Diabetes Management



Normal Blood Sugar


4-6 mmol/l






  • pallor

  • cool, moist skin

  • anxiety

  • restlessness

  • tingling in hands, feet tongue

  • confusion

  • drowsy

  • nausea






  • drowsy

  • confused

  • dry skin

  • nausea

  • headache

  • vomiting

Common Types of Insulin


Humulin R



Humulin N




onset 30-60 min

peak: 15-30min

duration 30-60 min






Duration: 24h

  • administered 30 prior to the first meal of the day

  • a second dose may be given before the evening meal or @ HS

  • may only be given Sub Q

  • may be given IV or subcutaneously

Do not mix







Duration: 24h


Multiple Sclerosis and Amyloid Lateral Sclerosis Comparison



Feature Multiple Sclerosis Amyloid Lateral Sclerosis
Disease Affects motor and sensory neurons Affects motor neurons/ Sensory and cognition not affected
Incidence Higher in women Higher in men
Genetics Mutation in the MHC portions of chromosomes on the HLA regions of the genes Mutation of the SOD1 gene on chromosome 21
Pathophysiology Neural demylination and Death of oligodenrocytes producing myelin Superoxide dismutase gene that neutralizes harmful free radicals is mutated

Signs and Symptoms

Depends on the region and extent of neural demylination.

Paresthesia (burning, tingling sensation)


decreased muscle strength and coordination

gait affected

visual impairment

bowel and bladder dysfunction


fascication (muscle twitch)

muscle atrophy



Diagnostics MRI for plaques.

Assay for presence of protein in CSF

indiciative of:

  1. compromised blood brain barrier
  2. autoimmune damage occurance
  3. inflammatory processes



Downs Syndrome




Downs Syndrome Etiology

The chromosomal defect trisomy 21 results in Downs syndrome.

  • 95% of cases are a result of nondysjunction or a cell division error during meiosis
  • the offspring of individuals carrying a Robertsonian translocation

The Robertsonian translocation involves

  • the long arm of chromosome 21q
  • with the long arm of one of the acrocentric chromosomes, A chromosome that has the centromere very near to one end (often 14 or 22)

The condition presents with a combination of birth defects:

  1. A degree of mental retardation
  2. characteristic facial features
  3. a variety of other health problems

Downs Syndrome Incidence

  • 1 in every 800 to 1000 births.
  • Risk increases with maternal age:
  • 1/1250 @ 25yrs old
  • 1/400 @35yrs
  • 1/100 @ 45 yrs
  • thought to reflect oocyte aging

Downs (prenatal screening tests) diagnostic tests

  • blood test to determine the probability of a woman giving birth to a Downs child
  1. maternal serum alpha-fetoproteins
  2. human chorionic gonadotropin
  3. unconjugated estriol
  4. inhibin A
  5. pregnancy associated plasma protein A
  • ultrasound for fetal nuchal translucency (increased in the Downs fetus)

Physical manifestations of Downs Syndrome

  • small square head
  • small nose
  • depressed nasal bridge
  • upward slanting eyes
  • small, low-set malformed ears
  • large protruding tongue
  • single simian palmar crease

Downs Syndrome Cognitive challenge and other functional compromises.

  • Language skills show a difference between understanding speech and expressing speech
  • Speech delays often require speech therapy
  • fine motor skill delay
  • Delayed walking onset

Seizures Types



Seizure Types

  1. Partial (focal) Seizures


involves a limited portion of the brain

may start on one side of the brain and travel only a short distance before stopping

foci = start location of abnormal electrical activity

  • Simple partial seizures: small, local, limited focus but progress to a generalized seizure
  • Symptoms:
  • precise location – vague
  • auditory or visual hallucinations
  • smell or taste things not present
  • emotional experiences of joy, sorrow or grief
  • arms, legs or face may twitch


  • Complex partial (psychomotor or temporal lobe) seizures:
  • Show sensory, motor and autonomic symptoms with some degree of altered or impaired consciousness
  • Total loss of consciousness may not occur during a complex partial seizure
  • a brief period of somnolence or confusion may follow the seizure
  • some seizures are preceded by an aura that is often described as an unplesant odour or taste
  • Seizures may start with a blank stare, may fumble with or try to remove clothing
  • most pts will not pay attention to verbal commands
  • pts may act as if they are having a psychotic episode
  • After the seizure pts do not remember the incident


