Lifestyle modification involving adequate physical activity is a cornerstone in the management of diabetes. It complements the effect of the medicines used in the management. There are different forms of physical activity both indoors and outdoors which can be followed towards reaching the goal.
Fishing is a popular outdoor recreational activity which can be followed by any person or any age or gender irrespective of how fit you are. There may be parts of the world where fishing is not practical due to paucity of fresh water lakes. Going fishing has often not considered as an exercise.
There are different types of fishing- it can be a leisurely type where one casts the line and waits for the catch while sitting on a chair probably reading a book or drinking beverages or snacking which might be rich in calories or can be as part of a sport or can be fishing while kayaking which are demanding.
The benefits of fishing are many such as the following:
- It is an enjoyable pastime where one can liaise with the beauty of nature in silence except for the sound of the water rhythmically rapping against the hull of the boat or the rocks and the sound of the sea gulls, crickets or frogs depending upon the location.
- This translates into a wealth of emotional, mental and physical benefits due to the relaxation involved.
- The absence of television, computers or even phone range signals might even relax one even further.
- The relaxation lasts long after the fishing is over.
- This can be made enjoyable by going along with friends or families or classmates. These days one spends a lot of time on the screen that prevents face to face contact, laughter and discussions in a real world setting.
- Even if going alone, one can use the time to reflect, listen to songs or even make decisions which would not have been possible in a regular day to day life.
- Generally the air will be pollution free which is good for the lungs and health. It also helps those with respiratory problems.
- One will get plenty of sunshine if fishing during the day which is good for vitamin D as well as for the body rather than spending time indoors.
- While fishing, one may have to move up and down the bank of the water body to set an ideal place for the catch. Sometimes one will have to wade in the water knee or waist deep which involves core muscles as one fights to regain balance against the water current which helps as a passive strength training for the lower abdominal and leg muscles.
- Fishing is a low impact exercise. Casting the line, rowing the kayak or climbing rocks to reach a better position all help to strengthen the arm muscles as well as the back. A lot of muscles which are rarely used in day to day living are used while fishing.
- Some even cook their catch and make the whole day affair very enjoyable.
While embarking on fishing it is wise to have someone experienced in this field to help tide over a crisis or unpleasant surprise. One will need to also be familiar with the local geography and possible currents and weather changes. Certain areas might need the use of means of communication other than the regular mobile network.
However as with any exercise or sport, injuries while casting, threading the bait, reeling in as well as injuries by the bite of the fish or slipping while wading are possible.
The above article was taken with permission from https://outdoorempire.com/11-reasons-fishing-makes-you-healthier-happier/
There are many types of insulin each working in its own unique manner, some types of insulin are suitable for one but not for another. Normally basal insulin acting for almost 24 hours is used once at night and rapid acting insulin used with the main meals is used thrice or twice as the case warrants. Most insulin preparations come either in pen delivery devices which are disposable or refill pens. Some preparations of insulin still come in vials or small bottles. The pen delivery devices are easy to use and for those who are visually handicapped there are audible clicks while turning the dose dialer to help know the dose. The basal insulin is clear looking insulin. This acts for 16 hours to 36 hours. Normally does not cause low sugar spells and can be taken before or after food. The dose is usually dependent upon the fasting sugar levels. There is also premixed insulin preparations available which is a combination of short acting and intermediate acting insulin.
The commonly available basal insulin ( long acting) preparations in Oman are: Insulatard®, Detemir ( under brand name Levemir®), Glargine 100 units/ml( under brand name Lantus®), ultra long acting Degludec (under brand name Tresiba®) and ultra long acting Glargine 300 units/ml (under the brand name Toujeo®).
The bolus insulin (rapid acting insulin) comes either in small bottles or vials or pen delivery devices (either as disposables pens or those which can be refilled with cartridges) This insulin is clear looking insulin. This is generally taken 15 minutes to half an hour before the main meals.
The commonly available brands in Oman are Human Actrapid®( which can also be given into the veins in the hospitals when sugar levels are really high) Humalog Lispro®, Novorapid ® and Glulisisne ( under the brand name,Apidra®).
