A multi-disciplinary approach is usually use in the management of patient with diabetes. Diabetic patients are likely to have vascular complications of diabetes such as coronary heart diseases, stroke, nephropathy and peripheral vascular complications. Therefore, the aim of treatment is to reduce their risks of such complications as well as to minimize symptoms while allowing a normal life.

This can be done through 2 main modalities: lifestyle modifications and pharmological interventions.

1) Lifestyle Modifications:

- Diet:

Control of caloric intake can be done through modifying the diet such that 30 calories is given per kilograms of ideal body wt: can be increased to 40 calories per kilograms for an active person and 50 calories per kilograms if the patient does heavy physical labour. Therefore, Mr Tan ideal calories intake should be 30 x 69 = 2070 calories per day. The calories should be distributed as 55% to 60% carbohydrates, 25% to 35% fat, and 15% to 20% protein.

Emphasis should be placed on complex carbohydrates rather than simple and refined starch as well as polyunsaturated fats instead of saturated fats in a ratio of 2:1. Therefore, Mr Tan should be advised to eat wholemeal bread, brown rice, margarine, vegetable oil instead of rice, fried food, and fatty meat.

He should also be educated on the glycemic index of various foods. A lower rise in blood sugar occurs after the ingestion of simple sugars compared to complex carbohydrates which is seen after the absorption of glucose.

Fiber (soluble and insoluble) intake should also be encouraged as it delays glucose absorption and have also been shown to lower elevated triglyceride level.

- Exercise:

He should be advised to exercise at least 3 times a day for at least 30 minutes each time.
And if possible, he should take the stairs instead of the lift. Working as a taxi driver requires him to sit for long hours, increases his risk of having deep vein thrombosis. Therefore, he should be advised to do some light exercises every few hours to improve blood circulation.

2) Pharmological intervention: Oral Hypoglycemic Agents

- Biguanides (insulin sensitizers)
Metformin is the commonly used drug in this group.
They work by increasing the density of insulin receptors; directly stimulate glycolysis in peripheral tissues; reduce hepatic gluconeogenesis; decrease glucose absorption from the gastrointestinal tract and reduce plasma glucagon level.

- Sulphonylureas (Insulin secretagogues)
Glibenclamide/ daonil is used in this patient as it produces a synergistic effect with metformin in the control of diabetes.
They work by closing ATP sensitive potassium channels, causing depolarisation of islet cells and influx of calcium ions which stimulates the release of insulin.

Other classes of drugs such as thiazolinediones, meglitinide, alpha-glucosidase inhibitors have also been prove their worth in diabetic control. Hence, they can be used as additions or subsitiutions to Mr Tan?s current regimen if glycemic control is inadequate seen in the subsequent follow-ups.

In all, Mr diabetic patients should be educated on the importance of good glycemic and blood pressure (preferably less than 130/80 mmHg) control to prevent the complications of diabetes mellitus. Good compliance with diet and medication as well as support from family and healthcare personnel will help to reduce the morbidity and mortality of the disease.

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Dr Greeve, MD
Where can you get Senior Doctor?s Professional Advice for free
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Source: http://www.healthclubsfitness.com/treatment-of-type-2-diabetes-mellitus/

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KETCHIKAN, Alaska ? A California taxidermist has earned a rare place in pop history.

Sergio Vigalato (VIG’-uh-lot-oh) preserved Lady Gaga’s now-famous raw-meat dress for display in the Rock and Roll Hall of Fame and Museum in Cleveland.

The project has prompted a swarm of media interest in the 66-year-old former Southeast Alaska charter boat skipper who’s originally from Brazil.

Vigalato operates American Taxidermy in Burbank, Calif. That’s where he was contacted by the museum about preserving the dress that Lady Gaga wore at the September 2010 MTV Video Music Awards.

Vigalato was unaware of the dress or the artist when reached two months after the show. But he agreed to the project anyway.

The ensemble, which Lady Gaga said was a statement about equality, arrived at his shop frozen and decomposing. He restored it over the next three and a half months, and the dress went on display in June.

Source: http://us.rd.yahoo.com/dailynews/rss/celebrity/*http%3A//news.yahoo.com/s/ap/20110730/ap_en_ce/us_odd_gaga_s_meat_dress_taxidermist

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Share With Friends: Share on FacebookTweet ThisPost to Google-BuzzSend on GmailPost to Linked-InSubscribe to This Feed | Rss To Twitter | Politics – Top Stories News, RSS Feeds and Widgets via Feedzilla.

