Prevention is Better than Cure

Alanraj Judewin, Jr. Counsellor,
Department of Primary Prevention

Knowing how to prevent diabetes is very important since there is, at present, no known cure for it. The best way to avoid it is by making some lifestyle changes which are quite easy to follow.

Here are some tips to prevent diabetes


1) Exercise is extremely important for preventing diabetes


Obesity is the highest risk factor for Type 2 diabetes. Every 20% increase in weight over desirable levels doubles the risk of diabetes. If you lose even 5% of extra weight, it will help you prevent diabetes. A sedentary lifestyle increases your chances of developing diabetes. You need at least ½ hour of exercise per day. Vigorous walking increases your heart rate. One hour a day is even better. Clinical trials have shown that when participants walked vigorously for 30 minutes a day, 5 days a week, they lost about 5-7% of their total body weight, and cut their risk of developing diabetes by 50%. Exercise not only helps reduces the risk of developing diabetes, but also enhances your immune system by getting your lymph system moving, it builds muscle and bones, improves heart and lung efficiency, reduces stress, burns fat, raises your metabolism and generally keeps your body young.



A Finnish study found that people who exercised for about 35 minutes a day had 80% less risk of developing diabetes when compared to those who did not. Experts believe that exercise helps increase the number of insulin receptors in cells so that they can use insulin more efficiently and help blood glucose move into them. The Nurses’ Health Study found that women who exercised more than once a week reduced the risk of becoming diabetic by 30%. Studies have revealed that exercise also lowers blood sugar and keeps it down for several hours after the exercise, and this also contributes to the prevention of diabetes.

2) Lose Weight:


Weight loss is also extremely important in preventing diabetes. About 80% of diabetics are overweight and excess weight has been shown to increase the risk of diabetes. In fact just losing weight and exercising can often completely control all symptoms of diabetes.









3) Eat healthy:


Be wary of fast foods. Most contain refined carbs, salt, sugar and trans- fats. In a study conducted in Minnesota, 3000 people of normal weight, aged between 18 and 30, were observed closely. Those who ate fast foods more than twice a week developed twice the rate of insulin resistance and gained around 4.5 kg more weight than those who ate fast food less than once a week.

Keep an emergency pack of nuts or fruits instead of picking up fast foods when you feel hungry


Choose unrefined cereals over refined ones. Avoid trans- fats (hydrogenated vegetable oils) of any kind. They have been shown to contribute to heart disease and may also contribute to Type 2 diabetes.

Processed and fried foods are particularly unhealthy and the fats and carbohydrates found in them undermine your health.

Choose foods with low glycemic index such as whole grains, oats, bran, brown rice.

Eat food with high fiber content such as raw fruits and vegetables, beans, whole grains, oatmeal, brown rice, and barley. Fiber helps to buffer high amounts of sugar or carbohydrates in your diet, keeping your blood sugar even, rather than having it fluctuate wildly.




Try to avoid red meats and processed meats. The cholesterol content can put you at risk for diabetes. A study conducted at Brigham and Women’s Hospital found that women who ate red meat daily, had a 29% higher risk of developing diabetes when compared to those who ate less than once a week. Also, eating processed foods like ham and hot dogs raised the risk by 43%.



4) Don't smoke: Smoking is not only associated with the development of diabetes but it also contributes to heart disease and causes lung cancer.



5) Don't drink alcohol: Alcoholic beverages contain quickly absorbed carbohydrates which can raise blood sugar quickly to unhealthy levels.


6) Find company: friends or relatives or a group can help support you in your effort to change over to your healthy, new lifestyle.


7) Manage stress: Stress increases blood glucose levels. Try to relax throughout the day by learning techniques of stress management and Yoga.

Slim and Fit Programme

Diabetes

Chennai Slim and Fit Programme

By,
Mr.Manikandan BCom.,M.S.W
Project Officer
WDF/DRC


Overweight and obesity are vital links in the web of causation in most non-communicable diseases such as cardiovascular diseases, diabetes Cancer etc. Due to industrialization and urbanization there has been a considerable increase in the proportion of population which is obese. These changes have trickled down to child population too. Successive studies conducted by the M.V.Hospital for Diabetes and Diabetes Research Centre have proved that there is a growing trend in the prevalence of obesity in urban children, particularly in Chennai.

Childhood obesity is very troubling because the extra kilos lead to many health problems such as diabetes, high blood pressure, high cholesterol, respiratory problems, sleep and eating disorders. Obese children are at a much higher risk of growing into obese adults. They may experience fatigue and emotional problems such as low self esteem and lack of confidence. The important fact is that each child requires proper nutritious food and physical activity to become physically and mentally strong. It is good to involve the whole family in healthy habits. Children are good learners and they often follow what they see. Hence parents must be involved in the process of making their children healthy.

