Diabetes and Nutrition

Diabetes mellitus is a continual disorder of carbohydrate and lipid metabolism in which blood levels of glucose and lipids are elevated. This abnormal metabolism results from a relative lack of insulin, either too little insulin is secreted or the insulin that is secreted is not effective. In addition, diabetes is associated with chronic systemic complications, which, over time, can affect the retina, kidneys, nerves, and cardiovascular system. The most common classifications of diabetes mellitus include type I, or insulin-dependent, diabetes mellitus (IDDM); type II, non-insulin-dependent diabetes mellitus (NIDDM); and gestational diabetes (GD).How it is DevelopedThe problems of diabetes originate in an organ located behind the stomach about the length of a human hand called the pancreas. The pancreas is necessary for both digesting food and regulating energy. It is the regulation of energy for the body that is important in the development of diabetes. The pancreas produces hormones that metabolize food. These hormones regulate the use of glucose, a simple sugar, which is used for most of the activities in our bodies. The pancreas regulates energy in a variety of behaviors in which humans engage such as exercise and movement, responding to trauma and stress, and infections.The pancreas emits three different types of hormones. Insulin is the first hormone that is produced when glucose rises in the blood. Insulin usually rises after eating a meal, and excess glucose that is not used is stimulated by insulin to be stored in muscles and fat cells so that energy can be used later. The liver also stores excess glucose in the form of a carbohydrate called glycogen. The second type of pancreatic hormone is glucagon. Glucagon breaks down glycogen stored in the liver so that it can be used as energy when blood glucose supplies are down. The third type of pancreatic hormone is called somatostatin, thought to be important in regulating both insulin and glucagon.When diabe tes develops, this balanced control system does not operate properly. The glucose in the bloodstream increases, and the cells are not able to utilize it. The individual develops hyperglycemia (excess glucose in the blood). This can be detected by measuring the glucose in the blood from a blood sample, or if the glucose is elevated enough, it can be detected in the urine as spillover. This sort of situation occurs when there is not enough insulin to permit the cells to utilize the glucose, or there is resistance most likely at the cellular level to the presence of insulin. Both cases produce diabetes.Symptoms of DiabetesSome of the symptoms of Diabetes Mellitus are increased thirst, increased urination, weight loss even though the individual is eating more, fatigue, nausea, and vomiting, skin infections, vaginitis, blurred vision, bladder infections, and impotence in men and cessation of menses in women.One severe symptom of diabetes is diabetic ketoacidosis. This symptom sometimes p roduces slightly sweet-smelling breath that is caused by acetone, a metabolic byproduct, when the body is forced to burn fatty acids rather than glucose. This process becomes more and more toxic to the body as it continues; the individual may develop diabetic coma and die. Ketoacidosis occurs when individuals are either not getting enough insulin or the insulin is not adequate to allow cells of the body to utilize the glucose.Effects of DiabetesDiabetes has two types of long-term effects. One type is associated with blood vessel involvement. Damage to the large vessels puts the diabetic at greater risk of stroke, heart attack, and gangrene of the feet. When small blood vessels are damaged, eyes, kidneys, and nerves become damaged. The other long-term effect is nerve damage usually in the feet, but also occasionally in the hands. This nerve damage is called diabetic neuropathy. This damage may cause a painful burning sensation with loss of sensation over time, making the body part mo re subject to injury and infection. Foot ulcers and gangrene can develop, with further damage in the extremities. In men, diabetic neuropathy may cause erectile impotence.Nutrition for DiabetesConsultation with a dietitian familiar with children and with type 2 diabetes is important for all patients. The dietitian should assess the nutritional status and practices of the patient and then counsel them to provide a meal plan which, at least initially, does not deviate in a major way from their usual eating practices. Changes made gradually, through subsequent appointments and interviews, frequently achieve compliance more successfully than does radical and rapid change.Individuals providing counseling must be clear about the differences in the management of patients with type 1 and type 2 diabetes. Because obesity is a typical finding in type 2 diabetes and caloric restriction results in improved glycemic control and insulin sensitivity, modest caloric restriction and weight loss or m aintenance are important goals: so is correction of the dyslipidemia, which frequently accompanies the metabolic syndrome or IRS.In general, calories from dietary fat should not exceed 30% of energy intake, and calories from saturated fat should not exceed 10%. An effort is also made to limit cholesterol in the diet to

