Inside Diagnostics Spring 2018 by nal von minden GmbH

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Inside Diagnostics Spring 2018

DIABETES MELLITUS

HEROIN

From medication to drug

Life with diabetes

COLON CANCER â&#x20AC;&#x201C; PREVENTION CAN SAVE LIVES Why early diagnosis is so important

Rapid Tests

In this issu

W P R I Z E D R Ae 10 ag More on p

Laboratory Diagnosis Laboratory Service Consulting & Service

Inside Diagnostics

Foreword

Imprint

Dear reader,

Inside Diagnostics Customer magazine from nal von minden GmbH Responsible according to press law: Thomas Zander Editor-in-chief: Iris Schubert Editorial Team: Nicola Barabas, Daniela Beer, Manuela Duschinger, Anne Kaiser, Manuela Kaml, Angela Metz, Helen Murr, Andreas Ott, Julia Rummel, Iris Schubert, Ulrike Tischler inside-diagnostics@nal-vonminden.com Graphics: Julia Stigler, Leonie Britzelmeier

Subscribe to our customer magazine Write to: inside-diagnostics@nal-vonminden.com

Contact/Editor in chief Iris Schubert • Tel.: +49 (0)941 29010-36 inside-diagnostics@nal-vonminden.com

Product overview:

iabetes affects people around the globe and can have grave consequences. Our main article deals with the most important questions in relation to this awful metabolic disease. What exactly is diabetes, how does it manifest itself, how is it treated and how much of a difference can exercise and healthy eating make?

Many of our articles feature products available at nal von minden. Here you can find a list of the article-related products that we offer. If you have any questions, feel free to contact us on +49 (0)941-290 - 0. Page 4/5: Hb/Hp Complex plus Product code: 272011N-25

Also in this issue:

FOB/Transferrin Product code: 272038

The topic for the month of March is colon cancer: Learn everything you need to know about this kind of cancer, and why an early diagnosis is so important. Heroin: How is this dangerous drug becoming even more common, what roles does it play in the pharmaceutical industry and how drug tests can save lives. Drug consumption in children and adolescents: How best to react if you are worried that your child may be taking drugs. Man-flu column – a counter-statement: As the men were somewhat affronted by our previous take on man-flu, they have now provided a tongue-in-cheek response from their point of view.

FOB60 plus Product code: 272035

We wish you all the best as we head into the warmer months, and hope you enjoy reading this issue of Inside Diagnostics! Your Inside Diagnostics editorial team

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Page 6/7 6-Monoacetylmorphine drug rapid tests 6-MAM-urine rapid tests are available with a 10ng/mL cut-off level Fentanyl drug rapid tests FYL urine rapid tests are available with a 10ng/mL cut-off level Page 12/13 CLOVER A1c® - Reliable, lab-quality diabetes management Product code: 980100, 980101 Page 14/15 Cannabinoid drug rapid tests THC-urine rapid tests available with varying cut-off levels (given as ng/mL): 25, 50, 150, 200, 300, 500

Inside Diagnostics

Content Topics Colon cancer – prevention can save lives �� 4 Heroin: From medication to drug �� 6 Column: One man, one virus �� 8 Diabetes mellitus – A blood sugar imbalance �� 12 Crime scene: Kids´bedrooms �� 14 nvm Inside Prize Draw �� 10 Contact �� 16 DIABETES MELLITUS – A BLOOD SUGAR IMBALANCE | Page 12 Diabetes is thought to affect one in every eleven adults worldwide, and numbers are rising.

More on page 12.

Cover © istockphoto.com/RyanKing999

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Oncology Colon cancer – prevention can save lives

COLON CANCER –

prevention can save lives As part of Colon Cancer Awareness Month, the Felix Burda Foundation, the ‘LebensBlicke‘ Foundation and the Network against Colon Cancer have come together with numerous other health organisations, communities and support bases in order to draw attention to the need for colon cancer screening. We would also like to do our bit for the cause in line with our motto ‘We help you care!‘

DON’T LET COLON CANCER BE YOUR FATE !

