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November 11, 2021 By Jigna Sheth 12 Comments

Manage Diabetes With These Lifestyle and Nutritional Tips

By this point, we are all well aware of the silent killer known as Diabetes. It is the leading cause of blindness, kidney failure, neurological and cardiovascular disorders. Diabetes Mellitus is a condition in which our body’s ability to utilize glucose from the blood lowers down. It is a disorder of carbohydrate metabolism characterized by impaired ability of the body to produce or respond to insulin. Glucose is the main source of energy to the body’s cells and insulin is a hormone (which is produced by pancreas) that controls the level of glucose in the blood.

Types of Diabetes

Type 1 Diabetes referred to as Insulin Dependent Diabetes Mellitus, is a condition in which the pancreas produce little or no insulin. Such individuals require daily insulin injections. This type of diabetes generally affects children or adolescents.
Type 2 Diabetes referred to as Non-Insulin Dependent Diabetes Mellitus, is a condition in which the insulin production may be normal or even high but the insulin produced is not as effective as normal insulin. This type of diabetes generally affects overweight or obese adults.
Gestational Diabetes develops during pregnancy and usually disappears after giving birth. Women with Gestational Diabetes are at a higher risk of developing Type 2 Diabetes later in life.

Factors Which Cause Diabetes

In order to manage Diabetes or eliminate it from our lives, we must understand the factors that cause it.

Obesity: Being overweight or obese has been identified as the number one risk factor for Diabetes. In fact, 80% of people diagnosed with Type 2 Diabetes are overweight.
Cigarette Smoking: Cigarette smoke elevates the level of inflammation in your body. This increases the risk of diabetes in smokers as opposed to non-smokers. Smoking can also elevate the level of blood glucose in your body and hence, worsen your insulin resistance.
Physical Inactivity: can increase your risk of diabetes, even if you are not overweight or obese. On the other hand, in case you are overweight or obese – physical activity can help you reduce your risk of diabetes.

Tips to Manage Diabetes

Medication: The first line of action to treat type 2 diabetes is anti-diabetic medications, and/or oral or IV insulin administration. Generally, insulin therapy is prescribed for type 1 diabetes. However, only medicines will not be able to control your diabetes. There are several other attached conditions, which we will discuss further.
Quality Sleep: is extremely important to effectively manage diabetes. Reduced sleep or insomnia can result in hormone fluctuations which in turn leads to a spike in the blood glucose levels, leading to weight gain.
Regular Examination: If possible, monitor blood glucose levels regularly in order to ensure that everything is under control. Medication, stress, physical activity, other illnesses and the foods we eat can all impact our blood glucose levels.
Stress Management: Physical or mental stress can aggravate diabetes. The degree at which stress impacts our blood glucose levels varies from one person to another. Studies show that almost all kinds of stress leads to a blood sugar spike.
Regular Exercise: not only has a multifold impact on controlling and even reversing diabetes, but also helps in burning fat and maintaining an optimum weight. Practicing any kind of exercise for at least thirty minutes a day can improve insulin sensitivity, help in maintaining blood glucose levels and even diminish the risk of developing heart diseases. Brisk walking, running, cycling, dancing, swimming and biking are some of the recommended exercises that can elevate heart rate and control diabetes.
Quit Smoking: Smoking increases the risk of diabetes as it narrows blood vessels, raises blood glucose levels and leads to inflammations.