Source: http://news.feedzilla.com/en_us/stories/politics/top-stories/118013803?client_source=feed&format=rss

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KABUL, Afghanistan ? An Afghan official says seven Afghan soldiers and a translator were killed alongside two NATO service members in a bombing and ambush in eastern Paktia province.

The deputy provincial governor of Paktia, Abdul Rahman Mangal, said Saturday the soldiers and a translator were killed on Friday while on patrol in the Zurmat district of the province.

NATO announced Friday that two of its service members were killed by a roadside bomb in eastern Afghanistan, but did not provide nationalities or any other details.

Mangal says the troops were on a joint patrol when a roadside bomb detonated. He added that the patrol was then attacked by insurgents. He did not have any further information on other casualties or wounded.

Source: http://us.rd.yahoo.com/dailynews/rss/asia/*http%3A//news.yahoo.com/s/ap/20110730/ap_on_re_as/as_afghanistan

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The Japanese constructors are finding an effective strategy to deal with the escalating costs of the polluting cars: the hybrid car, a concept that was also adopted by some European constructors.

There exist fifteen naval ships that deliver more harm to the environment as compared with all 750 million cars that exist on the road today.

That is, a single gigantic naval ship smogs up as much as 50 million cars. Nevertheless, the attention of all the governments is pointed at the individual cars, as they are polluting in the big cities, not in the ?green? zones of the oceans. The Japanese designers from Toyota had an idea in 1990.

These people wanted to create a car that could be less destructive to our environment. The car these designers created was the Prius and it was among the initial hybrid cars on the market but overall sales have not been successful.

The Prius happens to be wildly successful in the United States but continues to be experiencing tepid sales in Japan and in Europe. The main percentage of hybrid car sales in countries in Europe is almost exactly like high end luxury cars at less than 1%.

Europe in general have not been very keen to adopt hybrid cars. Europeans don?t really have any incentives to invest in hybrid cars considering that they are much more expensive than regular cars. The only ?bonus? that people get is a reduction in the pollution levy. However, the difference between the costs of hybrids and other vehicles of the same dimensions and performances are considerable.

Toyota did a survey and concluded that people who drive hybrids are usually people who have college degrees or higher like doctors, lawyers and engineers. These people are purchasing those cars due to the low consumptions. A good example would be the Lexus RX 450h SUV which has 300 horsepower even so it uses significantly less gas than your typical 1.4 liter car.

A lot of car makers today have their very own lines of hybrid cars, like Opel has the Ecoflex, Ford has the EcoNetic line, and Volkswagen has the BlueMotion line. There?s also a resistance to diesel cars also.

Despite the fact that the diesel cars are generally less consuming, they are generally used for trucks because of the higher buying price. Statistics show that the majority of Europeans prefer to drive the more highly effective and less expensive gasoline car than a hybrid or diesel car.

Initially,Japan and the US weren?t fans of the initial batch of hybrid cars, like the Blutec model from Mercedes which were considered toxic. Bear in mind all of the thousands of trucks that are on the road since the 80?s and how they must be removed.

The third edition of the Prius emits the same CO2 emission as the diesel Smart Car at 89 grams per kilometer but is a bigger car. Moreover, the Prius is the only hybrid car that has the ability to go all-electric for about 1 kilometer at speeds up to 50 kilometers and you can get this car for only 30,000 Euros.

Everyone is aware that crossbreed automobiles can receive significantly cheap car insurance quotes. Take action today and notice if you meet the requirements for such low rates with your car or truck.

Source: http://autorepairarticles.com/2011/07/30/the-entire-hybrid-vehicle-experience

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Posted: July 30, 2011 at 4:09 am | Tags: Premium Electronic Cigarette Coupon Codes, Premium Electronic Cigarette Reviews, Premium Electronic Cigarettes

Japan is well-known as one of the richest countries in the world. This statement is well-evidenced by the rising economy of Tokyo. It is no surprise that Tokyo is a rising powerhouse together with New York and London. However, Tokyo?s success worldwide does not affect the rich culture the Japanese has preserved for many years. In this case many people opt on going to Tokyo to become a part of a rich economy, competitive business field, stunning environment and rich culture. You can find various reviews and blogs, like the Premium Electronic Cigarette Reviews, on how Tokyo Metropolis is worth visiting.


In the world of economy, Tokyo Metropolis is one of the three ?command centers? in the world. Its success in the economic standpoint has made Japan the second most expensive city in the world and has been listed by the GaWc?s 2008 inventory an alpha+ world city. It is surely an advantage to live in Tokyo because of the astounding economy it presents. Although not all people can afford to go to Tokyo, still the city is a livable megalopolis ? full of opportunities and a busy lifestyle hub.