What is obesity ?

Obesity is the presence of excess fat in the body.

* Factors influencing childhood obesity



* BMI-FOR-AGE Percentile (5 – 20years)

* Less than percentile - Under weight

* 5th per to less than 85th Percentile - Healthy weight

* 85th per to less than 95th Percentile - Risk of weight

* 95th percentile or greater - Overweight

* BENEFITS OF NORMAL BMI

* Prevents diabetes.
* Prevents high blood pressure.
* Prevents heart disease.
* Prevents stroke.
* Prevents certain types of cancer.
* Prevents osteoarthritis (joint pains).
* Normalizes cholesterol levels and deranged blood fat levels (lipid profile).
* Increases life expectancy.
* Makes you look younger.

* HOW TO PREVENT OBESITY

* Exercise regularly for at least 30 minutes every day.
* Avoid high calorie fried snacks .Eat plenty of fruits instead.
* When thirsty, avoid drinking aerated bottled drinks. Drink more water.
* Play plenty of outdoor games and keep physically active.
* Reduce TV watching to a minimum. Help your parents in household work such as gardening and cleaning.
* Avoid frequent eat outs at restaurants.
* Do not skip main meals. This will help avoid unnecessary snacking.
* Keep to regular meal and sleep timings.
* Parental supervision is needed at most meal times.

* Healthy Tips
Eat Healthy

It’s important that your food choices are nutritionally adequate and low in calories.

* Include cereals, fruits and vegetables with a little fat.
* Avoid sugars, sweets, junk food and deep fried food.
* Eat smaller portions when you feel hungry.
* Drink water with your meals.
* Don’t skip meals to reduce weight.

* Make the Right Choice

* Be conscious of what you eat.
* Avoid munching while watching television or doing other activities.
* Eat slowly.
* Exercise daily and increase your physical activity.
* Check your weight once a week.

Anemia & Diabetes

Aruna.V
Jr. Dietitian
Diet Department

What is anemia?
Anemia is a condition where the level of hemoglobin is below normal. Hemoglobin is the protein in red blood cells that carries oxygen to all parts of the body.



Anemia can be a temporary condition, a consequence of other health conditions, or it can be a chronic problem. People with mild anemia may not have any symptoms or may have only mild symptoms. People with severe anemia may have problems carrying out routine activities and feel tired or experience shortness of breath with activity.

Normal Hemoglobin value:

Male = 13-18gm%
Female = 11-16gm%

What causes anemia in people with diabetes?

Anemia is one complication of uncontrolled Type 2 diabetes, due to a condition called diabetic nephropathy. Nephropathy is a disease of the kidneys, common in diabetics. When the kidneys are healthy they produce a hormone called erythropoietin. Erythropoietin acts on the bone marrow to stimulate it to make new red blood cells and helps to stabilize red blood cells. In nephropathy, erythropoietin levels are low and so the bone marrow does not make enough red blood cells to carry the required amount of oxygen to all parts of the body. When the number of red blood cells is low or when the amount of hemoglobin is abnormally low, it results in a state of anemia.


Anemia is one complication of uncontrolled Type 2 diabetes, due to a condition called diabetic nephropathy. Nephropathy is a disease of the kidneys, common in diabetics. When the kidneys are healthy they produce a hormone called erythropoietin. Erythropoietin acts on the bone marrow to stimulate it to make new red blood cells and helps to stabilize red blood cells. In nephropathy, erythropoietin levels are low and so the bone marrow does not make enough red blood cells to carry the required amount of oxygen to all parts of the body. When the number of red blood cells is low or when the amount of hemoglobin is abnormally low, it results in a state of anemia.



Other causes are as follows:

•Deficiency of Vitamin B12: Vitamin B12 deficiency develops when you cannot absorb this vitamin from food.
•When the body destroys cells responsible for absorption of vitamin B12.( pernicious anemia occurs).
•Surgery that alters the surface area of your stomach or the last section of your intestine (ileum)
•Digestive diseases such as Celiac disease and Crohn's disease
•Diabetes drug therapy with metformin. Anemia occurs in nearly 30% of diabetes patients using metformin for at least three years.

Iron deficiency is due to a lack of dietary iron. Nearly 20% of women, 50% of pregnant women, and 3% of men are iron-deficient.
•Women are at higher risk due to menstruation, lactation, or pregnancy – conditions that increase the requirement.
•Growth spurts demand higher iron levels.

What are the symptoms of anemia in diabetes?


