Low Blood Sugar: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

LOW BLOOD SUGAR A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Low Blood Sugar: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84487-9 1. Low Blood Sugar-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on low blood sugar. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON LOW BLOOD SUGAR ................................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Low Blood Sugar......................................................................... 12 The National Library of Medicine: PubMed ................................................................................ 14 CHAPTER 2. NUTRITION AND LOW BLOOD SUGAR ........................................................................ 17 Overview...................................................................................................................................... 17 Finding Nutrition Studies on Low Blood Sugar.......................................................................... 17 Federal Resources on Nutrition ................................................................................................... 18 Additional Web Resources ........................................................................................................... 18 CHAPTER 3. CLINICAL TRIALS AND LOW BLOOD SUGAR .............................................................. 21 Overview...................................................................................................................................... 21 Recent Trials on Low Blood Sugar............................................................................................... 21 Keeping Current on Clinical Trials ............................................................................................. 22 CHAPTER 4. BOOKS ON LOW BLOOD SUGAR .................................................................................. 25 Overview...................................................................................................................................... 25 Book Summaries: Federal Agencies.............................................................................................. 25 Book Summaries: Online Booksellers........................................................................................... 28 Chapters on Low Blood Sugar...................................................................................................... 29 CHAPTER 5. MULTIMEDIA ON LOW BLOOD SUGAR ....................................................................... 31 Overview...................................................................................................................................... 31 Video Recordings ......................................................................................................................... 31 CHAPTER 6. PERIODICALS AND NEWS ON LOW BLOOD SUGAR .................................................... 33 Overview...................................................................................................................................... 33 News Services and Press Releases................................................................................................ 33 Academic Periodicals covering Low Blood Sugar ........................................................................ 35 CHAPTER 7. RESEARCHING MEDICATIONS .................................................................................... 37 Overview...................................................................................................................................... 37 U.S. Pharmacopeia....................................................................................................................... 37 Commercial Databases ................................................................................................................. 38 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 41 Overview...................................................................................................................................... 41 NIH Guidelines............................................................................................................................ 41 NIH Databases............................................................................................................................. 43 Other Commercial Databases....................................................................................................... 45 APPENDIX B. PATIENT RESOURCES ................................................................................................. 47 Overview...................................................................................................................................... 47 Patient Guideline Sources............................................................................................................ 47 Finding Associations.................................................................................................................... 55 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 57 Overview...................................................................................................................................... 57 Preparation................................................................................................................................... 57 Finding a Local Medical Library.................................................................................................. 57 Medical Libraries in the U.S. and Canada ................................................................................... 57 ONLINE GLOSSARIES.................................................................................................................. 63 Online Dictionary Directories ..................................................................................................... 63 LOW BLOOD SUGAR DICTIONARY........................................................................................ 65

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INDEX ................................................................................................................................................ 87

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with low blood sugar is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about low blood sugar, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to low blood sugar, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on low blood sugar. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to low blood sugar, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on low blood sugar. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON LOW BLOOD SUGAR Overview In this chapter, we will show you how to locate peer-reviewed references and studies on low blood sugar.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and low blood sugar, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “low blood sugar” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Alzheimer's Disease and Dementing Disorders Source: Physical Medicine and Rehabilitation: State of the Art Reviews. 4(1): 9-17. February 1990. Summary: Dementia is a major cause of disability in the elderly. Alzheimer's disease and multiple brain infarctions account for more than 80 percent of patents with dementia. The rest suffer from other disorders such as Pick's disease, Parkinson's disease, Creutzfeldt-Jakob disease, Huntington's chorea, multisystem atrophy, and progressive supranuclear palsy. Other causes of dementia are potentially reversible, such as subdural hematoma, brain tumors, or normal pressure hydrocephalus. Subacute and chronic infections of the central nervous system (CNS) can also cause dementia, such as syphilis, AIDS, and cryptococcal meningitis. Factors extrinsic to the CNS may cause dementia, which is often preventable, arrestable, or reversible. Examples include

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drug intoxication, liver disease, thyroid disorders, high or low blood sugar, and thiamine deficiency. Lastly, mental depression in the elderly can sometimes mimic dementia. The etiology of Alzheimer's disease remains unknown, although evidence suggests a genetic factor. Experimental treatment of Alzheimer's disease with cholinergic agents has met with limited success. Reversible disorders must be ruled out prior to the diagnosis of Alzheimer's dementia in the elderly patient. 42 references. •

Diabetes Snack Bars: What Can They Do for You? Source: Diabetes Self-Management. 16(6): 68, 70, 72-74. November-December 1999. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This article assesses the claims of new diabetes snack bars that claim to improve blood glucose, stabilize blood sugar, and reduce the risk of hypoglycemia. These snack bars contain special forms of carbohydrate that do not cause the rapid increase in blood glucose levels typically seen when carbohydrate containing foods are eaten. All carbohydrates are built from single units of sugar that can exist alone or be combined with others. Although it was assumed that smaller carbohydrate molecules were broken down and absorbed more quickly than the long carbohydrate chains, it is now known that this is not true. Factors that alter the rate at which carbohydrate containing food is digested and absorbed into the bloodstream as glucose include the specific form of carbohydrate in the food, the presence of other nutrients such as protein, fat, and fiber, and the type of processing the food has undergone. The forms of starch used in the new snack bars either are naturally digested more slowly or have been chemically processed to slow the rate of their digestion. Starch contains the carbohydrates amylose and amylopectin. Their structural differences cause them to be digested differently. The way a food is processed can also alter the rate of starch digestion. The inclusion of resistant starch in the diet has several potential benefits for people who have diabetes, including decreasing blood glucose levels after meals, lowering the risk of low blood sugar, and improving blood cholesterol and blood triglyceride levels. Studies conducted on these snack bars suggest that the bars have a positive effect on diabetes management. The article provides facts about the snack bars and offers suggestions for incorporating the snack bars into a meal plan.

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Diabetes: An Epidemic on the Rise Source: Access. 15(6): 24-31. July 2001. Contact: Available from American Dental Hygienists' Association. 444 North Michigan Avenue, Chicago, IL 60611. Summary: This article brings dental hygienists up to date on current knowledge regarding diabetes mellitus and its potential impact on a patient's oral health and general health. The author stresses that dental hygienists' role in treating diabetes is more important than ever, given the growing prevalence of the disease. The author reviews the history and statistics of the disease, risk factors, monitoring for symptoms, recommending treatment, symptoms of hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar), and delivery of oral health care. The author notes that many people with diabetes do not realize they have it until they develop one of its major complications, including oral symptoms. Symptoms dental hygienists should monitor for include gingivitis, periodontitis, dryness or burning sensation in the mouth, fruity smelling breath, increased salivary viscosity (thickness), candida infection, periodontal abscesses, gingival (gum) proliferation, multiple carious lesions (cavities), asymptomatic

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parotid gland swelling, and xerostomia (dry mouth). One sidebar reviews the importance of diet in defeating diabetes, i.e., eating foods that offer maximum nutrition and learning how to make carbohydrates work for the body, rather than against it, by practicing portion control. Dental hygienists must reinforce the need for proper nutrition, exercise, compliance with medication regimens, monitoring of blood glucose levels, and the relationship of oral health and diabetes. •

Is Snacking Still a Must? Source: Diabetes Self-Management. 17(1): 80-82, 84. January-February 2000. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Website: www.diabetes-self-mgmt.com. Summary: This article considers the issue of whether people who have diabetes need to eat snacks. When diabetes drug therapy was limited to regular and N.H. insulin and first-generation sulfonylureas, people who had diabetes were routinely instructed to eat three meals and three snacks a day to prevent hypoglycemia. Today, there are more drug options available, so people who have diabetes may not need to eat snacks to prevent hypoglycemia. The relatively new oral medication repaglinide can cause hypoglycemia but can also eliminate the need for snacks. For people who use insulin, the quick-acting insulin lispro is an alternative to regular insulin. In addition to advances in drug and insulin treatment, improvements in the technology of blood glucose monitoring mean low blood sugar can be detected and treated in a timely manner. Incorporating these options into a diabetes self care regimen involves matching one's eating habits and lifestyle with diabetes medications. People who do not need to eat snacks to prevent low blood sugar should decide to include or not include them in their food plan on the basis of want. People who decide to include snacks in their meal plan should remember that there is no ideal snack. Some are more nutritious than others, some are more appropriate in certain situations, and some are more convenient than others. Advice about the inclusion of fruit and protein in snacks must be individualized. The article presents case examples to illustrate some of the points made in the article. In addition, the article presents questionnaires readers can use to decide whether to include snacks in a meal plan and how to fit medications into daily life.

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Polycystic Ovary Syndrome Source: Diabetes Self-Management. 18(6): 56-57,59. November-December 2001. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Website: www.diabetes-self-mgmt.com. Summary: This article discusses polycystic ovary syndrome (PCOS), a disorder characterized by high levels of male hormones (androgens) and chronic anovulation (failure to ovulate) in females. In addition, PCOS is associated with insulin resistance, the key problem underlying type 2 diabetes. In insulin resistance, body tissues, particularly muscle, fat, and liver cells, do not respond properly to insulin. As a result, more insulin than normal is needed to keep a person's blood glucose (sugar) level in the normal range. Diabetes develops in about one-third of all women with PCOS. Effective treatments are available for PCOS, and early diagnosis gives a woman the best chance of avoiding long term complications. The symptoms of PCOS typically develop during puberty and progress slowly. Symptoms can include increased body hair, thinning of scalp hair (alopecia), persistent acne, erratic menstrual cycles (two to six times a year), obesity, symptoms of low blood sugar after eating significant amounts of carbohydrate, and difficulty conceiving. Treatment usually includes weight reduction, exercise, and

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following a low carbohydrate diet. Additional therapy is tailored to the woman's main complaint, whether that is acne, hirsutism (excessive hair), alopecia, uncontrollable appetite, or infertility. Drugs used to treat PCOS can include oral contraceptives, androgen-blocking agents, and insulin-sensitizing agents. The author concludes that a multidisciplinary health care team is most appropriate for treating women with PCOS. One sidebar offers resources for readers who wish to obtain additional information about PCOS, its diagnosis, clinical features, potential complications, and treatments. •

Alcohol: A Primer Source: Diabetes Forecast. 52(3): 64-66. March 1999. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article discusses the impact of alcohol on diabetes. Alcohol usually has no adverse effects on blood glucose levels if it is used in moderation and with food by people who have well-controlled diabetes. However, problems can occur when alcohol is consumed in the absence of food or when excess amounts are consumed. Alcohol inhibits the liver from making glucose, and because it remains in the body for many hours, no glucose will enter the bloodstream from the liver. The glucose lowering effect of alcohol can last 8 to 12 hours. Hypoglycemia can develop at very mild intoxication levels if alcohol is consumed without food by people who use insulin or glucoselowering oral agents. Signs of low blood sugar can be confused with the signs of intoxication, so the occurrence of a low blood glucose reaction while consuming alcohol may not be treated. Consumption of too much alcohol can impair a person's judgment about his or her diabetes care. The article provides suggestions for staying healthy when alcohol is consumed, including eating prior to consuming an alcoholic beverage, consuming only one or two drinks over several hours, sticking with low-alcohol content drinks, being prepared for low blood sugar, talking with a doctor prior to drinking alcohol if taking a medication for diabetes, wearing medical identification, and monitoring blood glucose levels every few hours. 1 table.

