Thursday, October 12, 2006
Diabetes and its complications are serious
By Dr. Anthony Policastro

I was looking through my archives of articles. I found that it has been about eight years since I last wrote about diabetes. It is a common problem. It is a serious problem. For those two reasons, it is important to think about it from time to time. Insulin is a hormone that controls blood sugar levels. It lowers blood sugar after a meal. Diabetes is caused by a lack of insulin. Type 1 Diabetes is found most commonly in younger individuals. There appears to be some relationship to immunity. There also appears to be a genetic component. It runs in some families. These individuals have very little insulin. Therefore treatment always involves the use of insulin. Type 2 Diabetes is found in mostly older individuals. It is usually associated with overweight. As more young people become overweight, it is seen more often in younger people. There is also a genetic component to this type. These individuals have some insulin. They can be treated with weight loss. They can improve with diet. They can also take medication to help their insulin out. Once a person has been diagnosed as being diabetic, he/she has the biggest challenge. Physicians can guide the treatment. However, the individual becomes the one responsible for preventing the complications. Even though diabetes only affects 3.5 percent of the population (1 out of 30), it accounts for 15 percent of the health care dollar. This is because of the many complications. For example, the average annual cost of health care for the non-diabetic patient is $1,082. The average annual cost of health care for a diabetic is $4,415. At one time we thought a diabetic could avoid complications if they had reasonable levels of elevated blood sugar. Now we realize that is not true. The closer the blood sugar is kept to normal, the less likely the individual is to have complications. That means careful monitoring of blood sugar is essential. It means treatment of high levels of blood sugar is important. It means that proper diet is a must. That means that weight loss is a necessity. It means that the use of medication or insulin must be done as prescribed. There are three areas where the improvement in complications has been measured when the blood sugar is well controlled. The first of these is eye disease. Diabetics can suffer damage to the eye. Good control decreases the damage. Annual visits to the eye doctor can detect it earlier. Surgery and blindness are the consequences of not doing so. Good control reduces eye complications by 76 percent. The second area is nerve and small blood vessel damage in the skin. This can cause skin ulcers and gangrene of the toes and feet. The treatment for foot ulcers is long and complicated. The treatment for gangrene is amputation. Good control reduces these complications by 60 percent. The third major area is kidney problems. Diabetes affects the kidneys as well. Many diabetic patients eventually require renal dialysis three times a week. Good control reduces these complications by 56 percent. Diabetics also have a higher incidence of heart disease and stroke. This is due to the effects on the blood vessels in the heart and brain. The evidence supports the likelihood that poor diabetic control will result in significant complications at the 10-15-year point after the diagnosis. The result of all of these problems can be poor quality of life and early death. There is evidence that maintaining a normal weight can reduce the incidence of the adult type of diabetes. This should be a goal for all of us for multiple reasons. There is also evidence that the individual who develops diabetes can make their future medical status better by careful attention to treatment requirements. If you or someone in your family has diabetes, this is important to remember. It is better to prevent complications than to deal with them later.

Dr. Anthony Policastro is medical director at Nanticoke Memorial Hospital.

Nanticoke announces new Wound Care & Hyperbaric Center
Nanticoke Memorial Hospital has announced the opening of a new advanced Wound Care and Hyperbaric Center. The center specializes in the healing of chronic non-healing wounds. This is a growing problem for many patients, especially for those who suffer from diabetes. People with diabetes are prone to wounds that do not heal, particularly on their feet. In the U.S. alone, about 15 million people have been diagnosed with diabetes, and 15 percent of them, or more than 2.3 million will develop at least one foot ulcer, according to the American Diabetes Association. In addition to diabetic foot ulcers, the wound center treats wounds including frostbite, non-healing sores, carbon monoxide poisoning, and crush injuries. The center offers two hyperbaric chambers to assist with oxygen saturation and advanced healing. These clear tubes allow patients to lie comfortably inside and watch television while being pressurized and breathing pure oxygen (normally you breathe about 21 percent oxygen in the air). This is especially helpful for patients with circulatory issues. Nanticoke Memorial Hospital's new center is a joint venture with Medical Multiplex, Inc. based out of Louisville, Ky.. The company runs wound care programs in 12 states. The combination of advanced wound care techniques and adjunctive therapies with resources from all over the country give patients optimal care and positive outcome rates of over 90 percent of those who complete the recommended care plan. The center specializes in advanced wound healing technologies that include bioengineered skin grafts and silver-based medications which inhibit bacteria and allow the body tissues to regenerate. Nanticoke Health Services' Chief Executive Office, Daniel Werner states "We are proud to be the first in the state of Delaware to offer an Advanced Wound Care Center that provides hyperbaric oxygen therapy. This technology, combined with the specialized skills of our Wound Care Center team, brings a new spectrum of treatment options to our patients. "We believe that this collaborative relationship with Medical Multiplex, a nationally recognized expert in wound and hyperbaric services, will provide the highest quality of specialty services to address the healthcare needs of our community and surrounding areas."

