Avoid Holiday Weight

Rich festive foods pile on those extra kilos!!!!

Festive celebrations are a maze of family get- togethers, parties and lots of delicious rich food and drink. There is usually no time for one’s routine exercise. With Christmas and New Year round the corner, here are some guidelines that will help you prevent adding those extra kilos.

Move…
Walk, run, cycle or swim wherever you are.

Control temptation…
Miss a mouth-watering dish every now and then. It will check weight gain.

Track your alcohol intake…
Alcohol is not so good for a person with diabetes. It is a source of ‘empty calories’ that only adds to your weight. Drink water between drinks to cut calories and keep well hydrated. However, if you must, follow your doctor’s advice.

Snack before going out. ..
Have something to eat before going out to a party so that you don’t overeat.

Fill your plate wisely…
Avoid rich fried foods and opt for light food. Be careful with desserts.  Know your limits. Eat only as much as you should.

Listen to your body…
Eat slowly- It takes about 20 minutes for your stomach to register a full sensation and signal your brain you have had enough.

Catch up with friends …
Focus on socializing and not on the food. Choose healthy foods and control the portions.

Follow these tips and you will have a wonderful holiday and not have to worry about vigorous exercise to get back into shape after the holidays.

One Size Does Not Fit All

Managing Blood glucose 

Measures taken to control blood glucose vary from person to person. There is no ‘one size fits all’ approach. However, there are a variety of options available and a person with diabetes can get the best possible combination by working closely with their diabetologist and the rest of the team. Previously, if one medication did not work well insulin was used. Now a days, doctors have the option to mix and match different medicines to help control blood glucose levels.

The first step in managing Type 2 diabetes is   by eating the right food, losing weight, and exercising.

Exercise. Type 2 diabetes responds to regular exercise . Exercise makes the insulin work better. It also helps to lose weight, thereby lowering blood sugar.



A brisk walk for 30 minutes a day or any other moderate exercise is very important. In addition to exercise, physical activity at home or at work is required because a sedentary lifestyle does not help blood glucose control.

Consult your doctor about how you can exercise safely and be aware of the precautions you need to take to adjust medication for exercise.    

Eat right. A healthy diet keeps your blood sugar in good control. The basics of a healthy diet include eating less saturated fat, salt, and sugar and at least 5 portions of fruit and veggie a day.  Your dietitian or diabetes educator will explain how food affects your blood sugar and will help you to plan meals according to your customs and lifestyle.



Ease stress. Stress prevents the release of insulin. As a result, glucose begins to pile up in your blood and long term stress raises sugar levels. Identify the cause of stress and work towards overcoming it.

Regular exercise and relaxation techniques such as yoga, meditation, tai chi, and breathing exercises can help reduce stress. 

Lose weight.  Overweight and obesity interfere with good control of blood glucose. Consult your doctor or  certified dietitian about how you can lose weight in a healthy manner.

Sometimes, these measures are not enough to lower blood glucose levels to the normal range. The next step is taking medicines that lower blood glucose levels. 

• Oral medications can control blood sugar.  They work in different ways by 
• Decreasing the amount of glucose released from the liver, 
• Stimulating the pancreas to release more insulin right after a meal,
• Making the body more sensitive to the effects of insulin  , 
• Slowing the absorption of carbohydrate into blood stream after eating, or
• Providing a feeling of fullness after a meal. 

It has been observed that some oral medications work well in the beginning but slowly lose their efficiency over a period of time. This is when insulin is introduced into the treatment plan. Nowadays, there are a lot of new combinations of medicines to choose from.

If the insulin you take isn't enough to lower high blood sugar, your doctor may suggest some changes such as 

• Increasing your insulin dose.
• Using fast-acting insulin before meals to help with post prandial blood sugar.
• Using a long acting insulin once or twice a day to  help control blood glucose 
• Using an insulin pump to make it easier to control glucose levels.

Sometimes high blood glucose can be due to other reasons such as insulin resistance. This happens when your body doesn't respond as well as it should to the insulin it makes, or if you are using a drug for another health problem that interferes with insulin action, or by injecting insulin into the same place every time which can affect how well the hormone is absorbed. 

