The results from this study indicate that only about one in three people with asthma are receiving influenza vaccinations. This vaccination rate has changed little from 1999 through 2001. These results suggest that recommendations to vaccinate adults with asthma are not being met. In particular, younger people with asthma are not being vaccinated against influenza. Only approximately one in five people with asthma aged 18 to 49 years reported having received such a vaccination.

Respiratory infections, including influenza, can cause serious morbidity in people with asthma. Some evidence suggests that people with asthma may be more likely to experience influenza-associated morbidity than people who do not have asthma. For example, during periods when influenza virus was the predominant circulating upper respiratory virus, hospitalization rates for acute respiratory infections among children with asthma were much higher than those among children without a high-risk condition.

These considerations taken together with the fact that inactivated influenza vaccine has been shown to be both clinically effective and cost-effective—albeit not necessarily based on studies of participants with asthma—suggest that people with asthma could benefit considerably from receiving an influenza vaccine. Yet, a review of nine randomized trials noted that the benefits and risks of vaccination for patients with asthma were inconclu-sive.

All but three trials had sample sizes < 100 participants. In these trials, both early and late outcomes (mortality, hospital admission, pneumonia, asthma symptom scores, lung function measurements, medical visits, number of rescue courses of corticosteroids) were examined. The authors called for additional trials of sufficient size to study the question of the benefits and adverse effects of influenza vaccination in people with asthma. Questions about the short-term safety of the vaccine among people with asthma may have been answered by a large, randomized trial of children and adults with asthma that was published after the review.

In this trial, the administration of inactivated influenza vaccine did not affect the frequency of exacerbations of asthma during the 2 weeks following the vaccination. The cost-effectiveness of annually vaccinating all eligible people with asthma is unknown. The Healthy People 2010 objectives call for 90% of noninstitutionalized adults aged > 65 years and 60% of noninstitutionalized high-risk adults aged 18 to 64 years to receive an annual influenza vaccina-tion. People with asthma are included in the high-risk designation. The NHIS data show that 20.9 to 22.7% of asthmatic participants aged 18 to 49 years, 42.3 to 47.8% of asthmatic participants aged 50 to 64 years, and 64.8 to 72.8% of asthmatic participants aged > 65 years received a vaccination from 1999 to 2001.

THE POISONS IN THE SOIL

Commercial farmers in the United States sprayed over 1.1 billion pounds — 2% of the world’s total pesticides — in 2007. There are 21,000 pesticide products containing 860 active ingredients. All are designed to kill living organisms, which is why the Environmental Protection Agency (EPA) prohibits claims that these chemicals are safe or nontoxic. The top ten pesticides applied in the agricultural market are glyphosate, atrazine, metolachlor-s, acetochlor, 2,4-dichlorophenoxyacetic acid and pendimethalin, plus the fumigants, metam sodium, dichloropropene, methyl bromide and chloropicrin.

These are neurotoxic and known to cause cancer, birth defects, reproductive anomalies, liver and kidney damage and even death. They also cause developmental and behavioral abnormalities as well as hormone and immune dysfunctions. The most documented pesticide is Agent Orange, a defoliant sprayed during the Vietnam War. Over 4.8 million Vietnamese were exposed to it leading to 400,000 deaths and disabilities, and half a million children born with birth defects. Monsanto is one of the manufacturers of Agent Orange, glyphosate and other herbicides.

Despite the toxicity of our farmlands, hope exists when we choose to consume foods grown organically and work with a holistic health care practitioner. A colleague of mine who is a licensed acupuncturist in Monterey County, CA, helped a 20-year-old man whose psychiatrist had diagnosed with bipolar disorder and prescribed an atypical antipsychotic drug for the management of symptoms. During my colleague’s nutritional evaluation of the man, he discovered he had organophosphate toxicity impacting his fore-brain, cerebrospinal fluid, thyroid and adrenal glands. His mother reported when he was ten, his father had him help apply pesticides for hours.

