Type 2 Diabetes Mellitus

Heading towards being diagnosed with Type 2 Diabetes Mellitus

A sedentary lifestyle and excess weight can predispose a person to diabetes mellitus. Extra fatty tissue releases cytokines- inflammatory markers- into the blood stream, causing inflammation. Inflammation inhibits the action of insulin made in the pancreas and as a result, the body cannot use the insulin effectively and increases the demand for it. This damages body tissues.

Your body prompts β-cells in the pancreas to produce more insulin. The pancreas secretes insulin in two phases -  a quick burst to control the rise of blood glucose from the first bites of food  and a second phase where insulin is released more slowly for about 90 minutes during and after eating.

Large amounts of insulin in the blood stream help to keep blood glucose normal, but lipid levels rise and begin to become abnormal. Triglycerides rise and HDL lowers. Blood pressure often rises.

Blood glucose climbs slowly. Pancreatic β-cells cannot make enough insulin to keep blood glucose normal and blood glucose rises to pre- diabetes level.  This can  take 5 – 10 years in adults, and even  less  in children.

Soon the pancreas cannot keep up with the  demand for insulin  and the  stage  is reached where the person is  diagnosed for diabetes.  By the time most people are diagnosed with diabetes, they have lost 50 % insulin making capacity.

With time, the ability to make insulin goes further down. Now, to lower blood glucose, one needs drugs which help the body release more insulin and decrease insulin resistance.

 Eventually, as insulin production decreases, a person needs insulin injections to control blood glucose.

As insulin resistance continues over time, it may be necessary to take both.

(-   Diabetic Living Mar-Apr 2012)

Follow these steps to get a good drop of blood on the first stick with the least pain and an accurate result.

Wash your hands in soap and running water wherever available. If you don’t clean your hands, you could have a blood glucose level that is artificially high and if you use insulin, it can become an issue.  For example, if you have just eaten an apple, you may have some residue on your fingers. Hand sanitizer and alcohol wipes may leave residue on your finger.

Dry your hands well . Blood tends to spread on a damp finger. On dry skin it forms a nice bead.

Shake your hands briskly at your sides 3- 5 times just as you would do before using a mercury thermometer, to get your blood down to the fingertips.

Stick – set your lancet to the right depth- you need just a drop of blood. Use the side of your finger for less pain - there are fewer nerve endings.

Milk the finger down gently. Don’t squeeze hard or you may change the composition of the blood thereby affecting the result.

Test your blood glucose also if you are sick or if you have an infection, before you start a new medication, if you are under a lot of stress, or if feel as though your blood glucose level is too low.

(-   Diabetic Living Jan-Feb 2012)

Weighty medications

Some diabetes drugs cause weight gain. They put more insulin into circulation to lower blood glucose or cause the insulin the body produces to be more effective . The disadvantage of having more insulin is that it’s a growth hormone and likes to build tissues like fat cells with any extra calories. The growth of fat tissue means added weight.

(-   Diabetic Living Jan-Feb 2012)

For Type 1 Diabetes Mellitus , Support is Key to Coping.

There are many teenagers and young married men and women who have dropped out of work or school, or have been abandoned by their spouses because they could not cope with their diabetes.

They would not have eaten after injecting insulin, would have eaten much later, or would have forgotten to take the mid- day snack and gone into hypoglycemia. They may have lived in places where it is difficult to get insulin .Many times, chronic diabetics are unable to recognize the symptoms of hypoglycemia  and so their condition deteriorates.

Many people give up their jobs because they are afraid of ‘hypo’s’  at work. Once a teenager was injecting insulin in the school toilet and school authorities thought he was injecting drugs!

For coping with Type 1 diabetes mellitus,  one needs a good support system of family, doctor, educator and dietitian and the school/workplace/ spouses. In addition one needs to be open about the condition so that others are aware of how they should respond in times of emergency.

(- The Hindu- September 13,  2012)

Diabetes - Festival Food

DIABETES - FRIENDLY FESTIVAL FOOD    

Mrs. Sheela Paul and Ms.S.Vimala  - Dietitians

India is blessed with numerous festivals, all associated with happiness and merriment, food and drink. Holi, Easter, Janamashthami, Eid, Diwali and Christmas are celebrated throughout the country with a mind –boggling, mouth-watering assortment of food and drink.

