Jun 21, 2013

Metabolic Syndrome and Diabetes

Dr. Gabe Mirkin's Fitness and Health E-Zine
Metabolic Syndrome and Diabetes
October 11, 2009

As the standard of living in a country increases, so does the incidence of Metabolic Syndrome. Today, one of three North Americans will suffer premature death from the consequences of Metabolic Syndrome, which is caused too little activity and too much food (The Journal of Clinical Hypertension, September 2009). Warning signs include: abdominal obesity, high triglycerides, low good HDL cholesterol, overweight, high blood sugar and high HBA1C. (HBA1C is a blood test that measures sugar stuck on cells. An HBA1C greater than 5.7 shows that you have Metabolic Syndrome).

Metabolic Syndrome means that you are in the early stages of diabetes. If you store fat primarily in your belly, you probably have high blood insulin levels, a sign that your body cannot respond adequately to insulin. High insulin levels are caused by high blood sugar levels that cause blood sugar to stick to the surface of cell membranes. Once there, sugar can never get off. It is eventually converted to sorbitol which destroys the cell to cause all the side effects of diabetes. As long as your pancreas still makes insulin, you can reverse metabolic syndrome and diabetes. However, once your pancreas dies you cannot make insulin and your diabetes is not curable.

Read my recommendations on preventing diatetes, and for treating it if you have already been diagnosed. In summary:

• Exercise
• Don't be overweight
• Avoid refined carbohydrates except during exercise
Make sure you have enough vitamin D
• Don't smoke
• Limit alcohol to no more than two drinks per day
Eat a healthful diet with plenty of vegetables, beans, whole grains, nuts and other seeds.

                                 Make and keep your recipes, is easier
Video http://youtu.be/C-M7X05ukeE

Post Polio Litaff, Association A.C _APPLAC Mexico

Spinal anaesthesia is controversial in these patients because the abnormal spinal anatomy

Spinal anaesthesia guided by computed tomography scan in a patient with severe post-polio sequelae
  1. B. Palmier+Author AffiliationsToulon, France*E-mail: bordes.julien@neuf.fr
A 66-yr-old man (height, 180 cm; weight, 55 kg) was undergoing transurethral resection of a bladder tumour. He presented with severe PPS sequelae. He had a history of paralytic poliomyelitis when he was 19 yr old requiring ventilation. The patient's motor deficit due to polio at that time was severe with paraplegia, left-arm paralysis, and major spinal deformities (Fig. 1A and B). Preoperative evaluation showed difficult intubation criteria. After a risk–benefit discussion, spinal anaesthesia was proposed to the patient preferentially to general anaesthesia with fibreoptic nasotracheal intubation, because of the restrictive chest wall deformities with poor respiratory function and the need for neurological evaluation to prevent TURP syndrome, and despite the predicted difficulties in achieving spinal anaesthesia. The patient gave informed consent for this procedure. A pre-procedural spine CT scan (Fig. 1D) showed severe scoliosis associated with axial rotation of the lumbar spine and ossification of the interspinous ligament. The puncture was performed with a paramedian approach, 2 cm from the midline, at the L4/5 intervertebral level (Fig. 1C). The procedure was uneventful and successful after one attempt. We injected 10 mg of hyperbaric bupivacaine and 2.5 µg of sufentanil and the patient developed good sensory and motor block. Surgery was performed uneventfully and lasted 1 h. Approximately 2 h after surgery, his motor and sensory function returned to normal. Neurological examination was unchanged from the preoperative status. The postoperative course was uneventful, and the patient was discharged from hospital on day 4.
Fig 1
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(A and B) Severe spinal deformities with scoliosis and axial rotation of lumbar spine. (C) Surface landmarks. The circle indicates the puncture site at the L4/5 intervertebral level. (D) Pre-procedural CT scan at the L4/5 level.
To our knowledge, our case is the first report demonstrating that spinal anaesthesia guided by CT scan may be a safe option for patients with severe PPS spinal deformities. Spinal anaesthesia without incident has been reported in one PPS patient with relatively normal spinal anatomy.2In our case, the choice of spinal anaesthesia was based on an extensive risk–benefit analysis with discussion of general anaesthesia. The predicted difficulties of airway management, the effects of invasive mechanical ventilation on poor respiratory function, and the need for neurological checking during surgery to prevent a TURP syndrome were the key points to support our decision. As previously published, real-time ultrasound-guided spinal anaesthesia could have been an option, but this technique requires advanced skills in ultrasound-guided regional anaesthesia, both in terms of imaging the relevant anatomical structures and in terms of the simultaneous manipulation of the needle and transducer.3 Moreover, obtaining and maintaining alignment of the ultrasound beam with the needle and the acoustic window into the interlaminar space would be very challenging in our patient with such spinal deformities. Therefore, we preferred to guide procedure by pre-procedural CT scan. We hope that our case report will provide useful information for others in their clinical practice.
  1. Lambert DA
Post Polio Litaff, Association A.C _APPLAC Mexico

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