Diabetes and Lohri

Lohri is celebrated all over North India with great enthusiasm. It is a celebration of Truth and Justice as also time to celebrate harvest. Lohri coincides with the coldest period of winters.

A celebration by all means for all Diabetics as well. Even before the day ( or rather) night of Lohri lots of sweets are consumed- Patti, gajjaks are caramalized Sugar or jaggery with roasted ground nuts, til- sesame seeds and other spices and seeds. Most of the Indian diabetics are suffering from Diabetes type 2, most of the gajjaks are high in calories and contain sucrose. They would cause sudden rise in blood sugar levels, Persons with Diabetes or prediabetes are advised to restrain themselves from consuming sweet patti's or gajjaks. As the tradition has it- People gather around a pyre, Sing dance and enjoy...feasting on groundnuts with pattis, rewari's or popcorns while occasionally throwing then in the fire symbolically.

Diabetes comes no way in dampening Festive spirits ... make a wise choice Groundnuts, Popcorns would not raise blood sugar, they can be eaten normally. Avoid lot of sweets- gajjaks even though they may be made of jaggery which most of the people do not consider to be Sugar it contains almost as much calories as table sugar.

Wishing you all a Happy Lohri and Winter Festivals

Dr Rajesh Kesari

Hypoglycemia unawareness- Drowning with the anchor

We had a guest over at our home few days back, we were having a nice time, had tea together with some buscuits , As our friend is a Diabetic obviously the tea was without sugar and light diet buscuits with lot of fibres only accompanied, our friend refused to have dinner he said he was having some stomach problem since the morning , wasn't feeling like eating at all and had very light lunch as well because of the same reason.... Well knowing him well we did'nt press too much. As the time went by we noticed he started behaving strangely.. Started speaking ( we thought opening secrets') about some common friends, talking in a manner utterly uncompatible with himself- we've known since years as one of the most humble and respectable persons.. I could sense something was wrong. Then to our utter surprise he put his legs on the table and started angrily shouting about a politician..I knew now for sure something was gravely wrong! Either this was hypoglycemia or he was undergoing a stroke, we immdiately checked his capillary glucose it showed 30 by glucometer. This gentleman was still talking, sitting moving about..Had we not known him for so long we would have accepted him just as an angry man.
Even after giving 300 gms of glucose by mouth his capillary levels did not rise beyond 60, we finally gave him intravenous glucose and he was back to his normal self just in 15 min, Utterly surprised to the surroundings of a hospital emergency- he was absolutely unaware of whatever had happened, even though outwardly he'd been conscious all the time.

Very often this is what is felt by friends and family members of Diabetics who have been having uncontrolled diabetes for a long time, rarely this may end in a tragedy , because of coma or accidents.
Glucose is the principal form of energy required by brain, it cannot function without glucose which it must derive from blood as it does not have any sources of its own. If the level of glucose starts falling down below a critical level, the glucose counter regulatory system comes into action which releases blood glucose from stores in the body like liver, kidney muscles, causes outward manifestations like hunger, palpitations, sweating, headache which make the seek food and help.
These systems and their manifestations are controlled by the autonomic Nervous system, which is adversely affected by the continued damage of high blood glucose and other changes which happen in longstanding Diabetes. Since the person whose sugar levels are falling pricipitously doesn't get any warning signals he doesn't act and blood glucose keeps dropping like an anchor, this is termed as Hypoglycemia Unawareness. All the systems which ahve been put in place by nature to counter this simply do not activate.
click here to read more about Diabetic Neuropathy, theres a lot to it than just Hypoglycemia unawareness.

Act fast to Prevent Heart Disease

Every person affected with Diabetes or even mild forms of Glucose intolerance ( borderline blood sugar levels) is at higher risks for developing Heart diseases like coronary artery disease, Heart attacks and cardiomyopathies.

If other complications of Diabetes like those of eyes, kidneys, nerves etc. may take a long time to occur, complications of heart may happen at much earlier stages.

We Indians are more affected by these because of the inherent sizes of our tummies. Deposistion of fats under the abdomen makes us more insulin resistant which causes a chain of events leading to deposition of cholesterol in large and small arteries ( blood vessels supplying fresh oxygenated blood) to all vital organs including the heart itself. The depositions affect the walls of the arteries and may cause formation of blood clots which may lead to blockages of vessels supplying blood to heart , brain or kidneys leading to disastrous events like Heart Attacks, Stroke.

Complications of Heart start even before Blood Sugar has risen above the critical levels - which would make the Diagnosis of Diabetes. Progression of Diabetes is a constant process, in Type II Diabetes, the prominent cause of Diabetes in India - Insulin becomes less effective as a result pancreas produce more insulin to decrease the same amount of rise in blood sugar, but as the disease progresses the pancreas are not able to produce sufficient insulin to keep blood sugar levels normal and hence the rise in sugar levels either fasting or after meals. But the high levels of insulin increase Cholesterol and triglycerides which become the main culprits in causing heart diseases like angina and heart attacks.

