Insulin Therapy

-You can help prevent diabetes complications by understanding the importance of insulin in managing blood sugar, and the goals of insulin therapy.

The role of insulin in the body 

Insulin keeps the level of blood glucose within the normal range. Carbohydrates are broken down into sugar and enter the bloodstream in the form of glucose which is the main source of energy for the body. Under normal conditions, the pancreas responds to this by producing insulin, which allows sugar to enter the tissues. Glucose which is not used is stored in the liver as glycogen. When insulin levels are low,such as in between meals, the liver converts glycogen into glucose and releases it into the bloodstream. This keeps blood sugar levels within the desired range.

What happens when you have diabetes

In diabetes, the pancreas secretes no insulin, or produces too little insulin, or the body cannot use the insulin produced .The level of glucose in the bloodstream increases because it is unable to enter cells.  If left untreated, high blood sugar can lead to complications such as blindness, nerve damage and kidney damage.

Insulin therapy

If your doctor recommends insulin therapy, take the recommendation seriously. Most people try to delay it as far as possible.  Insulin therapy can help prevent diabetes complications by helping to keep blood glucose within the target range.

The goals of insulin therapy

In  Type 1 diabetes, insulin therapy replaces the insulin the body is unable to produce.

In Type 2 diabetes and gestational diabetes insulin therapy is sometimes needed when other therapies cannot keep blood glucose levels within the desired range.

Characteristics of Insulin

Insulin has 3 characteristics:

• Onset is the length of time before insulin reaches the bloodstream and begins lowering blood glucose.

• Peaktime is the time during which insulin is at maximum strength in terms of lowering blood glucose.

• Duration is how long insulin continues to lower blood glucose.

Types of Insulin

• Rapid-acting insulin, such as insulin lispro, insulin aspart,or insulin glulisine , begins to work about 5 minutes after injection, peaks in about 1 hour, and continues to work for 2 to 4 hours.

• Regular or Short-acting insulin (human) usually reaches the bloodstream within 30 minutes after injection, peaks from 2 to 3 hours after injection, and is effective for approximately 3 to 6 hours.

• Intermediate-acting insulin (human) generally reaches the bloodstream about 2 to 4 hours after injection, peaks 4 to 12 hours later, and is effective for about 12 to 18 hours.

• Long-acting insulin (ultralente) reaches the bloodstream 6 to 10 hours after injection and is usually effective for 20 to 24 hours. There are also two long-acting insulin analogues: glargine and detemir. They both tend to lower glucose levels fairly evenly over a 24-hour period with less of a peak of action than ultralente.

 Premixed insulin is convenient for people whose blood glucose levels  are stable   on this combination.

Insulin Strength

All insulin is dissolved or suspended in liquidsand has different strengths. U-100, means it has 100 units of insulin per ml of fluid,and  U-40 has 40 units of insulin per ml of fluid.Different countries use different types, so it is wise to carry sufficient reserves while traveling.

Using Insulin Therapy

There are several points to keep in mind when using insulin:

•      Method of taking the insulin
•      The  dosage and timing
•      Selection of the appropriate insulin preparation depending on its 'speed of onset and duration of action'.
•      Adjusting dosage and timing to fit the amount of food one eats, when one eats and what one eats.
•      Adjusting dosage and timing to fit exercise.
•      Adjusting dosage, type, and timing during conditions such as increased stress or  illness
•      Adjusting to  individual differences in the  absorption of insulin into the bloodstream  when injected.

 Even the best diabetic treatment with synthetic human insulin or even insulin analogs, however administered, cannot replicate the normal glucose control in the non-diabetic.

Making matters even more complicated is that glucose from some foods is absorbed faster or slower than the same amount of glucose in other foods.

 In addition, fats and proteins delay absorption of glucose from carbohydrates which are eaten at the same time. 

When you exercise the need for insulin is lowered even when all other factors remain the same, because working muscle has some ability to take up glucose without the help of insulin.

