About Alcohol and Diabetes

Why people with diabetes should avoid alcohol.

• Maintaining ideal weight is a very important task for good control of diabetes for people with Type 2 diabetes. Therefore the less alcohol they consume, the better they can control their weight.

1. Alcohol increases the appetite so people with diabetes may tend to overeat and this affects their efforts to keep blood glucose under control. 
2. Alcohol can influence a person’s choice of food leading to consumption of the wrong kind of food.  

     3.  Alcohol has a high caloric content and not many other nutrients. This is not really a good thing for people counting calories. 

• Alcohol tends to lower blood glucose.  This is of  great importance to people with diabetes who are on insulin.

• Alcohol can interfere with or change the effects of medicines such as metformin and sulfonylureas which are used to treat diabetes. It can result in side effects from insulin use.
• Some of the signs of too much alcohol such as flushing, nausea, increased heart rate, slurred speech are also symptoms of hypoglycaemia. People with diabetes may not be able to recognize a hypo and take the required action in time. People around them may not recognise a hypo but instead think that a person having a hypo has had too much to drink!
• Heavy drinking can also cause a build-up of ketone bodies in people with diabetes, which can result in medical complications related to diabetes such as retinopathy and neuropathy says health psychologist Dr. Nicola Davies.
• Alcohol abuse can also cause changes in lipid metabolism, raised triglyceride levels, high blood pressure, cardiovascular disease, peripheral neuropathy, and impotence. 

The effect of alcohol on diabetes varies considerably depending on whether it is consumed by well-nourished individuals when blood glucose levels are high or in a ‘fasting’ state when blood glucose levels are low.

Alcohol affects diabetes by causing insulin resistance and also affects insulin secretion in the body. Consuming too much alcohol can result in ‘alcohol induced insulin resistance’ which may lead to hyper glycaemia in well- nourished people with diabetes.

Consuming excess alcohol and not eating can cause blood glucose levels to drop resulting in ‘alcohol induced hypoglycaemia’. This can result in permanent neurological changes or even death. 

But what if a person with diabetes is in a social situation such as a party, a wedding, a get- together or just enjoys an occasional drink?

Responsible drinking - What every person with diabetes should know:

Make sure your diabetes is well controlled, take the right precautions, know your boundaries, and most important of all … be aware of the effect of alcohol on diabetes.

• Understand the importance of moderation or self- control and know how much you are allowed to drink and do not cross that line.
• Eat before you have a drink to prevent a  ‘hypo’
• Have a non- alcoholic drink between drinks. Quench your thirst with water, not the alcohol. 
• Sip your drink. Don’t gulp it down.
• If diabetes is being treated with insulin or sulfonylureas, do not drink immediately before or after exercise or physical activity because blood glucose falls naturally during exercise and there is a risk of a ‘hypo’.
• People with Type 1 Diabetes mellitus need to calculate the carb content of both the drink and the food.
• Do not mix alcohol and fruit juice as the calorie level goes up very high. 
• Wear diabetes identification if drinking outside home.

Please consult our dietitian for further information  

(Reference : Diabetes Update Winter 2014)

Glucose intolerance recognized for the first time during pregnancy.

                                                                        Dr. Mitalee Barman

CAUSES:
Placental hormones, human placental lactogen and placental growth hormone, which are meant  to shunt nutrients to the fetus, cause worsening of insulin resistance during the late 2nd trimester

Mothers are unable to produce enough insulin to overcome the overwhelming resistance to maintain normal blood glucose levels.

DIAGNOSTIC CRITERIA

All pregnant women should undergo a 2 hour 75 gm- oral glucose tolerance test between the 24th and 28th week of pregnancy.

Fasting – 92 mg/dl 

1 hr       - 180 mg/dl

2 hr       - 153 mg/dl

Gestational diabetes mellitus is diagnosed if any 2 values are equal to, meet, or exceed the values given above.

FOLLOW UP: 

• Every 3 weeks till 28 weeks of pregnancy
• Every 2 weeks from 29 weeks to 34 weeks of pregnancy
• Every week from 35 wks to term
• Every 2 weeks from 29 weeks to term, if not on insulin. 

AFTER DELIVERY    

RISK FACTORS FOR TYPE 2 DIABETES MELLITUS FOLLOWING GESTATIONAL DIABETES MELLITUS

Unmodifiable risk factors                                                          Modifiable risk factors

Ethnicity                                                                                         Obesity

Age                                                                                                  Future weight gain 

Family history

Degree of hyperglycemia in pregnancy

SCREENING:

6-12 weeks after delivery, a follow up of 75 gm oral glucose tolerance test (GTT) should be performed to determine the women’s risk of developing diabetes and her status. If found normal , GTT should be repeated after 6 months and then after each year.