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Night Hypo Source: Diabetes Forecast. 51(12): 56-59. December 1998. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article discusses the occurrence of low blood sugar reactions in the middle of the night. Although people who have type 1 diabetes are at highest risk for nocturnal hypoglycemia, it can occur in people who have type 2 diabetes and take insulin. Various insulins may cause nocturnal hypoglycemia if too much is taken, including NPH and Lente insulins, regular insulin, and short-acting insulin. Other causes of nocturnal hypoglycemia include too little food, more exercise than usual, autonomic neuropathy, unawareness of hypoglycemia, and alcohol consumption. The article offers suggestions on resolving problems with insulins, selecting a bedtime snack that tastes good and contains approximately the same nutritional value as a slow-release bar, compensating for increased physical activity, counteracting unawareness of hypoglycemia, and consuming alcoholic beverages. In addition, the article outlines ways to treat nocturnal hypoglycemia, offers suggestions on dealing with nocturnal hypoglycemia in a child, and lists nighttime and morning-after symptoms of nocturnal hypoglycemia.

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Diabetes Primer Source: Diabetes Forecast. 55(3): 63-67. March 2002. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article helps readers newly diagnosed with diabetes to better understand their disease. The author guides readers through the maze of lifestyle changes that a diagnosis of diabetes mandates. The author emphasizes that the earlier a patient educates him or herself and applies that new knowledge to every day diabetes care, the better chance they will have of living a normal life. The author defines diabetes and explains what goes wrong in type 1 and type 2 diabetes; explains the importance of nutrition; encourages readers to incorporate exercise into their diabetes management plan; and reviews the types of medications, including insulin, that can be used to treat diabetes. Other topics are monitoring (checking one's blood glucose levels), foot care, and the need for ongoing patient education and support groups. One sidebar explains low blood sugar (hypoglycemia) and how to combat it. 1 figure.

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Tackling the Tailgate Party Source: Diabetes Self-Management. 16(5): 42-43, 46-47. September-October 1999. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This article offers advice for people who have diabetes who attend a tailgate party. Suggestions include determining how the day's events will fit into one's diabetes management plan, bringing a potluck dish that is healthy, avoiding grazing on foods high in carbohydrates and calories, keeping track of alcoholic beverages, setting a watch alarm to be reminded to eat at a particular time, keeping testing supplies handy, having a convenient treatment for low blood sugar, and being prepared for changes in the weather. Other hints include keeping hot foods hot and cold foods cold by using insulated coolers and portable stoves and grills and considering one's level of physical activity and how it compares with one's normal routine. The article includes a list of books and web sites that offer information on tailgating.

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Preventing Blood Sugar Highs and Lows Source: Diabetes Self-Management. 16(6): 98-101, 104, 106, 108. November-December 1999. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This article offers tips for preventing hypoglycemic and hyperglycemic episodes during physical activity. Although physical activity has many benefits for people who have diabetes, it also presents some problems. The main problem is hypoglycemia, or low blood sugar. Hypoglycemia, which can happen during any type of physical activity, is usually defined as blood sugar below 70 milligrams (mg) per deciliter (dl). People who are active and take oral pills in combination with insulin may need to lower their insulin dose to prevent hypoglycemia. The article presents several examples of people who experienced hypoglycemia with physical activity and what actions they can take to solve problems such as having high blood sugar at bedtime after treating a hypoglycemic episode, overtreating hypoglycemia, and experiencing nighttime hypoglycemic episodes following physical activity in the evening. The article

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also discusses the management issues that arise when the new rapid acting insulin lispro is used and presents the experiences of one lispro user. Another problem people who have diabetes face when participating in physical activity is hyperglycemia. If a person does not burn up as much glucose as the liver is producing during physical activity, then it is possible for the level of glucose to be higher in the bloodstream following activity than it was prior to physical activity. People who have blood sugar levels above 240 mg/dl can still be physically active, but they should check their blood sugar 15 minutes after they start their activity. If it has decreased, they can continue their activity, but if it has increased, they should stop their activity. The article includes general exercise guidelines, provides suggestions for strategic snacking, and presents an example of adjusting the timing of insulin and meals in relation to activity. •

'Duh, Mom!' Source: Diabetes Forecast. 52(9): 68, 70. September 1999. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article presents a short quiz that parents can use to determine how much practical knowledge of food and diabetes they think their child possesses. Questions deal with identifying foods that contain carbohydrates, treating low blood sugar, compensating for sleeping late, eating chocolate, preparing for a physical activity, and understanding meal planning.

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All About Hypoglycemia Source: Diabetes Self-Management. 17(1): 21-22, 24, 26-27. January-February 2000. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This article presents an overview of hypoglycemia. When blood sugar gets too low, a condition called hypoglycemia, the body and brain are unable to function properly. Although hypoglycemia is defined as any blood sugar level under 70 milligrams per deciliter, people may treat themselves for hypoglycemia at different levels. Common causes of hypoglycemia include too much insulin or other medicine, too little food, too much physical activity, alcohol consumption, certain prescription medications, the menstrual cycle, and gastroparesis. Many symptoms accompany low blood sugar levels, but the most common symptoms are rapid heartbeat, sweating, shakiness, trembling, tingling or numbness in hands, feet, or face, difficulty thinking or concentrating, blurred vision, slurred speech, poor coordination, sleepiness, hunger, nausea, and headache. Hypoglycemia can also result in changes in emotions. Some people are unable to feel symptoms of low blood sugar until levels drop dangerously low, a condition known as hypoglycemia unawareness. Many people experience hypoglycemic episodes during sleep. This is a risky period to have hypoglycemia since a person is less likely to be aware of any warning symptoms. Failure to treat nighttime episodes of hypoglycemia can result in elevated blood glucose levels the following day. Hypoglycemia is a particular problem for older adults with diabetes. Treating hypoglycemia involves testing blood glucose levels, eating or drinking 10 to 15 grams of a fast-acting carbohydrate, and retesting blood glucose levels. A glucagon injection may be needed if a person is able to self treat for hypoglycemia. The article offers tips for preventing hypoglycemia.

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Taking Charge of Your Checkup Source: Diabetes Self-Management. 16(4): 8, 10-11, 14-15. July-August 1999. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This article presents the standards of medical care for people who have diabetes so that they will know if they are receiving appropriate care. A person who has diabetes should be receiving instruction from his or her physician on monitoring blood glucose levels, consuming the proper foods, exercising, following an insulin or other medication regimen, and preventing low blood sugar and other complications. During the first visit to a new physician, the physician should obtain a thorough medical history, perform a physical examination, conduct laboratory tests, and develop a diabetes management plan in collaboration with the patient. The frequency of visits to a physician following the first visit depend on the type of diabetes a person has, the success the person has in achieving blood glucose goals, the changes that may be needed in the treatment plan, and the effects of any complications from diabetes or other conditions. The standards of care also provide information on caring for children and adolescents who have diabetes; handling an illness; dealing with high or low blood glucose; caring for pregnant women; and treating hypertension, kidney disease, heart and circulatory problems, nerve damage, and foot problems.

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Preventing Injuries Source: Diabetes Self-Management. 16(4): 84, 86, 88, 90-92, 94, 96. July-August 1999. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This article provides guidelines for preventing exercise-related injuries. The article describes joints and ligaments, tendons, muscles, and bones; discusses injuries to these structures; and offers methods of preventing and treating these injuries. Joints are formed where two bones meet, and they are held together by ligaments. A sprain is a common joint or ligament injury. It occurs when the ligament is stretched beyond its normal length or torn from the bone. Although arthritis is not a joint injury, it can discourage exercise. Rheumatoid arthritis causes swelling or inflammation of the joints, and osteoarthritis results from a chronic breakdown of cartilage. Overuse of a joint or a joint injury can cause bursas to become inflamed and swollen. Tendons are tough, fibrous bands of tissue that connect the muscles to the bones. A common injury to tendons is an inflammation called tendinitis. Muscles are subject to various injuries, including pulls, tears, bruises, and strains. Bones form the hard skeleton that supports the body, and they may be broken. People who have osteoporosis, a condition in which bones gradually become weaker and less dense, are at risk of breaking a bone. Ways to keep the entire body healthy while exercising include stretching before and after a physical activity, wearing proper clothing, choosing good shoes, staying hydrated, avoiding low blood sugar, and paying attention to the body's reaction to physical activity. The article includes recommendations for selecting appropriate footwear; a list of exercise resources; and a description of balance, posture, and stretching exercises.

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Insider's Look at Insulin Pump Therapy Source: Diabetes Self-Management. 17(2): 28, 30-31, 33. March-April 2000. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Website: www.diabetes-self-mgmt.com.

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Summary: This article provides information on insulin pump therapy using a first person account of this form of insulin therapy. The insulin pump is a beeper size device that contains a cartridge filled with insulin. Insulin pump therapy mimics the pancreas by releasing small amounts of fast acting insulin every few minutes. This keeps the blood sugar level steady between meals and during sleep. When food is eaten, the pump delivers a larger quantity of insulin immediately to cover the carbohydrate in the meal. This type of treatment is ideal for people whose pancreas produces little or no insulin. Some of the advantages of pump therapy include more desirable blood sugar levels, fewer episodes of low blood sugar, a more flexible lifestyle, precise dosing, convenience, no shots, easy adjustments, and weight control. However, pump use does have some disadvantages. Disadvantages focus on the learning curve, inconvenience, technical difficulties, skin problems, risk of ketosis, and infusion set changes. The article describes what it is like to live with a pump, lists criteria for success in using an insulin pump, and outlines skills needed to make a successful transition to the pump. In addition, the article provides information on insulin pump manufacturers and distributors. •

Preventing Hypoglycemia (Low Blood Glucose) in Children Source: Diabetes Forecast. 52(6): 77-79. June 1999. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article provides parents of children who have diabetes with guidelines on preventing hypoglycemia, or low blood glucose. This condition can occur in anyone who takes insulin injections as well as in people who have type 2 diabetes and take sulfonylureas or Prandin. The level at which low blood sugar becomes serious depends on a child's age, health, and the occurrence of previous hypoglycemic episodes. The article presents strategies for preventing low blood sugar, including making sure that a child does not miss any meals or snacks, monitoring exercise levels, checking a child's blood sugar level at bedtime, and providing a bedtime snack. The article then outlines the mild, moderate, and severe signs of a low blood sugar and the symptoms of nighttime lows. Other topics include understanding hypoglycemia unawareness and ensuring that all the child's caretakers know how to recognize and treat hypoglycemia. In addition, the article provides guidelines for treating low blood sugar during the day and at night and for treating severe low blood glucose.

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Don't Let Diabetes Dog Your Date Source: Diabetes Self-Management. 17(4): 68, 70-72. July-August 2000. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Website: www.diabetes-self-mgmt.com. Summary: This article provides people who have diabetes with tips on dating. Although dating can bring hope and excitement, it can also can a lot of anxiety. Diabetes can add to the anxiety of dating because it is an important part of a person that could be seen as a flaw or imperfection. However, there are ways to keep diabetes from controlling a person's social life or preventing a person from seeking intimate relationships. The way a person feels about his or her diabetes strongly influences the way he or she presents it to others. Ways to change negative feelings about diabetes include taking the view that diabetes does not prevent a person from living a full life, viewing diabetes as a source of strength, being aware of one's own negativity, thinking about how one would react if his or her date had a medical condition, and getting support from others in a similar

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situation. People who have diabetes also need to balance their desire to be liked with their need to control their diabetes. Ways to accomplish this include being involved in planning the date, thinking through the specifics of the date and trying to imagine what types of problems or situations might occur, carrying a fast acting carbohydrate to treat low blood sugar, considering double dating with a friend, and being prepared for unacceptable offers. People who have diabetes should trust their instincts and reveal as little or much about their condition as makes them comfortable. •

Make Way for Baby Source: Diabetes Forecast. 50(12): 20-23, 25, 29, 31-38. December 1997. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article provides readers with information about preparing for and having a healthy pregnancy. The author points out that if a woman has not cared well for her diabetes before conceiving, she has missed an opportunity to decrease the risk of birth defects. Studies show that when diabetes is well controlled, the risk of birth defects drops from 17 percent to 3 to 5 percent, the same as that for women who do not have diabetes. The article provides information about planning for pregnancy and issues during each trimester. The risk for sudden, unexplained hypoglycemia (low blood sugar) is highest from the tenth to the sixteenth weeks. Diabetes care can not be abandoned after delivery, even though blood glucose levels can be monitored less frequently and are no longer as strict. One table in the article focuses on the rate of first trimester miscarriage in women with diabetes. Sidebars address type 2 diabetes and pregnancy; diabetic ketoacidosis; and breastfeeding. Nine personal stories conclude the article and feature photographs of each woman with her baby. (AA-M).

