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Neuropathy and Diabetes

Neuropathy and Diabetes

numbness feet

 

Neuropathy is a complication that is bothersome and not very often addressed or treated properly. This complication gradually develops over a period of time and is not always due to diabetes mellitus. This can be due to smoking or excessive alcohol intake as well. However,  longer the duration of diabetes, chances of developing a neuropathy are higher. Neuropathy can be aggravated by insulin and some medicines. Rapid control of sugar is known to cause neuropathy for some people.  Classically the neuropathy first affects the feet and toes and may gradually ascend.

 

numbness feet 2

 

 

There are four major types of neuropathy

  • Peripheral neuropathy- this is the commonest form which affects the feet and hands. This can present in many forms. There may be numbness of the digits and reduced ability to feel changes in temperature or pain. Patients may complain of  tingling or burning, feeling of insects crawling on the body, sharp pains at night, and some may experience extreme sensitivity to even the lightest of touches. Some may experience difficulty in walking or can have ulcers or deformity of the feet.
  • Autonomic neuropathy: This part of the nervous system controls the functioning of the eyes, heart, lungs, stomach,intestines and sex organs. Thus, a dysfunction of this part of the nervous system may cause either of the following: urinary bladder problems ( too much urine or lack of control in holding the urine), constipation or diarrhoea, slow emptying of the stomach leading to fullness, difficulty swallowing, dryness of vagina, erectile dysfunction in males, reduced sweating, problems regulating body temperature, difficulty in eyes adjusting to a dark room when coming from a bright room. Some people have variations in blood pressure while getting up from lying down posture leading to imbalance.
  • Radiculoplexus neuropathy- affects bigger nerves and hence the numbness can affect the thighs, buttocks, hip and legs. Characterestically patients complain of difficulty getting from sitting position. Some may complain of abdominal swelling and weak muscles.
  • Mononeuropathy- this is the type of neuropathy affecting one single nerve. This may disappear over a period of time. No long term complications associated with this type. There maybe difficulty in focusing of the eyes, paralysis of one side of the face with deviation of angle of mouth, carpal tunnel syndrome where there is numbness of one  part of the palm with weakness of muscles or loss of sensation. This can be corrected by a small surgery.

 

For details on how to test for neuropathy, please refer to the blog on feet.

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Let us walk to good health

Let us walk to good health

From time immemorial, man has been walking for traveling to reach one place, to hunt and gather food for self and family and also in search of a better place to live. Those were the days when there was no transport. God gave humans the legs so they could walk upright which is a feature not common among the animals by nature, though some animals can walk upright with training. Unfortunately, with the advent of modern transportation facilities as well as time pressures and deadlines to be met, people have literally forgotten to use their legs for the use they were meant to be used.

 

Benefits of walking
This is probably the safest form of exercise which can be done by anybody provided the eyesight is good and there is no neuropathy ( affection of the nerves which can cause lack of sensation on the feet making the person unaware of where the feet are planted on the ground).
The farther, faster and more frequently one walks can definitely improve the benefits by many folds. Walking also improves the balance and strengthens bones and muscles besides improving circulation.
Walking is proven to prevent the onset of diabetes, depression, cancer, joint problems, osteoporosis ( fragile bones) and heart ailments. This also helps the worsening of the above. The swinging action of the arms, the strides taken while walking, the fresh air , the sights to enjoy ( one does not get these benefits while walking the treadmill in the confines of either the gymnasium or home) and change in pace while walking navigating the turns all help in improving the muscle power and co-ordination.
Walking in groups with either your colleagues or with friends and family all could be entertaining as well you could even do long distances without being aware of the distance covered at all.

Walking at a speed of 6 km/hour , which amounts to a brisk walk, can burn up to 600 Kcals. But, may be not all can walk as fast. Some may be having either knee or back problems which needs a slower pace. But walking at any given speeds whether unaided or with the help of a walking stick is much better than not walking at all. Parking the car away from where you wish to go and just walking to your destination helps. You may still park close to your destination ( especially during the summer time when the heat maybe quite strong) and take a longer route rather than choosing the shortest route or just walking along the aisles in the malls are good options.
Walking with small children and pets is also a good option.

Ensure the following before walking:
• Check the blood sugar before walking.
• Ask your health care provider if it is safe to embark on a regime.
• Go at a pace comfortable. Walking should not leave one gasping for breath.
• It is okay to rest in between.
• It is okay to take sips of water in between the walk and before the walk.
• If you experience feeling of nausea, chest discomfort, pain in the arms, jaw or back while walking, please seek medical help immediately.

Stretching before any exercise program:
Proper stretching before any exercise or even walking can help tone up the body and prevent joint problems.
Some of the commonly done stretches:

 

Calf stretches- calf stretch

 

Stand at an arms length distance from the wall. Keep one leg forward with knees slightly bent. The other leg with knee straight and heel down. Keeping back straight, move hips towards the wall and feel the stretch. Hold for 30 seconds, relax and repeat with other leg.