People with diabetes who have anemia may feel weak, become tired easily, and have problems carrying out routine activities. Since these symptoms are also symptoms of diabetes, it may be difficult to determine if the symptoms are caused by anemia or by diabetes.

What are the effects of untreated anemia in diabetes?

Studies show that having anemia along with diabetes may increase the likelihood of developing diabetic eye disease, developing heart disease or having a stroke. People who have both diabetes and anemia are more likely to die earlier than those who have diabetes but not anemia. Fortunately, anemia can be treated, and benefits such as increased energy, activity level and improved quality of life can be achieved.

How to prevent anemia

People with diabetes can take steps to decrease their risk of developing anemia.
Cut the risk of developing anemia by controlling both blood glucose and blood pressure. Studies have shown that people with very good blood glucose control and blood pressure control have a lower risk of developing kidney damage.

Cutting the risk of kidney disease cuts the risk of anemia.

What are the treatments available?

Correction of anemia not only leads to less tiredness, more energy, and an improved quality of life but also to a reduction in mortality and admission to the hospital. Studies suggest that treatment of anemia slows the development of some of the complications of diabetes including damage to the nerves, the eyes and the kidneys.
Treatment varies according to the cause of the anemia. Iron or vitamin supplements may be recommended. Anemia that is associated with kidney disease may require treatment with drugs called erythropoiesis-stimulating agents (ESAs) that stimulate red blood cell production.

Another goal is to treat the underlying condition or cause of the anemia.

Dietary Factors:

Low levels of vitamins or iron in the body can cause some types of anemia. These low levels may be due to poor diet or certain diseases or conditions.


Iron

Iron found in foods is either in the form of heme or non-heme iron:

• Heme Iron. Foods containing heme iron are the best sources for increasing or maintaining healthy iron levels. Such foods include (in decreasing order of iron-richness) clams, oysters, organ meats, beef, pork, poultry, and fish.

•Non-Heme Iron. Non-heme iron is less well-absorbed. Eggs, dairy products, and iron-containing vegetables have only the non-heme form. Such vegetable products include dried beans and peas, iron-fortified cereals, bread, and pasta products, dark green leafy vegetables dried fruits, nuts, and seeds.

Vitamin C

Vitamin C helps the body absorb iron. Good sources of vitamin C are vegetables and fruits, especially citrus fruits


Vitamin B12

Low levels of vitamin B 12 can lead to pernicious anemia. The only natural dietary sources of B12 are animal products, such as meats, dairy products, eggs, and fish.


Folic Acid

Folic acid (folate) is a form of vitamin B that's found in foods. Your body needs folic acid to make and maintain new cells. Folic acid also is very important for pregnant women. It helps them avoid anemia and promotes healthy growth of the fetus.


Steps to Help Prevent Anemia
•Control your blood glucose
•Control your blood pressure
•Eat recommended amount of iron
•Include vitamin C rich foods in your diet
•Avoid caffeine which limits iron absorption

Prevent diabetes problems:

Keep your feet and skin healthy

S. Bamila MV Centre for Diabetic Foot Care, Podiatry, Research and Management

What are diabetes problems?

Too much glucose in the blood for a long time can cause diabetes problems. This can damage many parts of the body, such as the heart, blood vessels, eyes, and kidneys. Heart and blood vessel disease can lead to heart attacks and strokes. You can do a lot to prevent or slow down diabetes problems.

This information is about feet and skin problems caused by diabetes. You will learn the things you can do each day and each year to stay healthy and prevent diabetes problems.


High blood glucose can cause feet and skin problems.

What should I do each day to stay healthy with diabetes?


Follow a healthy eating plan that you work out with our doctor or dietitian.


Be active for a total of thirty minutes most days. Ask your doctor what activities are best for you.




Take your medicines as directed.



Check your blood glucose every day. Each time you check your blood glucose, record it.




Check your feet every day for cuts, blisters, sores, swelling, redness, or sore toenails.



Brush and floss your teeth every day.



Control your blood pressure and cholesterol.




Don’t smoke.


How can diabetes hurt my feet?

High blood glucose from diabetes causes two problems that can hurt your feet:

Nerve damage (diabetic neuropathy). With damaged nerves, you might not feel pain, heat, or cold in your legs and feet. A sore or cut on your foot may get worse because you do not know it is there. This lack of feeling is caused by nerve damage. Nerve damage can lead to infected ulcers.

Poor blood flow (peripheral vascular disease). Not enough blood flows to your legs and feet. Poor blood flow makes it hard for a sore or infection to heal. Smoking when you have diabetes worsens blood flow problems.