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Hypoglycemia in Patients with Renal Failure Source: Renal Failure. 22(2): 219-223. 2000. Contact: Available from Marcel Dekker Journals. P.O. Box 5017, Monticello, NY 127015176. (212) 696-9000. Summary: This article reports on a clinical study of hypoglycemia (low blood sugar) in patients with renal failure. Of a total of 1,545 admissions of end stage renal failure (ESRD) patients during a ten year period, 56 (3.6 percent) were admitted with hypoglycemia. Of these 56 patients, 38 had diabetes and the others were nondiabetic patients. The most common etiology found was drug induced hypoglycemia (the drugs responsible were hypoglycemic agents): 26 patients (46 percent). In 22 cases (39 percent), sepsis (infection) was the contributing cause of hypoglycemia. Severe malnutrition caused 7 percent of the hypoglycemic episodes. Of the patients, 18 (32 percent) with ESRD eventually died; however, none of them were from the drug induced group. However, sepsis induced hypoglycemia was a factor for 66 percent of the deaths; malnutrition was the etiologic factor for 17 percent of the deaths. The authors conclude that hypoglycemia is frequent in patients with ESRD and is often fatal if associated with either sepsis or malnutrition. 1 table. 11 references.

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Adapting Exercise to Your Health Source: Diabetes Forecast. 55(8): 77-80. August 2002. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org.

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Summary: This article, one in a series encouraging readers to undertake and maintain simple fitness programs, helps readers figure out what type of exercise may best fit their own individual situation. The author emphasizes that regular exercise offers many physical and psychological benefits. However, to develop a safe, effective, and enjoyable exercise program, one must take into account overall health, medical conditions, and exercise history. The author encourages readers to have a cardiac assessment, to choose an appropriate activity, to consider the types of medications that they are taking, and to make a commitment to exercise regularly and frequently. The article concludes with a sidebar that summarizes nine tips for exercising safely with diabetes: consult the diabetes team, monitor blood sugar (glucose), pay attention to how the exercise is affecting the body, time exercise around meals and medicines, always be prepared to treat low blood sugar (hypoglycemia), wear proper clothing and shoes, protect the feet, drink lots of fluids, and warm up and cool down. •

Have Diabetes, Will Travel: How to Help Patients Avoid Diabetic Emergencies Away from Home Source: Postgraduate Medicine. 105(2): 111-112, 117-118, 124-126. February 1999. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Summary: This article, the last of four articles on diabetes complications, provides physicians with guidelines on helping patients avoid diabetic emergencies when they travel. During a pretravel office visit, physicians can review diabetes management with patients and provide them with information and precautions for safe travel. This visit should be scheduled at least 4 to 6 weeks before departure. In addition to the office visit, consultation with a diabetes educator or other health care professional may be helpful. Advance planning with regard to meals, insulin storage and use, weather, and medical identification can help patients avoid diabetic complications and emergencies. For example, people who have diabetes should check with the airlines, trains, ships, and hotels about food preferences during travel; store insulin at the proper temperature; carry a letter from their doctor stating their insulin and syringe needs; review weather channels or newspapers for current weather conditions at their destination; wear or carry some form of medical identification; and pack at least twice the number of medications and supplies normally required. In addition, people who have diabetes should wrap their insulin vials in socks or pack them in soft clothing during travel, be prepared to treat low blood sugar, and review their health insurance policy for coverage abroad. The article also provides tips on preventing and managing illnesses and injuries, adjusting medications, and identifying sources of medical assistance. 1 figure. 1 table. 11 references.

Federally Funded Research on Low Blood Sugar The U.S. Government supports a variety of research studies relating to low blood sugar. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable

2

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to low blood sugar. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore low blood sugar. The following is typical of the type of information found when searching the CRISP database for low blood sugar: •

Project Title: IN VIVO STUDIES OF BRAIN GLYCOGEN IN HYPOGLYCEMIA Principal Investigator & Institution: Gruetter, Rolf; Associate Professor; Radiology; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2003; Project Start 01-DEC-2002; Project End 30-NOV-2007 Summary: (provided by applicant): Hypoglycemia unawareness is a complication of intensive insulin therapy often encountered after episodes of iatrogenic hypoglycemia. The associated blunting of counterregulation has been reported to occur in healthy humans after a single episode ofhypoglycemia. The mechanisms by which the brain detects low blood sugar concentrations are uncertain. The brain contains approximately 3 mM glycogen that may serve as a fuel during moderate hypoglycemia. In most tissues, glycogen metabolism is insulin- and glucose-sensitive. Brain glycogen thus provides an aspect of cerebral carbohydrate metabolism that is sensitive to alterations in glucose homeostasis such as those seen in diabetic patients. The purpose of this project is to determine the effect of hypoglycemia on brain glycogen and glucose metabolism and a potential involvement of glycogen metabolism in mediating hypoglycemia unawareness. In addition, we will assess the relationship between glucose transport and cerebral blood flow during hypoglycemia. The hypotheses of this project are (a) That brain glycogen concentration and metabolism are modulated by plasma glucose and/or insulin concentrations in vivo. (b) That brain glycogen can serve as a reservoir of glucose equivalents that are used for extended time periods during hypoglycemia in vivo when glucose transport becomes rate limiting for metabolism and cerebral blood flow is increased. (c) That following a hypoglycemic episode, the brain stores more brain glycogen such that longer and deeper subsequent hypoglycemia is necessary to deplete brain glycogen, which may provide a mechanism leading to hypoglycemia unawareness with the following specific aims: (1) To separate the effect of acutely elevated brain glucose concentrations from elevated plasma insulin concentrations on in vivo brain glycogen metabolism. (2) To determine the degree of supercompensation of brain glycogen following graded hypoglycemia and to establish that brain glycogen serves as a significant reservoir of glucosyl units during hypoglycemia. (3) To determine that depletion of brain glycogen as well as the acute increase in CBF is triggered when brain glucose concentrations approach the low Km of hexokinase. These aims will be achieved in rat brain using localized 1H and 13C NMR spectroscopy and perfusion-based fMRI. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NEUROCOGNITIVE IMPACT OF HYPOGLYCEMIA IN TYPE 1 DIABETES Principal Investigator & Institution: Hershey, Tamara G.; Psychiatry; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130

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Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-MAY-2008 Summary: (provided by applicant): A common difficulty in managing type 1 diabetes mellitus (T1DM) is hypoglycemia (low blood sugar). This complication is particularly common during childhood. Extreme hypoglycemia can cause coma or death, but less severe hypoglycemia can have consequences for cognitive function. However, it is not well understood how specific these cognitive consequences are and what their neural mechanisms might be, nor how these effects may differ across neural development. We propose to address these important questions. We hypothesize that severe hypoglycemia has a deleterious and specific effect on the hippocampus, a region particularly sensitive to metabolic insults, and on long-term memory, a skill that relies upon the integrity of the hippocampus, in children with T1DM. Using both retrospective and prospective methods, we will determine if the hippocampus is smaller in children with a history of repeated severe hypoglycemia. These measures will be obtained with high resolution structural magnetic resonance imaging and reliable volumetric measurements. We also will determine if reduced hippocampal volumes correlate with reduced long-term memory function. Memory function will be measured in part by a well-validated spatial delayed response measure that we have previously shown to be sensitive to repeated severe hypoglycemia in children with T1DM. We hypothesize that these effects will follow a developmental trajectory, with greater vulnerability in children who experienced hypoglycemia at younger ages due to interruption of critical developmental processes or to increased susceptibility for neuronal impact. The information obtained in this study will be important for the development of optimal treatment regimens for T1DM that minimize cognitive risk and maximize clinical benefit across the lifespan. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.3 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with low blood sugar, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “low blood sugar” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for low blood sugar (hyperlinks lead to article summaries):

3 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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Ideas for treating low blood sugar for diabetics on dialysis. Author(s): Littlefield D. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 1998 April; 8(2): 107. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9724493

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Is low blood sugar necessary? Author(s): Sheehan GA. Source: J Med Soc N J. 1973 January; 70(1): 59-60. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4509786

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Low blood sugar and motor vehicle crashes in persons with type 1 diabetes. Author(s): Songer T. Source: Annu Proc Assoc Adv Automot Med. 2002; 46: 424-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12361526

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Low blood sugar in the newborn. Author(s): Friedman M. Source: Midwife Health Visit. 1967 January; 3(1): 27-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5180504

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More to it than low blood sugar. Kason explores mystical experiences. Interview by Pam Harrison. Author(s): Kason Y. Source: Can Fam Physician. 1993 November; 39: 2316, 2318-20. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8268737

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CHAPTER 2. NUTRITION AND LOW BLOOD SUGAR Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and low blood sugar.

Finding Nutrition Studies on Low Blood Sugar The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.4 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “low blood sugar” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

4

Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “low blood sugar” (or a synonym): •

The lowdown on low blood sugar. Source: Tufts-Univ-diet-nutr-lett. New York, N.Y. : Tufts University Diet and Nutrition Letter, 1983-c1997. December 1995. volume 13 (10) page 4-6. 0747-4105

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

Nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

The following is a specific Web list relating to low blood sugar; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Minerals Chromium Source: Integrative Medicine Communications; www.drkoop.com Chromium Source: Prima Communications, Inc.www.personalhealthzone.com Chromium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10018,00.html Magnesium Source: Prima Communications, Inc.www.personalhealthzone.com Manganese Source: Healthnotes, Inc.; www.healthnotes.com Sulfur Source: Integrative Medicine Communications; www.drkoop.com

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Food and Diet Coffee Source: Healthnotes, Inc.; www.healthnotes.com Diabetes Source: Healthnotes, Inc.; www.healthnotes.com Tea Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. CLINICAL TRIALS AND LOW BLOOD SUGAR Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning low blood sugar.

Recent Trials on Low Blood Sugar The following is a list of recent trials dedicated to low blood sugar.5 Further information on a trial is available at the Web site indicated. •

Diagnosing and Treating Low Blood Sugar Levels Condition(s): Hypoglycemia; Insulinoma Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: Hypoglycemia is the term used to refer to lower than normal levels of blood sugar. This study will continue to research the causes of hypoglycemia. Patients involved in the study will be admitted to the Clinical Center of the National Institutes of Health and undergo tests for evaluating blood sugar. Patients will be required to refrain from eating for a set period of time and will undergo blood tests for insulin levels and several other specific diagnostic tests related to insulin secretion. The patients will be under supervision and will be provided with appropriate medical and surgical attention as needed. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001276

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These are listed at www.ClinicalTrials.gov.