The  beta cells of people without diabetes routinely and automatically manage this by continual glucose level monitoring and insulin release . A person with diabetes has to rely on a physicianor a diabetes educator and on his own individual experience. It is a continual balancing act for all people with diabetes, especially for those taking insulin.

Patients with insulin-dependent diabetes usually require a base level of insulin (basal insulin), as well as short-acting insulin to cover meals (bolus insulin). Maintaining the basal rate and the bolus rate is a continuous balancing act that people with insulin-dependent diabetes must manage each day. This is normally achieved through regular blood tests.

Ref:
www.diabetes.org
www.mayoclinic.com    

National Nutrition Week

Ms.Rohini,
Sheela Paul
-    Dietitian
 

National Nutrition Week is celebrated from September 1 to 7 every year.  Good nutrition is the focal point of health and well-being. In other words, it allows you to be strong, provides energy to do the things you want to do, and makes you look and feel good.

Food groups

Most of us know that the basic food groups are cereals and millets, pulses and legumes, green leafy and other vegetables, fruits, milk and milk products, nuts and oil seeds, meat and meat products.

But the question is HOW MUCH?

  

MUST DO’s

•    Make a habit of using  healthy food preparation methods.

•    Choose budget conscious meals with a focus on seasonal variety.

•    Appreciate the tastes and textures of wholesome foods.

•    Read and understand the food labels and making healthy choices.

•    Maintain a food log andrecord everything you eat and drink for at least five days. This will show you the  strengths and weaknesses of your diet and help you create a plan for eating more nutritiously in the future.

•    Eating breakfast helps you to consume less calories throughout the day, it will kick start your metabolism, improve your mental focus and give you energy.

•    Drink water, not colas. Sugary drinks are one of the causes for the nation’s overweight problem  andis the main source of empty calories in children’s diets.

•    Use salt sparingly.

•    Portion controlis key to healthy eating. Reduce cereal intake and increase vegetable intake. Half your dinner plate should contain 1 cup vegetables + 1 cup greens + 1 cup salad. A quarter of the plate should contain 1 cupcooked riceor3 chappathisand  the other quarter of the  plate  should have 1 cup of dhal/whole grams, half portion non-veg and one cup curds.

•    Nuts -  These are  great sources of healthy monounsaturated fats. Nuts are one of the best sources of omega 3- a heart healthy fatty acid. In addition to omega 3, nuts contain the amino acid, L-arginine. L-arginine may relax blood vessels making them more flexible and less prone to blood clots. Arginine has also been shown to promote wound healing, and boost immune function.

This  week,  evaluate what you usually eat  and make the necessary changes to your diet.

Foods that heal …

Ivy Gourd (tendli, tindora, kovakkai)

It is seen throughout the year on shelves in vegetable shops and is classified as an herb in Thai and Ayurvedic medicine. Ivy gourd contains beta carotene – a good source of Vit. A that is good for the eyesight,  and Vit. C which protects from cold and flu. Consuming it can help regulate blood glucose. Some research also supports its use as an antioxidant. In traditional medicine, it has been used to treat fever, asthma, bronchitis and jaundice. It is also known to have anti- histaminine properties. Its leaves are used as a poultice in treating skin eruptions.

Cinnamon  

One of the oldest spices, cinnamon possesses many health benefits one of them being a modest effect in lowering blood glucose levels in people with poorly controlled Type 2 diabetes.

It also has anti- microbial, anti-fungal, anti-tumour, blood pressure lowering, cholesterol and lipid lowering and gastro protective properties.

It can be used to add flavour to sweet as well as savoury foods. 

Spend Less, Eat Well.

With food costs on the rise it is high time to see how one can reduce money spent on weekly shopping. You can cut costs and still have a tasty and healthy diet. Small changes can bring big savings in the long run. 

Plan ….

Write down the menu for the week and shop for the exact quantities. It prevents you from buying things you don’t need.

Shop at the right time

Don’t go shopping on an empty stomach as you may be tempted to buy all the wrong things

Look out for offers.

Keep the receipts and make a note of your spending 

You need not be a loyal customer.

Compare costs and go to the shop that gives you the best deal.

