Power Salads for a Healthy Diet

Some foods which are really very healthy, many a times, get reduced in importance and are considered as side dishes. Here are some very healthy choices that you can use as salads.

Tomatoes : This contains a lot of antioxidants that help in decreasing the risk of arterial aging, heart disease, stroke, memory loss, impotence and wrinkling of the skin.

Broccoli : It is high in vitamin C and dietary fibre and contain nutrients with anti- cancer properties.









Fish: Packed with protein, vitamins and nutrients that can lower blood pressure and reduce the risk of heart attack or stroke.









Black beans (Urad) : Low in fat and high in protein and fibre they have anti- oxidant and anti- inflammatory  properties which combat cardiovascular disease.

ARUGULA (Tara Mira)

CABBAGE                                        SPINACH

Leafy greens: Spinach, cabbage and arugula, are rich sources of Vitamin B and pack a punch. One serving of leafy greens is loaded with fibre, calcium and almost the entire day’s recommended dose of beta carotene which is vital for immune system health.

While buying arugula leaves or rocket leaves, look for young crispy green leaves. Avoid flowered harvest, as its leaves are tough and bitter in taste. 

Ideal Diabetic Footwear

The DiaStep TM (shown above) is a unique product of research between M.V. Hospital for Diabetes and   the Central Leather Research Institute , Chennai, supported by Novo Nordisk Educational Foundation. It is specially designed for diabetic patients who have neuropathy, minor foot deformation and foot complication.

Special features:

• A PU sole with extra depth for effective pressure distribution.
• A special tread for extra depth sole for better grip and traction.
• A specially designed insole bed and foam layer for added comfort
• A rigid counter to ensure limited joint mobility.
• A specially designed upper with leather lining for comfortable wear.
• Adjustable Velcro fasteners to accommodate changes in foot volume.
• A special angle of slant on the sole to give the ‘rocker’ effect which eases pressure from the plantar surface of the feet.

Tips on Choosing Foot wear

When you have diabetes, the type of shoes you wear is very important.
The following are some important tips.

• Buy shoes in the evening because your feet swell a little during the day.
• Get your feet measured while standing, each time you buy shoes. Feet change in shape and size as neuropathy progresses. 
• Footwear should be well- fitting and comfortable when you buy it. 
• DON’T wear ill- fitting shoes. They usually cause ulcers on the pressure points.
• Shoes should fit both the length and the width of the foot. The toe-box should be sufficiently long, broad and deep so that toes are not cramped.
• DON’T expect tight shoes to stretch after use. 
• DON’T use footwear with toe grips, toe rings or thongs between the  toes.

• It is advisable to use sandals inside and outside the house. Use Velcro, adjustable laces, or straps to fasten footwear. 

• DON’T wear tight shoes, shoes with heels more than an inch, or shoes with pointed toes. They put too much pressure on parts of the foot and cause ulcers, corns and calluses. 

• Use therapeutic shoes and inserts for calluses. Moulded insoles are available to suit your foot.
• The inner lining of footwear should be made of soft material, free of in- seam to protect the foot from blisters.
• Leather breathes better than any other material. It absorbs the wetness of perspiration and allows moisture to evaporate. Wet skin could macerate, especially between the toes. Macerated skin spreads infection.
• DON’T wear footwear made of nylon or plastic.

• Wear clean, dry, cotton socks with shoes to prevent blisters. 
• Wear custom-made footwear prescribed by a podiatrist.
• Check shoes and socks for any foreign objects daily after you take them off, and check your feet too.
• Run a hand around the inside of footwear to detect rough, worn-out places. 
• DON’T wear worn-out shoes, replace them immediately. Change them every 6-8 months.

• Use walking shoes or sports shoes while exercising.     
• Change your shoes after 5 hours of wearing them during the day to change pressure points.
• Don’t wear new shoes continuously. Wear them for 1-2 hours each day for the first few days.

Finally… always remember to show your feet and your footwear to your doctor.

Know Your Diabetes Numbers

Target blood glucose for most people with diabetes:
In the morning before eating and before meals, it should be ≥ 70 mg/dl  and ≤120 mg/dl.
1 ½  - 2 hours after eating, it should be ≤160 mg/dl.