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Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “low blood sugar” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 4. BOOKS ON LOW BLOOD SUGAR Overview This chapter provides bibliographic book references relating to low blood sugar. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on low blood sugar include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “low blood sugar” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on low blood sugar: •

Diabetes Mellitus: A Practical Handbook Source: San Mateo, CA: Bull Publishing Company. 1990. 200 p. Contact: Available from Bull Publishing Company. 148 East Third Avenue, Suite 200, San Mateo, CA 94401. (415) 340-7288. PRICE: $10.95 plus shipping and handling. ISBN: 0923521089. Summary: This book is an easy-to-use, patient-oriented guide to managing the everyday concerns of living with diabetes mellitus. The authors, one a nurse and one a dietitian, provide specific suggestions and helpful hints on the following topics: meal planning, food shopping, utilizing the American Diabetic Association exchange lists, medications, exercise, self monitoring of blood glucose levels, and identifying and treating low blood sugar. Numerous illustrations, menus, lists, and charts help provide an accessible, survival-skills approach to managing diabetes. A brief subject index and numerous

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resources for additional information, including books, articles, and organizations are included. 33 references. •

Sweet Kids: How to Balance Diabetes Control and Good Nutrition with Family Peace Source: Alexandria, VA: American Diabetes Association. 1996. 314 p. Contact: Available from American Diabetes Association, Inc. Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. PRICE: $11.95 (members), $14.95 (nonmembers). ISBN: 0945448678. Order code CSMSK. Summary: This book is designed to provide nutrition advice to parents and caregivers of children who have diabetes. The introduction notes that diabetes can interrupt a dinner pattern in which each family member is accustomed to eating according to his or her preferences. As the authors point out, however, pleasant meals are not out of reach for children with diabetes and their guardians. Stories by and about families are included in the 14 chapters, which are divided into four sections: healthy eating and feeding for all families; diabetes nutrition and meal planning; food, diabetes, and development; and suggestions for caretakers to keep their own balance and reason. Topics include the development of internal control over food choices and amounts; the body's natural system for appetite regulation; necessary foods; the effect of food on blood sugar and the coordination of food intake with insulin and exercise; the establishment of blood sugar goals and family problem solving; the role of snacks in overall nutrition; methods for coping more effectively with low blood sugar; the benefits and risks of exercise; eating disorders; nutrition specific to babies and toddlers, preschool and school-age children, and teenagers; the comfort of the whole family and parental needs; and encouragement for the child. The authors note that, while good nutrition is central to overall health and successful diabetes management, good diabetes control only occurs in families that are coping reasonably well with the same issues of parenting, loving, and discipline that affect every family. Each chapter begins with a picture and main point and ends with summarizing points. Figures and tables are included throughout, and an index concludes the book. (AA-M).

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What You Need to Know About Diabetes: A Short Guide Source: Boston, MA: Joslin Diabetes Center. 1999. 60 p. Contact: Available from Joslin Diabetes Center. One Joslin Place, Boston, MA 02215. (800) 344-4501 or (508) 583-3240. Fax (617) 732-2562. Website: www.joslin.harvard.edu. PRICE: $11.50 each; plus shipping and handling. Order number JDC210. Summary: This guide provides people who have diabetes with information on the basics of diabetes self care. The guide begins with a chapter that explains normal metabolism and the impact of diabetes on body functioning, identifies the short-and long-term risks of high blood sugar, defines low blood sugar, and offers self care tips. This is followed by a chapter that explains how to use good nutrition practices to care for diabetes. Topics include eating the right amount and kind of food at the right time; developing a meal plan; and making healthy food choices by limiting fatty foods, consuming high fiber food, using less salt, replacing sugar with artificial sweeteners, and limiting alcohol consumption. The chapter also offers tips for eating out and developing healthy eating habits and provides examples of food choices from various food groups. Chapter three provides guidelines for using exercise to care for diabetes, focusing on starting an exercise plan and preventing a low blood sugar reaction. This is followed by a chapter that focuses on the use of medications to care for diabetes. The chapter provides

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information on insulin, offers tips for drawing up and injecting a single or mixed dose of insulin, and presents suggestions for taking care of insulin and syringes. In addition, the chapter explains how oral diabetes medications work, presents guidelines for taking oral diabetes medications, and summarizes tips for using oral medications that are currently available. Chapter five focuses on the monitoring of blood glucose. Topics include the steps involved in checking blood for sugar and urine for ketones. The sixth chapter discusses special problems, including hyperglycemia, diabetic ketoacidosis, hyperglycemic hyperosmolar nonketotic state, and hypoglycemia. Remaining chapters outline sick day rules; offer foot care tips; present guidelines for avoiding eye, kidney, nerve, heart and blood vessel, and foot damage; and provide suggestions for living with diabetes. •

Renal Lifestyles Manual. 3rd ed Source: Marina del Rey, CA: R and D Laboratories. 1999. 338 p. Contact: Available from R and D Laboratories, Inc. 4640 Admiralty Way, Suite 710, Marina del Rey, CA 90292. (800) 338-9066 ext. 264 or (310) 305-8053. Fax (310) 305-8103. E-mail: [email protected]. Website: www.rndlabs.com. PRICE: $29.95 plus shipping and handling. ISBN: 0967043905. Summary: This manual serves as a guide to understanding and following special renal diets. The manual begins with a diagram of the renal system and complete diets for predialysis, hemodialysis, and continuous ambulatory peritoneal dialysis (CAPD) patients. The predialysis diet section includes menus and food choices for a 35 gram, 40 gram, and 50 gram protein diet. The predialysis diabetic section provides menus and food choices for a 45 gram, 55 gram, and 65 gram protein diet. The hemodialysis diet section presents menu and food choices for a 70 gram, 80 gram, and 95 gram protein diet. The CAPD diet section provides menus and food choices for a 75 gram, 90 gram, and 105 gram protein diet. Other sections focus on dialysis for people who have diabetes, foot care for people who have diabetes, high and low blood sugar symptoms, control of phosphorus levels, renal vitamins and phosphate binders, blood chemistry tests and values, fluid allowance, adequate dialysis, and dry weight. Additional sections provide guidelines for patients with diabetes and renal disease and offer tips on gaining and losing weight. Remaining sections present recipes for appetizers, entrees, and desserts; list the fiber content of common foods; and discuss sodium, potassium, phosphorus, protein, and fast food protein. The manual also includes a glossary.

•

Managing Your Diabetes Source: Indianapolis, IN: Eli Lilly and Company. 1991. 110 p. Contact: Available from Eli Lilly and Company. Lilly Corporate Center, Drop Code 106746285, Indianapolis, IN 46285. (317) 276-2000. PRICE: free. Summary: This patient book, available with a flip chart and video tape, is part of an integrated diabetes educational system titled 'Managing Your Diabetes' introduced by Eli Lilly and Company. It is designed in a convenient color-coded modular format. This 14 model system can be customized to meet individual patient needs. Topics are entitled: What is Diabetes?; Taking charge of Your Diabetes; Meal Planning; Physical Activity; Diabetes Medicines: Insulin; Diabetes Medicines: Diabetes Pills; Blood Sugar Testing; Ketone Testing; Pattern Management; Complication: Low Blood Sugar; Complications: Very High Blood Sugar; Complications: Dangerously High Blood Sugar; Long-Term Complications; and General Health Care Tips. The book includes a glossary of important terms. A summary page to record an individual diabetes management plan

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is also included. The system is useful in one on one or small group teaching situations as well as for larger group presentations. Also available in Spanish (see DMDC00886, Como Controlar Su Diabetes.).

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “low blood sugar” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “low blood sugar” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “low blood sugar” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Carlton Fredericks' New Low Blood Sugar and You by Carlton Fredericks; ISBN: 0399510877; http://www.amazon.com/exec/obidos/ASIN/0399510877/icongroupinterna

•

Do's and Don'ts of Hypoglycemia: An Everday Guide to Low Blood Sugar by Roberta Ruggiero; ISBN: 088391087X; http://www.amazon.com/exec/obidos/ASIN/088391087X/icongroupinterna

•

FOOD COMBINING BEAT LOW BLOOD SUGAR; ISBN: 0722532490; http://www.amazon.com/exec/obidos/ASIN/0722532490/icongroupinterna

•

Hypoglycemia Fact or Fad: What You Should Know About Low Blood Sugar by L. Bennion; ISBN: 9997801636; http://www.amazon.com/exec/obidos/ASIN/9997801636/icongroupinterna

•

Is Low Blood Sugar Making You a Nutritional Cripple? by Ruth Adams, et al; ISBN: 091596211X; http://www.amazon.com/exec/obidos/ASIN/091596211X/icongroupinterna

•

Low Blood Sugar by Peter Steincrohn; ISBN: 0451143299; http://www.amazon.com/exec/obidos/ASIN/0451143299/icongroupinterna

•

Low Blood Sugar : The Hidden Menace of Hypoglycemia by Clement G. Martin (Author); ISBN: 0671764101; http://www.amazon.com/exec/obidos/ASIN/0671764101/icongroupinterna

•

Low Blood Sugar and You by Carlton Fredricks, Carlton Fredericks; ISBN: 0441497640; http://www.amazon.com/exec/obidos/ASIN/0441497640/icongroupinterna

•

Low Blood Sugar and You; ISBN: 0448017458; http://www.amazon.com/exec/obidos/ASIN/0448017458/icongroupinterna

•

Low Blood Sugar and You by Fredericks C; ISBN: 0448122464; http://www.amazon.com/exec/obidos/ASIN/0448122464/icongroupinterna

•

LOW BLOOD SUGAR CKBK by Francyne Davis (Author); ISBN: 055325085X; http://www.amazon.com/exec/obidos/ASIN/055325085X/icongroupinterna

•

Low Blood Sugar Gourmet Cookbook by Dannett; ISBN: 0064634280; http://www.amazon.com/exec/obidos/ASIN/0064634280/icongroupinterna

Books

29

•

LOW BLOOD SUGAR Hypoglycemia: The 20th Century Epidemic? by Martin L. Budd (Author); ISBN: 0806977922; http://www.amazon.com/exec/obidos/ASIN/0806977922/icongroupinterna

•

Low Blood Sugar You-J by Carlton Fredericks; ISBN: 042512701X; http://www.amazon.com/exec/obidos/ASIN/042512701X/icongroupinterna

•

Low Blood Sugar: A Doctor's Guide to Its Effective Control by J. Frank Hurdle; ISBN: 0135410789; http://www.amazon.com/exec/obidos/ASIN/0135410789/icongroupinterna

•

Low Blood Sugar: Coping With Low Blood Sugar (Hypoglycemia) by Martin Budd; ISBN: 0722531192; http://www.amazon.com/exec/obidos/ASIN/0722531192/icongroupinterna

•

My Battle With Low Blood Sugar by G.M. Thienell; ISBN: 0682471984; http://www.amazon.com/exec/obidos/ASIN/0682471984/icongroupinterna

•

My Victory over Low Blood Sugar an Autobiography by Thienell; ISBN: 0668039175; http://www.amazon.com/exec/obidos/ASIN/0668039175/icongroupinterna

•

Peace of Mind: A Close Look at the Nutritional Cost of Alcohol Abuse, Low Blood Sugar and Food Allergies by Roger Lasage; ISBN: 0962584312; http://www.amazon.com/exec/obidos/ASIN/0962584312/icongroupinterna

•

Recognizing and Treating Low Blood Sugar; ISBN: 0937721123; http://www.amazon.com/exec/obidos/ASIN/0937721123/icongroupinterna

