This is one area many are still unsure of. It is generally assumed cutting down the carbohydrate intake to as low as possible when one is a diabetic helps in control of diabetes.
” Gastronomic voyeurs have long proposed that eating is a holistic form of exercise involving various muscles necessary for scooping up the food, chewing it and getting the food to the mouth.”
Restaurants and supermarkets have taken marketing to whole new level. Terms such as biggies, jumbos, king size, grand,supreme and prompts such as all-you-can-eat -buffets and two-for-one -specials are enough to lure the unwary.
A good diet should contain 50% carbohydrate, 30% fat and 20% protein according to the American Diabetic association. One should aim for a weight loss of 5-7 % of the body weight. Most of the diets turn out to be failures as they are not practical or planned to give drastic results. Normally diabetics find it difficult to reduce weight and maintain weight loss when compared to a non diabetic. Some of the medicines taken for diabetes treatment also can cause weight gain.
Generally pregnant women and growing up children need more calories.
Culture or “habits” may have taught many of us to eat in response to any triggers such as stress, boredom, and guilt. We may multitask and eat and then wonder,” How on earth did I manage to eat that whole bag of chips or that large burger?”
Food , as a four letter word, is both a necessity as well as a burden when taken in excessive amounts. You must be familiar with the age old saying, “Eat to live and not live to eat”.
As one ages, the body weight may increase as you may be consuming more calories than needed. This coupled with the decreased physical activity and excuses such as “too tired from work”, “I just need to sleep for some time” ,” I shall grab a bite and then start”, and sink into the cozy sofa to seal the fate.
The daily need of calories depend on the following:
• The body size
• The age
• The height and weight.
• Level of activity
• Gender- whether male or female
• If pregnant.
Levels of activity
A person is labelled non active if the person is doing just normal activities such as going to work, shopping and going to school.
If the person does some physical activity such as walking for 2-4 kms daily or some form of exercise besides regular activity, the person is labelled moderately active.
If the person does heavy workouts like a gym workout, good games of squash, tennis or badminton or swimming, cycling, or walking more than 4 kms a day, the person is labelled very active.
One kilogram of body weight will equal 7700 calories. To reduce one kilogram over a week, one will have reduce 1100 calories daily. This may sound impossible. But, reducing the sugar intake by just one spoon daily can reduce the calorie intake by 500 calories. That is not a big burden, is it ?
The table given below will show the caloric needs based on age, gender and level of activity
|| Mod active
If one observes the above table carefully, the calorie intake for both gender groups is maximum between the ages 18-25 . Thereafter the recommended caloric intake comes down to that of a 10-15 year old irrespective of your level of activity. Well, that is something to seriously think about.
A healthy breakfast will include whole grains, lean protein such as peanut butter, lean meat, fish, poultry and hard boiled eggs, low fat dairy such as yoghurt, cheese and milk and a portion of fruits and vegetables.
Know the food
Starches are bread, grains, cereal, pasta, and starchy vegetables like corn and potatoes. They provide carbohydrate, vitamins, minerals, and fiber. Whole grain starches are healthier because they have more vitamins, minerals, and fiber.
Eat some starches at each meal. Eating starches is healthy for everyone, including people with diabetes.
Examples of starches are bread , pasta, corn, potatoes, rice, cereals, beans, lentils, yam
What are healthy ways to eat starches?
• Buy whole grain breads and cereals.
• Avoid fried and high-fat starches such as regular tortilla chips and potato chips, french fries, pastries, or biscuits. Try fat-free popcorn, baked or potato chips, baked potatoes, or low-fat muffins.
• Use low-fat or fat-free plain yogurt or fat-free sour cream instead of regular sour cream on a baked potato.
• Use mustard instead of mayonnaise on a sandwich.
• Use low-fat or fat-free substitutes such as low-fat mayonnaise or light margarine on bread, rolls, or toast.
• Eat cereal with fat-free (skim) or low-fat (1%) milk
Vegetables provide vitamins, minerals, and fiber. They are low in carbohydrate. Examples of vegetables are lettuce , broccoli, vegetable juice, spinach, peppers, carrots, tomatoes, Celery, cabbage, greens.
