CHOOSE FISH WISELY

Aardarsh –Dietitian, MVH

Mercury occurs naturally in the environment but it’s also an industrial pollutant. Once mercury is released into the water, fish absorb it. Larger, longer-living predatory fish such as, swordfish, shark, and many types of tuna end up with the most mercury. Cooking fish does not affect its mercury content.

• Eating high-mercury fish regularly can result in its build- up in the body and health problems such as birth defects in newborns, learning disabilities in children and, diabetes in adults.

• Higher intakes of omega-3 fats and magnesium, a mineral found in fish as well as legumes, nuts, seeds, wheat bran andspinachreducessome of the harm from mercury.

• High mercury exposure leads to elevated blood sugar and insulin levels. Some types of seafood can damage pancreatic cells that secrete insulinand bloodsugar goes out of control.

The question is - Should you stop eating fish?

No, definitely not. Eating fish rich in omega-3 fatty acids like salmon, and sardines may help reduce the risk of heart attack, stroke, Alzheimer’s disease and macular degeneration - an eye disease. 
• However, women of childbearing age and young children should limit intake of high-mercury fish and seafood.

• Fish high in mercury include tuna (albacore, big eye, black fin, and blue fin), king mackerel, shark, swordfish, marlin; and canned albacore (white) tuna . Canned light tuna, usually skipjack tuna, is lower in mercury.

• Some low mercury fish such as trout, catfish, crab, wild salmon, haddock, sardine, herring, shrimp are quite safe and healthy for everyone.

• Portion size should not exceed 300gmrs per week.

• Limiting exposure  to mercury, losing excess weight, preventing abdominal weight gain, getting regular exercise and eating a healthy diet that minimizes (or avoids) refined starches and added sugars are all  important strategies to reduce the risk of diabetes.

A healthy diet includes fish consumption, but if you eat a lot of high mercury level fish, you are more likely to have increased mercury levels.

You can’t control your age. You can’t control your genes. You can’t control your race, but you do have the power to control your diet and physical activity.

Hyperbaric Oxygen Treatment

Hyperbaric Oxygen Treatment (HBOT) for Healing Wounds

HBOT has for long been used for treating decompression sickness, gas gangrene, and carbon monoxide poisoning. It is finding wider application in the quick healing of severe wounds in people with diabetes, burn injuries, crush injuries and healing of skin grafts among others.

Keeping pace with the latest developments, MV Hospital for Diabetes &Prof.MViswanathan Research Centre will soon be the first hospital in Tamil Nadu to offer this facility.

Diabetes and Infections:

People with diabetes tend to get infections more often and with greater severity than those without diabetes. Certain tissues in people with diabetes are more prone to infection because of hyperglycemia, nerve damage, vascular disease and susceptibility to infections.

Nerve damage can change the pressure distribution on load bearing parts, especially the feet. Along with the lack of sensation, this can lead to the formation of ulcers which in turn can get infected.Nerve damage also results in retention of urine in the bladderwhich can predispose to infection of the urinary tract.

Due to vascular disease, there is less blood supply to various tissues. As a result, the amount of oxygen available to the cells is reduced. This lowers the body’s resistance to infections and also allows anaerobic microorganisms to multiply. In Type 1 Diabetes Mellitus, the immune system is altered and this sets the stage for certain infections.

High levels of blood glucose predispose people with diabetes to bacterial and fungal infections as bacteria and fungi flourish in this medium.This also weakens the immune response.
People who have had diabetes for a long time are very susceptible to infectionsof soft tissues and the skin.

It is a vicious cycle in which infection raises the levels of blood glucose, which in turn make  the infection worse.

Prevention and Treatment of Infections:

Steps taken to prevent infections in people with diabetes focuses on the factors that cause it - primary prevention of infection, tackling the cause of diabetes, controlling blood glucose levels, and preventing neurological and vascular disease.

The aim of these preventive techniques is to keep the blood glucose and glycosylated hemoglobin levels as close to normal as possible, and considerably reduce the risk of complications.

Managing infections in people with diabetes is different from those without diabetes. When people with diabetes get infections, antibiotics aregiven early and used for a longer time along with  other medications.

New Techniques in Wound Healing:

Over the past two decades there have been many new approaches to promote a more rapid healing in diabetic foot lesions. Of these, the Hyperbaric Oxygen Treatment(HBOT) uses oxygen at a level 2 – 2 ½ times greater than atmospheric pressure to heal severe wounds, especially in the lower limbs. In people with diabetes, vascular disease results in less oxygen to the tissues. HBOT raises the levels of oxygen in the plasma which in turn provides more oxygen to the tissuesso thatwounds can heal effectively.

It also increases the effectiveness of leucocytes, is harmful for some anaerobic bacteria and prevents toxin formation in others.

HBOT requires a pressure chamber made of rigid or flexible material and a means of delivering 100% oxygen.

A monoplace chamber compresses one person at a time, usually in a reclining position . Employees tend to the patient from outside the chamber and equipment remains outside the chamber.

