All posts in Special population with diabetes

Fishing as an enjoyable and healthy exercise

Fishing as an enjoyable and healthy exercise

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:

family-fishing-from-a-bridge-622x420 fisherman-fishing-in-a-peaceful-forested-area-631x420

  • 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/

 

 

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Understanding insulin

Understanding insulin

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.

 

Some precautions:

  • 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.

Some myths:

  • 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.

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Updates in insulin delivery devices and glucose monitoring

Updates in insulin delivery devices and glucose monitoring

New insulin delivery devices .

  • LifeScan One Touch Via®

index

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®
  • In pen

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.

  • OneDrop Premium®-

One-Drop 2

 

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.

Image Slim X2     Omnipod 2

 

 

 

 

 

 

 

 

 

 

 

Some new glucose monitoring devices:

  • Abbots Lifestyle Libre Pro®-

LibrePro 1   LibrePro 2

 

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.

 

  • Google Contact Lens®-

google contact

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®-

MiniMed

 

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.

  • Medtronics 630G®-

MiniMed 630

 

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.

 

 

 

 

 

 

 

 

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Exercising the brain

Exercising the brain

                                                                                    exergames-2brain-games-2

exergames-2Forgetting 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.

Sudoku

brain-games

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.

exergames

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.

 

 

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Exercises- how to start

Exercises- how to start

fitwatch sit-up

 

You must have been tired listening to doctors mentioning do some exercises …… but not many go into details of how to exercise, which exercises to do, how frequently one is to exercise or about the intensity.  The important thing is to get started in case you have not. Any small step is better than no step at all.

Before embarking on a fitness program, especially if you have never done exercises regularly, get a medical checkup done by the doctor which will include an assessment of the heart as well. Though exercises are beneficial, they can cause problems for some with certain problems like eye, kidney, joint, nerve or heart problems.

If all is okay, assess how fit you are by these simple steps:

  • Check pulse rate before and immediately after walking 1. 6 km or a mile. The pulse rate should not be racing away. The time taken for the heart rate to come back to normal level before you started walking is equally important.
  • How long does it take you to walk a mile or run 2.41 km or 1.5 miles.
  • Waist circumference
  • Body mass index

Once you have assessed how fit you are, then design a plan:

  • Define the need for the exercise plan- to don dresses that had been in the shelves for long, to look and feel good, for weight reduction, to do a marathon or to look good at a function.
  • The activity must be of at least 150 minutes of moderate aerobic activity a week
  • Include different activities so you do not get bored. You can walk, cycle, jog, do water exercises, skip the rope, do the hula hoop, aerobics, zumba dance and so forth.
  • Remember to start slow and progress slowly.
  • Stretching before exercises is very important.
  • Allow time for recovery.
  • You need not do all the activities at one go. You can conveniently space them out in intervals.
  • Be flexible. Do not punish your body.

Now that all is set, get the right footwear , get the right apparel, use a fitness app in your smartphone or use a fitness watch. The apps in the smartphone now-a-days gets one to be motivated to carry on.

Keep a diary to record the progress you made.

Reassess yourself every month.

Set new goals

Push outside your comfort zone as the body gets adjusted to the exercise quite soon and you will notice that the body needs to be pushed further to achieve more.

Do “listen” to your body. If weak or paining, do give a break and make sure all is okay. The injuries related to exercise too had been detailed in an earlier newsletter.

 

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Exercise tips in cold weather

Exercise tips in cold weather

 

Tai chi

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.

 


      image 3                                                    aqua aerobics 2

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:

Questions Yes No
Look better
Feel better
Feel comfortable in clothes
Improve self image and confidence
Improve physical stamina
Improve energy levels
Improve sleep
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.

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Artificial sweeteners – the facts

Artificial sweeteners – the facts

artificial sweeteners

 

Diabetes is on the rise the world over. Just about anybody can become a diabetic whether you are rich or poor or a male or female or whether your parents are diabetic or not. It is largely attributed to the disordered lifestyle habits and increased stress levels in day to day life that has caused this to blow out of proportion.

People turn to shortcuts such as the great number of diets available each one claiming superiority over the others, a great number of holistic medications or alternate medicines and of course, sugar free substitutes. It has taken the markets by storm and you have so many available in the market today which has been incorporated into carbonated soft drinks, chewing gums, baked goods, cakes, fruit juices, candies, ice cream and even yogurt.