The basal ( long acting) insulin is preferably injected on the thigh and the rapid acting insulin on the abdominal wall avoiding 2 finger breadths around the navel or belly button.
The commonly available premixed insulin preparations available in Oman are Human Mixtard 30/70®, Humalog Mix 25/75®, Humalog Mix 50/50®, Novomix 30/70® and Novomix 50/50®. Because there is a clear and a milky insulin as the constituents, the insulin preparation bearing vial or cartridge will have to be shaken before use.
There are some barriers facing the patients and the treating doctors when advising insulin. The fear of low blood sugar levels, the fear of the pain associated with the needle prick, the need for having to check the sugar levels frequently, the cost of the insulin, the possible negative impact insulin can have on ones social and married life, the scary feel associated with the insulin, the impact insulin has on ones friends are the common barriers. There are some who have seen their near or dear ones die or having developed a kidney failure or having amputated a limb after staring insulin. They feel the insulin was responsible for all this. The uncontrolled sugar levels can damage the eyes, the nerves, the blood flow to the legs, the heart, the brain, kidneys and once the damage has set in, insulin cannot help reverse the damage, but can help further worsen the damage. The insulin can cause weight gain, might cause allergy or numbness for some and episodes of low sugar when the patient has taken too high a dose and either exercised or taken less food.
Insulin is safe during pregnancy, in those with very advanced kidney failure and heart failure.
There are however some points to be considered while using insulin:
- Insulin is to be stored either in a cool room. It is never to be frozen by placing in the freezer. If frozen by any chance, it cannot be thawed and is best discarded.
- Insulin can be taken along while traveling by carrying it wrapped in between ice packs or by using cooled gel holders. Sometimes you might need a certificate while traveling to be allowed in the cabin bag.
- Never leave insulin in the car especially during the summer as it can get damaged and lose its efficiency.
- Always check the expiry date especially while buying large amounts of insulin.
- Do not inject cold insulin. Roll the pen between the palms of the hand for six to seven times to lightly warm it.
- Rotate the site every time you inject.
- The site to be injected must be lightly cleaned with a swab. Check the site of injection for small swellings or bumps. These sites are to be avoided as the insulin will not act well if injected into those areas.
- The dose to be injected is dialed if using a pen insulin delivery system.
- Inject perpendicular to the skin after the needle is plunged fully. Plunge the dialer button to deliver the insulin.
- After the dose has been delivered, count to five and remove the pen, lightly wipe the injection site and cap the pen again to place it back in the refrigerator or in a cool room away from direct sunlight. Sometimes a drop of blood is seen coming after the injection. Light pressure to that site for half a minute will help.
- There is no need for a vigorous massaging of the site after the injection has been given.
- You will need to have the food consumed within ten to fifteen minutes of the rapid or premix insulin shots to prevent low sugar levels.
- Dispose the needles in a sharps container. It is advisable to change the needles after every injection.
- Do not wipe the needles with an alcohol swab as it removes the silicone coating on the needles and makes the injections painful.
- The dose of insulin will have to modified when traveling by long haul flights involving more than 15 hours either towards the East or the West.
- If going for a party at night, it is safe to take the long acting insulin before the party if the patient is on a mix of short and long acting insulin. Take the rapid acting insulin after you come back home, and checking the sugar levels. Taking the rapid insulin before the party can lead to low sugar levels as there will be a delay in eating the food. Moreover, one is not sure of the kind of food either and how much one would consume.
- During Ramadan, please consult with your doctor on how best to take insulin.
- The dose of insulin always remain the same. The dose of insulin depends upon the sugar levels while checking.
- If I am sick and have not taken food, I do not need to take my insulin shots. When sick, though the appetite is compromised, the sugar levels will be high in response to the body`s defense mechanisms. Check the sugar levels and inject accordingly after consulting with your doctor. You might need either a smaller dose or higher dose depending upon the sugar levels.
