To eat or not to eat ( WHITE RICE) - that is the question!

Perhaps researchers from Britain have tried to rephrase the famous quote of Shakespeare into the Diabetes arena-and probably with same confusing implications. According to an article published in last month in the British journal of Medicine-Eating a diet rich in white rice may increase your chances of developing Diabetes . 

As the researchers have themselves remarked- white rice may not be the only cause of developing Diabetes moreover in certain Asian subgroups – the Chinese and Japanese, but it does seem to be increasing the odds of developing diabetes. The reasons suggested are many-White rice has high glycemic index meaning- it is quickly absorbed and causes a surge in glucose levels after meals- thus increasing the stress on pancreas to produce more insulin in a short period of time. The other plausible factor may be that white rice has relatively poor nutrient content, especially of those which are helpful in warding off diabetes- like magnesium etc.  

In India we have noted that the incidence of Diabetes in south Indian states is high- where diet is predominantly rice based as compared to wheat based north Indian diet.

Here are some facts and tips for rice lovers which may help them enjoy their favourite Biryani or Pulao without feeling guilty. Not all rice is high Glycemic index food, Basmati and most long grain rice varieties contain the starch amylose which is considered as moderate Glycemic index food and does not cause high levels of Blood Glucose after meals. Most of the nutrients in rice are eroded by polishing – some of those may be  present in the powder form along with the rice grains- but this is often washed or drained- so even the nutrients present in minute quantities are lost. So it is advisable to relish smaller servings than draining the boiled rice. Having rice together with vegetables or other low glycemic index foods is also beneficial as it lowers the total glucose absorption.  Vegetable biryani or pulao with plenty of green vegetables but less fat or ghee- preferably not fried at all are good options for rice eaters.

Meet your doctor atleast once in 2 weeks for faster control of Diabetes!

Meeting your Diabetes Doctor more frequently keeps your Sugar levels under better control and faster…

According to the results of a study published in the Archives of INTERNAL MEDICINE September issue. Researchers analyzed data of more than 26000 diabetic patients the years 2000 and 2009, with uncontrolled Blood Glucose, Total & LDL Cholesterol levels and high Blood Pressure . They concluded that those patients who visited their Diabetes doctors more frequently were faster to control their Blood Glucose levels- those who visited their doctors on average once in a week or once in 2 weeks were able to achieve HbA1c levels of 7% or less ( indicating Good Control) in just 4.4 months as compared to others who took average of 24.9 months  ( more than 2 years) to achieve same levels ; time to control BP to levels 130/85 was 1.3 months as compared to 13.9 months ( more than a year) for those who rarely visited their doctors, time to control  LDL Cholesterol to less than 100 mg/dl was 5.1 months versus 32.8 months ( almost three years) for the same contingents.  Not only this but also noticeable was that doubling the time between physician encounters  led to an increase in time to control these parameters, clearly showing that  frequent visits are necessary to bring Blood Sugar levels under control. An abstract of this article is available here..

When the Glucose and cholesterol levels are high pancreas is working under the considerable pressure of High Glucose and Lipids – which are toxic to the pancreas and decrease its ability to secrete the all important hormone Insulin. This is akin to flogging a sick horse to run faster. But once you bring Blood Sugar levels under control the pancreas is able to cope up with the increased workload fairly well and its easier to manage and maintain the same Blood Glucose levels.

Diabetes in Summers

What has the weather got to do with Diabetes control? seems an obvious question. Summer season has different implications in different parts of the world.. There are many factors which influence the management of Diabetes in this period of time.

Food:

Western

In the Colder countries summers bring plenty of fruits and vegetables which are highly recommended for Diabetics, Green leafy vegetables, fresh berries, available in plenty and  good for diabetics. Vegetables , specially salads have almost zero calories, they can be had as much as desired, help increase HDL ( the ‘Good Cholesterol’) and keep sugar down as they are of Low Glycemic Index and would decrease the absorption of foods consumed with them.

Indian

In most of the Indian subcontinent (except the north which may have climate similar to the western countries) A lot of refreshing drinks are consumed during the summers. Care must be taken to avoid Sugarcane juice – which is very popular in North India, as well as other sugar containing beverages and aerated drinks like the popular Colas, lemon, mango and fruit drinks. ‘Chach’ or buttermilk is one of the best thirst quenching drinks for diabetics in the scorching hot weather, lemonade should be taken either with salt and masala or with sugar substitutes .

Generally appetite is decreased in the hot weather which goes in favour of Diabetes control.

Infections & Dehydration

This season also causes a lot of diseases related to Gastrointestinal system like Diarrhea, vomiting – leading to loss of water and salts from the body. Children are more prone to such diseases. These may complicate into Diabetic Ketoacidosis if not treated promptly, remember sometimes even Diabetics on Oral medicines may have to be given insulin injections to prevent such complications.

Uncontrolled Diabetes may predispose to the frequent infections of stomach and throat which are prevalent in summers.

Dehydration specially due to Stomach infections frequently causes hypoglycemia as people do not tolerate food and liquids Oral rehydration solutions are helpful.

Plenty of water is lost due to sweating and evaporation- Drink adequate water and prevent dehydration.

Some FAQs :

Is the usual ORS Solution recommended for Diabetics?

In case of Dehydration – The same ORS solution may be recommended  as all the essential salts together with glucose are lost with body fluids-.

Are fresh fruit juices good for diabetics?

Fresh fruits would be preferable to Fresh fruit juices, but freshly made fruit juices are not bad for consumption in Diabetics.

Why be so afraid of taking Insulin injections

If necessary and recommended by your doctors Please do not hesitate to take Insulin injections- fortunately with the modern day Insulin Pens- an injection is almost painless...it is nothing compared to the pain and nausea of Kidney failure and Neuropathies - or Blind ness- which are complications of Diabetes and may be delayed or prevented if Insulin is initiated in time.

Insulin DOES NOT cause any addiction.you may stop it any time.. the only thing is Blood Sugar may go up.
Insulin not only controls Blood Glucose it also helps nerves grow, increases Blood circulation in Kidneys
By Stopping oral medications and starting Insulin patient might be saving the already damaged Kidneys from further onslaught.
Early Insulin administration gives the already stressed pancreas rest and they may regenerate and decrease progression of Diabetes.
And Last but not the least- Insulin treatment is cheaper than combination of many medications bieng taken by most Type 2 Diabetics.

Click here for more information on Insulin in Diabetes

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