„You can find out within utes – promise!“

2 min-

This is the slogan used by the Felix Burda Foundation regarding their online test. By answering just a few questions, you can find out whether you are at a heightened risk for colon cancer. Of course the test is not meant to substitute a visit to the doctor, but can at least encourage those at risk not to put off making an appointment.

Colon cancer is a delicate issue which many of us, if not directly affected, would prefer not to think about. However, after years of educational work by many organisations, the importance of prevention is increasingly centre-stage, and awareness of this awful, yet curable cancer is on the rise. But who really knows what a diagnosis with colon cancer actually entails? Colon cancer refers to cancers of the intestine, of which the most common is colorectal carcinomas (colon carcinoma = colon cancer, rectal carcinoma = rectal cancer). Carcinomas in the small intestine are very rare. In 90% of cases, colon cancer develops from a benign polyp in which the cells have degenerated and become cancerous. Estimations that 2.2 million people will be affected by colon cancer worldwide by 2030 is an alarming projection . It is expected that the disease will claim 50,630 deaths in 2018 alone. However, recovery rates can be higher than 90% when the disease is detected early and treated.

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In addition to genetic factors, the causes of colon cancer are also rooted in lifestyle and diet. It can continue to grow and spread without symptoms for years before being noticed. For this reason, regular screening is of particular importance. Caught early, colon cancer that has not yet spread to other organs can be cured in 90-100% of cases. Irregular bowel movements, abdominal pain, blood in the stool, and undesired weight gain are all characteristic symptoms of colon cancer that only appear when the cancer has already become malignant.

Sources: - Lothar Thomas: Labor und Diagnose, TH-Books, 2012, S. 777 - Präsentation Darmkrebs: Kann verhindert werden! F.Kolligs, M.E. Kreis, B. Strittmatter, K.W. Jauch - Fraseret al. (2008): Automated immunochemical quantitation of haemoglobin in faeces collected on cards for screening for colorectal cancer. Gut 57. S. 1256-1260.

Oncology Colon cancer â&#x20AC;&#x201C; prevention can save lives

Colon cancer has various stages of development by which the disease is classified, and during which different treatment measures are necessary: Stage I

What is happening at this stage?

The tumour is confined within the upper-most mucosal layer.

How is it treated? What are the chances of survival?

Stage II

The cancer invades the deeper The cancer breaks through the layers of the intestinal wall. intestinal walls and attacks the lymph glands locally.

Surgery

over 90 %

Stage III

Stage IV

Cancer cells infect the other organs, such as the liver.

Surgery, chemotherapy, possible radiotherapy

ca. 80 %

Bleeding is an important indicator of a carcinoma, though it is only visible when occuring in large amounts. Using immunological rapid tests for the detection of occult blood in stools (FOB, fecal occult blood) can help to diagnose colon cancer early, allowing for prompt treatment and significantly lowering death rates. It offers the possibility to test for free haemoglobin (Hb) in order to establish the presence of a disease in the lower intestine. In addition to this well-known method, the combined detection of free Hb and so-called haemoglobin-haptoglobin (Hp, Hb-bound protein in the blood plasma) gives the advantage of also detecting bleeding in the higher reaches of the intestine. The Hb-Hp complex is a lot more stable against acids and proteolytic degredation whilst passing through the intestinal passage than Hb, and is therefore detectable once released into the upper intestine. An alternative possibility of diagnosing diseases of the digestive tract is the combined detection of free Hb and transferrin (Tf, a protein which transports iron in blood serum). Similar to the Hb-Hp complex, Tf is very stable against acid- and proteolytic-based degradation.

50-70 %

under 10 %

this, and also to increase specificity levels, FOB tests with a higher cut-off level of 60-75ng/ml have been recommended. As standards vary widely from county to country, FOB tests with a range of cut-off levels are available, including 10 ng/ml, 25, 40, 60 and 75 ng/ml. This has contributed to the development of quantitative tests, in which the sensitivity/specificity ratio can be chosen by the user. These tests offer the possibility of flexible cut-off levels to suit different circumstances (instrument-based, logistic, personnel). For the early diagnoses and prompt treatment, individual responsibility in taking precautionary measures is absolutely essential. Faint or invisible blood in the stool can be detected easily and quickly using a simple rapid immunological FOB test. In contrast to earlier guaiac-based test methods, it is no longer necessary to adhere to a special diet prior to testing. A yearly colon cancer screening is recommended for those over 50 years of age, but can be requested by people of any age as a precaution.