What are healthy ways to eat vegetables?
• Eat raw and cooked vegetables with little or no fat, sauces, or dressings.
• Try low-fat or fat-free salad dressing on raw vegetables or salads.
• Steam vegetables using water
• Mix in some chopped onion or garlic.
• Use a little vinegar or some lemon or lime juice.
• Add a small piece of lean ham or smoked turkey instead of fat to vegetables when cooking.
• Sprinkle with herbs and spices.
If you do use a small amount of fat, use canola oil, olive oil, or soft margarines (liquid or tub types) instead of fat from meat, butter, or shortening.
There are two types of vegetables- the starchy and non starchy. The starchy vegetables can increase the sugar levels- potatoes, corn and peas are included.
Non starchy vegetables include broccoli, cabbage, sprouts, carrots, cucumber green, egg plants, ladies fingers (Okra), mushrooms, bell peppers, iceberg lettuce, tomatoes to name a few. These help in adding fiber and also keep the stomach full without increasing the sugar levels.
Fruits provide carbohydrate, vitamins, minerals, and fiber.
What are healthy ways to eat fruits?
• Eat fruits raw or cooked, as juice with no sugar added, canned in their own juice, or dried.
• Buy smaller pieces of fruit.
• Choose pieces of fruit more often than fruit juice. Whole fruit is more filling and has more fiber.
• Save high-sugar and high-fat fruit desserts such as peach cobbler or cherry pie for special occasions.
• Feel the fruits before purchasing them. If fruits are very soft, they are sweeter.
• Generally speaking bananas from the Philippines, grapes, dates, mangoes, water melon, cherries and pineapple are very sweet
Milk provides carbohydrate, protein, calcium, vitamins, and minerals.
What are healthy ways to have milk?
• Drink fat-free (skim) or low-fat (1%) milk.
• Eat low-fat or fat-free fruit yogurt sweetened with a low-calorie sweetener.
• Use low-fat plain yogurt as a substitute for sour cream.
Meat and Meat Substitutes
Meat and meat substitutes provide protein, vitamins, and minerals.
Examples of meat and meat substitutes include chicken , fish, eggs, peanut butter
What are healthy ways to eat meat and meat substitutes?
• Eat chicken or turkey without the skin.
• Cook meat and meat substitutes in low-fat ways: broil , grill, stir fry, roast, steam and micro wave
• To add more flavor, use vinegars, lemon juice, soy sauce, salsa, ketchup, barbecue sauce, herbs, and spices.
• Cook eggs using cooking spray or a non-stick pan.
• Check food labels. Choose low-fat or fat-free cheese.
Fiber diet can slow the gastric emptying and slow down the rate of glucose absorption from the intestine. Water soluble fiber includes oats and bran. Men need 38 g of fiber day and women need 25 g a day.
But, do remember………
- This does not mean one should avoid carbohydrates in total. Please be reminded that carbohydrates are needed for setting up the energy levels during the day.
- One should have a hearty breakfast, a moderate lunch and a light dinner.
- It will be worthwhile to have an approximate 45 grams carbohydrate inclusion with each of the main meals ( Normally a healthy person has 3 main meals and snacks in between).
- Spread the carbohydrate intake during the day to help one curb hunger and thereby prevent overeating.
- A toast of bread with an egg will fill you longer than a couple of toasts with jam.
- Please be reminded that fish, chicken, Turkey Ham, eggs do not have carbohydrate.
- But, addition of cheese or cream or milk while beating the gees to make them creamier, can shoot up the carbohydrate content.
- Addition of bread crumbs and other coverings such as chick pea flour or corn flour can also send the sugar levels high.
- All vegetables growing below the ground do contain some amount of carbohydrate and so excess consumption of the same can upset the sugar levels.
- Those who are on insulin roughly need a unit of insulin for every 12-15 grams of carbohydrates taken.
