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.

Diabetes is not a Handicap

Diabetes has grown into and epidemy, according to the results of a study conducted by ICMR recently approx 65 million people may be suffering from Diabetes and another 200 million may be in the prediabetic stage which effectively means that 1/3^rd of them may develop Diabetes in next 3 years.

According to Diabetologists in Delhi many Diabetes patients perceive their illness as a heavy burden both on the individual and the family, some patients and their family members sometimes consider imposing restrictions on the working or studies – which may not be true or required at all.

Diabetes Specialistin Delhi says Persons with Diabetes can perform very well in all spheres of life, just as any other healthy person without Diabetes. Diabetes disease by itself is not a handicap and does not require any restrictions to be imposed on individuals. Diabetics should take all necessary steps to keep their Blood Sugar, Cholesterol and Blood Pressure levels under control. This can be done by Lifestyle management and some patients may require medications or Insulin injections as well. Lifestyle management is the modification of all daily activities of persons in such a way as to help achieve the primary goals of Diabetes. Diabetes doctors consider Diet and physical activity to be the two main factors which are important for Diabetic patients.

Dr Rajesh Kesari Diabetologist inDelhi is personally of the opinion that Diabetes can infact be a boon on disguise. Persons who are getting proper treatment and counseling understand the importance of lifestyle management and are hence bound to lead a more disciplined lifestyle, they get up early in the morning, go out for walks regularly- this reflects in their performance in other spheres of their life as well.

So its better to control Diabetes and lead a Happy and Active life- yes Diabetes can be controlled and should ALWAYS BE CONTROLLED

Diabetes in Summers

Diabetes in Summers

Summer is a special season for all of us in India- We hate it at the same time we love it, The juicy fruits like Mangoes, Watermelon, Melons, Peaches, Apricots etc  are loved by all and specially enjoyed by the kids during their Summer Holidays.  But summers also bring the intolerable heat, Hot winds and a host of infections like Typhiod, Gastroenteritis, Viral fevers, Diarrhea etc.

Diabetics need to be very careful during these months as was elaborated by. Even though fruits are often recommended by all  Diabetes doctors in Delhi, one needs to be very choosy and careful while selecting fruits, Banana, Cheekoo ( or Sapota), Grapes, Mangoes and Litchis should be avoided. Some fruits like Mangoes may be had in very small quantities e.g. 1 slice but not more. In India people eat mangoes in Kgs- this can be very harmful for Diabetics, infact many people discover that they have Diabetes only during the Mango season.

Watermelon and Melon are also abundant during summers and they are sweet too! But these  can be eaten by the Diabetics, infact they are recommended for Diabetics- they are filling as they are mainly full of water, have some fibres and plenty of vitamins and minerals. In moderate quantities like one bowl a day these may  be good for Diabetics.

Lot of green vegetables are available during summers which can be had as salads e.g. Cucumber, Tomatoes, Kakdi. Eating green uncooked vegetables is very good for Diabetics, these vegetables have lots of fibres and water together with vitamins and minerals, all these are very good for Diabetics.These vegetables decrease the Glycemic index of whatever food has been taken, which leads to their slower absorption and release of glucose and consequently slower rise in Blood Glucose levels. Some salads like Cucumbers and Kakdi are abundantly available during summers and are loved by most Indians. Diabetes Specialists advise their patients to have plenty of salads before taking any meals and in place of snacks.

Low Sugar-Hypoglycemia- as Bad as High

We all knew that High Blood Sugar levels are bad and they cause lots of Complications like those of Heart ( Heart Attacks, Stroke Paralysis), Kidneys ( Renal failure), Eyes (Retinopathy, Glaucoma, Cataract), Nervous System ( Peripheral Neuropathy, Autonomic Neuropathy - Silent Angina, Gastropathy, Uropathy), Sexual Dysfunction in Males and Females, but we never paid adequate attention to the Low Blood Sugar levels.

Hypoglycemia is difficult to describe in words, it is an intense craving for food, an unsatisfiable hunger, may progress to weakness, lethargy, perspiration, Palpitations- Feeling ones heartbeats further lowering of Blood Sugar may affect the brain leading to epilepsy like fits or even loss of consciousness and coma....These are very rare but may happen in a Diabetic.

These symptoms start appearing only when the Blood Sugar levels drop to less than 60 mg/dl.

The causes of Hypoglycemia in Diabetic patients can be many:

•        Skipping meals or fasting while taking Insulin or Glucose lowering medication
•         Excessive or inappropriate medication as compared to Sugar levels
•         Infections in Diabetics, specially Loose motions, Dehydration
•         Complications of Diabetes like Renal / Kidney Failure
•         Inadvertent intake of Sugar lowering medicines or Insulin
•         Sudden Exercise without decreasing Insulin or Glucose lowering medications
•         Hypoglycemia may be caused by some medications for other purposes- they should be avoided.