Autonomy in Death Essay Example for Free

Autonomy in Death Essay Physician-assisted suicide is a controversial topic with only a few states having legalized it; however, many groups are advocating for its approval. Physician-assisted suicide has ethical limitations that only allow a doctor to prescribe, not administer, a lethal dose of medication for a patient who has been deemed terminally ill with less than six months to live by two physicians. The prescription allows the patient to choose both the timing and setting of death and the physician’s only role is provision of medication. This gifts patients with autonomy in their death and relieves the doctor of any moral burden in participation with death keeping this action an ethical practice. Oregon was the first of few states to have legalized physician-assisted suicide but I would like to argue its potential advantages to the entire United States. Ball (2010) said, â€Å"In Oregon — the one state in the U.S. where assisted suicide is legal – doctors are allowed to help only state residents who are expected to die within six months† (p.1). Giving terminally ill patients the power to choose a peaceful death demonstrates empathy toward the ill patients and their families. Terminally ill patients without this empowerment face the difficult choice of using limited resources to end their lives if not given the legal freedom to choose how and when they die. The Code of Ethics for Nurses provision 1.4 is the right to self-determination and it states that Respect for human dignity requires the recognition of specific patient rights, particularly, the right to self-determination. Self-determination, also known as autonomy, is the philosophical basis for informed consent in health care. Patients have the moral and legal right to determine what will be done with their own person; to be given accurate, complete, and understandable information in a manner that facilitates an informed judgment; to be assisted with weighing the benefits, burdens, and available options in their treatment; to accept, refuse, or terminate treatment without deceit, undue influence, duress, coercion, or penalty; and to be given necessary support throughout the decision-making and treat ment process. Such support would include the opportunity to make decisions with family and significant others and the provision of advice and support from knowledgeable nurses and other health professionals. Patient should be involved in planning their own health care to the extent they are able to choose to participate (American nurses association, 2001, p.148). Giving this added right to chose physician assisted suicide allows patients the autonomy described in the Nursing Code of Ethics. The purpose of this paper is to argue that physician-assisted suicide is ethical and beneficial because it allows for patient autonomy. â€Å"I would argue that by denying terminally ill people recourse to death with dignity via physician prescribed medication, they are inflicting their own brand of coercion and abuse. The concept of a â€Å"merciful death† needs to be part of this discussion. It is a sad commentary that our society responds to our pets’ terminal suffering more humanely than to our fellow human beings’ end-of-life struggles†(â€Å"Death is best approached†, 2012, p. 1). Many feel that denying patients the right to choose is not advocating for their b est interest and is a form of abuse. We wouldn’t leave our ill family pet alive to suffer so why wouldn’t we consider letting our loved ones put themselves out of their misery in a peaceful way? The entire point is to give the public a choice. It would still be up to each individual to decide whether or not to exercise that right if their physician deemed their situation appropriate. The Code of Ethics for Nurses says that â€Å"Respect for human dignity requires the recognition of specific patient rights, particularly, the right of self-determination† (American nurses association, 2001, p.148). This statement implies that the patient should have the right to make end of life decisions on their own. When terminal patients are in pain and suffering, they may not have the strength or will to fight any longer. It is cruel to prolong a patient’s pain and suffering and deny their autonomy to make the decision of having a peaceful death. Also, it can be argued that when patients have their mind set on ending their lives, they tend to follow through on their own even if their physician cannot assist them. This may lead to a more traumatic death and a scene that can be quite traumatizing for the family member or friend who finds their loved one’s remains. The alternative is a prescribed medicine that the patient may take home, choosing the preferred place to die, to allow the patient to die peacefully without sustaining disfiguring injuries thus allowing them a more dignified burial if the family chooses to view the body one last time. However, in most of the United States, physician-assisted suicide is still illegal so very few Americans are afforded the right to choose to end their life when they are terminally ill. Because physician assisted suicide was brought to the public’s attention as an option by the unconventional tactics of Dr. Jack Kevorkian, the idea of legalizing this was tainted from the beginning, making many states hesitant to allow assisted suicide. Miller (2011) notes that â€Å"Jack Kevorkian rose to national prominence as â€Å"Dr. Death,† a physician who insisted that sometimes a doctor’s first duty to his patient was to help him die. The retired pathologist, who became an assisted suicide advocate claiming to have had a hand in 130 deaths in the 1990s, helped spark a national debate over euthanasia† (p. A5). Jack Kevorkian’s tactics were questionable because he publicized the deaths of elderly, disabled, and terminally-ill patients using inhaled carbon dioxi de or using his self-made suicide machine. Although the patients had asked for Dr. Kevorkian’s assistance to end their suffering by assisting in their suicide, he received a lot of negative attention because he publicized his assistance in this process by encouraging CBS to broadcast a video of himself injecting a cocktail of lethal drugs into a patient suffering from Lou Gehrig’s disease (Miller, 2011). After much backlash from the public over the fact that he actually injected patients with lethal drugs, he developed a suicide machine which allowed the patient to press a button that caused the machine to administer a mixture of sodium pentothal and potassium chloride which was first used on Janet Adkins, a 54 year old sufferer of Alzheimer’s disease (Miller, 2011). â€Å"The last thing Janet Adkins said was, ‘You just make my case known,'† Dr. Kevorkian told the Associated Press† (Miller, 2011, p. A5). Although his tactics were extreme and caused a lot of public controversy, his patie nts wanted to end their suffering and his actions caused others to advocate for ethical standards to be put into place for legal physician assisted suicide while at the same time completely turning others away from the concept of legalizing euthanasia. Dr. Goodwin, a general practitioner, said he began advocating for the right to help terminally ill people die after listening to his patients (Miller, 2012). â€Å"They want autonomy at this time, to be allowed to die at home with the comfort and support of their families,† Dr. Goodwin said in a 2001 interview (Miller, 2012, p. 1). Because of the extreme tactics used by Jack Kevorkian, who initiated the debate on legalizing euthanasia, many people view those who advocate for the client’s right of physician assisted suicide as cruel or lacking in empathy for patient and families. However, â€Å"Peter Goodwin, a family physician who wrote and campaigned for Oregon’s right-to-die law in the 1990s, died after taking a cocktail of lethal drugs prescribed by his doctor, as allowed under the legislation he championed. Dr. Goodwin, 83 years old, had been diagnosed with a degenerative brain disorder similar to Parkinson’s disease and had been given less than six m onths to live.†(Miller, 2012, p. 1). Dr. Goodwin believed in a patient’s autonomy in death so much that he chose to exercise his own rights in the same fashion in order to end his own suffering. In an interview with the Oregonian, the local newspaper in Oregon, Dr. Goodwin said that his health was deteriorating and he would soon end his life. â€Å"His family gathered to bid him farewell. ‘The situation needs thought, it doesn’t need hope,’ he said. ‘Hope is too ephemeral at that time’†(Miller, 2012, p. 1). This clearly articulates the feelings of a terminally ill man towards the importance of autonomy in concern of his own death. â€Å"End-of-life decisions are not arbitrary or impulsive. Why shouldn’t a person choose to end his or her life with dignity if it is obvious that all options for leading any kind of meaningful life are non-existent? I would think any modicum of compassion would respect such a momentous, personal decision. Suffering, physical and mental, and the anguish it causes should produce empathy for the patient’s wishes and desires, even if they run counter to our own sense of rectitude. It is not about us. It’s about the patient’s right of autonomy. We need to understand that it is ultimately his or her decision to make, not ours†(Death is best approached, 2012, p. 1). In this statement, an unknown author expressed the utmost sympathy for those suffering from terminal illness. Physician assisted suicide is ethical as it demonstrates compassion and empathy towards someone else’s pain, suffering, and rights. There is nothing cruel about autonomy over the decision to die. These kinds of laws need to be considered using a deep emotional understanding of the terminally ill’s feelings and problems. Other countries have legalized euthanasia and have less restrictive laws which allow them to provide services for foreigners. Because of this, if all United States citizens aren’t granted the autonomy they desire in their own country they will still be able to get the results they so desperately want but the outcome may be more painful to family members whose loved ones would end up dying in other countries and in less desirable conditions. Mr. Minelli, who is head of Dignitas, a Swiss company that provides euthanasia services only to foreigners, said that â€Å"a memory of his seriously ill grandmother’s pleading in vain with her doctor to help her die left him with a particular interest in Switzerland’s growing right-to-die movement, and he joined one of the main groups. In 1998, he quit to found Dignitas†(Ball, 2010, p. 2). In 2008, his neighbors’ complaints forced Dignitas out of his rented apartment that he had