PREVENTION:

           Women who have had gestational diabetes mellitus are at a heightened risk for type 2 diabetes mellitus and so the best advice is:

• A LOW FAT DIET

• AVOIDANCE OF OBESITY   

• REGULAR EXERCISE.

A New Treatment for Diabetes?

Researchers at the Salk Institute for Biological Studies in California have shown that a single injection of a protein called Fibroblast Growth Factor (FGF1) is enough to restore blood sugar levels to a healthy range for more than two days in mice with diet -induced diabetes (the same as Type 2 Diabetes Mellitus in humans). The research is in its early stages so how this happens is still not known but scientists know that it works in a similar way to the existing diabetes drugs- glitazones by making cells more sensitive to insulin and thereby reducing blood glucose levels.

Glitazones can have side effects such as weight gain or heart problems in humans but this is not the case with FGF1. Researchers found that FGF1 did not set off these side effects or cause glucose levels to drop to very low levels, a risk factor associated with many glucose-lowering agents. Instead, the injections restored the body's own ability to naturally regulate insulin and blood sugar levels, keeping glucose amounts within a safe range.

Once perfected, it can become a very safe and effective alternative to controlling diabetes.

Diabetes Update - Autumn 2014

Hypoglycaemia Unawareness

(Not being able to recognize the symptoms of the onset of hypoglycaemia)

Hypoglycaemia is the most common side effect of insulin treatment and usually presents itself with symptoms such as sweating, palpitation and hunger. These symptoms alert the person with diabetes to the condition of their glucose level so that they can take the necessary action. Some people, however, lose the ability to recognize these symptoms. This condition is not just an issue for the person with Type 1 Diabetes Mellitus, it also affects the whole family…their peace of mind and the quality of their lives.

Hypoglycaemia Unawareness is often accompanied by confusion, changed emotions and anger.
The patient might stubbornly refuse to test blood when asked to do so, be aggressive, quarrelsome, or unreasonable when offered help. In extreme cases they can get verbally or physically abusive.

Caregivers become afraid of their relative /partner after violent reactions. They tend to stay awake at nights   or get disturbed sleep because of worries in case of coma. They tend to get up regularly to check if the patient is all right. They are unwilling to leave them alone because they are worried and concerned as well as because the patient is so reliant on them. Some even give up their hobbies or do not go out at all.

From a study that explored the impact of Hypoglycaemia Unawareness on the whole family it was found that …

A person with diabetes and Hypoglycaemia Unawareness:

• Relies on the family members to help detect and manage Hypoglycaemia Unawareness
• Does not like this reliance
• Does not respond positively to help
• Worries that they have become a burden to others
• Loses confidence and in some extreme cases has to cope with an unhappy marriage.

A relative or partner who has to care for a patient with Hypoglycaemia Unawareness:

• Is angry about how Hypoglycaemia Unawareness has affected his/her life
• Is sometimes frightened of the patient
• Feels tired, alone and unsupported

So people who have Hypoglycaemia Unawareness should be taught to recognize symptoms and appreciate that the condition can be serious.

Hyperglycaemia - A Short term Complication of Diabetes Mellitus

There are various reasons for this and knowing the cause and the treatment can help.

When does a person with diabetes get hyperglycaemia? – 
When blood glucose levels are > 130 mg/dl fasting OR >180mg//dl after meals.

Symptoms of hyperglycaemia:   

Increased thirst, the need to urinate more often, feeling tired, blurred vision, headaches, hunger and muscle cramps.

These are temporary symptoms that disappear when blood glucose level comes back to normal levels. 

There are many reasons why a person with diabetes can have hyperglycaemia.

It can happen accidentally because of

• Forgotten or miscalculated medication or insulin dose 
• An unusually high  amount of carbs in a meal, 
• Over treating a hypo, or 
• Getting less physical activity than normal.

It can last for longer periods of time because of

• Illness or infection 
• Hormonal changes 
• Stress 
• Weight gain or
• It may be time to make corrections to medication or insulin doses 

Hyperglycaemia can also be a side effect of non-diabetes medication.

Treatment for Hyperglycaemia…

Treatment depends on cause of the hyperglycaemia and the current diabetes treatment.

