Technology Has Changed the Live of Teen Agers Essay Example

Technology Has Changed the Live of Teen Agers Essay DOI: 10. 1111/j. 1464-5491. 2006. 01868. x Glycaemic control Review Article 23 0742-3071Publishing, alcohol Diabetic Medicine and2006 consumption D. Ismail et al. DME UK Oxford, article Blackwell Publishing Ltd Social consumption of alcohol in adolescents with Type 1 diabetes is associated with increased glucose lability, but not hypoglycaemia D. Ismail, R. Gebert, P. J. Vuillermin, L. Fraser*, C. M. McDonnell, S. M. Donath†  and F. J. Cameron Abstract Department of Endocrinology and Diabetes, Royal Children’s Hospital, Melbourne, *Wimmera Base Hospital*, Horsham and † Clinical Epidemiology and Biostatistics Unit, Royal Children’s Hospital, Melbourne, Australia Accepted 10 June 2005 Aims To determine the effects of social consumption of alcohol by diabetic adolescents on glycaemic control. Methods Fourteen (five male) patients aged 16 years were recruited from the diabetes clinic at the Royal Children’s Hospital. The continuous glucose monitoring system (CGMS) was attached at a weekend when alcohol consumption was planned for one night only. For each patient, the 12-h period from 18. 00 h to 06. 00 h for the night with alcohol consumption (study period) was compared with the same period with non-alcohol consumption (control period) either 24 h before or after the alcohol study night. Thus, each subject was his /her own control. Glycaemic outcomes calculated from continuous glucose monitoring included mean blood glucose (MBG), percentage of time spent at low glucose levels (CGMS 4. 0 mmol/l), normal glucose levels (CGMS 4. 0–10. 0 mmol/ l) and high glucose levels ( 10. mmol/ l) and continuous overall net glycaemic action (CONGA). Results The mean number of standard alcohol drinks consumed during the study period was 9. 0 for males and 6. 3 for females. There was no difference in percentage of time at high and normal glucose levels in the study and control periods. During the control period, there was a higher percentage of time with low glucose levels compared with the study period (P 0. 05). There was an increas ed level of glycaemic variation during the study time when compared with the control period. We will write a custom essay sample on Technology Has Changed the Live of Teen Agers specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Technology Has Changed the Live of Teen Agers specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Technology Has Changed the Live of Teen Agers specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Conclusions In an uncontrolled, social context, moderately heavy alcohol consumption by adolescents with Type 1 diabetes appears to be associated with increased glycaemic variation, but not with low glucose levels. Diabet. Med. 23, 830–833 (2006) Keywords adolescence, alcohol, glycaemic control Abbreviations CGMS, continuous glucose monitoring system; CONGA, continuous overall net glycaemic action; MBG, mean blood glucose; RCH, Royal Children’s Hospital Introduction Adolescents with Type 1 diabetes frequently engage in risk-taking activities [1]. Amongst these activities is the social Correspondence to: Dr Fergus Cameron, Deputy Director, Department of Endocrinology and Diabetes, Royal Children’s Hospital, Flemington Road, Parkville, Victoria 3052, Australia. E-mail: fergus. [emailprotected] org. au consumption of alcohol, frequently as underage drinkers [2]. Whilst the effects of alcohol consumption upon glycaemia have been well described in a controlled setting [3– 6], little is known about the impact on glucose levels of alcohol consumption by adolescents within an ambulant, social context. The purpose of this project was to utilize continuous glucose monitoring to study the impact of social alcohol consumption on glycaemic control in a group of alcohol-using adolescents.  © 2006 The Authors. 830 Journal compilation  © 2006 Diabetes UK. Diabetic Medicine, 23, 830–833 Review article 831 Patients and methods This study was approved by the Human Ethics Research Committee of the Royal Children’s Hospital (RCH). That approval was contingent upon the fact that the investigators should not be seen to encourage underage drinking in adolescents. Consequently, we only approached adolescents who we knew were drinking socially and, despite our previous counselling, elected to continue to drink alcohol on a semi-regular basis. We recruited 22 adolescents with Type 1 diabetes from the RCH diabetes clinic. The adolescents were considered eligible only if 16 years old and parental/patient consent was obtained. HbA 1c (Bayer DCA 2000 immunoagglutination method, Calabria, Barcelona, Spain) was measured, and diabetes duration and insulin doses were recorded. The MiniMed continuous glucose monitoring system (CGMS) was attached to the study patients over a weekend period. Patients were required to have an alcohol-free period for at least 24 continuous hours during the weekend trace period. A diary was kept of activities during the trace period (insulin injections, meal, snacks, dancing, alcohol consumption, sport). There was no change in insulin doses between study and control periods. In the evening when alcohol was consumed, patients were asked to recall how many and what type of drinks were consumed and how inebriated they became. Patients recall of alcohol consumption was converted to ‘standard drinks’ (one standard drink contains the equivalent of 12. ml 100% alcohol) using The Australian Alcohol Guidelines [7]. CGMS data was recorded between 18. 00 and 06. 00 h on the evening when alcohol was consumed (the study period) and between 18. 00 and 06. 00 h on the evening when no alcohol was consumed (the control period). CGMS data were only analysed if there had been regular calibrations with intermittent capillary blood glucose readings at a maximum of 8-h intervals. Each CGMS trace was qualitatively and quantitatively analysed using mean glucose values, per cent time in glycaemic ranges and ontinuous overlapping net glycaemic action (CONGA) [8]. CONGA values were calculated to assess glycaemic variation over 1-, 2- and 4-h intervals. Low glucose values were defined as CGMS values 4 mmol/ l, normal glucose values when CGMS values were 4– 10 mmo/ l and high glucose values when CGMS values were 10 mmol/ l. Each patient acted as their own control with study periods and control periods being compared. Inter-individual values were grouped for comparison. Differences between study and control periods were analysed using paired t-tests. Analyses were done in Stata [9]. ales and nine females. The mean age was 18. 5 years (range: 17. 4 – 19. 5). The mean duration of diabetes was 9. 4 years (range: 3 – 16. 3). Six of our subjects took four insulin injections per day and eight took two injections daily . The mean insulin dose was 1. 1 units /kg/day (range: 0. 7 –1. 8), and the mean HbA1c was 9. 6% (range: 8. 2 – 10. 8). Activities during the study period Thirteen subjects had dinner before drinking and only one subject did not consume any food before going out. Three subjects ‘danced a lot’ and six subjects went dancing but did not dance a lot. Ten subjects had something to eat after drinking. Alcohol consumption during the study period The mean number of alcohol drinks consumed on the study night was 9. 0 (range 3–16) for males and 6. 