What level of blood glucose is too low?
Less than 70 mg/dl

What level of blood glucose is too high?

Over 180 mg/dl : Talk to your doctor on next visit.

Over 300 mg/dl for 2 or more readings over 12 – 24 hours:  call your doctor.

Over 500 mg/dl: Call your doctor immediately or go to emergency room.

Always check your blood glucose levels: 

• Every day when you get up in the morning and at least one more time during the day
• If you take pills for your medication, check before breakfast and 2 hours after your biggest meal of the day.
• If you take insulin for your diabetes, check before each meal and at bedtime.

Your doctor may ask you to check your blood glucose level at other times as well.

Check any time you feel like your sugar is too high or too low.

How do you feel if your blood glucose is low?

Sweaty, shaky, fast heart - beat, dizzy, headache, not thinking clearly, hungry, tired, blurred vision, confused, moody or angry.

How to treat low blood glucose 

First eat 15 g of fast acting carbohydrate such as 

½ cup fruit juice

1 cup skimmed milk

1 tablespoon honey or sugar

A sweet

Then, test your blood glucose.

Test your blood glucose again in 15 minutes.

If sugar is not over 70 mg/dl, eat another 15 gm of fast acting carbohydrate.

Eat some protein and carbohydrate as soon as you can to stop from going low again. Try eating half a sandwich of peanut butter, meat or chicken or have your next meal or the meal you missed.

How do you feel if your sugar is high?

Increased urination, increased thirst, tired, blurred vision, dry skin/dry mouth.

What to do if you think you have high blood glucose.

Check your blood glucose as soon as you can.

Some tips to help you keep blood glucose low 

• Eat 3-4 small meals a day.
• Eat your main meals 4 -5 hours apart.
• Do not skip meals.
• Eat less food.
• Avoid the second helping.
• Do not snack between meals.
• Do not drink fruit juice, sodas or sweet tea but drink calorie free liquids such as unsweetened tea or coffee, or just plain water.
• Avoid foods high in sugar such as cake, pie, sweetened cereals, honey, jam, jelly.
• Do not add sugar to food.

At MVH, we advise all people with diabetes to manage their diabetes well so that they can live a normal span of life in perfect health.

World Diabetes Day

 

World Diabetes Day (WDD) was celebrated on November 14. The International Diabetes Federation (IDF) and its member associations spearhead the World Diabetes Day movement. It ropes in millions of people worldwide in diabetes advocacy and awareness.

A brief history

World Diabetes Day was created in 1991 by the International Diabetes Federation and the World Health Organization in response to growing concerns about the escalating health threat that diabetes now poses. World Diabetes Day became an official United Nations Day in 2007.  The campaign draws attention to issues of utmost importance to the diabetes world and keeps diabetes in the public spotlight.

On World Diabetes Day a new theme is chosen by the International Diabetes Federation each year to address issues facing the global diabetes community. While these campaigns last the whole year, the day itself is celebrated on November 14, to mark the birthday of Frederick Banting who, along with Charles Best, first thought of the idea which led to the discovery of insulin in 1921.

‘Healthy Living and Diabetes’ is the World Diabetes Day theme for 2014-2016. 

Breakfast  - The most important meal of the day. Do not neglect it.

Breakfast is the most neglected meal of the day for a lot of people. The early morning rush to get to school or workplace makes sure that people either grab a bite while running out of the house or skip it altogether.

Researchers at Purdue University recently found that eating foods that have a low glycemic index at breakfast may help prevent a spike in blood sugar all morning and even after lunch. 

In the study, people with diabetes who ate almonds as part of a balanced breakfast felt more full and had lower blood glucose levels after both breakfast and lunch. 

Another advantage of a good breakfast is that it helps boost the morning metabolism and keeps one full of energy all day long.

We are always advised not to skip breakfast as it is the most important meal of the day. A healthy breakfast can help to control weight and also keep blood sugar levels stable.

So, what is special about breakfast for a person with diabetes?  When you have diabetes, it is very important to keep the total carbohydrate content constant every day by including more fibre, replacing processed and refined foods with whole grain natural foods, and choosing foods that are good for the heart.