But all this can be prevented by early initiation of exercise and diet programmes which decrease weight, increase insulin sensitivity, and delay progress of diabetes.



for more on Diabetes : Diabetes Total control

Road to Control

There are few things which are in the hand of each Diabetic- his/her fundamental right to control.

What to control:

Longing for foods- Food habits, likings, disliking, tastes are formed over a long period of time, not just days or weeks but over years, it may not be possible to change them altogether in a day! Not only does the human being get used to a particular taste or flavors but also the quantity of food consumed by ourselves. We have taught ourselves to like or dislike particular Foods which we consider tasty , If we fully understand the need for a change we can successfully teach ourselves to appreciate and enjoy new different foods, discover the yet unexplored new frontiers of our taste buds.

If we eat more our stomach expands and we get used to more food being consumed with each meal- thus our expectations increase and we do feel full enough until the stomach has expanded that much. If we start eating lesser amounts our stomach contracts and gives our brain the signal of fullness earlier- so we eat less food.

Essential steps in controlling diet:

UNDERSTAND- what foods are to be preferred, what have to be avoided, what are the approximate quantities of the foods which you should take.

Start by modifying what you are taking already. Understand the concept of glycemic index which is as important as good or bad food for diabetics.

1. Start with at least one item and control its intake…slowly add more to this list. Soon you would find yourself a more confident and in CONTROL. For example- if you are fond of cheese, first decrease from 4-5 to 2-3 cubes / slices.
2. Once in control and confident try new diets, bring changes to your menu.
3. The change you bring in your food should be consistent….few days of control are not enough..Diabetes requires lifelong Control.

CONTROL QUANTITY

1. Decrease the total quantity or portion sizes of the food which you are consuming abundantly but are not favorable for a Diabetic. For example if you were consuming four slices of bread in your breakfast make it three…then two. If you were putting a thick layer of butter on the toast make it thin. If you were taking four roti’s make it three..

Also see DIET TIPS for more details

CONTROL TYPE OF FOOD

1. Try other food items, those considered or as advised by your doctor or nutritionist to be preferable for Diabetics. For example if you’d been taking white bread in breakfast try to substitute with, Breads with whole wheat flour and other coarse grains. Instead of taking Naans take roti. If you were taking precooked cereals switch over to semicooked or uncooked ones which you may prepare yourself- ( uncooked cereals have lesser glycemic index as they undergo lesser processing as compared to the precooked and ready to eat breakfast cereals)

Diabetestotalcontrol.com- Dedicated to Diabetes care of Indians in India and all over theWorld

Diabetes – More than just Blood Sugar

Diabetes – More than just Blood Sugar

Diabetes is more famous as ‘Blood Sugar’ in common parlance- Even doctors may also ask- Do you have Blood Sugar? But little do we know that Diabetes is a lot more than just rise in Blood Sugar levels. Diabetes actually is more about Energy storage and use- about growth and development. As one of the hypothesis of development of Diabetes goes- ‘the thrifty genes theory’- our ancestors were too dependent on the vagaries of weather, rain, floods , famines for food ; During the times of a good harvest they would eat well and their bodies make huge stores of energy inside ( as fats) - which would help them survive famines and floods. But with the onset of farming, food security increased – food became available throughout the year to all, but the body is still working in its old ways- conserving energy and depositing it as fat.
Fats are the most concentrated form of energy in our body, 1 gm of fat provides 9 kcals, more than twice as much as 1 gm of glucose. A 60 kg male may have upto 15 Kg of fat while a female of same weight may have up to 20 kg of fat. 20 Kg of fat can provide sufficient heat to boil 1800 litres of water or make 9000 cups of tea!
Hormone insulin has a pivotal role to play in the process of fat storage and utilization. After intake of meals Insulin not only decreases blood glucose but also promotes storage of digested fats into fat cells ( storage department of fat). During absence of fats in the blood insulin promotes their utilization from fat stores. This is why many Diabetics are obese (specifically those suffering from type 2 Diabetes). This type of Diabetes is caused due to insulin resistance i.e.. body cells become resistant to the actions of insulin- hence more and more of insulin is required to bring about the same glucose lowering - the excessive insulin results in large fat deposits- which themselves cause more insulin resistance and destroy the insulin producing beta cells in pancreas because of toxic effects of fat; this forms a vicious cycle which ends up in clinical Diabetes and its numerous side effects.
Insulin also encourages protein formation – proteins are the building blocks of our body. Presence of insulin in blood stimulates, whereas its deficiency causes destruction of proteins- This is the reason that mothers with Pregnancy induced Diabetes have large babies ( Due to excessive insulin because of insulin resistance) whereas Type I Diabetics are generally thin ( since they do not have insulin of their own).
Its not necessary for a Diabetic to completely stop eating sweets, bread, rice etc. Whats more important is the how the food gets digested and absorbed by intestines. Partially cooked foods would not be immediately absorbed and slowly increase blood glucose, Long grain rice like Basmati also gives slower rise in glucose, Breads with dietary fibre and whole grains may also prevent sudden rise of glucose levels, Green vegetables and fruits are also slowly absorbed. A diabetic has to be innovative and find things suitable both for the palate and the body, this is not difficult- leave alone impossible.
Exercise perhaps is one of the boons that a Diabetic enjoys. Perhaps there would be very few conditions afflicting the human body where a pleasant stroll could double up as treatment. Exercise not only helps consume the excess glucose and fat it increases blood flow to heart, muscles of legs, kidneys, decreases blood cholesterol, increases protective cholesterol. Exercise works as a medicine- it increases insulin sensitivity, which helps the body to more avidly respond to insulin and decreases its total quantity.
Every Diabetic’s foremost need and responsibility is to understand the disease, this condition requires continuous attention, application of the patients creative mind, innovation- what to eat? When to eat? How to prepare? How to increase physical activity? These questions have to be answered by each Diabetic individually, off course with the help of a Doctor or a trained professional.
Diabetes requires Total control- for total success.
Wishing all Diabetics Good control over Diabetes, Healthy and happy life on the occasion of World Diabetes day.