been using to conduct the assisted suicides and Zurich city officials refused permission for a new venue. In response to this Mr. Minelli organized suicides in cars, a hotel room, industrial sites, and his own home which drew the attention of local officials. â€Å"Someone who is used to a five-star hotel can’t come to Dignitas and expect the same,† says Mr. Minelli†(Ball, 2010, p. 2). Is it really beneficial to force terminally ill patients into a foreign country to a harsh environment to grant them the freedom to end their own lives? If terminally ill patients really want a physician assisted suicide, they will find another setting in which they can achieve one but allowing patients to have one in their own country optimizes the setting and allows for more family support near the time of death. It also saves the family the trouble of getting the body of a loved one from a foreign country after the time of death and allows the family to begin funeral arrangements sooner so that they can go through the stages of grieving that they need to in order to move forward with their own lives. This act of ending the life sooner also spares the family the pain of watching their loved one suffer longer than they want to. Another benefit to approving physician assisted suicide is that just know that the option is available can be therapeutic for terminal patients. â€Å"Mr. Minelli argues that making assisted suicide available removes a taboo around suicide, helping people who want to kill themselves open a dialogue and seek help. About 70% of people who get the green light from Dignitas for an assisted suicide never contact the group again, proving the palliative effect of knowing help is available, he says†(Ball, 2010, p. 2). This clearly proves that just knowing that euthanasia is an option is enough to help patients carry on with terminal illness. Even if a patient chooses never to exercise the right to a physician assisted suicide, the knowledge that they have an option for a way out of their suffering is comforting in itself. Craig Ewert was a retired university professor who suffered from Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig’s disease. He decided to end his life because he wanted to make this decision before he lost the ability to decide his own fate, overcoming the resistance of his doctors (Ball, 2010). â€Å"When you’re completely paralyzed and can’t talk, how do you let someone know you are suffering?† he told a television interviewer before his death in September 2006. â€Å"This could be a complete and utter hell† (Ball, 2010, p. 3). Mr and Mrs. Ewerts were from the U.K. but they traveled to Switzerland and chose Mr. Minelli’s group, Dignitas, because it accepts foreigners. Mrs. Ewert said that had she not been able to travel to get her husband the assisted suicide services that he desired she may have been forced to help her husband die and she worried that she wouldn’t have known exactly what to do (Ball, 2010). She defended Mr. Minelli saying â€Å"Sure, there have to be some protections for people, but I think we’re going way beyond what there needs to be, I admire Minelli for being willing to take the heat† (Ball, 2010, p. 3). Because Craig Ewert was allowed to make his own decision to die, his wife was spared the pressure that he may have put on her to help him end his life. Furthermore, had he been denied the right to make his own decision and his wife Mary had been coerced to help him commit suicide, there would have been extreme emotional and possibly even legal consequences to her action despite the fact that it was her husband’s wish. This is a situation that may Americans are also threatened with because physician assisted suicide is illegal in most of the country. All United States citizens should be afforded the right to choose a physician assisted suicide if they have been deemed terminally ill because this freedom shows compassion and empathy towards the patient’s suffering. If patients aren’t allowed to legally choose death here, they may travel to another country to receive services or chose to carry out suicide on their own. If patients chose to take matters into their own hands this would be harder on the patient as the death would probably not be as peaceful as the lethal injection that the physician would prescribe and if would also be harder on the patient’s loved ones. If patients decide to go to another country to achieve the death they desire they would lose the privilege of dying in their own comfort zone and the distance would make the death harder on the family to make funeral arrangements and move on with their own lives. The Code of Ethics for Nurses stated that â€Å"Respect not just for the specific decision but also for the patient’s method of decision-making is consistent with the principle of autonomy† (American nurses association, 2001, p.149). Regardless of whether or not we understand an individuals motivation for seeking a physician assisted suicide, nurses should support the autonomy that patients needs to make this choice on their own. Giving terminally ill patients autonomy in their death, by making physician assisted legal for every United States citizen, is only giving patients additional rights that they may or may not chose to exercise and is the most compassionate way to show empathy for those who are dying. Autonomy in Death. (2017, Feb 13).