These two problems can work together to cause a foot problem. For example, you wear shoes that do not fit and develop a blister. You may not feel the pain from the blister because you have nerve damage in your foot. You neglect it. The blister gets infected. If blood glucose is high, the extra glucose feeds the germs. Germs grow and the infection gets worse. Poor blood flow to your legs and feet can slow down healing. Sometimes a bad infection never heals. The infection might cause gangrene. If a person has gangrene the skin and tissue around the sore die. The area becomes black and smelly. To keep gangrene from spreading, a doctor may have to do surgery to cut off a toe, foot, or part of a leg. Cutting off a body part is called an amputation.










What can I do to take care of my feet?
















Look at your feet every day to check for problems.

Wash your feet in warm water every day. Make sure the water is not too hot by testing the temperature with your elbow. Do not soak your feet. Dry your feet well, especially between your toes.

Look at your feet every day to check for cuts, sores, blisters, redness, calluses, or other problems. Checking every day is even more important if you have nerve damage or poor blood flow. If you cannot bend over or pull your feet up to check them, use a mirror. If you cannot see well, ask someone else to check your feet.

If your skin is dry, rub lotion on your feet after you wash and dry them. Do not put lotion between your toes.

File corns and calluses gently with an emery board or pumice stone. Do this after your bath or shower.








Cut your toenails once a week or when needed. Cut toe nails after a bath, when they are soft. Cut them to the shape of the toe and not too short. File the edges with an emery board.


Always wear slippers or shoes to protect your feet from injuries.







Wear shoes that fit well. Shop for shoes at the end of the day when your feet are bigger. Break in shoes slowly. Wear them 1 to 2 hours each day for the first few weeks.

Always wear socks or stockings to avoid blisters. Do not wear socks or knee-high stockings that are too tight.

Before putting your shoes on, feel the insides to make sure they have no sharp edges or objects that might injure your feet.

How can my doctor help me take care of my feet?

Tell your doctor right away about any foot problems.

Your doctor should do a complete foot exam every year.

Ask your doctor to look at your feet at each diabetes checkup. To make sure your doctor checks your feet, take off your shoes and socks before your doctor comes into the room.










Ask your doctor to check how well the nerves in your feet sense feeling.

Ask your doctor to check how well blood is flowing to your legs and feet.

Ask your doctor to show you the best way to trim your toenails. Ask what lotion or cream to use on your legs and feet.

If you cannot cut your toenails or you have a foot problem, ask your doctor to recommend a podiatrist.

What are common diabetes foot problems?

Anyone can have corns, blisters, and other foot problems. If you have diabetes and your blood glucose stays high, these foot problems can lead to infections.


Corns and calluses are thick layers of skin caused by too much rubbing or pressure on the same spot. Corns and calluses can become infected.




Blisters can form if shoes always rub the same spot. Wearing shoes that do not fit or wearing shoes without socks can cause blisters. Blisters can become infected.




Ingrown toenails happen when an edge of the nail grows into the skin. The skin can get red and infected. Ingrown toenails can happen if you cut into the corners of your toenails when you trim them. You can also get an ingrown toenail if your shoes are too tight. If toenail edges are sharp, smooth them with an emery board.


A bunion forms when your big toe slants toward the small toes and the place between the bones near the base of your big toe grows big. This spot can get red, sore, and infected. Bunions can form on one or both feet. Pointed shoes may cause bunions. Bunions often run in the family. Surgery can remove bunions.



Plantar warts are caused by a virus. The warts usually form on the bottoms of the feet.



Hammertoes form when a foot muscle gets weak. Diabetic nerve damage may cause the weakness. The weakened muscle makes the tendons in the foot shorter and makes the toes curl under the feet. You may get sores on the bottoms of your feet and on the tops of your toes. The feet can change their shape. Hammertoes can cause problems with walking and finding shoes that fit well. Hammertoes can run in the family. Wearing shoes that are too short can also cause hammertoes.


Dry and cracked skin can happen because the nerves in your legs and feet do not get the message to keep your skin soft and moist. Dry skin can become cracked. Cracks allow germs to enter and cause infection. If your blood glucose is high, it feeds the germs and makes the infection worse.





Athlete’s foot is a fungus that causes itchiness, redness, and cracking of the skin. The cracks between the toes allow germs to get under the skin and cause infection. If your blood glucose is high, it feeds the germs and makes the infection worse. The infection can spread to the toenails and make them thick, yellow, and hard to cut.



Tell your doctor about any foot problem as soon as you see it.

How can special shoes help my feet?

Special shoes can be made to fit softly around your sore feet or feet that have changed shape. These special shoes help protect your feet.

