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during therapy. Family history of diabetes is often present. Urine sugar has to be tested especially with simultaneous blood sugar estimation after full meal with two sweets and two bananas, asking the patient to void urine after one hour. If blood sugar is more than 140 mg diabetes mellitus can be diagnosed.

Geriatric patients can be easily controlled with oral hypoglycaemic agents without insulin. These patients are advised to reduce their weight; with diet restriction and weight reduction, good control can be achieved in many patients. A diabetic is asked to avoid tubers, sugar, sweets, ghee, butter, vanaspathy, coconut oil, fruits (Except tomatoes and apples), Horlicks, 'Viva' and yellow of the eggs. They are allowed rice, wheat, ragi, otta preparations, mutton, chicken, fish etc. in limited quantities. Green vegetables. garlick and onion can be taken in plenty.

For patients requiring drug treatment, oral anti-diabetic agents may be added. Initially, Tolbutamide (Rastinon) 0.5 mg 1 bid or tabl. Glybicide (Glynase) 1 bid to 3 bid or tab. Glybandamide (Dionil) 1 bid to 3 bid or Tab. Chloropropamide (Diabenase) 100 to 250 mg. od can be used. If not controlled T. Penformin (DBI) 25 mg. liquid or long acting phenformin (DBI- TD) 50 mg. 1 bid can be added. If diabetes is not controlled, insulin therapy has to be started. To begin, 5 units of plain insulin may be given subscuteneously after each principal meal, increasing suitably every 3rd or 5th day testing the urine sugar. Once good control is achieved, lente insulin can be substituted. In old people, renal threshold for sugar is raised. Hence periodic blood sugar estimation is essential, till stabilization is attained.

THE ABOVE LECTURE TOOK ONE HOUR. THREE CASES OF DIABETES ONE EACH COMPLICATED WITH CATARACT, NEURITIS AND TROPHIC ULCER WAS DEMONSTRATED.

-M. Chandramohan

DERMATOLOGY

The skin disorders in the elderly can be broadly classified into (i) skin changes in the elderly due to ageing (ii) physiological changes (iii) disorders peculiar to senility (iv) common skin diseases as in other age groups.

(i) Skin changes in the elderly

The common changes that occur are (a) dryness of skin (b) Sparse, grey hairs (c) yellowness and thinness (d) diminished sweating and (e) diminished sebaceous gland activity.

(ii) The physiological changes

(a) Grey hair appear due to decreased MSH activity, decreased melanocytes and due to diminished melanogenesis in the remaining cells (b) Baldness with frontoparietal receding inherited from male members of the maternal side. (c) Seborrhoeic warts: These are asymptomatic brownish black in colour, ranging from few mms to several cms in size occurring in any area of the body. (d) Idiopathic guttate hypomelanosis: Hypopigmented multiple, white spots, less than few mm in size occurring

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