Diabetes - "Silent Killer"

Type 1 diabetes mellitus - diabetes, for short. This chemical disorder disrupts the body’s ability to utilize certain nutrients, primarily a blood sugar called glucose.


Treatment for diabetes is made more difficult because a person can have the disease a long time before it is diagnosed. “Because the early symptoms are relatively mild,” notes Asiaweek magazine, “diabetes often goes unrecognized.” Hence, diabetes has been dubbed the silent killer.


Why Serious
Diabetes has been called “a disorder of the very engine of life,” and for good reason. When the body cannot metabolize glucose, a number of vital mechanisms can break down, sometimes with life-threatening consequences. “People don’t die directly from diabetes,” says Dr. Harvey Katzeff, “they die from complications. We do a good job of preventing complications, but a poor job of treating [them] once they occur.”


Diet and Exercise
Although Type 1 diabetes cannot be prevented, scientists are studying the genetic risk factors and are trying to find ways to suppress an immune attack. “With type 2, the picture is much brighter,” says the book Diabetes - Caring for Your Emotions as Well as Your Health. “Many of those who might be genetically susceptible avoid showing any sign of this disease simply by eating a balanced diet and exercising regularly, thereby staying physically fit and keeping their weight within normal limits.”


Underscoring the value of exercise, the Journal of the American Medical Association reported on a large study involving women. The study found that “a single bout of physical activity increases insulin-mediated glucose uptake [by the body’s cells] for more than 24 hours.” Hence, the report concludes that “both walking and vigorous activity are associated with substantial reductions in risk of type 2 diabetes in women.” The researchers recommend at least 30 minutes of moderate physical activity on most if not all days of the week. This can include something as simple as walking, which, says the American Diabetes Association Complete Guide to Diabetes, “is probably the best, safest, and least expensive form of exercise.”


However, exercise by people with diabetes should be professionally supervised. One reason is that diabetes can damage the vascular system and nerves, thus affecting blood circulation and feeling. Hence, a simple scratch on the foot may go unnoticed, get infected, and turn into an ulcer - a serious condition that may lead to amputation if not treated immediately.


Insulin Therapy
Many with diabetes must supplement their diet and exercise program with daily testing of glucose levels along with multiple insulin injections. As a result of improved health through diet and a good routine of exercise, some with Type 2 diabetes have been able, at least for a time, to discontinue insulin therapy. Karen, who has Type 1 diabetes, found that exercise increases the efficiency of the insulin she injects. As a result, she has been able to cut her daily insulin requirements by 20 percent.


If insulin is needed, however, there is no reason for the sufferer to feel discouraged. “Going on insulin does not imply failure on your part,” says Mary Ann, a registered nurse who cares for a number of diabetes patients. “Whatever form of diabetes you have, if you carefully control your blood sugar, you will minimize other health problems later.” In fact, a recent study revealed that people with Type 1 who kept strict control of their blood-sugar levels “had drastic reductions in the occurrence of diabetic eye, kidney, and nerve diseases.” The risk of eye disease (retinopathy), for instance, was cut by 76 percent! Those with Type 2 who keep tight control of their blood-sugar levels enjoy similar benefits.


To make insulin therapy easier and less traumatic, syringes and insulin pens - the most common tools used - have microfine needles that give minimal discomfort. “The first shot is usually the worst,” says Mary Ann. “After that, most patients say they hardly feel a thing.” Other methods of injection include automatic injectors that shoot a needle into the skin painlessly, jet injectors that literally fire insulin through the skin by means of a fine jet blast, and infusers that employ a catheter that stays in place for two or three days. About the size of a pocket pager, the insulin pump has gained popularity in recent years. This programmable device dispenses insulin through a catheter at a steady rate according to the body’s daily needs, making insulin administration more precise and convenient.


Keep Learning
All told, there is no blanket therapy for diabetes. When considering treatment, each individual must take into account a number of factors in order to make a personal decision. “Even though you may be under the care of a medical team,” says Mary Ann, “you are in the driver’s seat.” In fact, the journal Diabetes Care states: “Medical treatment of diabetes without systematic self-management education can be regarded as substandard and unethical care.”
The more those with diabetes learn about their disease, the better equipped they will be to manage their health and increase their prospects of living a longer, healthier life.


The Role of Glucose
Glucose fuels the body’s trillions of cells. To enter the cells, however, it needs a “key” - insulin, a chemical released by the pancreas. With Type 1 diabetes, insulin is simply not available. With Type 2, the body makes insulin but usually not enough. Moreover, the cells are reluctant to let insulin in - a condition called insulin resistance. With both forms of diabetes, the result is the same: hungry cells and dangerous levels of sugar in the blood.