These festivals, however, are not very friendly toward people with diabetes, all 40 million of them, who are often forced to make  dietary  changes. During festivals, people with diabetes are exposed to calorie –rich and unhealthy food, yet not allowed to eat them by self-styled ‘diabetes police’ family members. Sweet, pastry, cake, pudding, savory, fast food and desert are prepared, bought and consumed by family and friends, without a thought for the people with diabetes, who are allowed to see, but not eat these delicacies.

If finally they do get to eat something, it is served with lots and lots of guilt, self-reproach and depression. Once people begin eating, they often find that they are unable to stop themselves, as if they are addicted to sweets.

Is there any way we can improve the quality of life of people with diabetes, allowing them to celebrate festivals, and life, with the rest of society, without harming themselves? -

Indian cuisine is rich in healthy, low-calorie diabetes- friendly recipes and food preparations. A slight imagination, originality and effort on the part of the family and kitchen staff can produce many diabetes friendly dishes.

*  Use Sugar- free sweeteners to make sweet dishes.
*  Various low-calorie nutraceutical preparations  and powders are available which can be used alone, or in combination with other foods.
*  Using low-fat milk, as well as fruits like papayas, oranges, apples, and grapes in suitable quantities can supplement food as well as tickle taste buds. 
*  People with diabetes should regulate and limit rich food intake during festivals. Small quantities taken after three hours or so (the 6-meal pattern) release less sugar into the body, and allow it to be absorbed easily.
*  If normal physical activity is maintained, glycemic levels remain under   control.
*  Anti- diabetic drugs or Insulin, if prescribed, has to be taken regularly.

 * Family members and friends should empathize with persons with diabetes and should try to understand their duty towards maintaining the health of their friends and relatives with diabetes. 

 After all a healthy family member or friend is an asset to the family as well as to the nation.    

Be aware about sweets       

Eating doesn’t mean eliminating sugar for people with diabetes. If you have diabetes, you can still enjoy a small serving of your favorite dessert now and then. The key is moderation.

But if you have a sweet tooth and the thought of cutting back on sweets sounds almost as bad as cutting them out altogether, the good news is that cravings do go away and preferences change. As your eating habits become healthier, foods that you used to love may seem too rich or too sweet, and you may find yourself craving healthier options.

How to include sweets in a diabetes-friendly diet

* Hold back on  the bread (or rice or pasta) if you want dessert. Eating sweets at a meal adds extra carbohydrates. Because of this it is best to cut back on the other carb-containing foods at the same meal.

* Add some healthy fat to your dessert. Fat slows down the digestive process and  blood sugar levels don’t spike as quickly. But later it will increase the sugar level. So be careful while taking fat rich foods.

* Eat sweets with a meal, rather than as a stand-alone snack. When eaten on their own, sweets and desserts cause your blood sugar to spike. But if you eat them

* When you eat dessert, truly savor each bite. How many times have you mindlessly eaten your way through a bag of cookies or a huge piece of cake. Can you really say that you enjoyed each bite? Make your indulgence count by eating slowly and paying attention to the flavors and textures. You’ll enjoy it more, plus you’re less likely to overeat.

Tricks for cutting down on sugar

* Reduce  aerated beverages and juice you drink. If you miss your carbonation kick, try a little  soda (carbonated water) either plain or with a little juice mixed in.

* Reduce the amount of sugar in recipes by ¼ to ⅓. If a recipe calls for 1 cup of sugar, for example, use ⅔ or ¾ cup instead. You can also boost sweetness with cinnamon, nutmeg, or vanilla extract.

* Find healthy ways to satisfy your sweet tooth. Instead of ice cream, blend with fruits. Or enjoy a small chunk of dark chocolate, rather than your usual milk chocolate bar.

* Start with half of the dessert you normally eat, and replace the other half with fruit.

* Eating right is vital if you’re trying to prevent or control diabetes. While exercise is also important, what you eat has the biggest impact when it comes to weight loss.

A diabetes diet is simply a healthy eating plan that is high in nutrients, low in fat, and moderate in calories. It is a healthy diet for anyone! The only difference is that you need to pay more attention to some of your food choices - most notably the carbohydrates you eat.

  

Nordic walking

Nordic walking - One of the fastest growing exercises in the UK.

It is a type of walking-gliding movement that burns more calories and increases overall fitness and strength, tones the upper and lower body,  puts less pressure on the knees and joints and improves balance.