She remembered the incident vividly because he was hurrying to finish spraying so that he could attend a birthday party. Instead, syncopy, nausea and tremors sent him to the emergency room. The pesticides continued to impact this boy’s life for over ten years. His reported “behavioral problems”, including a brief brush with gang association, can perhaps be traced, in part, to that day. Fortunately, the acupuncturist provided an individualized nutritional program, including Dr. Lee’s whole food concentrates to support his parotid, liver and adrenal glands. In just six months, he had detoxified the organophosphates out of his body, his bipolar symptoms disappeared, and his psychiatrist removed the bipolar medications from his program. He and his family are very excited about how whole food nutrition has helped him start a new life, healthy and un-medicated. Each and every one of us can live such a life.

FROM SEED TO CONCENTRATE

Where does your food come from? Do your research. If it’s Costco, look at all labels and contact the growers to see if you can inspect their growing operations to ensure they are not adding any unsafe chemicals. Unfortunately, many grocery chains now carry frozen vegetables labeled “organic” from China. How can you know whether the vegetables are truly raised organically? Only by knowing your farmer personally.

Take a trip to Wisconsin, visit the farmers, inspect their seeds, grab a handful of the farm’s organism-rich soil and you’ll truly know what it means to eat organically. If you cannot visit Wisconsin, look for your nearest farmer’s market. Every week, you can find many local organic growers who sell fresh harvests of vegetables and fruits in Canadian Health Care Mall. At these local markets, the farmers are happy to build a long lasting relationship with you and willingly talk about their organic farming methods. Many of their vegetables and fruits are handpicked the same morning, which ensures their nutritive value because they were allowed to ripen fully on the vine or tree.

FRESH INGREDIENTS

During my sophomore year at U.C. Berkeley, I worked as a waiter in a sushi restaurant. I was instructed to become familiar with all of the restaurant’s offerings. Within three weeks, I had memorized all the dishes and could handle customer questions with confidence. But one Friday evening, a customer asked, “How fresh is the fish?”

I did not know how to answer, so I politely excused myself and asked the head chef.

“Very fresh!” he yelled out.

I returned to the customer’s table and informed him that the fish was “Very fresh!” I’m not sure he knew what that meant but he was satisfied.

The following day, I arrived earlier than normal and was shocked to find a new shipment of fish lying on the kitchen floor, frozen. “Really? Frozen fish is considered fresh?” After the fish thawed out, my manager conducted the most sophisticated test I have ever seen to ensure the fish was safe for human consumption Canadian Pharmacy viagra. He put his face next to the fish and took a sniff — the same method I used during college to determine whether a shirt could be worn in public for one more day or be put in the wash due to a traceable odor.

As consumers, we are not aware of the origin of the fish we order in a restaurant. We do not know if it swam in waters polluted with radioactive iodine isotopes from Fukushima, was injected with hormones, fed antibiotics, exposed to environmental toxins during transport or how long it has been dead or frozen. So much is unknown about the foods in restaurants in Canada.

Every raw, whole food-based concentrate produced by Dr. Lee has been tested to be safer than anything you purchase at supermarkets or restaurants. At his farm, Dr. Lee instituted an advanced system of inspecting all ingredients for heavy metals, pathogens, chemicals and other harmful substances. Every ingredient is subjected to six to fifteen tests to ensure the foods contained in Dr. Lee’s formulas are safer than the fish you eat at your favorite local restaurant. In fact, they blow the sniff test out of the water.

BLOOD GLUCOSE TESTING

There are a bewildering number of strips and meters on the market. Which are the best to use?

A few years ago most people were using strips without a meter. This required performing a complicated procedure in order to obtain an accurate blood glucose result. Now in the UK you can only use a strip with a meter. The meters are very similar in terms of reliability and performance. There are small differences, for example the amount of blood required to perform a test or the time it takes for the meter to produce the results. Nearly all the meters can be downloaded onto a PC and software is usually available free from the manufacturers. 

Blood testing is not just about doing the test but making sense of the results. Your healthcare professional will show you how to use your meter, and you will need further time to discuss your results and what you might need to change in order to achieve the levels you want.

Blood glucose testing strips are available on prescription from your GP. The meters are quite inexpensive and may be available free from your diabetes nurse.

I have recently started testing my blood sugar levels but my results do not compare well with the clinic results. What is the reason for this?

