VITAMINS AND MINERALS: VITAMIN B1 (THIAMINE) & VITAMIN B2 (RIBOFLAVIN)Vitamin B, (Thiamine)Functions:   Normal growth; digestion; healthy nerves;Sources:Causes of Deficiency:Deficiency Signs and Symptoms: healthy heartWidely available in the diet; wholegrains, meat, fish, pulses, nuts, eggs, most vegetablesPoor diet (too much pure carbohydrate such as alcohol), dirty colon, colon disorders such as the Irritable Bowel SyndromeFatigue, loss of appetite, nervous tension (build up of lactic acid in the brain) phobias, confusion, constipation, pins and needles, sensitivity to noise, impairment of sense of touch, retention of fluid. Severe deficiency: beriberi – disorder affecting muscles and brain; tingling or burning in legs, tender calf muscles, double vision, nystagmus (involuntary movements of eyeballs), paralysis of muscles around eyes.Vitamin B2 (Riboflavin)Functions:   Helps the body use carbohydrates and protein; helps in alcohol and yeast sensitivitySources:   Wholegrains, pulses, liver, milk, eggs, leafy greens, brewer’s yeastCauses of   Dirty colon, colon disorders, major tranquillizers, Deficiency:   probably minor tranquillizers and sleeping pills (valium group), tricyclic antidepressants, alcoholism, slimming. Not a huge amount available in the diet, and so is quite a common deficiency (the most common one in the United States). Recovery from deficiency is slow.Deficiency Signs   Dizziness, shaking, pre-menstrual tension (PMT), and Symptoms:   sore eyes, gritty eyes, twitching of eyelids. Severe deficiency: corneal damage, cataract, anaemia, weak muscles.*137\326\8*

A representative cohort of 14,374 adults (aged 25-74) was identified in NHANES I in 1971-1975 and followed for 22 years. Death certificates were examined to determine cause of death in diabetic and nondiabetic subjects. Diabetes accounted for 5.1 % of the cohort but 10.6% of the deaths. Age-adjusted mortality rates were 57% higher in diabetic men than in women and 27% higher in African Americans than Caucasians with diabetes. Mortality was highest for insulin-treated patients and those with diabetes for 15 years or longer. Heart disease was listed most frequently—on 69.5% of the death certificates for people with diabetes. The excessive mortality, however, was not completely explained by differences in risk factors for heart disease. A twofold excessive risk can be attributed to other factors operative in the diabetic state. Similar findings were reported by Stamler in a 12-year analysis of diabetic men in the Multiple Risk Factor Intervention Trial (MRFIT).
Thus, despite underreporting of diabetes as a contributing factor on death certificates, mortality rates are substantially higher in people with diabetes compared with nondiabetics. Rates are higher in men than in women and in African Americans than in Caucasians. Life expectancy is markedly diminished. The majority of deaths are related to heart disease, suggesting that increased attention to management of cardiovascular risk factors can decrease the mortality rate and increase life expectancy for people with diabetes. These predictions are now strongly supported by prospective randomized trials directed at management of a variety of cardiovascular risk markers, including hypertension, dys-lipidemia, albuminuria, nephropathy, and the prothrombotic tendency that often occurs in diabetes.
*13\357\8*

LIVING WITH EPILEPSY/SCHOOL: LEARNING AND BEHAVIOR –JOSHUA’S PSYCHOLOGICAL AND SOCIAL PROBLEMS”This was the third time this fail that the teacher has called us in for a meeting. She says that Joshua is disruptive to the class. He bites, fights, and won’t sit still. His reading is terrible, and I’m afraid that he is going to be expelled. What should we do? Can they expel someone from the second grade? I think that the real problem is that the teacher is afraid that he’ll have a seizure in class and really just wants him out.”We would begin to analyze this problem by asking the parents to tell us more about Joshua. What sort of a child is he? Is he having these types of behavior problems at home? Are they new? When did they first start? Was he having similar problems in the first grade last year? Was there anything particular which might have caused them? What was the relationship of the onset of these problems to the onset of his seizures and to the initiation of his anticonvulsant medication?Behavioral problems such as biting, fighting, and other disruptive behavior can come from many different sources. Any of the anticonvulsant medications can cause behavioral changes such as this. If the change began shortly after the start of a new anticonvulsant, then perhaps a different medication should be tried. However, behavioral changes rarely occur weeks or months after the child has been on the same medicine, unless there has been a change in the dose. New behavior problems can be caused by psychological disturbances initiated by problems at home or in school; they could be caused by the teacher’s behavior towards the child and the child’s reaction to his teacher’s behavior. Does Joshua know about his seizures? Is he afraid or embarrassed by them? Perhaps a careful explanation of the seizures would alleviate some of his fears, and this might allow him to be less aggressive in school.Discussing the problems and concerns with the teacher (or the principal) and with your physician can help you to sort through these different causes. Whatever the cause, the recent change in Josh’s behavior certainly is reason for concern and investigation. It is a common symptom of problems that require solutions. It could be Joshua’s psychological way of asking for help.*248\208\8*