• If it is insulin related, the dose has to be corrected.
• If the hyperglycaemia does not come down by changing medication dosage or if there is no illness, then check urine and blood for ketones and be aware of diabetic ketoacidosis and hyper osmolar hyperglycaemic state that requires emergency treatment.
• If you are treating your diabetes by diet or by using non- insulin medications, drink plenty of liquids that do not contain sugar and if possible, do some light activity such as walking.
• Keeping blood glucose levels on target is a difficult task. If the episodes of hyperglycaemia are happening very often or if they are increasing in duration or happening at a particular time of the day, go to your doctor as you may have to change your medication or require other treatment.

Keeping HbA1C levels as close to target as possible is the best way to reduce risk of complications.

Here are some tips for remembering to take medications-

• Make it a habit …

It is easier to remember to take your medications if you always take it before or after a particular routine task.

• Sort it:

Put the day’s requirement into a pill box to keep track of whether you have taken it or the time you have to take a medication.

• Stick a note

A note about your medication will act as a reminder. Carry an extra dose, keep an up-to-date list of medications with the dosage and how and when to take it.

• Make a note in your diary so that you can restock you medication early enough.

• Keep an alarm or reminder on your phone or computer to help you remember to take your medications. 

It is very important to pick up any kidney problems at an early stage…

Look for these signs…

• Swelling in the feet, ankles or hands due to water retention 

As the stages of nephropathy develop, in addition to water retention, symptoms include…

• Weight loss and poor appetite
• Shortness of breath
• Passing more or less urine than normal
• Itchy skin
• Muscle cramps
• Erectile dysfunction in men

Many of the symptoms   mentioned above can be avoided if kidney disease is diagnosed and treated at the early stages. 

Diabetes balance Nov-Dec , 2014

Be GI Smart

If you have diabetes, choosing foods with low GI can help you to evenly balance blood glucose levels and reduce spikes after eating.

What is Glycaemic Index?

Glycaemic Index (GI) is a ranking of how quickly each carbohydrate containing food and drink makes blood glucose rise. 

The index was originally developed in 1981 in Toronto by researchers for people with diabetes so that they could manage their blood glucose levels better after mealtimes. Foods that are absorbed slowly have a low rating as compared to those that are absorbed quickly.

The GI index progresses from 0 – 100 and usually uses glucose or white bread as the basic reference point for comparing other foods.  Carbs that are absorbed in the body  slowly to moderately are rated as low to medium GI and include  foods such as wholegrain breads, lentils and many  fruits (papaya,  guava, apple, oranges, sweet lime, etc.) and non-starchy vegetables such as peas,  broccoli,  and cauliflower. 

Carbohydrates that are absorbed quickly have a high GI rating of 70 or more. These include foods such as white bread, rice cakes and cornflakes.

  

Generally speaking whole grain foods have lower GI and the more processed or cooked the higher is the GI. However, other factors also affect the GI of foods.

Cooking methods

Using cooking methods such as frying, boiling and baking can alter the GI level.

The longer pasta is cooked the higher the GI. So al dente (just cooked) is the best way to eat pasta.

Protein and fat content of foods 

Fat and protein slow down the absorption of carbohydrates so high- fat milk and dairy products have a low GI, however people with diabetes should be careful in the use of whole fat dairy products as the fat content may cause obesity and heart related problems.

Ripeness of fruit and vegetables

In general, the riper the fruit and some vegetables are, the higher the GI.

Fibre

Fibre in foods acts as a physical barrier that slows down the absorption of carbohydrates in the body. So, the higher the fibre content of the food, the slower it is absorbed.

MVH advises you to Go Low

• Instead of using white bread and bagels, include breads made of whole grain or sour dough.

• Add beans, lentils, and peas to your meals.  

• Include selected fruit and plenty of green vegetables 

 

• Choose whole wheat pasta or noodles or complex carbohydrates.

 

Get the most from a weight loss plan

The current trend of maintaining a healthy lifestyle has brought with it numerous irresistible programmes for losing weight.

However, a word of caution - weigh your options before you take the leap!

It is tempting to think that the ‘one size fits all’ approach will help you shed those extra kilos in a short time. BUT… The best weight loss plan is the one you enjoy and fits in with your everyday life.

You are more likely to succeed in your mission of shedding those extra kilos if the changes you make are small and realistic.

Here are some tips for choosing wisely.

Slow and steady wins the race. Look for a plan that aims for an initial weight loss of 10%. Research shows that this will improve your health – including blood pressure, cholesterol, and your risk for developing any long term health problems. It is also very important for controlling Type 2 diabetes mellitus.