Have a meat- free day

Meats and fish tend to be the most expensive item on the shopping list. You can have a healthy diet without using meat/fish. Replace meats with comparatively cheaper sources of protein such as beans and lentils.

Forget ready-to- eat meals

They cost more and are high in sugar, fat and salt. Instead, cook in bulk and freeze.

Bake your own bread and biscuits

You don’t need‘diabetic’ foods.

What you cook at home will be just as good and more economical. Just follow your dietitian’s advice.

Be brand savvy

Try using the supermarket brand. They are usually cheaper than other brands. You won’t find any difference in the taste.

Don’t waste. 

A lot of food usually goes waste. Don’t pile up food on your plate or others’ plates. Take only as much as is needed and come back for a second helping.

Leftovers can be frozen or stored to be reheated or made into another dish. 

Buy seasonal foods. 

Choose in -season fruits and vegetable as they are fresher and cheaper and contain large amounts of the  nutrients they are supposed to provide.

Eat Right During RAMADAN

Aadarsh & ROHINI (Dietitians)

BMVNES

During Ramadan people fast for a month during the day and feast at the break of dawn and at dusk. This can be a cause of serious dehydration due to no water consumption during peak sunny hours of the day and muscle loss due to lack of food intake. Mealtimes are not regular and the body may not get the nutrition it needs which can lead to health problems since the fasting continues for a month. Here are some ways in which the diet can be modified during this period of fasting.

Those who fast during Ramadan often end up overeating which can lead to weight gain, acidity and digestion problems. Experts say one must follow a proper diet plan, avoid fried food and red meat and exercise regularly.

People with diabetes should be careful and avoid hypoglycemia (low sugar level in blood).They needto pay special attention to their condition all year around and especially in the month of Ramadan as they become vulnerable to several complications during fasting. They should follow doctors instructions as they face risks due to changes in eating patterns that might cause serious complications like hypoglycemia and hyperglycemia . It is recommended that they also check their glucose levels twice while fasting and once after breaking the fast. 

Dietary recommendation during Ramadan:

- Eat food items like grains, barley, wheat, oats, millet, semolina, beans, lentils, bran, green peas, apricots, prunes and almonds.
- Avoid big meals and eat slowly.
- Drink juice to avoid digestive problems.
- Avoid deep fried food and red meat as it causes acidity and digestion problems.
- Have proper protein intake.
- Diabetic patients should be more careful and avoid hypoglycemia (low sugar level in blood).

     Start the day with water followed by vegetable sandwiches or oats with veggies and nuts. In the evenings, break your fast with water again and eat dates and fruits as well. After the prayers, take rice, rotis, salad, vegetables, dhal or chicken.

It is important to eat a good amount of vegetables to provide enough nutrition to the body. If you have a sweet craving, satisfy it by including fruits in your meal as it will help digest the food better. Include fibre and protein-rich foods. Avoid eating fried, oily and heavy food items as they cannot be easily digested and can make your stomach bloated later.

• Start your day with:
oats/brown rice/roties made of wheat , ragi, jowar fruits, and nuts
Milk, curds, and buttermilk
• Break your fast with fruits and opt for the following:
• salad/ soup
chicken/ fish – steamed, boiled, grilled, roasted or paneer
green veggies or mix  vegetables
• Drink plenty of water before you sleep to rehydrate yourself and rest well to rejuvenate your body for the next day’s fast.

It is safe to exercise during Ramadan. Exercise at the right time and at low to moderate intensity.

Exercises recommended:

1. Low intensity cardio exercise like walking or cycling. It helps in burning calories and improves stamina.
2. Low intensity resistance training. It helps to maintain your muscle strength.
3. Stretching exercise. Full body stretching.It helps to improve flexibility and also in detoxification.
4. Floor exercises like free squats, pushups, calf raises etc. It improves your functional activities.
5. Yoga and meditation. It helps in detoxification.
6. Low intensity group classes which helps to burn calories and with less difficulty as you are exercising with others.
7. Exercise for 20 to 40 minutes.
8. Don't exercise during the fasting phase. Exercise eitherbefore or after the meal. Exercising during fasting   will burn muscles.9. Avoid high intensity exercises like high speed running, stepper, heavy weight lifting, high intense group classes as it can lead to joint or muscle injuries and complications like low blood pressure, hypoglycemia, dizziness, etc.

