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.

Diabetes- Behind the scenes Killer ?

With time and progress even Yamaraj ( the Indian God of Death) has changed his ways. In early and mid 20th century the main cause of death used to be Infectious diseases, but the Antibiotic era has changed the situation, people are able to survive most of the infections and live longer, But here they get caught by the so called Non Communicable Diseases. Perhaps here that Yamraj is using Diabetes to its full potential...
Diabetes is a Silent Killer- it kills in more ways than one. Complications of Diabetes like Heart Diseases, Stroke, Chronic Kidney disease, all may cause death and considerable morbidity and may yet not be recognized as related to Diabetes in statistics..

Non Communicable Diseases or NCD’s are the major killers the world over responsible for about 63% of deaths worldwide according to World Health Organization. These diseases are not passed on from person to person, they are chronic in nature and of slow progression. NCD’s are divided in 4 major categories, cardiovascular, Cancers, Chronic Lung Diseases and Diabetes.

According to the numbers provided by the WHO, more than half of the recorded deaths – 53%  in India in the year 2010 were due to NCD’s, 24% due to CVD- cardio Vascular Diseases, 11% due to Respiratory disease, 6 % due to Cancers, 2% due to Diabetes and 10% due to other NCD’s like Alcohol abuse etc..

Diabetes occupies a special place in the whole gamut of Non Communicable Diseases, since the root cause of major Cardiovascular Diseases is same as that of Diabetes, Insulin resistance. Most of the Diabetics die due to Cardiovascular Diseases ( Heart Attack, Stroke) rather than Diabetes itself. So the actual nos. of death attributable to Diabetes is much more than the figures identified in the above mentioned.

NCD’s are responsible for more than 36 million deaths worldwide, of which 60-80% occur in the low to middle income countries. Not only this the NCD’s are “catching their victims young”- about 9 million deaths occur in persons less than 60 years of age.

Thus they steal away the breadwinners at the time a family is in need and my hurl the dependants into woes of poverty

Non communicable diseases prove a challenge to the developing economies, they may throw or entrench large sections of population in poverty, due to the catastrophic costs associated with these diseases. 

Fortunately the future may not be that bleak if we try hard, deaths from NCD’s are potentially preventable. Most of the risk factors which lead to Non Communicable diseases are modifiable. The major risk factors being Obesity, excess weight, High Levels of Cholesterol, High Blood Pressure, High Blood Sugar, Excessive Alcohol use, Tobacco use, Physical inactivity.  Thus about three quarters of Heart Attacks, Strokes, Type 2 Diabetes  and about 40% of Cancers may be prevented by acting on these modifiable risk factors.

Weight- 1.5 billion adults and about 43 million children under the age of 5 were overweight in 2010

Tobacco use caused about 6 million deaths every year and the figure is expected to rise to 7.5 million by 2020- causing 10% deaths.

The key to longevity is prevention of these diseases and treating them at early stages, And lead a healthy and active life at all costs...

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.