You will need light but strong Nordic walking poles, special gloves or straps and removable rubber tips for use on not grassy areas. Learn the simple technique and you are set to go.!

Visit www.uk-nordic-walking for ‘teach-yourself’ videos and more information.

Remember… before you start, ask your doctor if it is right for you, to adjust your medicines, and how often you need to test for blood glucose.

- balance,  September  – October 2012

Twins and Type 1 Diabetes

The risk of Type 1 Diabetes is 15 times higher than in the general population when a close relative - parent or sibling- has been diagnosed with it.

If a brother or sister is diagnosed with it, the risk of developing Type 1 diabetes is 10 %,

With non- identical twins, the risk is 10% -19. 5%, but with identical twins the risk shoots up to 30 –70 %.

- balance , September  – October 2012

Type 2 diabetes now common among children too.

Type 2 Diabetes is usually associated with adults but a study conducted in Chennai shows an increasing trend of Type 2 Diabetes among children and adolescents.

Startling facts:

• About 26%  diagnosed were under 15 years of age.
• Prevalence greater  among girls than boys.
• Life style factors play a huge role. Obesity is on the rise among children in private schools.They are mostly from affluent homes.
• Researchers have also observed a high prevalence of micro- vascular complications typical of Type 2 Diabetes- retinopathy, nephropathy and neuropathy among children.

- The Hindu

Meals that heal:

Cereal power-  The Goodness of Oats

• Oatmeal and oat bran are rich in dietary fiber, both soluble and insoluble, which helps to lower blood cholesterol.
• Oats helps to slow down the rise in blood sugar after a meal and also delays its absorption into the cells .The soluble fibre forms a gel- like structure while passing through the digestive tract. This increases the viscosity of the contents of the stomach and small intestine and delays the absorption of carbs into the bloodstream  –necessary forpeople trying to lose  weight  and for people with diabetes.
• Oats also has a good balance of essential fatty acids and is a good source of vitamins such as folic acid, thiamine, and minerals such as copper, iron, magnesium, manganese,  and  zinc .
• Regular consumption helps maintain healthy blood pressure.

Tip- Roasting helps add taste to the oats.

- The Hindu 

A wake-up call for India’s50-plus club 

A Prevalence of Risk Factors study by the WHO conducted among males and females aged 50 and more across 6 countries including India, shows that this age group faces serious risk of chronic diseases.

87.95% men and 93.5 % women in the group have insufficient nutrition intake while 24% men and 26% women have low physical activity.

Around 1 in 4 men and an equal number of women suffer from high blood pressure.

Almost 3 in 4 men and over 4 in 5 women have high risk abdominal obesity that greatly increases Cardio-Vascular Disease risk.

The biggest underlying risk factor for chronic disease in older people is high blood pressure.

- (Study on Global Ageing and Adult Health)

 

Nearly 1.3% males above 50 years and 3% Indian women are obese.

                                                                               - (Ageing in the 21^st century – UNFPA)

India has around 90 million elderly and the number is expected to increase to 315 million, which is 20% of the total population, by 2050. Kerala, Tamil Nadu, Maharashtra, Orissa, West Bengal, Punjab and Himachal Pradesh have higher proportion of elderly population.

Older people in developing countries have almost 3 times the occurrence ofvisual impairment than those in the developed world. The study found that about 65% of elderly suffer from a chronic ailment of which arthritis/rheumatism, hypertension cataract and diabetes are most prevalent in that order. About 1/3 of the elderly suffer from 2 or more chronic ailments simultaneously.

Currently 1 in 9 persons the world over is 60 years or above. This figure is projected to increase to 1 in 5 by 2050.  While increasing longevity is one of humanity’s greatest achievements, population ageing is a phenomenon which cannot be ignored.

A combined study by various agencies -(UNFPA, Institute for Social and Economic Change Bengaluru, Institute for Economic Growth- Delhi, Tata institute of Social Sciences Mumbai)       

  -  Times of India

 ‘Chair disease’ - the big risk in office

A research by the University of Sydney found that the increase in use of computers has almost negated the benefits of improved workstation design and posture. Spending hours in front of a computer screen in the office poses serious health problems including heart disease, diabetes and obesity. 

‘Work station design  has come a long way since the 80’s and they are good changes but the proportion of people reporting symptoms has not changed much despite this … and is not enough to keep up with health issues that arise from paperless IT-dominated offices.’  – Karen Griffiths, lead author of the study.

-  Times of India