During Ramadan people with diabetes should manage their diet, physical exercise, glucose levels and watch out for any complications that might emerge

Eat Well, Sleep Well, Work Well.

A large number of office- going people are getting insulin resistant diabetes, high blood pressure and high cholesterol at 20-25 years! Many surveys show that bad work habits are making office workers sick.

Sitting for hours at the desk results in poor posture  which leads to bad circulation, muscle strain and fatigue and  back problems, eye problems,  and carpal tunnel syndrome.  It also results in obesity which moves on to diabetes, heart disease, high blood pressure, deep vein thrombosis, or even fatal blood clots.

Take breaks from your work. Get up and move. Go for a brisk  4-5 minute walk every few hours. Use  flats or  shoes that fit well and are comfortable.

Poor eating habits such as skipping breakfast or having a working lunch, or eating junk food,  not including fresh fruit and vegetable in the diet, putting off visits to the restroom, drinking cups of coffee and ignoring  water add to the distress. .

Don’t skip breakfast. You cannot focus on an empty stomach. Choose carefully when you order food. 

  






It is better to bring home-cooked lunch and eat in the lunchroom. Include fruits and nuts in your diet. Carry some healthy mid- day snack. Drink plenty of water. It helps you stay hydrated and concentrate better. 

Long commutes result in sedentary time , less sleep,  and expanding waistlines. Walk  or cycle to work if possible. Lack of sleep makes a person more irritable, anxious and depressed. Sleep deprivation makes you less efficient and you can make bad decisions.

Get at least 6-8 hours of deep sleep every day. Drink less coffee and tea and have the last one at 4 p.m.to help you unwind.

HEALTHY FOOD CHOICES

Mrs. Sheela Paul, Dietitian
-  MVH

              

               Women in India have always been honoured and respected yet the majority of them go through life in a state of nutritional stress - they are anaemic and malnourished. Girls and women face nutritional discrimination within the family, eating the last and the least. Women work longer hours than men, carry the major share of household and community work, which is unpaid and invisible. Nowadays, more women work to support their families financially.

          So, women must take greater care of their nutrition in order to remain healthy and fit.

  Some surprising facts:

• Women are at an equal or sometimes higher risk for developing pre- diabetes, diabetes and diabetes-related complications than men.

• An increasing number of people with Diabetes belong to the middle and even lower socio- economic strata.

Healthy Tips for the Home maker and the Working Woman…

• Plan an individualized diet according to  dietary habits and nutritional requirements with the help of health professionals.

• Eat small regular meals at frequent intervals rather than heavy meals once or twice a day.

• Avoid fasting and feasting.                 
  
• Enjoy a variety of food.

• Snack on fresh vegetables and fruits.

• Use low- fat milk and milk products.

• Avoid nibbling high calorie food between meals.

• Eat slowly and take more time to chew the food. You can control how much you eat.

• Don’t eat left over foods.

• Leave the table as soon you finish eating.

• Stock your house with healthier food choices.

• Shop for groceries after a full meal. If you are hungry you may buy more than you need!

• Limit the amount of money you take with you when you go shopping.

• Plan meals and snacks. 

Never forget to read the label on the containers. It will be very useful to calculate your calories and other nutrients. 

EXERCISE:   

• The time of exercise varies from person to person and his\her individual preference. Exercise should preferably be done in the morning hours.

• One should avoid going for exercise after heavy meals like lunch and dinner.

• Exercise reduces the triglyceride and cholesterol in the blood.

• Exercise helps decrease excess fat and thereby increases the body’s cell sensitivity to insulin and helps maintain good glycemic control.

• Do exercises like skipping, jumping, jogging at home. Avoid sitting in a place for long continue hours.

