the flu. Doctors might prescribe an antiviral medication if you present early. These drugs may shorten the duration of illness and reduce the likelihood of developing serious complications.

Side effects of these Antiviral medication side effects may include nausea, vomiting and other more serious complications like hallucinations. As a result, it has been recommended that further studies be performed on antiviral drugs.

Self-Management

If you do come down with the flu, these home measures will ease your symptoms:

• Consume clear fluids.
• Get sufficient Rest..
• If necessary, painkillers like paracetamol can be used for symptom control

Prevention

The Center for Disease Control and Prevention recommends annual flu vaccination for everyone over the age of 6 months.

Each year's seasonal flu vaccine covers three or four influenza viral strains anticipated to thrive in the upcoming season.

Infection Control

• Wash your hands. Frequent Handwashing is strongly recommended. 
• Contain coughs and sneezes. Wear a mask or cover your mouth when coughing or sneezing
• Avoid crowds. Avoid crowded areas as the flu virus is spread through air

About The Author

Dr Lau Tzun Hon is a resident housecall doctor at CMY Medical. He received his MBBS (Hons) from Sydney University in 2001 and has served in the both private and government restructured hospitals prior to commencing his practice in Home Care.

While in the Government Restructured Hospitals, Dr Lau served primarily in the Department of Accident & Emergency Medicine and Anaesthesia. Upon entering the Private sector, Dr Lau worked in both public and private A&E departments before venturing into Home Care.

Over the years, he has developed a strong passion to maintain and  enhance the quality of life for patients under his care.  A strong believer that healthcare does not need to be financially straining, Dr Lau often delivers more value beyond expectations.

What Is Gastroenteritis

“Gastroenteritis” refers to inflammation and infection of the Gastrointestinal tract, commonly known as the “stomach flu” and is often associated with diarrhoea and vomiting.


Symptoms

Watery Diarrhoea, vomiting, stomach pain, abdominal cramps, fever, nausea and headaches are all known symptoms of Gastroenteritis.

As a secondary consequence, patients can become dehydrated. Clinically, patients will experience dry skin, dry mouth, feeling light headed and thirst.


Stomach Flu and Children

Children and toddlers dehydrate faster than adults. The child that constantly complains of persistent diarrhoea, nausea/vomiting and presents with dry skin is likely dehydrated. For toddlers, watch for dry and fewer diaper counts throughout the day.

Children with gastroenteritis should be kept at home away from school or day care centers until all the symptoms abate. It is best to have a full medical consult before returning to school.

There are vaccines available against viruses that cause Gastroenteritis. Do enquire with your attend physician.


Causes  of Gastroenteritis

There are many ways gastroenteritis can be spread:

• Contact with someone who has the virus.
• Contaminated food or water.
• Unwashed hands after going to the bathroom or changing a diaper.

Most commonly, Gastroenteritis is caused by a virus, either of the rotavirus or norovirus strains.

Rotavirus is the world's most common cause of diarrhea in infants and young children. Norovirus is the most common cause of serious gastroenteritis and also foodborne disease outbreaks in the U.S.

Bacteria, on the other hand, such as E.Coli, Campylobacter and Salmonella can also trigger severe Gastroenteritis. They can be spread by unwashed hands after toileting, poorly cooked poultry, eggs, poultry juices, and even through live poultry.

Another common bacteria of the shigella strain, is often found in day care centers as it typically spreads via contaminated food and drinking water.

Parasites can also cause gastroenteritis, but it's not common. Parasites like giardia and cryptosporidium spread via contaminated swimming pools or contaminated water.

Other less common causes of gastroenteritis include:

• Heavy metals (arsenic, cadmium, lead, or mercury) in drinking water.
• Eating a lot of acidic foods, like citrus fruit and tomatoes.
• Toxins that might be found in certain seafood.
• Medications such as antibiotics, antacids, laxatives, and chemotherapy drugs.

About The Author

Dr Lau Tzun Hon is a resident housecall doctor at CMY Medical. He received his MBBS (Hons) from Sydney University in 2001 and has served in the both private and government restructured hospitals prior to commencing his practice in Home Care.