The Emergence of Globalization and the Marketing Mix Essay

The Emergence of Globalization and the Marketing Mix - Essay Example The marketing mix that is appropriate for all this multicultural world market for multinationals must converge to achieve the same goal of expanding the market while at the same time saving the firms cost of operation. Different regions or countries have a specific social framework and any marketing strategy and the communication strategy need to conform to this diversity factor lest it realizes insignificant publicity and product promotion. The cultural factors are closely attached to the economic policies of the specified regions, their religious beliefs, political ideologies and the level of economic development. An effective marketing communication plan needs to be designed to promote the image of the firm at the local level with a global view. It is therefore imperative that market research is thoroughly carried out to develop a communication plan that is in line with the demands of cultural diversity and political environment (Smith, Pulford, & Berry, 2009, pp.75). In reporting this subject a case study of two firms is important to bring out the real concept of integrated market communication strategy. Some examples of multinational companies include Coca-Cola, Toyota, Nokia Inc and others. These firms have central headquarters in a given country but their operations are decentralized in different regions like the Middle East, West Africa, North America, and Europe, East and Central Africa and many other regions. In this report, Middle East market is to be compared with Europe such that appropriate marketing plans can be observed by the multinationals to capture a substantial market share through the market (Bjerregaard, Lauring, Klitmoller, 2009, pp.55). One product that would serve best to be used for comparison is the Coca-Cola soft drinks which are consumed at international level. Comparing the United Kingdom and Saudi Arabia would provide the best results in terms of the best-integrated marketing communication plans viable across two market environme nts. The choice of these two states is based on their cultural, taste, behavior and the general spending pattern differences across the consumer body. This would facilitate designing of a customer-focused marketing communication strategies for Coca-Cola Company and other multinational counterparts operating in the same product line like Pepsi (Egan, 2007, pp.134). To establish this comparison, the local cultural model of the two states need to be discussed and the prevailing marketing communication environments in each provided by the aid of graphs and charts. Some of the key marketing focal points that will provide comparison grounds comprise of the culture of the citizens of the two countries, their political system, consumer behavior, level of media activity and effectiveness and the overall competition within each country’s local market.

Accounting report Assignment Example | Topics and Well Written Essays - 1500 words

Accounting report - Assignment Example Therefore, this additional information such as the macro environment effects, business performance in comparison to its competitors, etc. generally guide the investor in making the right choice. The statements provided by Chairman and CEO are more or less same with both them talking about the performance of British Airways during the year in comparison with last year and the difficulties being faced due to economic downturn, loss of consumer confidence, increasing oil prices and other environmental factors. Furthermore, both the heads highlighted the fact that next year is going to be much tougher in terms of performance due to economic conditions prevailing, yet they are confident that the company will manage to survive and achieve their long term future goals of being a premium airline. However, the main difference among both the statements was the measures highlighted by CEO to survive currently and tackle the future business appropriately with a brief detail about their future development and ways to achieve those (British Airways 2009). The report provided by CFO highlight some of the problems that company is facing and which will be important for investor like Paul. Firstly, the CFO talks about the decline revenue caused by a decrease in passenger traffic especially premium passenger leading to reduction on amount of flying. Furthermore, the report highlights the company’s susceptibility towards fluctuating oil prices and showing an increase in operating expenditure due to this. Moreover the company faced a net unrealized loss on fuel derivatives due to volatile prices. Lastly, company posted a negative EPS which will have an adverse impact on its investors as no dividend was announced (British Airways 2009). The environment in which airline industry operates involves lot of risks and uncertainties which are out of their control and can have severe impacts on their business. Some of the risks involved in their industry are act of terrorism, any