Given below are 3 options for a meal containing 45 grams of carbohydrates
One cup of cooked oatmeal - 32 gram carbohydrate
Half medium sized banana - 13 grams of carbohydrate
A Hard boiled egg and some black coffee – no carbohydrate
2 scrambled eggs - no carbohydrate
A slice whole wheat bread – 15 grams
An orange - 18 grams
A cup of low fat milk - 14 grams
3 Rye bread pieces – 24 grams
Half cup non fat cheese – 5 grams
One cup blueberries - 15 grams
Avoid fizzy carbonated drinks and sugar free items as one may compensate by eating or drinking more.
Some tips for breakfast:
Those who eat a healthy and balanced breakfast regularly manage their body weight better as well as have better concentration. The breakfast is what sets the tempo and energy levels for the day.
• Turkey sandwiches are a good option.
• Smoothies with berries and low fat yoghurt are another good option
• Whole grain oat meal with fruits or nuts
• Making a French toast with whole grain bread dipped in batter made from egg white, cinnamon powder, salt to taste and vanilla essence makes a delicious dish. This can be topped with thinly sliced apples , berries or bananas.
• Do not watch television or use the computer while eating as many studies show an increased consumption of food and improper chewing of the food as well.
• Mid day snacks can be either fruits, low energy granola bars, non salted or non sweetened nuts comprising pistachios, walnuts, almonds, pecan , pine nuts and hazel nuts.
• 2 tablespoonfuls of olive oil is enough a day. Light olive oil is more processed than either the virgin or extra virgin olive oil. The light olive oil is lighter in color, but not lighter in calories or fat. Even too much of olive oil is not healthy.
• Having a bowl of salads is a healthy low calorie option ( of course without the rich creamy sauce or dressing).
• Base meals on starchy foods such as potatoes, bread, rice and pasta, choosing wholegrain where possible.
• Eat plenty of fiber-rich foods – such as oats, beans, peas, lentils, grains, seeds, fruit and vegetables, as well as wholegrain bread and brown rice and pasta.
• Eat at least five portions of a variety of fruit and vegetables each day, in place of foods higher in fat and calories.
• Eat a low-fat diet and avoid increasing your fat and/or calorie intake.
• Eat as little as possible of: fried foods, fizzy drinks and confectionery high in added sugars
• Eat breakfast.
• Watch the portion size of meals and snacks, and how often you are eating.
• For adults, minimize the calories you take in from alcohol.
• Chew food thoroughly rather than gulping down the food.
• A small gesture such as cutting back on a spoon of sugar a day or even using the salad dressings or mayonnaise as dips rather than mix with the salads can cut back on calories.
- Try having food on a 9 inch plate with half the plate comprising non starchy vegetables, the other quarter comprising one half of starchy vegetables or grains and the other quarter with protein. The tendency to have plate of 12 inches is quite common these days to get value for money.
- Some dairy product can be added such as glass of low fat milk or low fat yoghurt. No second helpings! Food must not be more than an inch deep in plate ………!
- Eat slowly, chew well. It gives enough time for the brain to register the stomach is full.
- If you feel hungry after meals, try brushing your teeth or drinking water or having non starchy vegetables.
- Eat more of vegetables which are non starchy ( those grown below the ground contain more starch)
- Choose whole grains instead of processed grains
- Use liquid oils rather than solid fats (solid fats contain high amounts of saturated fats which have high calories)
- Use non fat or low fat dairy products
- Drink water in plenty. Use less of fruits juices, cocktails, alcoholic beverages.
- Lentils and kidney beans have more proteins and less fat
- Beware of high calorie snacks which taste good
- Beware of junk food.