Whatever the cause of your high blood sugar, consult your diabetologist and the diabetes team to find what suits you the best. 

(Ref: www.webmd.com)

Healthy Mouth, Healthy Body

People with diabetes have a greater risk of oral infections.

Here is another reason for you to control your blood glucose level -  you run the risk of developing oral complications.

People with uncontrolled diabetes are more prone to oral disorders such as

• Dry mouth( xerostomia )
• Taste impairment,
• Painless swelling of the parotid salivary glands on both sides of the face (sialosis)
• Yeast or fungal infection (oral candidosis)  and 
• Inflammation of mucous membranes inside the mouth (oral lichen planus)  

They are more likely to develop periodontal disease or gum disease. Gum disease becomes more severe with long periods of uncontrolled blood glucose levels.

 In general, gum disease may increase the risk of serious health problems such as heart attack, stroke and diabetes. Inflammation that starts in the mouth weakens the body’s ability to control blood sugar, while high blood sugar provides ideal conditions for infection to flourish.

People with diabetes produce less saliva.  Saliva is very important for oral health. Saliva removes food particles and neutralizes acids produced by bacteria in the mouth. It also helps to prevent the growth of microbes that cause disease.  It prevents the build-up of plaque. Plaque increases the risk of periodontal disease and dental caries in people with diabetes. Saliva flow can be increased by chewing non- sugar gum. Another way of keeping the mouth moist is by sipping water regularly.

Good oral health depends on one’s personal hygiene habits and on regular visits to the dentist.

Early detection and treatment of dental caries, periodontal disease and other diseases will protect from harmful oral complications associated with diabetes.

To protect your oral health, practice good oral hygiene every day.

• Brush your teeth at least twice a day.
• Floss daily.
• Rinse your mouth after each meal.
• Eat a healthy diet and limit snacking between meals.
• Replace your toothbrush every three to four months or sooner if bristles are frayed.
• Go for regular dental check- ups.

Switch to Whole Grain

The basics of a healthy diet include eating less saturated fat, salt, and sugar and at least 5 portions of fruit and veggie a day. 

Grains are an important part of a healthy diet. Whole grains are a good and economical source of carbs and protein, fibre and many micro nutrients. They also have less fat.



What are whole grains? Seeds of cereal plants such as wheat, maize, corn, rye, barley, oats, rice, quinoa etc.

Grains are refined to make them taste better, for a finer texture and to increase shelf life. But in the process they lose many nutrients. Make at least half the grains in your diet whole grains.

Whole grains are good not only for people with diabetes but for the whole family. For people with diabetes, they help to manage blood glucose levels better.

However, if all the grains you eat are whole grains, make sure you include fruits, legumes and vegetables to top up folic acid, a B- vitamin.

Ways to eat more whole grains

• Have a whole grain cereal for breakfast.    

• Use whole grain bread instead of white bread. 

• Use brown rice instead of polished rice.  
• Use whole meal flour for baking. Start with a mix of refined and whole meal flours and slowly experiment with the second one till you are satisfied with the end product.

• Use bulgar wheat in place of couscous as it is rich in proteins and minerals, high in fibre and tastes nutty and delicious.  

• Add barley to soups and stews.
• Use unsalted, sugar- free popcorn. It’s a whole grain! 
• For crumble toppings on pies, mix porridge oats with the flour.  

• Use oats or crushed whole wheat bran instead of dry breadcrumbs for cutlets or rolls.

Planned Pregnancy with Diabetes

Dr. Mitalee Barman

Consultant Diabetologist 

• Women with diabetes face the risk of developing obstetric complications and diabetic complications as well as congenital defects in their babies.  They have to monitor blood glucose levels more frequently throughout their term and they often need more frequent interventions and visits to the doctor. 
• Women with diabetes also face the risk of having big babies. This happens when the blood sugar level of the mother is high and   the foetus gets too much sugar through the placenta. The baby's pancreas senses the high sugar levels and produces more insulin to use up all the extra sugar. That extra sugar is converted to fat and as a result the baby may become too large to be delivered normally and a Caesarean delivery becomes necessary.
• Sometimes babies of women with diabetes develop   dangerously low blood glucose levels as soon as they are born. This is because the uncontrolled levels of blood sugar of the mother during pregnancy and especially 24 hours before delivery makes the pancreas increase secretion of insulin in the baby to cope with the extra sugars. After delivery, when the source of sugar is suddenly taken away, the blood sugar levels drop.