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Sugar and your health : nutritional problems, diabetes, and low blood sugar by Ray C. Wunderlich; ISBN: 0910812217; http://www.amazon.com/exec/obidos/ASIN/0910812217/icongroupinterna

•

The Do's and Don't s of Low Blood Sugar: An Everyday Guide to Hypoglycemia by Roberta Ruggiero; ISBN: 0811907910; http://www.amazon.com/exec/obidos/ASIN/0811907910/icongroupinterna

•

The Low Blood Sugar Cookbook; ISBN: 0553238353; http://www.amazon.com/exec/obidos/ASIN/0553238353/icongroupinterna

•

The Low Blood Sugar Cookbook: Sugarless Cooking for Everyone by Edward A. Krimmel, Patricia T. Krimmel; ISBN: 0916503011; http://www.amazon.com/exec/obidos/ASIN/0916503011/icongroupinterna

•

The Low Blood Sugar Gourmet Cookbook, by Sylvia G. L., Dannett; ISBN: 0847313484; http://www.amazon.com/exec/obidos/ASIN/0847313484/icongroupinterna

•

The Low Blood Sugar Handbook: You Don't Have to Suffer. by Edward A. Krimmel, et al; ISBN: 0916503046; http://www.amazon.com/exec/obidos/ASIN/0916503046/icongroupinterna

Chapters on Low Blood Sugar In order to find chapters that specifically relate to low blood sugar, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and low blood sugar using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “low blood

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Low Blood Sugar

sugar” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on low blood sugar: •

Treating Low Blood Sugar at Home Source: in Lincoln, T.A.; Eaddy, J.A. Beating the Blood Sugar Blues. Alexandria, VA: American Diabetes Association. 2001. p.32-43. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $12.95 plus shipping and handling. ISBN: 1580400485. Summary: This chapter is from a book that offers first hand knowledge from two doctors who have more than 100 years of combined experienced with the day-to-day balancing act of blood glucose (sugar) and diabetes. The authors, both of whom have type 1 diabetes, share their own stories as well as those of over 40 of their patients. In this chapter, the authors review the home treatments for hypoglycemia (low blood glucose levels), noting that treating low blood sugar at home should be simple. The patient just needs to eat or drink something with carbohydrate in it. As the food is digested and absorbed, the blood glucose level rises. However, when the level falls too low, the patient may not be able to feed himself or herself. The patient may even resist eating, fight being helped, have convulsions, or lapse into unconsciousness. The authors review strategies with which family members can handle most of the severe lows that occur at home. The authors discuss the role of self monitoring of blood glucose (SMBG), treatment of mild hypoglycemia, specific food and drink options and how much of each one to ingest, other factors that might have an impact on low blood glucose levels, the rebound effect, how to decide when to use glucagon, and treatments for severe hypoglycemia. 3 tables.

31

CHAPTER 5. MULTIMEDIA ON LOW BLOOD SUGAR Overview In this chapter, we show you how to keep current on multimedia sources of information on low blood sugar. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on low blood sugar is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “low blood sugar” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “low blood sugar” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on low blood sugar: •

Managing Diabetic Hypoglycemia Source: Alexandria, VA: American Diabetes Association. 2001. (videorecording). Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. E-mail: [email protected]. Fax: (770) 4429742. Website: www.diabetes.org. PRICE: $29.95. ISBN: 580401597. Summary: Hypoglycemic (low blood glucose) episodes can happen anywhere, anytime. They are frightening and can, indeed, be life-threatening. This upbeat videotape presents diabetes facts on how to prevent, identify and treat mild, moderate and severe hypoglycemia (low blood sugar reactions). This video is for people with diabetes, their family, friends, teachers, coaches and fellow employees. The video explains low blood sugar or insulin reactions for teachers, relatives, babysitters, and siblings. This video vividly portrays the mild, moderate, and severe forms of hypoglycemia. The program notes the symptoms and portrays the reactions in simple, clear, non-technical language. The program also explores the causes of low blood sugar and how to prevent them. Key

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Low Blood Sugar

instructors are: H. Peter Chase, M.D., Professor of Pediatrics, Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center and American Diabetes Association 2001 Physician of the Year; Robert Eckel, M.D. Professor of Medicine, University of Colorado Health Sciences Center; Kathy Jensen, RD, CDE. In addition, a wide variety of people with diabetes and parents of children with diabetes share their experiences and perspectives.

33

CHAPTER 6. PERIODICALS AND NEWS ON LOW BLOOD SUGAR Overview In this chapter, we suggest a number of news sources and present various periodicals that cover low blood sugar.

News Services and Press Releases One of the simplest ways of tracking press releases on low blood sugar is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “low blood sugar” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to low blood sugar. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “low blood sugar” (or synonyms). The following was recently listed in this archive for low blood sugar: •

Nightcap ups risk of low blood sugar in diabetics Source: Reuters Health eLine Date: October 25, 2001

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•

Low blood sugar shortens attention span: report Source: Reuters Health eLine Date: September 26, 2001

•

Low blood sugar impairs diabetic drivers Source: Reuters Health eLine Date: February 10, 2000

•

Low blood sugar puts diabetic drivers at risk Source: Reuters Health eLine Date: August 24, 1999 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “low blood sugar” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “low blood sugar” (or synonyms). If you know the name of a company that is relevant to low blood sugar, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/.

Periodicals and News

35

BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “low blood sugar” (or synonyms).

Academic Periodicals covering Low Blood Sugar Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to low blood sugar. In addition to these sources, you can search for articles covering low blood sugar that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

37

CHAPTER 7. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for low blood sugar. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with low blood sugar. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.).

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Low Blood Sugar

The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to low blood sugar: Antidiabetic Agents, Sulfonylurea •

Systemic - U.S. Brands: Amaryl; DiaBeta; Diabinese; Dymelor; Glucotrol; Glucotrol XL; Glynase PresTab; Micronase; Orinase; Tolinase http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202742.html

Diazoxide •

Oral - U.S. Brands: Proglycem http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202191.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

39

APPENDICES

41

APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute6: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

6

These publications are typically written by one or more of the various NIH Institutes.

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Low Blood Sugar

•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

Physician Resources

43

NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.7 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:8 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

7

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 8 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway9 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.10 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “low blood sugar” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 7755 14 994 9 107 8879

HSTAT11 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.12 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.13 Simply search by “low blood sugar” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

9

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

10

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 11 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 12 13

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

Physician Resources

45

Coffee Break: Tutorials for Biologists14 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.15 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.16 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

14 Adapted 15

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 16 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

47

APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on low blood sugar can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to low blood sugar. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to low blood sugar. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “low blood sugar”:

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Low Blood Sugar

Diabetes http://www.nlm.nih.gov/medlineplus/diabetes.html Diabetic Diet http://www.nlm.nih.gov/medlineplus/diabeticdiet.html Hypoglycemia http://www.nlm.nih.gov/medlineplus/hypoglycemia.html Hypoglycemia http://www.nlm.nih.gov/medlineplus/tutorials/hypoglycemialoader.html Juvenile Diabetes http://www.nlm.nih.gov/medlineplus/juvenilediabetes.html

Within the health topic page dedicated to low blood sugar, the following was listed: •

Diagnosis/Symptoms Glucose Tests Source: American Association for Clinical Chemistry http://www.labtestsonline.org/understanding/analytes/glucose/test.html

•

Specific Conditions/Aspects Are Low Blood Sugars Dangerous? Source: Joslin Diabetes Center http://www.joslin.harvard.edu/education/library/low_bs_danger.shtml Hyperinsulinemia Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ00896 What Can I Do to Prevent Serious Hypoglycemic Episodes When I Am Hypoglycemic Unaware? Source: Joslin Diabetes Center http://www.joslin.harvard.edu/education/library/hypoglycemic_unaware.shtml What Is Hypoglycemia? (Low Blood Sugar) Source: American Diabetes Association http://www.diabetes.org/type-1-diabetes/hypoglycemia.jsp

•

Children Ketotic Hypoglycemia in Infants Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=AN00302

•

Latest News Blood Sugar Sensor Improves Diabetes Control Source: 03/08/2004, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_16459 .html

Patient Resources •

49

Organizations American Diabetes Association http://www.diabetes.org/ National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on low blood sugar. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

How to Handle Low Blood Sugar Source: Patient Care. 33(8): 41. April 30, 1999. Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Fax (201) 573-4956. Summary: This article provides people who have diabetes with general guidelines on managing low blood sugar. Symptoms include shakiness, nervousness, dizziness, weakness, and irritability. Suggestions on managing low blood sugar include treating it immediately, wearing a medical identification bracelet, preparing for long drives or trips, informing one's doctor about all drugs being taken, and using alcohol only after consulting a doctor. The article also lists good sources of carbohydrates to treat low blood sugar.

•

Recognizing and Treating Low Blood Sugar Source: Minneapolis, MN: International Diabetes Center. 1994. 11 p. Contact: Available from International Diabetes Center. Attention: IDC Publishing, 3800 Park Nicollet Boulevard, Minneapolis, MN 55416. (612) 993-3874. PRICE: $1.95. ISBN: 1885115059. Summary: This booklet reviews the basics of recognizing and treating low blood glucose, or hypoglycemia. Sections address recognition of hypoglycemia, including symptoms, pseudo-hypoglycemia, and hypoglycemic unawareness; treatment, including carbohydrate, glucose gels, and glucagon; and prevention, including blood glucose testing (SMBG), exercise, schedule changes, and precautions for drivers. The authors conclude by reiterating the importance of continual preparedness for

50

Low Blood Sugar

hypoglycemic reactions and remind readers of the importance of medical alert identification. One chart lists the levels of hypoglycemia and the symptoms and recommended treatment for each level. •

Low Blood Sugar Source: San Diego, CA: Linda Vista Health Care Center. 1992. 2 p. Contact: Available from Linda Vista Health Care Center. 6973 Linda Vista Road, San Diego, CA 92111. (619) 279-0925. PRICE: Single copy free. Reproduction is allowed. Summary: This brief patient education brochure reviews the problems of low blood glucose. Written in easy-to-understand language, the brochure defines low blood glucose, explains when and how it can happen, lists the symptoms, and gives suggestions for treating a hypoglycemic reaction. A final section reminds readers of steps to take to avoid problems with low blood glucose. Simple line drawings accompany each point presented. This brochure is also available in Laotian (see DMBR01846) and Vietnamese (see DMBR01847). The National Guideline Clearinghouse™

The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “low blood sugar” (or synonyms). The following was recently posted: •

2001 USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 1999 August (updated 2001 November 28); 64 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3080&nbr=2306&a mp;string=low+AND+blood+AND+sugar

•

American Gastroenterological Association medical position statement: guidelines for the evaluation and management of chronic diarrhea Source: American Gastroenterological Association - Medical Specialty Society; 1998 November 8 (reviewed 2001); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3065&nbr=2291&a mp;string=low+AND+blood+AND+sugar

•

American Gastroenterological Association medical position statement: short bowel syndrome and intestinal transplantation Source: American Gastroenterological Association - Medical Specialty Society; 2003 April; 6 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3795&nbr=3021&a mp;string=low+AND+blood+AND+sugar

Patient Resources •

51

Assessment and management of acute pain Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 2000 October (revised 2002 Oct); 74 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3500&nbr=2726&a mp;string=low+AND+blood+AND+sugar

•

Chemotherapy and biotherapy: guidelines and recommendations for practice Source: Oncology Nursing Society - Professional Association; 2001; 226 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3209&nbr=2435&a mp;string=low+AND+blood+AND+sugar