3 (range 3–14) for females. All the females consumed pre-mixed sweetened alcohol drinks (5% alcohol), with only one consuming beer and one consuming wine. Four of the males consumed mixed spirits, one mixed spirits and beer and one beer only. Forty per cent of the males had more than seven standard drinks during the study and 67% of the females had more than five drinks. In total, 80% of the subjects had pre-mixed sweetened alcohol drinks at some point during the study period. Forty-three per cent of the subjects reported that they became inebriated and 14. 3% consumed alcohol to the point where they became physically sick. None of the subjects lost consciousness or took recreational drugs during the study period. Comparative CGMS data between study and control periods Results Patients There was no significant difference between the overall mean glucose levels of patients when comparing study and control periods (Table 1; P = 0. 43). Similarly, there were no significant differences in the amount of time spent with either normal or high glucose values between study and control periods (Table 1). A larger proportion of time was spent with low glucose values during the control period when compared with the study period (1. 9 vs. 16. 8%, P = 0. 03). A significantly larger degree of glycaemic variation was seen in the CONGA values in the study period when compared with the control period (Table 1). The difference in CONGA values were consistent and independent of whether glycaemic variation was assessed over 1-, 2- or 4-h intervals. Of the 22 subjects recruited, eight were excluded because their CGMS traces did not have sufficiently frequent calibration points with intermittent capillary measures of blood glucose. Of the 14 subjects remaining, we were able to obtain study period data on 14 patients and matched control period data on only 12 patients. The study period occurred on the night prior to the control period in nine subjects. There were five Discussion It has long been recognized that a prohibitionist approach is usually ineffective when counselling adolescents who engage in risk-taking behaviours [10]. Many centres today, ourselves included, have instead adopted a harm minimization approach in dealing with such behaviours. An important component  © 2006 The Authors. Journal compilation  © 2006 Diabetes UK. Diabetic Medicine, 23, 830–833 832 Glycaemic control and alcohol consumption †¢ D. Ismail et al. Outcome measure Mean difference between Study period Control period study period and mean value mean value control period (95%CI) P-value 10. 6 16. 8 58. 6 24. 6 2. 1 3. 2 3. 7 1. 2 (? 2. 1, 4. 4) ? 14. 9 (? 28. 1, ? 1. 8) ? 0. 8 (? 27. 3, 25. 8) 15. 7 (? 4. 5, 35. 8) 0. 6 (0. 2, 1. 0) 1. 1 (0. , 1. 9) 1. 8 (0. 4, 3. 1) 0. 43 0. 03 0. 95 0. 12 0. 006 0. 01 0. 01 Table 1 CGMS outcomes, study and control periods Blood glucose levels (mmol/l) 11. 8 Per cent time low glucose 1. 9 Per cent time high glucose 57. 8 Per cent time normal glucose 40. 3 CONGA1* 2. 7 CONGA2* 4. 3 CONGA4* 5. 5 *CONGA calculated at 1-, 2- and 4-h intervals. CONGAn is the standard deviation of differ ent glucose measures n hours apart for the duration of the CGMS trace. of counselling using a harm minimization approach is that the information provided be credible and reflective of ‘real’ or ‘lived’ circumstances. Continuous glucose monitoring provides a technique whereby the glycaemic consequences of various behaviours can be documented in an ambulant or non-artificial setting. Adolescents with Type 1 diabetes frequently consume alcohol in a social context [11]. Alcohol is known to inhibit the gluconeogenic pathway, to inhibit lipolysis, impair glucose counter-regulation and blunt hypoglycaemia awareness [3,4]. Previous studies in young adults with Type 1 diabetes have shown that moderate consumption of alcohol in the evenings without concomitant food intake may cause hypoglycaemia the following morning [5]. Consumption of alcohol after a meal, however, has shown no similar adverse effects on glucose [6]. It is reasonable to assume, therefore, that alcohol consumption may be a significant risk factor for hypoglycaemia in adolescents with Type 1 diabetes [5]. Studies of the glycaemic effects of alcohol consumption in an ambulant adolescent/young adult population can be difficult. This is because such behaviours are uncontrolled, often spontaneous and usually in the context of other social activities (parties, dancing, etc. ). In order to ensure that we only reported accurate CGMS data during these activities, capillary blood glucose calibration was considered vital and those patients who failed in this regard were excluded from analysis. Just over 60% of the patients recruited were able to successfully wear and calibrate a CGMS unit during these activities. Given that patients who experience hypoglycaemic symptoms are more likely to perform capillary self measures of blood glucose, we feel that it is unlikely that those patients excluded from the analysis had a greater frequency of hypoglycaemia than those patients reported. We were unable to record our subjects’ alcohol consumption in a contemporaneous fashion and hence were reliant upon their recall. It is possible that their remembered patterns of consumption were not entirely accurate. This potential inaccuracy should not be seen as a weakness of this study, as we only set out to determine patterns of glycaemia in adolescents engaging in spontaneous and uncontrolled alcohol consumption. We neither specified the type nor the amount of alcohol to be consumed (our ethical approval was contingent on this not occurring). The data as to amount of alcohol consumed have been included for descriptive purposes only. The results of this study show that alcohol consumption by adolescents in a social context is associated with a greater degree of glycaemic variation and less time spent with low glucose values than evenings where no alcohol is consumed. Whilst the second of these findings appears counter-intuitive, there may be several possible explanations. Firstly, the vast majority of our study group ate a meal prior to going out and ate upon their return before going to bed. These are practices that we have instilled as harm minimization strategies to avoid alcohol-induced hypoglycaemia in our clinic. Secondly, most of the alcohol consumed was as pre-mixed spirit and sweetened, carbonated beverages. Finally, alcohol consumption was only associated with vigorous exercise (dancing) in a minority of our study group. All of these factors could have combined to negate the hypoglycaemic effects of alcohol. In a previous study of glycaemia during alcohol consumption in adult men [5], hypoglycaemia occurred most often 10–12 h after wine consumption when the evening before ended at 23. 0 h. We analysed our data to see if a similar phenomenon occurred in this study and found that the per cent of time spent with CGMS readings 4 mmol/l between 06. 00 and 12. 00 h on the morning after the study period (i. e. the morning after the drinking night) was only 1. 1%. Notwithstanding the fact that our cohort frequently consumed alcohol later than 23. 