Some of the commonly used items and their caloric values:
Item Quantity Calories
Canned beans ½ cup 127
Bread One loaf 70
Normal butter ( salted) Big spoon 102
Non fat creamy cheese 28.35 g 23
Low fat cheddar cheese 28.35 g 79
Half fat creamy cheese 2 big spoons 64
Full fat mozzarella 28.35 g 90
Non fat yoghurt Cup 137
Flavored non fat yoghurt Cup 162
Low fat yoghurt Cup 155
Flavored low fat yoghurt Cup 250
Full fat yoghurt Cup 150
Flavored full fat yoghurt Cup 292
Non fat milk Cup 86
Full fat milk Cup 150
Boiled egg One 66
Egg mixed with oil fried 2 197
Fried falafel 28.35 g 111
Dried dates 5 114
Fried potatoes ½ cup 87
Fruit juice Cup 117
Beef 85.05 g 176
Roasted beef 85.05 g 211
White rice ½ cup 103
Brown rice ½ cup 108
Spaghetti macaroni Cup 197
Nuts ¼ cup 161
Peanut ¼ cup 212
Almonds ¼ cup 211
All oils One big spoon 120
Mushroom Cup 18
Mixed vegetables 1 cup 38
Ice cream 10-12% fat ½ cup 143
Fruit salad ½ cup 47
Chicken 28.35 g 56
Some have cereals with milk or some just put in a handful or two into their mouth and chew on them. The market is flooded with innovative labels and cereal boxes have attractive packs to lure the people. Most of the cereals are made targeting the kids and so they are rich in sugar.
• Go for the ones made for adults
• Read the nutrition labels well
• If sugar is written near the top half of the label, it means the sugar content is more.
• High fructose corn syrup, honey coated cereals, dextrose are all forms of sugar.
• Look for serving size- some may have one cup, some half a cup
• Look for calories per serving- Go for the ones which have < 160 cals per serving.
Go for adequate portions of vitamins and minerals, have some fruits and vegetables and limit trans fats, saturated fats.
Did you know?
• Stress levels and infections can increase the sugar levels.
• Sports drinks contain as much sugar as in a fizzy drink
• Dried fruits contain more carbohydrates
• Birth control pills can increase the sugar levels.
• Prolonged moderate intensity exercise can predispose to low sugar during or after the exercise
• High intensity exercise for a short time can lead to high sugars!
• Cold temperatures and high altitude can increase the risk of low sugars
• Repeated episodes of low sugar can reduce the body`s ability to recognize low sugar. The counter regulatory response by the body is also blunted in such patients.
Is this the shape of things to come?
This is an interesting concept to follow:
To get the maximum of the food one has try these tips:
Pick food from different groups such as using fruits, vegetables, low fat milk, yoghurt, whole grain bread, pasta, brown rice, lean meat, fish, poultry and eggs.
Keep a track of unhealthy eating habits:
- The day and time of the day
- The mood at that time
- What one was doing at that time
- The location
- Portion sizes
Fasting from dawn to dusk in the holy month of Ramadan for healthy adult Muslims has been ordained and physically sick Muslims are exempt from it. However many Muslims with mild to moderate Diabetes, Hypertension and other medical conditions do want to fast.
The purpose of this presentation is make some recommendations how one can fast safely in light of research on fasting. Many are concerned they cannot fast when they have diabetes mellitus . Please consult with your doctor.
Some people may need some tests to be done to assess fitness for fasting.
The salient features of fasting are :
It is a voluntary undertaking rather than being ordered by a physician
There is no selective food intake i.e. protein only, juice only, fruit only , water only etc
There is no total calorie malnutrition i.e. it not a semi starvation diet.
An exercise in self discipline i.e. from constant nibbling , drinking, smoking etc
Psychological effect on the body and additional prayer give additional peace.
People who should ideally not fast, but can fast under supervision
Diabetes Mellitus Type 1
Those who get recurrent low sugar levels.
Chronic Renal Failure including Renal Transplant
Severe heart and lung conditions
Physically sick ( Quran 2: 184-185)
Traveler on a journey
Women during menstruation
Pregnant and lactating women
pre pubertal children
Do you know?
Blood glucose and Insulin levels will fall during the fast.
The first few days will take some adjustment. If in doubt( headache, sweating, dizziness) check sugar or blood pressure.
What to do during the fasting:
Beware the sweets and the fried food.
Remember that by eating throughout the night will not help one tide over the next day. Instead indigestion and gas related problems may set in.
Fluid intake must be adequate during the night to make up for the reduced intake during the day
Having too much of sweets or fried food during the Sahoor can lead to dryness of the mouth which can be a cause of concern during the fast.
Points to remember while breaking the fast at Ifthaar:
- Drink enough water, butter milk or juice. A glass of water melon juice, butter milk or tender coconut water will be a good option to break the fast. One need not add glucose. Water melon juice is sweet by itself and usually people add more sugar. Water melon has a higher glycemic index.