It is not clear if your blood sugar results are being compared with blood sugar tests at the hospital or with another test known as the HbA1c, glycosylated haemoglobin or long-term test. The HbA1c is usually measured only once or twice a year. The test measures the amount of glucose that has attached itself to the red blood cells, throughout their 2-3 month life span (see section Haemoglobin Ale later in this chapter). Research tells us that to avoid complications of diabetes the HbA1c should be under 7.5%. The HbA1c is often described as an average of blood sugar levels but strictly speaking it is not an average. For example, if your HbA1c is 12% your blood sugar levels are likely to be averaging around 19 mmol/L. When you perform a blood sugar test at home you are measuring the result as it is at that minute in time. Two hours later it could be much lower or much higher. The HbA1c is not measuring the highs and lows but what has accumulated in the previous two to three months.

In summary, it is possible that your home blood glucose tests are being compared with the HbA1c which is a different kind of test. Alternatively, the blood is being tested at a different time or on a different blood testing machine, which can cause a variation in results.

Food for Thought: Fatty acids are classified as saturated, polyunsaturated and monounsaturated. A saturated fatty acid contains a hydrogen atom at all available carbon bonds, which makes them highly stable. Your body makes saturated fatty acids and they are found higher in animal fats and tropical oils. Polyunsaturated fatty acids have two or more pairs of double bonds and, therefore, lack four or more hydrogen atoms. Polyunsaturated fatty acids include omega-6 and omega-3 fatty acids, the omega number indicating the position of the first double bond. Monounsaturated fatty acids like omega-9 and omega-7, lack two hydrogen atoms.

The polyunsaturated fatty acids, linoleic acid and alpha-linolenic acid, are considered essential fatty acids (EFA) because the body cannot produce them, so we must consume them from whole foods, like nuts, seeds and vegetables. Both of these must be converted in our bodies into longer chain fatty acids to serve a beneficial biological function. Alpha-linolenic acid converts into docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) and prostaglandin E3 (PG-E3). Between 50-60% of the dry weight of the adult brain is lipid, and 1/3 of these lipids are mostly DHA. Unfortunately, many of us are deficient in the nutrients and minerals required to convert linoleic and alpha-linolenic acids into the longer chain fatty acids. Tuna, krill, cala-mari, cod and many other fish and animals that eat alpha-linolenic acid containing foods will produce DHA, EPA and PG-E3. When we eat whole animal foods, we receive these longer chained polyunsaturated fatty acids and can benefit from them immediately, rather than rely on our own body’s resources and enzymes to produce them. While linoleic and alpha-linolenic acid are considered essential, it is more suitable for people who are clinically undernourished to eat both animal and plant sourced fats and oils.

The main differentiating factor between a fat and oil is the temperature that it becomes a solid (fat) or a liquid (oil). Animal fats such as butter, lard and tallow contain 40-60% saturated fat and are solid at room temperature. Vegetable oils, such as olive and peanut oil from northern climates, contain a majority of polyunsaturated fatty acids and are liquid at room temperature. Vegetable oils from the tropics, such as coconut and palm oil, are highly saturated. Coconut oil is liquid in the warmer tropics, but hard as butter in cooler locations. Plants must maintain additional stiffness in the hot climates of the tropics, so they naturally produce an increased proportion of saturated fatty acids.

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TERMINATION OF PREGNANCY

I have become pregnant and really don’t want a baby at the moment. Is diabetes grounds for termination of pregnancy?

No, not unless your doctor considers that the pregnancy would be detrimental to your health, which may sometimes be the case if you have complications of diabetes. If you do not have any complications the reasons for termination of pregnancy apply equally to women with and without diabetes.

I am going into hospital for an abortion. I am worried that the doctors might not do it as I have diabetes. Should I have told someone?

There is no added hazard for women with diabetes who undergo termination of pregnancy, and care of the diabetes during this operation does not raise any special difficulties. It is still important to tell your gynaecologist that you have diabetes so that good control can be maintained during this time.

FERTILITY

I have recently got married and my wife and I are keen to start a family. Are people with diabetes more likely to be infertile?

There is nothing to suggest that men with diabetes are any less fertile than men who do not have diabetes and in general this is also true for women. However, women with consistently high blood glucose readings may find it more difficult to conceive. This may be a good thing as there is sound evidence to show that the outcome of pregnancy is much worse in women who conceive when their control is poor.