00 h, the facto rs that impacted upon glycaemic control during the study night appear to have carried over to the ‘morning after’. The findings in this study highlight the importance of ambulant testing. It is important to note that the findings of the group studied here may not be seen in adolescents who drink non-sweetened alcoholic drinks or in those adolescents with better underlying metabolic control. Whilst alcohol consumption in isolation may reasonably be thought to cause hypoglycaemia, alcohol consumption by adolescents in the context of meals, sweetened mixers and little activity did not result in more hypoglycaemia than an alcohol-free evening. Whether the increase in glycaemic variation seen on an evening  © 2006 The Authors. Journal compilation  © 2006 Diabetes UK. Diabetic Medicine, 23, 830–833 Review article 833 of alcohol consumption has negative clinical outcomes remains an area for further investigation. Competing interests CMM was a Novo Nordisk research fellow. FJC received fees for speaking at conferences and funds for research from Novo Nordisk. References 1 Cameron F, Werther G. Adolescents with diabetes mellitus. In: Menon, RK, Sperling, MA, eds. Pediatric Diabetes. Boston: Kluwer Academic Publishers, 2003: 319–335. 2 Frey MA, Guthrie B, Lovelandcherry C, Park PS, Foster CM. Risky behaviours and risk in adolescents with IDDM. J Adol Health 1997; 20: 38–45. 3 Avogaro A, Beltramello P, Gnudi L, Maran A, Valerio A, Miola M et al. Alcohol intake impairs glucose counterregulation during acute insulin-induced hypoglycaemia in IDDM patients. Diabetes 1993; 42: 1626–1634. 4 Kerr D, Macdonald IA, Heller SR, Tattersal RB. Alcohol causes hypoglycaemic unawareness in healthy volunteers and patients with type 1 diabetes. Diabetologia 1990; 33: 216–221. 5 Turner BC, Jenkins E, Kerr D, Sherwin RS, Cavan DA. The effect of evening alcohol consumption on next morning glucose control in type 1 diabetes. Diabetes Care 2001; 24: 1888–1893. 6 Koivisto VA, Tulokas S, Toivonen M, Haapa E, Pelkonen R. Alcohol with a meal has no adverse effects on postprandial glucose homeostasis in diabetic patients. Diabetes Care 1993; 16: 1612–1614. 7 National Health and Medical Research Council. Australian Alcohol Guidelines: Health Risks and Benefits. DS9. Available from: http://www7. health. gov. au/nhmrc/publications/synopses/ds9syn. htm. 8 McDonnell CM, Donath SM, Vidmar SI, Werther GA, Cameron FJ. A novel approach to continuous glucose analysis utilising glycaemic variation. Diab Tech Therap 2005; 7: 253–263. 9 StataCorp. Stata statistical software. Release 8. 0. College Station, TX: Stata Corporation, 2003. 10 Kyngas H, Hentinen M, Barlow JH. Adolescents perceptions of physicians, nurses, parents and friends: help or hindrance in compliance with diabetes self-care? J Adv Nurs 1998; 27: 760–769. 11 Patterson JM, Garwick AW. Coping with chronic illness. In: Werther, GA, Court, JM, eds. Diabetes and the Adolescent. Melbourne: Miranova Publishers 1998, 3–34.  © 2006 The Authors. Journal compilation  © 2006 Diabetes UK. Diabetic Medicine, 23, 830–833 Technology Has Changed the Live of Teen Agers Essay Example Technology Has Changed the Live of Teen Agers Essay DOI: 10. 1111/j. 1464-5491. 2006. 01868. x Glycaemic control Review Article 23 0742-3071Publishing, alcohol Diabetic Medicine and2006 consumption D. Ismail et al. DME UK Oxford, article Blackwell Publishing Ltd Social consumption of alcohol in adolescents with Type 1 diabetes is associated with increased glucose lability, but not hypoglycaemia D. Ismail, R. Gebert, P. J. Vuillermin, L. Fraser*, C. M. McDonnell, S. M. Donath†  and F. J. Cameron Abstract Department of Endocrinology and Diabetes, Royal Children’s Hospital, Melbourne, *Wimmera Base Hospital*, Horsham and † Clinical Epidemiology and Biostatistics Unit, Royal Children’s Hospital, Melbourne, Australia Accepted 10 June 2005 Aims To determine the effects of social consumption of alcohol by diabetic adolescents on glycaemic control. Methods Fourteen (five male) patients aged 16 years were recruited from the diabetes clinic at the Royal Children’s Hospital. The continuous glucose monitoring system (CGMS) was attached at a weekend when alcohol consumption was planned for one night only. For each patient, the 12-h period from 18. 00 h to 06. 00 h for the night with alcohol consumption (study period) was compared with the same period with non-alcohol consumption (control period) either 24 h before or after the alcohol study night. Thus, each subject was his /her own control. Glycaemic outcomes calculated from continuous glucose monitoring included mean blood glucose (MBG), percentage of time spent at low glucose levels (CGMS 4. 0 mmol/l), normal glucose levels (CGMS 4. 0–10. 0 mmol/ l) and high glucose levels ( 10. mmol/ l) and continuous overall net glycaemic action (CONGA). Results The mean number of standard alcohol drinks consumed during the study period was 9. 0 for males and 6. 3 for females. There was no difference in percentage of time at high and normal glucose levels in the study and control periods. During the control period, there was a higher percentage of time with low glucose levels compared with the study period (P 0. 05). There was an increas ed level of glycaemic variation during the study time when compared with the control period. We will write a custom essay sample on Technology Has Changed the Live of Teen Agers specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Technology Has Changed the Live of Teen Agers specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Technology Has Changed the Live of Teen Agers specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Conclusions In an uncontrolled, social context, moderately heavy alcohol consumption by adolescents with Type 1 diabetes appears to be associated with increased glycaemic variation, but not with low glucose levels. Diabet. Med. 23, 830–833 (2006) Keywords adolescence, alcohol, glycaemic control Abbreviations CGMS, continuous glucose monitoring system; CONGA, continuous overall net glycaemic action; MBG, mean blood glucose; RCH, Royal Children’s Hospital Introduction Adolescents with Type 1 diabetes frequently engage in risk-taking activities [1]. Amongst these activities is the social Correspondence to: Dr Fergus Cameron, Deputy Director, Department of Endocrinology and Diabetes, Royal Children’s Hospital, Flemington Road, Parkville, Victoria 3052, Australia. E-mail: fergus. [emailprotected] org. au consumption of alcohol, frequently as underage drinkers [2]. Whilst the effects of alcohol consumption upon glycaemia have been well described in a controlled setting [3– 6], little is known about the impact on glucose levels of alcohol consumption by adolescents within an ambulant, social context. The purpose of this project was to utilize continuous glucose monitoring to study the impact of social alcohol consumption on glycaemic control in a group of alcohol-using adolescents.  © 2006 The Authors. 830 Journal compilation  © 2006 Diabetes UK. Diabetic Medicine, 23, 830–833 Review article 831 Patients and methods This study was approved by the Human Ethics Research Committee of the Royal Children’s Hospital (RCH). That approval was contingent upon the fact that the investigators should not be seen to encourage underage drinking in adolescents. Consequently, we only approached adolescents who we knew were drinking socially and, despite our previous counselling, elected to continue to drink alcohol on a semi-regular basis. We recruited 22 adolescents with Type 1 diabetes from the RCH diabetes clinic. The adolescents were considered eligible only if 16 years old and parental/patient consent was obtained. HbA 1c (Bayer DCA 2000 immunoagglutination method, Calabria, Barcelona, Spain) was measured, and diabetes duration and insulin doses were recorded. The MiniMed continuous glucose monitoring system (CGMS) was attached to the study patients over a weekend period. Patients were required to have an alcohol-free period for at least 24 continuous hours during the weekend trace period. A diary was kept of activities during the trace period (insulin injections, meal, snacks, dancing, alcohol consumption, sport). There was no change in insulin doses between study and control periods. In the evening when alcohol was consumed, patients were asked to recall how many and what type of drinks were consumed and how inebriated they became. Patients recall of alcohol consumption was converted to ‘standard drinks’ (one standard drink contains the equivalent of 12. ml 100% alcohol) using The Australian Alcohol Guidelines [7]. CGMS data was recorded between 18. 