Controlling Carbs at Breakfast

Breakfast foods are usually high in carbohydrate content. The usual choice in a western breakfast is from cereal, egg, milk, yogurt, waffles, granola, and fruit; idli, dosa, upma in a South Indian breakfast or paranthas, puri and potato in a North Indian breakfast.  

The quantity as well as the quality of carbs is important. How many grams of carbohydrates is ideal for an individual depends on his/her calorie needs.

To get quality carbs, replace   toast and pancakes made of refined grains with whole grains, millets, fruit, and low-fat dairy products. Whole grains, millets  and fruit will give you extra fiber, which helps control blood sugar, while dairy products provide the protein.

Also make sure you get enough protein. Spreading out the protein you eat throughout the day may help you maintain a healthy weight.

Get Enough Protein at Breakfast

Include egg whites, plain Greek yogurt or hung fat- free curd, skimmed milk, nuts, beans, and reduced-fat cheese.

Don’t forget about the smaller amounts of protein you can get in other foods, such as whole-grain breads and vegetables.

Remember that diabetes increases the risk of heart disease, so do everything you can to keep your heart as healthy as possible.  Use very little salt and saturated fat, and add more fibre with whole grains, fruits, and vegetables. 

Pressed for time? Some quick breakfast ideas !

1. Breakfast Shake     

Blend one cup of fat-free milk or plain nonfat yogurt with a half cup of fruit, such as strawberries, apple or blueberries. Add one teaspoon of wheat germ, a teaspoon of nuts, and ice if needed and blend. It makes a a tasty, filling, and healthy breakfast.

2. Muffin Parfait   

Cover half a  bran muffin or other high-fiber muffin with berries, and top with a low- or nonfat yogurt for a fast and easy breakfast.

3. Whole-Grain Cereal    

Enjoy a bowl of high-fibre, low-sugar cereal with skim milk, or heat up plain oatmeal. Top with fresh fruit, skim milk, or a sugar substitute to sweeten your meal.

4. Scrambled Eggs and Toast 

   

Scramble the egg in a non- stick pan brushed with cooking oil. Enjoy this with a slice of whole-wheat toast topped with a light butter substitute, low-fat cream cheese, or sugar-free jam.

5. Breakfast Burrito   

  

Scramble an egg with onions and green peppers or spinach using a nonstick pan brushed with cooking oil. Place in a warmed whole-wheat chapati, sprinkle with nonfat cheddar cheese, add some salsa.

6. Almonds and Fruit

Take a handful of whole almonds and a small serving of low glycemic-index fruit, such as berries, a peach, an apple, or an orange. The fiber and healthy fats in the nuts will help you feel full, and the fruit adds additional fiber and a touch of sweetness to your morning without causing a blood-sugar spike.

When you're planning or preparing your healthy breakfast, keep these points in mind:

• Watch your portion sizes.
• Keep the diabetes dietary goals in mind, which involve eating more grains, millets, beans, and vegetables than any other type of foods. Use the diabetes food pyramid  as a reference for what is good for you . Include meat and protein, non-starchy vegetables, fruit, and milk and other dairy products.

• Cut down on cooking oil by using non-stick pans and heart-healthy butter substitutes.
• Choose low-fat dairy foods: milk, yogurt, and cheeses.
• If you cannot avoid coffee, use skimmed milk and a sugar substitute.

To get more breakfast ideas and to make sure you are eating the right portion sizes and type of foods consult a dietician or certified diabetes educator. A dietician can help create a meal plan that is right for you and your type 2 diabetes.

(Reference: www.everydayhealth.com      

                 www.webmd.com/)

CAUTION: Germs Thrive at Work too.

A study found that a virus went from the front door to half the office in four hours!

In a study researchers contaminated the front door  of an office with a  virus and found it had  spread  to  half the office employees in 4 hours.

Within 2 hours it had spread to the break room – coffeepot, microwave button, fridge door handle and then spread to rest rooms, individual offices and cubicles where it had heavily contaminated the phones, desks and computers. Within 4 hours they found it on more than 50% of commonly touched surfaces and on the hands of about half the employees in the office, many of whom did not even know each other!