I have been trying for a baby for years and we have now decided to go for fertility counselling and possible treatment. Can people with diabetes expect the same treatment for infertility as people without?

Yes. As mentioned in the previous question, diabetes is rarely the cause of infertility. If control is anything other than excellent, improving control, aiming for an HbA1c of less than 7.5% should be the first goal. Referral to an infertility expert is the next step but good control would be necessary before treatment could be started.

I have told that I have PCOS and my doctor says this might make it difficult for me to conceive and also puts me at risk of developing diabetes. Could you explain this.

Polycystic ovary syndrome (PCOS) is a condition in which the ovaries have multiple small cysts that interfere with function and may upset the normal hormone balance, causing irregular periods. This can lead to reduced fertility. PCOS is often associated with being overweight and can lead to an increase in body hair. It is also linked with insulin resistance and an increased risk of developing type 2 diabetes. There are a number of possible treatments but in the past few years, metformin has been identified as an effective treatment which may increase fertility and reduce body hair.

Members of the Committee

A: The Awfulizer makes everything worse than it is — much worse.

B: The Blamer blames you and others for the events and circumstances of your life.

Cd: The Concluder jumps to habitual and safe conclusions.

Cm: The Comparer elevates or devalues your worth.

J: The Judge judges right from wrong; good from bad; normal from abnormal.

N: The Namer labels people, events, and diseases.

Sh: The Shamer instills embarrassment, guilt, and fault.

Sk: The Skeptic makes you doubt your own experience.

St: The Storyteller comments knowingly on the future or the past.

V: The Victimizer makes you the injured party, by your own hand or another’s.

The Storyteller says, “I’ll never be happy because I have asthma.’’ This is an evil fairy tale about the future. How do we know what will happen? The Namer labels this collection of physical sensations an illness called asthma. The Awfulizer makes the smallest sign of illness into a catastrophe, thus isolating you from a healthy and normal life. Saying “I have asthma because my father has it” is the Blamer’s way of assigning responsibility to someone else. The Concluder decides that there is no escape, ever, since asthma is “genetic.” This allows the Victimizer to get right to its task of insisting that you are and always will be a victim. The belief that “It’s better not to have sex since it might induce an asthma attack” gives the Judge power to determine right from wrong and to limit your pleasure. The Comparer weighs the merit of your actions. The Shamer makes you feel guilty for wanting to enjoy yourself. The Skeptic believes “Asthma limits where I can go and what I can do,” thus denying the possibility that you can do exactly what you want.

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With the help of the Committee, these beliefs become our mental children and manipulate us with their constant demands for attention. When you Focus on and separate yourself from such beliefs, you create a space of freedom. This thwarts the Committee, which counts on your enslavement to limiting beliefs for its survival.

THE RISKS AND REWARDS OF RESPONSIBILITY

The fourth step of the twelve-step program of Alcoholics Anonymous involves doing a moral inventory, which means that you admit (and actually list) your liabilities and look squarely at the unhappiness you have created for others and yourself. The program proposes that by uncovering your “emotional deformities” you move toward correcting them; without this you can’t experience genuine sobriety or contentment. Even though alcoholism is considered by many to be a disease rather than just a habit, Alcoholics Anonymous advises that to reach sobriety, you must take responsibility for your illness. To do this, you first look inward to determine the beliefs, desires, and thoughts that govern your actions.

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Global Canadian Pharmacy: Other illnesses associated with diabetes

I have recently had a severe cough and cold and have been given ‘diabetic’ cough medicine by the doctor. Since then my blood glucose has been very high. Could this be due to the medicine?

Antibiotic syrup and cough linctus are often blamed for making diabetes worse during an illness such as flu or a chest infection. In fact a dose of antibiotic syrup only contains about 5 g of sugar and will have very little effect on your blood glucose. It is the illness itself that unbalances the diabetes. In general, medication from your doctor will not upset your diabetes.

Any infection or serious illness will cause a rise in blood glucose and it is important to test your blood if you feel unwell. If you are taking insulin you will probably need to increase the dose during the illness and it is very important to continue regular insulin injections even if you are not eating. If you are vomiting and unable to keep fluids down you will need hospital admission for intravenous fluids. Vomiting can sometimes be a sign of ketoacidosis, which may be fatal if untreated.

