Enjoy life and Festivities -Happy Diwali

Diwali symbolizes everything good that is their in life that we may cherish.Victory of Good over evil, Enlightening of Darkness within and obviously all that is associated with such a festival is happiness , meeting friends and relatives, Gifts, Sweets and Good food.

Even if you have Diabetes you can still enjoy these festivities and even have a small bite of everything you love..try not to overdo have a little bit of all that is there to be had on such occasions.

The important thing is to enjoy and feel the festivities.

Happy Diwali & Festivities to all our readers from Diabetologist Dr Rajesh Kesari and team members of Total Care Control - Diabetes Care Centre 

Navratri and Diabetes

Navratri and diabetes

The celebrations in Navratri draws the excitement among people and among the devotees it’s the time for nine days fasting. Fasting will help in cleansing and detoxifying your body and mind.

  

Being a diabetic, you should avoid excess of festive food as well as fasting. Diabetics are more prone to health risk. As it is the personal choice it is not desirable not to eat for a long time in fact small frequent meals are advisable to maintain the blood glucose level. Include more of fruits, vegetables and salads.

Consult your Diabetologist in Delhi before fasting 

You may need a change in medication or dosage modification of some medicines or Insulin if you have to fast. Some antidiabetic medicines (like Glimipiride, Gliclazide, Glibenclamide, Glipizide, etc..), and short acting and premixed Insulins are prone to cause hypoglycemia in absence of sufficient food intake whereas others may not. 

Choose wisely

Usually in fasting high calorie food intake is more like pakoras, papad, pooris, tikka, sabudana, buckwheat flour, etc.  All these are calorie rich and can quickly shoot up the blood glucose.

Try to include food cooked in less oil, and cooking methods to be adopted should be baking, grilling, or in non-stick pan

Also during fasting avoid caffeine beverages as they can be dehydrating and lead to difficulties, and hydrate yourself with plenty of water and beverages like lemon water, coconut water and buttermilk whole day.

One should check the blood glucose levels frequently when on fasting as you should be more careful about your health. Listed below few points which will help you to manage your diabetes well during fasting:

·         Drink any beverage or eat fruit after every 2 hour.

·         Consume milk and its products after every short interval.

·        Do consult your Diabetologist before fasting Don’t miss your medicine

·         If you feel hypoglycaemia or low sugar levels immediately take some form of sugar.

·         Modify the dose of  insulin as per the sugar levels

Stress and Diabetes

WHAT IS STRESS?

Stress is a natural feeling that is created in the mind, and is the way the body responds to a particular threat. Stress triggers physiological, emotional and chemical reactions in the body through a complex signaling pathway between neurons and body cells-either mental or physical. Physically it can be injury or illness and mentally problems in personal or professional life.

In our lives reason of stress can be many - family, job, finance, relationship or illness. If someone is having stress, it may cause following symptoms:

•          Changes in eating habits- Loss of appetite or binge eating
•          Disturbance in sleep
•          Weight gain or loss
•          Anxiety - Becomes nervous easily
•          Muscle tension
•          Feeling depressed
•          Increased irritability-Anger
•          Common problems like constipation, diarrhea, indigestion
•          Loss of interest in sex
•          Feeling weak
•          Sweating

Stress & Diabetes

Managing the stress with diabetes is essential as it can alter the blood glucose levels. Generally mental stress raises the glucose level in diabetics but with type 1 diabetes it show the varied reactions, like in stress there glucose levels can go down and it may leads to hypoglycemia.

The relationship between diabetes and stress has other causes like:

• —  Lifestyle changes
• —  Fear of diabetes related complications in future
• —  Frustration of having diabetes
• —  Depressed about following the diabetic diet
• —  Worry about blood glucose levels
• —  Distress of insulin dependence
• —  Lack of family support
• —  Challenges in social group
• —  Increased Financial burden
• —  Medication

How can Stress Be Harmful?

Diabetes management can get disturbed by stress due to elevated blood glucose levels, provoking negative thoughts, difficulty in decision making, or changing eating habits. Continued stress also leads to elevated levels of Cholesterol, raises Blood Pressure and increases Heart rate. These all work together to push a Diabetic person into vicious cycle of poor control and increasing complications. So Stress management should be an inherent part of any Diabetes management plan.

Women and Diabetes

This is the story of Manisha, who's just celebrated her 34th birthday and is a mother of 2, she works in an MNC as an accounts executive.  She works for long hours and is constantly under stress to manager both her professional and personal responsibilities. She visited Total Care Control- Diabetes Care Centre three months ago, complaining of frequent urination and excessive hunger, weight gain and excessive fatigue. I advised her to get the blood glucose level checked. She was hesitant at start, saying she cannot develop this endemic disease. Also, her family had no history of diabetes. When, Diabetologist in Delhi Dr Rajesh Kesari saw her report, her blood glucose level were alarming. She immediately had to start medication along with strong lifestyle modification that included diet plan, physical activity and stress management. After 3 months, she stills follows all the medication and diet, but has her Blood Sugar level under control.

Our country has many such Manisha’s who are not aware that they are suffering from diabetes. India presently has 62 million diabetic patients out of which 29 million are women. People are not even aware that they are suffering from a disease that exposes them to:

•          Heart attack
•          Stroke
•          Amputations
•          Nerve damage
•          Blindness
•          Kidney disease

Thus, it becomes imperative to raise awareness about diabetes in Indian women.

Women in India with diabetes die at an average age of 57.4 years. Thus, Indian women with diabetes have an average life of 9.5 years shorter than women without diabetes.