LIFESTYLE MODIFICATION:

• Reduce the time spent in watching TV.

• During leisure time instead of watching TV try to do some walking on the terrace.

• Do gardening.

• Walk to the nearby temple or church and close- by places instead of using a vehicle.

• Pick up your children from school.

• Do not sleep during leisure time.

• Climb the stairs instead of using the lift.

• Park at the far end of the shopping centre parking lot and walk to the store. 

 

 

               To improve your body image and the way you feel about yourself, monitor your snacking and do your best to follow a disciplined eating routine. Eat balanced meals, exercise and maintain a positive outlook and you will be on your way to a healthier body, mind and soul.

Eat less, work more. Moderation is the key     
  

                                             

Lipohypertrophy

Dr.Mitalee Barman
Diabetologist , MVH

Lipohypertrophy is a fatty tumour- like growth at or around the injection site. These spongy growths result when insulin has been injected over and over again into a single area. Over time, the skin around the hypertrophied area becomes numb. People with diabetes, who continuously use a single area for injecting insulin, develop lipohypertrophy over a period of time. They then add to the problem by continuing to inject into this area because they do not feel any pain while injecting. However, it is not the same in all cases as some people feel pain at the site.

Treatment:

The treatment consists of systematically rotating injection sites.

It is your choice where you want to inject. You will get the best results if you are consistent because insulin is absorbed at different rates in different body areas and inconsistency could cause your body to respond differently to each injection.
Insulin is absorbed most swiftly when injected into the abdomen, more slowly in the arms, and even slower in the thighs and buttocks.
Other factors that affect insulin absorption are temperature and exercise. The greater the temperature is, the greater the rate of absorption. Exercise or massage may increase absorption leading to large fluctuations in blood glucose levels.
 

Prevention:

Rotation of sites is important to prevent lipohypertrophy.

Instead of randomly using different areas for each injection, some doctors recommend that individuals with IDDM inject in a given area before moving to another. For example, using areas in the abdomen systematically before moving to the deltoid becausean injection in the abdominal area and an injection in the hip have different rates of absorption and it may be difficult to interpret the body’s response to dosage.

Another approach is that if you eat a big breakfast and need a faster response from insulin,
but a slower one from night insulin because you like to go to bed early and want night insulin to last all night, in the morning you can use the abdomen and at night the thighs.

Based on your needs, your diabetologist will be able to suggest a rotation plan, which you must follow.

Typical injection sites
 

The best site is a layer of fat above a muscle tissue. Don’t inject into muscle tissue anywhere in the body.Several areas of the body have enough fat tissue under the skin for insulin injection.
Insulin is absorbed most quickly and at the most consistent speed from one injection to another in the area of the abdomen, except for a 2 inch circle around the navel. The tough tissue around the navel causes inconsistent absorption.
Another suitable area is the top of the outer thighs which is best used in a sitting position. The backs of the upper arm, hips and buttocks also work well.
Keeping these points in mind, divide the body area into injection sites about the size of a coin and try to keep each new injection at that distance from your last shot.

At MVH, we teach our patients to inject on the abdomen and thighs.

Precautions

Avoid the deltoid muscle - the large triangular muscle that covers the shoulder joint.
Avoid injecting too close to moles, scars.
When injecting in the thighs, avoid the inner thighs Use  the top and outward areas. Friction between the legs when moving about may make the inner thigh sore.
Persons who exercise should avoid injecting into subcutaneous tissue adjacent to the muscle to be used as rapid absorption can lead to hypoglycemia.

Stress and Diabetes - Part 2

Reducing Mental Stress

Making changes
For some problems, stress may be a sign that something needs to change. With change, you may be able to get rid of some stresses of life. If traffic upsets you, for example, maybe you can find a new route to work or leave home early enough to miss the traffic jams. If your job demands too much from you, you can possibly discuss with your boss how to improve things. If you are in conflict with a friend or relative, you can make the first move to make up.

There are other ways to fight stress as well:
                                                                    

Start an exercise program or join a sports team.

                                                                 

Take dance lessons or join a dancing club.

