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.
Normally during the cold winter months, the levels of HbA1C, the 3 month average of sugar, can be higher due to higher food quantity consumed to combat the cold, the frequent outdoor barbeques and probably excess liquor consumption with the co incident Christmas and New Year festivities. People spend more time indoors in places where the weather is extreme. Lack of adequate physical activity and excess sleeping hours cuddled up under the warm blankets add more insult. It is quite natural to gain 5-6 kilos during the winter.
Blood Sugar Testing
The finger tips may be cold and so warm them by rubbing them together or wrapping them around a hot mug before pricking the finger for testing. In places where it snows, the glucometer kit has to be kept warm in covered bags so that errors do not come in the readings
It is difficult to work up a sweat while exercising during this time and one may feel cold after the exercise due to the evaporation. Remember to dress adequately while going for outdoor exercises. Hydration with adequate amounts of fluids is still important even in the colder months. Dehydration can increase the sugar levels.
Exercise such as skipping rope, doing the Hula Hoop, aerobics, dancing, yoga, swimming in thermal controlled swimming pools or working out in an indoor gymnasium do wonders. The benefits of exercise are the same whether done during winter or summer!!
Some blame the cold for exercising outdoors, but then they also blame the summer heat and humidity when that sets in.
Care of Skin
It is important to take good care of the skin as it can dry quite fast. Adequate and generous application of moisturising creams, and sunscreen if going to winter sports such as skiing or snow surfing or those just trekking in the snow laden mountains are very important. Adequate hydration keeps the skin shining and hydrated.
Those with neuropathy ( where the nerves of the feet are not working properly) may have difficulty in gauging the heat of water used for bathing.
Take care of the feet. Do not use hot water bags to keep yourself warm. Use multiple layers of clothing or socks at night to the feet. In some countries warm fireplaces keep the rooms warm, but beware the carbon monoxide accumulation.
Food & Beverages
Alcohol may cause a sense of warmth caused by dilatation of blood vessels, but the same may be lost after some time. Manage the consumption of alcohol wisely. Try to take hot beverages and easily digestible food such as soups, oats, porridge, steamed food and some fruits. Black tea with crushed ginger and black pepper is a good drink to even soothe the throat. Remember that excess red meat consumption can lead to high cholesterol levels in some races. The temperature can get quite low at night and it is natural people may eat more to raise their body temperature. Remember you do not need that much food at dinner whether it is summer or winter. It is healthier to sleep on a lighter stomach.
Frequent respiratory infections , mostly viral, are quite common. It is wise to have a Flu vaccine taken once a year rather than have to take multiple courses of antibiotics and medications to combat the infection. The elder adults should have a shot of pneumococcal vaccine once in their life.
It is also quite common to get infections due to food poisoning from eating out .
Use tissues, frequent washing of hands using soap and water or sanitizers especially before shaking hands with others help to prevent transmission.
Gargling of the throat with warm saline helps. So also does steam inhalation.
Fizzy cool sugary drinks do not help whether it is summer or winter.
Enjoy the winter because you will wish it was like this when summer blasts in.
Cancer care for women
Cancer is one major problem these days and it has become so common to hear of someone known to you, perhaps, on treatment for cancer. It is better to avoid having a cancer than to be treated for one. I do agree that treatment modalities have improved by leaps and bounds and so also have the investigative modalities. Different cancers affecting different areas of the body are known. However, the common ones known among women are the cancer of the breast, the uterus, the ovary and cervix. The drastic changes in lifestyle and increased use of chemicals in various cosmetics and food have led to a steep rise in the prevalence of cancers.