Please note: The presence of blood in stool samples can be caused by factors other than cancer, such as haemorroids, anal fissures, colon polyps, stomach ulcers, chronic inflammatory bowel disease, blood in the urine or gastric irritation.

AMe

There are varying opinions when it comes to the topic of cutoff levels in FOB tests. In Germany, a detection limit of 40ng Hb/ml buffer solution is normal. The necessity of confirming positive test results with a follow-up colonoscopy has revealed a shockingly high rate of false-positive results. In order to avoid

Sources: - Guittet et al. (2006): Comparison of a guaiac-based and an immunochemical fecal occult blood test in screening for colorectal cancer in a general average-risk population. Gut 4. S. 4. www.istockphoto.com ÂŠ RyanKing999

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Rapid Tests Heroin: From medication to drug

Heroin:

From medication to drug America’s doctors have been willingly feeding their patients opioid-based analgesics for decades. The basis for this is an illusion of 100% freedom from pain, a claim which is pedaled by the pharmaceutical industry. However, with the dulling of pain comes the dulling of the soul, and resulting addictions can no longer be quelled by prescriptions. Something else is needed. Meanwhile, opioid-based prescription medications have left more than a million Americans with a heroin addiction – but the battle against pain relief is certainly nothing new. Heroin was first synthesised in 1884 by the British chemist C.R Alder Wright, intended as an equivalent to opium (De Ridder M., 2000; Wright C. R. A., 1874). Even by this time, the advantages of opium consumption and its suitability for therapeutic purposes had been known about for centuries, as had the problems that come with it. In Ancient Rome, the juice of the opium poppy, from which opium is extracted, was seen as the drug of the affluent. The Ancient Greeks were also well acquainted with the substance – including its dark sides. Nevertheless, interest in this dangerous substance has not waned over the centuries. Even Wright was not alone in his research, and hope of finding a more tolerable morphine derivative occupied many research groups during that time (De Ridder M.,

2000). At the beginning of the 1890s, a chemist at the main Bayer plant named Felix Hoffman carried out a chemical reaction that produced diacetylmorphine from morphine. Bayer perfected the synthesis process, and in 1896 coined the soonto-be well known brand name ‘heroin’. As part of a large-scale advertising campaign, heroin was marketed as a non-addictive alternative to morphine and declared a miracle cure for numerous afflictions – especially pain and coughs. Morphine withdrawal was also amongst its range of applications (De Ridder, 2000). Heroin became internationally sought-after and highly profitable within just a short time, and was exported to more than 20 countries within a year of its introduction to the market. Kilo sales in 1913 equalled almost one tonne - 20 times more than in 1898. It was thought that heroin harboured all the benefits of morphine with none of its undesirable side effects. They were soon to see just how wrong they were. The number of those dependent rose rapidly as the first consumers began injecting themselves with heroin rather than taking it orally. Under much pressure, the substance was withdrawn from the market less than 20 years after its introduction (V. Schmitt, 2013). In Germany, it wasn’t until 1971 that the Federal Opium www.istockphoto.com © 123ducu

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Schmitt V. (2013): Bayer AG - Weltapotheke mit dunkler Vergangenheit. In: http://www.zeit.de/wirtschaft/unternehmen/2013-08/150-jahre-pharmaunternehmen-bayer/komplettansicht (Stand 14.02.2018) De Ridder M. (2000): Heroin. Vom Arzneimittel zur Droge. In: https://books.google.de/books?id=cqJDGipF0sQC&printsec=frontcover&hl=de&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false Wright C. R. A. (1874): On the Action of Organic Acids and their anhydrides. In: J. Chem. Soc.

