MV Hospital

Welcome to M.V Hospital for Diabetes, established by late Prof. M.Viswanathan, Doyen of Diabetology in India in 1954 as a general hospital. In 1971 it became a hospital exclusively for Diabetes care. It has, at present,100 beds for the treatment of diabetes and its complications.

Wednesday, May 27, 2015

Stress & Health

When does stress begin to affect health?



Life without stress can become quite monotonous. A little bit of stress is good. It usually encourages people to do better.

Stress is the ‘brain’s response to any demand’. It quickly releases hormones that make people find ways to protect themselves. The ability to cope with stress varies from person to person.

Too much stress can result in lack of sleep, headache, anxiety, depression and at times may affect one’s health.

                                                                            
 

The Heart:-
One study found that stress could increase heart attack risk by 23%.

After a stressful day at work some people tend to relax by drinking alcohol, or smoking, or gorging on food and this can result in adding weight. These activities can also contribute to heart problems by raising blood pressure and causing damage to the walls of the arteries.

Stress may also reduce blood flow to the heart, especially for women. Studies show that intense anger or anxiety may raise heart attack risk by more than nine times.

Diabetes:-
Stress increases the risk of diabetes. During times of stress the body increases the production of the hormone cortisol, which can increase the amount of glucose in the blood.  

 Stress can affect people with diabetes by poor management of the condition. They may drink more alcohol or exercise less. They may forget, or not have time, to check their glucose levels or eat well planned meals at the proper time.

Studies suggest that stress may contribute to the development of Alzheimer's disease.

Fertility:-
Stress can result in couples having problems getting pregnant or continuing a pregnancy. In men, stress could trigger the release of some steroid hormones that affect the metabolism of carbohydrates, fats and proteins. This could lower testosterone levels and sperm production in men hence making them infertile.

How can people protect themselves against stress-induced health problems?










The best way to reduce the risk of stress-related health problems is to tackle the stress itself.
  1. Recognize the symptoms of stress. They could be sleeplessness, exhaustion, eating too much or too little and feelings of depression, anger or irritability, excessive smoking or drinking or even taking drugs.
  2. Talk to and get support from friends and family. If they cannot help you,  get professional help from a counsellor or psychiatrist.
  3. Move about. Exercise to relieve stress.  Physical activity and exercise increase production of the ‘feel good’ endorphins in the brain. Exercise helps with symptoms of depression, as well as improves sleep quality.
Some other ways to help deal with stress:
  1. Be positive: Instead of saying "I can't do this," say "I'll do the best I can." Negative self-talk increases stress.
  2. Use quick stress stoppers: If you start to feel stressed, count to 10 before you talk,  or take a few deep breaths or go for a walk.
  3. Do something you enjoy: Engaging in activities you enjoy is a great way to hold back stress. Take up a hobby, watch a movie or have a meal with friends.
  4. Daily relaxation: Use relaxation techniques such as meditation, yoga and tai chi. They can reduce stress levels.

Tuesday, May 19, 2015

Have Diabetes? Stay Active

Being active increases the amount of glucose that your muscles can use for energy. This results in lowering the level of glucose in the blood. Increasing physical activity can improve control of blood glucose by allowing the body to use insulin or oral medication more effectively. Over a period of time it may help you to reduce your medication.

Regular physical activity helps a person to maintain a healthy weight which is very important for  diabetes control. Activities can be labelled according to their levels of intensity. So, there are moderate activities , vigorous activities as well as muscle strengthening activities.

Activities to strengthen muscles

Lift weights using plastic bottles or cans as weights. Gardening activities such as shovelling  and digging can tone and strengthen the muscles. Use resistance bands. Work out with push ups  and sit ups where you use your body weight  for resistance. Carry or move heavy loads such as furniture or groceries. Practice yoga asanas.

 

 Moderate intensity aerobic activities

Activities such as brisk walking, cycling on level ground, hiking, mowing the lawn or volley ball make the heart beat faster and increase the heart rate. You breathe faster and you can talk but not sing words to a song.