Dr. Rajesh Kesari M.D



Diabetestotalcontrol.com- Dedicated to Diabetes care of Indians in India and all over theWorld
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Why are Indians more prone to Diabetes and what should we watch for ??

Yes indeed indians are more prone to Diabetes than Europeans or africans. The reason perhaps lies in our genes.
The 'thrifty genes hypothesis' which has gained considerable popularity mentions that in ancient times human race lived through the alternating times of famine and abundance- specially in our subcontinent. During the times of abundance body would store energy to survive droughts & famines - these stores are by the way of fats.
But in the modern era - food supply is abundant while physical work and more over hardships of famine are completely gone.
Our body still keeps on storing energy ( fat deposits) without subsequent utilizations, this leads to rise in blood lipids ( fats), damage to pancreas due to excessive glucose and fats in blood, excessive insulin requirements- insulin resistance, damage to blood vessels, formation of atheroscler otic plaques and its complications like Heart attack, stroke etc.
Important thing to watch for is Intra Abdominal deposition of fat. This is more harmful than subcutaneous fat deposits. But it can be used as a measure to predict the possiblity of Diabetes and insulin resistance.

• in males the maximum abdominal girth should be less than 100 cms
• in Females less than 87.5 cms

It may be easier to understand pear or apple shaped body, apple shaped body with largest abdominal girth predisposes to higher intra abdominal fat and its complications.

Abdominal girth should be measured as the maximum circumfrence of the abdomen near the umblicus.

Holy Navratras - Fasting & Feasting

The holy Navratras are associated with prayers and fasting all over India.

But Fasting and Feasting have special significance for Diabetics.

During prolonged fasting when no food or water at all is taken, the blood glucose levels may drop down causing hypoglycemia (this is a serious complication and may result in irreparable damage to brain).
This may specially be aggravated in patients taking either insulin or on frequently used oral medicines like Glimeperide ( Amaryl etc. ), or Glibenclamide ( Daonil etc. ).

Symptoms of Hypoglycemia are:

Sudden weakness
Hunger
Palpitations( increased heart beat),
tremor of hands
Sweating on foreheadand hands
Difficulty in walking, performing simple tasks
Incoherent speech
Loss of consciousness
Seizures

If any of these symptoms occur immediately put some sugar/ glucose / candy / sweets or a bread slice in your mouth and if the symptoms still continue seek medical attention.

It is also important to take sufficient amount of water during fasting periods - to avoid dehydration and resulting consequences.


During the periods of "fasting" many special "Fast-foods" are consumed for some people it may cause excess rather than deficiency of calories and carbohydrates. Most of the foods consumed in north india are fried, fried potatoes, nuts, seeds, halwa made from Singhara ( dried water chestnut) atta Kottu atta ( Buck wheat flour ) and rock salt or fruits etc. while restricting the intake of regular food grains and pulses like wheat, rice, daals etc and common salt.

Consumption of fruits is highly beneficial and preferable for diabetics, But consumption of fried Starchy foods like potatoes and water chestnut ( Singhara/ Kottu atta) is not recommended as this may result in increased blood sugar and cholesterol.


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