For women above the age of 40 years should be caring for their breasts as much as probably their face ! All it needs a self examination and the earliest changes can be detected by oneself much quicker than a healthcare professional. This is called breast self examination. One can stand in front of mirror and compare the 2 breasts. If the nipple or breast size varies in relation to the other note that down. Feel the breast while lying down. Use the left hand to feel the right breast and the left hand for the right breast. Feel the whole breast from the collar bone to the top of the abdomen and from the armpit to the cleavage with the flat of the hand in a circular motion. Do not panic if you feel any lumps. All lumps need not be cancer. There are lumps which may come and go during the menstrual cycles. Normally the upper and outer part of the breast has the most of lumps. The lower half of the breast can feel like sand on a beach. The area under the nipple can feel like big grains of sand.
It is wise to have the breast examined annually by a doctor who is trained to do so. The doctor will examine the breast by inspection, by feeling for any changes, feeling for any lumps in the breast or in the armpit. The doctor will confirm the presence of lumps by doing an ultrasonogram of the breast. This will detect any lumps hidden in the breast tissue. Sometimes a piece of tissue is taken with a needle which will be inserted into the suspicious lump. A mammogram, a type of X ray examination, will also be performed by the doctor which will have some radiation, but will view the breast in multiple views by pressing the breast tissue for better delineation of any masses. The doctor will look for asymmetry, inversion of the nipple, spots of calcium in the breast tissue and skin deformity. Make it a routine to have a check annually. The check up may take about an hour at the most. These tests are the most commonly performed though there are much more sophisticated tests. It is not wise to perform a mammogram in young women in her thirties as the fat content in the breast at that age is more. However the doctor will decide especially if falling in a high risk category to develop breast cancer. Remember that not all lumps can be detected by the mammogram and tests.
When should you be concerned about a breast examination:
• Family history in a close relative such as mother, sister or aunt.
• If the other breast had been treated for cancer
• If the skin becomes dimpled like an orange peel
• If any lumps are felt in the breast or armpit
• If any blood discharge is seen from the nipple
Similarly any women above the age of 50 years must be careful of the vaginal bleeding. If any bleeding occurs from below after total stoppage of bleeding, one should be concerned and should have a gynecologist examine it. A Pap smear is important and the doctor will decide if a biopsy is needed.
There are tumor markers which can be examined by blood tests at good centers. These are blood tests which show the efficacy of treatment or used for follow up to detect spread. These can also be used to suspect a cancer of the breast, ovary or cervix at an early stage. Tumor markers can be used for a whole lot of cancers besides the ones mentioned above.
Generally women remain subdued as far as society is concerned and they are not even allowed out in public in some of the parts of the world. They are thus forced to swallow their own problems and if there are any, they are not helped out by their male counterparts. There are many symptoms which are attributed to the monthly cycles and some even to the stoppage of the cycles. This newsletter will help address some of the major issues that concern women and also the implications of having diabetes among women. Some of the women do not even speak to the health care providers or even their husbands, about their problems.
Poor diabetic control can impair normal reproductive function. Thus the women with diabetes may have problems conceiving.
Glucose levels may increase in the weeks preceding menstruation
Polycystic ovary: (PCOS)
PCOS is a condition characterized by reduced periods, obesity, acne, increased hair on face, chin. Values of testosterone and another hormone called DHEA will be raised. The condition is called a form of insulin resistance ( a major cause of type 2 diabetes) PCOS can thus be associated with development of type 2 diabetes in the long term. It is usually treated by the obstetrician and gynecologist who may run some tests including an ultrasonogram of the abdomen to look for the ovaries which may be riddled with small fluid containing cysts. This is treated with either metformin or pioglitazone ( both are medicines used in management of diabetes, but can cure the insulin resistance , which in turn will regularize the periods and correct the menstrual irregularities). Usually seen among the adolescent or young women and they would not get pregnant due to the irregularity of periods. In some societies, women after marriage are viewed with suspicion if they do not carry within a year or two.
Fractures among women
Hip fractures are common among those with type 2 diabetes ( almost 2 fold increase than when compared with those without diabetes). Generally fractures are more common among the elderly.