 

Vigorous intensity aerobic activity  

Running , swimming ,skipping, martial arts, fast  cycling,  tennis , volley ball and football  make you breathe hard and fast, increase  the heart rate and you can speak  only a few words without taking a breath.

 

Exercise every day. 

Vary your activities so that your routine does not become monotonous.
  • A minimum of two and a half hours of moderate aerobic activity in a week along with muscle strengthening activities that target  all muscle groups  for at least  2 days in  a week .
  • a minimum of one and a quarter hours of vigorous intensity aerobic activities in a week  along with  muscle strengthening  for at least 2 days a week.
  • A mix of moderate and vigorous aerobic activities Plus muscle strengthening at least 2 days a week.

Wednesday, April 15, 2015

You Can Prevent Type 2 Diabetes











Here are some research statistics. Start before it’s too late…

Although genes may influence the development of type 2 diabetes, lifestyle factors such as excess weight, lack of exercise, an unhealthy diet, and smoking play a far greater role in the development of the condition.

Some research statistics.
  • Women who have a healthy weight (body mass index less than 25), a healthy diet, 30 minutes or more of exercise daily, and  are non- smokers have 90 % less chance of developing diabetes
  • Consuming a “Western” diet ( a lot of red meats and processed meats)  along with  lack of physical activity and excess weight, significantly increases the risk of Type 2 diabetes in men. 
  • In the Diabetes Prevention Program on men and women with pre-diabetes, the ‘weight loss and exercise’ group  showed 58 percent fewer cases of diabetes and the benefits continued even after the program ended!
Simple Steps to Lower Your Risk

Make a few Lifestyle changes. They can significantly lower the chances of developing Type 2 diabetes as well as lower the chances of developing heart disease and some cancers.
  • Control Your Weight
Excess weight is the single most important cause of Type 2 diabetes.   
  • Are you overweight? Shed the excess weight because it increases the chances of developing Type 2 diabetes seven times over.
  • Obesity makes you 20 to 40 times more likely to develop diabetes than someone with a healthy weight. 
  • If your weight is above the healthy-weight range, get rid of 7 to 10 percent of your current weight. It can reduce your chances of developing Type 2 diabetes by half.
Get Moving—and Turn Off the Television
Not being active increases your chances of developing Type 2 diabetes.
  • Exercising more often and increasing the intensity helps muscles to use insulin and absorb glucose. This puts less stress on insulin-making cells.
You don’t need long hours of hot, sweaty exercise. 
  • Take a brisk walk for half an hour every day. It reduces the risk of developing Type 2 diabetes by 30 percent.  This amount of exercise has a variety of other cardiovascular benefits as well.  








A very harmful type of inactivity is when you do nothing but watch serial after serial or other programmes for most of the day on television. 
  • Every two hours you spend watching TV increases the chances of developing diabetes by 20 percent.
  • It also increases the risk of heart disease by 15 percent and early death by 13 percent.
The more television people watch, the more likely they are to be overweight or obese, and this could be part of the TV viewing-diabetes link.







Also, most people cannot resist the bag of chips or popcorn or the cold drink while watching TV. These unhealthy diet patterns may also explain some of this relationship. 

So, take a break from watching TV and take up other hobbies.

Tune Up Your Diet  
Four dietary changes can have a big effect on the risk of Type 2 diabetes.
  • Choose whole grains and whole grain products over highly processed carbohydrates.
Diets rich in whole grains protect against diabetes.
  • Women who averaged two to three servings of whole grains a day were 30 percent less likely to have developed Type 2 diabetes than those who rarely ate whole grains. 
  • Eating an extra 2 servings of whole grains a day decreased the risk of Type 2 diabetes by 21 percent.
What’s so special about whole grains?  

The bran and fibre in whole grains make it more difficult for digestive enzymes to break down the starches into glucose. This leads to lower and slower increases in blood sugar and insulin, and a lower glycaemic index. Whole grains are also rich in essential vitamins, minerals, and phytochemicals that may help reduce the risk of diabetes.

