DIA OBESITY PEOPLE BEWARE OF FAST AND JUNK FOODS

MRS.SHEELAPAUL
MRS.MALINI

People always believe that DIETING means bland food without taste. Certainly not, In fact diets are also tastier like our normal and usual diet. The diet for a person with diabetes is a diet without sugar or fats. It can also be tried out by all people especially obese and who want to prevent diabetic. When you make changes in your lifestyle and eating habits that will make you feel healthier and more energized. You need to pay strict attention to the food that you eat when you have diabetes and diet guidelines need to be followed. However, this does not mean that your days now need to be filled with boring tasteless food. Many people find that their new diabetes diet plan actually tastes better and is more satisfying that the food they were eating before.

Junk food refers to fast foods which are easy to make and easy to consume. They have only fats lying in it causing ill effects on the health of the consumer. The taste is the most attractive feature in junk foods. Nevertheless, junk foods are popular because of their simplicity to manufacture, consume and of course, their taste. People have their own notions about a certain food being listed as junk. However, huge Burgers, full pizzas, potato wafers ,Ghee roasted Masala Dosai, Idlies with Sambar vadai ,Mutton Biriyani , high calorie wedding food, chocolates and fries will surely find their way into everyone's list.

Junk food and fast food when taken in excess in daily basis make health hazardous too. And affects the cholesterol levels. Secondly, the sugar and sodium salts have their effects on health. High calorie content with sugar can lead to obesity. Cholesterol and salt are known to increase the blood pressure, stroke and heart diseases in a chain. Excessive salts can affect functioning of kidneys too. Consuming junk food has reduced level of essential nutrients thereby causing weakness in the body.

Diabetes:

Junk foods also cause damage to the pancreas resulting in diabetes mellitus. These foods they are filled with carbohydrates which will spike their blood sugar levels, sugar levels rise and fall drastically Fluctuation in the blood sugar not good Glycemic control.

Obesity:



Junk food enthusiasts are prone to put on weight, especially when they eat this kind of food very often. The fat and processed flour only make you fatter and fatter, as does the oil and grease that are used for fries and other deep-fried foods. Besides, when you eat junk food, you tend to gulp down sodas and colas which are laden with sugar and which increase your tendency to put on weight. Junk food makes you feel sleepy and less inclined to be active and alert. Your reflexes and senses become duller day by the day and you start to lead a more sedentary life

Heart Diseases:

Junk foods have been identified as a major cause of heart diseases including myocardial infraction, cardiac arrest and atherosclerosis. This is due to the fact that junk food contains excessive amount of low-density lipoproteins and cholesterol that get deposited on the inner linings of blood vessels. This result in formation of plaques and the heart is required to put an extra effort for pumping blood through the arteries. Presence of fat in the blood also causes reduced oxygen levels. Another harmful factor present in junk foods is excess concentration of sugars and salt. Excessive concentration of sodium ions causes an increased heart blood pressure.

Liver Failure:

Even liver gets damaged due to presence of fat, cholesterol and salt in the junk foods.

Poor Concentration:

When a person consumes junk food in excess, body finds difficult to digest and needs to spend high amount of blood and enzymes as a result, the person feels drowsy and suffers with reduced concentration.

Poor nutrition:

When you eat too much junk food, you neglect to eat the nutritious food like fruits and vegetables and other wholesome food. This means that your body does not get the necessary nutrition it needs and you end up with a weak immune system. So you’re often prone to illnesses like colds and fevers which although not serious, tend to have a nagging effect on your life. They prevent you from being as active and organized as you would like to be. Processed foods have no fiber content whatsoever and that is why you feel constipated when you go on a junk food binge.

These days’ teenagers and young children prefer to take fast and junk food in their regular diet parents also encourage them to take these foods which can affect their health in future. So all teenagers and IT people try to take healthy food like vegetables ,whole grains ,nuts, whole grams and fruits at least once or twice a day. Whenever you take pizza or burger or noodles or fried rice add more vegetables.

KEY NUTRTITIONAL CARE FOR WOMEN WITH GESTATIONAL DIABETES

Mrs.sheela Paul & Ms.Vimala

Pregnancy alone is a critical condition, how much more if the mother is going through another serious medical situation such as diabetes? Gestational diabetes is a type of diabetes that occurs only during pregnancy. Like other forms of diabetes, gestational diabetes affects the way your body uses sugar (glucose) — your body's main source of fuel. Gestational diabetes can cause high blood sugar levels that are unlikely to cause problems for you, but can threaten the health of your unborn baby. Any pregnancy complication is concerning, but there's good news.

You can manage gestational diabetes by eating healthy foods, exercising
regularly and, if necessary, taking medication. Taking good care of yourself can help ensure a healthy pregnancy for you and a healthy start for your baby. Fortunately, gestational diabetes is usually short-lived. Blood sugar levels typically return to normal

soon after delivery.

Gestational diabetes will affect about 4 percent of all pregnant women, potentially causing major consequences for both the mother and her child


Healthy Eating:

• No single diet is right for every woman. Your meal plan should be based on your blood sugar levels, height, weight, exercise habits and food preferences

• Eating the right kind and amount of food is one of the best ways to control your blood sugar level.

• Making healthy food choices also helps prevent excessive weight gain during pregnancy, which can put you at higher risk of complications

• A healthy diet often means including more fruits, vegetables and whole grains.

• Take a well balanced and nutritious food, calories in required amount, low in fat and complex carbohydrates.

• Choosing high fiber foods will help to control your blood sugar and have regular bowel movements. Include fiber foods such as fresh fruits, vegetables, green leafy vegetables, whole grain cereals, legumes, dhal, and nuts.

• No harm taking Non-Veg in prescribed amount. Avoid deep fried preparations

• Use combination of oil (groundnut oil+gingelly oil +sunflower /saffola oil.

• Include 3% fat milk and milk products in your every meal to strengthen your bones and promote healthy development of your baby’s bones.

• Artificial sweetener are NOT safe during pregnancy.

• Some people with gestational diabetes can control their blood sugar with diet alone. They do this by eating 3 meals and 1 to 3 snacks each day.

• You will need a snack at bedtime to prevent low blood sugar levels during overnight..

• Eat at the same times each day, whenever possible, and never skip meals or snacks. Spread your food out evenly over the day so that you eat about every 2 to 3 hours.

• Avoid foods and beverages with added sugar, sugar syrup, honey, or jams and jellies.

• Read the labels of packaged foods to find the nutritive value.
There are no guarantees when it comes to preventing gestational diabetes — but the more healthy habits you can adopt before pregnancy, the better. An expectant mother who is going through gestational diabetes must be closely monitored by a pediatrician to ensure her safety and of the child as well.