 

Quadriceps stretch- quadriceps stretch

 

While supporting a fixed structure, grasp the ankle with one hand and pull the heel up and down till one feels the stretch in the front of the thighs. Hold for 30 seconds, relax and then repeat with other side.

 

Hamstrings stretch-

hamstrings

 

Sit on one chair, and keep the other leg on another chair in front. Keeping the back straight, bend the pelvis forward till a stretch is felt in the back of the thighs.

 

Low back stretch- lying on the back with the feet kept flat and knees bent, bend the knees ( both together or separately) towards the chest using both hands. If one has knee problems, one can hold hands behind the thighs instead.

 

Chest stretches- chest stretches

Clasp hands behind the head. Pull elbows gently by pinching the shoulder blades together.

How to walk?

The ideal way of walking involves walking upright, head held up eyes looking forward, chest pulled out, shoulders thrown back, landing the feet on the heel and taking the stride on their toes. Swing the arms freely slightly bent at the elbows. Walking with small weights held in the hands further enhance the calories burned.
The neck, shoulder and back must be relaxed and not stiff. While walking the treadmill one usually does not maintain these as people have to be holding onto the side railings and the back is usually arched back and stiff to prevent slipping.
Please make sure the footwear is of a good quality and have the insoles and heels checked for wear and tear. View the shoes from behind. If the shoe is tilted to one side, it is time to change the shoes. Change the shoes after it has done 400-600 km.

walking to good health 17
One should dress appropriately in attire that suits the climate, a comfortable and well padded pair of shoes, a scarf or hat as the case may be and some music if needed to be played and listened with an ear phone if needed. Generally the pavements are safe, but it still pays to look ahead and down as well.
150 minutes of any exercise a week is recommended. You can do 30 minutes 5 days a week or split that every day in some form like three sessions of ten minutes each or two sessions of fifteen minutes each.
The long term goal is to make 10000 steps a day. This is ideal for maintaining good health.
One needs to walk at least 30 minutes a day to maintain his or her weight and at least 45 minutes a day to have some weight reduction.
A pedometer is a small device which can be clipped on to the belt or kept in your pocket close to your body. This will count the steps one takes during the course of your daily chores such as walking, climbing stairs, jogging and even adventure sports. But, pedometers vary in their function.

clipped on pedometer

pedometer

 

Get to know your pedometer

 

Ease of use: Some of the pedometers just have to be clipped and it starts. These will be needed to be reset to zero the next day so you could count the number of steps taken.

All pedometers have a battery which needs to be replaced depending on the life.
Some pedometers need to have the data fed in such as date and time, the weight of the person, the length on ones stride which will be calculated and input fed in.
The extra benefits: Some just give the number of steps taken during the day till one resets it back to zero. Other pedometers count the calories burned during the activity, the distance walked and some even upload the data to a remote computer which will maintain a log book of the progress.
Accuracy: generally all pedometers are accurate. However change of strides such as a sudden increase in pace ( or decrease) , jogging in between or even climbing stairs in between the walk may not be counted by the machine( after all it is a machine) and so the calories counted may not be very accurate in that way.
Get a pedometer that has good back lighting so it could be easy to use both indoors and outdoors and also during either the day or night.
Some pedometers are small, others are big. Go for a size that suits you.
The pedometer must have a sturdy clip to help attach on the waistband or have a strap.
Price is also of major concern.
The recent smartphones have an app which could be downloaded for performing the same function as that of a pedometer.
Before you use the pedometer regularly the following are to be noted:

 

  • Please attach the pedometer on yourself for three days in succession whenever you are awake. The total number of steps covered in 3 days divided by three will give the average steps in a day. This is called the baseline steps. ( This will also give you an idea how many steps you had taken in a day which might be embarrassing)
  • Once you know the baseline steps, set up short term goals such as adding a thousand steps a day, for example, to your baseline number which you do target for a week.
  • Once you have achieved this short term goal, you could set yourself another goal. You could reward yourself and make this interesting.

 

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Love your feet !!

Love your feet !!

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:

foot ulcers

 

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.
Smoking
Previous amputation or ulcer foot
Poor eye sight

 

What can be done to prevent foot problems?

foot ulcer

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 1

Ingrowing toe nail due to improper cutting of nails

ingrown-toenail 2

 

 

Look at the difference in the left foot

Charcots 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

bunion 2
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.

 

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Know more about Uric Acid

Know more about Uric Acid

PRinc_photo_of_inflamed_gout_toe

Gout is an inflammatory disease affecting the joints , commonly the big toe of the foot, the mid foot or the ankle. This is caused by an increased level of uric acid in the blood. Purines break down inside the body to form uric acid. When there is too much of purine intake or when there is less of excretion of uric acid by the kidneys, it leads to an increase in the body.

A lot of people are affected by this and often are mistaken for having fractures and land up having X-rays taken. The pain is excruciating and can make life miserable to a point where common chores such as walking, standing, driving are so much limited.