Good blood sugar control means keeping blood glucose levels within the ideal range (70 to 100 mg/dL before meals, less than 120 mg/dL two hours after eating, and 100-140 mg/dL before the bedtime snack) by balancing meals, exercise, and diabetes medications.

So, a planned pregnancy is essential for women with diabetes as good sugar control before conception is vital as many women do not realize they are pregnant until they are well into two to four weeks of pregnancy. 

For healthy off- spring and a complication -free pregnancy 

1. Avoid pregnancy till HbA1c  is in good control (< 6.5 %)  because high blood sugar levels early in the pregnancy (before 13 weeks) can cause birth defects as the first 8 weeks of pregnancy are very important for  the baby’s physical development. There is also an increased risk of miscarriage and diabetes-related complications. 
2. Eat a well - balanced diet
3. Exercise and be active
4. Keep blood glucose at optimum levels
5. Get eyes and kidneys checked, 
6. Stop smoking and avoid alcohol.
7. Let your doctor know about your medications as some of them such as statin, ACE inhibitor or similar blood pressure medications should not be taken by pregnant women.

(Ref: Diabetes Balance)

Making Lifestyle Changes for Better Health…

Changing old lifestyle habits related to one’s diet and physical activity is not an easy task and it gets harder if there are lots of changes to be made.

The best way to achieve one’s goal of reducing weight and preventing Type 2 diabetes is by making the change one step at a time.

Get Started

1. Find out how focussed you are by asking yourself if you are willing to change your habits.

2. Find out what lifestyle changes you need to make. The changes must be important enough to motivate you. Break them up into smaller steps.

3. Choose a few areas for improvement that are easy to do, you want to do the most, and that will make the biggest impact.

4. Make your goals SMART

Specific - Your goal must be clear and well defined. Vague or generalized goals are not helpful.

Measurable - Include precise amounts, dates, and so on in your goals so you can measure your degree of success.

Attainable - Make sure that it's possible to achieve the goals you set.

Relevant - Goals should be relevant to your requirement. This will help you to develop the focus you need.

Time Bound - Your goals must have a deadline.

For example

1. Setting diet related goals : 

How long?… For the next month

How often?... four days each week

Realistic and Specific?… I will eat two pieces of fruit a day — one at breakfast and one as an afternoon snack. 

2. Setting activity  related goals: 

How long?... For the next month

How often?... four days each week 

Realistic and specific?... I will take a 15  a minute- walk after lunch 

5. Pin up your goals where you will see them often and practice them.

6. At the end of the specified period see if you were successful.

If you weren't successful, try again. Revise your goals or choose easier ones.

Were you successful? CONGRATULATIONS! Now choose some new goals to work on.

A Healthy Habit: Read Food Labels

Shelves in the supermarket are stocked with a variety of ready to eat, instant or processed foods and in today’s fast paced life there are choices that we make because we just don’t have the time or the energy to start from scratch. For instance most people buy packaged wheat flour and choosing a good brand is a dilemma, as there are so many available, each one professing to offer the best! Most processed foods and instant foods come with nutrition fact labels. Learning how to interpret food labels can help educate people with or without diabetes about how to make better food choices for better health.

Food labels provide a lot of information.  Understanding the information   that food labels provide allows people to compare foods, make better choices, and understand serving sizes in relation to carbohydrate content.

The Serving Size

The first place to start when you look at the Nutrition Facts label is the serving size and the number of servings in the package. Serving sizes are standardized to make it easier to compare similar foods; they are provided in familiar units, such as cups or pieces, followed by the metric amount, e.g., the number of grams.

Calories 

Calories provide a measure of how much energy you get from a serving of this food. The calorie section of the label can help you manage your weight .