Get out of Diabetes burn out

Dr. Sripriya Shaji

Burnout arises when we're overworked, overtaxed emotionally, physically exhausted or unwell, and often unable to cope with everyday situations. Trying to achieve that perfect balance between family and work life is hard enough; throw in the demands of living with and managing a chronic medical condition,
And it’s not surprising that you get burnout, when your doctor points the numbers in the investigation profile and says you need work on diet and exercise.

When we become truly burned out, it's time to take stock and make changes.

Let’s take inventory of the situation.

Accept the fact that burnout is a time of self-evaluation and change. Just as you would treat a physical illness with rest and restriction of activities, cut back as much as you can on commitments and responsibilities for a time and allow yourself to "treat" this emotional and mental exhaustion. AADE recommends these 7 strategies as Self-care behaviors

* Healthy eating
* Being active
* Monitoring
* Taking medicines
* Problem solving
* Reducing risk and
* Healthy coping

Diabetes Diet – No doubt it is frustrating to count on every rice you eat. But why to count?
Diabetes diet just demands you to spare proper time and making nutritious choice. Plan your meal. Make yourself determined that you eat healthy food on time, without excuses.

Exercise – ADA recommends 150 minutes of walking / week. Just think can’t we spare 30 minutes a day? Can’t we keep our self active?
Monitoring – Right from the school days, we are worried about the term examination. Fails to understand, they improvise us for facing the final exams. same way the regular SMBG check up helps us to keep our blood sugar in control, which leads to better HbA1c control and over all glycaemic control.

Medications – Regular medication is as important as diet and exercise.

Problem solving, Reducing risk and Healthy coping - Try to identify those things most responsible for your present state, and ask yourself which areas are most in need of drastic change. Don't forget to take inventory of your strengths, skills, and resources, both internal and external, as well. Do you have good friends willing to lend a listening ear, family members who'll babysit, or anyone who can help you through this time? Think, too, about the inner strengths you have to fall back upon. What have you done in the past to solve similar, or other, problems?

If you need to make critical decisions concerning job or personal life, you'll be much better prepared to make healthy, sound choices when you're rested and not deep in the throes of burnout.

Alternatively, if you find that an overcrowded schedule is one of the main factors causing your burnout, you may need to pass along or delegate some of your regular commitments on a permanent basis. Accept offers of help from friends and family, and don't forget to show your gratitude. If your financial situation allows, hire someone to do household tasks or errands - or equip yourself to better self care management - or whatever seems unbearable at the moment - to give you more time for yourself.

Be good to yourself. You need plenty of rest, good nutrition, exercise, and the support of friends and/or family. Do something for yourself that gives you joy or pleasure. Read a good book or take in a film you've wanted to see. Allow your loved ones to help too, although you may have to explicitly communicate to them exactly what kind of help you need. Give yourself permission to spend the necessary time and energy to take care of yourself.

Reactive Hypoglyceamia

Mrs.sheela Paul
Chief Dietitian

Reactive hypoglycemia is a medical condition occurring from low sugar in the blood. It is mainly associated with people who suffer from diabetes, but has been also know to occur in non-diabetics. Though there are some people who experience this state even if they are not fasting, and the blood sugar drops irrespective of there food intake--this condition is referred to as reactive hypoglycemia.

So how does the sugar in the blood drop?
The most common cause of this is when a person goes hungry for a long period of time or is in a state of fasting. Basically the body needs food to keep all its functions going correctly, so if a person is fasting the body does not have the necessary fuel and so the sugar levels drop.

There has been quite a bit of research done on this subject and many researchers and experts have come to believe that this condition is mainly caused by the lack of a hormone called Glucagon. This hormone is the one that is mainly responsible for keeping the balance levels of sugar in the blood.

The main symptoms of this condition can be confused with other diseases as they are quite similar.

Listed here are of the symptoms of hypoglycemia:
-Dizziness, sweating, hunger
-Inability to sleep
-Excessive sweating
-Trembling and being nervous all the time
-Fatigue and tiredness.

A simple healthy diet will greatly help in improving your condition, like eating more often, up to 6 times a day. You don’t need to eat a lot every time, just small meals every three hours. Skipping meals will cause your blood sugar to fall down, as well as not eating for longer periods of time can have the same effect.


Nutrition tips to manage hypoglycemia
• Eat a small meal or snack about every 2-3 hours. Skipping meals can make symptoms worse.
• Choose high fiber foods at each meal and snack.
Fiber helps stabilize blood sugar. Increase fluid intake when you increase fiber intake.
• Eat a source of protein and or a source of fat with carbohydrate at each meal or snack.
Protein and fat eaten with carbohydrates will help slow glucose release and absorption.
• Limit simple sugars. (candy, soda, fruit juice, sweets)
Simple sugar intake can make hypoglycemia symptoms worse. Moderate your intake.
• Limit alcohol and caffeine (coffee, tea, soda, chocolate).
• Eat a meal or snack 1-3 hours before exercise.
Extra carbohydrates may be needed before exercise to compensate for energy used.

Physical Activity: Although excessive physical activity can bring your blood sugar level low, a simple exercise is still beneficial. All you need to do is to time your activity after a meal to make sure that your insulin hormone will have the needed sugar to break down in your system. Make sure not to overdo your physical activities as this can lead to sudden drop in your blood sugar level. Don’t forget to consult your physician before engaging in extra physical activities, they can best advice on how much exercise you can handle.

Controlling this condition can be done through right diet, which is the only treatment available for now. Following a healthy eating lifestyle can help blood sugar levels steady, as well as provide you with the necessary nutrients you need for good health. If you believe you are suffering from Reactive Hypoglycemia, it is best to consult a physician and a dietician to help plan your treatment.

What is Insulin Pump Therapy?

All people, with or without diabetes, need insulin for two reasons:

a background amount of insulin for normal functions of the body without food and a burst of insulin "on demand" when food is eaten. People without diabetes can trust that their pancreas will produce this insulin for them. People with diabetes need to take insulin as similar as possible to the way their pancreas would produce it if it could.

With multiple daily injection therapy, it is not always clear how much insulin is being used for background and how much is being used for food. In insulin pump therapy, the two are clearly separate. Insulin pump therapy allows you to set a basal rate, or background insulin, to be delivered continuously throughout the day and night for the normal body functions. When you eat you can then give a bolus, or delivery of insulin, "on demand".

When you exercise, you can reduce the basal rate so that your blood glucose does not drop too low. Or when you are sick or have an infection, you can increase the basal rate so that your blood glucose does not go up too high. You can also increase or decrease your meal bolus based on the foods you choose to eat.

