DM is characterized by hyperglycaemi due to absolute or relative insulin deficiency.there are two subtype.
a)type 1 -severe insulin deficiency due to autoimmune destruction of the pancreatic islets
b).type 2:commonly affectes people who are obese and insulin -resistant,although impaired beta cell function of pancrease.
The differece between type 1 and type 2 are:
Type 1:'
Usually age of onset is les than 20,body weight normal or low,plasma insuline low or absent,plasma glucagon high ,can be suppressed ,plasma insulin increase,insulin sensitivity is normal,ketonuria is present,no family history of diabetes and death is rapid without insulin therapy.For type 1 DM ,oral drugs cannot be used.Only insulin injection can be given.
Type 2:
Age of onset usuualy 40 above,obese,plasma glucagon high and resistant to supprression,plasma insulin mormal or high,plasma glucose high,ketonuria is absent ,family has a history of DM .for this type weight loss and oral hypoglycemic agent is sufficient.
Lab investigation that can be done are:
-Urine test for glucose and ketones
-blood glucose level:fasting -3.6 to.6.1 if more than 7.8 is DM
:Random plasma glucose -7 to 11,more than 11 is DM
Ater meal-should be less than within 11.1 if more thanh 13,its DM.
Clinical features of Diabetes are:
-frequent urination(polyuria)
-excessive hunger and thrist
-rapid weight loss
-weakness or fatigue
-tachycardia(heart rate more than 100)
-dehydration
-hypotension
-hypoithermia(feeling cold)
-confusion
-drowsiness
-hyperventilation(sweating )
-muscle wasting
Complication of diabetes:
Impaired vision
Renal failure
Sensory loss
Postural hypotension
Foot ulceration
Sometimes itching of the genetalia(pruritus vulvae in women or balanitis in men can occur due to candida yeast infection(trush).This occur due to high sweetness of urine which favour fungal infection.
Sometimes the breath may have sweet smell of ketones.skin infection with boils and abscess are common
Acanthosis nigricans(soft velvety ,brown skin) is a sign of hyperinsulinism and frequently seen in axillae(armpit) and groins of patients with insulin -resistant type 2 diabetes.
Look for xanthomata (a soft nodules like_) which indicates hyperlipidaemia.
Examine insulin injection site for evidence of lipohyperttophy(which may cause unpredictable insulin release).
Treatment for Diabetes:
Type 1 and gestation DM (which occur during pregnancy can only be treated with insulin injection.insulin is toxic to baby.so it should not be given to pregnant mother.
Type 2:
-glibenclamide
-glipizide
-glimepiride
-tolbutamide
-chloropropamide (those drugs is not suitable for obese people cause it can increase weight and cholestrol level.
Incase of obese people-metformin
For person have increase glucose level after meal-repaglinide and nateglinide can be use.
Others
-pioglitazone
-rosiglitazone
-acarbose
-miglitol
-sitagliptin
-vildagliptin can be given.
Normal walking can also stimulate insulin secretion,so people with diabetes can go for a walk after meal .
Legend of Our World
Legend of Our World:Powerful People On Earth
Those are actually most powerful people on earth that change the world with their great knowledge and mind.The are some achievements that so notable, so ground-shaking, that even within the short space of a few decades we can feel their impact. Few examples of this revolutionary people are :
Jesus Christ (c.5BC - 30AD) Spiritual Teacher, central figure of Christianity.
Thomas Jefferson (1743- 1826) 3rd President of US. Principle author of Declaration of Independence
Mikhail Gorbachev (1931 - ) Leader of Soviet Union. Oversaw transition from Communism in Eastern Europe.
Muhammad - (570 – 632) Prophet of Islam
St Paul (5 - AD 67) - Christian missionary
George Washington (1732 – 1799) - 1st President of US
Sri Krishna (c. BC) - Spiritual Teacher of Hinduism
Emperor Constantine (272 – 337) First Roman Emperor to embrace Christianity
Martin Luther (1483 – 1546) - Key figure in Protestant Reformation.
Socrates (469 BC–399 BC) - Greek philosopher
Karl Marx (1818 – 1883) - German philosopher, founder of Marxism
Charles de Gaulle (1890- 1970) French politician.
Martin Luther King (1929 - 1968) Non-violent civil rights leader
Nelson Mandela (1918 - ) Anti-apartheid leader. First President of democratic South Africa in 1994.
Lord Buddha (c 563 - 483BC) Spiritual Teacher and founder of Buddhism.
Winston Churchill (1874 - 1965) Prime Minister of Great Britain during Second World War.
William Shakespeare (1564- 1616) English poet and playwright.
Adolf Hitler (1889 - 1945) Dictator of Nazi Germany.
Abraham Lincoln (1809 – 1865) President of US during civil war, helped end slavery.
Franklin D. Roosevelt (1882 - 1945) US President 1932-1945
Charles Darwin (1809 – 1882) - Developed theory of evolution
Sir Isaac Newton (1642-1727) - English mathematician and scientist.
Akbar (1542 – 1605) - Moghul Emperor
Queen Victoria (1819 – 1901) - Queen of Great Britain during Victorian age.
Konrad Adenauer (1876-1967) - German Chancellor post WWII.
Jawaharlal Nehru (1889-1964) - First Indian Prime Minister
Ramses II (1279 - 1213 BC) - Powerful Egyptian king.