Half the employees were then given hand sanitizers and disinfectant wipes to use and the level went down from 39% to 11 %.

The human body harbours viruses all the time. The average person has trillions of bacteria and dozens of virus species. Studies at a day care centre found 30 – 40 % of children without symptoms have respiratory viruses on them.

The handshake is a common source of pathogens.

Infecting one hotel room with the virus led to the infection of nearby rooms. Cleaning tools, such as mops and towels spread germs.

Survival of pathogens depend on environmental factors such as temperature, material , metal, and anything with textured grooves or connection points such as keyboard or child’s toys which can harbour dirt.

However, just because you are exposed to a virus or bacteria does not mean you will get sick. Much depends on the dose you are exposed to, whether you have been exposed to the germ before, and your general health conditions.

Beware - ‘The Hand is Quicker than the Sneeze’

• A work space with plastic and formica surfaces and grooved keyboard offers a hospitable environment for germs. 

• Most common respiratory viruses can survive on a surface such as the light switch or the door handle for 2 to 4 days.

• Coffee pot handles are some of the first places the virus spreads to.

• Water  fountains and wash basins can be breeding grounds for  most pathogens as they prefer moist environments.

• Hands …The average adult touches nose, mouth or eyes about 16 times an hour and for children between 2 – 5 years it is as high as 50 times.

• Microbes survive better on  synthetic porous surfaces  of carpeting  and upholstery  than on cotton. 

• Pathogens are readily transferred on stainless steel surfaces while  on copper  they won’’t last for more than a few hours. 

A New Approach to Clinical Trials

Patients play the role of researchers in drug trials 

Scientists regularly sign up new patients in clinical trials to test new forms of treatment. In a recent trend, they are getting help from patients to help them design some of the treatments!

Patients and researchers can contribute to treating disease as each group perceives a problem from different points of view. For example, in a trial of a potential prostrate cancer drug at Mount Sinai in New York, doctors had planned to ask patients periodically about side effects such as nausea but patient input convinced them to ask additional questions such as how many days they felt good enough to go to work.

Patients have also helped design a trial at the University of Wisconsin where researchers are testing a new strategy to help children with diabetes monitor their disease. A mother of a 10- year old child with diabetes serves on the advisory board for the diabetes trial that is testing a survey tool to identify patient needs and see if adapting interventions to these needs enable patients to control their blood sugar better.

An epilepsy patient has joined a trial as a member of the executive committee and her vote counts the same as that of the researchers when it comes to making a decision. 

Parents of pediatric patients show great concern about the possibility for side effects such as paying attention in school and remembering things when using some drugs and researchers hope to identify the drug with the least cognitive  and behavioural side effects.

In a prostrate cancer trial, researchers say that data suggested that metformin , an anti- diabetes drug, might also slow down the progression of prostrate cancer. In a bid to test whether patient input was useful, they designed a trial, set it up on a web- based platform and invited feedback from patients for 6 weeks. They decided they would consider the process useful if the input led to at least 1 major change in their design or 3 minor changes.  In the end, the trial design incorporated 4 major and 5 minor changes!

Other ways to involve patients is by enlisting them to serve on hospital committee. Some researchers create a dictionary of scientific and technical terms to help patients who are advisors in their studies. 

The new approach represents a dramatic shift in sharing control at the critical stage of designing trials to test new treatments. However some researchers are concerned that patient involvement will not work in every clinical trial as it might slow down the process. 

Pharma companies and researchers who earlier used methods like  public awareness campaigns or monetary  incentives hope that the outreach program helps to  increase the number of patients who participate in clinical trials.  Patients also seem to be the best resource to highlight the relevance of the research and show if it is really meaningful to the end users. 

(Source: The Wall Street Journal)

New pump could cut diabetes treatments.

Two studies conducted by a Boston based start up  to test a pump  they are developing  have shown that a diabetes drug delivered continuously from the  implantable pump resulted in a marked and sustained reduction in blood sugar in patients. This opens possibilities for a once- a- year treatment option to manage the disease.