Additionally, the pump uses only fast-acting insulin. You will not need to follow as rigid a schedule as you did before, because there is no long-acting insulin telling you when you should eat or when you will need more insulin.

Sound exciting? It is exciting... not only can your blood glucose be easier to manage, but your lifestyle can be easier too.

Gestational Diabetes

Gestational diabetes is a temporary condition that occurs during pregnancy. Gestational diabetes affects two to four per cent of all pregnancies and involves an increased risk of developing diabetes for both mother and child.

Gestational diabetes means diabetes mellitus (high blood sugar) first found during pregnancy. In most cases, gestational diabetes is managed by diet and exercise and goes away after the baby is born.

Gestational diabetes is also called glucose intolerance of pregnancy.

Risk for Developing Gestational Diabetes

Some of the most common risks for developing gestational diabetes are:

* A family history of diabetes in parents or brothers and sisters.
*Gestational diabetes in a previous pregnancy.
*The presence of a birth defect in a previous pregnancy.
*Obesity in the woman, BMI greater than 29.
*Older maternal age (over the age of 30).
*Previous stillbirth or spontaneous miscarriage.
*A previous delivery of a large baby (greater than 9 pounds).
*A history of pregnancy induced high blood pressure, urinary tract infections, hydramnios (extra amniotic fluid), etc.
*Women of Hispanic, First Nations, or of African-American decent.


Risk for babies born to mothers with Gestational Diabetes

*Macrosomia (large, fat baby)
*Shoulder dystocia (birth trauma)
*Neonatal hypoglycemia (low blood sugar in the newborn)
*Prolonged newborn jaundice
*Low blood calcium
*Respiratory distress syndrome
*Develop jaundice
*Stillbirth
*Die in infancy


How Is Gestational Diabetes Diagnosed?

Gestational diabetes is usually diagnosed between the 24th and 28th week of pregnancy when insulin resistance usually begins. If you have had gestational diabetes before, or if your doctor is concerned about your risk of developing gestational diabetes, the test may be performed before the 13th week of pregnancy.

Cure for Gestational Diabetes

A cure for Diabetes has not been found yet.However, it can be controlled. Ways to control diabetes are: maintaining blood glucose levels, blood fat levels and weight.Controlling diabetes is very important and should be supervised by a medical doctor.When diabetes is controlled, it will help prevent serious complications such as: infections, kidney damage, eye damage, nerve damage to feet and heart disease.

Can Gestational Diabetes be Treated?

Gestational diabetes can be treated. Treatment involves taking steps to keep your blood glucose levels in a target range. Your blood glucose levels can be controlled by:

* Changing your meal plan
*Physical activity
*insulin (if needed)

Diabetes and Erectile Dysfunction

One of the most common problems related to diabetes is erectile dysfunction. Erectile dysfunction is a consistent inability to have an erection firm enough for sexual intercourse.

Men who have diabetes are three times more likely to have erectile dysfunction as men who do not have diabetes. Studies show that 35% to 75% of men with diabetes will develop some degree of erectile dysfunction.

High blood sugar, which must be managed carefully if you have diabetes, causes blood vessel and nerve damage that affects sexual responses. Damage to the blood vessels blocks the release of nitric oxide. A lack of nitric oxide causes erective dysfunction because it results in constricted blood vessels and reduces blood flow to the penis.

Having high blood pressure also increases your risk of erective dysfunction. The combination of high blood pressure and diabetes also increases the risk for blood vessel damage, further reducing blood flow.

High cholesterol is also common in people with diabetes. LDL cholesterol, can interfere with the ability of blood vessels to dilate. High cholesterol levels result in fatty deposits in artery walls. This buildup of fatty deposit can reduce blood flow to the penis.

Combat erectile dysfunction

By living a healthy lifestyle and working with your doctor, you can get your diabetes under control and treat erectile dysfunction if it becomes a problem for you. Some of the most common treatments for erectile dysfunction are: psychotherapy, drug therapy, vacuum devices, and surgery to repair damaged nerves.

TOP TEN FACTS ABOUT DIABETES

1. Diabetes is a silent epidemic and according to WHO there are 246 million people in the world living with diabetes. This is almost 6% of the world's adult population.

2. Diabetes in Asians is five times the rate of the white population

3. India is the diabetes capital of the world. It is estimated that currently there are 40 million people with diabetes in India and by 2025 this number will swell to 70 million. This would mean every fifth diabetic in the world would be an Indian.

4. Central obesity or apple shape of the body and insulin resistance is the main reason for diabetes increase in Indians

5. Diabetes causes 6 deaths every minute and one in 20 deaths in the world. Every year it is estimated that 3.2 million people in the world die due to the diabetes or its related causes.

6. Diabetes is an important 'silent killer disease' as there is usually no early symptom of the disease. The commonest early symptom is feeling thirsty

7. Almost 90 to 95% of diabetes is of type 2 or maturity onset type; that affects people in their middle age. Type 1 or juvenile diabetes affects 70,000 children under the age of 15 years every year.

8. The major cause of increase in the incidence of diabetes is a sedentary lifestyle. Exercise and diet can either reduce or delay the incidence of diabetes by over 50%.

9. Diabetes is the number one cause of kidney failure in the world. Besides this every year it is responsible for 5% or 5 million blindness in adults and one million limb amputations. Diabetes is also an important cause of heart disease, stroke and cataract.

10. The current cost of treating diabetes and its complications in the world is estimated as US $ 215-375 billion. The disease is growing fastest in developing countries where there are more people in the lower and middle-income group.

Diabetes & Oral Health: How to Protect Your Teeth

Diabetes and your teeth may not seem to be linked, but they are.

Having uncontrolled diabetes can boost your risk for oral health problems such as gum disease.

But the link goes the other way, too, most experts believe. If you have gum disease, it may make it harder to keep blood sugar under control. So the diabetes and oral health link is a two-way street.

The good news: taking care of your oral health will help not only your teeth and gums, but perhaps help your diabetes control.

Other oral health problems, although not as common, are also associated with having diabetes.

Among them:

* Slower healing time after dental surgery
* Fungal infections
* Dry mouth
* Cavities

Even so, you can take steps to protect your teeth and oral health. Here's how to minimize the risks.


Diabetes & Oral Health Risks Explained
Having diabetes can make you less able to fight off infection, including gum infections that can lead to serious gum disease.

In early stages, gum disease is known as gingivitis. The gums are swollen, soft, and may bleed, particularly during brushing or flossing.

