Topic 44 Diabetes

Owing to the lag time between initiation and effect, capsaicin is not used for treatment of acute pain from injury. Instead, topical capsaicin is used for chronic pain from musculoskeletal and neuropathic disorders. Capsaicin preparations have been studied in the treatment of pain from diabetic neuropathy, osteoarthritis, rheumatoid arthritis, postherpetic neuralgia, and other disorders.48 It is often used as an adjuvant to systemic analgesics in these chronic pain conditions. 

Lectures and symposia are used to orally give information to a group of practitioners or patients. These methods can be used to address broad topics (e.g., the MCO s process for developing practice guidelines) or narrow topics (e.g., use of the MCO s practice guideline for insulin-dependent diabetics). An advantage of lectures, compared to written communication, is that two-way interaction can occur. Allowing people to ask questions and discuss issues can help clarify information and can facilitate their use of the information. 

The material is presented in 17 chapters, covering topics such as trends in ion selective electrodes, advances in electrochemical immunosensors, modem glucose biosensors for diabetes management, biosensors based on nanomaterials (e.g. nanotubes or nanocrystals), biosensors for nitric oxide and superoxide, or biosensors for pesticides. 

At present, numerous free radical studies related to many pathologies have been carried out. The amount of these studies is really enormous and many of them are too far from the scope of this book. The main topics of this chapter will be confined to the mechanism of free radical formation and oxidative processes under pathophysiological conditions. We will consider the possible role of free radicals in cardiovascular disorders, cancer, anemias, inflammation, diabetes mellitus, rheumatoid arthritis, and some other diseases. Furthermore, the possibilities of antioxidant and chelating therapies will be discussed. 

A 50- year-old male diabetic develops an external otitis from which Pseudomonas organisms are cultured. Topical therapy with polymyxin is effective. What is the mechanism of action of polymyxin ... 

See Chap. 77, Diabetes Mellitus, authored by Curtis L. Triplitt, Charles A. Reasner, and William L. Isley,for a more detailed discussion of this topic... 

The many studies conducted on this topic failed to clearly demonstrate the relationship between Lp(a) and diabetes (C13, D8, G31, H3, H4, J5). Moreover, many of these studies are biased by the small number of subjects included or by... 

Cell signalling and signal transduction are topics of great research interest, partly because defects of these processes are associated with diseases such as type 2 diabetes, cancer and obesity. In recognition of this is the fact that a number of Nobel Prizes for Medicine or Chemistry have been awarded to researchers of cell communication. This chapter describes the nature of the disparate signalling molecules and how they regulate the activity of their targets. 

Ovemutrition is difficult to define but is synonymous with excessive intake in the following discussions. Recent emphasis has been directed towards diets that contain excess energy in relation to expenditure, which result in obesity. This is a major problem in developed and increasingly in underdeveloped countries. There is particular concern about the marked increase in obesity in children, which can lead to major health problems in later life and will result in a massive increase in financial expenditure on health provision in the future some obese children are now developing type 2 diabetes as young as 12. The topics obesity and type 2 diabetes are discussed in Appendix 15.4. 

Phenylephrine is a nasal decongestant that mimics the sympathetic system, thereby increasing the heart rate and blood pressure. It may aggravate conditions such as diabetes, hypertension and glaucoma. Patients with hypertension, ischaemic heart disease, hyperthyroidism, diabetes and glaucoma are therefore given topical nasal sympathomimetics rather than systemic sympathomimetics. Both topical and systemic sympathomimetics are contraindicated in patients taking monoamine oxidase inhibitors, because concurrent administration of the two products may lead to a hypertensive crisis. 

Unlabeled Uses Systemic Treatment of acne vulgaris, chancroid, Campylobacter enteritis, gastroparesis, Lyme disease, diabetic gastroparesis Topical Treatment of minor bacterial skin infections... 

Topical sucralfate (4-10%) is also useful in management of decubitus ulcer, diabetic ulcers, chemical and thermal burns, radiation induced skin damage, vaginal ulceration, oral and genital ulceration. 

B. Indications and nse Regranex Gel is indicated for the topical treatment of deep diabetic foot and leg ulcers that have an adequate blood supply. Patients with diabetes who develop chronic ulcers of the foot and leg are at higher risk for local and systemic infections and amputation. 

Salicylism and death have occurred following topical application. In an adult, 1 g of a topically applied 6% salicylic acid preparation will raise the serum salicylate level not more than 0.5 mg/dL of plasma the threshold for toxicity is 30-50 mg/dL. Higher serum levels are possible in children, who are therefore at a greater risk for salicylism. In cases of severe intoxication, hemodialysis is the treatment of choice (see Chapter 58). It is advisable to limit both the total amount of salicylic acid applied and the frequency of application. Urticarial, anaphylactic, and erythema multiforme reactions may occur in patients who are allergic to salicylates. Topical use may be associated with local irritation, acute inflammation, and even ulceration with the use of high concentrations of salicylic acid. Particular care must be exercised when using the drug on the extremities of patients with diabetes or peripheral vascular disease. 

Ross, D.R. and Varipapa, R.J. Treatment of painful diabetic neuropathy with topical capsaicin, New Engl. J. Med. 1989, 321, 474-475. 

The Capsaicin Study Group Treatment of painful diabetic neuropathy with topical capsaicin a multicenter, double-blind, vehicle-controlled study, Arch. Intern. Med. 1991, 151, 2225-2229. 

Capsaicin (Capsin, Zostrix, Others) [OTC] [Topical Anesthetic/ Analgesic] Uses Pain d/t postherpetic neuralgia, chronic neuralgia, arthritis, diabetic neuropathy, postop pain, psoriasis, intractable pruritus Action Topical analgesic Dose Apply tid-qid Caution [C, ] Disp Creams, gel, lotions, roll-ons SE Local irritation, neurotox, cough Interactions May T cough W/ ACEIs EMS ... 

This pungent product is responsible for the intense irritant effects of topical Capsicum preparations. Repeated application of capsaicin can deplete and prevent reaccumulation of substance P, an endogenous mediator of pain impulses from the periphery to the CNS. Since the early 1990s, capsaicin cream has been available in the U.S. as an approved drug for relief of postherpetic neuralgia and pain due to diabetic neuropathy and osteoarthritis. 

Yucca is used for the treatment of arthritis, diabetes, and stomach disorders. The concentrated plant juice can been used topically to soothe painful joints (see Cupp, 2000). 

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