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.

Thursday, July 17, 2014

Millets for People with Diabetes


Dr. Vimala Sanjeevi & Ms. Rohini U.
Dept. of Nutrition.















Millets are a group of small-seeded grasses which can grow in dry lands and land with poor soil quality and requires much less water that rice and wheat. They are a major crop in the semi – arid tropics of Asia and Africa. They are a rich source of Vitamin B especially niacin, B6, folic acid, and minerals such as calcium, phosphorus, iron, potassium, magnesium and zinc.













Millets include jowar (great millet), ragi (finger millet), korra (foxtail millet), arke (kodo millet) and sama (little millet). All these are available in the form of rice (example: foxtail millet rice), rawa (example: jowar and bajra rawa) and flour. These may look coarse and unappealing when compared to mill polished white rice, but provide immense health benefits.

Millets are part of our forgotten tradition. People  forget that 50 years ago everyone was eating these grains. There are different millets, each with a unique flavour.

Millets are very nourishing











      
 In general,
  • Millets contain lignans that act against hormone - dependent cancers and also help reduce risk of heart disease. 
  • The high phosphorus content plays a vital role in maintaining the cell structure of the human body. 
  • Lecithin is excellent for strengthening the nervous system. 
  • They are gluten free and so are appropriate for those with celiac disease or other forms of allergies or intolerance to wheat. 
  • Millet is alkaline and easily digested and has low glycemic index. 
  • Millet protects from constipation and has a probiotic effect. 
  • The high levels of tryptophan in millet produce serotonin which is calming. 
  • All millets show high antioxidant activity. 
  • The high protein content makes it a significant addition to a vegetarian diet.
For people with diabetes, millets contain insoluble fibre that reduces the secretion of bile acids, increases insulin activity and lowers triglycerides and prevents spikes in the level of blood glucose. They are a good substitute for rice. The magnesium acts as a co-factor for more than 300 enzymes including those involved in the body’s use of glucose and secretion of insulin. The B vitamins help in processing carbohydrate from foods. The fat content is 75% heart healthy PUFA.

Consuming carbohydrates that have been processed or refined can cause extreme ups and downs in blood glucose levels, overwork the liver and pancreas and rob the body of existing vitamin and minerals such as calcium and magnesium from its stores in order to break down and digest food properly.










How to use millets

Include it gradually into your diet.
  • Mix it with rice or use it instead of rice and potatoes. 
  • Add millet flour to idli/dosa batter or chapatti dough. 
  • Make cookies, cakes, bread and laddus with whole wheat and jowar flour and jaggery. 
  • Use millet rawas and millet rice to make khichdi/upma with lentils and vegetables. 
  • Use sprouted millets in salads and soups. 
  • Add millet to your favourite chopped vegetables and make a stir fry. 
  • Make breakfast porridge with cooked millet and add your favourite nuts and fruits to it.
Regular consumption of millet is associated with reduced risk of T2DM.

Tuesday, July 8, 2014

Artificial Sweeteners: A Boon or Bane?


Dr. Patricia Trueman
Dept. of Diet &Nutrition







Today “size zero” is the fashion and in an effort to maintain and reduce weight the market is flooded with foods that contain sugar substitutes (artificial sweeteners). 










Artificial sweeteners and other sugar substitutes are found in a variety of food and beverages marketed as "sugar-free" or "diet," including soft drinks, chewing gum, jellies, baked goods, candy, fruit juice, and ice cream and yogurt.











Just what are all these sweeteners? And what's their role in your diet?

Sugar substitutes are loosely considered any sweetener that you use instead of regular table sugar (sucrose).

Artificial sweeteners are just one type of sugar substitute. 

The following chart lists some popular sugar substitutes and how they're commonly categorized.

 













Possible Health Benefits of Artificial Sweeteners











  • One benefit of artificial sweeteners is that they don't contribute to tooth decay and cavities.
They may also help with the following:  
 

 








  • Weight control. One of the most appealing aspects of artificial sweeteners is that they are non-nutritive — they have virtually no calories. In contrast, each gram of regular table sugar contains 4 calories. A teaspoon of sugar is about 5 grams. For perspective, consider that one 200 ml can of a sweetened cola contains 8 teaspoons of added sugar, or about 160 calories. If you're trying to lose weight or prevent weight gain, products sweetened with artificial sweeteners rather than with higher calorie table sugar may be an attractive option.  
 