00 and 06. 00 h on the evening when alcohol was consumed (the study period) and between 18. 00 and 06. 00 h on the evening when no alcohol was consumed (the control period). CGMS data were only analysed if there had been regular calibrations with intermittent capillary blood glucose readings at a maximum of 8-h intervals. Each CGMS trace was qualitatively and quantitatively analysed using mean glucose values, per cent time in glycaemic ranges and ontinuous overlapping net glycaemic action (CONGA) [8]. CONGA values were calculated to assess glycaemic variation over 1-, 2- and 4-h intervals. Low glucose values were defined as CGMS values 4 mmol/ l, normal glucose values when CGMS values were 4– 10 mmo/ l and high glucose values when CGMS values were 10 mmol/ l. Each patient acted as their own control with study periods and control periods being compared. Inter-individual values were grouped for comparison. Differences between study and control periods were analysed using paired t-tests. Analyses were done in Stata [9]. ales and nine females. The mean age was 18. 5 years (range: 17. 4 – 19. 5). The mean duration of diabetes was 9. 4 years (range: 3 – 16. 3). Six of our subjects took four insulin injections per day and eight took two injections daily . The mean insulin dose was 1. 1 units /kg/day (range: 0. 7 –1. 8), and the mean HbA1c was 9. 6% (range: 8. 2 – 10. 8). Activities during the study period Thirteen subjects had dinner before drinking and only one subject did not consume any food before going out. Three subjects ‘danced a lot’ and six subjects went dancing but did not dance a lot. Ten subjects had something to eat after drinking. Alcohol consumption during the study period The mean number of alcohol drinks consumed on the study night was 9. 0 (range 3–16) for males and 6. 3 (range 3–14) for females. All the females consumed pre-mixed sweetened alcohol drinks (5% alcohol), with only one consuming beer and one consuming wine. Four of the males consumed mixed spirits, one mixed spirits and beer and one beer only. Forty per cent of the males had more than seven standard drinks during the study and 67% of the females had more than five drinks. In total, 80% of the subjects had pre-mixed sweetened alcohol drinks at some point during the study period. Forty-three per cent of the subjects reported that they became inebriated and 14. 3% consumed alcohol to the point where they became physically sick. None of the subjects lost consciousness or took recreational drugs during the study period. Comparative CGMS data between study and control periods Results Patients There was no significant difference between the overall mean glucose levels of patients when comparing study and control periods (Table 1; P = 0. 43). Similarly, there were no significant differences in the amount of time spent with either normal or high glucose values between study and control periods (Table 1). A larger proportion of time was spent with low glucose values during the control period when compared with the study period (1. 9 vs. 16. 8%, P = 0. 03). A significantly larger degree of glycaemic variation was seen in the CONGA values in the study period when compared with the control period (Table 1). The difference in CONGA values were consistent and independent of whether glycaemic variation was assessed over 1-, 2- or 4-h intervals. Of the 22 subjects recruited, eight were excluded because their CGMS traces did not have sufficiently frequent calibration points with intermittent capillary measures of blood glucose. Of the 14 subjects remaining, we were able to obtain study period data on 14 patients and matched control period data on only 12 patients. The study period occurred on the night prior to the control period in nine subjects. There were five Discussion It has long been recognized that a prohibitionist approach is usually ineffective when counselling adolescents who engage in risk-taking behaviours [10]. Many centres today, ourselves included, have instead adopted a harm minimization approach in dealing with such behaviours. An important component  © 2006 The Authors. Journal compilation  © 2006 Diabetes UK. Diabetic Medicine, 23, 830–833 832 Glycaemic control and alcohol consumption †¢ D. Ismail et al. Outcome measure Mean difference between Study period Control period study period and mean value mean value control period (95%CI) P-value 10. 6 16. 8 58. 6 24. 6 2. 1 3. 2 3. 7 1. 2 (? 2. 1, 4. 4) ? 14. 9 (? 28. 1, ? 1. 8) ? 0. 8 (? 27. 3, 25. 8) 15. 7 (? 4. 5, 35. 8) 0. 6 (0. 2, 1. 0) 1. 1 (0. , 1. 9) 1. 8 (0. 4, 3. 1) 0. 43 0. 03 0. 95 0. 12 0. 006 0. 01 0. 01 Table 1 CGMS outcomes, study and control periods Blood glucose levels (mmol/l) 11. 8 Per cent time low glucose 1. 9 Per cent time high glucose 57. 8 Per cent time normal glucose 40. 3 CONGA1* 2. 7 CONGA2* 4. 3 CONGA4* 5. 5 *CONGA calculated at 1-, 2- and 4-h intervals. CONGAn is the standard deviation of differ ent glucose measures n hours apart for the duration of the CGMS trace. of counselling using a harm minimization approach is that the information provided be credible and reflective of ‘real’ or ‘lived’ circumstances. Continuous glucose monitoring provides a technique whereby the glycaemic consequences of various behaviours can be documented in an ambulant or non-artificial setting. Adolescents with Type 1 diabetes frequently consume alcohol in a social context [11]. Alcohol is known to inhibit the gluconeogenic pathway, to inhibit lipolysis, impair glucose counter-regulation and blunt hypoglycaemia awareness [3,4]. Previous studies in young adults with Type 1 diabetes have shown that moderate consumption of alcohol in the evenings without concomitant food intake may cause hypoglycaemia the following morning [5]. Consumption of alcohol after a meal, however, has shown no similar adverse effects on glucose [6]. It is reasonable to assume, therefore, that alcohol consumption may be a significant risk factor for hypoglycaemia in adolescents with Type 1 diabetes [5]. Studies of the glycaemic effects of alcohol consumption in an ambulant adolescent/young adult population can be difficult. This is because such behaviours are uncontrolled, often spontaneous and usually in the context of other social activities (parties, dancing, etc. ). In order to ensure that we only reported accurate CGMS data during these activities, capillary blood glucose calibration was considered vital and those patients who failed in this regard were excluded from analysis. Just over 60% of the patients recruited were able to successfully wear and calibrate a CGMS unit during these activities. Given that patients who experience hypoglycaemic symptoms are more likely to perform capillary self measures of blood glucose, we feel that it is unlikely that those patients