While in the Government Restructured Hospitals, Dr Lau served primarily in the Department of Accident & Emergency Medicine and Anaesthesia. Upon entering the Private sector, Dr Lau worked in both public and private A&E departments before venturing into Home Care.

Over the years, he has developed a strong passion to maintain and  enhance the quality of life for patients under his care.  A strong believer that healthcare does not need to be financially straining, Dr Lau often delivers more value beyond expectations.

Chickenpox

Chickenpox is a common childhood viral illness that is characteized by the formation of itchy, red blisters all over the body.


Signs and Symptoms of the Chickenpox

The most recognizable sign of Chickenpox is its characteristic rash. However, other symptoms prior to the development of the rash include:

• Fever
• Headache
• Loss of appetite

The rash itself undergoes three different phases:

• Formation of red or pink bumps all over your body.
• Rupture and/or leakage of infectious fluid from the Bumps.
• Scab formation and healing.

Patients will be contagious until all the bumps have scabbed over.

Causes of Chickenpox

Chickenpox is caused by a virus from the Herpes family called Varicella-Zoster. Most cases are transmitted via direct contact with an infected person’s body fluid. These include:

• Saliva
• Coughing
• Sneezing
• Contact with blisters

At Risk Population

Previous infection, vaccination, or vertical immunity passed from mother to newborn (immunity lasts about three months from birth) reduces risk. Anyone who has not been exposed may contract the virus. Risk of infection also increases under any of these conditions:

• Recent contact with an infected individual.
• Under 12 years of age.
• Adults residing with infected children.
• Spending time in a school or childcare facility with infected individuals.
• Immunocompromised individuals.

Diagnosis

Diagnosis is often clinical. See your doctor for confirmation. If the attending physician is unsure, farther lab investigations are also available to ascertain diagnosis.

Complications

Seek medical attention if the following conditions develop::

• Eyes become affected by the Rash.
• Rash becomes infected.
• Systemic symptoms like shortness of breath or dizziness develop.

Populations most at risk include:

• Infants
• Elderly patients
• Immunocompromised individuals
• Pregnant women

Affected pregnant women may bear children with birth defects, including:

• Poor growth
• Small head size
• Eye problems
• Intellectual disabilities

Treatment

Most forms of treatment for Chickenpox concentrates on symptomatic and supportive care and infection control. Because it is caused by a virus, the body’s immune system needs time to heal. Infection control measures should also be instituted to prevent spread of the disease.

In the event of an unbearable itch, antihistamines can be used.  Itching can also be soothed by:

• Bathing in lukewarm water
• Moisturizing lotions
• Comfortable clothing

High-Risk Patients

Antiviral drugs may be prescribed to those who experience complications from the virus, or who are at risk for adverse effects. Note though that these antiviral drugs do not cure chickenpox. Instead, they make the symptoms less severe, and make your body more likely to heal faster.

Duration of Disease

Most cases of chicken pox resolve within 10 days or so.

Chickenpox Immunity

Once exposed, most people become immune to the virus for their lifetime. However, in later stages of life, the varicella virus may re-emerge as Shingles during adulthood if the patient’s immune system is compromised.

Prevention

A chickenpox vaccine is available and should be given to the child between 12 and 15 months of age. A booster is given between age 4 and 6. 

Adults can opt to take the vaccination though efficacy is reduced.

About The Author

Dr Lau Tzun Hon is a resident housecall doctor at CMY Medical. He received his MBBS (Hons) from Sydney University in 2001 and has served in the both private and government restructured hospitals prior to commencing his practice in Home Care.

While in the Government Restructured Hospitals, Dr Lau served primarily in the Department of Accident & Emergency Medicine and Anaesthesia. Upon entering the Private sector, Dr Lau worked in both public and private A&E departments before venturing into Home Care.

Over the years, he has developed a strong passion to maintain and  enhance the quality of life for patients under his care.  A strong believer that healthcare does not need to be financially straining, Dr Lau often delivers more value beyond expectations.

Bronchiolitis

Bronchiolitis is a common childhood disease found in children less than 2 years of age, often affecting infants aged between 3-6 months. It can affect up to one in three children within their first year of life.