Fractures can be affected by the number and type of falls, the padding of the bony prominences, the strength of the bones and the geometry of the bone. Remember that falls may be due to retinopathy ( when poor eye sight is the cause), poor balance or fall in blood pressure with change in posture, in co-ordination, hypoglycemia(low blood sugar) and muscle weakness.
How to prevent bone loss?
- Regular exercise and a healthy diet.
- Good glycemic control
- Maintaining an adequate intake of vitamin D and calcium
- By avoiding smoking and alcohol.
If above the age of 45 years, have the following done:
Blood tests such as 25( OH) vitamin D3, calcium, blood tests for thyroid and parathyroid and a bone mineral densitometry. This is besides the usual check for eye, heart, blood for lipids, sugar, kidney, hemoglobin, and liver. One must also have a routine mammogram, blood cancer markers, a pap smear of the cervix and a regular check by the gynecologist.
If the bone mineral densitometry( BMD) for short, shows a value of 1.0 – 2.5 SD below normal you will be called osteopenic and if the value is >2.5 SD below normal, you will be labeled as osteoporotic. BMD is a type of scan for the bones where the bone densities are measured at the hip or upper part of thigh bones or the wrist.
How to prevent falls?
- Use of walkers
- Night lamps
- Muscle strengthening exercises.
You can make exercising a joy by doing something out of the way, say for example, you may dance to music within the confines of one`s own room, or use the Hula Loop, climb stairs or walk to the grocery store for a change. Generally women after menopause have chances of developing a heart attack unlike when they had their regular cycles.
Who are prone for fractures?
Those with low BMD( bone mineral density), old age, females, those having light body weight, those with previous fractures or those who smoke cigarette.
Men and women respond differently to sexual dysfunction. Men focus on physiologic function and women on the psychological factors including the quality of relationship. Vaginal dryness and impaired arousal are common among women after menopause. There is little evidence to show benefits of using medicines such as sildenafil ( popularly called as viagra) and tadalafil ( called cialis or snafi)
Pregnancy and diabetes
Most of the patients have a condition called gestational diabetes ( which is diabetes occuring during diabetes and disappear after delivery, but can again come for the next delivery) or people who are already type 1 or type 2 diabetics who become pregnant.
Who is at risk?
• If the BMI >30
• Previous big babies at delivery
• Previous GDM ( Gestational Diabetes Mellitus)
• Family history of DM ( Diabetes Mellitus)
• If belonging to Asian, African or Middle east population
• Diabetes in pregnancy is associated with risks to the baby and mother
• Pre term delivery ( delivery before the expected date)
• Big babies cause problems at delivery
• Associated congenital malformations
• Associated raise in blood pressure in the mother
• Chances of low sugar in the baby after delivery, chances of developing respiratory problems and jaundice ( yellow color)
Before planning pregnancy:
• Reduce weight so that BMI is close to 25
• Maintain good glycemic control.
• Avoid pregnancy if the HbA1c is > 10%
• Avoid unplanned pregnancy
• Assess eye for retinopathy and kidney for nephropathy
Remember that good control only reduces the risk for problems for the baby and the mother, it does not eliminate the risks.
Remember that the sugar levels normalize after delivery, but the risks for developing diabetes type 2 are there if not controlling lifestyle, after delivery.
Also remember that the baby delivered is at risk for developing obesity and type 2 diabetes later on .
Fetal malformation may occur with diabetes, some may have large for age babies, some may have larger tummies either due to more than one baby or large babies or extra water.
Control sugar before planning pregnancy.
Oral contraceptive pills taken for regularizing periods may be associated with poor glycemic control. If on these pills, monitor the sugar and blood pressure from time to time.
Once you become pregnant:
• Make timely appointments with your obstetrician
• Maintain sugar levels at 3.9-5.5mmol/L in fasting and <7.8 mmol/L after meals.