In the first study involving 460 patients, it was seen that the device when used with standard oral medications resulted in average reductions in HbA1c of 1.4% to 1.7% from an average of 8.5%. In the other study, testing 60 high risk patients with average HbA1c levels of 10.8%, the average reduction was 3.45 points to 7.4%, while 25% of the patients reached the goal of below 7% after nine months of using the pump.

The match stick size device called the ITCA 650 holds up to a year’s supply of a drug already being used to treat Type 2 diabetes and is implanted under the skin in the abdomen. It continuously releases the drug in micro quantities into the body to control blood sugar.

In the advanced stages of the disease, heart attacks, strokes, kidney disease, blindness and amputations are among the possible consequences. The constant delivery addresses one of the major challenges in treating the disease which is that of making sure patients take their medicines to keep blood sugar levels under control. Also there is no wastage of the drug and patients get 100% of the benefits out of the drug. Failure to stick to treatments is associated with significant increased medical costs. This is good for patients who are averse to shots in any form.

The company plans to file for approval for 6 month and 12 month pumps with the FDA by early 2016.

( Source: The Wall Street Journal)

Transient Ischaemic Attack (TIA)

Transient Ischaemic Attack or TIA is a temporary disruption in the blood supply to part of the brain. This can happen when a clot develops in the blood vessel due to atherosclerosis. This is more likely if you have diabetes, high blood pressure, high cholesterol,  are overweight or obese, or have a family history of heart disease or if you smoke/drink in excess.

The brain needs a constant supply of blood to provide vital nutrients and oxygen to its cells.

Symptoms of TIA are similar to stroke but effects last for a few minutes and subside within 24 hours. Unlike a stroke, blood supply resumes to the part of the brain affected. TIA increases the risk of having another TIA or stroke and is a sign that the brain is not getting enough blood. Some of these symptoms may resemble a hypo so treat as an emergency.

Use the FAST test  - Face, Arms, Speech, Time –to recognize the symptoms of TIA.

Face:  Can the person smile? Has the face fallen to a side?

Arms: Can the person raise both arms and keep them there?

Speech: Can the person  speak clearly and understand what you say or is the speech slurred?

Time: Call the doctor if any of these symptoms are present.

Other symptoms of TIA can include sudden weakness, memory loss or vision loss.

(Source: balance May-June 2014)

Polycystic Ovarian syndrome (PCOS)

The cause of polycystic ovarian syndrome is unknown but most experts think that several factors including genetics could play a role.

Polycystic ovarian syndrome affects millions of women around the world. Its prevalence is much higher in women of South Asian origin. It is one of the leading causes of fertility problems in women and runs in families.

It is also thought that insulin may be involved in the development of polycystic ovarian syndrome. Many women with PCOS have insulin resistance. When tissues are resistant to the effects of insulin the body has to produce more insulin to compensate. The high levels of insulin found in the bodies of women with PCOS and insulin resistance stimulate the ovaries to produce large amounts of testosterone which results in many of the symptoms of the condition.

It is estimated that 10% of women who are obese and have PCOS develop T2DM by 40 years.  A higher proportion develops impaired glucose tolerance by this age. Because of its link to diabetes, if PCOS not managed properly, it can lead to additional health problems in later life.

(Source - balance – Mar-April 2013)

Know Your Diabetes Numbers

Target blood glucose for most people with diabetes:

In the morning before eating and before meals, it should be ≥ 70 mg/dl  and ≤120 mg/dl.

1 ½  - 2 hours after eating, it should be ≤160 mg/dl.

What level of blood glucose is too low?

Less than 70 mg/dl

What level of blood glucose is too high?

Over 180 mg/dl : Talk to your doctor on next visit.

Over 300 mg/dl for 2 or more readings over 12 – 24 hours:  call your doctor.

Over 500 mg/dl: Call your doctor immediately or go to emergency room.

Always check your blood glucose levels: 

• Every day when you get up in the morning and at least one more time during the day
• If you take pills for your medication, check before breakfast and 2 hours after your biggest meal of the day.
• If you take insulin for your diabetes, check before each meal and at bedtime.