There are natural sweeteners such as Agave nectar, date sugar, fruit juice concentrate, honey, maple syrup and molasses which are available in the market.

The artificial sweeteners are always artificial though some products such as those containing stevia are claiming themselves to be natural. But it has to be either refined or processed to be marketed. These are intensely sweet and are many times sweeter than natural sugar. All the sweeteners leave an aftertaste.

There are different types of sweeteners such as :

  • Low calorie or no calorie sweeteners
  • Non nutritive sweeteners
  • Sugar substitutes
  • Reduced calorie sweeteners

Some of the sweeteners can be used for either baking or cooking as well. These can come in different forms such as tablets, or sachets containing powder or in liquid forms.

Sugar alcohols do not contain alcohol and do not contain ethanol which is seen in alcoholic drinks. These are naturally seen in certain vegetables and fruits, but can also be manufactured. These help to increase the bulk and improve texture when added during cooking or baking. These are seen in toothpastes, mouthwashes, chewing gums, frozen desserts, fruit spreads and chocolate. It is labeled as Xylitol or sugar alcohol in the nutrition labels.

When consumed in large quantities the use of sugar alcohols can cause a bloated up feeling, loose stools and abdominal fullness

I have seen many people who had a craving for sweets after consumption of the artificial sweeteners which in turn, causes the sugar levels to fluctuate. This in turn, leads to an increase in either the doses of medicines or injectables with the hope to control sugar levels. Just being off the artificial sweeteners bring about so many changes and reduces the cravings as well.

Some of the common brands available in the market are:

  • Sweet N low®      contains sachharin
  • Equal®                  contains aspartame
  • Sweet one®          contains Acesulfame potassium
  • Splenda®              contains Sucralose
  • Fruit juice concentrates contain Neotame

 

How sweet are these artificial sweeteners?

Sachharin is 300 times sweeter than sugar, aspartame is 180 times sweeter, acesulfame is 200 times sweeter, sucarlose is 300 times sweeter and Neotame is 7000 times sweeter than sugar.

When artificial sweeteners are used there are some health concerns to be careful of- these can attribute to weight gain, tooth decay, probable increase in incidence of diabetes, cancer and troublesome numbness of the hands and feet, muscle spasms, giddiness and cramps. Generally people who are diabetic or those at risk to develop diabetes tend to rely more on ingestion of the so called sugar free containing food items. Besides having a lot of artificial sweeteners, the rest of the ingredients are the same which do add to the calories. Also it is worth bearing in mind that the taste has to be modified to enhance the flavor and also help it being sold off the racks at the supermarkets. The enhancement of flavor is done with the help of adding more hydrogenated oils or butter or fats which leave an excellent buttery taste and can help increase cholesterol levels !!!! People in this mad frenzy, tend to overeat their portions because of the false security given by the artificial sweeteners.

Being a diabetic does not mean you should be off sugar in totality. Your body needs a balance of sugar, salt, fats, carbohydrates, proteins and fat to make a complete meal which can be taken as small frequent meals to prevent cravings later on. Combine this with adequate physical activity and all will be well.

 

 

The solution to sugar needs:

You can substitute the white sugar with brown sugar or cane sugar which is the unrefined version of sugar. It is extremely hygroscopic and hence absorbs water from the atmosphere once the cover if opened. Store this in air tight containers. Roughly 3 spoons of brown sugar equals one spoon of white sugar.

Remember that people of the previous generation did not rely on artificial sweeteners.

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Hypertension or high blood pressure

Hypertension or high blood pressure

blood pressure 4Checking the blood sugar is as common as checking ones blood pressure these days, but is not done as frequently though.  There may be no symptoms at all related to high blood pressure or there maybe headache, giddiness or even shortness of breath. Some may present with severe headache or paralysis of one side of the body with a slurred speech or chest pain as part of a massive heart attack.

Having high blood pressure undetected and untreated over a long period of time, can put a strain on the important organs such as the heart, kidney, brain and eyes. 

Blood pressure, diabetes mellitus and high cholesterol levels are like close friends. These all are affecting the blood vessels and having one can put you at risk for developing the other two.