excluded from the analysis had a greater frequency of hypoglycaemia than those patients reported. We were unable to record our subjects’ alcohol consumption in a contemporaneous fashion and hence were reliant upon their recall. It is possible that their remembered patterns of consumption were not entirely accurate. This potential inaccuracy should not be seen as a weakness of this study, as we only set out to determine patterns of glycaemia in adolescents engaging in spontaneous and uncontrolled alcohol consumption. We neither specified the type nor the amount of alcohol to be consumed (our ethical approval was contingent on this not occurring). The data as to amount of alcohol consumed have been included for descriptive purposes only. The results of this study show that alcohol consumption by adolescents in a social context is associated with a greater degree of glycaemic variation and less time spent with low glucose values than evenings where no alcohol is consumed. Whilst the second of these findings appears counter-intuitive, there may be several possible explanations. Firstly, the vast majority of our study group ate a meal prior to going out and ate upon their return before going to bed. These are practices that we have instilled as harm minimization strategies to avoid alcohol-induced hypoglycaemia in our clinic. Secondly, most of the alcohol consumed was as pre-mixed spirit and sweetened, carbonated beverages. Finally, alcohol consumption was only associated with vigorous exercise (dancing) in a minority of our study group. All of these factors could have combined to negate the hypoglycaemic effects of alcohol. In a previous study of glycaemia during alcohol consumption in adult men [5], hypoglycaemia occurred most often 10–12 h after wine consumption when the evening before ended at 23. 0 h. We analysed our data to see if a similar phenomenon occurred in this study and found that the per cent of time spent with CGMS readings 4 mmol/l between 06. 00 and 12. 00 h on the morning after the study period (i. e. the morning after the drinking night) was only 1. 1%. Notwithstanding the fact that our cohort frequently consumed alcohol later than 23. 00 h, the facto rs that impacted upon glycaemic control during the study night appear to have carried over to the ‘morning after’. The findings in this study highlight the importance of ambulant testing. It is important to note that the findings of the group studied here may not be seen in adolescents who drink non-sweetened alcoholic drinks or in those adolescents with better underlying metabolic control. Whilst alcohol consumption in isolation may reasonably be thought to cause hypoglycaemia, alcohol consumption by adolescents in the context of meals, sweetened mixers and little activity did not result in more hypoglycaemia than an alcohol-free evening. Whether the increase in glycaemic variation seen on an evening  © 2006 The Authors. Journal compilation  © 2006 Diabetes UK. Diabetic Medicine, 23, 830–833 Review article 833 of alcohol consumption has negative clinical outcomes remains an area for further investigation. Competing interests CMM was a Novo Nordisk research fellow. FJC received fees for speaking at conferences and funds for research from Novo Nordisk. References 1 Cameron F, Werther G. Adolescents with diabetes mellitus. In: Menon, RK, Sperling, MA, eds. Pediatric Diabetes. Boston: Kluwer Academic Publishers, 2003: 319–335. 2 Frey MA, Guthrie B, Lovelandcherry C, Park PS, Foster CM. Risky behaviours and risk in adolescents with IDDM. J Adol Health 1997; 20: 38–45. 3 Avogaro A, Beltramello P, Gnudi L, Maran A, Valerio A, Miola M et al. Alcohol intake impairs glucose counterregulation during acute insulin-induced hypoglycaemia in IDDM patients. Diabetes 1993; 42: 1626–1634. 4 Kerr D, Macdonald IA, Heller SR, Tattersal RB. Alcohol causes hypoglycaemic unawareness in healthy volunteers and patients with type 1 diabetes. Diabetologia 1990; 33: 216–221. 5 Turner BC, Jenkins E, Kerr D, Sherwin RS, Cavan DA. The effect of evening alcohol consumption on next morning glucose control in type 1 diabetes. Diabetes Care 2001; 24: 1888–1893. 6 Koivisto VA, Tulokas S, Toivonen M, Haapa E, Pelkonen R. Alcohol with a meal has no adverse effects on postprandial glucose homeostasis in diabetic patients. Diabetes Care 1993; 16: 1612–1614. 7 National Health and Medical Research Council. Australian Alcohol Guidelines: Health Risks and Benefits. DS9. Available from: http://www7. health. gov. au/nhmrc/publications/synopses/ds9syn. htm. 8 McDonnell CM, Donath SM, Vidmar SI, Werther GA, Cameron FJ. A novel approach to continuous glucose analysis utilising glycaemic variation. Diab Tech Therap 2005; 7: 253–263. 9 StataCorp. Stata statistical software. Release 8. 0. College Station, TX: Stata Corporation, 2003. 10 Kyngas H, Hentinen M, Barlow JH. Adolescents perceptions of physicians, nurses, parents and friends: help or hindrance in compliance with diabetes self-care? J Adv Nurs 1998; 27: 760–769. 11 Patterson JM, Garwick AW. Coping with chronic illness. In: Werther, GA, Court, JM, eds. Diabetes and the Adolescent. Melbourne: Miranova Publishers 1998, 3–34.  © 2006 The Authors. Journal compilation  © 2006 Diabetes UK. Diabetic Medicine, 23, 830–833

Essay on The Civil War in the United States in 1861-1865 part 2

Essay on The Civil War in the United States in 1861-1865 part 2 Essay on The Civil War in the United States in 1861-1865 part 2 Essay on The Civil War in the United States in 1861-1865 part 2Essay on The Civil War in the United States in 1861-1865 part  1South was lack of basic necessities. Its small industry worked for the war effort, and sea blockade prevented export of cotton to Europe and getting food and medication. Although the human and material resources of the South were at the limit, its military power has not yet been broken.In the spring of 1863, under the command of Lee, southerners again dealt a severe blow to the federal army on the Virginia portion, but it was the last major victory of the rebels. Human resources of the North were huge, former slaves appeared to be good soldiers. Industry of the North, which ended the industrial revolution, worked at full capacity, farmers expanded supply of agricultural products (they purchased cotton in England or replaced with wool), thousands of immigrants came to the states.The army of Lee was stopped at Gettysburg (PA) and dropped back to Virginia in J uly 1863, and the Grant troops took Confederate stronghold on the river Mississippi. This marked a turning point in the war. In the spring of 1864, federal troops began an offensive in the west in the heart of the Confederacy Georgia. In the fall, General William Sherman took the largest industrial center of the South, Atlanta, and began famous march to the sea. On April 9, 28,000 army of Lee was surrendered, as well as troops of the other generals of the South (175 thousand people). Thus ended the civil war, which killed over 600 thousand people from both sides (Mousseau, 2012).Lincoln’s deathOn April 14, 1865, in the theater Lincoln was shot by the actor Booth, fanatic killers. It was the revenge of the slaveholders. Lincolns death plunged America into mourning. He gained respect and love of people of different political views and beliefs. Consistently following the universal values in politics and in life, unselfish and friendly, a great American, was one of the few polit ical figures of his time, who impressed even the