Nanticoke announces Leadership honorees
Nanticoke Health Services recently announced the recipients of the 2nd Annual Nanticoke Tributes for Healthcare Leadership. The awards will be presented at a dinner and reception on Nov. 2 at the Baywood Greens. The Founders Award will be presented to Karl Brown, Sr. for his role in the establishment of Nanticoke Memorial Hospital in 1952. This award will be presented posthumously to his family. The Charles C. Allen, Jr. Philanthropy Award is being awarded to The Auxiliary of Nanticoke Health Services. The Nanticoke Tributes will also recognize the two new inductees into the Nanticoke Physicians Hall of Fame. This year, Judith Tobin, MD and John Lynch, MD will be presented with the Hall of Fame Award. The dinner will be from 6 to 9 p.m. at Baywood Greens in Long Neck. Mitzi Perdue will be the guest speaker. Tickets are $75 and may be purchased by calling 629-6611, ext. 2404.

Nanticoke offering flu shots
Nanticoke Memorial Hospital will be offering flu shots to the public on Thursday, Oct. 26 (3-7 p.m.) and Friday, Oct. 27 (9 a.m.-1 p.m.) located at the Nanticoke Mears Health Campus (across from Seaford Post Office). The cost of the vaccination will be $10. The vaccine is not recommended for anyone under 18. The influenza vaccine is recommended for elderly and high-risk individuals. Healthy working adults may also benefit from the influenza vaccine. Large outbreaks of influenza usually do not occur before December in the U.S.A. and reach a peak between late December and early March and many continue into the spring. For additional information contact Nanticoke Memorial Hospital at 629-6611, ext. 2505. No appointment or pre-registration is required.

Breast Cancer Walk
October is breast cancer awareness month and Women Supporting Women, regional breast cancer support group, is getting the word out to the community through its annual walk - "5th Annual Walk for Awareness." The event is held on Saturday, Oct. 14, at Winter Place Park in Salisbury, Md. The cost is $15 before the walk and $20 the day of the event. For an additional $5 you can bring your pooch. Registration begins at 9 a.m. and the one-mile fun walk starts at 10 a.m. Texas Road House will be there to provide food and everyone will receive a t-shirt. Every three minutes a woman is diagnosed with breast cancer in this country therefore early detection is becoming more and more critical.

Family-to-Family Course
The National Alliance on Mental Illness in Delaware (NAMI-DE) is sponsoring a Family-to-Family Education Course. This is a free, 12-week educational program for families of persons diagnosed with serious mental illness. If you have a family member who suffers from schizophrenia, bipolar disorder, obsessive-compulsive disorder, panic disorder or other serious mental illness, you may benefit from this course. The fall class for Sussex County will be on Mondays, starting Oct. 23, at 6:30 p.m., at St. John's United Methodist Church, Seaford. Find out more about the Family-to-Family Education Program and how it can help you. Call (888) 427-2643.

Division of Public Health influenza vaccination
Delaware's Division of Public Health announces its influenza vaccination schedule for Delawareans without a healthcare provider or whose insurance does not cover flu shots. The first clinics take place Oct. 23 in Newark, with clinics in Kenton and Greenwood on Oct. 24. While many DPH adult clinics accept walk in clients, DPH will vaccinate children by appointment only on scheduled days. Medicare Part B and donations are accepted. For a comprehensive list of community flu shot clinics, go to Vaccines provided at DPH clinics provide protection against influenza strains expected this year and DPH encourages all residents to get a flu shot this year. DPH and community physicians expect the first vaccine shipments to arrive in mid October. No vaccine has been developed to protect against avian influenza H5N1, which has not occurred among people in North America. People in one of the following groups can be vaccinated at DPH clinics:
Children age 6-23 months;
Adults 50 years and older;
People ages 2-49 with chronic medical conditions;
Adults or children with spinal cord injuries, seizure disorders, or other muscle and nerve conditions that lead to breathing and swallowing problems. Women who will be pregnant during flu season. Vaccination can occur in any trimester; Household contacts of out-of-home caregivers of children less than six months old. Residents of long-term care facilities; Healthcare workers involved in direct patient care; and Out-of-home caregivers and household contacts of people in the other high-risk categories. Flumist, the nasal flu vaccine, may be available through community physicians. Flumist may be administered at any time during the flu season to vaccinate healthy people ages 5-49 years who are not pregnant, including most health-care personnel, other persons in close contact with groups at high risk for influenza-related complications, and others desiring protection against influenza. Sussex County adult clinics
Oct. 24, Tuesday, Greenwood Fire Hall, 13 Governors Ave., Greenwood, 9 a.m.-1 p.m. Walk In.
Oct. 26, Thursday, Greenwood Fire Hall, 13 Governors Ave., Greenwood, 4 - 7 p.m. Walk In
Oct. 14, Tuesday, Laurel Fire Hall, 205 West 10th St., Laurel, 4-7 p.m. Walk In
Oct. 16, Thursday, Laurel Fire Hall, 205 West 10th St., Laurel, 9 a.m.-1 p.m. Walk In
Oct. 28, Tuesday Blades Fire Hall, 200 East 5th St., Blades, 4-7 p.m. Walk In
Dec. 7, Thursday, Blades Fire Hall, 200 East 5th St., Blades, 9 a.m.-1 p.m. Walk In
Flu shots for children under 18
Children under the age of 18 will be seen by appointment only at the DPH Clinics and State Service Centers. Parents or guardians interested in making appointments for flu shots should call one of these DPH clinics. Sussex County, Georgetown State Service Center, 856-5213 Sussex County, Shipley State Service Center, 628-2006 For more about flu clinic locations and dates, go to