Center Of Obesity Diabetes & Endocrinology (CODE)
DIABETES:
Diabetes is a chronic progressive disorder that affects millions of Indians. What is worrying is that most statistics project that this “millions” are likely to grow into several hundreds of millions if the onslaught of the disease is not checked and soon. This in turn may lead to severe consequences as the complications of diabetes are both life-threatening and extremely morbid. Therefore the need to the device and discuss ways to prevent diabetes.
The two main types of diabetes are type 1 and type 2 – in the Indian context, the type 2 variety is of paramount importance as this is by far the commoner variety. We shall therefore focus on this disease in the present article.
The main risk factor for type 2 diabetes is CENTRAL OBESITY. Deposition and collection of fat around the abdomen and this fat forming a coating of sorts around the main abdominal organs like the liver and pancreas is called central obesity and this causes diabetes. The mainstay of prevention of type 2 diabetes is the prevention of central obesity or the prevention of fat gathering around the tummy region. This translates into maintaining a healthy weight. The main way to keep one’s weight and/or central obesity at bay is to stick to a healthy lifestyle. A healthy lifestyle entails a few things:
- Healthy diet: A healthy diet contains fruits, vegetables, particularly green leafy vegetables and legumes such as dal in good and filling quantities. Complex carbohydrates like rice, chapatti and pasta should be taken in modest quantities. However, fried and fatty food, sweets and simple unrefined sugar, ghee and butter must be avoided. Sweeteners are safe.
- Regular exercise: Brisk walking, jogging, swimming, cycling etc, ie, exercises that increase one’s heart rate without causing excessive muscle strain are excellent modalities to keep one’s weight under check. This in combination with dietary restrictions keeps one’s weight under check. The current guideline states that one should take this form of exercise 30-45 minutes per day for at least 5 days of the week.
In a study conducted in the USA, named the Diabetes Prevention Program, it was found that people sticking to a healthy lifestyle, as mentioned above, reduce their risk of developing diabetes by 58%. Indeed in people aged over 70 years, this risk reduction may be as high as 71%. Even drugs used to reduce the risk of diabetes do not confer as much protection as lifestyle changes, this study also revealed.
Therefore, the cornerstone of diabetes prevention is healthy eating coupled with regular exercise.
The main other risk factors for diabetes are non-modifiable. Indians particularly those over 40 years of age have a high risk of developing diabetes. This risk is compounded by 40% if either parent have diabetes.
In these people it is advisable to have regular screening for diabetes with blood sugars checked every 6 months – both fasting (after 12 hours fasting) and 2 hours after a drink of 75 grams of glucose in water. Early diagnosis goes a long way to prevent mortality and morbidity in this group of people.
So, what does the future hold for diabetes prevention? Certain medicines are still under research but results with some drugs like Acarbose, Metformin and Rosiglitazone seem to be yielding positive results. Also of interest is the isolation of susceptibility genes like PPAR γ and ABCC8, which seem to predispose to type 2 diabetes. However, these are early days for such research to be translated into meaningful application in the day-to-day prevention of diabetes. Therefore, lifestyle changes and screening remain the best modalities for Type 2 Diabetes prevention as of today.
SOME GENERAL TIPS FOR DIABETICS:
- Stick to a healthy diet as prescribed
- Take REGULAR EXERCISE
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- Brisk walking is an ideal exercise for diabetics – make sure when you are walking your speed should be such that you feel slightly breathless but not very breathless.
- Start slow and then work up speed
- From 5-10 minutes work up to 30-45 minutes at least 5 days of the week
- Wear comfortable shoes for walking.
- Drink plenty of fluids during/after exercise
- Carry some sugar/glucose/sweets with you when you are exercising in case you become hypoglycaemic. It is best to have a piece of fruit 15 minutes prior to starting exercise.
Other suitable exercises for diabetes include jogging, cycling etc.
- Regularly MONITOR your blood glucose levels
- One should monitor one’s own blood glucose regularly.
- If one has access to a glucometer one should check one’s blood sugars – fasting, after lunch and pre-dinner or if one feels unwell in any way and as prescribed by the physician. Once a week is a minimum that one should try to measure blood glucose levels at home. Glucometer readings are quite accurate.
- Otherwise, have laboratory measurements of blood glucose (on medicines) once every fortnight.
FOOT CARE IN DIABETICS:
Patients with diabetes should take good care of their feet, as diabetics are prone to developing nasty foot ulcers, which might need an amputation. This is because of three reasons:
- Neuropathy: Loss of sensation, therefore unable to realize and protect oneself from injury to the foot.