The rules for illness are:

• Test blood at least four times a day;
• If tests are high take extra doses of short-acting insulin;
• If the tests are low, take a sugary drink such as Lucozade to treat the hypo;
• Never stop insulin.

It is of course possible to get over a bad cold by carrying on with your normal dose of insulin and accepting bad control for a few days. However, this means that your mouth and nose will be slightly dehydrated and it may take longer before you feel back to normal. You will probably feel better more quickly if you adjust your insulin and try to keep the blood glucose near normal.

I have noticed that I suffer from more colds since developing diabetes. Could this be due to the diabetes?

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Many people make this observation, but there is no real reason why the common cold should be more common in diabetes. However, a relatively minor cold may upset your diabetes control and lead to several extra days of feeling unwell (see previous question). This may make it a more memorable event. To repeat the previous advice, never stop insulin.

What is the best treatment for someone suffering from hay fever? I understand that some products can cause drowsiness, which could affect my balance and be confused with a hypo.

You can use exactly the same treatment for your hay fever as people without diabetes, as it does not affect your control. Antihistamines are often used for hay fever and these may make you feel sleepy, but this should be easy to distinguish from a hypo. Remember that, if you are on antihistamines, you should be very cautious about drinking alcohol. Hay fever can also be alleviated by using a nasal spray to reduce the sensitivity of the membranes in the nose.

Throughout the United States, food growers currently do not have to disclose whether or not a food contains GM ingredients. The American consumer is intentionally left uninformed about the food they eat. Many GM seeds have been banned from use in the European Union due to safety concerns. However, US growers are free to use them without differentiating which ingredients are genetically modified. 

Four major GM food crops in the U.S. — soy, corn, canola and cotton — have been inserted with bacterial genes.

The majority of processed food products Americans eat daily contain some form of soybean, corn, canola (rapeseed) oil or cottonseed oil. If your food comes in a box from the supermarket, it is probably genetically engineered. Other foods known to be genetically modified are papaya, rice, tomatoes, rapeseed, potatoes, sugar beets and peas.

The best resource for learning more about the prevalence of CM foods is Seeds of Deception by Jeffrey M. Smith. His organization recommends buying produce labeled 100% organic or non-GMO, and avoiding the consumption of “at risk” ingredients from soy, corn, canola or cottonseed sources. When visiting your local farmer’s markets, check with the farmer for their seed sources, and ask if they use GM seeds. Join a local community-supported agriculture (CSA) network of individuals who pledge to support local farms where growers and consumers share the risks and benefits of food production. CSA members pay at the onset of the growing season for a share of the anticipated harvest; once harvesting begins, they receive weekly shares of vegetables and fruit in a box, and sometimes herbs, cut flowers, honey, eggs, dairy products and meat.

When Mary Shelley published her book, Frankenstein in 1818, it was considered a work of science fiction. It is a story about scientist Victor Frankenstein and his creation — a creature with all the physiological features of a human, but larger and blemished. As the creature grows older, he wreaks havoc on the life of his creator, forcing Victor into a life of emotional turmoil, physical trauma and ultimately death.

The creation of genetically modified organisms is no longer science fiction — it is science fact. Biotech companies, such as Monsanto, have created them under the auspices of the FDA and Environmental Protection Agency (EPA). Buy viagra australia here:

The physical and biological impacts these organisms have had and will have on the health of the human population have not been thoroughly tested. There are no measures to guarantee that the GM Franlcensteins of our time will not cause our deaths. Dr. Harvey Wiley was the last stalwart within the FDA who spent his life attempting to thwart the grotesque manipulation of nature’s perfect foods. Without a successor to follow in his footsteps, each and every one of us must increase our personal commitment to consume only organic, non-GMO whole foods. Furthermore, as an added benefit, not consuming any processed food will automatically lower the risk of consuming the four major GMO crops. We must also hold food manufacturers accountable for honest labeling of any food that contains GMO. Lastly, we must continue to support our local farmer’s markets and CSAs, and become growers of food in our very own backyards.