How can diabetes hurt my skin?

Diabetes can hurt your skin in two ways:

If your blood glucose is high, your body loses fluid. With less fluid in your body, your skin can get dry. Dry skin can be itchy, causing you to scratch and make it sore. Also, dry skin can crack. Cracks allow germs to enter and cause infection. If your blood glucose is high, it feeds germs and makes infections worse. You may get dry skin on your legs, feet, elbows, and other places on your body.








Drinking fluids helps keep your skin moist and healthy.

Nerve damage can decrease the amount you sweat. Sweating helps keep your skin soft and moist. Decreased sweating in your feet and legs can cause dry skin.

What can I do to take care of my skin?

After you wash with a mild soap, make sure you rinse and dry yourself well. Check places where water can hide, such as under the arms, under the breasts, between the legs, and between the toes.











Keep your skin moist by using a lotion or cream after you wash. Ask your doctor to suggest one.

Drink lots of fluids, such as water, to keep your skin moist and healthy.

Wear all-cotton underwear. Cotton allows air to move around your body better.

Check your skin after you wash. Make sure you have no dry, red, or sore spots that might lead to an infection.

Tell your doctor about any skin problems.

PACKED LUNCH FOR DIABETICS

Mrs.Sheela Paul,Dietitian
M.Malini, Dietitian
M.V.Hospital for Diabetes and Prof.M.V.DRC, Royapuram

These days many people are away from home at lunchtime and don't think about lunch ... until it is lunchtime! Diabetics need to pay extra attention to their diet because they have to regulate their blood sugar levels. They often wonder why their pre-dinner blood glucose reading is high. The first question they ask themselves is “What did I have for lunch?”According to the American Diabetes Association, diabetics should balance the carbohydrate, protein and fat in their meals to prevent blood sugar spikes.

If lunches are eaten at home, their preparation and serving do not present problems... For a diabetic, lunchtime can be quite a challenge if eaten away from home. Eating out, picking up a sandwich, some fast food or having business lunches can create problems with both blood sugar and weight.

Although it is possible to eat out and still keep your diabetes under control, it is definitely not an easy task.

Consult a registered dietitian who can suggest a plan for you.

Here are some tips for lunches that are tasty as well as nutritious.

* Choose a healthy beverage to include with your lunch. Water is the best choice because it quenches thirst and has no sugar or calories. . Avoid regular sodas and juices, as they are full of sugar.



* Use whole grain cereal such as wheat flour. Whole grains are richer in fiber, vitamins and minerals than refined grains such as white bread. The fiber content helps keep you feeling full and minimizes blood sugar spikes.
* Your lunch should have a protein-rich food to stabilize blood sugar levels.
* Balance your lunch with a fruit and vegetable servings. Pack an apple, a guava, an orange, or a pear in your lunch box for some extra nutrients.
* Diabetics can take any amount of non-starchy vegetables as they are low in calories and carbohydrate.
* It is important to know how many servings of each food group you can eat daily.
Eating out includes extra large portions or food choices that are too high in carbohydrate, fat and calories. Even when you think you are making a healthy choice, it may be the wrong choice.
* Use fresh vegetables like cucumber, cabbage, carrot, beetroot, radish, tomato, onion , sprouted grams and fruits in salads.

Things to consider when packing a lunch that will be nutritious and keep blood sugars controlled...

Prepare and pack whatever you can the night before so that you are not rushing around in the morning: Plan your menu keeping in mind the different food groups.


Carbohydrate – Carbs have the greatest effect on your blood sugar. If you have too much carbohydrate, your blood sugar will be too high. You need to be aware of how many carbs to eat at each meal. Be familiar with the amount of carbohydrate in the foods you choose.

* Protein – Milk ,curd, dhal, whole grams, sprouted grams, roasted grams, nuts, meat, fish, chicken and eggs are good sources of protein.

* Fat – Fat is expensive in terms of calories (9 calories per gram). Pack a lunch that minimizes fat intake.

* Fiber – Add fiber to your lunch. 25-40 grams of fiber each day is the daily requirement. Whole grains, whole grams, vegetable greens, salads and fruits should be included in your regular diet.

Mixed rice dishes such as tamarind rice, lime rice, curd rice with pickles, papads, vatal, chips, chutney, vada, and pakodas are favourite items for lunch.





But these are the wrong choice of food. You can have rice and dhal, vegetables and curd, or chapatti with vegetable kootu and curd. Fruits can be eaten as a snack between meals.

Be creative with your lunch to avoid boredom. It may be easier to buy lunch everyday, but by investing a little time and effort in home-made lunches you can be on your way to better blood sugar control. You may even save some money!