Hypoglycemias may occur while trying to achieve tight control of Blood Sugar. Our body has a very intricate mechanism of controlling Blood Sugar levels, At high blood glucose levels Insulin is secreted from the pancreas which lowers Blood Glucose, while at lower glucose levels – the so called counter regulatory hormones like Glucagon, Cortisol, Epinephrine are secreted which increase the Blood Glucose levels by facilitating release of Glucose from stores of the body like muscles, fat, liver cells etc. But in Diabetes both these mechanisms may be derailed, Due to prolonged uncontrolled Diabetes- mechanisms which increase Blood Glucose- the counter regulatory mechanisms may get impaired and lead to severe and  prolonged hypoglycemia. This is called Hypoglycemia unawareness, when despite decreasing Blood Glucose levels the diabetic patient does not feel any symptoms.

How to avoid Hypoglycemia in Diabetes:

• Hypoglycemia can be avoided with some simple precautions-
• If you have skipped meals or are fasting use may have to change the dosages of some medicines or skip them altogether.
• Insulin dosages should be uptitrated slowly, step by step under the guidance of an expert in prescribing Insulin, don’t lose patience…
• All infections should be proimplty and effectively treated
• Medicines which may cause Hypoglycemia should be avoided.
• Proper dose adjustment of Insulin and medications should be done before starting intense exercise.

Discuss with your doctor if you ever have the above symptoms so that the dosage of medications may be adjusted accordingly..

Hypoglycemia may be very harmful,

First of all it puts back the patients confidence by years and makes him or her over cautious, It may be a precipitating factor for Heart Attacks, Arrythmias and even sudden death. Hypoglycemia may result in falls which may cause fractures of accidents while driving.

But this does not mean that Blood Sugar need not be controlled, Judicious use of medications and with good patient education using structured programmes as is the standard practice in our  centre- Total care Control- Diabetes Care Centre;  it is possible to achieve good HbA1C control even in patients who are taking Insulin 3-4 times a day.

Dr Rajesh Kesari-  Diabetologist in Delhi

Dir. & Consultant at Total Care Control

Diabetes Care Centre

B-294, New Ashok Nagar, opp. main gate East End Appts

near New Ashok Nagar Metro Station

Tel:9899764447, 011-22710663, 9871110663

Diabetes- Catching its prey young!

Nation is getting younger..So is Diabetes, specially Type 2 Diabetes.

Earlier Diabetes or High Blood Sugar used to be a disease of the elderly, it wouldn’t even be suspected in a young patient, or if found it would be straightaway labeled as Type 1 Diabetes requiring lifelong insulin injections.

Its more and more frequently seen that even children of school going age being on anti diabetic medication. A big blame goes to the rising weight of the young population- according to available statistics some 29% children going to private schools and 11.9% children going to government funded schools in Delhi in the year 2009 were overweight. Excess weight leads to deposition of abdominal fat in Indians and the results in decreased insulin sensitivity, which fires a chain reaction leading to Diabetes, Hypertension, Obesity and Dyslipidimea- all these conditions together constitute the Metabolic Syndrome.

Lifestyle changes taking place in the society are squarely to be blamed for this change, children prefer Fast Food which is rich in calories, harmful Lipids, Salt and Transfats, they usually have high glycemic index, all these causing high Blood Glucose levels, raising blood levels of fatty acids, causing Insulin resistance and its sequale like blockage of arteries in heart and Brain leading to Heart Attacks and stroke. Added to these is the sedentary lifestyle of our children;  outdoor games have been replaced by computer and Television, which require no physical effort and leave the children snacking while sitting on a sofa engrossed in their favourite shows or games. The same behavior may be tracked to adulthood- According to WHO estimates on NCD ( Non Communicable Diseases)- physical inactivity causes 6% of global deaths- same as Diabetes. A recent report mentions the average age of TCS (Tata Consultancy Services – a leading Indian Software Giant)- employees as 28 years, most of these are spending there time sitting at the desktops with no opportunity for physical activity.

The perils of Diabetes in this generation  are that  generation is more prone to risky behavior, and under peer pressure less likely to conform to the lifestyle changes advised ny doctors than the ‘wiser’ senior generation which has already undergone the ups and downs of life..If blood sugar levels are not controlled in this age group would soon end up with serious complications of Diabetes like Heart Attacks, Nephropathy, Retinopathy, Diabetic  Foot Disease. Most of the Diabetes complications are predictable, the morst may already appear in a span of 15 to 20 years, so these individuals at the prime of their lifetimes may be at great disadvantage because of the time and costs associated with these complications.