Normally one unit of rapid acting insulin corrects sugar spike caused by intake of 10-15 gm of carbohydrate. (this is called the insulin to carbohydrate ratio) The carbohydrate content of food can be understood by referring to apps available on the smartphones or by checking on some sites such as www.carbsandcals.com
Another number to known is the insulin sensitivity factor. If you divide 1800 by the total dose of insulin taken in a day it will give the insulin sensitivity factor. Suppose you inject 50 units of insulin a day ( add all the insulin doses taken on a day), divide 1800 by 50 to get 36. This means by injecting one unit of insulin 36 mg/dL or 2 mmol/L of sugar comes down. This number will vary from person to person.
There are so many new insulin preparations and combinations being researched and soon to come into the market.
Points to consider while exercising if you are on Insulin:
Please check the sugar levels before exercising. If sugar level is < 5 mmol/L or 90 mg/dL, take 20 g carbohydrate, wait till the sugar levels reach 7 mmol/L ( 126 mg) . If sugar levels are between 10-15 mmol/L( 180-270 mg/dL) you can still exercise but be reminded that the sugar levels go up while exercising. If sugar levels before exercising are above 15 mmol/L (more than 270 mg/dL), check ketone levels in blood( there are blood ketone meters available with Freestyle® which uses a test strip for ketone like using the glucose test strip) If the blood ketone is between 0.6 to 1.4 mmol/L, you can do moderate intensity exercise and drink more fluids for half an hour. If the blood ketone levels are more than 1.5 mmol/L, you need to meet the doctor for correction of the sugar and ketone levels with insulin and IV fluids. Upper abdominal pain and nausea or vomiting can be sign of high blood sugar levels.
During the exercise you might need to snack in between depending upon the duration . An exercise time of not more than an hour needs no carbohydrate replacement, if the exercise duration is between an hour to 2 hours, take 30-60 gm carbohydrate snack and some water. If the exercise duration is more than 2 hours, take 30 gm carbohydrate every 20 minutes with water.
Prevention of low sugar levels after exercise : If doing exercise 2 hours after taking basal insulin, reduce the dose of basal insulin by 20%. If doing the exercise in the late afternoon or evening, reduce the dose of basal insulin by 20% at night to prevent low sugar episodes. A short sprint before or after the exercises causes a spike in sugar levels which prevent getting low sugar following the exercise regime. A proper cooling down after exercise can prevent the high sugar levels soon after exercising.
New insulin delivery devices .
This is a super slim pump device which delivers only bolus (rapid acting ) insulin. The cartridge can store 200 units which means less frequent refilling of the insulin. Squeezing 2 buttons simultaneously on the pump allows 2 units bolus dosing.
- Companion Medical`s InPen®
This is the first insulin pen with in-built Bluetooth- sends the dose data to a phone and app automatically. This calculates and recommends the optimal dosing of insulin, tracks the history and timing of the dose, monitors the temperature of insulin, displays the last dose and insulin on board available. This can even send reports to the health care team if synchronized.
This a Bluetooth enabled meter which helps in diabetes education by paying an annual fee besides monitoring sugar levels and administering insulin.
- Tandems T Slim X2, OmniPod Dash System also are soon to hit the markets.
Some new glucose monitoring devices:
- Abbots Lifestyle Libre Pro®-
After the sensor is applied on to the body, there is no need for the patient to interact with the system. There is no need for the finger stick calibration. This can monitor 2 weeks of continuous glucose monitoring.
This is a contact lens with a reader device which can check the sugar levels from the eye tears. The lens has a wireless chip and a miniaturized glucose sensing device. A tiny pin hole in the contact lens helps the tear drop to seep in for glucose sensing. The electronic connections lie outside of the normal eye thus not harming the normal eye. There is a wireless antenna inside the contact which is thinner than the human hair and this helps to communicate the information to the wireless device.
- Medtronics MiniMed Pro Infusion®-
This has a very small catheter and has lesser tendency for blockage. The tubing has a side port which be used for insulin delivery even if the main port is blocked.
This calculates and recommends precise bolus dose. This prompts the patient to take action by predicting low levels. This has an inbuilt continuous glucose monitoring devise. The insulin can be delivered every 5 minutes, if set to deliver so.