Your doctor may ask you to check your blood glucose level at other times as well.

Check any time you feel like your sugar is too high or too low.

How do you feel if your blood glucose is low?

Sweaty, shaky, fast heart - beat, dizzy, headache, not thinking clearly, hungry, tired, blurred vision, confused, moody or angry.

How to treat low blood glucose 

First eat 15 g of fast acting carbohydrate such as 

½ cup fruit juice

1 cup skimmed milk

1 tablespoon honey or sugar

A sweet

Then, test your blood glucose.

Test your blood glucose again in 15 minutes.

If sugar is not over 70 mg/dl, eat another 15 gm of fast acting carbohydrate.

Eat some protein and carbohydrate as soon as you can to stop from going low again. Try eating half a sandwich of peanut butter, meat or chicken or have your next meal or the meal you missed.

How do you feel if your sugar is high?

Increased urination, increased thirst, tired, blurred vision, dry skin/dry mouth.

What to do if you think you have high blood glucose.

Check your blood glucose as soon as you can.

Some tips to help you keep blood glucose low 

• Eat 3-4 small meals a day.
• Eat your main meals 4 -5 hours apart.
• Do not skip meals.
• Eat less food.
• Avoid the second helping.
• Do not snack between meals.
• Do not drink fruit juice, sodas or sweet tea but drink calorie free liquids such as unsweetened tea or coffee, or just plain water.
• Avoid foods high in sugar such as cake, pie, sweetened cereals, honey, jam, jelly.
• Do not add sugar to food.

At MVH, we advise all people with diabetes to manage their diabetes well so that they can live a normal span of life in perfect health.

Prevent India from becoming the Diabetes Capital of the World

Are there other ways of tackling the problem? 

Life style modification and drug intervention in people with impaired glucose tolerance are Post primary prevention strategies which delay the development of Type 2 Diabetes mellitus. 

We need to concentrate on Primary prevention which is more important to reverse or halt the disease. 

One area of focus can be women with Gestational Diabetes Mellitus (GDM) who are an ideal group for primary prevention as they as well as their children are at increased risk of future Type 2 Diabetes Mellitus. 

Studies indicate that women with GDM have an increased lifetime risk of developing diabetes 16 years after the first pregnancy when compared with controls. One third of children born to mothers with GDM get evidence of IGT or T2DM. 

Pregnant women with glucose intolerance, due to decreased insulin secretion or action, have excess of glucose amino acids and lipids. When these elements cross the placenta, the foetus responds by secreting large quantities of insulin. This eventually causes decrease in foetal pancreatic reserve and results in risk for developing diabetes later.

So, screening for GDM is essential. 

Are we screening pregnant women at the right time?

Screening for glucose intolerance  is usually between 24 -28 weeks but foetal islets of Langerhans differentiate during 10th -  11th  weeks and begin to release insulin in response to nutrients as early as 11th  – 15th  weeks of gestation .

So undetected glucose intolerance in the early weeks of gestation influence foetal growth resulting in large babies for GDM mothers despite good glucose control in the third trimester.

Another area to focus on is the occurrence of T2DM within families. 

Is the familial nature of T2DM only due to genetic factors?

The genetic factor may be due to the major role played by maternal mitochondrial DNA in the transmission of the disease. A study revealed that children exposed to maternal diabetes before birth are at higher risk of obesity and diabetes than their unexposed siblings. This suggests that the increased risk is not only due to genetic causes.

Therefore, it is essential to focus on intrauterine environment, especially in our country. In India, both under -nutrition and over- nutrition exist during pregnancy. Both, nutritional deprivation or nutritional plenty can result in changes in pancreatic development and response to insulin that may lead to adult onset GDM or T2DM. So, both small – for date infants and large for date infants are at risk for future diabetes.

The aim should be to help pregnant women to have infants born with weight that is appropriate for gestational age by both sufficient and fitting nutrition and good blood glucose control.  (Fasting - < 90 mg/dl and peak < 120 mg/dl.)

(Ref: Transgenerational Transmission of Diabetes – Sesiah.V, Balaji.V, Balaji, Madhuri.S, Das, Ashok.K)