Being more active and reducing the amount of calories is something that all weight loss programmes have in common.

  

However, good programmes recommend eating around 600 Kcal less each day resulting in a slow and steady weight loss of 0.5 kg – 1 kg per week which is the best way to lose weight.

Don’t believe in hype. Be cautious of plans that promise drastic results, offer quick fixes, eliminate entire food groups, or promise too much.

Less & more Eating less and doing more will bring your blood glucose levels down, so consult with your doctor in case you have to make adjustments to your medication.

…and finally

It is easy to give up so keep a diary of your progress so that you can track it.

Diabetes stigma – Another challenge for people with diabetes

In addition to the difficulties of managing blood glucose levels, many people with diabetes face an additional burden – that of diabetes stigma.

For people with Type 2 Diabetes (T2DM) the main form of stigma relates to how it began.  People sometimes associate it with a poor and indisciplined lifestyle - lack of physical activity, eating too much of the wrong food and obesity.

However, although this may be a reason for the onset of T2DM, one has to also take into account other important causes such as age, inherited genes, other reasons for gaining weight, demands of the job and so on.

People with Type 1 diabetes mellitus report stigma for other reasons such as eating the wrong food, not having good control, and being blamed as being irresponsible all the time.

In general, diabetes of any type can arouse feelings of over - protectiveness or pity towards the patient as many people think that having diabetes prevents a person from leading a normal life.

However, diabetes is not a death sentence if managed well and it definitely does not make people sickly, weak or limit their opportunities.

Sometimes managing diabetes also often leads to embarrassment. At times the act of injecting insulin can be mistaken for using recreational drugs and symptoms of severe hypo can be mistaken for rudeness, aggressiveness, or even drunken behaviour!

People around a person with diabetes should be sensitized to these aspects.

Diabetes and Dementia

People with Type 2 Diabetes mellitus may have a 1 ½ to 2 ½ times increased risk of developing dementia when compared to those without diabetes.

There are many different types of dementia. The most common is Alzheimer’s disease. Early symptoms include forgetfulness, repetition, short term memory loss, and impaired word finding ability. As it progresses it is marked by disorientation, impaired reasoning and decision- making, and loss of both daily living and social skills.

People with diabetes who have dementia have difficulty in managing diabetes. On the other hand, poorly controlled diabetes can also have an effect on the safety and well- being of people with dementia.

EXTRACTS…

Change your eating habits 

It’s not just what we eat… It’s also when we eat!

Are you a late night eater? Well, it’s time to change that habit as eating food late at night triggers obesity.  Researchers at Salk Institute in a study on mice have found that limiting eating hours to a 12- hour window, for example from 8 a.m to 8 p.m., and fasting for the rest of the time can make a huge difference on whether fat is stored or burned up by the body and could help fight high cholesterol, diabetes and obesity. They also caution against constant snacking and say that that restricting calories consumption to an 8 to 12 hour period can protect you from lifestyle diseases.

Source: The Hindu  4/12/14

A new system designed to change how people test their glucose levels is in clinical trials and is expected to be launched soon. It eliminates the need for routine finger pricks. Blood glucose readings are taken through a small sensor worn on the body that automatically measures, captures and stores glucose data for 8 hours. The system is designed to provide both patients and doctors of a visual snapshot of a typical day. It also allows doctors to make better decisions in patient care. At the moment intermittent testing does not give a full picture of the daily pattern due to the pain and hassle of testing.

Source: Diabetes Update Summer 2014

Neuropathy in the brain

Are there any changes in the brain due to peripheral neuropathy?  Earlier considered a peripheral nervous system disease, in a first such study on T1DM subjects researchers have found that grey matter volume in regions associated with sensory perception was significantly lower in people with diabetic neuropathy. 

New findings could lead to better assessment, monitoring and improved treatments for the condition.

Source: Diabetes Update Summer 2014

Researchers at the University of Sheffield have found that periods of overnight hypo often go undetected and can cause unexpectedly long periods of very slow heart rate in older patients who have Type 2 DM as well as associated heart problems. It could also explain the ‘dead in bed’ syndrome – a rare condition in Type 1 DM patients who experience high rates of overnight hypos. 

The findings suggest that all people with diabetes should be aware of the risk of running low sugars overnight.

Source: Diabetes Update Summer 2014

Power Salads for a Healthy Diet

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

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

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









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









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

ARUGULA (Tara Mira)

CABBAGE                                        SPINACH

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

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