supporters of revolutionary class struggle.Lincoln did not sought to the dictatorship in relation to the South. He wanted to restore the US on the same, equal to all states constitutional basis, with the only condition the recognition of the abolition of slavery. He considered magnanimity to the defeated, restoration of their political rights the most appropriate course of promoting civil peace. Life has shown, however, that solving problems of post-war reconstruction of the South was not so easy, and events have gone in a different direction than Lincoln relied.Reconstruction Era (18651877)   Slavery was abolished in the country irrevocably by the 13th Amendment to the Constitution, which was approved in April by the Senate, and by 3/4 of the states in December, 1865. There remained unresolved specific questions of the further existence of the South the conditions of admission of the former Confederate states into the Union, posi tion of former slave owners and freed slaves, device power and others. In the US, there was no consensus in ruling circles in this respect. A group of influential congressional Republicans headed by Thaddeus Stevens and Charles Sumner insisted on a military dictatorship over the South, deprivation of active participants of the rebellion of civil rights and providing them to blacks.After the death of Lincoln, disagreement between the President and Congress worsened. The new President Andrew Johnson, a former vice president, continued Lincoln’s course. He had neither fame nor the authority of his predecessor, and the practical results of the first peacekeeping policy turned against him. He adopted the decree of amnesty in May 1865, which restored the planters in civil, political and proprietary rights (except the right to have slaves).Confiscated during the war plantations were returned to former owners, who forced and threatened black population to work for former owner. There branched terrorist organizations, including the famous Ku Klux Klan. Having power, they adopted black codes laws that deprived former slaves land property rights, freedom of movement, freedom of speech, assembly and meetings, right to marry whites, and so on (Harvey, 2012).In July 1866, Congress passed the 14th Amendment to the US Constitution. It deprived the leaders of the Confederation of the right to hold public office, and equalized the rights of blacks with whites. Radical Reconstruction meant the forced democratization of life in the South, with the support of the army, which entered southern states, but without unleashing terror and dictatorship.The agrarian question was decided by a resolution to buy property. By 1880, almost total illiteracy among blacks reduced to 70%. By the end of the 60s, in the southern states they actively used their political rights and were elected even to Congress. Constitution of the southern states was revised, which was a decisive factor in i ts acceptance to union on a new basis.A booming capitalism in a natural, evolutionary way leveled the differences between the North and the South, and in the 70s Radical Reconstruction gradually diminished. As the Democratic Party stepped up its mass base, including the expense of the farmers and poor whites of the South, the Republican lost its former influence over the masses. In 1876, presidential candidate of the Democrats, Samuel J. Tilden (NY) received more votes than Republican Rutherford B. Hayes of Ohio. However, the election results were reviewed and majority was given to Hayes. Leaders of both parties made a deal: the US president was a Republican in exchange for a commitment to withdraw federal troops from the territory of the South.Meaning of the Civil War and Reconstruction Era   Both events were a single entity, and went far beyond the military victory of the North over the South. Conflict of free enterprise and plantation slavery can be seen as a conflict between t wo forms of ownership and diametrically opposed types of work organization of capital: slavery excludes wage labor, and vice versa.The main outcome of the Civil War was the abolishment of slavery. The remaining components of the US economy industry, commerce, agriculture farm developed before the war. In the northeast United States, the industrial revolution ended before the 60s. The Civil War temporarily reduced the rate of economic growth, but ultimately it prepared the development of capitalism on a much broader basis. Adopted in 1862 Homestead Act was the most progressive solution of the agrarian question, and the Republican Party, staying in power from 1861 to 1884, held a series of activities for the benefit of entrepreneurs.As for the South, after the Civil War it still was behind the North and West of the USA. Part of plantations were transferred to new owners, a part was divided into small plots and leased. Still mostly blacks worked on plantations, but as farm laborers or tenant sharecroppers, giving part of the harvest to the owner.The abolition of slavery created a crucial prerequisite for the formation of the labor market in the South, but it was not fully formed even in the years of radical Reconstruction. The main obstacle was the fact of racial discrimination black Americans usually could get only the most difficult and dirty work. Black people in general remained at the position of lower class, although a small portion of them became educated people, owners and even entrepreneurs.Reconstruction could not solve all the problems of turning the South into the same region of the US, as free north and west. However, it pushed the events follow the evolutionary path.ConclusionIt took almost a century the struggle of black Americans for their civil rights to culminate in the actual, real success. This occurred not only under the influence of their own struggle, which took sometimes violent forms, but also because of the evolution of American societ y on the way of recognition of human values and respect for human rights, which for the first time were proclaimed in America in 1776. The first step in this direction was made by the great document abolishing slavery, signed by Abraham Lincoln.The civil war between northern and southern states was the inevitable consequence of the contradictions between the two social systems in the country. The question of slavery, which was entirely determined by the economic and political interests of the planters, was the key issue. Maximum program of the most aggressive circles of the South was turning the US into a single slave power, but they were quite satisfied with separation from the Union as an independent state (Carroll, 2011).In the winter-spring 1861, Confederation of 11 southern states was formed. On April 13, southerners unleashed hostilities with shelling federal Fort Sumter in Charleston bay (South Carolina), whose small garrison capitulated and lowered the American flag. Thus be gan a four-year Civil War the most bloody and destructive of all that took place on the territory of the United States. The turning point in the war in favor of the free states was achieved through conducting it in a revolutionary way. Homestead Acts from May 20, and the act of freeing the slaves from September 22, 1862 had a crucial meaning. While South was lack of basic necessities, the north finished industrial revolution. On April 9, 1864 the victory was taken by the north and there started Reconstruction Era (1865-1877). The main outcome of the Civil War was the abolishment of slavery.