- Peripheral vascular disease: Poor blood flow impairing healing, leading to gangrene.
- Infections: diabetics are prone to infections and small cuts and scratches on the foot may develop into life/limb-threatening ulcers easily.
Additionally, diabetics tend to have dry feet and have a tendency to form corns, hard skin and foot deformities, which worsen the risk for major foot disease.
Once ulcers or gangrene have set in treatment becomes difficult, lengthy, costly and only partially successful. So the best option is to PREVENT foot problems in diabetes by following the advised DOs and DON’Ts!!!!
DOs:
- Keep blood sugar under strict control
- Keep feet clean by washing daily in soap and water and then drying carefully with a dry towel particularly between the toes
- After washing and drying feet, apply a moisturizer like Liquid petroleum jelly, all over the feet except between the toes
- LOOK at your feet every day, if necessary use a mirror. Ensure there are no cuts scratches or blisters – if there are any signs of injury consult your doctor immediately.
- Wear comfortable shoes with cotton seamless socks while out and slippers all the time at home. Make sure your shoes don’t give you blisters and always check the insides of your shoes for nails/pebbles before wearing them every day.
- Trim your nails straight across and file with a nail file.
DON’Ts:
- Do not smoke
- No home surgery – Do not cut dry or hard skin or corns with blades etc
- Do not use chemicals, corn caps or strong antiseptics on your feet
- Do not use adhesive tape on your feet
- Do not soak your feet in hot water or keep your feet near hot objects/appliances.
HYPOGLYCAEMIA:
Hypoglycemia or low blood sugar is the commonest side effect of treatment for Diabetes. It is seen only in people on Insulin or Sulphonylureas (Glimepiride, Gliclazide, Glibenclamide, Glipizide). This does not occur in diabetics who are not taking these medicines or are only on diet treatment.
The common reasons for hypoglycemia are:
- Inadequate food intake
- Delayed meals
- Unaccustomed exercise
- Improper dose adjustment of medications and/or Insulin
- Intercurrent illness, for e.g., fever, diarrhea and vomiting etc.
The common symptoms of hypoglycemia are:
- Profuse cold sweating
- Palpitations and trembling
- Dizziness, fainting
- Blurred vision
- Profound hunger
- Confusion, aggression
- Left untreated this may cause coma, convulsions and even death
Treatment of Hypoglycaemia:
All Diabetics on Insulin/Sulphonylureas are advised to carry on their person some glucose, sugar, sweets (candy). At the slightest symptom, if possible they should check their blood glucose on the glucometer and if the reading is below 70mg/dl take 2 – 3 spoons of glucose or 2-3 candies or if possible a glass of orange juice or sweetened milk. If a glucometer is not handy they should take the glucose/Candies/Juice etc in any case at the slightest onset of symptoms. They should then have something to eat like – bread, bananas, chapattis etc. If this happens more than once they should contact the hospital/their doctor immediately and seek an urgent consultation. People who get hypoglycaemic due to tablets may need hospitalization. The patients’ carer and family need to be aware of this as much as the patient him/herself.
Insulin Injections and Glucometry:
Does Insulin therapy mean the ‘last stage’ of Diabetes?
This is a question asked by many people. NO – NOT AT ALL!! Insulin is a modality of the treatment of diabetes. Diabetes is a progressive disease characterized by dwindling levels of Insulin. There comes a stage in type 2 diabetes usually after 7-10 years when one needs to be supplemented Insulin in the form of injections. Though it is injectable, it is a wonderful medicine, with minimal side effects and it is proven to ensure a long and healthy life. So far from being the ‘last stage’it is actually a new beginning.
But are the Insulin injections very tedious and painful?
No they are not – these days there are wonderful delivery devices called ‘Pens’ available with ultra fine needles which make injections not painful at all. In fact newer insulins take away the tedium of dictated lifestyle by being extremely flexible in the way that they can be used. It is also of note that though expensive, Insulin pumps are also widely available and can reduce the need for needle pricks to a bare minimum. Research on Insulin as tablets, sprays and gels are currently in progress and should be available for commercial use in the not too distant future.
How useful is measuring blood glucose at home on a glucometer? Are they accurate?
Indeed the ones manufactured by leading companies are highly accurate. There is even research to suggest that those patients who regularly monitor their blood glucose levels at home tend to live healthier and longer. It not only helps the doctor adjust the treatment properly it also empowers the patient to be aware of his/her own situation and able to take corrective action accordingly.
IF IN DOUBT CONSULT YOUR DOCTOR!!!!
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