  • Diabetes. Artificial sweeteners may be a good alternative to sugar if you have diabetes. Unlike sugar, artificial sweeteners generally don't raise blood sugar levels because they are not carbohydrates.
The Health Dangers of Artificial Sweeteners

Here's a list of the top four artificial sweeteners, along with information about what's in them and the negative impact they can have on your health.

1. Aspartame

What's in it: Phenylalanine, aspartic acid and methanol.

Reported side effects: Headaches, fibromyalgia, anxiety, memory loss, arthritis, abdominal pain, nausea, depression, heart palpitations, irritable bowel syndrome, seizures, neurological disorders, vision problems, brain tumors and weight gain

Your body converts the amino acid phenylalanine to neurotransmitters that regulate your brain chemistry. These important neurotransmitters are:
  • L-dopa
  • norepinephrine
  • epinephrine 
The resulting increased levels of neurotransmitters can cause problems in the physiology of your brain -- problems which have been linked to a variety of psychiatric disorders. You can also be prone to anxiety attacks, depression, headaches, seizures, and tremors. Phenylalanine and aspartic acid directly impact brain and central nervous system functions; evidence shows they play a role in mood disorders, memory problems and other neurological illnesses.

The second largest component of aspartame is aspartic acid. Aspartic acid functions as a major excitatory neurotransmitter in your brain. People who suffer from depression or have brain atrophy have been found to have low levels of aspartic acid in their bodies. As you might expect, the chemical is found in abnormally high levels in people who suffer from seizures and strokes. In very high doses, aspartic acid can cause brain damage and cell death.

Methanol is converted into formaldehyde when metabolized.  Makers of aspartame say methanol and its by-products are quickly excreted.  But research has found measurable amounts of formaldehyde in the livers, kidneys and brains of test subjects after ingestion of aspartame.

At high temperatures, phenylalnine breaks down into diketopiperazine (DPK), a known carcinogen. Phenylalnine is especially dangerous for people with the hereditary disease, phenylketonuria.

2. Acesulfame-K

What's in it: Acesulfame-K is a potassium salt containing methylene chloride, a known carcinogen.

Reported side effects: Long term exposure to methylene chloride can cause nausea, headaches, mood problems, impairment of the liver and kidneys, problems with eyesight and possibly cancer.

Concerns: Of all artificial sweeteners, acesulfame-K has undergone the least scientific scrutiny. Early studies showed a potential link between the sweetener and development of multiple cancers in laboratory animals.

3. Sucralose

What's in it: Sucralose is a synthetic additive created by chlorinating sugar. Manufacturers say the chlorine in sucralose is no different from that in table salt. Fact: the chemical structure of the chlorine in sucralose is almost the same as that in the now-banned pesticide DDT.

Reported side effects: Head and muscle aches, stomach cramps and diarrhea, bladder issues, skin irritation, dizziness and inflammation

Concerns: Research has shown sucralose can cause shrinking of the thymus gland, an important immune system regulator, and liver and kidney dysfunction. A recent study by Duke University found sucralose reduces healthy intestinal bacteria, which are needed for proper digestion and can impact the effectiveness of prescription and other drugs.

According to the Sucralose Toxicity Information Center, the absorbed sucralose and its metabolites (chemically altered substances) concentrate in the liver, kidney, and gastrointestinal tract.

One study on sucralose showed an increase in glycosylated hemoglobin (meaning damage to the oxygen carrying part of a red blood cell). Research in animals has shown:
  1. Up to 40 percent shrinkage of the thymus gland. (Critical for the response to disease – the ‘heart’ of our immune system)
  2. Enlarged liver and kidneys
  3. Atrophy of lymph follicles
  4. Reduced growth rate
  5. Sucralose affects the glucose and insulin response to glucose ingestion, the mechanism responsible is not known.
 4. Saccharin

What's in it: Saccharin is a sulfa-based sweetener; its primary ingredient is benzoic sulfimide.

Reported side effects:
For those with sulfa allergies, saccharin may cause nausea, diarrhea, skin problems or other allergy-related symptoms.