• HbA1c, the 3 month average of sugar, is recommended to be between 6-7%
• Have an eye check if not done in the last 6 months preceding pregnancy
• Diet should be having 30% less calories than before pregnancy
• Diet should contain 50% carbohydrates, 15% protein ( fish, white meat, dairy products, beans, egg) and 35% fat ( polyunsaturated fat)
• Avoid low sugars
• You can exercise- walking is still the best form of exercise. But, consult with your healthcare provider.
• Hydrate yourself well
• REMEMBER that you are caring for another life as well. Hence no rigorous diet.
• It is normal to gain weight during pregnancy.
• The Obstetrician will be checking your weight, blood pressure, feet for swelling and do periodic tests for the growing baby to make sure the baby is growing well and has no problems. Some centers even have facilities for correcting some problems while the baby is still in the uterus without compromising the life of baby and course of pregnancy. ( however it does carry a risk, though).
• Normally a test called GTT ( glucose tolerance test) will be done at 24 weeks You will be given 75 g of glucose to drink and a 2 hours sugar reading will be done. Depending on the levels, diagnosis of diabetes will be made.
• Urine sugar levels are not reliable during pregnancy as there will be sugar in urine even if not pregnant as the glucose spills in urine even at low blood levels.
• Oral medicines for control of diabetes will be stopped once you become pregnant
( however, metformin is safe and so also is glibenclamide during pregnancy and breast feeding).
• However, it is safe to use rapid insulin in suitable doses to prevent sugar fluctuations.
• Periodic sugar measurement and liaise with the Health care providers to correct the dose
• Check sugar before bedtime. If below 7 mmol/L, do have some carbohydrates before bed to avoid low sugars in the early hours of the morning
• Most medicines for blood pressure and for control of cholesterol will be stopped. However there are medicines for control of blood pressure which can be safely used.
• It is safe to continue the thyroid medicine given for low thyroid function.
• Please consult the Health care providers for advice on your regular medications.
• During delivery you will be given a drip which will contain glucose to keep the sugars at level.
• The delivery will be either a normal or cesarean section
• Early breast feeding to prevent low sugars in the baby. This also helps in early bonding between mother and the new baby and also helps the uterus to contract.
• Some women are even started on an insulin pump which will deliver insulin at regular intervals.
Menopause is the phase of life after your periods have stopped. Diabetes and menopause may team up for varied effects on your body, including:
• Changes in blood sugar level. The hormones estrogen and progesterone affect how the cells respond to insulin. After menopause, changes in the hormone levels can trigger fluctuations in the blood sugar level. One may notice that the blood sugar level is more variable or less predictable than before. If the blood sugar gets out of control, one might have a higher risk of diabetes complications.
• Weight gain. Some women gain weight during the menopausal transition and after menopause. This can increase the need for insulin or oral diabetes medication.
• Infections. Even before menopause, high blood sugar levels can contribute to recurrent urinary and vaginal infections. After menopause — when a drop in estrogen makes it easier for bacteria and yeast to thrive in the urinary tract and vagina — the risk is even higher.
• Sleep problems. After menopause, hot flashes and night sweats may keep one up at night. In turn, the sleep deprivation can make it tougher to manage the blood sugar level.
• Sexual problems. Diabetes can damage the nerves of the cells that line the vagina. This can interfere with arousal and orgasm. Vaginal dryness, a common symptom of menopause, may compound the issue by causing pain during sex.
Menopause can wreak havoc on the diabetes control. But there’s plenty one can do to better manage diabetes and menopause.
How to overcome Diabetes during menopause
• Make healthy lifestyle choices. Healthy lifestyle choices — such as eating healthy foods and exercising regularly — are the cornerstone of your diabetes treatment plan.
• Measure your blood sugar frequently. You may need to check your blood sugar level more often than usual during the day, and occasionally during the night. Keep a log of the blood sugar readings and symptoms. Your doctor may use the details to adjust the diabetes treatment plan as needed. Your doctor may also recommend regular hemoglobin A1C testing to reflect your average blood sugar level for the two- to three- month period .