Forgetting things has always been a matter of concern for most of the people. Most are concerned about the scare of Alzheimer’s as well. It has to be emphasized that our forefathers had been much better off during their days. Just as the body ages, the brain too ages and so also a decline in cognitive power can ensue. That is inevitable, but one can delay the onset and slow the progress of the decline with some efforts.
Now- a- days with the advent of improved technology, people are able to communicate better and faster and people from across the globe can be connected easily, but it has caused other problems as well. People are so busy peering into their mobile phones or electronic gadgets, they get frequent eye strain issues and dry eyes, neck and back pain due to the hunched posture, finger pain and wrist pain due to punching the buttons and have the lost of communication and eye contact. There are, however, a lot of people who use the mobile devices as an organizer which stores telephone numbers or helps schedule their appointments or remind them of things to be done. It has reached a point where people have almost stopped taxing their brain or mental capabilities to a point where they do not even recollect their families phone numbers !!! Strangely, many pharmaceutical companies have started capitalizing on this weakness and have brought about “magic cures” to help boost memory. Some medicines being taken for regular ailments have also been implicated in loss of memory !
Most of the time, the brain is not stretched to use its full potential causing it to be dull and lazy.
There are some good and harmless ways to get over this handicap before it gets out of control.
- Reading a book
- Learning a new language
- Play games
- Visiting a museum
There are good steps which can be done to help wake up the “sleeping brain”. There are the right handed and the left handed people. For the right handed people the right side of the brain is not used much and likewise for those who are left handed.
Neurobics is a type coined for the exercises which help the brain.
Playing Sudoku, chess, solving crosswords or the Rubiks cube are effective neurobics. Writing or drawing with the non dominant hand helps wake up and fire the sleeping side of the brain.
Trying to guess the dish by tasting it while blindfolded also helps to stretch ones imagination. You can add up fun by asking to guess the ingredients used in the cooking of the dish.
Playing exergames ( video games which involve exercise as in X box, play station, Kinect or Wii Fit ) helps creative skills and burns calories as well. These are particularly useful for those staying in places of extremes of climate, for the aged, for those shy to go outdoors and for those who do not have many friends. These also help the younger generation to bond well with the elders and people with joint problems can get moving as well. I do agree a walk in garden or beach side or a park will have its own benefits, but if unfavorable, this is a good alternative.
It goes without mentioning that adequate sleep, getting enough sunshine, exercise, having a good social support and a healthy diet all help in boosting brain power.
Try remembering phone numbers or appointments without the help of the mobile gadgets or the organizer.
Socialising and staying calm also help boost the brain functioning. Being stressed out does jolt your brain to standstill. When you are stressed, the brain refuses to think straight.
Though there are medicines which do claim improvement of brain ability, I am not competent enough to comment on those. I would rather you try boosting the mental power the natural way.
It is a welcome change in the climate after months of scorching heat in the middle East. This might last for a couple of months before the scorching heat picks up again. It is the time for outdoor partying, smell of inviting barbeques and probably increase in bad cholesterol levels !!!!! It is also the time for contracting viral fevers. Have you had your annual flu shot? The Flu Vaccine at least helps against many of the strains of virus which are getting more complex with each passing year.
Losing weight is something the doctor always stresses on. Interestingly, you might notice that the males are generally reluctant to address the obesity as well as their female counterparts. Moreover, weight loss is slower among those with diabetes due to the medicines they are on and also due to diabetic dysregulation. But , that cannot be used as an excuse for losing weight or even trying to.!!!! There is always a weight loss plateau that is to be expected and that should not deter yourself from continuing, but will need a self assessment as how to overcome the plateau.
Many now blame the cold weather and cold breeze and wish to remain cuddled under the blankets or remain indoors and try eating more to keep the body heat.
Impulsive eating can occur when stressed ( positive stress is during a vacation and negative stress during a personal tragedy) , when angry, when depressed or when worried about an upcoming event or even when stewing over a conflict at office or work. This often leads to impulsive eating followed by the guilt and again feeling low followed by eating again which gets you nowhere healthy !!!