Many business men opt on investing in Tokyo because they see it as an asset. Being one of the three world finance command centers, Tokyo has the largest metropolitan economy in the entire world. You can also find several of the world?s largest investment banks and insurance companies in Tokyo since it is one of the major international finance centers. For many Japanese Tokyo is the hub for many transportation, publishing and broadcasting industries where many find it beneficial. With that in mind, starting a business in Tokyo is an advantage if you know how to run it within Japanese terms. For example, you can sell various Premium Electronic Cigarette Coupon Codes and know that there is a certain market for that in the city.


Amidst all advancement, the Japanese still has a heart for the environment. One measure they enacted to save the planet is by creating their first emissions cap system. This system?s goal is to reduce the greenhouse gas pollution by a total of 25%. Overtime, the extensive emission of greenhouse gas has made Tokyo a modern-day urban heat island. This phenomenon is a serious matter where all locals make it a point to do something about it; thus, the creations of the emissions cap system. In the end, Tokyo is a great example of establishing a good relationship between the growth of the city and the climate.


Just like any prefectures in Japan, Tokyo cherishes its culture as evidenced by the vast quantity of museums, parks, theaters, festivals, shrines, food, and palaces. In Tokyo, the Tokyo National Museum is the country?s largest museum that specializes in traditional Japanese art. You can also find more of Japan?s rich history in other museums as well as in the Ueno Zoo. The performing arts in Tokyo also leaves a great impact in the lives of many Japanese Their numerous theaters house various arts including Japanese drama, international pop and rock music and other musical organizations. Last but not the least, there are many festivals that occur all throughout Tokyo. This includes major events like the Sanno being held at the Hie Shrine. You can find many people selling branded products even Premium Electronic Cigarettes.

Source: http://shoppingandproductreviews.therefinedgeek.com.au/index.php/2011/07/discover-tokyo-and-what-it-offers/

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Skip to navigation ? Skip to content ? AP By The Associated Press The Associated Press ? Thu?Jul?28, 3:50?pm?ET

The average rate on 30-year fixed mortgages rose to 4.55 percent this week, Freddie Mac said Tuesday. Here’s a look at rates for fixed and adjustable mortgages for the past 52 weeks:
Current week’s average rate Previous week’s average rate 52-week high 52-week low
30-year fixed 4.55 4.52 5.05 4.17
15-year fixed 3.66 3.66 4.29 3.57
5-year adjustable 3.25 3.27 3.92 3.22
1-year adjustable 2.95 2.97 3.53 2.95

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    Source: http://us.rd.yahoo.com/dailynews/rss/business/*http%3A//news.yahoo.com/s/ap/20110728/ap_on_bi_ge/us_mortgage_rates_glance

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    July 28, 2011 ? 9:06 pm PT by Mike
    Tags: Contest Carnage, DIV, Lance Mountain, Raven Tershay, Tom Remillard, VBS ?

    The closest thing to vert skating us kids growing up in the 90?s ever really experienced were the homemade stolen construction wood half pipes we would make with our dad?s TOOLS.? The lasting power of those things all depended on the kid down the street who after hours of hard work and labor, he comes over without a lifting a finger to help and decides to drive all his force right into the poor ramp, completely obliterating it into several wood pieces and hundreds of splinters.? So with that much effort and little reward, we sort of shunned vert skating.? It was too difficult and not very accessible.

    Then came the days when property owners were no longer liable for injuries taken place on their land and KABOOM!? Skateparks everywhere.? Every fortunate skater with the their city?s support were popping up skateparks at every school, recreational park, and even in the parks where MI VIDA LOCA used to take place.? Now we are seeing the evolution of skaters who not only know how to skate street exceptionally well, but also know how to skate vert without the fear of their Chinese FRIEND from down the street tearing it up into a million pieces.? And this is what VBS?s new show Contest Carnage featuring Tom Remillard, Raven Tershay, DIV, Lance Mountain and others is all about.

    The mid 80s saw skateboarding explode into pop culture for the third time, driven by high flying vertical tricks and major personalities. Ramps and bowl contests stoked the imaginations of kids and built careers for a handful of major stars. But with the dawn of street skating, contests became less crucial, and for much of the 90s, with a few exceptions, faded from sight. Beginning around 2000, however, a new breed of skater emerged, the product of a new wave of DIY and public skateparks. And with them came a new kind of contest that brought the masters of the 80s together with kids who hadn?t yet been born the first time around.