•

Chronic kidney disease (non-dialysis) medical nutrition therapy protocol Source: American Dietetic Association - Professional Association; 2002 May; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3293&nbr=2519&a mp;string=low+AND+blood+AND+sugar

•

Clinical practice guideline (second edition) for the diagnosis, treatment, and management of reflex sympathetic dystrophy/complex regional pain syndrome (RSD/CRPS) Source: Reflex Sympathetic Dystrophy Syndrome Association - Private Nonprofit Organization; 2002 February; 46 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3204&nbr=2430&a mp;string=low+AND+blood+AND+sugar

•

Clinical practice guidelines for nutrition in chronic renal failure Source: National Kidney Foundation - Disease Specific Society; 2000 June; 121 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2545&nbr=1771&a mp;string=low+AND+blood+AND+sugar

•

Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock Source: American College of Critical Care Medicine - Professional Association; 2002 June; 14 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3433&nbr=2659&a mp;string=low+AND+blood+AND+sugar

52

•

Low Blood Sugar

Congestive heart failure in adults Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1997 October (revised 2002 Jan); 71 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3165&nbr=2391&a mp;string=low+AND+blood+AND+sugar

•

Diagnosis and treatment of adult degenerative joint disease (DJD) of the knee Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1996 June (revised 2002 May); 42 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3355&nbr=2581&a mp;string=low+AND+blood+AND+sugar

•

Diagnosis of chest pain Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1995 July (revised 2002 Oct); 50 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3674&nbr=2900&a mp;string=low+AND+blood+AND+sugar

•

Evidence-based guidelines for breastfeeding management during the first fourteen days Source: International Lactation Consultant Association - Professional Association; 1999 April; 31 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2109&nbr=1335&a mp;string=low+AND+blood+AND+sugar

•

Hyperglycemic crises in patients with diabetes mellitus Source: American Diabetes Association - Professional Association; 2000 October (revised 2001; republished 2003 Jan); 9 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3582&nbr=2808&a mp;string=low+AND+blood+AND+sugar

•

Hyperlipidemia medical nutrition therapy protocol Source: American Dietetic Association - Professional Association; 2001 June; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3295&nbr=2521&a mp;string=low+AND+blood+AND+sugar

Patient Resources •

53

Lipid management in adults Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1997 October (revised 2002 Jul); 61 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3410&nbr=2636&a mp;string=low+AND+blood+AND+sugar

•

Management of chronic kidney disease and pre-ESRD in the primary care setting Source: Department of Defense - Federal Government Agency [U.S.]; 2000 November; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3099&nbr=2325&a mp;string=low+AND+blood+AND+sugar

•

Management of type 2 diabetes mellitus Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1996 March (revised 2002 Sep); 77 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3499&nbr=2725&a mp;string=low+AND+blood+AND+sugar

•

Massachusetts guidelines for adult diabetes care Source: Massachusetts Department of Public Health, Bureau of Family and Community Health, Diabetes Control Program - State/Local Government Agency [U.S.]; 1999 June (revised 2001 Jun); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3429&nbr=2655&a mp;string=low+AND+blood+AND+sugar

•

Practice guidelines for the management of infectious diarrhea Source: Infectious Diseases Society of America - Medical Specialty Society; 2001 February; 21 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2791&nbr=2017&a mp;string=low+AND+blood+AND+sugar

•

Reflex sympathetic dystrophy/complex regional pain syndrome clinical practice guidelines - third edition Source: International Research Foundation for RSD/CRPS - Private Nonprofit Research Organization; 2003 January 1; 48 pages http://www.guideline.gov/summary/summary.aspx?doc_id=4117&nbr=3162&a mp;string=low+AND+blood+AND+sugar

54

•

Low Blood Sugar

Specialty referral guidelines for cardiovascular evaluation and management Source: American Healthways, Inc - Public For Profit Organization; 2002; 26 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3168&nbr=2394&a mp;string=low+AND+blood+AND+sugar

•

The management of diabetes mellitus in the primary care setting Source: Department of Defense - Federal Government Agency [U.S.]; 1999 December; 147 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2583&nbr=1809&a mp;string=low+AND+blood+AND+sugar

•

The primary care management of erectile dysfunction Source: Department of Veterans Affairs - Federal Government Agency [U.S.]; 1999 June; 67 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2577&nbr=1803&a mp;string=low+AND+blood+AND+sugar

•

Translation of the diabetes nutrition recommendations for health care institutions Source: American Diabetes Association - Professional Association; 1996 August (reviewed 1997; republished 2003 Jan); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3570&nbr=2796&a mp;string=low+AND+blood+AND+sugar

•

Treatment of pressure ulcers Source: Agency for Healthcare Research and Quality - Federal Government Agency [U.S.]; 1994 December (reviewed 2000); 154 pages http://www.guideline.gov/summary/summary.aspx?doc_id=810&nbr=8&st ring=low+AND+blood+AND+sugar

•

VHA/DoD clinical practice guideline for the management of substance use disorders Source: Department of Defense - Federal Government Agency [U.S.]; 2001 September; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3169&nbr=2395&a mp;string=low+AND+blood+AND+sugar Healthfinder™

Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database:

Patient Resources •

55

Hypoglycemia Summary: Hypoglycemia, or low blood sugar, occurs when blood levels of glucose drop too low to fuel the body's activity. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=838 The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to low blood sugar. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to low blood sugar. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with low blood sugar. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about low blood sugar. For more information,

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Low Blood Sugar

see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “low blood sugar” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “low blood sugar”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “low blood sugar” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “low blood sugar” (or a synonym) into the search box, and click “Submit Query.”

57

APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.17

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

17

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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Low Blood Sugar

libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)18: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

18

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries 59 •

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries 61 •

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

63

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

65

LOW BLOOD SUGAR DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abscess: A localized, circumscribed collection of pus. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Acne: A disorder of the skin marked by inflammation of oil glands and hair glands. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Agonists: Drugs that trigger an action from a cell or another drug. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alopecia: Absence of hair from areas where it is normally present. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amenorrhea: Absence of menstruation. [NIH]

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Amylopectin: A highly branched glucan in starch. [NIH] Amylose: An unbranched glucan in starch. [NIH] Analytes: A component of a test sample the presence of which has to be demonstrated. The term "analyte" includes where appropriate formed from the analyte during the analyses. [NIH]

Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anovulation: Suspension or cessation of ovulation in animals and humans. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Appetite Regulation: Physiologic mechanisms which regulate or control the appetite and food intake. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Articular: Of or pertaining to a joint. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Neuropathy: A disease of the nerves affecting mostly the internal organs such as the bladder muscles, the cardiovascular system, the digestive tract, and the genital organs. These nerves are not under a person's conscious control and function automatically. Also called visceral neuropathy. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH]

Index 67

Basal Ganglia Diseases: Diseases of the basal ganglia including the putamen; globus pallidus; claustrum; amygdala; and caudate nucleus. Dyskinesias (most notably involuntary movements and alterations of the rate of movement) represent the primary clinical manifestations of these disorders. Common etiologies include cerebrovascular disease; neurodegenerative diseases; and craniocerebral trauma. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brain Infarction: The formation of an area of necrosis in the brain, including the cerebral hemispheres (cerebral infarction), thalami, basal ganglia, brain stem (brain stem infarctions), or cerebellum secondary to an insufficiency of arterial or venous blood flow. [NIH] Brain Stem: The part of the brain that connects the cerebral hemispheres with the spinal cord. It consists of the mesencephalon, pons, and medulla oblongata. [NIH] Brain Stem Infarctions: Infarctions that occur in the brain stem which is comprised of the midbrain, pons, and medulla. There are several named syndromes characterized by their distinctive clinical manifestations and specific sites of ischemic injury. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

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Breakdown: A physical, metal, or nervous collapse. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Cardiac: Having to do with the heart. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular System: The heart and the blood vessels by which blood is pumped and circulated through the body. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral hemispheres: The two halves of the cerebrum, the part of the brain that controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. The right hemisphere controls muscle movement on the left side of the body, and the left hemisphere controls muscle movement on the right side of the body. [NIH] Cerebral Infarction: The formation of an area of necrosis in the cerebrum caused by an insufficiency of arterial or venous blood flow. Infarcts of the cerebrum are generally classified by hemisphere (i.e., left vs. right), lobe (e.g., frontal lobe infarction), arterial distribution (e.g., infarction, anterior cerebral artery), and etiology (e.g., embolic infarction). [NIH]

Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that

Index 69

contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Cholinergic Agents: Any drug used for its actions on cholinergic systems. Included here are agonists and antagonists, drugs that affect the life cycle of acetylcholine, and drugs that affect the survival of cholinergic neurons. The term cholinergic agents is sometimes still used in the narrower sense of muscarinic agonists, although most modern texts discourage that usage. [NIH] Chorea: Involuntary, forcible, rapid, jerky movements that may be subtle or become confluent, markedly altering normal patterns of movement. Hypotonia and pendular reflexes are often associated. Conditions which feature recurrent or persistent episodes of chorea as a primary manifestation of disease are referred to as choreatic disorders. Chorea is also a frequent manifestation of basal ganglia diseases. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH]

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Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Dental Hygienists: Persons trained in an accredited school or dental college and licensed by the state in which they reside to provide dental prophylaxis under the direction of a licensed dentist. [NIH] Dentate Gyrus: Gray matter situated above the gyrus hippocampi. It is composed of three layers. The molecular layer is continuous with the hippocampus in the hippocampal fissure. The granular layer consists of closely arranged spherical or oval neurons, called granule cells, whose axons pass through the polymorphic layer ending on the dendrites of pyramidal cells in the hippocampus. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diabetic Ketoacidosis: Complication of diabetes resulting from severe insulin deficiency coupled with an absolute or relative increase in glucagon concentration. The metabolic acidosis is caused by the breakdown of adipose stores and resulting increased levels of free fatty acids. Glucagon accelerates the oxidation of the free fatty acids producing excess ketone bodies (ketosis). [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Dietitian: An expert in nutrition who helps people plan what and how much food to eat.