Bed time snacking
People might keep on snacking to give them the so called energy while staying up awake while working late hours. There are certain occasions when you are allowed to snack especially when having an early light dinner and sleeping late. But, there are certain things to be known while snacking.
- Warm milk contains tryptophan and helps in sleep
- A bowl of cereal with milk or a glass of labaan( butter milk) , crackers or bread and cheese all can cause sleep due to the carbohydrate content.
- Sources of hidden caffeine and fatty food such as burgers can impair with sleep.
- Alcohol ( nightcap) might cause nightmares, frequent awakening, night sweats and headache for some which can impair with sleep. Drink plenty of water after the sleep.
- Protein rich and high fat food will cause problems in digestion which can impair sleep.
- Spicy food and smoking can impair with digestion.
So make healthy choices while snacking. Snack is just a small meal and not another meal.
The winter months are a cause for celebrations and family outings . The smell of barbeque fills the air after the sun sets. People might eat more of meat and prawns which might increase the cholesterol levels. You can however go a walk outside as the climate is much better than the hot humid summer climate.
Generally sugar levels and cholesterol levels rise with the increased food and alcohol consumption during the winter months.
You can safely exercise indoors if the weather outside is not to your liking. Tai Chi, Pilates, using the Hula Hoop, dancing to music, yoga, skipping rope or just spot jumping helps burn calories. Zumba or kick boxing are options that needs a trainer to help you out. For the fitness freaks who like to sweat it out in a gym, try something new at the gym or use resistance bands. You can swim or do any exercise in the pool as water is kind to the joints. Aqua aerobics is catching up in a big way as it is entertaining and kind on the joints as well. One can enjoy shopping by walking in the malls and doing window shopping !!!! Walking is still a good exercise. Take care of your footwear and use proper clothing if walking outdoors. Cover your head and neck if very chilly. The new form of play station using the X box helps you engage in interactive games and helps you combine entertainment with exercise and it can be enjoyable when performed with either family of friends.
For those who are interested in resistance training using small weights, remember to always warm up, stretch and do repetitions of ten to twelve in a smooth controlled motion. The muscles might ache at the beginning, Give a rest in a between and try these on alternate days to help the muscles to recover.
How to overcome barriers to exercise?
- Break the times of exercise to smaller periods if it not practical to spend 30 minutes a day for five days a week.
- Identify causes of waste of time such as watching the television, lying on the sofa. See if these can be overcome.
- Reframe the concept of exercise such as walking the dog or taking the kids for playing, playing ball on the beach or even dancing, walking in a mall, walking around a large airport terminal while waiting for the flight.
- Join a group who can motivate you.
- Watch the television or listen to music while exercising.
- Take stairs instead of the lift or escalators.
- When ill, do not exercise.
There are numerous apps which can be downloaded from the app store if you have a smartphone. These can monitor the progress and can even motivate you to get moving.
Ask yourself why you want to lose weight:
|Feel comfortable in clothes
|Improve self image and confidence
|Improve physical stamina
|Improve energy levels
|Be a role model for my family
|Improve the blood pressure, cholesterol and diabetes
|Reduce joint pain
|Improve life expectancy
You might want to add more…..such as want to look good at a function or don those clothes which you outsized and so on…..
Write down the challenges and obstacles you face towards achieving the goals. The more honest you are with yourself, both in recognizing the obstacles and coming up with realistic strategies, greater are your chances at succeeding. Let that be your New Year resolution.
Urinary problems can happen to all people at some time of their lives. Most of the time, the women tend to ignore this till it becomes very advanced. The presentation: The urinary problems may present as a delay in passing urine, it may be as recurrent urinary infection, it may present as a sudden urge to pass urine and if not voiding, it may spill ( urge incontinence) or can leak when coughing, laughing or sneezing( stress incontinence) This may occur with advancing age when the muscles controlling the sphincters are not strong enough to hold the urine. This can happen for some following operations on the uterus. Most of the women tend to hold back urine till they feel the toilet is clean and hygienic. During the menstrual cycle when the blood flow in the pelvis is more than normal, urine flow may increase. There are many factors that can be the cause for the problems. Urinary problems also can occur among those women who have had many deliveries during the child bearing age. Prolapse of the uterus ( uterus coming down) is another cause for urinary problems among women. When sugar levels are high, urinary output will increase. Infection of the terminal part of the urinary system,the urethra, may also cause urinary frequency. Other causes:
- Too much of fluids over a short period of time can cause urgency. However, too little fluid intake also will cause the urine to get concentrated when the urine gets dark and this can irritate the bladder causing urgency.