Women more at the risk of diabetes are those

·         who lives in poverty

·         obese/overweight

·         less physical active

·         Stress

As hormones and inflammation respond differently in women it is very difficult to diagnose symptoms of diabetes in them. The unique symptoms of diabetes seen specifically in women are:

•                     vaginal infections and vaginal thrush

•                     urinary infections

•                     female sexual dysfunction

•                     polycystic ovary syndrome

Diabetes specialists  in Delhi and NCR recommend both men and women to watch out for these symptoms of Diabetes:

•                     increased thirst and hunger

•                     frequent urination

•                     weight loss or gain that has no obvious cause

•                     fatigue

•                     blurred vision

•                     wounds that heal slowly

•                     nausea

•                     skin infections

•                     patches of darker skin in areas of the body that have creases

•                     irritability

•                     breath that has a sweet, fruity, or acetone odour

•                     reduced feeling in your hands or feet

Pregnancy and diabetes

Preexisting diabetes in pregnancy is also called pregnancy complicated by diabetes. In these cases, women already have diabetes and then become pregnant. Careful monitoring of blood glucose level are to be tracked before and during pregnancy which will results in good outcomes for both mother and child. It is consider as high risk pregnancy      

Pregnancy induced diabetes is called as gestational diabetes. Gestational diabetes occurs in latter stage of pregnancy, generally develops around 24-28 weeks of pregnancy. This increases the risk to both the mother and the foetus. Women with gestational diabetes are at increased risk for type 2 diabetes later in life.

Preventive measures

There are certain lifestyle modifications which can be adopted to prevent or delay diabetes.

·         Lose weight/ exercise

·         Don’t smoke

·         Good nutrition

·         Say no to stress

·         Do meditation

·         Regular monitoring of blood glucose levels

·         Knowledge about symptoms and complications of diabetes.

Impediments in Diabetes Treatment

Impediments in Diabetes Treatment

In Delhi and other big metros Diabetes prevalence close to 10% of the population, Diabetes is a chronic illness and now rampant in our society, by various estimates every 5^th-12^th person living in this country’s cities could be suffering from Diabetes,– it is now also spreading its tentacles in the smaller towns and villages. As urbanization is spreading to smaller towns more and more people are getting affected by the lifestyle diseases like Diabetes, High Blood Pressure and Heart Diseases leading to the lethal consequences of Heart Attack and Stroke.

Majority of Diabetes in our country is Type 2 Diabetes, Type 1 Diabetes accounting for 5% or less of all the Diabetes cases. Diabetes requires lifelong treatment or management, even though patients own efforts are very important in controlling Blood Sugar and other important parameters but most of the times they are not sufficient at the best. Diabetes Specialist inDelhi Dr Rajesh Kesari shares some of the key reasons why despite good efforts people fail to control Diabetes:

•                 Lack of understanding of the disease process- may be due to improper of insufficient counseling of patients who are laymen and not supposed to be too familiar with diseases
•                 Insufficient understanding of the consequences of uncontrolled Diabetes- When people are told of the ghastly consequences of Diabetes they tend to take Diabetes more seriously, control diet, do regular exercise and take their medicines regularly.
•                 Delay in initiating Insulin,- Most of the Diabetics require extraneous Insulin after about 10 years of Diabetes, some may require earlier- depending on the Type of Diabetes and the average control of Blood Sugar- but most are reluctant to start taking Insulin- this perhaps is the biggest impediment in achieving adequate control of Diabetes.
•                 Inappropriate Insulin dose- It’s often seen that people start taking Insulin but not in adequate quantities hence are unable to achieve their targets, here the responsibility may lie also with the Diabetologist. In Delhi at our Centre- Total care Control we pay a lot of emphasis on timely Insulin initiation and Insulin dose titrations to achieve our patient’s goals of Diabetes.
•                 Lack of Regular Testing and Follow up- Patients must regularly test their Blood Sugar levels and do other essential tests as HbA1C to assess their Diabetes control. Since Diabetes is asymptomatic patients do not understand whether the Blood Sugar levels are normal or not. Diabetes cannot be cured and has to be managed- so we must use the principles of management to achieve best results, hence regular controls are important to monitor the progress. 

What to look for in your Diabetes Specialist or Diabetologist and the Centre..?

Diabetes is a chronic disease which unfortunately is not curable as of yet. Heance it requires constant care and interventions both on the part of the patient as well as the Doctor. All doctors are true well wishers of their patients, the doctor - patient relationship is a special and holy relationship which in Diabetes takes different dimensions, instead of being Doctor centric it becomes a patient centric relation- in other- specially acute conditions its the doctor and his or her treatment which plays the decisive role but in Diabetes its the patients behaviour which plays a very decisive and important role in the the control of Diabetes and Prevention of its complications. Hence not only the technical knowledge but the ability to communicate and impress upon the patient the need and means of good Diabetes control become obligations of Diabetologist as well. There are certain essential qualities in the specialists which would enable more effective treatment of Diabetes.

• Diabetologist should devote adequate time to their patients
• Impress upon the patients the need of Diet Control & Exercise
• Conduct regular checkups and explain the importance of monitoring to pateints
• Keep communication channels open with the patients and listen to them ,be sensitive to their problems and issues
• Consider the affordability and economical burden of disease while prescribing treatment
• Explain the importance of preventing complications and recognizing them at an early stage
• Should have well trained staff and support personnel like Diabetes Counselor, Educator, Pharmacist etc.
• Keep himself updated with the latest developments and guidelines to offer the best available treatment
• Make use of the latest technology available like CGMS, Insulin Pumps, Internet, Mobile telephony for the better management of Diabetes.

Diabetes should be controlled by the combined effort of all the medical and non medical professionals, and all play a very important role. A good Diabetes centre should provide not onlt the services of a Diabetologist but also the ancilliary support team cosisting of Educators, Counselors, Pathology Lab, Dispensary, Conduct tests for early diagnosis and prevention of complications.