Index 71

[NIH]

Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duct: A tube through which body fluids pass. [NIH] Dura mater: The outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and spinal cord; called also pachymeninx. [EU] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Eating Disorders: A group of disorders characterized by physiological and psychological disturbances in appetite or food intake. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Endocrine Glands: Ductless glands that secrete substances which are released directly into the circulation and which influence metabolism and other body functions. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Entorhinal Cortex: Cortex where the signals are combined with those from other sensory systems. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH]

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Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] Facial: Of or pertaining to the face. [EU] Facial Nerve: The 7th cranial nerve. The facial nerve has two parts, the larger motor root which may be called the facial nerve proper, and the smaller intermediate or sensory root. Together they provide efferent innervation to the muscles of facial expression and to the lacrimal and salivary glands, and convey afferent information for taste from the anterior two-thirds of the tongue and for touch from the external ear. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Food Preferences: The selection of one food over another. [NIH] Foot Care: Taking special steps to avoid foot problems such as sores, cuts, bunions, and calluses. Good care includes daily examination of the feet, toes, and toenails and choosing shoes and socks or stockings that fit well. People with diabetes have to take special care of their feet because nerve damage and reduced blood flow sometimes mean they will have less feeling in their feet than normal. They may not notice cuts and other problems as soon as they should. [NIH] Fructose: A type of sugar found in many fruits and vegetables and in honey. Fructose is used to sweeten some diet foods. It is considered a nutritive sweetener because it has calories. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Emptying: The evacuation of food from the stomach into the duodenum. [NIH] Gastroparesis: Nerve or muscle damage in the stomach. Causes slow digestion and emptying, vomiting, nausea, or bloating. Also called delayed gastric emptying. [NIH] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Genital: Pertaining to the genitalia. [EU] Gingivitis: Inflammation of the gingivae. Gingivitis associated with bony changes is referred to as periodontitis. Called also oulitis and ulitis. [EU]

Index 73

Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glucokinase: A group of enzymes that catalyzes the conversion of ATP and D-glucose to ADP and D-glucose 6-phosphate. They are found in invertebrates and microorganisms and are highly specific for glucose. (Enzyme Nomenclature, 1992) EC 2.7.1.2. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heartbeat: One complete contraction of the heart. [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hexokinase: An enzyme that catalyzes the conversion of ATP and a D-hexose to ADP and a D-hexose 6-phosphate. D-Glucose, D-mannose, D-fructose, sorbitol, and D-glucosamine can act as acceptors; ITP and dATP can act as donors. The liver isoenzyme has sometimes been called glucokinase. (From Enzyme Nomenclature, 1992) EC 2.7.1.1. [NIH] Hippocampus: A curved elevation of gray matter extending the entire length of the floor of the temporal horn of the lateral ventricle (Dorland, 28th ed). The hippocampus, subiculum, and dentate gyrus constitute the hippocampal formation. Sometimes authors include the entorhinal cortex in the hippocampal formation. [NIH]

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Hirsutism: Excess hair in females and children with an adult male pattern of distribution. The concept does not include hypertrichosis, which is localized or generalized excess hair. [NIH]

Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hyperglycemia: Abnormally high blood sugar. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrichosis: Localized or generalized excess hair. The concept does not include hirsutism, which is excess hair in females and children with an adult male pattern of distribution. [NIH] Hypoglycemia: Abnormally low blood sugar [NIH] Hypoglycemic: An orally active drug that produces a fall in blood glucose concentration. [NIH]

Hypoglycemic Agents: Agents which lower the blood glucose level. [NIH] Hypotension: Abnormally low blood pressure. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Impotence: The inability to perform sexual intercourse. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins,

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intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infectious Diarrhea: Diarrhea caused by infection from bacteria, viruses, or parasites. [NIH] Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intravenous: IV. Into a vein. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Isoenzyme: Different forms of an enzyme, usually occurring in different tissues. The isoenzymes of a particular enzyme catalyze the same reaction but they differ in some of their properties. [NIH] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Ketoacidosis: Acidosis accompanied by the accumulation of ketone bodies (ketosis) in the body tissues and fluids, as in diabetic acidosis. [EU] Ketone Bodies: Chemicals that the body makes when there is not enough insulin in the

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blood and it must break down fat for its energy. Ketone bodies can poison and even kill body cells. When the body does not have the help of insulin, the ketones build up in the blood and then "spill" over into the urine so that the body can get rid of them. The body can also rid itself of one type of ketone, called acetone, through the lungs. This gives the breath a fruity odor. Ketones that build up in the body for a long time lead to serious illness and coma. [NIH] Ketosis: A condition of having ketone bodies build up in body tissues and fluids. The signs of ketosis are nausea, vomiting, and stomach pain. Ketosis can lead to ketoacidosis. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Libido: The psychic drive or energy associated with sexual instinct in the broad sense (pleasure and love-object seeking). It may also connote the psychic energy associated with instincts in general that motivate behavior. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Lipid: Fat. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malabsorption syndrome: A group of symptoms such as gas, bloating, abdominal pain, and diarrhea resulting from the body's inability to properly absorb nutrients. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Medical Assistance: Financing of medical care provided to public assistance recipients. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH]

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Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Miscarriage: Spontaneous expulsion of the products of pregnancy before the middle of the second trimester. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Motor Activity: The physical activity of an organism as a behavioral phenomenon. [NIH] Muscarinic Agonists: Drugs that bind to and activate muscarinic cholinergic receptors (receptors, muscarinic). Muscarinic agonists are most commonly used when it is desirable to increase smooth muscle tone, especially in the GI tract, urinary bladder and the eye. They may also be used to reduce heart rate. [NIH] Muscular Dystrophies: A general term for a group of inherited disorders which are characterized by progressive degeneration of skeletal muscles. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Nephropathy: Disease of the kidneys. [EU]

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Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Nervousness: Excessive excitability and irritability, with mental and physical unrest. [EU] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Oligomenorrhea: Abnormally infrequent menstruation. [NIH] Opportunistic Infections: An infection caused by an organism which becomes pathogenic under certain conditions, e.g., during immunosuppression. [NIH] Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovulation: The discharge of a secondary oocyte from a ruptured graafian follicle. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Pachymeningitis: Inflammation of the dura mater of the brain, the spinal cord or the optic nerve. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palsy: Disease of the peripheral nervous system occurring usually after many years of increased lead absorption. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior

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abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Parotid: The space that contains the parotid gland, the facial nerve, the external carotid artery, and the retromandibular vein. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Periodontal Abscess: Localized circumscribed purulent area of inflammation in the periodontal tissue. It is a derivative of marginal periodontitis and commonly associated with suprabony and infrabony pockets and interradicular involvements, in contrast to periapical abscess which is attributable to pulp necrosis. [NIH] Periodontitis: Inflammation of the periodontal membrane; also called periodontitis simplex. [NIH]

Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneal Dialysis: Dialysis fluid being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized

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by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polycystic: An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. PKD may cause chronic renal failure and end-stage renal disease. [NIH] Polycystic Ovary Syndrome: Clinical symptom complex characterized by oligomenorrhea or amenorrhea, anovulation, and regularly associated with bilateral polycystic ovaries. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Problem Solving: A learning situation involving more than one alternative from which a selection is made in order to attain a specific goal. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prophylaxis: An attempt to prevent disease. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Puberty: The period during which the secondary sex characteristics begin to develop and

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the capability of sexual reproduction is attained. [EU] Public Assistance: Financial assistance to impoverished persons for the essentials of living through federal, state or local government programs. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Purulent: Consisting of or containing pus; associated with the formation of or caused by pus. [EU] Rebound effect: The characteristic of a drug to produce reverse effects when either the effect of the drug has passed, or when the patient no longer responds to the drug. [EU] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Resolving: The ability of the eye or of a lens to make small objects that are close together, separately visible; thus revealing the structure of an object. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH]

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Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Ships: Large vessels propelled by power or sail used for transportation on rivers, seas, oceans, or other navigable waters. Boats are smaller vessels propelled by oars, paddles, sail, or power; they may or may not have a deck. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Short Bowel Syndrome: A malabsorption syndrome resulting from extensive operative resection of small bowel. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Sorbitol: A polyhydric alcohol with about half the sweetness of sucrose. Sorbitol occurs naturally and is also produced synthetically from glucose. It was formerly used as a diuretic and may still be used as a laxative and in irrigating solutions for some surgical procedures. It is also used in many manufacturing processes, as a pharmaceutical aid, and in several research applications. [NIH] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Sperm: The fecundating fluid of the male. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spirochete: Lyme disease. [NIH]

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Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subiculum: A region of the hippocampus that projects to other areas of the brain. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH] Syphilis: A contagious venereal disease caused by the spirochete Treponema pallidum. [NIH]

Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Tendinitis: Inflammation of tendons and of tendon-muscle attachments. [EU] Tendon: A discrete band of connective tissue mainly composed of parallel bundles of collagenous fibers by which muscles are attached, or two muscles bellies joined. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thiamine: 3-((4-Amino-2-methyl-5-pyrimidinyl)methyl)-5-(2methylthiazolium chloride. [NIH]

hydroxyethyl)-4-

Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [NIH]

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Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Triglyceride: A lipid carried through the blood stream to tissues. Most of the body's fat tissue is in the form of triglycerides, stored for use as energy. Triglycerides are obtained primarily from fat in foods. [NIH] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venereal: Pertaining or related to or transmitted by sexual contact. [EU] Venous: Of or pertaining to the veins. [EU] Venous blood: Blood that has given up its oxygen to the tissues and carries carbon dioxide back for gas exchange. [NIH] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary

Index 85

artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Vivo: Outside of or removed from the body of a living organism. [NIH] Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Xerostomia: Decreased salivary flow. [NIH]

87

INDEX A Abdominal, 67, 78, 81 Abscess, 67, 81 Acetylcholine, 67, 71 Acidosis, 67, 72, 77 Acne, 5, 67 Adenosine, 67, 81 Adverse Effect, 6, 67, 84 Affinity, 67, 84 Age of Onset, 67, 86 Agonists, 67, 71, 79 Algorithms, 67, 69 Alopecia, 5, 67 Alternative medicine, 34, 67 Amenorrhea, 67, 82 Amylopectin, 4, 68 Amylose, 4, 68 Analytes, 48, 68 Androgens, 5, 68 Anovulation, 5, 68, 82 Antibody, 67, 68, 77 Antigen, 67, 68, 77 Anxiety, 10, 68 Appetite Regulation, 26, 68 Arterial, 68, 69, 70, 76, 82, 85 Arteries, 68, 69, 72, 79 Arterioles, 68, 69 Artery, 68, 69, 70, 72, 81, 83, 87 Articular, 68, 80 Asymptomatic, 4, 68 Atrophy, 3, 68 Autonomic, 6, 67, 68, 81 Autonomic Neuropathy, 6, 68 B Bacteria, 68, 77, 83, 86 Basal Ganglia, 68, 69, 71 Basal Ganglia Diseases, 69, 71 Base, 69, 77, 85 Benign, 69, 75 Bilateral, 69, 82 Bile, 69, 74, 78 Biochemical, 69, 80 Biotechnology, 14, 34, 43, 69 Bladder, 68, 69, 71, 79, 86 Bloating, 69, 74, 78 Blood Glucose, 4, 5, 6, 7, 8, 9, 10, 11, 25, 27, 30, 31, 49, 50, 69, 76, 77 Blood pressure, 69, 76, 79, 84

Blood vessel, 27, 69, 70, 71, 77, 81, 84, 85, 86 Body Fluids, 69, 73, 84 Bowel, 69, 73, 81, 84 Bowel Movement, 69, 73 Brain Infarction, 3, 69 Brain Stem, 69, 70 Brain Stem Infarctions, 69 Branch, 63, 69, 84, 85 Breakdown, 9, 70, 72, 73 C Carbohydrate, 4, 5, 8, 10, 11, 13, 30, 49, 70 Cardiac, 12, 70, 73, 79 Cardiovascular, 54, 68, 70 Cardiovascular System, 68, 70 Case report, 70, 71 Case series, 70, 71 Cell, 67, 68, 69, 70, 73, 74, 77, 81, 82, 83 Central Nervous System, 3, 67, 70, 74, 75 Central Nervous System Infections, 70, 75 Cerebellum, 69, 70 Cerebral, 13, 68, 69, 70, 72 Cerebral hemispheres, 68, 69, 70 Cerebral Infarction, 69, 70 Cerebrum, 70 Character, 70, 72 Chest Pain, 52, 70 Chin, 70, 79 Cholesterol, 4, 69, 71 Cholinergic, 4, 71, 79 Cholinergic Agents, 4, 71 Chorea, 3, 71 Chronic, 3, 5, 9, 50, 51, 53, 71, 73, 77, 78, 82, 85 Chronic renal, 51, 71, 82 Clinical study, 11, 71 Clinical trial, 13, 21, 22, 43, 71, 82 Cloning, 69, 71 Collapse, 70, 71 Compliance, 5, 71 Computational Biology, 43, 71 Consciousness, 71, 72 Consultation, 12, 71 Consumption, 6, 8, 26, 71, 83 Contraindications, ii, 71 Convulsions, 30, 72 Coordination, 8, 26, 70, 72 Coronary, 72, 79

