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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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Using moisturizers

Using moisturizers

                                                                       moisturizer-2

The winter is coming and it is time for special care for your body. This is a time where one tends to have more parties and celebrations, will definitely eat and drink without guilt and sleep well due to the cold weather. But there are certain things to be careful of- the water intake might go less which can result in urinary infection or stones, indigestion due to excess spicy food, and dry skin especially on the exposed parts of the body. People might exercise less outdoors in view of the cold climate. You could still exercise indoors and can go outside dressing appropriately for the climate conditions outside.

Moisturizers help in treatment and prevention of dry skin. Besides this, it also protects sensitive skin and improves skin tone and texture. The moisturizers act by trapping water in the outermost layers of the skin and acts as a temporary barrier to water loss.

Moisturizers usually contain humectants and emollients which help retain moisture. They also claim to contain peels of fruits and fragrances to make it smell pleasing. But, for those with sensitive skin, these adulterants can cause irritation and allergy. The expensive moisturizer does not always mean it is the best.

For those with normal skin, apply water based creams which are non greasy ( non oily)

For those with dry skin, use one with a heavier oil base. Petrolatum based one s are ideal.

For those with oily acne prone skin, use lotions and must be noncomedogenic( not closing the pores which can worsen the acne). Most of the soaps and face washes can dehydrate the skin further. Use of foam free face wash is recommended.

For those with sensitive skin prone for rashes, allergy and irritation, look for ones with soothing ingredients such as aloe or chamomile. These are non perfumes usually.

Use moisturizers soon after bathing.

Heavy creams are used in areas where dry skin is there and hence the face is spared of heavier creams.

Some of the brands of moisturizers come with a sun protection as well.

If the skin dryness does not improve, please do consult a skin doctor.

Hydration and eating healthy are essential to retain the glow and moisture of the skin.

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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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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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Treadmill ….not dreadmill

Treadmill ….not dreadmill

treadmill 4Treadmill is the commonest equipment bought for the home gym and is also one of the commonest equipment used if one frequents the gym. It is often believed that the cardio exercises such as running, jogging or cycling help lose weight and also to keep one fit. But, it is worthwhile to note that the low intensity exercises help the body to adapt over a period of time thereby losing its efficiency at reducing the calories burned per minute.

 

Most of the people buy the treadmill and it soon becomes a dread mill- some use it as a storage space for books and other commodities.  Some use the treadmill as a stand for hanging clothes.

 

treadmill 3

There are, however, some points to ponder before buying one.

The advantages of a treadmill:

  • Can exercise indoors despite adverse climate
  • The smooth cushioned belt is kinder to the joints than when running on hard surfaces outside.
  • Those who have no baby sitter or those who cannot leave home can benefit having this at home.
  • This can be folded and kept aside if space is being compromised.
  • Can listen to audio or see videos while on the treadmill.
  • The programmable workout can be done to make the treadmill more interesting

 

The disadvantages:

  • Can be monotonous
  • The force of impact while stamping on the belt can cause injuries or pain to the knee, ankle or hip joints for some.
  • While running or walking outside, the muscles make small adjustments to improve the co-ordination and balance which is not there while on the treadmill.
  • While walking or running outside, the hamstring muscles ( muscles of the back of thigh and calf) help to propel the body forward. This does not take place while on the treadmill as the machine pulls the body forward.
  • There is no wind resistance which can be encountered while exercising outdoors.
  • There is nothing to match the downhill running on treadmill. While running downhill, there has to be a good co-ordination between the muscles of the front of thighs and lower leg muscles.
  • Can fall off the treadmill with injuries if not concentrating while on the treadmill
  • Adequate footwear is essential as the footwear can wear and tear easily due to the friction.
  • Cannot enjoy the sights outside, no fresh air and also change in pace is not possible.

 

Points to ponder while buying one:

 

treadmill5

  • There are two types-  manual and motorized type. The manual needs one to use force to start it moving and some need even an inclination, but once it gets moving, the inclination cannot be adjusted unless you come off the machine. The manual one costs lesser than the motorized one.
  • Stand on the belt and see if there is any jerky movement or instability of the base of the machine
  • Look for a continuous duty rating of > 1.5 HP
  • The belt size must be at least 48” long and 16” wide.
  • The control panel must be easily accessible
  • There must be an emergency stop button which can be used if there is a mishap.
  • Look for the programmable versions available where the pace and inclination can be adjusted.
  • Addition of audio and video plug ins cost more
  • Water bottle holders are another option.
  • Look for the warranty period
  • If any other person besides you are planning on using the machine, please buy the high end machine. Those who are heavily built need a better machine.
  • Regular servicing or maintenance is needed.

 

Before using the treadmill, do the following:

  • Proper attire including good shoes
  • Make sure you are fit to undergo the exercise. If a first timer, make sure the doctor clears you of any heart, eye, kidney or nerve problems. If having back pain, ask the doctor before starting the treadmill.
  • Make sure the sugar levels are not too high or too low. Correct the sugar levels before the exercise.
  • Carry with you an ID card mentioning you are diabetic. Have fast acting carbs with you. Carry either orange juice or water which can be had midway between a heavy work out if the duration lasts more than an hour. If you feel dizzy or complain of difficulty breathing, do consult a doctor before continuing.
  • Adequate warm up is essential, start slow and then build up the pace or inclination and also stop slowly. Do not suddenly stop unless it is an emergency.
  • Leave a space behind while on the belt, it is safer you have some space behind in case you slip.
  • Hold on to the side railings while using an inclination or losing balance.
  • Swing arms if possible as in natural walking.
  • The short bursts of fast pace followed by slow pace improve the fitness levels as well do not exhaust the body.
  • Keep back straight and not slouched over.

treadmill 2

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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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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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