Alcoholic Drinks: Friend or Foe?

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The drinking of alcohol is often viewed as a normal social activity and part of everyday life. Many adults will relax and unwind with a glass or two of their favourite alcoholic beverage, either after work in the evenings, or on the weekends. It is often viewed as a small personal reward for working hard, and a pleasant way to achieve a feeling of relaxation. As along as sensible levels of consumption are observed and respected, drinking alcohol is perfectly acceptable and enjoyable.

Daily guideline amounts, as recommended by the National Health Service, are 3-4 units per day for a man and 2-3 units per day for a woman. To illustrate what this might represent, one unit is equal to: half a pint of regular beer, lager or cider; one small glass (125ml) of wine; or 1 single measure (25ml) of spirits. It must be noted however, that stronger beers and wines are going to be worth additional units; for example, a 440ml can of super strength lager is equivalent to four units, which is the maximum level for a male. To consume a bottle of wine, depending on the strength, you are looking at about 9 units.

In comparison to Public Houses, alcohol is relatively cheap to buy at the supermarket or local off-licences, and so many people now choose to drink at home instead. The generosity of drink measures, however, can easily be over-estimated at home. Domestic glassware measures may not be obvious and easy to monitor, and there is also a tendency to be a little more lavish when you know that the alcohol represents good value for money. The resulting outcome is that many people will unwittingly exceed their daily guideline units, or may even go further, and finish the bottle or the last can, just because it is not really worth leaving.

According to the Department of Health (2007), 24% of people in the UK are drinking heavily, either through regular drinking or binge drinking. As these people are not addicted to alcohol, they will probably not be concerned about their drinking levels, when actually they probably should be. Their short term risks may include loss of consciousness, accidents or injuries, or alcohol poisoning (potentially fatal); while their long term risks may include cancers, heart disease, liver disease or brain damage, such as memory loss or dementia.

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Heavy drinkers may also start to put on weight, as alcohol is very calorific. They may also start to age prematurely, as alcohol is not good for the skin, as it dehydrates the body; and alcohol will affect the quality of a person’s sleep, with them often missing out on the deep REM stages of the sleep cycle. Coupled with a smoking habit, which is often a common accompaniment to a heavy drinking habit, the effects upon health and personal appearance are going to be even worse.  

Alcohol is a depressant, and so heavy alcohol consumption is often linked to poor mental health. A depressed person who drinks will initially feel elated, but afterwards they will feel more depressed than before. To feel better again, they are likely to reach for another drink, and so the vicious cycle will negatively repeat itself. If a person is suffering with depression, it really is advisable to avoid alcoholic drinks altogether, as they are not going to aid with recovery.

It is worth knowing that one unit of alcohol will take roughly one hour to be metabolised by the body, and so after a heavy night’s drinking, many people will still be over the drink-drive limit in the morning. Driving when over the limit may cost you your licence and your job. In extreme circumstances, it may even cost your life or someone else’s.

This all seems really negative, but this is precisely why daily guideline unit recommendations were initially formulated. To enjoy alcohol safely, take note of the guideline amounts, the size of drinks and their alcohol content. It is always best to eat when drinking, or at least to eat prior to drinking. It is sensible practice to alternate alcoholic drinks with water or a soft drink, as this helps to prevent dehydration and to limit consumption.

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For further information, some good sites are:

Drink Aware, the Facts

http://www.drinkaware.co.uk

NHS Choices, Drinking and Alcohol

http://www.nhs.uk/Livewell/alcohol/Pages/Alcoholhome.aspx

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The wonderful world of the Guide Dogs

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Following on from last week’s blog about diabetes, I recently found out from the Guide Dogs society, that 905,000 in England have diabetic retinopathy.  The condition is a potential complication which can accompany diabetes.  Diabetic retinopathy is damage which is caused to the retina due to high blood glucose levels or high blood pressure.  If hyperglycaemia or hypertension persists long-term, the retina’s blood vessels will gradually deteriorate and begin to bleed or abnormally grow.  Symptoms do not appear until the later stages, and typically present as blurred or double vision, seeing spots or eye pain (NHS Choices).  Blindness may eventually result, and indeed is the main cause of blindness in working age adults (Diabetes UK).  To help prevent diabetic retinopathy, it is essential that people with diabetes look after their health through diet, exercise, good blood glucose control and regular annual eye checks.