It is a condition that results in inflammation of the bronchioles, the smallest airways in the lungs and presents with coughing, wheezing, shortness of breath with secondary difficulty in feeding.

It is caused by the Respiratory Syncytial Virus in 70% of cases and is much more common in the winter months in Temperate countries.

Treatment for Bronchiolitis is often supportive and symptomatic.


Signs and Symptoms

Coughing, Wheezing, Shortness of breath over one to two days, followed by crackles and/or wheezing are typical presentations of Bronchiolitis.

After the episode, it is common for the airways to remain sensitive for several weeks, leading to recurrent cough and wheezing.

Severe signs of the disease include:

• Poor feeding (less than half of usual fluid intake in preceding 24 hours)
• Lethargy
• History of apnea
• Respiratory rate >70/min
• Presence of nasal flaring and/or grunting
• Severe chest wall recession
• Cyanosis

Causes

The Respiratory Syncytial Virus is responsible for up to 70% of cases. Other viruses include the common influenza virus, coronavirus, adenovirus, rhinovirus, and other respiratory viruses.

Some studies have suggested a connection between voluntary caesarean births and bronchiolitis. This link becomes more prominent in studies done amongst premature babies, those with low birth weights and/or congenital heart defects.

On a lighter note, studies also show evidence that breastfeeding provides some protection against bronchiolitis.

Diagnosis

Diagnosis of Bronchiolitis is clinical. A chest X-ray is useful to exclude bacterial pneumonia but it is not indicated in routine cases. Testing for specific viral strains can be done but has a low risk -  benefit ratio as identifying the virus has little effect on management.

As bronchiolitis is often caused by a virus, antibiotics are not indicated unless a superseding bacteria infection occurs. Some studies have shown that as low as 6% of affected infants develop superseding bacteria infections concurrently.

Prevention

Basic procedures like handwashing, avoiding exposure to symptomatic individuals, good hygiene and maintain a strong immune system are the best forms of protection against the Respiratory Syncytial Virus. Breast milk contains antibodies from the mother and hence confer immunity to the infant, especially during the first month of life. Immunizations for premature infants are also available but it should only be administered to infants that meet specific criteria.

Treatment

High flow oxygen therapy with a high flow device that can provide precise flow/FiO2 and medical grade vapor forms an important part of the management of bronchiolitis.

As mentioned, treatment for Bronchiolitis is primarily symptomatic and supportive. Some drugs like Bronchodilators have been used with a fair margin of success.

Bronchodilators

Inhaled Epinephrine has been shown to reduce total length of Hospital stay when compared to Salbutamol. Salbutamol, on the other hand, when administered via the inhalation route, has also been shown to reduce initial hospital admission rates in some studies but has no no clear effect on the length of hospital stay.

The routine use of bronchodilators in children with bronchiolitis is however not recommended as there has been no clear effect on any important outcomes in children but carries with it a small risk of potential adverse effects from the administered drugs and hence should be used with care and under medical supervision.

Currently other medications do not yet have evidence to support their use.  Antiviral drugs like Ribavirin have not been shown to be effective. Administration of Antibiotics in the event of a complicating bacterial infection will have no effect on the underlying viral infection. Corticosteroids also have not shown proven benefits in Bronchiolitis.

Epidemiology

90% of the people affected are between 1 and 9 months old. Bronchiolitis is the most common cause of hospitalization up to the first year of life especially during winters in temperate countries.

About The Author

Dr Lau Tzun Hon is a resident housecall doctor at CMY Medical. He received his MBBS (Hons) from Sydney University in 2001 and has served in the both private and government restructured hospitals prior to commencing his practice in Home Care.

While in the Government Restructured Hospitals, Dr Lau served primarily in the Department of Accident & Emergency Medicine and Anaesthesia. Upon entering the Private sector, Dr Lau worked in both public and private A&E departments before venturing into Home Care.

Over the years, he has developed a strong passion to maintain and  enhance the quality of life for patients under his care.  A strong believer that healthcare does not need to be financially straining, Dr Lau often delivers more value beyond expectations.