Nutritional Strategy to Manage Diabetes

Try these nutritional tips and strategies to manage Diabetes effectively

The distribution of carbohydrates, fats and protein in the diet should be such that it maintains blood glucose and reduces the risk of cardiovascular diseases
Replacing saturated fat with healthy fats such as avocados, nuts and olive oil can reduce insulin resistance and consume lean proteins.
Take small frequent meals at regular intervals. Avoid large jumbo-sized meals.
Keep a watch on portion size as having too much food can also lead to weight gain and related problems.
1 tsp of overnight soaked Methi seeds or Methi powder should be consumed every day in the morning or can be added with food.
Consume more complex carbohydrates than simple sugars as they breakdown and release glucose slowly in the bloodstream.
Fiber rich food like whole fruits, whole cereals, whole pulses, salads, sprouts, and green leafy vegetables to be added to the daily diet. Be sure to pick whole fruits over juices.
Avoid prepackaged, processed and sugar sweetened beverages completely.
Recent study shows consumption of Moringa Leaves, fruits, seeds or powder lowers Blood Sugar levels which in turn helps in reducing Cardiovascular Diseases. Roots of Moringa are to be avoided because of the toxic content.
Glycemic Index (GI) of foods is important in deciding whether to include them in the diet or not. Low GI foods are to be consumed to maintain blood glucose levels.

Food Selection As Per Glycemic Index

Food Groups	Foods With Low GI (Permitted in prescribed amount)	Foods With High GI (To be restricted)
Cereals	Whole wheat flour, wheat bran, bajra, jowar, oats, ragi, dalia, brown rice, barley, whole wheat pasta, multigrain & whole wheat bread.	Polished rice, white bread, Sago, maida, noodles, pasta, corn flakes, puffed rice.
Pulses	All pulses can be consumed moderately.	–
Vegetables	Green leafy vegetables, tomatoes, cucumber, radish, cauliflower, broccoli, cabbage, mushroom, onion, green beans, carrot, green peas, capsicum, gourds, parwal etc.	Potato, Beet root, sweet potato, yam, pumpkin, colocasia (arbi).
Fruits	Apple, guava, orange, sweet lime, peach, papaya, pineapple, pomegranate, muskmelon etc.	Dates, watermelon, plum, grapes, banana, chickoo, mango, custard apple, canned fruits.
Nuts & oilseeds	All nuts & oilseeds can be consumed but in moderate proportion.	–
Milk & milk products	Skim milk, cow’s milk, curd, buttermilk.	Buffalo milk, full fat milk, cheese, cream.
Fats & oils	MUFA-PUFA-SFA in the ratio 1:1:1 to be consumed but not more than 4 tsp/day. MUFA- groundnut, mustard, linseed, olive, rice bran oil PUFA- sunflower, safflower, soyabean, corn oil SFA- ghee, butter, coconut oil	Vanaspati, Margarine, Mayonnaise.
Sugars	–	Sugar, honey, jaggery, sugarcane.
Snacks & desserts	Roasted chana, makhana, popcorn (low fat), American corn, air fry snacks, steamed snacks.	Ice cream, cold drink, pastries, patties, waffles, doughnuts, potato wafers, muffins, all fried and baked items

Diabetes is a disease which can be controlled if we are fully aware of its complications and by following strict dietary and lifestyle protocol. Our priority should be to monitor blood glucose, blood pressure and cholesterol levels and ensure they are in control on a periodic basis to avoid complications in the future.

We hope this article helps you make a shift to a healthier lifestyle and manage diabetes effectively! Leave your thoughts in the comments below! For more on Diabetes, check out Healthy Reads. To manage Diabetes, get the best advice from certified experts by subscribing for GOQii’s personalized coaching here: https://goqiiapp.page.link/bsr

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November 20, 2019 By Parveen Nake 3 Comments

What Gestational Diabetes Can Do To You & Your Unborn Child

We all know about Diabetes Mellitus to some extent as Diabetes Mellitus is a chronic metabolic disorder that prevents the body from utilising glucose completely or partially. It is characterised by raised glucose concentration in the blood and alterations in carbohydrate, protein and fat metabolism. But have you ever heard of Gestational Diabetes or Pregnancy Diabetes?

Gestational Diabetes is a high blood sugar (glucose) condition that develops during pregnancy and usually disappears after giving birth. It can happen at any stage of pregnancy, but is more common in the second or third trimester. Insulin requirements goes up one to three times in pregnancy. During normal pregnancy the level of plasma insulin is raised by the action of placental hormones thus placing a burden on the insulin secreting cells of the pancreatic islets. The pancreas may be unable to meet these demands in women genetically predisposed to develop both types of diabetes. Long term studies show that some 80% of women with gestational diabetes ultimately develop permanent clinical diabetes requiring treatment.