Evaluation of Reader-Based Writing within a company Essay

Evaluation of Reader-Based Writing within a company - Essay Example higher profit margins through an increase in sales volume. While goods are sold at cost to the customer, there are no apparent losses incurred by these stores. It has a Marketing Business Unit (MBU) located in Virginia to mange all military commissary stores throughout the world.   The MBU spearheads a marketing strategy that is identical to what is adopted by all major food retail chains – â€Å"the customer has many a store to step in while the store has one step to welcome all customers†. Organizational marketing literature is essentially the bye-product of a strategic faith in corporate culture that is unique to each organization. DeCA has adopted a marketing strategy that seeks to drive out competition with a `sledgehammer tactic in which contracted suppliers are straight jacketed into a procurement network that spans the entire globe. Backed by an administrative team of heavyweights in the industry, the writing within the organization for its own internal communication has been the subject of discussion among organizational communication strategists who have been intrigued at the often cyclostyled memorandum being replaced with a more objective content centric approach. As for its external communication strategy, it is determined by the type of competition that civilian retail chains present. There cannot be any doubt about its own mission statement â€Å"Deliver a premier commissary benefit to the armed services community that encourages an exciting shopping experience and satisfies patron demand for quality grocery and household products and delivers exceptional savings while enhancing quality of lifeâ⠂¬ , (DeCA website) because it implies â€Å"customer focused selling†, the self-same approach adopted by big retail chains throughout the world. DeCA has been managed more like a military establishment where the customer is subject to a process of

Media appraisal Essay Example | Topics and Well Written Essays - 2500 words

Media appraisal - Essay Example By combing these methods the author has an original approach to her research and this makes it very interesting to criticise. The paper shows how the role of popular music in society has been studied traditionally and challenges some classical methodologies while also proposing new ones. It is the combination of these points which makes this article good to study in terms of research methodology analysis. The study is of popular music in the lives of young people. It positions itself with cultural and social studies. Its aim is to approach the study of the role of popular music in a slightly different way from other researchers on this subject. Initially the author states that few studies work directly with the people who use and consumer music. The study therefore aims to change this by asking people directly what their experience of music is, instead of making theories that do not in interact with reality. The author emphasises the need to concentrate on the real experiences which people have, or say they have, in relation to music. Related to this is the aim to explore what the author refers to as the ‘everydayness’ of music. Rather than focusing on the cultural significance of music through issues such as identity construction, the paper aims to explore the possibility that these issues of music consumption are in fact less important than the more mundane and routine uses of music in everyday life, as a background noise whose meanings are irrelevant. She focuses on the ‘fallacy of meaningfulness’, arguing that music doesn’t necessarily have to be significant or used to define a particular group or consumed by a particular ethnic group or social class. The methodology used by the author involves the use of unstructured informal discussions with three groups of GCSE sociology students, around fifteen years old. Three groups of four to five students were involved in one discussion, all on the same day. There were fewer boys than girls in all

Market Orientation in Business Essay Example | Topics and Well Written Essays - 2250 words

Market Orientation in Business - Essay Example Considering any business term requires a clear understanding of what is meant by its name. Thus, it is necessary to give an explanation of the term ‘market orientation’ before going to its detailed analysis. According to a definition provided by the Business Dictionary, market orientation is ‘a business approach or philosophy that focuses on identifying and meeting the stated or hidden needs or wants of customers’. As stated in the Cambridge Dictionary, by the term ‘market orientation’ one should understand ‘management of a company, product, brand, etc. so that it satisfies the needs of customers’. In the book ‘Changing Market Relationships’ written by Jean-Jacques Lambin, market orientation is defined as ‘a set of capabilities, activities and behaviors needed to implement a strong marketing orientation’ (Lambin 2008).Despite the fact that all the definitions mentioned above reflect the main idea behind mar ket orientation quite clearly, the most comprehensive definition of the term is presented by Morgan and Strong in their work named ‘Market Orientation and dimensions of strategic orientation’. In this work, the two authors define perceive the concept of market orientation as a certain mode of corporate management that is founded on encouraging a permanent gathering and sharing of statistical information regarding customers, appreciation of customer needs as a fundamental aspect of the business.