  1. Generalized Seizures


  • not localized to one area
  • travel throughout entire brain on both sides
  • the seizure is through to originate bilaterally and symmetrically within the brain


  • Absence (Petit mal) Seizures


  • most often occur in children
  • last only a few seconds
  • involve a loss or reduction of normal activity
  • Staring of transient loss of responsiveness are the most common signs
  • there may be slight motor activity with eyelid fluttering or myoclonic jerks
  • due to subtlety these seizures may go unnoticed or be mistaken for daydreaming or ADD.


  • Atonic Seizures


  • may be referred to as drop attacks
  • pt may stumble and fall for no apparent reason
  • Episodes are short lasting only a few seconds


  • Tonic-clonic seizures


  • seizures may be preceded by aura
  • some pts may perceive a warning sign described as a spiritual feeling, flash of light or special noise

Tonic Phase

  • Intense muscle contractions indicate the tonic phase
  • a hoarse cry may occur at the onset of a seizure due to air being forced out of the lungs
  • clients may temporarily lose bladder or bowel control
  • breathing may become shallow with moments of apnea


Clonic Phase

  • alternating contraction and relaxation of muscles
  • seizures usually last 1-2 minutes

Postical State

  • afterwards the pt becomes drowsy, disoriented and sleeps deeply


  1. Special Epileptic Syndromes


  • special epileptic seizures include the febrile seizures in infancy
  • reflex epilepsies
  • other forms of myoclonic epilepsies
  • Myoclonic epilepsies often accompany other neurological abnormalities or progressive symptoms


  • Febrile Seizures


  • typically cause tonic-clonic motor activities lasting 1-2 minutes
  • with rapid return of consciousness
  • Occur in conjunction with a rapid rise in body temperature
  • usually occur only once during any given illness
  • most likely to occur in the 3mo-5yr age group
  • preventing the onset of fever is the best way to control the seizures


  • Myoclonic Seizures


  • characterized by large, jerking body movements
  • major muscle groups contract quickly and pts appear unsteady and clumsy
  • Pt may fall from sitting position or drop whatever they are holding
  • Infantile spasms exemplify a type of generalized, myoclonic seizure
  • distinguished by short-lived muscle spasms involving the trunk and extremities
  • The spasms are often not identified as seizures by parents or healthcare providers because the movements are much like those the normal infantile Moro (startle) reflex


  • Status Seizures


  • medical emergency
  • occurs when a seizure is repeated continuously
  • can occur with any type of seizure
  • usually generalized tonic-clonic seizures are exhibited


  • generalized tonic-clonic seizures are prolonged or continuous
  • the time in breathing is affected by lengthened muscle contraction
  • may result in hypoglycemia, acidosis and hypothermia due to increased metabolic needs
  • lactic acid production and heat loss during contraction
  • carbon dioxide recension also leads to acidosis
  • if untreated, status eptilepticus can lead to brain damage and death
  • medical treatment involves IV administration of antiseizure medications and ensuring an open airway.

Genetics vs Environment


IMG_0206 copy2

Don’t know much about you
Don’t know who you are
We’ve been doing fine without you
But, we could only go so far
Don’t know why you chose us
Were you watching from above
Is there someone there that knows us
Said we’d give you all our love

Will you laugh just like your mother
Will you sigh like your old man
Will some things skip a generation
Like I’ve heard they often can
Are you a poet or a dancer
A devil or a clown
Or a strange new combination of
The things we’ve handed down

I wonder who you’ll look like
Will your hair fall down and curl
Will you be a mama’s boy
Or daddy’s little girl
Will you be a sad reminder
Of what’s been lost along the way
Maybe you can help me find her
In the things you do and say

And these things that we have given you
They are not so easily found
But you can thank us later
For the things we’ve handed down

You may not always be so grateful
For the way that you were made
Some feature of your father’s
That you’d gladly sell or trade
And one day you may look at us
And say that you were cursed
But over time that line has been
Extremely well rehearsed
By our fathers, and their fathers
In some old and distant town
From places no one here remembers
Come the things we’ve handed down

The Things we’ve handed down – Marc Cohen