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A representative from the Guide Dogs society visited our university and shared some amazing facts about being visually impaired and having a guide dog.  The visitor was accompanied by a beautiful and highly intelligent, fully-trained guide dog called Alfie – a Labrador and Retriever cross.  It has generally been found that these two breeds, along with German Shepherds, usually have the best success with guide dog training. 

guide dog in training

Our visitor told us that a guide dog costs about £50,000 to train and keep, and only 2.5% of people with a visual impairment actually have a guide dog.  There is apparently a waiting list and a system of prioritisation, but also there are some people who consciously choose not to have a guide dog.  This may be because they prefer to use a stick or a person to guide them, or they may not like dogs or have an allergy to their fur.  In view of the last point, Labradoodles have been trained with some degree of success, as poodles are usually beneficial for people who suffer with allergies, as they do not tend to moult hair in the same way as other breeds.  The biggest restriction upon providing more guide dogs however, has got to be funding.  The Guide Dogs society is solely reliant upon charitable funding, and therefore has to raise money through the generosity of others; either through direct donations, fund-raising events or the sponsorship of guide dog puppies.

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Our visitor told us that 76 people are registered with visual impairment or blindness in England every day.  There is apparently no obligation for a person to include themselves on the register, although opticians will usually notify the Drivers Vehicle Licensing Authority on their behalf, regarding conditions such as glaucoma.  Surprisingly, a person who loses sight in one eye is not classified as being partially sighted, as they usually manage sufficiently with, and adapt to having, just one eye. 

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As part of the visit I took part in an experiment where I was blindfolded and led by another person.  The blindfold was totally black and I could not see a thing.  My partner led the way, with me holding on to her elbow with a ‘c’ grip.  This is a preferred grip for many blind people, as they can easily let go if necessary, and they have good overall control.  Despite this, I felt really disorientated and afraid to walk at my normal pace.  It was really strange going up a step; having to put both my feet against the edge of the step before going up.  The oddest experience of all however, was going down a sloping ramp, because it made me feel very vulnerable to slipping, as I cautiously felt for the ground with my feet.  My partner and I then swapped over, and I talked her around the same route while she held on to my elbow.  She also found it fairly scary, but seemed to take the step more confidently than I did.  Afterwards we rewarded ourselves with a pat and stroke of the beautiful Alfie.  I could have really cuddled him, but I felt that it was important that I showed some restraint and respect for his role as a guide dog! 

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To find out more about the fantastic work being done, please visit The Guide Dogs, http://www.guidedogs.org.uk/microsites/sponsor-a-puppy?gclid=CPj7o-mcz78CFYIewwod4KEAQA#.U8lDuVJOUth

For more information on sight, visit: Diabetes.co.uk, http://www.diabetes.co.uk/diabetes-complications/retinopathy-symptoms.html

Royal National Institute for the Blind, www.rnib.co.uk

NHS Diabetic Eye Screening Programme, http://diabeticeye.screening.nhs.uk/diabetic-retinopathy

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The Prevention and Management of Diabetes

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This week I have been learning about diabetes – its symptoms, its management and what can go wrong.  The subject choice was particularly apt, given the huge attention that the topic has currently been raising within the media.

On 4th July, Diabetes UK revealed that 738 people are being diagnosed with Type 2 diabetes and 30 more with Type 1 diabetes, every day within the UK.  This is equivalent to a massive 280,000 people every year, and with a further 18 million people having pre-diabetes symptoms already.

So, you may be wondering, what is the difference between Type 1 and Type 2 diabetes?  From what I have learnt, Type 1 diabetes is usually diagnosed in the very young and is basically an autoimmune disease in which the body attacks itself.  In Type 1 diabetes the pancreas stops producing insulin and replacement insulin needs to be injected every single day to keep the person alive.  In addition to this, the person’s blood glucose level needs to be monitored before every meal, and their dietary needs and insulin amounts must be adapted to balance these needs.