Rapid Tests Heroin: From medication to drug

Agency outlawed the marketing and prescription of heroin for medicinal purposes. From then on, possession and use of the substance was illegal. The situation since then is all too well known - the genie was already out of the bottle.

Today, heroin comes in

many forms – usually powders.

In its purest form, heroin is a fine white powder, the quality of which varies greatly on the market. It is available in its base form (brown heroin) or as hydrochloride salt (white heroin). The first is from an earlier stage of production, and is thus cheaper to manufacture. Heroin can also come in the form of a black, sticky substance known as ‘black tar heroin’ (brown heroin). Different characteristics such as colour, structure, solubility, pH value and heat stability all influence how heroin is consumed and give clues as to where it comes from (Ciccarone D., 2010). Black tar heroin can be traced back to Mexico and is generally characterised by its low purity. It is usually distributed over land routes, its main target being the US black market. Comparatively pure white heroin comes overwhelmingly from Southeast Asia, finding its way not only to America, but also to Europe, where brown heroin is more common - a form that originates in Afghanistan. But that’s not enough. To satisfy the thirst for deadly substances, fentanyl and its derivative, carfentanyl (which is up to 5000 times more potent than heroin), are now flooding the market. A substance which was actually intended for anaesthetising elephants is now on the rise within the German drug scene, often being sold as heroin or blended with it. The European Monitoring Centre for Drugs and Drug Addiction states that 0.1 g of carfentanyl is enough to produce 10,000 single doses.

overdose. In an emergency, the physician attending to the patient needs to know which substance has been consumed. It is also of interest to criminal authorities to know whether an addict is intoxicated with fentanyl, heroin or prescription drugs. A possibility for detection is offered by the presence of 6-monoacetylmorphine (6-MAM), an opioid analgesic and active metabolite of heroin. It is easily detectable using a rapid test and, as 6-MAM only occurs as a result of heroin consumption and not where opioids such as codeine have been taken for medical reasons, can indicate whether the drug has been used. Just how essential these tests can is noticeable when looking at the situation in the US. In 2017 alone, more than 60,000 Americans died as a result of heroin overdose – 20 out of every 100,000 residents. In German, 1.5 drug-related deaths per 100,000 is comparatively few. According to the European Drug Report of 2017, almost 80% of these deaths can be traced back to opioids. A worrying trend is clearly emerging here. DBe,UTi

The cheaper and substantially more effective heroin substitute is most likely responsible for the rising rate of drug-related deaths in Germany. Long-term consumers of heroin develop high tolerance levels, meaning the dose needed in order to wrap their souls in a warm blanket is always rising over time. For this reason, switching to fentanyl can easily result in an

The potency of newer opioids, such as fentanyl and carfentanyl, considerably exceed that of heroin, and so much lower doses are needed to achieve a comparable effect. Whereas this in turn lowers drug-related costs, it raises the risk of overdoses.

European Drug Report 2017: Trends and Developments. In: http://www.emcdda.europa.eu/system/files/publications/4541/TDAT17001ENN.pdf (Stand 15.02.2018) Ciccarone D. (2009): Heroin in brown, black and white: Structural factors and medical consequences in the US heroin market. In: Int. J. Drug- Policy Quintana P. et al. (2017): The hidden web and the fentanyl problem: Detection of ocfentanil as an adulterant in heroin. In: Int. J. Drug Policy Carrol J. et al.: Exposure to fentanyl-contaminated heroin and overdose risk among illicit opioid users in Rhode Island. In: Int. J. Drug Policy

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Column One man, one virus - A counter-statement

A counter-statement

One man, one virus 20,000 years before Christ, deep in a cave on the edge of the Mountains of Thunder: Granogh is rudely awoken by his wife, poking him with a long stick. “Get up, lazybones! Today is for hunting – the people are hungry!” Granogh slowly opens his eyes. “Not today, I’m wiped out. I have a headache, a blocked nose and a sore throat. I can’t go hunting today, I have to stay lying by the fire,” he sniffed and turned back to the flames. “I love the fire….” His wife is having none of it. “So, you’ve got man flu? Ever since your brother Jakktor lit the fire, all you have done is stare into the flames the whole day, instead of going out and taking care of us. “Well, my dear…!” she hisses, and stamps out the fire.