Blood pressure is the pressure of the blood in the blood vessels which help propel the blood forward from the heart to different parts of the body carrying oxygen where needed and also carrying away the waste products from the kidneys and liver.

 

blood pressure 1

Blood pressure is recorded by a machine called sphygmomanometer in which a mercury expansion is measured. This is operated only by health care professionals as you have to hear the sounds to decide the blood pressure.

blood pressure 2

Now-a -days, digital blood pressure machines are available. The ones measuring the blood pressure by inflating the cuff around the arms is preferred. The ones measuring around the wrist is not reliable. The digital machines can be battery operated and or AC/DC operated. The batteries have to be removed after each check to prevent the leak of the batteries while kept inside for indefinite periods of time. There are two readings for the blood pressure, called systolic for the top reading and diastolic for the lower reading. So if the doctor tells your blood pressure is 130/80 mm it means, 130mm is the systolic and 80 mm is the diastolic reading.

The blood pressure can vary with the position, posture, soon after exercise, soon after driving, and even for some when they come to the hospital or clinic due to anxiety. It is wise to check the blood pressure after relaxing for some time. For those where anxiety visiting the hospital causes high readings, it is wise to have the blood pressure recorded at home with a machine and make a set of readings for a week and have the doctor analyse that. There is a devise which can be connected to the upper arm for 24 hours ( 24 Hour ambulatory Blood pressure monitoring) which will measure the blood pressure every 20 minutes even during sleep and activity and have the data downloaded. Keep the arms straight while the cuff is inflating to avoid errors in the machine reading. For some, the blood pressure is highest while at work, for some it is highest at night. Mental and physical stress plays a major role in fluctuations of blood pressure levels.

Pregnant women may get high blood pressure readings which are treated with some specific medicines as they will not cause harm to the growing baby. The blood pressure spike is usually associated with swelling of the feet and proteins in the urine. Some even get blurred vision.

Normally a doctor will not start medications for blood pressure based on one reading. An average of readings which show a persistent set of high levels will decide. The blood pressure can be high even for children in those having some diseases of the kidney. The cuff diameter is different while measuring the blood pressure for children and for those who are obese. The normal blood pressure readings are between 120-140 systolic and 70-90 diastolic. Generally the elasticity of the blood vessels is lost as one advance in age and so the blood pressure can be slightly high for the elderly and hence a level of 140/90 mm Hg is normal for the elderly.

What can be done from your side:

  • Avoid stressful situations as much as possible. Learn relaxing techniques such as doing something you like or meditation or just relaxing on a rocking chair, or listening to songs or reading a book or enjoying a swim or watching a movie.
  • Incorporate a healthy lifestyle which includes at least 150 minutes of physical activity a week and a diet in which salt consumption is reduced. Sausages, sauces, tinned vegetables , olives soaked in brine, potato fries all come with salt. Use of rock salt is better or low sodium salt is another option. One can use lemon or vinegar to add a salty taste without actually adding salt. Among the exercises, Tai Chi, Yoga, swimming, skipping rope, aerobics, walking, cycling, golf, playing shuttle badminton or tennis if it is okay , are good options. Enjoy the exercises sessions.
  • Avoiding spicy and oily food helps.
  • Take plenty of vegetables, fruits depending on diabetes levels, non roasted and non salted nuts, fish and chicken and lean meats.
  • Avoid too much of caffeine
  • Maintaining a normal weight is equally important.
  • Limit alcohol consumption- for males 21 units a week and for women 14 units a week ( one unit is half a pint of beer, a glass of wine or a single measure of spirits)
  • Cigarette smoking is another thing to be careful of. Smoking can make the blood cells stick together which can help form blocks and also increase the chances for a block in the blood vessels. There are ways to stop smoking by using various nicotine replacement techniques such as nicotine chewing gum, lozenges or patches.
  • Be regular in your visits to the doctor.
  • If there is a history of high blood pressure running in the close family ( parents or uncle and aunt), have the blood pressure monitored. If your parents have had either a stroke ( paralysis of one side of the body) or a heart attack at an earlier age ( below the age of 50) you have to be careful.
  • If you are overweight or obese ( having a body mass index of more than 25) or having diabetes,  you have to check the blood pressure.