What Causes Gestational Diabetes?

The causes of Gestational Diabetes is not known clearly yet. Some, but not all women with gestational diabetes are found to be overweight before getting pregnant or have a family history of diabetes. It is more common in Native American, Alaskan Native, Asian and Black women, but white women may develop it due to poor lifestyle.

Are There Tests to Determine it?

Oral glucose tolerance test (OGTT) is a confirmatory test. The OGTT measures blood glucose after you fast for at least 8hours. Firstly, the blood sample is drawn in fasting state. Then, 75g of glucose dissolved in 250-300 ml of water is given, Lemon juice may be added for flavour and to prevent nausea. Then the blood specimens are collected every 30mins for 2-3 hours after the administration of glucose.

High blood glucose levels at any two or more blood test times – Fasting, 1 hour, 2 hours or 3 hours – mean you have Gestational diabetes.

Complications During Pregnancy

If blood sugar is not controlled, it can lead to problems for both maternal and foetal health. Uncontrolled diabetes during the first trimester of pregnancy increases the risk of abortions and congenital malfunctions in the foetus. Some of the major consequences are:

High Blood Pressure (Preeclampsia): Preeclampsia is a potentially dangerous pregnancy complication characterised by high blood pressure. Due to the high blood pressure levels of the mother, the protein in urine spikes up and swelling in fingers and toes and lower body persists. High blood pressure can be harmful to both – the mother and the unborn baby. It might lead to the baby being born early and also could cause seizures or a stroke (a blood clot or a bleed in the brain that can lead to brain damage) in the woman during labour or delivery.
An Extra Large Baby: Uncontrolled Diabetes in the mother causes the baby’s blood sugar to be high. The baby tends to “overfeed” and grows extra-large. Besides, causing discomfort to the mother, it can lead to problems during delivery causing prolonged labour pain which might need a C-section to deliver the baby. The baby can be born with nerve damage due to pressure on the shoulder during delivery.
Low Blood Sugar (Hypoglycaemia): People with diabetes who take insulin or other medications can develop blood sugar that is too low or hypoglycaemia. Low blood sugar can be very serious and even fatal if not treated quickly.

How to Manage Gestational Diabetes

The main modes of treatment of Gestational Diabetes include:

1. Eating a Healthy Diet: Dietary measures are an essential part of the treatment of diabetic patients whether they are on diet alone or on metformin drug or insulin. Carbohydrate restriction impairs insulin sensitivity and reversed by high carbohydrate diet but it needs to be maintained between 60-65% of total calories. So include more complex carbohydrates or polysaccharides like Multi-grain flour, Oats, Muesli, Granola, Amaranth, Bajra, Ragi, Quinoa, etc. Studies have shown that raising carbohydrates does not adversely affect the fasting blood glucose levels, glucose tolerance or insulin requirements provided that total calories are not increased.

Along with carbs, include more protein-rich foods like pulses and lentils, Rajma, Soya Bean, peas, beans, peanuts, milk and dairy products like yogurt, buttermilk, paneer, eggs, chicken, etc. to ensure weight gain and prevent osteomalacia during pregnancy. Inclusion of fibre like fruits and green leafy vegetables are must as it improves glucose metabolism without increasing insulin secretion. It increases the intestinal transit-time, delay gastric emptying slow glucose absorption.

2. Drugs or Insulin Treatment: Metformin or Insulin therapy is the accepted medical management of gestational diabetes. Insulin is the first drug of choice and metformin can be considered after 20 weeks of gestation. Insulin must be taken without delay if it is suggested by the doctor.

3. Exercise: Stay Active to help keep your blood sugar under control. Exercise regularly – before, during and after pregnancy. Moderate exercise such as brisk walking for 30mins a day for 5 times a week is a good goal to set.