Multiplace chambers treat multiple patients at the same time, generally with a nurse or another inside observer who monitors the patients and assists with equipment manipulation or emergencies.

The patient stays in the chamber for about 60 – 90 minutes, breathing in pure oxygen.

A schedule is drawn up according to the needs of the patient and introduced and monitored by trained personnel. Depending on the type and severity of the infection, 10-20 sittings are required which can be taken once a day or sometimes even twice a day.

HBOT has been widely used for the management of non-healing diabetic foot ulcers in the USA for many years.

Benefits of HBOT for People with Diabetes:

• In people with Type 1 diabetes, it increases muscle oxygenation and immune response.
• People with diabetes with complications of the lower extremity, and those with acute peripheral ischemia benefit from this treatment.
• Diabetic Foot- In cases where a combination of vascular ischemia and infection may lead to gangrene, HBOT is used as additional treatment along with antibiotics.
• Gangrene- The absence of or limited arterial blood supply to the limb can cause gangrene. HBOT can help stop further progression of gangrene and limit the rate of amputations.
• HBOT puts an end to soft tissue and bone infections by killing microorganisms, improving leucocyteand macrophage function and enhancing the effect of microbials.

Drawbacks:

It is expensive and time consuming.

Source:

1. RSSDI Textbook of Diabetes Mellitus. Edited by –MMS Ahuja, BB Tripathy, Sam GP Moses, HB Chandalia, AK Das, PV Rao, SV Madhu.

2. International Textbookof Diabetes Mellitus.- 3rd Edition, Vol.2., Editors-in –Chief- RA Defronzo, E. Ferrinnini, H Keen, P Zimmet

Some Facts On Pre-diabetes

What is pre-diabetes?

Pre-diabetes is when a person's blood glucose levels are higher than normal but not high enough to be Type 2 diabetes. People with pre-diabetes are more likely to develop Type 2 diabetes.

People with pre-diabetes don’t often have symptoms.

Symptoms develop very gradually and people often don't recognize them. Some people have no symptoms at all. Look out for symptoms such as increased thirst, frequent urination, fatigue and blurred vision. Sometimes, dark, thick patches may appear in areas of your body where there are skin creases or folds such as on the neck, armpits, elbows, knuckles and knees.

The most important warning sign that you are at risk for pre-diabetes is an expanding waistline- a waist circumference of more than 40 inches for men and 35 inches for women.

 Another sign is being overweight with a BMI above 25.

Other risks for pre-diabetes -

• More than 45 years old.

• Inactive or sedentary lifestyle
• A family history of Type-2 diabetes
• Polycystic ovary syndrome or gestational diabetes during pregnancy, or having a baby with birth weight more than 4.1kg.
• High blood pressure.
• HDL ‘good’ cholesterol levels below 35 mg/dl or triglyceride level above 25 mg/dl.

• Too little or too much sleep.

Pre-diabetes does not always progress to diabetes -

Although pre-diabetes is a big risk factor for Type 2 diabetes, it need not always progress to Type-2 diabetes.

The International Diabetes Federation reports that ‘40-50 % of people with IGT will develop Type-2 diabetes (accompanied by increased risk of cardiovascular disease) within ten years’. But they believe that about 30 % of people with pre-diabetes will return to normal glucose tolerance if they take certain measures to slow down or prevent pre-diabetes progressing to diabetes.

Progression of pre-diabetes can be slowed down or prevented -

Research studies from the National Institute of Diabetes and Digestive and Kidney Diseases (DPP) and from Finnish Diabetes Prevention Study (DPS), found that risk for diabetes could be delayed or prevented by 58 %by changing one’s lifestyle with a low fat, low calorie diet and moderate intensity physical activity of at least 150 minutes per week.

Lifestyle changes are very important –
* Begin the day with a nourishing breakfast. Have three meals a day.Add 2 – 3 snacks per day.
* Use whole grain and high fiber foods instead of processed foods.

* Eat nuts, seeds, lentils (dal), fish or poultry instead of red meat.
* Consume lots of freshfruits and vegetables such as greens, carrot and broccoli and less ofcommercial fruit juices.

* Choose low calorie foods instead ofhigh calorie ones. For example, choose low fat cheese instead of regular ones, or skimmed milk instead of whole milk.
* Lose excess weight.
* Be on the move.  Being active allows your body to use insulin and absorb glucose better and puts less stress on your insulin-making cells. Even brisk walking for half an hour every day

can reduce diabetes risk.
* Quit smoking and drinking alcohol. Those who smoke increase their diabetes risk by 50 % when compared with non-smokers.

* Keep track of blood glucose levels if you have pre-diabetes.

Pre-diabetes is the same as Impaired Glucose Tolerance or Impaired Fasting Glucose.

Doctors sometimes refer to high blood glucose levels as Impaired Glucose Tolerance (IGT) or Impaired Fasting Glucose (IFG), depending on what test was used to detect it.

Source: http://www.diabetes.org/