Concerns: Early safety studies of saccharin showed the sweetener caused bladder cancer in rats. The FDA recently lifted the requirement that saccharin be labeled as a probable carcinogen on food packaging. The link between saccharin and bladder cancer has contributed to saccharin being the most investigated of all artificial sweeteners.

 








Each one of us should now decide: Are artificial sweeteners a boon or bane?
And should we include it in our diet? 

References:

1. Medical Author  Melissa Conrad StopplerMD
    Medical Editor William C. Shiel Jr. MD FACP FACR Medicine Net on Health.com
2. Author: Betty Kovacs, MS, RD
Medical Editor: William C. Shiel Jr., MD, FACP, FAC Medicine Net on Health.com
3. Dr. Mercola Artificial Sweeteners -- More Dangerous Than You Ever Imagined Mercola.com Take control of your Health

Thursday, June 26, 2014

Diabetes - A Wake up Call for the 21st Century










The 6th Edition of the IDF Diabetes Atlas reports that the number of people living with diabetes rose to 382 million in 2013 and evidence shows that diabetes prevalence by 2035 will be nearly 600 million with diabetes and approximately 470 million will have impaired glucose tolerance. 1 in 8 people in the world, 1 billion people,will live with or be at risk of diabetes















                              
Bionic Pancreas to Control Blood Glucose












A recently published paper on a study by Boston University and Massachusetts General Hospital provides a boost to the global fight against diabetes. The Bionic Pancreas is a wearable experimental device that has passed the test of constantly monitoring blood glucose and automatically giving insulin or a sugar boosting drug as needed.

The device controls blood glucose in people with Type 1 Diabetes mellitus using doses of both insulin and  the blood glucose raising hormone, glucagon.

Unlike other artificial pancreas in the process of being developed that just correct high blood glucose, this one can also fix low blood glucose thereby imitating what a natural pancreas does.

The device has three parts, 2 cell phone sized pumps for insulin and sugar- raising glucagon and an IPhone wired to a Continuous Glucose Monitor. Three small needles go under the skin usually in the belly, to connect patients to the components which can be kept in the pocket.

The study results were published in the New England Journal of Medicine.

                                      New Causes of Neonatal Diabetes










Neonatal diabetes is diagnosed when a child is less than 6 months old and has added complications such as muscle weakness, learning difficulties and, at times, epilepsy.

A study from Exeter (UK) has revealed 2 new genetic causes of neonatal diabetes which affects  approximately 1 in 100,000 births and provides further insight into the formation of insulin producing beta cells in the pancreas.

Exeter is a leading centre for neonatal diabetes. Subjects were screened for mutations in genes important for human pancreatic development . Mutations were found which increase the number of known genetic causes of neo natal diabetes to 20. 

As well as shedding light on the genetic causes of the disease and providing answers for parents of children with this rare condition, this work helps to understand how the pancreas develops.

 Many people with diabetes can no longer make insulin and would benefit from therapies that replace insulin producing beta cells of the pancreas.

(Diabetes Update Spring 2014)

                                                 Islet Cell Transplant

The first successful islet cell transplant in the UK took place in 2005. Today it can be a life- saving therapy for those experiencing more than one severe hypo each year.

People who use insulin to control their blood glucose levels sometimes experience episodes of very low glucose or hypoglycaemia.Most people with Type 1 diabetes mellitus are able to manage these hypos because of the characteristic symptoms that tell them when their blood glucose is low such as feeling shaky, sweaty or anxious. 












These symptoms are very important because they urge people to manage each hypo thereby preventing their blood glucose levels from falling further which could have potential serious consequences.

Severe hypos can occur in anyone taking insulin but it is more likely to happen in people who have had diabetes for more than 15 years, and thosewho are unable to recognize the low blood glucose level – hypo unawareness.

There are several different medical approaches to help reduce the risk of having a severe hypo.

These include 
  • The use of multiple injections of modern insulin  or
  • The use of DAFNE(Dose Adjustment For Normal Eating) style education that help people match their insulin dose to the amount of carbs in each meal.
  • Insulin pump therapy sometimes combined with continuous blood glucose monitoring can be helpful. 
For people who continue to experience more than one severe hypo each year, an islet celltransplant can be very beneficial and might help them regain control of diabetes. It can be life changing and at times life- saving. They are also suitable for kidney transplant patients who have Type 1 diabetes mellitus and poor blood glucose control.