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Coronary Thrombosis, 72, 79 Cranial, 70, 72, 74, 75, 81 Craniocerebral Trauma, 69, 72, 75 Curative, 72, 85 D Degenerative, 52, 72, 80 Dementia, 3, 72 Dental Hygienists, 4, 72 Dentate Gyrus, 72, 75 Diabetes Mellitus, 4, 14, 25, 52, 54, 72, 75 Diabetic Ketoacidosis, 11, 27, 72 Diagnostic procedure, 34, 72 Dialyzer, 72, 75 Diarrhea, 50, 72, 77, 78 Diastolic, 72, 76 Dietitian, 25, 72 Digestion, 4, 69, 73, 74, 78, 85 Digestive system, 22, 73 Digestive tract, 68, 73 Direct, iii, 37, 73, 83 Dizziness, 49, 73 Drug Interactions, 38, 73 Duct, 73, 74, 83 Dura mater, 73, 79, 80 Dystrophy, 51, 54, 73 E Eating Disorders, 26, 73 Electrolyte, 73, 82, 84 Endocrine Glands, 73 Endometrium, 73, 79 End-stage renal, 71, 73, 82 Entorhinal Cortex, 73, 75 Environmental Health, 42, 44, 73 Enzyme, 73, 75, 77 Epigastric, 73, 81 Erectile, 54, 73 Erection, 73 Esophagus, 73, 85 Excitability, 73, 80 Exocrine, 74, 80 Exogenous, 74, 86 Extracellular, 74, 84 Extravasation, 74, 75 F Facial, 74, 81 Facial Nerve, 74, 81 Family Planning, 43, 74 Fat, 4, 5, 74, 78, 84, 86 Fatigue, 74, 75 Fatty acids, 72, 74 Food Preferences, 12, 74 Foot Care, 7, 27, 74

Fructose, 74, 75 G Gallbladder, 67, 73, 74 Ganglia, 67, 69, 74, 80, 81 Gastric, 74 Gastric Emptying, 74 Gastroparesis, 8, 74 Gels, 50, 74 Gene, 69, 74 Genital, 68, 74 Gingivitis, 4, 74 Gland, 5, 75, 80, 81, 83, 85 Glomerular, 75, 83 Glucokinase, 75 Glucose, 4, 6, 8, 9, 10, 12, 13, 30, 48, 50, 55, 69, 72, 75, 77, 84 Glucose Intolerance, 72, 75 Glycogen, 13, 75 Governing Board, 75, 82 Growth, 68, 75, 82, 85 H Headache, 8, 75 Headache Disorders, 75 Heart failure, 52, 75 Heartbeat, 8, 75 Hematoma, 3, 75 Hemodialysis, 27, 72, 75 Hemorrhage, 72, 75, 85 Hexokinase, 13, 75 Hippocampus, 14, 72, 75, 85 Hirsutism, 6, 76 Homeostasis, 13, 76 Hormonal, 68, 76 Hormone, 76, 77, 85 Hydrogen, 67, 69, 70, 76, 80 Hyperglycemia, 4, 8, 27, 76 Hypertension, 9, 75, 76 Hypertrichosis, 76 Hypoglycemia, 4, 5, 6, 7, 8, 10, 11, 12, 13, 14, 21, 27, 28, 29, 30, 31, 48, 49, 55, 76 Hypoglycemic, 7, 8, 10, 11, 13, 31, 48, 49, 50, 76 Hypoglycemic Agents, 11, 76 Hypotension, 72, 76 I Id, 18, 48, 50, 51, 52, 53, 54, 55, 62, 64, 76 Immune response, 68, 76, 85, 87 Immunodeficiency, 50, 76 Impairment, 76, 79 Impotence, 73, 76 In vitro, 76 In vivo, 13, 76

Index 89

Indicative, 28, 76, 86 Induction, 68, 76 Infarction, 70, 72, 76, 79 Infection, 4, 11, 76, 77, 78, 80, 85 Infectious Diarrhea, 53, 77 Infertility, 6, 77 Inflammation, 9, 67, 74, 77, 79, 80, 81, 82, 85 Infusion, 10, 77 Insulin, 5, 6, 7, 8, 9, 10, 12, 13, 21, 26, 27, 31, 72, 77, 86 Insulin-dependent diabetes mellitus, 77 Intermittent, 77, 81 Interstitial, 77, 83 Intestinal, 51, 77, 78 Intestines, 67, 77 Intoxication, 4, 6, 77 Intracellular, 77, 82 Intravenous, 77 Invasive, 77, 78 Involuntary, 69, 71, 77, 79, 83 Ischemia, 68, 77 Isoenzyme, 75, 77 J Joint, 9, 52, 68, 77, 80 K Kb, 42, 77 Ketoacidosis, 77, 78 Ketone Bodies, 72, 77, 78 Ketosis, 10, 72, 77, 78 Kidney Disease, 9, 21, 22, 42, 49, 51, 53, 55, 78 L Large Intestine, 73, 77, 78, 83 Lens, 78, 83 Libido, 68, 78 Library Services, 62, 78 Ligament, 9, 78 Lipid, 53, 77, 78, 86 Liver, 4, 5, 6, 8, 67, 69, 73, 74, 75, 78 Localized, 13, 67, 75, 76, 77, 78, 81, 82 Lymphatic, 77, 78 M Magnetic Resonance Imaging, 14, 78 Malabsorption, 78, 84 Malabsorption syndrome, 78, 84 Malnutrition, 11, 68, 78 Medical Assistance, 12, 78 MEDLINE, 43, 78 Membrane, 72, 73, 78, 81 Memory, 14, 72, 78 Meninges, 70, 72, 73, 79

Meningitis, 3, 79 Menstrual Cycle, 5, 8, 79 Menstruation, 67, 79, 80 Mental, iv, 4, 12, 23, 42, 44, 71, 72, 74, 78, 79, 80, 82, 86 Mental Disorders, 23, 79 MI, 65, 79 Miscarriage, 11, 79 Molecular, 43, 45, 69, 71, 72, 79 Monitor, 4, 12, 79 Motion Sickness, 79 Motor Activity, 72, 79 Muscarinic Agonists, 71, 79 Muscular Dystrophies, 73, 79 Myocardium, 79 N Nausea, 8, 74, 78, 79, 86 NCI, 1, 22, 41, 79 Need, 3, 5, 7, 11, 25, 26, 29, 31, 56, 71, 75, 79 Neonatal, 52, 79 Nephropathy, 78, 79 Nerve, 9, 27, 71, 74, 80, 85 Nervous System, 70, 80, 81 Nervousness, 49, 80 Neural, 14, 80 Neuronal, 14, 80 Neurons, 71, 72, 74, 80 Neuropathy, 68, 80 Nitrogen, 68, 80 Nuclei, 78, 80 O Oligomenorrhea, 80, 82 Opportunistic Infections, 50, 80 Oral Health, 4, 80 Osteoarthritis, 9, 80 Osteoporosis, 9, 80 Ovaries, 80, 82, 84 Ovulation, 68, 80 Oxidation, 72, 80 P Pachymeningitis, 79, 80 Palliative, 80, 85 Palsy, 3, 80 Pancreas, 10, 67, 73, 77, 80 Parotid, 5, 81 Patient Education, 7, 49, 50, 60, 62, 65, 81 Perfusion, 13, 81 Periodontal Abscess, 4, 81 Periodontitis, 4, 74, 81 Peripheral Nervous System, 80, 81, 85 Peritoneal, 27, 81

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Peritoneal Cavity, 81 Peritoneal Dialysis, 27, 81 Peritoneum, 81 Pharmacologic, 81, 86 Phospholipids, 74, 81 Phosphorus, 27, 81 Physical Examination, 9, 81 Physiologic, 68, 79, 81 Plants, 75, 81, 86 Plasma, 13, 75, 82 Pneumonia, 71, 82 Poisoning, 77, 79, 82 Polycystic, 5, 82 Polycystic Ovary Syndrome, 5, 82 Posterior, 70, 80, 82 Postmenopausal, 80, 82 Potassium, 27, 82 Practice Guidelines, 44, 50, 51, 54, 82 Prevalence, 4, 82 Problem Solving, 26, 82 Progressive, 3, 71, 72, 75, 79, 80, 82, 83 Prophylaxis, 72, 82 Protein S, 69, 82 Proteins, 68, 80, 82, 86 Protocol, 51, 53, 82 Psychic, 78, 79, 82 Puberty, 5, 82 Public Assistance, 78, 83 Public Policy, 43, 83 Pulse, 79, 83 Purulent, 81, 83 R Rebound effect, 30, 83 Rectum, 69, 73, 78, 83 Refer, 1, 21, 73, 83 Reflex, 51, 54, 83 Regimen, 5, 9, 83 Renal failure, 11, 83 Resection, 83, 84 Resolving, 6, 83 Respiration, 79, 83 Retrospective, 14, 83 Risk factor, 4, 83 S Saliva, 83 Salivary, 4, 73, 74, 83, 87 Salivary glands, 73, 74, 83 Screening, 71, 83 Secretion, 21, 77, 83 Self Care, 5, 26, 83 Senile, 80, 83 Sepsis, 11, 83

Septic, 52, 84 Sex Characteristics, 68, 82, 84 Ships, 12, 84 Shock, 52, 84 Short Bowel Syndrome, 51, 84 Side effect, 37, 67, 84, 86 Skeletal, 68, 79, 84 Skeleton, 9, 77, 84 Sodium, 27, 84 Soft tissue, 84 Sorbitol, 75, 84 Spatial disorientation, 73, 84 Specialist, 56, 84 Species, 84, 86 Sperm, 68, 84 Spinal cord, 69, 70, 71, 73, 79, 80, 81, 83, 84 Spirochete, 84, 85 Sterility, 77, 85 Stimulus, 83, 85 Stomach, 67, 73, 74, 76, 77, 78, 79, 81, 85 Stress, 79, 85 Stroke, 23, 42, 85 Subacute, 3, 77, 85 Subarachnoid, 75, 85 Subclinical, 77, 85 Subiculum, 75, 85 Substance P, 83, 85 Support group, 7, 85 Syphilis, 3, 85 Systemic, 38, 69, 77, 85 Systolic, 76, 85 T Temporal, 75, 85 Tendinitis, 9, 85 Tendon, 85 Therapeutics, 38, 85 Thiamine, 4, 85 Threshold, 73, 76, 85 Thrombosis, 82, 85 Thyroid, 4, 85 Tin, 8, 85 Tissue, 9, 68, 69, 73, 74, 75, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86 Toxic, iv, 80, 86 Toxicity, 73, 86 Toxicology, 44, 86 Toxins, 68, 76, 86 Trace element, 85, 86 Trachea, 85, 86 Transfection, 69, 86 Transplantation, 51, 71, 86 Triglyceride, 4, 86

Index 91

Type 2 diabetes, 5, 6, 7, 10, 11, 53, 86 U Unconscious, 76, 86 Uremia, 83, 86 Urethra, 86 Urine, 27, 69, 78, 86 V Vaccine, 82, 86 Vascular, 75, 76, 77, 86 Vein, 77, 81, 86 Venereal, 85, 86 Venous, 69, 70, 82, 86

Venous blood, 69, 70, 86 Ventricle, 75, 83, 85, 86 Venules, 69, 87 Veterinary Medicine, 43, 87 Virus, 50, 70, 87 Visceral, 68, 81, 87 Viscosity, 4, 87 Vivo, 13, 87 W Windpipe, 85, 87 X Xerostomia, 5, 87

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