during therapy. Family history
of diabetes is often present. Urine sugar has to be tested
especially with simultaneous blood sugar estimation after
full meal with two sweets and two bananas, asking the patient
to void urine after one hour. If blood sugar is more than
140 mg diabetes mellitus can be diagnosed.
Geriatric patients can be easily controlled
with oral hypoglycaemic agents without insulin. These patients
are advised to reduce their weight; with diet restriction
and weight reduction, good control can be achieved in many
patients. A diabetic is asked to avoid tubers, sugar, sweets,
ghee, butter, vanaspathy, coconut oil, fruits (Except tomatoes
and apples), Horlicks, 'Viva' and yellow of the eggs. They
are allowed rice, wheat, ragi, otta preparations, mutton,
chicken, fish etc. in limited quantities. Green vegetables.
garlick and onion can be taken in plenty.
For patients requiring drug treatment, oral
anti-diabetic agents may be added. Initially, Tolbutamide
(Rastinon) 0.5 mg 1 bid or tabl. Glybicide (Glynase) 1 bid
to 3 bid or tab. Glybandamide (Dionil) 1 bid to 3 bid or Tab.
Chloropropamide (Diabenase) 100 to 250 mg. od can be used.
If not controlled T. Penformin (DBI) 25 mg. liquid or long
acting phenformin (DBI- TD) 50 mg. 1 bid can be added. If
diabetes is not controlled, insulin therapy has to be started.
To begin, 5 units of plain insulin may be given subscuteneously
after each principal meal, increasing suitably every 3rd or
5th day testing the urine sugar. Once good control is achieved,
lente insulin can be substituted. In old people, renal threshold
for sugar is raised. Hence periodic blood sugar estimation
is essential, till stabilization is attained.
THE ABOVE LECTURE TOOK ONE HOUR. THREE CASES
OF DIABETES ONE EACH COMPLICATED WITH CATARACT, NEURITIS AND
TROPHIC ULCER WAS DEMONSTRATED.
The skin disorders in the elderly can be
broadly classified into (i) skin changes in the elderly due
to ageing (ii) physiological changes (iii) disorders peculiar
to senility (iv) common skin diseases as in other age groups.
(i) Skin changes in the
The common changes that occur are (a) dryness
of skin (b) Sparse, grey hairs (c) yellowness and thinness
(d) diminished sweating and (e) diminished sebaceous gland
(ii) The physiological
(a) Grey hair appear due to decreased MSH
activity, decreased melanocytes and due to diminished
in the remaining cells (b) Baldness with frontoparietal receding
inherited from male members of the maternal side. (c) Seborrhoeic
warts: These are asymptomatic brownish black in colour, ranging
from few mms to several cms in size occurring in any area
of the body. (d) Idiopathic guttate hypomelanosis: Hypopigmented
multiple, white spots, less than few mm in size occurring