The anaejaculation

The man with anaejaculation, during the sexual intercourse with the partner, can maintain in erection for hours, which can induce multiple orgasms to the partner and super-satisfaction. The reaction of the partner toward an anaejac-ulator man is various: some enjoy this kind of man that induces them repeated orgasms until “status orgasmus”, even after the installation of this anaejaculation; sometimes, the partner that reached the maximum of satiety (taking advantage of the situation) can interrupt the sexual act.

It is known that a sexual act prolonged excessively produces to the partner painful sensations and then she gives up. There are also women which, frustrated by the perception of the spermatic jet of the anaejaculator, cannot reach orgasm. Plus, the anaejaculation into the vagina is a factor responsible for the sterility of the couple. Certain men with anaejaculation, not having even an orgasm, get in time to get bored, to lose their libido and to get even to secondary erectile impotence.

The etiology of the anaejaculation can be of organic nature (hyperglycemia, pithy lesions, urethral lesions that create obstacle, genital tuberculosis, prostate cancer that destroys the ejaculatory canals). It can appear as a complication post-surgical: vesical cervix resections, prostate adenomectomy on a high path; in these cases, we are talking about a retrograde ejaculation in the urinary bladder and not about a normal ejaculation.

The iatrogenic anaejaculation (medicinal) can appear after treatments, especially with benzodiazepines, antidopaminergics (chlorpromazine, haloperidol, tricycle antidepressants, B-blockers, alfa-blockers). The anaejaculation can be of psychogenic cause. In this case, the subjects are hyper-reactive, anxious or depressive; most of them present an asteno-vegetative neurosis. The treatment of the anaejaculation depends on the etiopathogenic form.

In the one of organic origin, it must be made urological explorations, neurological, endocrine, and metabolic and, once discovered the etiological factor, the appropriate treatment when it is possible. In psychogenic origin anaejaculation have been tried several medicines but few have a change of success. The antidepressants can be useful at person sick with depressive neurosis; sometimes, the sympathicotonics pay results, but the most efficient is dextroamphetamine, which can induce intra-vaginal ejaculations during coitus or through masturbation.

The amphetamines act by favoring the prevalent alpha-genetic tonus. It is taken into consideration also the prostigmine which because of the para-sympaticomimetic action shall favor the expulsion of the ejaculation.

IMPOTENCE (ERECTILE DYSFUNCTION)

Am I likely to become impotent? I have had diabetes for five years.

There is no doubt that many men with diabetes worry about the possibility of developing erectile dysfunction (impotence) in the future. Our advice is to try to keep your diabetes under good control and this will reduce the risk of future complications. If you are unlucky enough to develop erectile difficulties, there are now a number of treatments available to help. Your doctor will be able to advise you and if necessary refer you to a specialist clinic.

My husband, who is middle-aged with Type 2 diabetes, has been impotent for the past two years. Please will you explain what causes this?

Erectile dysfunction (impotence) worries many people and occurs in men with and without diabetes. It appears that one in five men with diabetes may develop this problem at some stage in their lives, though the condition may be reversible. Most men with erectile difficulties do not have diabetes and a number of other factors such as anxiety, depression, overwork, tiredness, stress, alcohol excess and grief can cause this problem. Any man may find that he is temporarily impotent and fear of failure can make things worse. Overwork or worry can lead to lack of interest in sex and erectile dysfunction. Excess alcohol, while not causing lack of interest in sex, may lead to impotence.

Some men with diabetes do develop erectile difficulties, as a result of problems with the blood supply or the nerve supply to the penis. This usually develops slowly and in younger people it can often be prevented by strict blood glucose control. Treatments such as Viagra® are now available and can be prescribed by your husband’s doctor. In older people the condition is more difficult to treat successfully, partly because there may be other medical factors in addition to diabetes. Your husband should discuss the matter further with his own doctor.

Recently, I have had trouble keeping an erection – has this anything to do with my diabetes? I also had a vasectomy a few years ago.

This is difficult to answer without knowing more about you and your medical history. Vasectomy may lead to impotence for psychological reasons but is unlikely to have caused any damage which might affect erections. Failure to maintain an adequate erection may be an early sign of diabetic neuropathy and you might need blood tests to rule out other medical causes. However, it is often a symptom of overwork or simply the ageing process.