If gum disease progresses, however, the gums may begin to separate from the teeth, forming pockets that can trap bacteria and boost the risk of infections. Untreated, the infections can destroy the underlying bones that holds the teeth in place.

Surgery may be needed. In one technique, called pocket depth reduction, the periodontist folds back the gum tissue, removes the bacteria, and secures the tissue into place so that it fits more tightly around the teeth.

With diabetes, you may heal more slowly after oral surgery. Your health care provider may prescribe antibiotics to keep post-operative infection at bay. Pay close attention to your blood sugar levels and control before and after oral surgery.

If you have diabetes, you are also at risk for fungal infections in the mouth, called oral candidiasis or thrush. This is true even if you wear dentures.

Dry mouth, called xerostomia, is another common problem among people with diabetes. Saliva is important to oral health -- it helps wash away food particles and keep the mouth moist. When you don't have enough saliva, bacteria thrive, tissues can get irritated and inflamed, and your teeth can be more prone to decay.

Diabetes & Your Teeth: How to Minimize Risk

Taking care of your oral hygiene at home every day is crucial. Make sure you brush twice a day and floss once a day. Using an antibacterial mouthwash or toothpaste can help reduce bacteria in the mouth that can cause gingivitis.

Examine your mouth for an inflammation or signs of bleeding gums. If you notice either, let your dentist know as soon as possible.

Experts recommend having your teeth professionally cleaned every six months, or even every three or four months. Step up the professional cleaning schedule if you know you tend to be lax about home care.

Be sure to tell your dentist that you have been diagnosed with diabetes. It will also help your dentist to know the names of all prescription and over-the-counter drugs you take.

You may want to see a periodontist -- a dentist who specializes in gum disease -- if your gum problems persist or seem to get worse.

Diabetic Nephropathy

Kidney disease in diabetes as we all knows ‘diabetic nephropathy’ is a major microvascular complication occurring in around 20-40 % diabetic patients with prolonged diabetes. It’s a leading cause of end stage renal disease, dialysis and transplant.

Diabetic nephropathy is characterised by persistent proteinuria of >500mg/day with concomitant diabetic retinopathy, hypertension and absence of other kidney or renal tract disease.



Years of diabetes
GFR-Glomerular filtration rate
ESRD-End Stage Renal Disease




Symptoms:-

* Ankle and leg swelling. (Pedal oedema) and/ facial puffiness.
* Reduced urination (<400ml/day-oliguria). * Episodes of hypoglycaemia.
* Less requirement of insulin or antidiabetic medication.
* Reduced appetite (anorexia) and weakness.
* Nausea and vomiting.
* Itching.
* Breathlessness.
* Palpitation.

Diagnosis of diabetic nephropathy
Evidence of diabetic retinopathy ( retina changes in diabetes)
Presence of proteins in urine- presence of urine microalbumin or urine spot protein creatinine ratio of >0.2.
High levels of blood urea and creatinine
Enlarged renal size on ultrasonography.
Associated findings of- high blood pressure, anaemia and increased serum potassium levels.

What to eat?

Patient should take low sodium and protein diet. Recommended dietary protein intake is 0.6 to 0.8 gm/kg body weight/day and salt of 2 to 3 gm/day.

Lifestyle modification

Patient is required to exercise daily and loss weight to maintain ideal body weight. To avoid tobacco and alcohol.

Medications supposed to be avoided in renal diseases.

Avoid nephrotoxic drugs like NSAIDS, aminoglycosides etc, over the counter medications (medicines brought directly from the pharmacy without prescription), alternate and native medication and painkillers unless very necessary, use nephrosafe painkillers like paracetamol and tramadol. Avoid intravenous contrast agents for imaging like CT scan and angiography. Avoid metformin in renal diseases, insulin is the best choice.

Management
Good glycaemic control of HbA1c<7% Good Blood pressure control of <130/80mm hg with ACE inhibitors/ARB (angiotensin receptor blocker) as first line followed by beta blockers and calcium channel blockers. Lipids levels to remain under control

Can we cure diabetic nephropathy?
Once onset complete reversibility is not possible but we can slow the progression of diabetic nephropathy and delay onset of end stage renal disease with good glycaemia and blood pressure control and use of ACE inhibitors/ARB in early stages.

Pregnancy and diabetic nephropathy?
ACE inhibitors/ARB should be avoided as they cause foetal malformations. Best is to maintain a strict glycaemic control of HbA1C <7.0% and blood pressure control of <130/80mm of hg. Benefits of early diagnosis of kidney disease.

Kidney being an innocent organ, in diabetes, it’s prone to microvascular insult. Any further damage due to infections drugs, etc can further compromise the renal function, recovery from which may not be possible through conservative means.

Hence early diagnosed kidney diseases can have a better and prolonged survival if certain precautions are attained at the beginning itself, for example, avoiding use of painkillers, alternate medicines, intravenous contrast agents during imaging studies and nephrotoxic drugs. Taking plenty of fluids and consulting your physician each time you need to take medicines. Regular checkup for renal functions and urine for proteinuria.

Consult your physician if you have, reduced urine, burning micturition, swelling in feet, loin pain, any urinary discoloration.

Nephrology evaluation is must for patients having skin or joint problems (ex- SLE, psoriasis, leprosy, etc), cyst or stones in kidney, family history of renal diseases and patients with prolonged pain killer intake.

Complications of Diabetes

Definition
Diabetes is a chronic (lifelong) disease marked by high levels of sugar in the blood. Those with diabetes are at high risk for a number of complications.

Causes, Incidence, And Risk Factors
Insulin is a hormone made by the pancreas, an organ located behind the stomach. Insulin is needed to move glucose (blood sugar) into cells, where it is stored and later used for energy.

Diabetes is caused by a problem in the way your body makes or uses insulin. There are several types of diabetes. This article discusses the possible complications related to diabetes.

Signs And Tests
If you have diabetes, you should see your health care provider every 3 months. At these visits you can expect the health care provider to:
• Check your blood pressure
• Check the sensation (feeling) on your feet
• Check the skin and bones of your feet and legs
• Examine the back part of your eyes with a lighted instrument called an ophthalmoscope

Complications
After many years, diabetes can lead to serious problems throughout your body, including your eyes, kidneys, and nerves.

EYE PROBLEMS
Diabetes can also damage blood vessels in the eyes, causing vision problems or blindness. Conditions may include:
• Cataracts
• Diabetic retinopathy
• Glaucoma
• Macular edema

FOOT AND SKIN PROBLEMS
People with diabetes are more likely to have foot problems because of nerve and blood vessel damage. Small sores or breaks in the skin may turn into deep skin ulcers if not treated properly. If these skin ulcers do not improve, or become larger or go deeper, amputation of the affected limb may be needed. (Diabetes foot care.)