4. Monitoring Blood Sugar Often: Be aware that your blood sugar can change very quickly, becoming too high or too low depending on what you eat and how much you exercise and your growing baby’s blood sugar also varies several times during the day. Check your blood sugar level as often as directed by the doctor and any time you have symptoms.

By adopting these measures one can enjoy a healthy Antenatal period.

#BeTheForce

November 13, 2017 By Dr Akshat Chadha Leave a Comment

Diabetes – (Die-in-bits OR NOT)

So I started writing this blog almost a year back and could not complete it in this one year because I felt everybody knows everything about diabetes and what was the point of repeating the same things over and over again. Then, I realized, that this World Diabetes Day instead of the same diabetes facts, what we really need is a real patient case and scenarios to make everybody understand how intense and life-threatening, diabetes as a disease can be.

I remember long back we had a worried parent of a 6year old come into our clinic saying that his son’s urine had ants in it. After taking a proper history we realized that it was not ants in his urine but sugar in the kid’s urine left on the commode which was attracting the ants. Few blood tests later the child was diagnosed with Juvenile Diabetes. That’s Type 1 diabetes, the type which is most commonly seen in the younger kids. Basically, the pancreas barely produces any insulin in these kids which leads to sugar flowing through the blood and causing diabetes.

Diabetes is a group of metabolic disorders in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body’s cells do not respond properly to insulin or both.

Causes can range from autoimmune destruction, heredity or positive family history, insulin resistance to various infections like pancreatitis. But, the main cause or the root cause of Diabetes especially type 2 which affects mostly the adult population has to be a poor lifestyle.

Diabetes-like we all know can easily go unnoticed, even when a patient has already been diagnosed. Because of this, unfortunately, many don’t pay attention to the possible terrible problems that can happen if your diabetes is not under control.

I remember a case at the beginning of my career, a 40year old man having diabetes for more than 10 years came to our clinic with a complain that he had wound on his foot which was not healing. He knew his sugars were high but still wasn’t taking care. We started him off on the required medicines and within 10 days of better sugars, the wound had healed. He had no memory of how he had hurt himself. After 4months the same patient came back with an even bigger wound but unfortunately this time it had spread so much that his foot could not be saved and had to be amputated.

Does it make sense being so careless with your health and losing your foot just because your sugars are not controlled?

diabetes 1

Let’s discuss the complications of uncontrolled diabetes which can affect almost every organ of your body. Most commonly Diabetes affects your heart, kidneys, eyes, feet and your nerves (neuropathy) at varying degrees. Apart from these, diabetics have a higher risk of infections and dental problems. It is difficult to say what gets affected first but easier to remember that if your blood sugars are not under control, you have set yourself on the path to trouble.

diabetes image 3

During my internship, I got a call from a friend that his dad had a heart attack and they were shifting him to the same hospital where I was working. Fortunately, that month I was posted in the ICU itself so I was happy that I was going to be able to monitor his dad. Just on the opposite bed, there was another man of the same age who had suffered a heart attack the morning before. Almost two weeks later, my friend’s dad was still in the ICU whereas the other man was on his way to get discharged. Another 2 weeks went by but unfortunately, we didn’t see much signs of improvement and eventually we lost him in the next few days. The only big difference between the two patients was that my friend’s dad had uncontrolled diabetes!!

Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you have diabetes, you are more likely to have heart disease or stroke.

Your body and your health need a lot of care, attention and need to be your first priority not only at the time when you are sick but more when you are well. The point of this blog is not to scare you but to make you aware, and part of that awareness is knowing how to be able to help yourself. Follow the below tips and start your healthy journey today!

diabetes image 4

Tips to prevent or live well with diabetes

Maintain a healthy weight and look out for belly fat
Make healthy food choices
Be physically active (gradually increase everyday steps and try and reach the 10,000 target)
Monitor your sugar levels regularly and keep a check on your blood pressure
Get your full body tests done once a year
Sleep well and work to manage daily stress
Quit smoking
If on medications, make sure you take them regularly

November 14, 2016 By Dr Ashwin Nanda 2 Comments

DECODING DIABETES

Last month, I had 2 patients on the same day diagnosed with Diabetes- one an overweight 34 year old IT professional and the other a 6-year-old girl. The reason, why this incident comes to my mind today is because they were both diabetics but, had different diabetes and even their course of treatments was different.