- Try to be careful with the fried and sweet food. Take them in moderation.
- Have a good Ifthaar or Isha meal. Have your prayers and then go for a walk to allow digestion.
- Have some fruit at about midnight if need be. Have a good Sahoor of needed.
- Avoid too salty food at Sahoor as that can make the mouth dry forcing more fluid intake.
- Check the sugar level 2 hours after Ifthaar to decide whether any additional dose of medicines is needed.
Exercise and Ramadhaan
One can exercise during the month. Please check the sugar before exercise. One can exercise lightly before Isha or after the heavy meal.
Try to avoid strenuous workouts as the body may be tired due to the lengthy fast.
Those who want to exercise before Iftaar should check their sugar before exercise. If sugar is below 100mg(5.5 mmol/L) avoid exercising.
Those with type 1 diabetes are exempt from fasting as their sugar levels are dependant on insulin. However, there are some who do fasting alternate days only. This is depending on your health status.
Some more tips
Check sugar levels just before Ifthaar and before the Sahoor meal.
One can check the sugar levels at 7 am before going to work. If the sugar levels are either too low or too high, it is wise to seek medical advice immediately. You may be advised to forego the fast that day.
Time your medicines between Iftaar and 1am.
If on long acting insulin such as Glargine or detemir, it is advised to take 20% less either at Ifthaar or Sahoor time
Normally the doses of most of the medicines could be reduced during the month.
The medicines have to be tailored in such a way that there is no hypoglycemia
Be careful of sulphonyl ureas and rapid acting insulin
Among the sulphonyl ureas, gliclazide is safe in that the chances of hypoglycemia is lesser and the weight gain is minimal.
Intermediate acting insulin are avoided during the month due to the 10-12 hour action which can go into the period of fasting
The essence of Ramadhaan is the same all over the world, but the flavors may differ.
Have a blessed Ramadhaan
Though close to 85% use the internet even if from the low socioeconomic population, digital technology and web based application usage has been very slow to catch on when compared to the boom experienced in the retail shopping and banking sectors worldwide. The vast majority of online communities, mobile applications ( Apps, as they are commonly known) and web sites have been very sluggish in integrating with the mainstream health care stream.
Social networking sites such as Facebook, Twitter, Instagram, WhatsApp and many others I am unsure of, have helped transform social life in a big way to a point where people avoid face to face contact. But these sites have also helped create a platform to support sharing of knowledge, communication and understanding, lever positive behavioral changes and also help in using the audiovisual mode of communication which lingers longer in memory.
More frequent consultations will be costly and not affordable to many even this day. This way of e- health will help tide over this if used well. This will help in increasing treatment adherence, health related behaviors as well as give a feeling of being looked and cared for.
But, there are some barriers to accepting the digital technology such as :
- in those with physical or visual impairment
- those who are illiterate
- those who do not read or speak english
- those residing in geographically remote areas
- those with social phobias
- those concerned about their privacy
Telephones have become more than just a gadget to either receive or make a call. With the new generation smartphones, one can record conversations, take excellent photographs, transfer them instantly through internet, chat with friends on the social media, create presentations for meetings, store data in excel format, fax documents, scan documents, use the phone as an organizer, store songs and movies which can be played when alone or bored. Now – a days, these smartphones have also taken the role of a health assistant which can track the progress in exercise schedule, diet, weight loss, and store personal data such as sugar readings over the past 3 months with a graphical representation included. These can be uploaded where you are on this planet and can be linked to the doctors phone for an instant viewing. The list is endless. Maybe there is an app which can remind one to take the medicines on time in case one has forgotten.
There were days when people used log books to record their sugar readings and might even forget to get them when coming for the consultation. Now – a – days with advancements in technology, there have been significant developments in the way a person with diabetes can record their progress or even hide their frustrations by making excuses such as worn out batteries and even having forgotten them at home.
Things have become so technological these days with the data being uploaded to a remote system or a good mobile devise or even the doctors chambers. This comes particularly handy among the young children who sometimes tell lies to escape the wrath of their parents. The data is instantly shared with the parents phone devise helping them keep a track of the events.