Islet cell transplantation involves extracting the insulin producing islet cells from the pancreas of a deceased donor and implanting them in the liver of someone with Type 1diabetes mellitus. This minor procedure is usually done twice for each transplant patient and can be performed with minimal risk using a needle under local anaesthestic.

Most people who receive islet cell transplantation continue to take low dose insulin therapy so this is not seen as a cure for diabetes.

Benefits
  • Reduces risk of severe hypos
  • Leads to improved awareness of hypos
  • Less variability in blood glucose levels
  • Improved quality of life and reduced fear of hypos.
Risks include a small but increased risk of certain cancers, severe infections and other side effects related to medication needed to prevent the islet cells from being rejected by the body.

The following people might be suitable for an islet transplant:
  • Those who have experienced two or more severe hypos within the last two years and have impaired awareness of hypos
  • Those with a functioning kidney transplant who experience severe hypos and impaired hypo awareness or poor blood glucose control despite best medical therapy.
The following people are not suitable for an islet transplant:
  • Those who need a lot of insulin a day – e.g more than 50 units a day for a 70 kg body weight.
  • Who weigh over 85 kg
  • Those with poor kidney function.
(balance – May – June 2013)

Tuesday, June 17, 2014

What is Type 2 diabetes?













India has been designated the ‘Diabetes Capital’ of the world with the maximum number of cases of diabetes and an equally large number of undetected cases. 


What is Type 2 diabetes?











Diabetes is a disease in which sugar builds up in the blood.


Type 2 diabetes is the most common type of diabetes. In Type 2 diabetes, your body makes insulin, but the insulin is either not enough or the body cannot use it, so glucose from the blood which is very necessary for energy cannot be used by the cells.

Why does Type 2 diabetes occur?

Type 2 diabetes can occur due to excess weight, low levels of activity, carbohydrate rich diet, or genes that run in the family - the familial tendency for diabetes is passed on from one generation to the next through genes. This is transmitted to the offspring even if they were born before the parents developed diabetes.

Why do Indians have a tendency for  insulin resistance?
It could be

  • Genetic,  





  • Due to  physical inactivity, 








  • Consuming excess calories, 







  • Obesity, especially around the waist,  






  • Use of large amounts of saturated fats  








  • Low intake of fruit and vegetable in the Indian diet 








What are the symptoms of diabetes?

Frequent urination, increased thirst, increased appetite, loss of weight, frequent infections, blurred vision, feeling of tiredness or fatigue , a burning sensation in the feet, losing feeling in your feet or getting a tingling sensation in the feet… are all symptoms of diabetes

However, many people with diabetes do not show any of these signs. So don’t wait for them. Consult your doctor for screening for diabetes, if you are at risk.

Am I at risk for diabetes?

The following are some of the risk factors for Type 2 diabetes:
  • Being overweight or obese.  










  • Age — being older than 45 










  • Inactivity — exercising less than 3 times a week  








  • Family history — having a mother, father, brother, or sister with diabetes 









  • Race— It is more common among people of African, Asian or Latin American origin 





  • Having a baby with a birth weight more than 9 pounds
  • High blood pressure
  • High cholesterol
  • Abnormal results in an earlier diabetes test
  • Having a history of heart disease or stroke
Many people show no symptoms before they are diagnosed with diabetes. So, if you are in the high risk group, you should get yourself tested routinely.

What is pre- diabetes?

Pre-diabetes is a condition where your blood glucose is higher than normal but is lower than the diabetes range. This puts you at risk of getting Type 2 diabetes and heart disease. 

However, you can reduce the risk of getting diabetes and even return to normal blood glucose levels with reasonable weight loss and moderate physical activity.

  • If you are diagnosed with pre- diabetes, lose weight (5-10 percent of total body weight) through diet and through moderate exercise, such as walking 30 minutes a day, 5 days a week. 








  • Pre-diabetes increases your risk for heart disease or stroke by 50 percent; so stop using tobacco and alcohol, and control high blood pressure and high cholesterol.
  • If your blood glucose levels are within the normal range, it is reasonable to be checked every 3 years. If you have pre-diabetes, follow your doctor’s advice to check for Type 2 diabetes

People with pre-diabetes don’t often have symptoms. Some people have no symptoms at all! 