This could be one of the first documented cases in the history of mankind when nature’s cleverest system has failed: the socalled man flu. Myth and mystery surrounds man-flu. For many (mostly women), it is laughed off as just simple tiredness, and equated with laziness and self-pity. This couldn’t be further from the truth. It is in fact a vital mechanism, designed to protect those with limited abilities as a result of their illness from harming themselves or their environment. Specialists have given this problem a name (‘presentism’) and studied its consequences. According to a 2012 study by the Federal Institute for Occupational Safety and Health, as well as the Federal Institute for Vocational Education and Training, every second member of the working population goes to work whilst sick. In another study in the same year, a so-called ‘stress report’, 36% of people said that they had gone to work that year even when they were still sick.

“I wanted to watch that until it went out!” grumbled Granogh, before getting up.

There are numerous factors involved, and presentism can occur for both positive and negative reasons:

A few hours later:

• Fear of the workplace

Granogh and his group of brave hunters are stalking through the undergrowth. With sharpened senses, they seek out deer, buffalo and other prey.

• Poor economic situation of the company

The spear feels heavier than usual today, and does not glide so elegantly through the branches as on other days. And then he sees it… a mighty mammoth in a clearing, just a few meters away. He lifts his spear, and aims at the beast’s heart. His men do the same, waiting for the signal that they should all attack.

• Performance-, deadline- or time pressures • Relationship with team or supervisors • Over-motivation • Desire to be heavily involved with job

“AAA-CHOO!!” Granogh suddenly lets out an almighty sneeze. The mammoth is startled and storms at the band of hunters. They don’t stand a chance of escaping the giant and are all trampled.

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www.shutterstock.com © GoodStudio

Column One man, one virus - A counter-statement

A study published in 2011 by the consulting firm Booz & Company is of the opinion that the consequences of presentism are fatal:

Workers who are ill: • perform worse • make more mistakes • are more likely to be involved in an accident • can potentially infect their healthy co-workers

A solution, suggested by Dr. Hans Wurst is as follows:

ear gents, if your throat is scratchy, your stomach hurts and you have a runny nose – take these symptoms seriously! Take it easy, don’t rush anything. Let yourself be looked after, and enjoy the peace and comfort of your four walls, bed and sofa. Take some time out. You are not doing this for yourself – but for society as a whole!

• risk serious illness

The statistics: • The cost of sick leave (in Germany) is, on average, €1197 per employee. • The hidden costs of presentism, however, are shown by the study to be considerably higher – at €2394. Men’s internal instinct to take even a light cold seriously, and to cure their colds by staying on the sofa and breaking high scores on their PlayStation, saves the economy – and so all of us – real money. Following a short time out, a well-rested and healthy man returns to the workplace motivated, engaged and ready to devote himself to his work.

20,000 years before Christ, Granogh and his band of brave men are carefully stalking through the undergrowth on the trail of an enormous mammoth. Granogh feels invincible today, his muscles tense, his eyes on the target. He is well-slept and fit – nothing can stop this perfect hunter from taking down his prey and feeding his tribe. He lifts the spear and takes aim perfectly. One more step and he is within range. Granogh’s foot makes a loud “Crack!”, a saber-tooth tiger is startled, springs out of the thicket and lunges at the petrified hunter. Perhaps Granogh just wasn’t born to be a hunter… AOt

As our male colleagues felt a little badly done-by as a result of our last issue‘s column about man-flu, they decided to write a humorous counter-statement to restore balance (in their view).

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nvm inside Prize Draw

Take part Dear reader,

and win!

We are pleased to give you the opportunity once again to win a great prize! In this edition we are giving away a Herschel ‘Little America’ rucksack. All you have to do is answer the following question:

rised by... te c ra a h c is s te e b Dia balance im r a g u s d o lo b A ) a levels b) Low vitamin D ss c) Short-sightedne

Good luck!