 

 

Treatment

This involves the basic essentials such as reducing stress levels, stop smoking and alcohol consumption, reducing excess salt intake, maintaining a healthy diet, exercising regularly and having a check up on time.

When the above measures do not work or if you develop some complications such as problems with the kidneys, heart or brain, medicines are prescribed.

The eye doctor looks into the eye and checks for early changes in the blood vessels on the retina which needs you to be starting treatment soon to prevent further damage to the eyes.

There are certain basic tests which are necessary such as checking the haemoglobin, sugar, cholesterol, kidney, liver, urine for leak of proteins, ECG and ECHO for the heart, an eye check up and further tests if anything is amiss and needs further evaluation. Some need a scan of the brain if there has been a stroke.

Some people need one medicine and some need more than one medicine. There are different medicines coming in different strengths. The number of mg of each tablet does not reflect upon the severity of the blood pressure. The doctors decide which medicine based upon the kind of protection needed. Some need to have additional protection to the heart and kidney, some need to have their heart rates reduced, some need to have their feet swelling reduced, some need to have the pressure in their kidney reduced and so forth. The aim is to bring down the blood pressure to normal without causing further damage.

As with all tablets, there are some side effects with the medicines for blood pressure. Some may cause slow heart rate, some cause swelling of the feet, some cause coughing and throat irritation, some cause electrolyte disturbances and some medicines are not tolerated well. The dose of medicines has to be adjusted based on individual needs. Generally, once you are on medicines it must be continued for life. But, having a metabolic surgery ( bariatric surgery) can help avoid the need for a medication. This will help control the diabetes, blood pressure as well as your weight. If the blood pressure is solely due to increased stress levels, change of job or relocation will help cure the blood pressure as well.

Many people delay the initiation of treatment despite the medical advice. This is putting your life in danger as changes once they occur, in important organs, are difficult to reverse. It is much better to control the blood pressure than having a massive heart attack or a stroke and put your family or yourself at risk.

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Dry eyes

Dry eyes

dry eyes 2

 

Dry eyes occur when the tears are not able to lubricate the eyes properly. This is quite a common symptom in today`s world, but poorly understood among the public.

Tears are a mix comprising of mucous, water and fatty oils which help in lubricating the eyes as well as protecting the eyes from infection.

The common symptoms::

  • Eyes may sting or burn
  • Scratching sensation
  • Redness of the eyes
  • Difficulty in wearing contact lenses
  • Blurred vision
  • Watering of the eyes

 

Causes ::

  • Ageing. Those who are above the age of 50 have reduced tears production.
  • Some diseases such as diabetes, rheumatoid arthritis, thyroid disorders, deficiency of vitamin A can be associated with dry eyes.
  • Some medicines such as antihistaminics, some medicines for blood pressure control, anti depressants, hormone tablets can cause dryness of the eyes
  • Inflammation or radiation can damage the tear glands
  • Diseases of the eye lids where it is turned inwards or outwards can increase tear evaporation.
  • Those exposed to smoke, hot air or heavy winds can have increased evaporation of tears.
  • Reduced blinking of the eye lids as in those reading a lot or driving a lot or those using the computers for long hours can have dryness of the eyes.
  • Those who consume a diet deficient in omega 3 or vitamin A can have dry eyes.
  • Those using contact lenses are prone to dry eyes.

 

Prevention::

  • Avoiding air blowing directly to the eyes from the air conditioners as in cars, hair dryers or fans.
  • Humidified air will help
  • Donning protective eye wear
  • Giving the eyes breaks of rest while reading or computing for long hours at a stretch.
  • Close eyes in between to reduce evaporation as when flying in aeroplanes, traveling through deserts or in high altitude areas.
  • Position the computer below eye level

 

  • Stopping smoking or avoiding being in a smoke filled room.
  • Using artificial tears

 

Treatment::

  • Meet the eye Dr who might advise antibiotics if inflammation is the cause or advise surgery if there are problems with the eye lids or tear ducts. The treatment depends on the severity.
  • Special contact lenses, if applicable.
  • Eye drops ( artificial tears) can be those with preservatives to increase shelf life or those without preservatives. The ones with the preservatives might be a cause of irritation.
  • Eye ointments are oily and will last longer, but can cause clouding of vision and hence advised to be sued at night time before bedtime.
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Urinary problems among women

Urinary problems among women

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.

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