Hyperuricemia ( high levels of uric acid) are associated with the following:
kidney stones

 

 

 

• Abdominal obesity
• Associated with diabetes mellitus type 2
• Associated with metabolic syndrome
• Joint destruction with recurrent attacks
• Stones in the urinary system- these cannot be seen in normal X-Rays as it does not block the X -rays. Uric acid stones are smooth rounded and so may not cause blood in urine.

• Generally males are affected more. Women after menopause can be affected.

Stages in Gout

gout3

 

• Hyperuricemia- high uric acid levels in blood.
• Precipitation of uric acid crystals in the joints ( commonly the base of the big toe, mid foot joints or ankle)
• Acute pain and swelling of the foot or joints. The skin may be reddened which is why it is often mistaken for an abscess.
• Chronic inflammation leading on to joint destruction and change in bone shape. This can lead to Tophi ( pronounced as TOE-fi)

 

What precipitates high uric acid levels? :
kidney stones 3kidney stones 2

 

 

 

 

 

 

• Being exposed to very cold climate
• Binge drinking of alcohol
• Red wine in excess of 2 units/day
• Tea in excess of 4 cups a day ( whether green or black)
• Coffee in excess of 4 cups a day.
• Dark chocolate in excess
• Food such as mushrooms, asparagus, anchovies, moong beans, lentils, soya beans, white beans and raisins.
• Sea food such as mussels, lobster, shrimps or prawns, scallops, salmon and tuna.
• Rabbit meat, duck meat, turkey, chicken, Pork, salmon, beef and mutton.
• Some medicines for blood pressure, medicines taken for preventing rejection after organ transplant, those on cancer chemotherapy and low dose aspirin.
• Drastic weight loss measures.
• Dehydration
• To vigorous an exercise regime
• Too much of sugar sweetened carbonated beverages

What are the gout friendly food items ?:
• Fruits such as apples, figs, bananas, pineapples, grapes, cherries, water melon, grape fruits, papaya, peaches, pears, guavas, lemon, orange, strawberries.
• Vegetables such as celery, egg plant, onion, lettuce, cabbage, cucumber, ginger
• Tofu, eggs, low fat dairy, sesame seeds, cereals, vitamin C, nut butter.
Beware the sugar content of some of the food items listed above.
Interestingly, the high blood sugar levels can help in excretion of uric acid by the kidney. Thus, when the sugar levels improve, the uric acid levels can increase leading onto a flare.
How to prevent gout:
• Adequate water or fluid intake
• Avoid the precipitating factors
• Consume the gout friendly food
• Maintain a healthy lifestyle and prevent being overweight or obese.
• Avoid sugar sweetened beverages

How to treat:
• Meet the doctor.
Ice cubes to be used for fomentation of the affected areas.
• Pain killers such as Indomethacin or Naproxen or Sulindac are preferred. However noted pain killers such as Ibuprofen ( Cataflam®) or diclofenac ( voltaren®) will not always be effective.
Colchicine to be used within the first 24 hours of an attack helps.
Oral Steroids ( prednisolone) in high doses can be used to reduce the inflammation. Some need an injection of steroids into the joints to relieve the pain.
• After the acute attack is subsided, allopurinol can be used to prevent the flares. Taking this during an acute attack may cause worsening of the attack.
• Sometimes Probenecid is advised by the doctor along with the other medicines to help in excretion of uric acid.

 

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Vitamin D

Vitamin D

sunshine

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.

good food

Assessment of vitamin D levels
VitD-13-grph3

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
>100ng/mL                         intoxication

How is Vitamin D produced in the body?

Vit-D-Sources-and-Cycle

 

 

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 .

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Tips for Dining Out With Diabetes

Tips for Dining Out With Diabetes

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

Appetizers

fruits

  •        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.

Salads

  •        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.

Main courses

  •        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.

Desserts

cakes 3

  • 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…

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Some nutritional facts

Some nutritional facts

the_food_pyramid 1 vegan-pyramid 3

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.

Calories

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

 


Age
in years

Males Females
Non              active              Mod          active       very active
Non active Mod active

very active

10 1600 1800 2000 1400 1800 2000
11 1800 2000 2200 1600 1800 2000
15 2200 2600 3000 1800 2000 2400
18 2400 2800 3200 1800 2000 2400
21-25 2400 2800 3000 2000 2200 2400
26-35 2400 2600 3000 1800 2000 2200
36-45 2200 2600 2800 1800 2000 2200
46-55 2200 2400 2800 1600 1800 2200
56-65 2000 2400 2600 1600 1800 2000
66-75 2000 2200 2600 1600 1800 2000
>76 2000 2200 2400 1600 1800 2000

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

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

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

Fruits provide carbohydrate, vitamins, minerals, and fiber.

fruits sugar  fruits

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
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

 

Option 1:

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

Option 2:      

2 scrambled eggs -                                                 no carbohydrate
A slice whole wheat bread –                                 15 grams
An orange -                                                                  18 grams
A cup of low fat milk -                                              14 grams

Option 3        

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).

Diet
• 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.

Some tips:

  • 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
Cereals:
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?

 

Food-Pyramid 2

This is an interesting concept to follow:

my_food_pyramid 4

 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
More