College Essay Help Online

College Essay Help Online College Essay Help Online If you are applying for admission in to university this year or applying for higher studies, the chances are that you are going to need some solid college essay help.A college application essay is usually of around 500 words and it is really your only chance (apart from the interview-if there is one)- to tell the admissions committee why you are the ideal candidate for admission in to your chosen course and why. Are you looking for free college admission essays? Do you want to know how to write good college essays? Get college entrance essay outline for free at our site! We provide professional college essay help for students online! Custom college application essay written by professional writer wins attention of the readers immediately! Some colleges offer you the freedom to zero in on yourself to discuss your dreams, values and achievements Other colleges may specify that your college essay should center around a particular incident, theory or book. Your Choice of Essay Matters Choosing topic B over topic A can tell the admissions committee so much about yourself. You obviously prefer one choice over the other due to the kind of person you are; so if you are looking for somecollege essay help let me tell you that the choice of a college application essay also plays a crucial role in your assessment. It is not only the content, but the way in which you present it. What ever you write in your college application essay should showcase your ability to persuade, organize and lucidly write about your chosen topic. What and How What you prefer: Are you artistic or do you have a scientific bent of mind? This will clearly be reflected in the choice of essay. E.g. If you choose to write an essay on Michael Angelo then you are obviously a creative person. If you choose to write about Air Pressure then you quite obviously have a scientific bent of mind. What you believe How you think: your choice also offers college essay helpby indicating the type of person you are to the admissions committee. You must let them know you are an organized, hardworking and sincere person. If you make a point and leave it hanging while jumping to another unrelated sentence then this will show that you are a confused thinker. A more organized thinking pattern shows that you are dependable and methodical. Read also: Human Rights Law Business Essay Good Essay Example of Argumentative Essay Essay Term Paper on Doing Business in China Concept Paper

Love or Morality.What Takes Precedent Essay Example | Topics and Well Written Essays - 1250 words

Love or Morality.What Takes Precedent - Essay Example This paper seeks to discuss how love, and morality is intertwined with an aim of finding out which one is precedes the other. It is undeniable that the power of love is greater than any other feeling that man can experience. It makes people do unimaginable things. However, love, like any other aspect of life is governed by social rules and expectations, which are collectively referred to as morality. Gurov, a banker in Moscow had been married for a long time and had two sons and a beautiful daughter. However, his relationship with his wife was not in good terms. In fact, â€Å"he secretly considered her shallow, narrow-minded, and dowdy, he  stood in awe of her, and disliked being at home† (Chekhov web). Although there were no conflicts, it was certain that love missed in the marriage. This is a clear evidence of ambiguity since the society thought of the family as a happy and loving family. According to the society, they were expected to remain in their stale relationship i n order to maintain moral integrity. Certainly, the absence of love in the marriage initially made him despise and classify women as â€Å"the lower race.† This was notwithstanding that, the same women were the source of love that he longed for. He recounted the many times that he would sleep with other women but would not find the true love â€Å"when they discovered their mistake, they went on loving him just the same. And not one of them had ever been happy with him† (Chekhov web). Many of the women loved him not because of who he was but because of who they thought he was. This is a phenomenon worth noting. Chekhov intended to show that love can make people compromise their moral standards, or at least the moral standards set by the society. However, it is evident that morality failed in this situation where Gurov slept with so many women due to lack of love. Most notably, Gurov was willing to compromise his moral standards and cheat on his wife. However, he was al ways very careful not to make it known by the society. Therefore, he still maintained a cover over the societal moral standards. A twist of events happened when Gurov met with Anna. Anna  had gone to the town for a vacation and most importantly, to take time off her husband. She too was tired of loveless relationship with her husband. A relationship ensued and the two new lovers began recounting the predicaments that had befallen them in their lives. At this moment, it was evident that Anna had experienced a loveless life with her husband. She felt that she had all along been deceiving herself. She claimed, â€Å"I despise myself and have not the least thought of self-justification. It is not my husband I have deceived, it's myself. And not only now, I have been deceiving myself for ever so long† (Chekhov web). Although her husband was an honest man, she certainly did not love him. Therefore, she experienced the same ambiguous situation with Gurov. It was easy for her to co mpromise the moral integrity due to lack of love in the marriage. Similarly, she was afraid to put it open to the society in fear of compromising the moral standards set by the society. It does not come by surprise that she slept with Gurov albeit in secrecy. The two fell in love and it became apparent that they were meant to be together. However, Anna was recalled by her ailing husband and had to go back. Although the two were deeply in love, they still respected the moral values of the family and therefore agreed that she had to go and attend to her

Training Trends and Issues Essay Example | Topics and Well Written Essays - 750 words