Stress and diabetes 












Acute physical and mental stress affects blood glucose levels.

During stress times, the body increases the levels of other hormones which do not allowinsulin to work effectively on glucose.

Nowadays, young adults  are under tremendous stress at work because of  irregular timing, pressure of deadlines, irregular meals, working at night  and lack of  physical exercise.

People are very busy with their lives  and face a lot of stress, anxiety and have unhealthy food habits such as depending on fast foods and packaged foods.












Lack of physical activity in school children along with overeating, eating large amounts of high-calorie food and the stress of school seem to be the reason for large increase in cases of diabetes among children.












Over- feeding  by parents and the resulting obesity in childhood leads to obesity in adulthood. Overfed children, who don't play and spend too much time in front of the computer and TV are prone to diabetes.










Lifestyle, lack of exercise, high carbohydrate diet, abnormal cholesterol levels lead to early diabetes.

Prevention of Type 2 diabetes

Control  your  weight.












Eat healthy. Avoid high-calorie/high-fat and high sugar diets.  Replace white bread, pasta and white rice with brown rice, millets and whole grain flour. Eat a lot of fresh fruits and vegetables and replace red meat with fish or white meat. 











Be active. Half an hour of cardiovascular activity daily like running or swimming is good.




Be aware.  Health education should start from the school level. Schools should conduct workshops to make students aware about the disease.  


 

Nurture your children. Children should not be allowed to take junk food and should be encouraged to increase physical activity.


No smoking. Restrict alcohol


Prevent obesity, especially central obesity and increased visceral fat due to physical inactivity.








Prevention begins right from pregnancy. Studies have shown that if the mother is undernourished then the risk for diabetes in the off spring is great. And if the mother is optimally nourished you can reduce that risk to a large extent.


Regular heath check- up is a must because if diabetes remains undiagnosed it can lead to severe complications.

Thursday, June 5, 2014

Quality Care for People with Diabetes

The DAWN study that was initiated in 17 countries in 2001 provided startling evidence that managing diabetes was more than just blood glucose reading and medications. Diabetes care must also focus on personal issues of the individual, the health system and how society views the condition of diabetes.The study identified that to improve the health and quality of life of people with diabetes, there should be

  • Better communication between them and their healthcare providers 








  • Better communication among healthcare professionals 







  • Promotion of effective self - management skills for people living with diabetes.


  • Improved psychological care for people with diabetes.










“Not everything that can be counted counts, and not everything that counts can be counted” –Albert Einstein

Living with diabetes is not only about treatment and management, outcome and numbers, it also involves 
  • How people with diabetes are coping 
  • what is important to them
  • The barriers they have to face every day while managing their condition and their life 
  • Treating them with dignity and respect
  • Listening carefully to what they say 
  • Equipping them with the knowledge ,tools and relationships  with family friends and diabetes specialists for efficient self- management, health and well - being. 
A new needs model for diabetes.

People with diabetes should be able to cope with their condition and live a full healthy and productive life
Family and friends should provide emotional and practical support
Community should provide medical care and treatment, access to quality diagnosis, treatment, care, and information.
Lifestyle–People with diabetes should have the same opportunities to enjoy life as others.
Work/school – Show support for and understanding of the condition.
Society- a healthcare system, government and public willing to listen, change and be supportive of the condition.

The DAWN 2 study was initiated 10 years later with the goals of providing a better understanding and awareness of the potential impact that diabetes can have on the quality of life of people with diabetes and their family members.

It was found that people with diabetes
  • Often find it difficult to accept, make and maintain life style changes,and
  • Face some societal issues such as discrimination, intolerance, lack of community support and observance of rigid religious practices among others.
Results from India
India reported high scores on person centred care and strong support from family, community and healthcare teams,but scored poorly on self - monitoring, adherence and foot care. 

Indian respondents reported low participation in educational programs and very few people found participation useful. 

According to the study, areas that need to be dealt with include primary prevention, early diagnosis and treatment of diabetes, and concerns about the risk of hypoglycemia. Also reported are the need for more diabetes educators and nurses, access to psychologists, and better communication within the healthcare team.

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