In Type 1 diabetes, a person’s immune system attacks the insulin-producing beta cells in the pancreas. Hence, Type 1 diabetes is an autoimmune disease and is sometimes called immune-mediated diabetes. Factors that can trigger an immune reaction include viruses, toxic chemicals, and certain drugs. Genetic makeup may also be implicated, for Type 1 diabetes often runs in families, and it is most common among Caucasians.


With Type 2 diabetes, the genetic factor is even stronger but with a greater occurrence among non-Caucasians. Australian Aborigines and Native Americans are among the most affected, the latter having the highest rate of Type 2 diabetes in the world. Researchers are studying the relationship between genetics and obesity, as well as the way excess fat seems to promote insulin resistance in genetically susceptible people. Unlike Type 1, Type 2 diabetes occurs mainly in those who are over 40 years of age.


About 90 percent of those with diabetes have Type 2. Previously, this was referred to as “non-insulin dependent” or “adult onset” diabetes. However, these terms are imprecise, for up to 40 percent of those with Type 2 diabetes require insulin. Furthermore, an alarming number of young people - some not even in their teens - are being diagnosed with Type 2 diabetes.


The Role of the Pancreas
About the size of a banana, the pancreas lies just behind the stomach. According to the book The Unofficial Guide to Living With Diabetes, “the healthy pancreas performs a continuous and exquisite balancing act, managing to sustain smooth, stable blood-sugar levels by releasing just the right amount of insulin as glucose levels wax and wane throughout the day.” Beta cells within the pancreas are the source of the hormone insulin.


When beta cells fail to produce enough insulin, glucose builds up in the blood, causing hyperglycemia. The opposite - low blood sugar - is called hypoglycemia. In concert with the pancreas, the liver helps manage blood-sugar levels by storing excess glucose in a form called glycogen. When commanded by the pancreas, the liver converts glycogen back into glucose for use by the body


The Role of Sugar
It is a common misconception that eating a lot of sugar causes diabetes. Medical evidence shows that getting fat - regardless of sugar intake - increases the risk among genetically susceptible individuals. Still, eating too much sugar is unhealthy, since it provides poor nutrition and contributes to obesity.


Another misconception is that people with diabetes have an abnormal craving for sugar. In reality, though, they have the same desire for sweets as most others. When it is not controlled, diabetes can lead to hunger - but not necessarily for sugar. People with diabetes can eat sweets, but they must factor their sugar intake into their overall diet plan.

5 Surefire Ways To Get Your Dog To Behave

"MY DOG won't come when I call him." "My dog barks so much that the neighbors are complaining." "My dog is always jumping on me and on my visitors." In all such cases, frustrated pet owners are asking, "What can I do?"

The answer is probably to give your dog basic obedience training - teaching it to respond to simple commands. Of course, it is best to begin while your dog is still a puppy. But even older dogs can learn. One professional dog trainer said: "The minimum age of dogs that we receive for training is four months, and the maximum is five years. But I have taught basic obedience to dogs that are even ten years old."

Dogs are intelligent. They have been trained to sniff out drugs and explosives, assist the handicapped, and perform search-and-rescue missions. But how can you train your dog to obey you?

Genetic Makeup
First, you need to know about the genetic makeup of your dog. Like wolves, dogs are hierarchy conscious. They instinctively gravitate toward living in a pack under a leader, or alpha dog. Your family is your dog's pack, and it needs to understand that you are the leader.

In a wolf pack, the leader chooses the warmest, most elevated spot to sleep. It also eats before the others. So if your dog is allowed to sleep on your bed or get on the furniture, it may conclude that it is the leader. The same might happen if it is fed tidbits from the table at mealtime.

Even as a puppy, your dog can learn that it is subordinate to you. How? Try holding its gaze with your eyes until it looks away. Also, rubbing the dog's belly while it is on its back is a good exercise, as this puts it in a submissive position. If your dog is being a nuisance and does not stop when you say "No," try ignoring it or leaving the room.

When your dog responds to your commands, it is acknowledging that you are in charge. If you as the owner do not establish your position of leadership, your pet may conclude that it is equal or superior to you, and this might affect its behavior.

How to Teach Simple Commands
To teach your dog basic commands, you will need a collar, a leash, and plenty of patience. One training manual recommends the following: (1) Give a simple, one-word command, (2) demonstrate the desired action, and (3) immediately give praise when the action is performed. Your tone of voice is more important than the words you use. A command should be given in an affirmative tone, and praise should be given in a happy, affectionate tone.