On the other hand, white bread, white rice, mashed potatoes, doughnuts,  and many breakfast cereals have a high glycaemic index and glycaemic load. They cause continuous spikes in blood sugar and insulin levels, which in turn may lead to increased diabetes risk. 
  • Researchers found that women and men who ate the most white rice—five or more servings a week—had a 17 percent higher risk of diabetes than those who ate white rice less than one time a month. 
  • People who ate the most brown rice—two or more servings a week—had an 11 percent lower risk of diabetes than those who rarely ate brown rice. 
  • Researchers estimate that using whole grains in place of some white rice could lower diabetes risk by 36 percent
  • Avoid the sugary drinks, and choose water, coffee, or tea instead.









Just like refined grains, sugary drinks have a high glycaemic load, and drinking a lot of this can increase the risk of diabetes
  • Women who drank one or more sugar-sweetened beverages per day had an 83 percent higher risk of Type 2 diabetes, compared to women who drank less. 
  • For every additional 12-ounce serving of sugary beverage that people drank each day, their risk of Type 2 diabetes rose 25 percent
Studies also suggest that fruit drinks   - either fortified drinks or juices, are not the healthy choice that they are advertised to be.
  • Women who drank two or more servings of fruit drinks a day had a 31 percent higher risk of Type 2 diabetes, compared to women who drank less than one serving a month.
How do sugary drinks lead to this increased risk? Weight gain may be one reason.

However, weight gain caused by sugary drinks does not completely explain the increased diabetes risk.  There is increasing evidence that sugary drinks can cause chronic inflammation, high triglycerides, decreased “good” (HDL) cholesterol, and increased insulin resistance, which are all risk factors for diabetes

Drinking water is an excellent replacement.  
  • Choose good fats instead of bad fats.
The type of fats present in the food you eat can also affect the development of diabetes.



Good fats, such as the polyunsaturated fats found in liquid vegetable oils, nuts, and seeds can help hold off Type 2 diabetes.  








But beware of Trans fats or bad fats that are found in margarine, packaged baked goods, fried foods in most fast-food restaurants, and any product that has “partially hydrogenated vegetable oil”.

Polyunsaturated fats from fish also known as “long chain omega 3” fats, do not protect against diabetes, however there is much evidence that they help prevent heart disease. 

If you already have diabetes, eating fish can help protect you against a heart attack or dying from heart disease. 
  • Reduce red meat and avoid processed meat; choose nuts, whole grains, poultry, or fish instead.







Eating a lot of red and processed meats seems to trigger diabetes in people who are already at genetic risk. 
  • The evidence is growing stronger that eating red meat (beef, pork, lamb) and processed red meat (bacon, hot dogs, deli meats) increases the risk of diabetes, even among people who consume only small amounts.
  • Researchers found that eating just one daily 3-ounce serving of red meat  increased the risk of Type 2 diabetes by 20 percent
  • Eating even smaller amounts of processed red meat each day—just two slices of bacon, or one hot dog—increased diabetes risk by 51 percent.
  • The good news:  Replacing red meat or processed red meat with nuts, low-fat dairy, poultry, or fish, or for whole grains lowered diabetes risk by up to 35 percent. The maximum reductions in risk came from not having processed red meat at all.
Why do red meat and processed red meat appear to increase diabetes risk?

Researchers feel that the high iron content of red meat could reduce the effectiveness of insulin or damage the cells that produce insulin .The high levels of sodium and nitrites in preservatives in processed red meats may also be culprits.
  • If You Smoke, Try to Quit   
Smokers are roughly 50 percent more likely to develop diabetes than non-smokers, while heavy smokers are at an even higher risk.










STAY LEAN AND STAY ACTIVE.

Five key words for preventing diabetes


( Statistics from the Nurses Health Studies I and II , Black Women’s Health Study and the Health Professionals Follow-Up Study…)

Friday, March 20, 2015

About Alcohol and Diabetes








Why people with diabetes should avoid alcohol.