HEART AND BLOOD VESSELS

If you have diabetes, your risk of a heart attack is the same as someone who has already had a heart attack. Both women and men with diabetes are at risk. You may not even have the typical signs of a heart attack. Other problem with the heart and blood vessels include:

• Damage to blood vessels that supply the legs and feet (peripheral vascular disease)
• High blood pressure (hypertension)
• High cholesterol
• Stroke

NERVE PROBLEMS

Diabetes can damage nerves, which means you may not feel an injury until a large sore or infection develops. Nerve damage causes pain and numbness in the feet, as well as a number of other problems with the stomach and intestines, heart, and other organs. ( Diabetic neuropathy.)

OTHER COMPLICATIONS

• Infections of the female genital tract, the skin, or the urinary tract
• Kidney disease and kidney failure (diabetic nephropathy)
• Problems attaining or maintaining an erection (impotence)

Calling Your Health Care Provider

Call your health care provider if you have:
• Numbness, tingling, or pain in your feet or legs
• Problems with your eyesight
• Sores or infections on your feet
• Symptoms of high blood sugar (being very thirsty, having blurry vision, having dry skin, feeling weak or tired, needing to urinate a lot)
• Symptoms of low blood sugar (weakness or tiredness, trembling, sweating, feeling irritable, unclear thinking, fast heartbeat, double or blurry vfision, feeling uneasy)

Prevention

You should learn basic diabetes management skills. They will help prevent complications and the need for medical care. These skills include:
• How to handle sick days
• How to recognize and treat low and high blood sugar
• How to take medications, if needed
• How to test and record your blood sugar level
• What to eat and when
• Where to buy diabetes supplies and how to store them

It may take several months to learn the basic skills. Always continue to education yourself about the disease and its complications. Learn how to control and live with diabetes. Over time, stay current on new research and treatment.

The American Diabetes Assocation recommends keeping blood sugar levels in the range of:
• 80 - 120 mg/dL before meals
• 100 - 140 mg/dL at bedtime

EXERCISE

Regular exercise is important for everyone, but especially if you have diabetes. Regular aerobic exercise lowers blood sugar without medication and helps burn excess calories and fat so you can mange your weight.

Exercise can help your overall health by improving blood flow and blood pressure. Exercise also improves your ability to handle stress.

The following are important for preventing complications of diabetes:
• Get yearly tests to be sure your kidneys are working well (microalbuminuria and serum creatinine)
• Have your blood pressure checked at least every year (pressure should bve 130/80 mm/Hg or lower)
• Have your cholesterol and triglyceride levels checked yearly (LDL levels should be 100 mg/dL or below)
• Have your glycosulated hemoglobin (HbA1c) check every 6 months if your diabetes is well controlled or every 3 months if it's not
• See the dentist every 6 months for a thorough cleaning and exam. Make sure your dentist and hygienist know you have diabetes
• Visit your ophthalmologist at least once a year -- more often if you have signs of diabetic retinopathy

FOOT CARE

To prevent problems with your feet, you should:
• Check and care for your feet EVERY DAY, especially if you already have known nerve or blood vessel damage or current foot problems. Follow the instructions below.
• Get a foot exam by your health care provider at lesat twice a year and learn whether you have nerve damage
• Improve control of your blood sugar
• Make sure you are wearing the right kind of shoes
• Stop smoking if you smoke

MEDICATIONS TO PREVENT COMPLICATIONS

Since those with diabetes have a much higher chance of developing heart disease, kidney disease, and other medical problems, they may need to take certain medicines to treat or prevent these problems.

An ACE inhibitor (or ARB) is often recommeded:
• As the first choice medicine for treating high blood pressure
• For those who have signs of early kidney disesae (microalbuminuria)
• ACE inhibitors include captopril (Capoten), enalapril (Vasotec), quinapril (Accupril), benazaeprl (Lotensin), ramipril (Altace), perindopril (Aceon), and lisinopril (Prinivil, Zestril)

Statin drugs are usually the first choice to treat an abnormal cholesterol level. Aim for LDL cholesterol level less than 100 mg/dL.

Addressing diabetes is vital for strengthening tuberculosis control

Patients with type-2 diabetes may be at increased risk of contracting tuberculosis (TB) because they generally have a compromised immune system, which results in life-threatening lung infections that are more difficult to treat. Research shows that type 2 diabetes, especially when it involves chronic high blood sugar, is associated with altered immune response to TB. Patients with diabetes and TB take longer to respond to anti-TB treatment, and that patients with active tuberculosis and type-2 diabetes are more likely to have multi-drug resistant TB (MDR-TB). Almost six percent of people with diabetes had MDR-TB, reported this study. 30 per cent of those with MDR-TB also had type 2 diabetes.

According to World Diabetes Foundation (WDF), it was estimated that in 2007 there were 246 million people living with diabetes, 6 million new cases were diagnosed and 3.5 million people died due to diabetes.

According to the Global TB Control report, published by World Health Organization (WHO) for the same year, there were 14.4 million people living with TB, 9.2 million new cases and 1.7 million died due to this disease. While it is recognized that 95% per cent of TB patients live in developing world, it is not so well known that 70 per cent of people with diabetes also live in developing countries, especially in Southeast Asia and the pacific region.

India has a strong TB control programme in the world, referred to as the Revised National Tuberculosis Control Programme (RNTCP) or Directly Observed Treatment Shortcourse (DOTS). However, we need to focus more for its effective implementation. Public- private partnership can alleviate the problem of TB in people living with diabetes. “There are many risk factors for TB, which include HIV/AIDS, silicosis, malnutrition and smoking. While the link between TB and diabetes has been known since roman times, it is only recently that unequivocal evidence has been gathered to show a strong association between the two diseases. With an estimated 21 million adults with diabetes and 900000 incident pulmonary tuberculosis (PTB) cases in 2000, diabetes accounted for nearly 15% of pulmonary TB and 20% of smear- positive pulmonary TB. Diabetes therefore appears to increase the risk of active TB.”

Diabetes Diet - Frequently Asked Questions

Q: Can I Still Have Some Sugar in my Diet?

A: Yes. The diet for diabetes does not mean a ‘sugar free’ diet. Sugar can be eaten as part of a balanced, healthy diet without having a harmful effect on blood glucose control. However, you should still try to cut down on sugary foods and drinks since eating them has implications for tooth decay, weight control and the overall balance of your diet.

Blood glucose control depends on diabetes medication and lifestyle factors, such as how much activity you do as well as what you eat.