Your Inside Diagnostics Team

Up for grabs is a Herschel ‘Little America’ rucksack! Inspired by mountain climbers, the ‘Little America‘ rucksack boasts robust material, plenty of space and a timeless design. The interior consists of Herschel‘s typical red and white stripes. Outer material: Polyester, faux leather Measurements: 51 x 25.5 x 13 cm Volume: 23.5l

Participation deadline is 15.06.2018 Take part via: https://www.nal-vonminden.com/de/inside-diagnostics-gewinnspiel or gewinnspiel@nal-vonminden.com

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nvm inside Prize Draw

Please mark the right answer,

simply fill in the form & win!

Name

Address

City

E-Mail

Signature Participation Conditions 1. The promoter of this competition is nal von minden GmbH. 2. To take part, fill in the form and fax it to +49 941 29010 50, or send it by post to nal von minden GmbH, Iris Schubert, Friedenstraße 32, 93053 Regensburg. It is also possible to take part via email. Send the correct answer along with your full address to gewinnspiel@nal-vonminden.com with the subject heading ‘Gewinnspiel‘, or simply fill in the online form on our website at https://www.nal-vonminden.com/de/inside-diagnostics-gewinnspiel. The winner is chosen in a prize draw. Those taking part must have an address in Germany, Switzerland or in Austria and be at least 18 years old at the time of participation. nal von minden employees or those involved in the conception or implementation of this competition are not permitted to take part. Only one entry per person is permitted. An illegal or repetitive attempt at participation in the competition will result in the competition closing. Participation is free and does not depend on the purchase of goods or services. By taking part in the competition, the participant agrees to these conditions. The competition closes on 15.06.2018. 3. The winner will be informed by writing and will receive their prize by post. 4. The promoter of this competition witholds the right to change the conditions of this competition within the promotion period, and to end or cancel at any time. This is especially the case in cases of force majeure or if the competition cannot continue to be carried out for organisational, technical or legal reasons. In such cases, the partcipants are not entitled to any claims against the promoter. Through participation, individuals can win a Herschel ‘Little America’ rucksack. The prize cannot be exchanged for cash or another prize. 5. The promoter of this competition takes no responsibility if the prize is lost or damaged during delivery. 6. Any liability for damages of nal von minden GmbH and their officers, employees and agents in connection with the competition, irrespective of the legal reason is, as far as legally permissible, limited to cases of intent or gross negligence. 7. This is not subject to legal recourse. 8. Should one or more of the above clauses be partially or fully invalidated, void or unfeasible, the remaining clauses are not invalidated. A corresponding clause will be applied instead. This also applies in the case of omissions. 9. The promoter’s decision in respect of all matters to do with the competition will be final and no correspondence will be entered into. Legal recourse is excluded. Data Protection 1. The promoter utilises data shared by those participating - (name, address), in as far as this is in accordance with German data protection law. The data collected will be used to conclude contracts between the two parties. The promoter additionally holds the right to send future issues of ‚Inside Diagnostics‘ to the email address provided, as long as the participant in question has consented to the legal requirements of the shipment. The receipt of future copies of the Inside Diagnostics magazine can be cancelled at any time at the end of each promotional email. In accordance with the Federal Data Protection Act, particpants and users have the right to information regarding their stored data and, where necessary, a right to report, block or delete this data. Participation in the promotion is then no longer possible.

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Diabetology Diabetes mellitus – A blood sugar imbalance

Diabetes mellitus – A blood sugar imbalance It is estimated that 150 million people worldwide suffer from diabetes mellitus – a number set to double by 2025*. Permanently raised blood sugar levels have a number of negative consequences, though many people remain unaware that they have a metabolic condition. What is diabetes?

HbA1c value– the long term blood sugar memory

iabetes mellitus is a chronic metabolic disease which is characterised by raised blood sugar levels. It indicates that either you can no longer produce your own insulin, or that the insulin cannot be produced in sufficient quantities. Alongside glucagon, insulin is a very important hormone for the metabolisation of carbohydrates and is produced in the pancreas. Insulin lowers the blood sugar, whereas the insulin-antagonist known as glucagon prompts the release of blood sugar reserves in the liver – causing blood sugar levels to rise.