  • Maintaining ideal weight is a very important task for good control of diabetes for people with Type 2 diabetes. Therefore the less alcohol they consume, the better they can control their weight.
  1. Alcohol increases the appetite so people with diabetes may tend to overeat and this affects their efforts to keep blood glucose under control. 
  2. Alcohol can influence a person’s choice of food leading to consumption of the wrong kind of food.  


     3.  Alcohol has a high caloric content and not many other nutrients. This is not really a good thing for people counting calories. 
  • Alcohol tends to lower blood glucose.  This is of  great importance to people with diabetes who are on insulin.






  • Alcohol can interfere with or change the effects of medicines such as metformin and sulfonylureas which are used to treat diabetes. It can result in side effects from insulin use.
  • Some of the signs of too much alcohol such as flushing, nausea, increased heart rate, slurred speech are also symptoms of hypoglycaemia. People with diabetes may not be able to recognize a hypo and take the required action in time. People around them may not recognise a hypo but instead think that a person having a hypo has had too much to drink!
  • Heavy drinking can also cause a build-up of ketone bodies in people with diabetes, which can result in medical complications related to diabetes such as retinopathy and neuropathy says health psychologist Dr. Nicola Davies.
  • Alcohol abuse can also cause changes in lipid metabolism, raised triglyceride levels, high blood pressure, cardiovascular disease, peripheral neuropathy, and impotence. 
The effect of alcohol on diabetes varies considerably depending on whether it is consumed by well-nourished individuals when blood glucose levels are high or in a ‘fasting’ state when blood glucose levels are low.

Alcohol affects diabetes by causing insulin resistance and also affects insulin secretion in the body. Consuming too much alcohol can result in ‘alcohol induced insulin resistance’ which may lead to hyper glycaemia in well- nourished people with diabetes.

Consuming excess alcohol and not eating can cause blood glucose levels to drop resulting in ‘alcohol induced hypoglycaemia’. This can result in permanent neurological changes or even death. 

But what if a person with diabetes is in a social situation such as a party, a wedding, a get- together or just enjoys an occasional drink?

Responsible drinking - What every person with diabetes should know:

Make sure your diabetes is well controlled, take the right precautions, know your boundaries, and most important of all … be aware of the effect of alcohol on diabetes.
  • Understand the importance of moderation or self- control and know how much you are allowed to drink and do not cross that line.
  • Eat before you have a drink to prevent a  ‘hypo’
  • Have a non- alcoholic drink between drinks. Quench your thirst with water, not the alcohol. 
  • Sip your drink. Don’t gulp it down.
  • If diabetes is being treated with insulin or sulfonylureas, do not drink immediately before or after exercise or physical activity because blood glucose falls naturally during exercise and there is a risk of a ‘hypo’.
  • People with Type 1 Diabetes mellitus need to calculate the carb content of both the drink and the food.
  • Do not mix alcohol and fruit juice as the calorie level goes up very high. 
  • Wear diabetes identification if drinking outside home.

(Reference : Diabetes Update Winter 2014)

Tuesday, March 10, 2015





Glucose intolerance recognized for the first time during pregnancy.
                                                                        Dr. Mitalee Barman









CAUSES:
Placental hormones, human placental lactogen and placental growth hormone, which are meant  to shunt nutrients to the fetus, cause worsening of insulin resistance during the late 2nd trimester

Mothers are unable to produce enough insulin to overcome the overwhelming resistance to maintain normal blood glucose levels.











DIAGNOSTIC CRITERIA

All pregnant women should undergo a 2 hour 75 gm- oral glucose tolerance test between the 24th and 28th week of pregnancy.

Fasting – 92 mg/dl 

1 hr       - 180 mg/dl

2 hr       - 153 mg/dl

Gestational diabetes mellitus is diagnosed if any 2 values are equal to, meet, or exceed the values given above.

