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DIABETES AND HYPNOSIS: C. DEVIN HASTINGS: NGH JOURNAL: SEPT 2004
Marketing Tools Plus More People You Can Market Your Services To:
the last article you were given lnformat1on on how to begin coaching a diabetic client to create change. Again, scripts are important but more important is the fact that hypnotic stress reduction can create wonderful benefits for the diabetic client.
Another type of diabetic client that stress reduct1on can greatly help is the woman
who gets gestational diabetes. This is a growing market that really needs the help of NGH trained hypnotists. And. as it is likely you will get many inquiries in this area and also because you are actually making a great difference in two lives at once, the following information is very useful for two reasons: (1) It is a great piece of marketing that you can copy and use and (2) It is more information that makes you more of an expert.
Remember. any information you supply to a client must have their physician's
approval before having any impact on their health care program as prescribed by their doctor. So, for this column please feel free to use the following handouts either when speaking one-on-one with a client or when sending information to a prospective client who-calls with questions. By the way, be sure to include on the information you supply your contact information! Until next time, remember these famous words: Cogito Ergo Spud---I think, therefore I am."
Gestational Diabetes Facts:
Gestational diabetes occurs when a woman exhibits
high blood sugars during pregnancy. This occurs in about 4% of all pregnancies and is usually discovered after 24 weeks of pregnancy. It can happen in women of all body shapes but it usually goes away after birth.
In the U. S., nearly 135,000 pregnant women get gestational diabetes every year.
This makes GD a top health concern as related to pregnancy.
The following are risk factors that increase chances for developing gestational
* A family history of diabetes or previous abnormal glucose levels
* Had previous birth of an over weight child (9 pounds or .63 stones) or a stillbirth
* Excessive stress
* Previous case of gestational diabetes
* Have too much amniotic fluid (polyhydramnios)
* Client is older than 25 * Carrying twins or triplets
* Member of certain ethnic groups: African descent, Latinos and low income. Other important facts about gestational diabetes:
* 40-609C of women with a history of gestational diabetes will develop Type 2 diabetes
later * About 2!3 of women who develop gestational diabetes will get it again.
* Often there are no noticeable symptoms!
Gestational diabetes is often treatable with a meal plan and
exercise. If blood sugars can't be kept in their target range by diet and exercise, insulin therapy may be required. This condition must be treated during the pregnancy to prevent problems for the mother and the baby.
What can gestational diabetes do to your baby?
* Cause your baby to store extra glucose as excess fat causing a high birth weight.
* Possibly cause your baby to be born with low glucose levels (hypoglycemic). During
pregnancy, your baby's body can produce too much insulin due to your high sugar levels.
If this happens, the baby may continue to have high insulin levels causing seizures
and possibly even a coma. * Create breathing problems, jaundice or premature delivery * In rare cases, cause still birth* Untreated gestational diabetes does put your baby at a higher risk of becoming obese and therefore developing Type 2 diabetes later in life.
With an NGH trained hypnotist working in accordance with your doctor's
suggestions, you can discover your inner abilities to successfully deal with gestational diabetes. thus minimizing yours and your baby's risks whilst increasing your health.
DIABETES DRUGS: Medications for Type 2 diabetes:
Please understand that
this information sheet is intended for you to become somewhat familiar with the medications for a Type 2 diabetic. It is not intended to convey al the information available.
Never give any advice concerning the alternation of a person’s drug regiment.
That must always be done by their physicians. Fell free to help a client learn more about their possible medications but make sure they understand you are not advising them in any way as to what medications they should take. Please be sure they understand that any alterations to their current health management program must always be approved by their physician.
Two approaches are used to medically treat Type 2 diabetes:
There are four main types of oral medications for the treatment of
Type 2 diabetes.
* Sulfonylureas: Important: Your client should know that they can only take a sulfa-
containing pill for their diabetes if their liver and kidney function are good.
* Sulfonylureas, known as oral hypoglycemic (glucose-lowering) agents. have been in
use for decades. They lower blood sugar by stimulating the pancreas to produce more
insulin. Sulfonylureas have been the main medication for Type 2 diabetes for many
years. Disadvantages of sulfonylureas are that they may cause blood sugar to go too low
hypoglycemia and that over time, their effectiveness tends to diminish. It has been said
that sulfonylureas may playa role in some types of heart problems. An older study that
made that connection was discounted until recently, when a better understanding of how
sulfonylureas work raised the question again. There is a possibility of a connection, but it
is not known for sure. The use of sulfonylureas also is often associated with modest
weight gain. However, any person who is just getting their diabetes under control may
experience a 50/c-l5% weight gain.