Regular glucose measurements can reflect the success of a patient’s individual treatment. Modern measurement devices and lancing devices make this very simple. The measurement determines how much blood sugar-lowering insulin is to be injected, or whether diet and exercise can suffice. Just a small prick of the finger can provide a quick result. Blood sugar measurements distinguish between two kinds of values – short-term sugar and long-term sugar levels. The short-term values are measured daily, and long-term values looked at 2-4 times per year. Daily levels are something of a snapshot, and depend on various factors such as food and exercise. These measurements are particularly useful in the acute control of blood sugar levels.

Forms and symptoms of diabetes We generally talk of two kinds of diabetes mellitus: Type-1 diabetes commonly occurs as early as childhood or adolescence. It is an autoimmune disease, meaning that the body’s own defence system attacks healthy cells. The immune system destroys the pancreas’ beta cells and, as a result, little or no insulin is produced. The regulation of blood sugar levels is then only possible through the external administration of insulin. Type-1 diabetics must inject themselves within insulin several times a day. Type-2 diabetes is the most common form, occurring in 90% of diabetics, and is mostly associated with being overweight (though this does not have to be the case). The body is still able to produce insulin, but the body’s cells do not react adequately – this is when we speak of a ‘resistance to insulin’. In most cases, type-2 diabetics can manage the illness through a special diet, plenty of exercise and medication where necessary. As well as type-1 and type-2 diabetes, there are also other forms of the disease such as gestational diabetes (diabetes during pregnancy).

HbA1c (glucose-bound haemoglobin) is known as the longterm blood sugar value and plays an important role in the follow ups of diabetes patients. The HbA1c level shows the amount of glucose-bound haemoglobin in comparison to the ‘glucose-free’ haemoglobin (millimoles per mole of haemoglobin, or as a percentage), giving a picture of the blood sugar levels over the last eight to twelve weeks – the time in which red blood cells can survive in the body. Raised HbA1c levels indicate that the patient’s blood sugar levels were raised during this period. In healthy individuals, HbA1c values should be approximately 30mmol/mol, or 5%, but target values should always take into account individual circumstances and the living situations of those affected. Contemporary diagnostic devices installed in GP practices can give physicians and patients fast, lab quality results. Studies have confirmed that prompt adjustments to treatment in light of raised HbA1c levels help to achieve successful glycemic control. Patients tend to adhere to recommendations regarding treatment better after face-to-face consultations with their doctor than after telephone follow ups.**

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*Source: http://www.who.int/mediacentre/factsheets/fs138/en/

Diabetology Diabetes mellitus – A blood sugar imbalance

Life with diabetes For those affected, a diagnosis of diabetes mellitus comes as a shock. Their lifestyle must completely change from one day to the next, and the fear of long-term consequences such as vascular diseases and nerve disorders is ever-present. For diabetic patients, the risk of having a heart attack or stroke is 2-3 times higher than in non-diabetic individuals, meaning that pre-diagnosis habits must be thought through and changed. Self-help groups, diabetes courses and an open approach to the disease can all have a positive effect on both body and soul. Healthy food and exercise is the key to the modern management of diabetes. Dr Nicolai Worm, a qualified Munich nutritionist, has dealt extensively with the topics of obesity, insulin resistance and secondary diseases.*** Aside from a low carbohydrate diet, he recommends something absolutely essential: exercise, exercise, exercise. Regular physical activity significantly lowers blood sugar levels and incidentally also improves blood pressure, aids weight loss and weight stabilisation. Moderate

training is sufficient, and small sessions aimed at strength and endurance can be easily integrated into daily life. Diabetes mellitus may not (yet) be curable, and is certainly no walk in the park, but can be influenced positively in order to allow individuals to lead a happy and fulfilled life.