FOLLOW UP: 
  • Every 3 weeks till 28 weeks of pregnancy
  • Every 2 weeks from 29 weeks to 34 weeks of pregnancy
  • Every week from 35 wks to term
  • Every 2 weeks from 29 weeks to term, if not on insulin. 













AFTER DELIVERY    

RISK FACTORS FOR TYPE 2 DIABETES MELLITUS FOLLOWING GESTATIONAL DIABETES MELLITUS

Unmodifiable risk factors                                                          Modifiable risk factors
Ethnicity                                                                                         Obesity
Age                                                                                                  Future weight gain 
Family history
Degree of hyperglycemia in pregnancy

SCREENING:

6-12 weeks after delivery, a follow up of 75 gm oral glucose tolerance test (GTT) should be performed to determine the women’s risk of developing diabetes and her status. If found normal , GTT should be repeated after 6 months and then after each year.

PREVENTION:

           Women who have had gestational diabetes mellitus are at a heightened risk for type 2 diabetes mellitus and so the best advice is:
  • A LOW FAT DIET













  • AVOIDANCE OF OBESITY   











  • REGULAR EXERCISE.

Thursday, March 5, 2015

A New Treatment for Diabetes?












Researchers at the Salk Institute for Biological Studies in California have shown that a single injection of a protein called Fibroblast Growth Factor (FGF1) is enough to restore blood sugar levels to a healthy range for more than two days in mice with diet -induced diabetes (the same as Type 2 Diabetes Mellitus in humans). The research is in its early stages so how this happens is still not known but scientists know that it works in a similar way to the existing diabetes drugs- glitazones by making cells more sensitive to insulin and thereby reducing blood glucose levels.

Glitazones can have side effects such as weight gain or heart problems in humans but this is not the case with FGF1. Researchers found that FGF1 did not set off these side effects or cause glucose levels to drop to very low levels, a risk factor associated with many glucose-lowering agents. Instead, the injections restored the body's own ability to naturally regulate insulin and blood sugar levels, keeping glucose amounts within a safe range.

Once perfected, it can become a very safe and effective alternative to controlling diabetes.

Diabetes Update - Autumn 2014

Wednesday, February 25, 2015

Hypoglycaemia Unawareness

(Not being able to recognize the symptoms of the onset of hypoglycaemia)











Hypoglycaemia is the most common side effect of insulin treatment and usually presents itself with symptoms such as sweating, palpitation and hunger. These symptoms alert the person with diabetes to the condition of their glucose level so that they can take the necessary action. Some people, however, lose the ability to recognize these symptoms. This condition is not just an issue for the person with Type 1 Diabetes Mellitus, it also affects the whole family…their peace of mind and the quality of their lives.

Hypoglycaemia Unawareness is often accompanied by confusion, changed emotions and anger.
The patient might stubbornly refuse to test blood when asked to do so, be aggressive, quarrelsome, or unreasonable when offered help. In extreme cases they can get verbally or physically abusive.

Caregivers become afraid of their relative /partner after violent reactions. They tend to stay awake at nights   or get disturbed sleep because of worries in case of coma. They tend to get up regularly to check if the patient is all right. They are unwilling to leave them alone because they are worried and concerned as well as because the patient is so reliant on them. Some even give up their hobbies or do not go out at all.

From a study that explored the impact of Hypoglycaemia Unawareness on the whole family it was found that …









A person with diabetes and Hypoglycaemia Unawareness:
  • Relies on the family members to help detect and manage Hypoglycaemia Unawareness
  • Does not like this reliance
  • Does not respond positively to help
  • Worries that they have become a burden to others
  • Loses confidence and in some extreme cases has to cope with an unhappy marriage.









A relative or partner who has to care for a patient with Hypoglycaemia Unawareness:
  • Is angry about how Hypoglycaemia Unawareness has affected his/her life
  • Is sometimes frightened of the patient
  • Feels tired, alone and unsupported
So people who have Hypoglycaemia Unawareness should be taught to recognize symptoms and appreciate that the condition can be serious.

Tip of the Week

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