Diabetes was described more than 2000 years ago in Egypt and in an ancient Indian Ayurveda by Indian physician Sushruta. For the past 200 years, it has featured in the history of modern medicine. After the dicovery of Insulin, work on diabetes at both cellular and clinical levels has expanded. Newer insulins, modern insulin delivery systems and home blood glucose monitoring systems have revolutionised the management of diabetic patients.
This chapter provides an overview of the chronologically important land marks in Diabetes.
HISTORICAL LANDMARKS IN DIABETES:
1500 B.C. : Egyptian Ebers Papyrus first described an illness associated with the passage of excess urine, found in tomb at Thebes.
500 B.C. : Diabetes was described in the Indian Ayurvedic literature as ‘Madhumeha’ or honey urine or sweet urine. For diagnosis testing of urine was the standard method up to 19th century.
2nd Century A.D.: ARETAEUS of Cappadocia gave the name Diabetes (‘a passer through’).
3rd Century A.D.: Scholars from China and Japan wrote about a condition associated with polyuria where the urine was sweet and sticky.
1647 : THOMAS WILLIS rediscovers the sweetness of urine and the name Mellitus (honey) was established.
1776 : MATHEW DOBSON of Manchester demonstrated that sweetness in urine was due to sugar.
1869 : PAUL LANGERHANS, a German scientist described islets of cells scattered throughout the pancreas. We know now these islands or islets consist of the insulin producing cells. At the end of his description Paul Langerhans wrote, “I admit frankly that I am not able to explain the nature and function of these cells”.
*1\329\8*

COPING WITH THE UNCERTAINTIES OF SEIZURES AND EPILEPSY: COPING WITH LABELS – HOW SHOULD I TREAT MY CHILD WHO HAS BOTH RETARDATION AND EPILEPSY?The answer depends on the child’s level of retardation. The natural tendency of most parents and grandparents is to overprotect a child with epilepsy. However, overprotection, particularly of a mentally retarded child, leads to infantilization, ultimately a greater handicap to a child than the seizures themselves. It is crucial for such a child to be as independent as possible. The retarded child needs every opportunity to achieve his optimal potential.When your child has multiple problems, such as mental retardation and epilepsy, the family has a lot of compensating to do. With epilepsy alone, you can usually maintain your expectations for his future— assuming, of course, they were realistic to begin with—since most epilepsy can be controlled or outgrown. Even when epilepsy occurs in children with retardation, your expectations for your child should rarely be changed.Helping your child to cope with mental retardation depends greatly on the degree of retardation. The severely retarded child may not be clearly aware of his disability. Today many moderately retarded individuals function in noncompetitive employment, are able to live in the community with assistance, and engage in a variety of social activities. The process of developing these capabilities begins in childhood with mainstreaming in schools and socialization through churches, scouting, and athletics. Developing these capabilities begins within the family as well—seeing a child’s potential, encouraging him to learn to participate, helping him to achieve his full worth.*197\208\8*

In healthy people, the pancreas, a powerful enzyme-producing organ, produces the hormone insulin in sufficient quantities to allow the body to use or store glucose (blood sugar). When this organ fails to produce enough insulin to regulate sugar metabolism or when the body fails to use insulin effectively, a disease known as diabetes mellitus occurs. Diabetics exhibit hyperglycemia, or elevated blood sugar levels, and high glucose levels in their urine. Other symptoms include excessive thirst, frequent urination, hunger, tendency to tire easily, wounds that heal slowly, numbness or tingling in the extremities, changes in vision, skin eruptions, and, in women, a tendency toward vaginal yeast infections. Each year an average of 650,000 new cases are identified, with rapidly rising incidence rates in recent decades. Diabetes mellitus is among the leading causes of death in America and is a major contributor to cardiovascular disease (CVD), blindness, and renal failure. A recent CDC study indicated an alarming increase in diabetes cases, with an overall increase in prevalence in diagnosed cases of 4.9 percent in 1990 to 6.5 percent in 1998. Of grave concern was the fact that for people in their 40s, diabetes cases increased by 40 percent during the eight-year study. However, diabetes cases increased by over 70 percent for those in their 30s.
Of the estimated 16 million people with diabetes in the United States today, nearly 6 million are unaware that they have a problem. Many remain ignorant of their condition until they begin to show overt symptoms. How does a person become diabetic? The more serious form, known as type I (insulin-dependent) diabetes, is an autoimmune disease in which the immune system destroys the insulin-making beta cells, and it usually begins early in life. Type I diabetics typically must depend on insulin injections or oral medications for the rest of their lives because insulin is not present in their bodies. Adult-onset (non-insulin-dependent), or type II diabetes, in which insulin production is deficient or the body resists or is unable to utilize available insulin, tends to develop in later life. People with this form of diabetes can often control the symptoms of their disease with minimal medical intervention by maintaining a regimen of proper diet, weight control and exercise. They may be able to avoid oral medications or insulin indefinitely. A third type of diabetes, called gestational diabetes, can develop in a woman during pregnancy. The condition usually disappears after childbirth, but it does leave the woman at greater risk of developing type II diabetes at some point.
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