    Source: http://www.lat34.com/2011/07/28/vbs-tv-presents-contest-carnage/

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    Tri Nations Championship 2011
    All Blacks vs South Africa
    Date ? ??? : 30 July 2011, Saturday
    Kick Off? : 7:35 pm (NZT)
    Time?? ?? : from 09:35 until 11:35 (CET)
    Venue ? : Westpac Stadium (AKA Caketin), Wellington NZ
    All Blacks vs Springboks Live Streaming

    Referee: Alain Rolland (Ireland)

    The New Zealand national rugby league team represents New Zealand in the sport of rugby league and are the current World Cup and Four Nations champions and are currently considered the sporting pride of New Zealand. They are commonly known as the Kiwis, after the native bird of that name and are administered by the New Zealand Rugby League. The team?s colours are black with white and the players perform a haka to challenge their opponents before every match they play.
    New Zealand national rugby side is known as the All Blacks and are famous throughout the world for their ability, fitness and stamina. The team first played in a 1907 professional rugby tour which pre-dated the birth of rugby league football in the Southern Hemisphere, making it the second oldest national side after England. Since then the Kiwis have regularly competed in international competition, touring Europe and Australia throughout the 20th century. New Zealand have competed in every Rugby League World Cup since the first in 1954, reaching the final of the past three tournaments. In 2008 New Zealand made history by winning the World Cup for the first time. They also contest the Baskerville Shield against Great Britain, and play an annual ANZAC Test against Australia. The All Blacks are currently ranked as the world?s top rugby team by the International Rugby Board (IRB) based on their game results.

    Club Information

    Nickname: The Kiwis
    Governing body : New Zealand Rugby League
    Head coach ? : Stephen Kearney
    Captain : Benji Marshall
    Most caps ?? ?: Ruben Wiki (55)
    Top try-scorer: Nigel Vagana

    (19)[1]Top point-scorer: Des White (467)

    RLIF ranking : 2nd

    The South African national rugby union team (the Springboks) are the current holders of the Rugby World Cup and 2009 British and Irish Lions Series winners.They are currently ranked as the third best team in the IRB World Rankings and were named 2008 World Team of the Year at the prestigious Laureus World Sports Awards.

    Club Information

    Nickname: The Springboks
    National Emblem (s): (i) The Protea flower, (ii) The Springbok
    Home Union: South Africa Rugby Union
    Founded: 1992 (SA Rugby ? previously South Africa Rugby Football Union)
    Rugby World Cup Record: Winners 1995, 2007, Semi-finalists 1999, Quarter-finalists 2003
    Current IRB Ranking: 3
    Coach: Peter de Villiers
    Captain: John Smit

    A two-time World Cup winner, South Africa quickly resumed its place as one of Australia?s fiercest on-field rivals, after returning to international sporting competition following an end to the apartheid-enforced isolation, in 1992. South Africa re-emerged at a time where Australia held the Rugby World Cup, and the state of competition between the two countries has generally been a lot tighter in the years since isolation ended, than it was in the period before apartheid South Africa was shunned.

    Watch all the Tri Nations Rugby Live Streaming Online.? All Blacks vs Springboks (big match) Live Stream with fast and easy setup without needed any extra hardware and get the updates of the match, score summery, winner team of the match, exciting clips, latest news, interviews, videos and highlights in your computer. Access all sports all the time! Watch all the Rugby Big Events online on Live Broadcast from all over the world. No matter where are you can always watch your favorite teams play from any place of the world live online.

    Source: http://submitseoarticle.com/live-watch-nz-vs-sa-rugby/

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    If you don?t know any chiropractic coaching agency, nor do you have a computer to help you seek online websites about chiropractic coaching, why not buy a book about it instead? It seems hard to study relying only on your limited knowledge, but it?s the easiest option for you. Professional chiropractors write self-help books to guide their fellow doctors achieve the same success they have. Chiropractic coaching books like ?Breakthrough Coaching: The book?, ?Breakthrough living?, ?E-Myth Revisited?, and ?The No New Patient Solution for New Chiropractors? (with an included monthly member newsletter and a free consultation via phone or skype) are just some of the bestsellers around. You can also download e-books. Another choice available is to download self help chiropractic coaching books in PDF file. You can also download podcasts and audio lessons. With their years of experience, expert chiropractors will aid you in boosting your patient count effectively.

    Source: http://www.mvsafari.com/news/general/self-help-chiropractic-coaching

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