Physical punishment, such as hitting or kicking, is not necessary. Simply say ‘No' in a sharp tone, prolonging the vowel, so that the dog will know that you are displeased with its performance. A dog is intelligent enough to know when you are rewarding and when you are reprimanding.

If anything more drastic is needed, you might grasp the dog by the scruff of its neck and shake it lightly while saying "No." Reprimands should be given during or immediately following the undesirable behavior. Remember, a dog cannot discern why it is being scolded if the scolding occurs minutes or hours after the act. Neither does it understand why a certain action is acceptable on one occasion but objectionable on another. So be consistent.

The foundation for all obedience is the command "Sit!" If your dog knows this command, you can control it when it becomes overly active. For example, you can tell your dog to sit when it begins to jump on visitors. To teach your dog to sit, put the leash on it, and give the command while pushing down on its hindquarters and gently pulling its head up with the leash. Give praise immediately. Repeat these steps until the dog obeys the command on its own.

To teach your dog to remain in the sitting position, use the command "Stay!" while standing in front and putting your hand out with the palm facing flat toward the dog. If the dog moves, say "No" and place it back into position. Repeat the command, and praise your dog when it stays sitting for a short period. Gradually increase the time it sits and then the distance between you and your dog as it responds to the command.

The best way to teach a dog to come to you is to use a long leash and give a gentle tug while calling your dog's name and giving the command "Come!" Back up as the dog moves toward you, and continue giving it praise. Soon it will respond to your call without being prompted by the leash. If your dog gets loose and will not respond to the command "Come!" call it and run in the opposite direction. Often, a dog will instinctively give chase.

A word of caution: Never use the word "come" for a negative reason, such as to give a reprimand. Your dog must learn that responding to "Come" will bring pleasurable results, whether praise or a food treat. If you lose your patience while teaching this command, your dog will learn that coming is unpleasant and is to be avoided.

You can also teach your dog to walk by your side without pushing ahead or lagging behind. To do this, use a link-chain training collar and a short leash. With the dog on your left, give the command "Heel!" and step out with the left foot. If your dog attempts to push ahead or lag back, give a quick, sharp jerk on the leash and repeat the command. Give praise for compliance.

How can you keep your dog from jumping up on you? One method is to back away while using the command "Off!" followed by "Sit!" Another is to catch a forepaw in each hand and step toward the dog, repeating the "Off!" command. Give praise when it obeys.

A Loyal Companion
Remember, a dog is a social animal. Long periods of confinement can lead to hyperactivity, excessive barking, and destructive behavior. With training, your dog can become a delightful, loyal companion - instead of a nuisance.

Tips for Training a Dog
1. Be consistent in your use of words for commands.
2. Dogs like to hear their name, and it gets their attention. So use your dog's name along with commands. ("Rover, sit!") But do not use your dog's name in conjunction with a reprimand, such as "No!" Your dog must learn that responding to its name brings positive - not negative - results.
3. Use liberal praise as a reward. Many dogs will do more for affection than for food.
4. Keep training sessions short and pleasurable.
5. Do not inadvertently reinforce negative behavior by giving your dog a lot of attention when it misbehaves. This will only result in repetition of the undesired behavior.

Housebreaking Your Puppy
A puppy can be housebroken when six to eight weeks old. According to Dog Training Basics, the keys to successful housebreaking are confinement, training, timing, and praise. A dog does not normally like to soil its sleeping area. Therefore, keep your puppy confined when unsupervised. Know its schedule, and teach it a designated toilet area. Take it (on a leash) out to this area immediately after it wakes up, after a meal, after a play session, or before bedtime. Praise it as it eliminates. You may want to teach it a trigger word. When your puppy is not confined, be alert to signs that it needs to relieve itself, such as an abrupt stop of play, circling and sniffing, and running out of the room. If you catch your puppy in the act of eliminating in the house, scold it, and take it outside immediately. Again, no good will come if you give correction long after the act. Clean up any accidents with vinegar water to remove the scent; otherwise, the dog will continue to use that place to eliminate.

Urination during an excited greeting is an involuntary, natural behavior in dogs. Sometimes called submissive urination, it can mean that the dog recognizes that you are the leader, or in the alpha position. Reprimanding your dog in this situation may only worsen the problem, as this may cause it to urinate more in order to show further that it views you as the one in charge. Usually, this behavior stops by the time a dog reaches two years of age.