There are numerous applications ( Apps) which can be downloaded either for free or for a price which can help in various functions and even take over as a personal health secretary. The list is so vast and all have not been mentioned here. Some are free to download , some have to be paid for.
Some apps for nutrition include : Fooducate, Carbs and Cals, Carbmaster free, calorie counter, calorie tracker, daily burn, lose it, Go meals, weight watchers mobile
Some apps for exercise include: my fitness pal, run tracker,workout trainer
Some for glucose monitoring include: Bant, dLife, Glucose buddy, GluCoMo, Wave sense, Glooko, DBees.com, Glucatrend diabetes, VRee, On track, Handylogs sugar
Ihealth wireless smart glucomonitoring system and TelCare wireless glucose meter can help synchronize ( or sync ) the data with an App, website or even an i cloud.
This is a devise connected to a glucometer which can transfer data to a remote system or website.
This is a cable connecting a phone to a glucometer. This can be uploaded to the cloud .
Some of the Apps can even show long term trends and graphically represent them making the visualization much better ( if all is going well) . The only problem is one will have to enter the data and allow the App to take care of the rest. This data can be shared with the health care provider almost immediately which helps taking health care to another level.
Diabetes Pal- this helps even recording and advising on level of physical activity and can record the glucose readings as well.
This app lets you record blood glucose levels and note the time of day—such as “before breakfast” or “during activity.” You can view trend graphs, interact in the Glucose Buddy forums, and record insulin injections, exercise, and food eaten. You can also sync your phone to an online account to manage your data on Glucose Buddy’s website. Devices: iPhone, iPod Touch, iPad
Manufacturer AgaMatrix’s app lets you log blood glucose levels and type in personal notes. You can record the amount of insulin injected and the number of carbohydrates eaten, and view one-, three-, seven-, 14-, 30-, and 90-day trends in graph or chart form. High, in-range, and low readings are color coded in the logbook. And you can e-mail your stats to family or your doctor. The app comes loaded with about 50 diabetes-related videos. Devices: iPhone, iPod Touch, iPad
With this app one can log and store the blood glucose level as well as food intake, blood pressure, weight, exercise, pulse, A1C results, body fat percentage, and medications taken. For each entry, personal notes can be added. Results can be exported via e-mail to your medical team. Devices: Android phones
Track weight loss, daily food intake, and exercise with this comprehensive app. Meals taken can be added instantly (from a list of common foods, brand-name foods, and restaurant meals, or own recipes) and watch the sliding scale climb toward the recommended daily calorie limit. One can record exercise (choose from a long list of activities), graph the weight loss, get reminders, and share the progress on Facebook and Twitter. Devices: iPhone, iPod Touch, iPad
Calorie Counter by MyNetDiary
With this app, eon can record meals (choose from an expansive food library that includes restaurant picks), exercise, water intake, medications, weight and measurements. Food selections include nutrition facts
This app gives an idea of food and how it affects the sugar, recipes and even short videos. The diabetes website dLife makes a diabetes application that you can use to log glucose levels, find recipes and nutrition information, watch dLife videos, and connect with the dLife community and experts to get answers to your diabetes-related questions. Aside from logging the sugar levels, you can graph daily, weekly, or monthly levels and track trends—all of which can be e-mailed to yourself or your health care provider. Devices: iPhone, iPod Touch, iPad
This app could be your shopping companion on the next trip to the grocery store. You can scan barcodes, search for products, and browse categories to find foods you’re shopping for. By selecting a food, you’ll get a list of health pros (100 percent whole grain!) and cons (loaded with high-fructose corn syrup!) and can compare it to similar products. Keep track of products you eat regularly by “liking” a food. Then, next time you hit the store, you can pull up a “my likes” list of foods you might want to buy again. Devices: iPhone, iPod Touch, iPad
7 MINUTE WORKOUT
This is an app which can fit into any routine, has 12 simple exercises which are scientifically formulated.
This has exercises for strength training, yoga, cardio and stretching. All one has to do is to select a workout category, and how long the exercise plan should be for. Accompanying videos will help show how to perform the exercises properly with minimum injury and maximum effect.