• Ask your doctor about adjusting your diabetes medications. If the average blood sugar level increases, one may either need to increase the dosage of the diabetes medications or begin taking a new medication — especially if one gains weight. Likewise, if the average blood sugar level decreases, one may need to reduce the dosage of your diabetes medications.
• Ask your doctor about cholesterol-lowering medication. If you have diabetes, you’re at increased risk of cardiovascular disease. The risk increases even more when you reach menopause. To reduce the risk, eat healthy foods and exercise regularly. Your doctor may recommend cholesterol-lowering medication as well.
• Seek help for menopausal symptoms. If one is struggling with hot flashes, vaginal dryness, decreased sexual response or other menopausal symptoms, remember that treatment is available. For example, your doctor may recommend a vaginal lubricant to restore vaginal moisture or vaginal estrogen therapy to correct thinning and inflammation of the vaginal walls (vaginal atrophy). If weight gain is a problem, a registered dietitian can help you revise your meal plans. For some women, hormone therapy is an option.
Diabetes and menopause is a twin challenge. Work closely with your doctor to ease the transition.
What is diabetes?
Diabetes Mellitus ( there is diabetes Insipidus, which is caused by over production of dilute urine due to disorder of pituatary gland ) is a condition caused by either a relative or absolute deficiency of Insulin( produced by the beta cells of the pancreas) which results in increased glucose levels. Type 1 diabetes is when there is an absolute absence of insulin caused by some genetic problems or a destruction of pancreas by some viruses or unknown causes. Type 2 diabetes is caused when there is either not enough insulin to meet the demands or when the insulin is blocked from acting.
Type 1 is usually seen in young people, but can be seen in adults as well. This is less common when compared to type 2 diabetes. There is no treatment yet as successful and effective as insulin injection for those with type 1 diabetes. Research is going on to establish the efficacy of islet cell transplantation and stem cell therapy , but with mixed results.
Type 1 is caused by environmental and genetic factors. Destruction of the pancreatic beta cells by a viral fever can also cause diabetes. Type 2 is caused by poor lifestyle and resulting obesity.
Certain medicines also can worsen the glucose tolerance. Long term steroid administration, anti psychotic medication, hormones are some of the well known offenders.
Who are to be tested?
- Any person who is above the age of 45 years,
- Those who has a family history of diabetes, high blood pressure , high cholesterol levels, heart attack at an young age
- Those with kidney disease
- Those with unexplained weight loss in spite of good appetite
- Those with increased thirst and urination out of proportion to the environmental changes
- Those with problems with eye sight
- Those with waist sizes above 88 cm for men and 80 cms for women ( this differs from race to race)
- Those who experience long time for healing of small cuts and wounds
- Those with polycystic ovarian disease( small water filled swellings on ovaries seen in young women which can lead to hair growth on face, obesity, irregular menstruation and sometimes infertility)
- women who have had diabetes during pregnancy( gestational diabetes)
- Those recurrent urinary infections or boils on skin
- Unexplained weakness
The extent of the epidemic
In today`s world things are moving at a fast pace and often we all struggle to keep pace. This leads to unnecessary mental stress, lack of sleep, improper food intake, smoking, alcoholism or other recreational drug abuse, fast food and intake of large quantities of sweetened beverages in the form of fizzy (carbonated) drinks. This habit coupled with lack of exercise or activity has led to the gigantic proportions at which Diabetes is becoming an epidemic. The arrival of fast food( which unfortunately is very tasty and presentable!), processed food, high calorie food have caught on with the young generation in a big way and the parents do not mind as it is readily available and keeps the children happy and content! Large portion size, eating in front of the TV, eating more at night and lack of adequate physical activity are important factors.