- Acidic fruits such as grapefruit, orange, lemon, intake of spicy food, tomato based products, corn syrup, carbonated drinks, caffeinated drinks, alcohol, use of artificial sweeteners, chocolate, and cranberry juice can increase urine output.
- Certain medicines can upset the bladder function. Drugs used to control blood pressure, those acting on the heart, those acting as diuretics, muscle relaxants, some sedatives, some anti depressants and some anti histaminics are known to disturb normal bladder habits.
The solution: Exercises: Improving pelvic floor muscles by doing Kegels exercises can help in a major way. Squeezing the pelvic floor muscles as if trying to stop urination can help improving the strength of the muscles. There are some people who place a weighted cone into the vagina and contracting the pelvic muscles to prevent it from falling also helps. Personal hygiene: The manner in which some women wash their private parts with a full jet of warm or hot water as a hand shower jet is to be condemned. The actual manner of using a tissue paper is to wipe from top to bottom and not from bottom to top as it may cause contamination from the anus to irritate the urinary system. Water intake: Spread out the water intake during the day and early half of the night. Normally the cold weather can trigger urination. Leading a healthy lifestyle with dietary changes and adequate exercises can go a long way in improving this condition. Cessation of smoking among those who smoke and minimizing constipation are also important.
Feet are, strangely, the most neglected of all the body parts. There are many who pamper their feet, more ladies than men. The feet are an important part to be checked for while being a diabetic. Generally the problems with the feet can occur whether one has either type 1 or 2 diabetes, whether young or old and in any part of the feet though generally the under surface are affected more than any other part of the feet.
Feet are the parts of the body that keep one mobile, that maintain the balance and stance of a person, help drive us around, help us to swim, pedal a cycle, go on hikes or trekking, the list is endless.
Causes of foot problems while having diabetes mellitus:
• Trauma to the foot due to poor or ill fitting footwear, not wearing a footwear,
• Foot deformities such as an in growing toe nail caused by improper nail clipping, having flat foot when the arches of foot collapse, having claw toes, having over ridden toes.
• Poor blood flow to the feet due to small blocks in the blood vessels
• Neuropathy due to diabetes which leads to poor sensation- impaired sensation to temperature changes or pain or touch.
• Lack of proper access to proper education.
• Living alone.
• Poor socioeconomic conditions
• Poor control over blood sugar, blood pressure and cholesterol.
• Previous amputation or ulcer foot
• Poor eye sight
What can be done to prevent foot problems?
DFU- Diabetic foot ulcer
• Maintain good blood sugar and blood pressure control
• Maintain normal lipid levels
• Stop smoking
• Regular exercise
• Check the feet regularly- check for cracks or fissures on the heels. Check between the toes for any fungal infection.
• While clipping the nails make sure it is cut straight taking care not to take the corners. The corners can be filed.
• Do not cut callosities which are thickened pads of skin. Have either a trained podiatrist( who specializes in foot care and pedicure) manage it. You also use a pumice stone after bathing to rub down the thickened skin.
• Apply moisturizing creams on the feet and under surface before retiring at night. Take care not to apply moisturizing creams between the toes as they will retain moisture and favor fungal infection. Use the ones containing Aloe Vera or vitamin E.
• Use a hand held mirror to check the under surface of the feet.
• Use cotton based socks without tight bands. Some socks now come with silicone impregnated gel pads as well.
• Use shoes that are one size bigger. Buy the shoes towards the end of the day when the feet will be swollen slightly. There should be enough room for the toes to wriggle comfortably. Wear and also the sole of the footwear for any nails or sharp objects. Pointed shoes are not advisable.