As we are all different in terms of our nutritional needs, the limits are different too. Lots of foods contain sugar – natural or added – and it is the overall food choices you make, rather than just one food, that will determine whether you are eating a healthy diet.

Q: When I was first diagnosed I was told I could only have two egg-sized potatoes at my main meal. Is this still true?

A: Starchy foods like potatoes, bread, cereals, rice and pasta should be the basis of all your meals. This is because these foods help you to keep your blood glucose levels steady. Try and choose wholemeal or wholewheat varieties where possible. Everyone with diabetes has individual dietary requirements, which is why it is important to get specific advice from a local dietitian. He or she will guide you on the amounts of different foods you should eat.

Q: Which fruits contain the most sugar?

A: People with diabetes can eat any kind of fruit, regardless of the sugar content. Everyone is encouraged to eat at least five portions of fruit and vegetables every day. Spreading the fruit you eat through the day will avoid a sudden rise in blood glucose levels. Although some fruits have a lower glycaemic index, which shows how foods affect blood glucose levels, the important thing is to increase the amount of fruit you eat, including a wide variety of different fruits.

Q: Is it true that I shouldn’t eat bananas or grapes?

A: No. All fruit and vegetables are extremely good for you. They are high in fibre, low in fat and packed with vitamins and minerals. Research has shown that eating more can reduce the risk of coronary heart disease, some cancers and some gut problems. You should aim to eat five portions of fruit and vegetables per day: for example, three portions of fruit and two portions of vegetables or vice versa. Eating more fruit and vegetables also helps to improve the overall balance of the diet. Fruit is the perfect snack.

One Portion of Fruit/Vegetables =
• one medium- sized fresh fruit (apple, pear, banana, etc)
• two small fruits (apricots, plums, kiwi fruit, etc)
• a cupful of berries or very small fruit (grapes, raspberries, etc)
• a bowlful of salad
• a large slice of a large fruit (melon, pineapple, etc)
• three serving spoons of tinned or stewed fruit
• half a serving spoon of dried fruit
• a small glass of unsweetened fruit juice
• three serving spoons of a small vegetable (sweetcorn, peas, etc)
• two serving spoons of green or root vegetables or pulses (beans, carrots, etc)

Natural Choices for Painful Neuropathy

Alternatives for this Painful Nerve Condition

Peripheral neuropathy may be one of the most common conditions you've never heard of -- and it is indeed common. Estimates are that it affects as many as two-thirds of people with diabetes, 10% to 20% of people with cancer and 8% of all people over age 55. One reason may be that neuropathy is not an isolated medical condition. Rather, it results from other medical problems including vitamin deficiencies, autoimmune disorders and heavy metal exposure, in addition to diabetes and cancer. Symptoms generally come on gradually over a period of weeks or even months, starting in the toes and sometimes the fingers. They include burning and tingling sensations, numbness, and occasional sharp, sudden pains similar to electrical shocks. Intensity of symptoms varies widely, from mild annoyance... to numbness severe enough to impair function... to debilitating pain.

MEDICAL TREATMENTS
Mainstream medical doctors often treat peripheral neuropathy with pharmaceutical drugs, but they all have serious side effects, including dizziness, sleepiness, dry mouth, blurred vision, weight gain, nausea, headache and in serious cases, allergic reaction and confusion, among others.

People with diabetes must control blood sugar levels to help slow further peripheral neuropathy development. People who suspect vitamin deficiencies should see a holistic physician for blood level tests and to help them establish a healthy diet and vitamin protocol. They must also avoid or greatly reduce alcohol consumption. Those having chemotherapy should alert the supervising doctor immediately if numbness or tingling starts in their feet or hands. The doctor may be able to alter the drugs somewhat to keep the neuropathy from escalating. However, when chemo-related peripheral neuropathy begins weeks or even months after completion of chemotherapy -- as is often the case -- the next step is to seek treatment to alleviate the discomfort and possibly help reduce or even heal it. This advice holds true for other causes of peripheral neuropathy as well, although you should check with your doctor to be sure it is appropriate for you.

NATURAL APPROACHES

The natural substance with the longest record for helping both diabetic peripheral neuropathy and chemotherapy-induced peripheral neuropathy is alpha lipoic acid, a powerful antioxidant that scavenges many harmful free radicals. (Note: Alpha lipoic acid can reduce blood sugar levels so your doctor should monitor your medication and blood sugar for the duration.) .The other natural substance is acetyl-L-carnitine, a regenerative effect on the nerves. Again, stay on acetyl-L-carnitine therapy for eight to 12 weeks to assess its efficacy. To further reduce nerve irritation a B vitamins including B-12 van be prescribed.

If You Have Diabetes, Your Risk for Glaucoma May Be Higher

In one of the American study they estimated 3 million Americans have glaucoma, which can stealthily cause vision loss even before people realize they have the disease. People with diabetes face special risks from glaucoma. This January during Glaucoma Awareness Month, through its EyeSmart (TM) campaign, the American Academy of Ophthalmology in partnership with the American Glaucoma Society and the Glaucoma Research Foundation, remind Americans that knowing your glaucoma risks can save your sight and that people with diabetes need to be extra-vigilant.

Both diabetes and glaucoma are leading causes of blindness. In their early stages these diseases often have few symptoms, so damage may occur before people know they need treatment. Several large studies suggest that people with diabetes are more likely to develop glaucoma, and other data shows that glaucoma patients who are diabetic are more likely to suffer vision damage. If caught early, diabetes and glaucoma can usually be managed and vision can be saved.

About Glaucoma: Glaucoma damages the optic nerve that transmits images from the eye to the brain. As glaucoma worsens, cells also die in the retina -- a special, light-sensitive area of the eye -- which further reduces the optic nerve's function. In the most common form of the disease, primary open-angle glaucoma, often a patient first notices that her peripheral vision is reduced, then that other areas of her visual field are blank. But in many people glaucoma-related vision changes are so gradual that they go unnoticed, which is why regular eye exams are so important. Symptoms of the less common but more immediately dangerous closed-angle glaucoma include blurred vision, severe eye pain and headache, rainbow-colored halos around lights, and nausea and vomiting. Anyone with these symptoms needs to be seen by an Eye M.D. right away.