The main culprits
Automation of chores such as having a remote for almost everything- opening and closing the gates, controlling the television, controlling the music system, the air-conditioners, the blinds of the windows, the watering of the garden, switching on the lights and even cooking has made us all so dependant as well as lazy! We even resort to ordering food or things from the market through the phone rather than walk. How many of us prefer to take the stairs than the lift or the escalator? How many of us prefer to walk rather than drive the car even for short errands? The boom of the computer age has worsened the matters by encouraging the children to play games, study, acquire knowledge, socialize, watch movies all within the confines of their rooms leading to an absence of activity outside in the fresh air and leading to another threat, OBESITY. Of course, they may be exercising their hands, eyes and rain, but that alone is not enough!
It has become so bad that if one does not have these “modern diseases” such as high blood pressure or diabetes, one is labeled abnormal!
Let us sit and recollect that the previous generation ( not so long ago) had mostly naturally available food, had plenty of oily food, had enough of sweets made with sugar or ghee, did not use additives or flavoring agents and still were happy and almost disease free. They used to work hard and walk where possible. Medicines were so few those days and so also were the medical facilities. They used coconut oil, there was almost no taboo food and stress was much less.
We have reached a stage where the inevitable cannot be avoided, but it can be delayed by a sensible lifestyle.
BMI ( body mass Index) >25, fat in diet< 30%, Saturated fat < 10%, increased fiber, physical activity 150 minutes per week. If any one of these goals can be achieved the incidence of diabetes can be lessened by as much as 20%! It is time we started something drastic to grab Diabetes by its roots.
Testing for diabetes
Fasting blood sugar >7.0 mmol/L or 126 mg/dL ( this means a fasting period of 8-10 hours)
A post prandial blood sugar of > 11.1 mmol/L or 200 mg/dL ( 2 hours post meal- some doctors advise an hour and half)
HbA1C of >6.5% ( this test gives an average of 3 months sugar readings)
Please be aware that the fasting and post prandial can be misleading depending on what the patient ate, but the HbA1C will give the overall picture.
Please note that a glucometer checks the glucose level on the capillary blood ( at the finger tips) and in the traditional method, blood is taken from the blood vessel at the hospital or clinic. There will be a difference between the different meters at the same time and also a difference between the reading taken from the finger tip and the blood vessel.
The HbA1C is done every 3 months to assess how one is progressing, but it can be done once in 6 months if the control is excellent.
There is a pre diabetes state: if the fasting sugar reading is between 5.6-6.9 mmol/L( 100-125 mg/dL) the patient is labeled as having impaired fasting glucose. If the 2 hour post meal sugar is between 7.8-11 mmol/L(140-199mg/dL) the patient is labeled as having impaired glucose tolerance. If the HbA1C is between 5.7-6.4%, the patient is labeled as having pre diabetes. This means you are not yet a diabetic, but may become one. Usually life style changes are all that matter at this stage. Some doctors prescribe medicines at this stage depending on other factors such as body weight, age, BMI and associated diseases.
Other tests to be done:
Urine sugar estimation is not done these days as much as it used to be done long back. It has become unreliable to monitor diabetes control only on urine sugar levels.
Type 1 diabetics are diagnosed by checking some markers in the blood ( GAD 65, ICA, IAA and C peptide) which will not be normally seen in the blood. This is released by the destruction of the cells producing insulin, the beta cells. C peptide shows how much insulin is being produced by the pancreas.
Other tests of the blood to assess kidneys, liver, lipid profile, urine for protein, check for eyes, heart, feet are to be done periodically to make sure Diabetes has not affected any of these organs.
The eyes ( causing blindness), heart ( attacks ), brain ( strokes or paralysis), kidneys( kidney failure), feet ( numbness or inability to feel or differentiate between hot and cold sensation) and erectile dysfunction in males or infertility among males or females.
Diabetes is the commonest cause of preventable blindness and the commonest cause of amputation ( cutting away an extremity) due to non traumatic causes