• Check the inside of the footwear with the hands for any irregularity or wearing off.
• Have the feet checked at least once by a health care provider.
Ingrowing toe nail due to improper cutting of nails
Look at the difference in the left foot
This is a foot disorder that can happen to almost anybody with diabetes. The loss of deep sensation leads to destruction, degeneration and disorganization of the bones and joints of the foot. The foot can be swollen, warm to touch and be red. But, the pulses of the feet will be normal on examination. Once suspected of this, you will be referred to either a foot care team or the orthopedic doctor. Normally, the foot will be immobilized in a cast. This will be removed after a period of time as suggested by the team and protective custom made footwear will be given.
For those who are used to wearing high heel footwear, the pressure while walking is shifted to the forefoot and there will be strain on the Achilles tendon at the back of the foot ( the thickened cord felt behind the ankle)
Regular check up of the feet:
The feet will be checked for color, any cracks, any infection between the toes, any deformities, any callosities, and non healing wounds, any color changes, the skin of the feet, the hair growth and the nails.
Blisters are water filled collections ,corns are thickened skin due to repeated friction, calluses occur usually on the bottom of the feet which are due to thickened pads of skin, and bunions are those out projections seen from the joint of the big toe which is a structural deformity.
Clawing of toes
The feet will be checked for local warmth, the sensation will be checked with a monofilament, the sensation to appreciate hot and cold sensations, vibration sense will be checked. The pulse will be checked for on the feet. The ankle brachial index ( comparing the pressure of the ankle and arm BP are compared to assess blood flow) are checked in high risk feet.
A podoscan can be used to measure the pressure while walking or stepping.
Customized foot wear is often required when there is a problem to the feet which have to be designed by cobblers specialized for this.
There are tests to measure the amount of blood flow to the legs such as an ultrasound Doppler test ( which is non invasive) or an angiogram which is invasive. If blood flow is compromised ,depending on the severity, either medicines or stents or surgery are advised.
Ulcers ( breach of the skin) may heal with medicines or may remain active or in some people may progress rapidly to cause infection. In some cases, an amputation is performed to save the limb or even life. There are many comfortable prostheses available in the market to get over the handicap.
Vitamin D is a fat soluble vitamin which is not excreted through kidneys unlike the water soluble vitamin . Over the past 6 years, Vitamin D has caught the attention of both patients and health care providers alike.
Causes of deficiency:
• Animal based products are richer in Vitamin D in comparison to vegetarian diet.
• Those who spend more time indoors.
• Those using a lot of sun block lotions.
• Those with dark skin absorb less.
• Obese people absorb less.
• Elderly people are more prone as they spend less time outdoors, kidneys do not work well, the skin will not absorb sunshine effectively.
• Some people have digestive tract problems which will not help in absorption. Those with Crohns` disease, cystic fibrosis and Celiac disease are known to have associated Vitamin D deficiency.
In the Muslim population wearing of the ” Abhaya” by the women which covers the whole body as well as the men who wear long robes can prevent sunshine falling on the body. This robe is helpful against the harsh sunlight in the middle east.
Vitamin D deficiency is quite common among the middle East population as they prefer spending more times indoors. Vitamin D deficiency is quite common in the USA or UK because of lack of effective sunlight.
A study was conducted in Hawaii among 93 people who spent an average of 29 hours a week in the sunshine without sun block. Interestingly, slightly more than half of them had low levels of vitamin D !!!.
Sunshine is a good but unreliable source of vitamin D. The vitamin D inactive form absorbed from the intestine and skin are converted to the active form in the kidney.
Dietary Sources of vitamin D
• Fish and fish oils
• Egg yolks
• Fortified dairy products including milk, cheese, yoghurt, buttermilk. Most of the calcium containing food and beverages can be fortified with vitamin D.
• Grain products
One tablespoon cod liver oil contains 1360 IU of vitamin D
3 oz salmon contains 800 IU vitamin D
8 oz fortified milk contains 100 IU vitamin D
8 oz fortified orange juice contains 100 IU vitamin D
Check the nutrition labels for the vitamin D levels which will be entered into the DV ( Dietary value) section.