Benjamin Franklin (1706 - 1790) - US writer and polymath
Confucius (551 – 479 BC) - Chinese philosopher.
Alexander the Great (356 – 323 BC) - King of Macedonia.
Woodrow Wilson (1856 – 1924) - President of US during WWI
William Wilberforce (1759 – 1833) - Campaigner against slavery
Christopher Columbus (1451 – 1506) - Explorer
Marcus Aurelius (121 – 180) - Roman Emperor and philosopher
Galileo Galilei (1564 -1642) - Astronomer and physicist
Mahatma Gandhi (1869 - 1948) - Indian nationalist and politician
Joan of Arc - (1412-1431) - French saint
Charlemagne (742 - 814) - King of Franks and Emperor of the Romans
Aristotle (384 BC – 322 BC) - Greek philosopher
Mother Teresa - (1910-1997) - Nun who served the poor
Saladin (1138 – 1193) - Leader of Arabs during Crusades.
Babur (1483 - 1531) - Founder of Moghul Empire
Sir Walter Raleigh (1552 – 1618) - English explorer.
Voltaire (1694 – 1778 - French philosopher.
Samuel Johnson (1709 - 1784) - British author and creator of dictionary.
Catherine the Great (1729 – 1796) - Russian Queen
Mozart (1756 – 1791) - Austrian Music composer.
Princess Diana (1961 – 1997) - Humanitarian
Oscar Wilde (1854 – 1900) - Irish writer.
Napoleon Bonaparte (1769 – 1821) - French military and political leader
Beethoven (1770 1827) - German composer
Benjamin Disraeli (1804 – 1881) - British Prime Minister.
Leonardo da Vinci ( 1452 – , 1519) - Italian scientist, artist, polymath.
Louis Pasteur (1822 - 1895) - French chemish and Biologist.
Leo Tolstoy (1828 – 1910) - Russian writer and philosopher
Albert Einstein (1879 – 1955) - German physicist.
Ataturk (1881-1938) - founder of the Turkish Republic.
Pablo Picasso (1881-1973) - Spanish painter and sculptor
Pope John Paul II (1920 - 2005) - Polish Pope from 1978-2005
Margaret Thatcher (1925 - ) - British Prime Minister
Mohammed Ali (1942- ) American boxer
Aung San Suu Kyi (1945 - ) Burmese opposition leader
John F. Kennedy (1917 – 1963) - US President.
Lord Nelson (1758 – 1805) - Admiral in British navy
Rosalind Franklin-discovery of the structure of DNA
Boris Yeltsin (1931 – 2007) - Russian President
Lyndon Johnson (1908 – 1973) - US President 1963-69
Indira Gandhi (1917 – 1984) - Third Prime Minister of India.
Eva Peron (1919 – 1952) - First Lady of Argentina
William Tyndale (1494 – 1536) - Translated Bible into English
Tim Berners Lee (1955 - ) Credited with founding World Wide Web
Rosa Parks (1913-2005) - Civil Rights activist
Benazir Bhutto (1953 – 2007) - Prime Minister of Pakistan
Schubert (1797 – 1828) - Austrian Composer
Tim Berners Lee (1955 ) - Creator of World Wide Web
Kofi Annan (1938 - ) United Nations Secretary General
14th Dalai Lama (1938 - ) Spritual and political leader of Tibetans
Barack Obama (1961 - ) 44th President of United States
Albert Schweitzer (1875 – 1965) - Humanitarian, philosopher.
Malcolm X (1925 – 1965) Black nationalist leader
Lech Walesa (1943 - ) Leader of Polish solidarity movement.
John M Keynes (1883 – 1946) Influential economist.
Mary Wollstonecraft (1759-1797) - Feminist, author
Marie Curie (1867 – 1934) - Chemist and Physicist
Elvis Presley (1935 – 1977) - Rock star.
Oliver Cromwell (1599 – 1658) - British Parliamentarian
Oprah Winfrey (1954 - ) US media celebrity.
Boudicca ( - 60AD) - British leader against Roman rule
Swami Vivekananda (1863 - 1902) Hindu monk and Indian nationalist
Jesse Owens (1913-1980) US Sprinter
Bill Gates (1955 - ) Founder of Microsoft
Ernest Hemingway ( 1899 – 1961) US writer
John Lennon (1940 – 1980) British popstar and Beatle
Henry Ford (1864-1947) US Industrialist
Genghis Kahn - Leader of Mongol Empire stretching from China to Europe.
Haile Selassie - Ethiopian Leader
George Orwell (1903 – 1950) - English author
Thomas Edison (1847 – 1931) - Inventor and businessman.
Dwight Eisenhower (1890 – 1969) - Supreme Allied Commander.
Queen Elizabeth II (193- British Queen
Plato (424 – 348 BC) - philosopher.
Osama bin Ladens -terrorism (bad example actually)
Mahathir Mohamad-ex malaysian prime minister who change country
Paul Lauterbur and Peter Mansfield- invention, magnetic resonance imaging
Susan B Anthony - Human Rights (Women's Suffrage), Democracy.
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Several years ago I was at a Jim Ryerson salesOctane sales training session as part of anEntrepreneurs' Organization workshop. After covering a good bit of material we were in a section of the program on sales questions and prospect conversations. There, I learned one of the best sales questions ever that still sticks with me today:
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