Total carbohydrate tells us how many grams of carbs there are in a serving. It includes sugar, complex carbohydrate and fibre. Do not concentrate only on sugar content as you may miss out on foods that are naturally high in sugar but also have other necessary nutrients.

The value under sugar shows the amount of natural or added sugar.

Avoid unhealthy ingredients such as hydrogenated or partially hydrogenated oil and refined sugar. Look for foods with less fat, sugar and salt.

However, there are some facts one must be aware of in order to choose wisely.
Sometimes sugar, salt and fats come under different names

 Did you know?

   ‘Sugar free’ does not mean ‘Carbohydrate free’

   ‘No added sugar’ does not mean ‘no carbohydrate’

READ FOOD LABELS CAREFULLY.

Managing Type 2 Diabetes mellitus

Managing Type 2 diabetes is not a fixed process. It keeps changing. At first, oral medication may be enough. Later insulin may be needed to control blood sugar levels. 

For some people with diabetes, a healthy diet and plenty of physical activity is enough to control blood glucose; for others, oral medications and injections work well. The medication that people with diabetes use to manage glucose levels depends on what they eat, their level of physical activity and their weight.

Medications to treat Type 2 diabetes help the body to produce more of its own insulin; produce a feeling of fullness after meals; and slow down the movement of food through the stomach.

Losing weight and being more active can help avoid or delay the use of insulin ―a hormone that helps to control blood glucose levels  by allowing the  body to absorb glucose from the blood. As Type 2 diabetes progresses, the person with diabetes may need to take more tablets and insulin injections. 

There are different types of insulin:  

• Short- acting human insulin
• Intermediate acting human insulin
• Premixed insulin
• Analog insulins

The number of insulin injections a day depends on personal needs. For some people with diabetes, injecting just once a day is sufficient to manage blood glucose levels but as diabetes progresses, there is a chance that this will increase.  

It is important to test blood glucose regularly when using insulin. 

Tips on choice of injection sites:  

• It is important to rotate your site to get the best benefit from the insulin. 
• Do not use the same spot on a particular site to inject insulin. Injecting the same spot can cause small hard lumps that can affect the way insulin is absorbed thus affecting blood glucose control.
• The best places to inject are the abdomen, buttocks and outer thigh as they have a layer of fat below the skin and not too many nerves. 
• Massaging the site before or after injection may speed up absorption of insulin and so, is not recommended. 
• Exercise can also increase the rate at which insulin is absorbed in the body. So, don’t inject the part you are going to exercise. If you do, wait at least 45 minutes before starting. 
• Use a new spot within a chosen site each time. Move around within the chosen site keeping at least one finger distance from the last injection.
• Move in the same direction. 

Best injection  sites

The abdomen is the best site for injecting morning and noon doses of insulin and injecting into the upper thigh at night decreases the risk of having hypos during the night.

A few points to keep in mind when using insulin:

• It can lower blood glucose levels so make sure you know what to do in case of a hypo.
• Be careful when you drive
• Control portion sizes as insulin can add on weight
• Consult your dietitian for a good diet plan and learn how to count carbs.

Vitamin D- the Sunshine Vitamin

Most of the Vitamin D we need is made when the skin is exposed to the sun’s ultraviolet B rays.

Vitamin D is required for strong teeth and bones, muscle health and general health. It helps the body to absorb calcium and phosphate from food.

Deficiency of vitamin D can result in softening and weakening of bones - rickets in children and osteomalacia  in adults, and  can also make bones  porous and brittle - osteoporosis in adults. A lack of it is also related to other health conditions such as heart disease, cancers, allergies, and Type 2 diabetes.

We get most of the vitamin by going out in the sun but some foods such as oily fish ( sardines and mackerel ), egg yolk, meat and some fortified foods also provide some quantities.

At risk of Vitamin D deficiency:

• People with darker skin, as it takes the skin  a longer time to synthesize the vitamin
• Babies and children from the age of 6 months to 5 years. 
• Pregnant or breast- feeding women especially teens and young women
• Older people who are over 65 years
• People in situations such as illness who are unable to come out of their homes or live in climates without much sunlight
• Vegetarians and those who have insufficient intake of milk products 

Vitamin D made in the body from food or from sunshine is safe but supplements can cause bone and kidney problems especially in children and older people.