But, the first question I was asked in both the cases was whether they will need to be put on insulin injections immediately. Well, this is a common question asked by patients. To understand this condition better, let me try and explain a bit about the different types of diabetes on the basis of which the required treatment is normally recommended.

Diabetes is a group of metabolic disorders in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body’s cells do not respond properly to insulin or both. Common symptoms of either diabetes are unexplained weight loss, excess hunger, and excess thirst and delayed wound healing.

Today, I would like to take you through specifically 3 major types of diabetes namely, Type 1, Type 2 and gestational Diabetes.

Let’s talk about

Type 1 Diabetes: is caused by a loss or malfunction of the insulin-producing cells in the pancreas, called beta cells. Damage to beta cells results in absence or insufficient production of insulin. Most cases of Type 1 Diabetes have an autoimmune basis in which immune system mistakenly attacks and destroys its own beta cells. These cases are detected either in childhood or teenage years. There are many theories about what causes type 1 diabetes like autoimmune disease, viral infection, genetic predisposition and environmental factors may also play a role.

Whatever be the cause, this missing insulin has to be replaced as insulin is necessary to sustain life. It is responsible for entry of glucose into the body cells from where the glucose is further utilized for energy and other activities. This glucose which is not entering the cells is circulating in the blood which gets detected as high blood sugar. The replacement insulin is administered by injection using a syringe or an insulin pump. Thanks to the invention of Insulin clubbed with a healthy lifestyle, a Type 1 diabetic is able to lead a happy good quality life.

Coming to Type 2 diabetes most often than not your tissues will be resistant to insulin, so the insulin is being produced but unfortunately not being utilized properly. It is the most common form of diabetes worldwide and accounts for 90-95% of the cases.

Insulin resistance in type 2 diabetes means the signal insulin gives to a cell is weakened. This results in less glucose uptake by muscle and fat cells and a reduction in insulin mediated activities inside cells.

Risk factors for Type 2 Diabetes include an Unhealthy Lifestyle (being physically inactive or less active, erratic food and sleep habits, stress), being overweight or obese and importantly family history of diabetes in close relatives.

We have ample medicine combinations for type 2 diabetes like tablets which keep the blood sugar under control. But if sufficient sugar control is not achieved in spite of oral medications and a healthy lifestyle, then insulin might be required for further management.

Another type of Diabetes I would like to talk about is Gestational diabetes which basically refers to diabetes diagnosed during pregnancy.

Pregnancy hormones can interfere with the way insulin works in the mother’s body which can lead to elevated blood glucose levels during pregnancy. Women are typically screened for gestational diabetes at 24-28 weeks of pregnancy, however, women who have risk factors may be screened earlier.

Risk factors for developing gestational diabetes include having a family history of diabetes, being overweight, or over 28 years old. Blood glucose control during pregnancy is critical as elevated maternal glucose levels can lead to pregnancy complications and pose risks to the health of the baby. Gestational diabetes is likely to recur during subsequent pregnancies.

Gestational diabetes requires specialized treatment for the rest of the pregnancy. After the pregnancy is over, most women will have normal blood sugars again; however, up to 20-50 % can develop type 2 diabetes within 10 years. Regular screening is recommended.

A study conducted on people at risk of type 2 diabetes, it was seen that those who lost just 7% of their weight and exercised about 30 minutes a day cut their risk of diabetes by nearly 60%. In a nutshell, irrespective of the type of diabetes the best prevention or diabetes management strategy is to eat healthy, stay active and keep a check on your weight.

Reference: University of California, San Francisco – Diabetes online Education website.