                                                              

Start a new hobby or learn a new craft.

                                                               

Volunteer at a hospital or charity, or NGO.

Coping Style

Coping style is how a person deals with stress. For example, some people have a problem-solving attitude. They say to themselves, "What can I do about this problem?" They try to change their situation to get rid of the stress.

Other people talk themselves into accepting the problem as okay. They say to themselves, "This problem really isn't so bad after all."

These two methods of coping are usually helpful. People who use them tend to have less blood glucose elevation in response to mental stress.

Learning to Relax

For some people with diabetes, controlling stress with relaxation therapy seems to help, though it is more likely to help people with Type 2 diabetes than people with Type 1 diabetes. This difference makes sense. Stress blocks the body from releasing insulin in people with type 2 diabetes, so cutting stress may be more helpful for these people. People with type 1 diabetes don't make insulin, so stress reduction doesn't have this effect. Some people with type 2 diabetes may also be more sensitive to some of the stress hormones. Relaxing can help by reducing this sensitivity.

There are many ways to relax

Breathing exercises

Sit or lie down and uncross your legs and arms. Take in a deep breath. Then push out as much air as you can. Breathe in and out again, this time relaxing your muscles on purpose while breathing out. Keep breathing and relaxing for 5 to 20 minutes at a time. Do the breathing exercises at least once a day.

Progressive relaxation therapy

In this technique, which you can learn in a clinic or from an audio tape, you tense muscles, then relax them.

Exercise

Another way to relax your body is by moving it through a wide range of motion. Three ways to loosen up through movement are circling, stretching, and shaking parts of your body. To make this exercise more fun, move with music.

Replace bad thoughts with good ones

Each time you notice a bad thought, purposefully think of something that makes you happy or proud.

Whatever method you choose to relax, practice it. Just as it takes weeks or months of practice to learn a new sport, it takes practice to learn relaxation.

Stress and Diabetes - Part 1

Stress can be physical or mental.

Most people get stressed when physical conditions like injury or illness or mental conditions like problems in relationships, job, health, or finances cause their bodies to behave as if it were under attack.

When stress strikes, the body prepares to take action. This preparation is called the fight- freeze or-flight response. In the fight-freeze or flight response, levels of many hormones shoot up and make a lot of stored energy — glucose and fat — available to cells so that they can help the body get away from danger.

 What is the fight-freeze or flight response?

The fight-freeze or flight response is a mechanism which helps us to deal with threats and stressful situations.

When faced with a threat, one automatically gets ready to either freeze or  stop in shock, fight the threat or make a quick escape. The level of blood sugar for energy increases, blood pressure increases to take fresh oxygen to working muscles and adrenalin is released for better concentration and alertness.

What can cause stress?
 

Every- day stresses such the stress of a job, meeting deadlines, economic uncertainty, maintaining social relationships and the demands of raising children all activate the same fight –freeze or flight response.

Stress can result in Type 2 diabetes

Different forms of emotional stress increase the risk of occurrence of diabetes and also its advancement.

Emotional stress, especially depression, general emotional stress, anxiety, anger/hostility, and sleeping problems can increase the risk for the development of type 2 diabetes in 2 ways. The first is through behavioural changes such as unhealthy lifestyle behaviours, - poor food habits in terms of quality and quantity of food, low exercise levels, smoking and alcohol abuse (Bonnet et al., 2005; Rod et al., 2009). 

The other is through physiological changes that result in abdominal obesity (Björntorp, 2001; Vogelzangs et al., 2008) and other changes in immune system activity (Leonard and Myint, 2009), (Anisman, 2009).

All these factors are well-known risk factors for the development of Type 2 diabetes.

We still know very little about the mechanisms by which different forms of emotional stress increase the risk of diabetes incidence and progression. It is important for future research to explore these and other potential pathways in detail.

How Stress Affects Diabetes

In people who have diabetes, the fight-freeze or-flight response does not work well. Insulin is not always able to let the extra energy into the cells, so glucose piles up in the blood.