The Reason why Diabetics Suffer Bluriness and Dizziness

When glucose levels are too high in the body, the result would be a chemical imbalance in the body. There would be deep emotional pain, depression or stress felt by the individual as the liver and pancreas lose control of the amount of glucose in the body. This can also result in dizziness and later on unconsciousness. When glucose levels are too low, because of an oversupply of insulin, the individual experiences fatigue, weakness, hunger, heavy perspiration and anger. Here dizziness also occurs, as the body is unable to provide the necessary energy for its normal processes. Diabetes also slowly causes degeneration of the eye function. This is called diabetic retinopathy. This is the result of the degeneration of the retinal nerves of the eyes. Also, the blood vessels towards the eyes burst because of the thickened character of the blood because of the oversupply of glucose. Diabetes affects the liver functions. With the oversupply of glucose in the bloodstream, the liver works double time to keep the balance. Thus a sudden increase or spike in the blood glucose levels affects the retina and this causes blurred vision. The repeated blurring of the vision is a portent of further damage to the eyes due to diabetes. Diabetes causes problems to the cardiovascular system. The veins towards the heart are clogged because of the thickened blood and the smaller veins because of the diabetes. This means the blood rich with oxygen cannot travel fast and properly throughout the body, leading to a form of dizziness for the individual.

Dizziness and Blurred Vision

Dizziness relates to the body’s equilibrium and this is highly dependent upon the body’s central nervous system. This together with the inner ears, eyes and sensory receptors in the skin, muscles and joints add up all the necessary information for the proper sense of balance of the body. Diabetes affects the nervous system of the body by cellular degeneration. The incomplete information makes the individual dizzy during bouts of high glucose levels. Blurred vision is one of the early symptoms of diabetic retinopathy. The retinal nerve of the eyes degenerate slowly because of the inadequate supply of nutrients to the eyes and the cellular decay caused by the cell’s inability to process glucose. Also, the blood vessels of the eyes also degenerate because of the thickening of the walls of the veins and the overall increase in viscosity of the blood. These are the effects of the body’s inability to produce insulin for the proper management of glucose in the body. Dizziness and blurred vision are symptoms of both short term and long term blood glucose problems leading to diabetes. These two symptoms are a result of hyperglycemia, which is one of the general consequences of diabetes. This is a result of having too little or inadequate insulin in the body. Another cause is despite the presence of insulin, the body is unable to metabolize the hormone. If you experience blurriness in vision at any given time especially after a meal, it would mean that there is too much glucose in the bloodstream. Conversely, there is too little insulin present to regulate this problem as the liver goes on overdrive to process the extra glucose. This can be easily remedied by taking insulin intravenously or antidiabetes medication. On the other hand, if you experience dizziness when you stand up, difficulty in breathing or even sudden unconsciousness, you have been carrying a very high glucose level for quite sometime. This is a very dangerous situation because the liver and pancreas has been unable to regulate the amount of glucose in the body and the major organs are already feeling the crush of diabetes.

Diabetes and Foot Problems

Introduction:
For people with diabetes, having too much glucose (sugar) in their blood for a long time can cause some serious complications, including foot problems.

How Can Diabetes Affect My Feet?
Diabetes can cause two problems that can affect your feet.

Diabetic neuropathy
Uncontrolled diabetes can damage your nerves. If you have damaged nerves in your legs and feet, you might not feel heat, cold, or pain. This lack of feeling is called "sensory diabetic neuropathy." If you do not feel a cut or sore on your foot because of neuropathy, the cut could get worse and become infected. The muscles of the foot may not function properly because the nerves that make the muscles work are damaged. This could cause the foot to not align properly and create too much pressure in one area of the foot. It is estimated that up to 10% of people will develop foot ulcers. Foot ulcers occur because of nerve damage and peripheral vascular disease.

Peripheral vascular disease
Diabetes also affects the flow of blood. Without good blood flow, it takes longer for a sore or cut to heal. Poor blood flow in the arms and legs is called "peripheral vascular disease." Peripheral vascular disease is a circulation disorder that affects blood vessels away from the heart. If you have an infection that will not heal because of poor blood flow, you are at risk for developing ulcers or gangrene (the death of tissue due to a lack of blood).

What Are Some Common Foot Problems of People With Diabetes?
Anyone can get the foot problems listed below. For people with diabetes, however, these common foot problems can possibly lead to infection and serious complications, such as amputation.
Athlete's foot, Fungal infection of nails, Calluses, Fungal infection of nails, Foot ulcers, Hammertoes, Ingrown toenails, Plantar warts.

Can These Foot Problems Be Prevented?
Proper foot care can help prevent these common foot problems and/or treat them before they cause serious complications. Here are some tips for good foot care:
1. Take care of yourself and your diabetes. Follow your health care provider's advice regarding nutrition, exercise, and medication. Keep your blood glucose level within the range recommended by your doctor.
2. Wash your feet in warm water every day, using a mild soap. Do not soak your feet. Dry your feet well, especially between the toes.
3. Check your feet every day for sores, blisters, redness, calluses, or any of the other problems listed above. If you have poor blood flow, it is especially important to do a daily foot check.
4. If the skin on your feet is dry, keep it moist by applying lotion after you wash and dry your feet. Do not put lotion between your toes. Your doctor can tell you which type of lotion is best to use.
5. Gently smooth corns and calluses with an emery board or pumice stone. Do this after your bath or shower, when your skin is soft. Move the emery board in only one direction.
6. Check your toenails once a week. Trim your toenails with a nail clipper straight across. Do not round off the corners of toenails or cut down on the sides of the nails. After clipping, smooth the toenails with an emery board.
7. Always wear closed-toed shoes or slippers. Do not wear sandals and do not walk barefoot, even around the house.
8. Always wear socks or stockings. Wear socks or stockings that fit your feet well and have soft elastic.
9. Wear shoes that fit well. Buy shoes made of canvas or leather and break them in slowly. Extra wide shoes are also available in specialty stores that will allow for more room for the foot for people with foot deformities.
10. Protect your feet from heat and cold. Wear shoes at the beach or on hot pavement. Wear socks at night if your feet get cold.
11. Keep the blood flowing to your feet. Put your feet up when sitting, wiggle your toes and move your ankles several times a day, and don't cross your legs for long periods of time.
12. If you smoke, stop. Smoking can make blood flow problems worse.
13. If you have a foot problem that gets worse or won't heal, contact your doctor for advice and treatment.
14. Make sure your diabetes doctor examines your feet during each check-up. An annual foot exam should be performed which should include an inspection of the skin -- he or she may check for redness or warm of the skin. The exam will also be to check for pulses and temperature of your feet and an assessment of sensation to the foot with something called a monofilament.
15. See your podiatrist (foot doctor) every two to three months for check-ups, even if you don't have any foot problems.