**Source: Miller CD, Barnes CS, Phillips LS, Ziemer DC, Gallina DL, Cook CB, et al. Rapid A1c availability improves clinical decision-making in an urban primary care clinic. Diabetes Care 2003;26: 1158 – 63. ***Source: Dr. Nicolai Worm: Menschenstopfleber: Die verharmloste Volkskrankheit Fettleber- das größte Risiko für Diabetes und Herzinfarkt. Diagnose, Therapie, Prävention. ISBN-13: 978-3927372788, Verlag Systemed

NBa,MDu

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Rapid Tests Crime scene: Kids´bedrooms

crime Kids´bedrooms scene Drug consumption amongst youths I

t is no great secret that children’s bedrooms are not places of unquestionable safety. They are not sheltered havens in which children and teens cannot come into contact with drugs and other substances. Over the last few years, it has become common to hear stories from concerned parents and overwhelmed teachers. Numerous prevention methods have now made their way into the classroom, from teaching the topics of drug and alcohol to comprehensive campaigns. The goal? To provide pupils with an awareness of the potential consequences of drug consumption, as well as its associated dangers. But have these measures been successful? And what should parents do if they (correctly) suspect that their child is consuming drugs?

Case study: statistics from the German State Office of Criminal Investigation and Interior State Ministry: Rise in the number of drug offences within schools At the beginning of the year, a number of federal states in Germany release statistics on drug consumption and related offences in schools. The comparison of statistics between 2011 and 2015 is startling: According to the report, the number of drug offences in Baden-Württemberg almost tripled (from 348 to 939 cases). A similar picture is seen in Saxony-Anhalt (2011:42, 2015: 109 offences), North Rhine-Westphalia (2011: 443, 2015: 897 offences) and Saxony (2011: 69, 2015: 128 offences). Slight increases were also observed in Rhineland-Palatinate, Lower Saxony and Hessen. Statistics show that middle- and upper-grade students are most at risk. The number of children under 14 selling or buying substances is significantly lower.1

It seems that cannabis poses a particularly large risk. It remains one of the most popular and easily-accessible illegal drugs amongst youths, common even in the school yard. Some would argue the reason behind this problem is the ever-increasing ’trivialisation‘ of cannabis, whereas others see that its condemnation and a strict approach is to blame. How to deal with it is, of course, not only a question for teachers but also for affected parents.

Signs of drug consumption amongst youths Changes in the behaviour of the child or teen can be a sign that drug use is at play: The following may be an indicator of drug use: • Problems with concentration • Social isolation, avoiding friends • Forgetfulness • Sudden drop in school performance • Aggressiveness • Loss of appetite • Perpetual tiredness • Insomnia • Proneness to infections It should be noted that these points are by no means irrefutable signs of drug consumption. Many of these are simply phases of adolescence, much like teenage rebellion or lovesickness. Should several of the aforementioned symptoms and/or further signs (such as stealing from family and friends, or sudden financial problems) occur simultaneously, this raises the likelihood that illegal substance consumption is involved.

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Rapid Tests Crime scene: Kids´bedrooms

What’s the best way to counteract the problem?

ven when brimming with concern, disappointment and anger in such a situation, it is not wise for parents to be accusatory or to shout at the child, nor is it a good idea to dish out threats and prohibitions. In the majority of cases this will only cause the children in question to go on the defensive and cut them off from their parents. Withdrawing pocket money is also not recommended as, in a worst case scenario, they may turn to criminality in order to acquire the drugs.

first discussion. In such cases, it could be useful to have several talks with the child, as well as enlist the help of a psychologist or social worker. In extreme scenarios, addiction counseling or withdrawal treatment could be necessary. One of the most important points is safety, not to abandon those affected, and to ensure that the child feels they remain loved and welcome at home. ISc

So what should be done? First of all, it is important to address what lead the child to become involved with drugs, as well as how they got hold of the substances. Parents should be sure to face the issue head on and comprehensively. The next step should be to take a careful approach to conversation – one cannot expect that the child will be 100% honest during the

Source: http://www.zeit.de/gesellschaft/schule/2017-01/cannabis-drogen-schulen-rauschgift-praevention

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