This is an app which is ideal for those interested in cycling, running, swimming and biking. This has an in built Goal Coach which sets a realistic goal to follow.
ManageBGL is an app that offers a simulated insulin pump. This is of use among those who are having Type 1 diabetes or those having type 2 diabetes with multiple doses of insulin.This needs some input such as current and previous blood sugar levels, carbohydrate intake, insulin dose and this will predict the future glucose readings and aid in auto calculation of bolus insulin dose.
To help those who are handicapped with poor eyesight, some glucometers have come with a voice readout.
Sharing the data through social media such as WhatsApp, TalkRay , Viber, Instagram and Facebook have made the modes of sending across data almost instantaneously. If you ever noticed, a once upon a time luxury called email, has now almost become mandatory. There have been instances when patients have even used the above to send me snaps of the medicines they wish to have refilled or even to send me snaps of some ulcers on their foot to help monitor the progress and even to help with their appointments. Scanning and sending their test results from the far corners of the world can be sent across through one of these portals.
Smoking has been the passion of many though the prevalence has come down from a lofty 40% in 1965 to 20.9% in 2006. 90 % of the smokers were below 20 years of age. 18.1% of the adult females and 23.9% of the adult males smoked in a survey conducted across some continents in 2008. It sure must be higher now.
Peer pressure, stress at work, status symbol, a recreation, a pastime, copying their role models all are causes of initiating smoking.
All are aware that smoking is associated with reduced life span, higher risk of different types of cancers, digestive problems, staining of the teeth, leg problems and also problems during pregnancy.
Those who remain in the company of smokers are equally at risk for developing complications– called environmental tobacco smoke. Children whose parent/s smoke had a higher chance of being an asthmatic , having recurrent respiratory infections or even ear infections.
Diabetes and smoking
Among those with diabetes who smoked , the risks were greater than those who did not smoke and had diabetes.
Metabolic control was poor among the diabetic patients who smoked. The following were noted among the diabetic patients who smoked:
• Increased fluctuations in sugar levels and HbA1c, the 3 month average of sugar
• Increased blood pressure and retinal blood flow
• Increased bad cholesterol- LDL and triglyceride
• Associated increase in adrenaline, growth hormone or cortisol which could increase glucose levels.
• There could be associated alcohol intake with an increased high fat diet consumption.
• Less likelihood of exercising.
• There may be a progression of complications such as retinopathy, neuropathy and nephropathy.
Cessation of smoking is an important step in the management of diabetes management. This is associated with less chances of developing a heart related disorder, stroke, cancer or leg vascular disease and improving life expectancy. Those who benefit most are those who quit at a younger age, those who have lesser tobacco pack years. Smoking cessation has health benefits for all ages even after the age of 65 years or even after smoking related complications develop. Mortality rates of those smokers who have abstained for more than 15 years closely approach that of those non smokers.
Withdrawal symptoms -craving, depression, anger, frustration, irritability and sleep disorders.
The treatment of withdrawal includes psychological treatment, positive reinforcement and medicines which help to replace nicotine such as nicotine patches kept on the skin ,nicotine containing chewing gums, lozenges, nasal sprays or even inhalers.
Menthol cigarettes or low tar cigarettes do not reduce the risk for hazards to smoking.
Electronic cigarettes have not yet been approved for withdrawal, though many claim to find them beneficial.
Benefits of cessation of smoking
Half of the excess cardiovascular risk is eliminated in first year of quitting. There is 30- 50% excess risk for lung cancer even after quitting for almost 10 years.
The highest risk for the development of type 2 diabetes occurred in the first 3 years after quitting but this risk gradually declined to 0 at 12 years.
In lighter vein…….
- 46% admitted to not eating sweets when smoking and 38% admitted smoking calmed them down…..
- But, those who stopped smoking were found to gain 3.8 to 4 kg per year in men and among women a 2.8-3 kg increase per year. But, this increase can be prevented by good lifestyle management.
- I even had patients tell me they felt smoking was able to control their diabetes better due to the absence of weight gain as well as by not eating sweets. But, the hazards of smoking outweigh these small “benefits”.