Many sources of stress are long-term threats. For example, it can take many months to recover from surgery. Stress hormones that are designed to deal with short-term danger stay turned on for a long time. As a result, long-term stress can cause long-term high blood glucose levels. With mental stress, the body pumps out hormones for no useful purpose. Neither fighting nor fleeing is any help when the "enemy" is your own mind.

In people with diabetes, stress can alter blood glucose levels in two ways:

People under stress may not take good care of themselves. They may drink more alcohol or exercise less. They may forget, or not have time, to check their glucose levels or plan good meals or take medication.

Stress hormones may also alter blood glucose levels directly.

In people with type 2 diabetes, mental stress often raises blood glucose levels. Physical stress, such as illness or injury, causes higher blood glucose levels in people with either type of diabetes.

  Find out whether mental stress affects your glucose control    

Before checking your glucose levels, write down a number on a rating scale of 1 to 10 ranking your mental stress level. Then write down your glucose level next to it. After a week or two, look for a pattern. Drawing a graph may help you see trends better. Do high stress levels often occur with high glucose levels, and low stress levels with low glucose levels? If so, stress may affect your glucose control.

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

TRANS- FATTY ACID AND HEALTH PROBLEMS

Karthika & Sheela Paul
Dietitians - MVH 

There has been a lot of focus on the need to avoid  trans-fatty acids . To understand why you should avoid trans-fats, it's important to understand what they are and what they can do to your overall well-being. 

 They are unsaturated fats that contain trans-isomer fatty acids which in turn are a by-product of the hydrogenation process. When unsaturated fats are hydrogenated, to make margarine or vegetable shortening, for example, trans-fatty acids are created in that process. This process was developed years ago as a way of keeping fats from spoiling and  to improve flavour.

Studies have shown that diets high in Trans- fats lead to health problems such as stroke, diabetes and coronary heart disease. There is even more evidence that these foods help to contribute to cancer, obesity, infertility and liver dysfunction. With all these negative effects, it’s better to avoid a diet high in these fats.

What are these foods that we should avoid? Processed foods, as well as every kind of fast food available have high levels of trans-fats. . While many of these foods taste good, and are easy to make meal of, they   are harmful for the  body. The American Heart Association has advised limiting trans- fat consumption to less than 1% but it is better to cut it out entirely from the diet. Though this may be difficult at first, once you avoid these processed foods , you won’t miss them much.

Animal products do contain trans-fats, but the main  source  of trans-fatty acids  in the diet is from  partially hydrogenated vegetable oils, such as margarine or the oils used to fry fast foods. These trans-fatty acids are not essential to our body's needs, and they do not promote good health as other fats may do. Studies show that trans-fats raise levels of LDL (bad cholesterol) in the body, at the same time lowering HDL (good cholesterol). This can lead to a many health problems.

Studies show a link between trans-fats and the onset of Alzheimer's Disease and obesity. Overconsumption can lead to liver disease, infertility and the development of cancer and type 2 diabetes.

A diet that includes monounsaturated fats such as olive oil, avocadoes and safflower or sunflower oil is considered the healthiest way to eat.

Trans Fat Labeling on Foods

Look at the  nutritional facts, as well as at the  ingredients list. Anything that contains “partially hydrogenated” oil contains Trans- fat. Though it may only be a small amount, these fats add up quickly.  

Foods to Avoid
Originally created to enhance flavor, extend shelf life and improve texture, these fats are present in a many foods that people take on a daily basis.

You should look for Trans- fats in any of these products:

• Cookies
• Crackers
• Cakes
• Muffins
• Pie crusts
• Pizza dough  
• Margarine    
• Vegetable shortening
• Cake mixes
• Pancake mixes
• Chocolate drink mixes
• Donuts
• French fries
• Potato chips
• Candy
• Packed popcorn
• Frozen dinners       

Because most of the foods that contain trans- fats are snack foods, even without containing trans- fats, they are not necessarily nutritionally sound. They are often loaded with empty calories and should be avoided regardless.

The only way to have a truly healthy diet is to eat a wide mix of fruits, vegetables and whole grains.

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/