* Newer sulfonylureas include:
* Glimepiride (Amaryl). It is similar to other sulfonylureas, but may have fewer side
effects. Most importantly, it may be effective over a longer period of time and be safe for
people with impaired kidney function.
* Biguanides These medications enhance the ability of tissues to take up glucose and
reduce the amount of glucose released by the liver. An older biguanide, Phenformin, wa~
taken off the market in the 1970s because it caused lactic acidosis, a serious condition in
which sugar is incompletely metabolized.
* Metformin (Glucophage) is most often prescribed for obese people with diabetes because it is associated with less weight gain. It rarely leads to lactic acidosis.
Side effects may include stomach upset and diarrhea. There are precautions to be
followed when using this medication. It should not be used in patients with impairment of the kidneys, heart and liver. It should also be withheld when individuals are undergoing tests requiring intravenous dye. * Alphaglucosidase inhibitors These relatively new drugs work by blocking the digestion of starches, slowing down the rise of glucose in the blood after eating. Two drugs of this class are currently available: Acarbose (Precose) ( old) and Miglitol (Glycet) (new-2/99). The former has been reported as being a very safe and effective medication, but many people can't tolerate it because of gastrointestinal side effects that include bloating, gas. cramping and diarrhea. It must be started at very low doses that are gradually increased. * Miglitol (Glycet) acts in a similar fashion. Gastrointestinal side effects remain the most commonly encountered. The glucose lowering effects of both of these agents is modest. * Thiazolidinediones These drugs reduce resistance to insulin by increasing muscle and fat cell sensitivity to insulin. The first agent of this class to be released was troglitazone (Rezulin). Shortly after its release it was associated v.ith liver test abnormalities leading to several fatalities. It was recently removed from the market. Two drugs from this class remain available. Persons using medications to treat heart failure are to be very careful using thiazolidinediones! * Rosiglitazone (Avandia) and Pioglitazone (Actos) both lower insulin resistance. They are not associated with high frequency of liver injury. Regardless, careful monitoring of liver tests at the onset of therapy is advised. * Meglitinides Repaglinide (Prandin) ( 4/98) stimulates insulin secretion but is not the same as sulfonylureas. Its effects tend to diminish quickly. Also, it is quicker and used as a phase one insulin mimic.
It lowers postprandial blood sugar levels and lowers fasting levels.
* Nateglinide (Starlix) is "improved" version of Prandin.Drug combinations In view of the growing number of oral medications now available in the treatment of Type 2 diabetes mellitus, there are a larger number of potential combinations.
The goal of combination therapy is to maximize glucose lowering effects by using
drugs that lower blood sugar by different mechanisms. As a result, it would rarely be advised to combine tv.-o medications from the same class. The combinations that have been studied and found effective in providing additional blood sugar lowering than when used individually are: * Sulfonylureas with metformin and acarbose. * Metforrnin and repaglinide (Prandin) or rosiglitazone (Avandia).
Although there are more medications available, good blood sugar control is the
most important factor in avoiding medical complications of diabetes. For that reason, if several medications are not effective, insulin therapy should be considered. Insulin and oral medications have been combined to help Type 2 diabetics but thi.5 must be done with extreme care.
Important information for the person newly diagnosed with diabetes; When first
diagnosed with diabetes, some people have extremely high blood sugar levels. This can result in glucotoxicity. This effect is caused by a buildup of glucose in the body causing
an impairment of the insulin producing beta cells. This produces a slowing of the release of insulin into the bloodstream. What this means is that a Type 2 diabetic may initially need high levels of medications to lower their sugar levels. Once these levels are more normal, the body v.'ill be more in balance and less medication will be required.
Ó The Author 2008. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: email@example.com. doi:10.1093/fampra/cmn057Family Practice Advance Access published on 3 October 2008Patients’ view on screening for depression in generalpracticeK A Wittkampfa,b, M van Zwietenb, F Th Smitsb, A H Schenea, JHuysera and H C van WeertbWittkampf
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