When Should I Contact My Doctor?
Contact your doctor if you experience any of the following problems:
Changes in skin color.
Changes in skin temperature.
Swelling in the foot or ankle.
Pain in the legs.
Open sores on the feet that are slow to heal or are draining.
Ingrown toenails or toenails infected with fungus.
Corns or calluses.
Dry cracks in the skin, especially around the heel.
Unusual and/or persistent foot odor

World Diabetes Day 2009

World Diabetes Day, on the 14th November every year, has grown from humble beginnings to become a globally-celebrated event to increase awareness about diabetes. Comprising hundreds of campaigns, activities, screenings, lecture, meetings and more, World Diabetes Day is proving internationally effective in spreading the message about diabetes.

Who introduced World Diabetes Day?
World Diabetes Day was jointly introduced by the World Health Organisation (WHO) and the International Diabetes Federation (IDF). The global diabetes awareness campaign was introduced amidst concern over an escalating diabetes epidemic.

Why is November 14th World Diabetes Day?
November 14 th is a significant date in the diabetes calendar because it marks the birthday of the man who co-discovered insulin, Frederick Banting. Banting discovered insulin in 1922, alongside Charles Best. Read more in the Diabetes.co.uk history of diabetes. World Diabetes Day is internationally recognised and is now an official United Nations Day.

Where is World Diabetes Day celebrated?
World Diabetes Day is celebrated throughout the world. A truly global event, World Diabetes Day occurs in over 200 diabetic member associations, in over 160 different countries. Further associations, medical professionals, and individuals all over the world join together to celebrate World Diabetes Day.

How do people celebrate World Diabetes Day?
World Diabetes Day is celebrated in a vast number of ways around the globe. These include a range of activities and events, including meetings and lectures to spread public information, sporting events for adults and children, television and radio programmes, leaflet and poster campaigning, exhibitions and conferences and much, much more.

Is World Diabetes Day the same every year?
World Diabetes Day is different every year, because each year a theme is decided upon to help those most in need. For instances, 2004 saw World Diabetes Day themed Diabetes and Obesity.

This year, World Diabetes Day is concerned with diabetes in children and adolescents.

The Natural Solution for Lowering Blood Sugar

Some of the most promising alternative therapies for high blood sugar come from nature's pharmacy, which isn't surprising. Plants and herbs have long been part of traditional response to diabetes, and they may be the closest thing to "real" medicine in the entire alternative arsenal. In fact, some countries, such as Germany, require doctors to study herbal medicine as part of their medical training.

GYMNEMA: THE SUGAR BLASTER
In India and Africa, where Gymnema sylvestre can be found creeping in tropical forests, the woody plant has been used for centuries as a remedy for diabetes. In fact, its name in Hindi is gurmar, which means "sugar destroyer". It got its reputation in part because chewing its leaves is said to make you insensible to the taste of sweetness, but there's probably more to it than that. Lab analyses have found that gymnema boosts the activity of enzymes that help cells take up glucose, so there's less of it floating in the blood. More than a decade ago, animal studies found that it brings down blood sugar - but not in animals that had had their pancreases removed. These revelations have led researchers to theorize that gymnema may battle high blood sugar by:
• Boosting the realese of insulin by making cells in the pancreas more permeable
• Stimulating insulin-making beta cells in the pancreas
• Increasing the number of beta cells.

FENUGREEK: A POTENT SPICE
In Mediterranean and near Eastern countries, fenugreek has a long history as a spice and flavor enhancer, but that's not all it's been used for over the centuries. Early Greek and Latin catalogs of medicines list it as a therapy for high blood sugar. Animal research and a handful of small human studies suggest that ancients were on to something. In one study, for example, 60 people with type 2 diabetes who took a total of 25 grams of fenugreek powder in two equal doses at lunch and dinner for six months dropped their fasting blood sugar from an average 151 to 112.

Fenugreek seems to make the stomach empty more slowly, hinder the absorption of carbohydrates, and put the brakes on the movement of glucose through the body - all of which may be due to the fact that fenugreek is extremely high in fiber.

BITTER MELON: A STRONG VEGETABLE
Although it's a staple of Chinese and Indian cuisine, bitter melon lives up to its name - or names: It's also known as bitter gourd, bitter apple, and bitter cucumber. Cultivated in tropical areas of Asia, Africa, and South America, it's been used as a contraceptive, a therapy for psoriasis, and a variety of other purposes. Mainly, though, it's been hailed for lowering blood sugar, and the fruit and seed are loaded with chemicals that appear to have an impact on glucose or insulin (one of the chemicals is similar to cow insulin).

Lab and animal studies suggest that bitter melon may work on several levels, such as boosting insulin secretion, improving the ability of cells to absorb glucose, and hindering the release of glucose from the liver. One of the largest studies of bitter melon in people with type 2 diabetes lasted only two days, but it caused significant drops in blood sugar.

15 Point Healthy Lifestyle Checklist

To make things easier for you, I’ve put together a checklist so you can make lifestyle changes, which will help control or prevent diabetes and heart problems.
Remember, don’t try to change everything at once. Instead, choose a few things you think you can manage right now, then come back to the list at a later date and make some additional changes:
**Check off each bullet point as you make each change successfully**

• I will eat at least 5 servings of fruits and vegetables each day.
• I will eat less fat, especially saturated fat, trans fat, hydrogenated oils, lard, and shortening.
• I will regularly choose lean meats and healthy meat substitutes, such as dried beans and peas (kidney beans, soy bean, chickpeas), lentils, and tofu.
• I will get healthy fats from olive or canola oil, nuts, avocados, and oily fish (1-2 times each week) for example fresh tuna, salmon, or mackerel.
• I will use baking, roasting, or grilling, rather than frying foods most of the time.
• I will focus on getting lots of fiber into my diet, from healthy foods such as oatmeal, oat bran, fruits, vegetables, dried beans and peas.
• I will make sure I am not eating too much salt—maximum of 6g per day.
• I will choose water and other low-calorie drinks, rather than sodas, juices, and other sugar-laden drinks. I will also try to control my alcohol consumption (no more than 1 to 2 drinks per day).
• I will watch my calorie and fat intake by cutting back on sugary, fatty junk food, such as potato chips, cookies, cakes, and full-fat ice cream.
• I will control my portion sizes—healthy plate proportions are ¼ meat or alternative, ¼ carbohydrate, ½ vegetables or salad.
• I will try to be more physically active—aiming for at least 30 minutes, 5 times each week.
• I will take my medications at directed by my doctor.
• I will quit smoking.
• I will try to maintain a healthy weight.
• I will continue to monitor my ABCs—A1C (try to maintain below 7), blood pressure (below 130/80 mmHg), and cholesterol (HDL men: above 40 mg/dl, HDL women: above 50 mg/dl; triglycerides: below 150 mg/dl; and LDL: below 100 mg/dl).