Assessment of vitamin D levels
Laboratory assays for vitamin D measurement are highly variable from laboratory to laboratory. Different standardizations are there in different labs.
Ordering the test is to be done after careful deliberation by the health care team.
Interpretation of the results
< 10 ng/mL Deficient
10-30 ng/mL Insufficient
30-100 ng/mL Sufficient
How is Vitamin D produced in the body?
Effects of low vitamin D levels
• In children, the bones become soft- called Rickets
• In adults, the bones become fragile and altered in shape which is prone for fractures- called osteomalacia.
• Low levels are found linked to cancer of breast and prostate, high blood pressure, diabetes mellitus type 1 or 2, asthma, depression, unexplained weakness and muscle fatigue, multiple sclerosis, rheumatoid arthritis.
Treatment of low levels:
- Maintenance -Vitamin D is available in tablet forms combined with calcium (available as an over-the-counter form). This is given in those who have near normal levels.
- Intensive- Vitamin D is available as capsules or sachets or even injection forms. This is used for treatment of those with low levels.
Like calcium, this vitamin is a threshold nutrient which means, once levels are normal, any excess ingestion will not be of any benefit. All of the vitamin D cannot be absorbed from the intestines. But, there is no easy test to measure the rate of absorption.
International governing bodies from around the world have recommended the following needs of vitamin:
• Infants up to 6 months of age need 400 Units a day and safe limit not more than 1000 IU a day
• Infants aged between 6 and 12 months need 400 units daily and safe limit not more than 1500 IU a day
• Children between 1-3 years- 600 units a day and not more than 2500 IU a day.
• Children between 4 and 8 years 600 Units daily and safe limit not more than 3000 IU daily
• Those between 9 and 70 years, 600 units a day and safe limit not more than 4000 IU daily
• Those above 70 years 800 units daily and not more than 4000 IU daily.
• Pregnant and breast feeding ladies need 600 IU daily.
Magnesium has a huge role in absorption of vitamin D from the intestines. Soya beans, black beans, sesame seeds, green leafy vegetables and dark chocolate are good sources.
Spending quality time outdoors in sunshine such as playing at the beach, getting a whiff of fresh air or going for a swim will definitely make one more energetic rather than remaining indoors. But, too much of sunshine can also predispose to cancer of the skin .
Tips for Dining Out With Diabetes
Eating less salt can substantially reduce the risk of health problems associated with high blood pressure, which is a risk factor for heart disease and stroke — a cause of death for more than 2 out of every 3 people with diabetes
- Select fresh fruit or vegetables.
- Avoid creamy soups .
- Stay away from bread and rolls with salty, buttery crusts.
- Stay away from fried food or breaded snacks.
- Muffins, croissants and garlic toast are rich.
- Select fresh fruits and vegetables.
- Avoid pickles, canned or marinated vegetables, cured meats, cheeses, salted seeds.
- Order salad dressings on the side and use small amounts of them.
- Be careful of mayonnaise based salads.
- Select plain foods including broiled, grilled, or roasted meat, poultry, fish, or shellfish.
- Select plain vegetables, potatoes, and noodles.
- Ask about low salt menu items
- Request food to be cooked without salt or mono sodium glutamate (MSG).
- Avoid restaurants that do not allow for special food preparation (such as buffet-style restaurants or diners).
- Avoid casseroles, mixed dishes, gravies, and sauces.
- At fast food restaurants, skip the special sauces, condiments, and cheese.
- Avoid salted condiments and garnishes such as olives and pickles.
- Select fresh fruits, ices, sherbet, gelatin, and plain cakes.
Controlling Portion Size at Restaurants
Servings at many restaurants are often big enough to provide lunch for two days.
- Ask for half or smaller portions.
- Eyeball your appropriate portion, set the rest aside, and ask for a take home pack.
- If you have dessert, share.
Beware of the urge to order more and the urge to eat all that is on the plate…
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