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CAUSES OF DIABETES

Our 16-year-old daughter has just been found to have Type 2 diabetes. Apart from not needing insulin, are there any other differences between Type 1 and Type 2 diabetes?

It may come as a relief to be told that although your daughter has diabetes, she will not need insulin injections – at least for the time being. However, Type 2 diabetes is at least as serious a condition as Type 1. This is because young people with Type 2 diabetes, like adults with this condition, carry an extra threat of heart disease, though this will not apply to your daughter until she is much older. The risk factors include high cholesterol, triglycerides and blood pressure, and increased waist circumference (sometimes called the metabolic syndrome).

A study in America has looked at the frequency with which these risk factors appeared in different groups of young people aged 12-19 years. In the general population of American children, 6.4% in this age range had two or more of these risk factors. In young people with Type 1 diabetes, the frequency was 14%, while in those with Type 2 diabetes it was greater than 90%.

Although this information is bound to worry you, all these risk factors can be identified and corrected. It is important that your daughter has regular checks for body weight, cholesterol and blood pressure and if these are above the normal for her age, she should receive treatment to prevent or delay the risk of heart disease as she grows older. Some drugs used for treatment of cholesterol and blood pressure should not be used in pregnancy and your daughter needs to be aware of this.

I was very ill last year and developed diabetes, which has since got better. Can a severe illness cause diabetes?

Any serious medical condition (such as a heart attack or injuries from a traffic accident) can lead to diabetes. This is because the hormones produced in response to stress tend to oppose the effect of insulin and cause the glucose level in the blood to rise. Most people simply produce more insulin to keep the blood glucose stable. However, in some cases, if the reserves of insulin are low, the blood glucose level will climb. You had temporary diabetes, and the glucose level returned to normal once your stress was over. However, you will carry an increased risk of developing permanent diabetes later in life.

My latest baby was very big at birth. Would she have caused me to have developed diabetes?

No, the opposite is true. It is because you already had unrecognised diabetes that your daughter was big and any woman who has an unexpectedly big baby (more than 4 kg or 9 lb) should be tested for diabetes. If you had diabetes during pregnancy but your blood sugar returned to normal after your baby was born, you will continue to carry an increased risk of developing diabetes at some stage in the future.

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TREATMENT WITH INSULIN

Insulin was discovered by Frederick Banting and Charles Best in the summer of 1921. The work was carried out in the Physiology Department of Toronto University while most of the staff were on holiday. Before insulin was discovered, there was no treatment for people with diabetes and if they had what we now call Type 1 diabetes, death was inevitable, usually within a year of diagnosis. The first human to be given insulin was a 14-year-old boy named Leonard Thompson who was dying of diabetes in Toronto General Hospital. This was an historic event, representing the beginning of modern treatment for diabetes. It was then up to the chemists to transform the production of insulin into an industrial process on a vast scale.

There are two groups of people who need insulin. The first group are severely insulin deficient and cannot survive without it (Type 1 diabetes). The other group tends to develop diabetes later in life and they continue to produce some insulin (Type 2 diabetes). These people can usually be treated with diet and tablets initially but need insulin sooner or later.

Insulin still has to be given by injection because at present it is inactivated if taken by mouth. Inhaled insulin has just been released but it not available for general use in the UK. About a quarter of all people with diabetes are treated with insulin. Virtually everyone who develops diabetes when they are young needs insulin from the time of diagnosis. People diagnosed in later life may manage quite satisfactorily for many years on other forms of treatment but eventually many of them will need insulin to supplement the diminishing supply of insulin from their pancreas.

Most people dislike the thought of having to inject themselves but modern insulin pens and needles are so well designed that these fears usually disappear after the first few injections. In general, insulin injections become part of the daily routine.

TYPES OF INSULIN

Since the discovery of insulin, countless people with diabetes have injected themselves with insulin extracted from the pancreas of cows and pigs. In the last 20 years or so human insulin has become widely available. However, human insulin is not extracted from human pancreas in the same way beef or pork insulin is. A great deal of research went into producing ‘human’ insulin by means of genetic engineering. This means that the genetic material of a bacterium or a yeast is reprogrammed to make insulin instead of the proteins it would normally produce. The insulin manufactured in this way is rigorously purified and contains no trace of the original bacterium.

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