Training Trends and Issues - Essay Example The organizations have become more demanding due to globalization factor, hence an individual’s worth in his organization has increased manifold. Due to the complex business nature, the organizations are marked by a scuttle and commotion to attract the best talent of the industry. There is huge dearth of skilled, experienced and competent workforce that help in the enhancement of organization overall efficiency and accomplishment of pre-defined goals and objectives (Rolph J. CIPD, 2004). In such an intense situation, business heads are looking out for innovative and effectual ways through which existing employees can be trained for future challenges. After analyzing and deeply evaluating the current trends in training and development, three specific styles have been identified. First and foremost is the impact of globalization on training delivery tools and techniques. It has become mandatory for firms to intensely compare the cost that is incurred on training in terms of inve stment made in different countries, regions, centers, units etc. The primary objective is to attain maximum output with minimum input along with optimum utilization of resources. In order to realize the above objective, reconstruction of integrated potential of the organization is preferred by most of the firms these days. A large training cluster is formed within the organization or can be outsourced as well to an agency that provides timely delivery of resources exceptionally manages the project and provides effective administration services (Polson, 2001). For rendering the above mentioned services, the company charges a fixed cost. The practitioners must ensure that organization must be proactive rather than reactive in identifying to the emerging skills that are needed to combat the current market threat. They need to highly focused and clear regarding their needs and requirements, and should be in a position to put pressure on outsourced companies to deliver the best and top m ost quality service. Second most upcoming trend is e-learning that aims to extract the best possible training from any part of the world at lowest price possible. On-line training is the solution to all problems faced in training employees and those companies, who have yet not adopted the trend or find no such need for it, would soon be ravaged (Polson, 2001). This is the most effective method as the learner can move as per his individual pace, it is cost effective as mass scattered audience can be targeted, and quality and cost are the two main attributes of the emerging trend overpowering the limitation of distance or location. The practitioners in this case need to understand that here the learners need constant motivation as different age groups have different grasping power, distinct goals and pace. A 21 year old energetic, vibrant and inquisitive learner can’t be taken on the same platform as a 50 year old experienced employee who wants to be at ease in his own created comfort zone. Technology alone can’t resolve all learning challenges hence must be taken as an additional source of training, the fundamental designing must be sound, meticulous planning and effective instructional skills are required. ‘Talent Hunt’ is another recent trend observed in the current business scenario where there is acute shortage of well trained, capable and highly skilled employees. It is contradictory statement when we say that the unemployment rate in most of

The World of Chariots :: essays research papers

The World of Chariots Chariot Racing, popular public game in the classical world of ancient Greece and Rome, in which horses pulled a two-wheeled chariot, or small cart, driven by a charioteer. Often the chariot driver stood in the chariot, rather than sitting. A chariot driver cracks his whip to encourage his horses. Chariot racing was a popular pastime in ancient Greece and Rome and was recorded as an event in the ancient Olympic Games. At the ancient Olympic Games, which began in 776 bc, the chariot race was often the first and most spectacular of the events. The course consisted of 12 double laps, nearly 14 km (9 mi) in all. The most important race was for teams of four horses controlled by one driver. The owners of these teams were nobles, and the victory wreaths were awarded to the owners. By the early 7th century bc there were also professional charioteers from the lower classes. Greek chariots were light, two-wheeled vehicles driven with the driver standing up. Accidents were frequent, and emotions often reached a high pitch. Greek lyric poet Pindar, who sometimes wrote victory odes for the owners of winning teams, tells of one race in which 40 teams were entered but only one finished. Chariot racing was a popular theme in Greek art, appearing in sculpture, vase painting, and engravings on coins. Chariot racing in the Roman Empire was significantly different than it had been under the Greeks. Racing stables were distinguished by the color that their drivers and horses wore. Red and white were the older colors, but green and blue gradually eclipsed them, eventually overtaking them entirely. Interest in chariot racing centered on the victory of the color rather than on the skill of the driver or the quality of the horses. Political and even religious importance came to be attached to the colors. Chariot drivers were commoners, freedmen, or slaves who had been professionally trained from boyhood. If successful, their prestige and earnings were tremendous; unlike the Greeks, the Romans regularly awarded monetary prizes. Roman satirical poet Juvenal remarked that a certain charioteer earned a hundred times the salary of a lawyer. Honorary inscriptions in stone recorded many interesting facts about both drivers and horses. The most prized horses came from Libya, Sicily, Spain, Thessaly, Armenia, Parthia, and Cappadocia. A team of four horses controlled by one driver was the most common, although races were run with teams of as many as ten or as few as two horses.

Coca Cola vs. Pepsi

We often have a Coke or a Pepsi when we have lunch, hang out with friends, or even just simply when watching television. Some people choose one of them simply by their taste. Others choose due to its popularity. But also there are people who are not choosy between one and the other because they can not tell the difference. The reality is that Coca Cola and Pepsi are very different. The first way to distinguish between a can of Coke and Pepsi is the brand color. Cokes come in red cans, while Pepsi comes in blue cans. Though the drink has the same color, the branding is always in the specified red and blue colors. The tastes of both drinks are distinct and it is easy to make out the difference. Pepsi is a little sweeter in taste than Coke. This is due to the addition of the artificial sweeteners to it. You will be able to make it right when you take a sip of the drink. The additions of the sweeteners leave a mild chemical taste after you drink it. Compared to Pepsi, Coca Cola does not have that chemical after taste owing to the less artificial sweeteners added. When you drink Coke you feel more of that cola flavor in it, while with Pepsi, you get sort of a fruity taste. The carbonization level of both drinks is also different. It is higher in Coke. So when you take that first sip of Coke, you get that fizzy effect. The frizz is less in Pepsi. The fizzy nature can be indentified by the bubbles formed when you first open the bottle or just simply shake. You do get that bubbly taste down your throat with Pepsi, but is more with Coke. When it comes to the branding part, the logo of Coca Cola has not varied much since its first appearance. May be a minor change in the font is all what changed. This has helped it to stay on the minds of people. But Pepsi, on the other hand, has come up with various logos and slogans. This kept on changing almost yearly. Though the company and market analysts claim that this is in tune with the changing trends in the society, many do not accept this. Each time they see a new logo, they are afraid to try it thinking that the whole drink has changed. Although Coca Cola and Pepsi are similar in the color of their drink, there are remarkable differences in their brand color, flavor, carbonization level, and branding techniques. However, both brands are still dominating the soda market and it is more likely that they are going to keep doing it for many years to come.