Type 2 diabetes is usually diagnosed as a consequence of bad lifestyle choices, and needs to be managed through adopting a healthy diet, taking regular exercise and effectively managing weight.  People with Type 2 diabetes do not need to take insulin, as their bodies are still producing it, but are not able to utilise it effectively.

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One of my nurse lecturers commented that when she started nursing 30 years ago, Type 2 diabetes was only diagnosed in the over 40s age group, and was typical of individuals who were ‘fat, forty and middle-aged’.  Nowadays however, it is increasingly common in people as young as 20.  The reason for this is our Western diet and sedentary lifestyle.  Many of us do not respect our bodies.  We have too much fat and sugar in our diets, not enough fruit and vegetables, too much alcohol, we might sit down in offices all day, we drive our cars everywhere, we sit down in the evening watching TV, we sit down on the Playstation or chat on social media, and added to all that (if that weren’t enough), we might even be indulging in the smoking of cigarettes.  Considering all this therefore, it is not really surprising that the incidence of diabetes is on the increase.

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In order to address this spiralling problem, we clearly need to be doing the opposite of all the habits in the paragraph above.  Prevention is undoubtedly the way we need to be going.  To do this therefore, we need to be adopting the principles of the Eat Well plate, as advocated by the NHS.  We require: at least five daily portions of fruit and vegetables; complex carbohydrates such as wholemeal varieties of bread, rice, pasta and cereals; smaller amounts of dairy products such as cheese, yoghurt, eggs and semi-skimmed milk; proteins such as beans, lentils, soya, nuts, fish and lean meat; and very small amounts of fat (preferably unsaturated) such as polyunsaturated margarine and olive oil; plus sparing amounts of sugary treats, such as cake and biscuits.

Added to this, we should be drinking plenty of water, limited amounts of tea and coffee, and non-sugary drinks.  We need at least 30 minutes of exercise daily, which can easily be achieved through a simple walk.  Furthermore, we need to limit our alcohol intake, perhaps just using it as a weekend treat.  We must adhere to our recommended units sensibly, and should avoid resorting to binge drinking.  The perils of smoking meanwhile, are now widely accepted and acknowledged, and it is up to each individual to get the help they need to help them to give up.

If we can all respect our bodies just a little more, our bodies will hopefully continue to work and serve us in the way in which they were intended.  We do not have to give up everything that we love; moderation is the key to good overall health.

So what if you are wondering whether you might be at risk of diabetes already?  What are the signs?  The common indicators are excessive thirst (polydipsia), excessive urinating (polyuria) and perhaps using the toilet throughout the night (nocturia), increased appetite (polyphagia), loss of weight, frequent fungal infections such as thrush, and extreme tiredness and lethargy.  The presence of diabetes can easily be determined through a simple blood test.  A healthy blood glucose level reading should be between 3.5 to 7 mmol/Litre.   If you have any concerns, you should visit your GP.

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At university I am really enjoying learning about the physiology of the pancreas and its role in the production and regulation of insulin levels.  It has also been really fascinating finding out about the pathophysiology – about what happens when things go wrong with the body.  Crucial to my nurse training, is the understanding of how to recognise and deal with low glucose levels (hypoglycaemia) and high glucose levels (hyperglycaemia), and furthermore what either extreme can lead to.

To look after my patients who have diabetes effectively, I have also been learning about the types of health problems that may be encountered, and particularly moreover, when patients fail to properly manage their long term condition.  Diabetes puts people at long term risk of neuropathy (nerve damage to the fingers and toes), nephropathy (kidney damage), retinopathy (damage to the eyes) and heart disease; so it is therefore really important that patients with diabetes attend for regular health check-ups with the diabetes nurse, have their eyes checked at the opticians and have their feet checked with the podiatrist.  With good management and a healthy lifestyle, people with diabetes can enjoy a good standard of living; but without this however, the future could be bleak.

For further information, visit http://www.diabetes.org.uk/