Help your body make Vitamin D

Exposing hands and face to the sun is the main source of Vitamin D. BUT…

• 10 – 15 minutes is enough depending on skin colour.  Darker skins need longer exposure.
• The best time of the day is between 11 a.m. and 3 p.m. as the sun is the strongest at that time but that is also the time when you are most likely to burn. 
• It takes less time for the body to make Vitamin D than it takes to burn your skin, so expose yourself to sunshine only for short periods of time.

A Mediterranean diet could reduce the risk for Type 2 diabetes.

The Mediterranean Diet is a way of eating based on the traditional foods and drinks of the countries surrounding the Mediterranean Sea including Italy, France, Greece and Spain.

It includes unprocessed plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts, plenty of olive oil and a glass of wine with a meal and is often regarded as one of the healthiest of diets.

Bread is an important part of the diet throughout the Mediterranean region, and is eaten plain or dipped in olive oil — not with butter or margarine, which contain saturated fats or trans-fats.

Although fat consumption is high, the prevalence of hypertension, cardiovascular disease, obesity, cancer and diabetes has always been significantly lower in Mediterranean countries.

Nuts are another part of a healthy Mediterranean diet. Nuts are high in fat, but most of the fat is healthy. Because nuts are high in calories, they should not be eaten in large amounts — generally no more than a handful of plain nuts a day.

The Mediterranean diet is healthy because 

• butter is replaced with healthy fats, such as olive oil. 25% to 35% of calorie intake consists of fat. Saturated fat makes up no more than 8% of calorie intake.
• foods are flavoured with herbs and spices  instead of salt.
• red meat is recommended only a few times a month.
• fish and poultry  are included at least twice a week.
• a little red wine is included along with the meal (optional).

Meals are prepared and eaten together with family and friends. 
Physical activity is considered important .

Foods you can choose from

Vegetables:  Tomatoes, broccoli, kale, spinach, onions, cauliflower, carrots, Brussels sprouts, cucumbers, etc. 

Fruits:   Apples, bananas, oranges, pears, strawberries, grapes, dates, figs, melons, peaches, etc.

Nuts and Seeds:   Almonds, walnuts, Macadamia nuts, hazelnuts, cashews, sunflower seeds, pumpkin seeds and more.

Legumes:   Beans, peas, lentils, pulses, peanuts, chickpeas, etc.

 

Tubers:   Potatoes, sweet potatoes, turnips, yams…

Whole Grains:   Whole oats, brown rice, rye, barley, corn, buckwheat, whole wheat, whole grain bread and pasta.

Fish and Seafood:   Salmon, sardines, trout, tuna, mackerel, shrimp, oysters, clams, crab, mussels, etc.

Poultry:   Chicken, duck, turkey and more.

Eggs: Chicken, quail and duck eggs.

Dairy:   Cheese, yogurt, Greek yogurt. 

Herbs and Spices:  Garlic, basil, mint, rosemary, sage, nutmeg, cinnamon, pepper, etc.

Healthy Fats:   Extra virgin olive oil, olives, avocados and avocado oil

Evidence of health benefits …

Eating more legumes such as peas, chick peas, lentils, alfafa and beans helps improve glycaemic control in people with Type 2 diabetes, as well as lowers the risk of developing coronary heart disease. – (Scientists from the University of Toronto)

Certain dietary patterns that include vegetables, nuts,  and monounsaturated fatty acids keep the heart healthy. – ( Researchers at McMaster University)

The traditional Mediterranean diet can help protect people from Type 2 diabetes. – (A study published by the BMJ7)

The combination of foods in the Mediterranean diet lowers the risk of heart attack and cardiovascular-related death much more than a strictly low-fat diet does. – ( A study published in the American Journal of Medicine)

Researchers have suggested that the diet could also help to slow the aging process.

A Mediterranean diet enhanced with additional portions of antioxidant-rich extra virgin olive oil or mixed nuts could protect cognitive functioning in older adults-  (Researchers in Spain)

Researchers suggest that keeping to the diet can cut the risk of endometrial cancer in women by more than half.