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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

sugar sweetened beverages

sugar sweetened beverages

It is of a major concern that the increased consumption of sugar sweetened beverages has been linked to the development of the dangerous chronic illnesses such as diabetes type 2, hypertension and coronary heart disease.

The increased consumption has been a potential contributor to the pandemic of obesity.

Unlike carbohydrates which have a high fiber content, the sugar sweetened beverages are nutrient poor and are often accompanied by intake of salty fast food as well. High levels of fructose corn syrup promote insulin resistance as well as fatty liver which can lead on to diabetes type 2.

The pictures given below show the amount of sugar in some of the commonly used things. It is eye popping. Out here in the Middle East, Coca Cola and Mountain Dew are considered like the national drinks and no party is complete without a similar beverage.

sugar beverages                  sugar beverages 2

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Diabetes and digital age

Diabetes and digital age

Though close to 85% use the internet even if from the low socioeconomic  population, digital technology and web based application usage has been very slow to catch on when compared to the boom experienced in the retail shopping and banking sectors worldwide. The vast majority of online communities, mobile applications ( Apps, as they are commonly known) and web sites have been very sluggish in integrating with the mainstream health care stream.

Social networking sites such as Facebook, Twitter, Instagram, WhatsApp and many others I am unsure of, have helped transform social life in a big way to a point where people avoid face to face contact. But these sites have also helped create a platform to support sharing of knowledge, communication and understanding, lever positive behavioral changes and also help in using the audiovisual mode of communication which lingers longer in memory.

More frequent consultations will be costly and not affordable to many even this day. This way of e- health will help tide over this if used well. This will help in increasing treatment adherence, health related behaviors as well as give a feeling of being looked and cared for.

But, there are some barriers to accepting the digital technology such as :

  • in those with physical or visual impairment
  • those who are illiterate
  • those who do not read or speak english
  • those residing in geographically remote areas
  • those with social phobias
  • those concerned about their privacy

 

Telephones have become more than just a gadget to either receive or make a call. With the new generation smartphones, one can record conversations, take excellent photographs, transfer them instantly through internet, chat with friends on the social media, create presentations for meetings, store data in excel format, fax documents, scan documents, use the phone as an organizer, store songs and movies which can be played when alone or bored. Now – a days, these smartphones have also taken the role of a health assistant which can track the progress in exercise schedule, diet, weight loss, and store personal data such as sugar readings over the past 3 months with a graphical representation included. These can be uploaded where you are on this planet and can be linked to the doctors phone for an instant viewing. The list is endless. Maybe there is an app which can remind one to take the medicines on time in case one has forgotten.

There were days when people used log books to record their sugar readings and might even forget to get them when coming for the consultation. Now – a – days with advancements in technology, there have been significant developments in the way a person with diabetes can record their progress or even hide their frustrations by making excuses such as worn out batteries and even having forgotten them at home.

Things have become so technological these days with the data being uploaded to a remote system or a good mobile devise or even the doctors chambers. This comes particularly handy among the young children who sometimes tell lies to escape the wrath of their parents. The data is instantly shared with the parents phone devise helping them keep a track of the events.

There are numerous applications ( Apps) which can be downloaded either for free or for a price which can help in various functions and even take over as a personal health secretary. The list is so vast and all have not been mentioned here. Some are free to download , some have to be paid for.

 

Some apps for nutrition include :  Fooducate, Carbs and Cals, Carbmaster free, calorie counter, calorie tracker, daily burn, lose it, Go meals, weight watchers mobile

Some apps for exercise include: my fitness pal, run tracker,workout trainer

Some for glucose monitoring include: Bant, dLife, Glucose buddy, GluCoMo, Wave sense, Glooko, DBees.com, Glucatrend diabetes, VRee, On track, Handylogs sugar
Ihealth wireless smart glucomonitoring system and TelCare wireless glucose meter can help synchronize ( or sync ) the data with an App, website or even an i cloud.

 

Ditto

ditto glucose data system

This is a devise connected to a glucometer which can transfer data to a remote system or website.

Glook O

glooko

This is a cable connecting a phone to a glucometer. This can be uploaded to the cloud .
Some of the Apps can even show long term trends and graphically represent them making the visualization much better ( if all is going well) . The only problem is one will have to enter the data and allow the App to take care of the rest. This data can be shared with the health care provider almost immediately which helps taking health care to another level.

Diabetes Pal- this helps even recording and advising on level of physical activity and can record the glucose readings as well.

Glucose Buddy

diabetest apps_0

This app lets you record blood glucose levels and note the time of day—such as “before breakfast” or “during activity.” You can view trend graphs, interact in the Glucose Buddy forums, and record insulin injections, exercise, and food eaten. You can also sync your phone to an online account to manage your data on Glucose Buddy’s website. Devices: iPhone, iPod Touch, iPad

WaveSense Meter
wavesense app

 

Manufacturer AgaMatrix’s app lets you log blood glucose levels and type in personal notes. You can record the amount of insulin injected and the number of carbohydrates eaten, and view one-, three-, seven-, 14-, 30-, and 90-day trends in graph or chart form. High, in-range, and low readings are color coded in the logbook. And you can e-mail your stats to family or your doctor. The app comes loaded with about 50 diabetes-related videos. Devices: iPhone, iPod Touch, iPad
OnTrack

Medivo-Acquires-OnTrack-Diabetes

With this app one can log and store the blood glucose level as well as food intake, blood pressure, weight, exercise, pulse, A1C results, body fat percentage, and medications  taken. For each entry,  personal notes can be added. Results can be exported via e-mail to your medical team. Devices: Android phones

 

Lose It

 

lose it app

Track  weight loss, daily food intake, and exercise with this comprehensive app. Meals taken can be added instantly (from a list of common foods, brand-name foods, and restaurant meals, or  own recipes) and watch the sliding scale climb toward the recommended daily calorie limit. One can record exercise (choose from a long list of activities), graph the weight loss, get reminders, and share the progress on Facebook and Twitter. Devices: iPhone, iPod Touch, iPad

Calorie Counter by MyNetDiary

my net diary app

With this app, eon can record meals (choose from an expansive food library that includes restaurant picks), exercise, water intake, medications,  weight and measurements. Food selections include nutrition facts

dLife-

app for DM

This app gives an idea of food and how it affects the sugar, recipes and even short videos. The diabetes website dLife makes a diabetes application that you can use to log glucose levels, find recipes and nutrition information, watch dLife videos, and connect with the dLife community and experts to get answers to your diabetes-related questions. Aside from logging the sugar levels, you can graph daily, weekly, or monthly levels and track trends—all of which  can be e-mailed to yourself or your health care provider. Devices: iPhone, iPod Touch, iPad
Fooducate

 

fooducate-diabetes-app-icon

This app could be your shopping companion on the next trip to the grocery store. You can scan barcodes, search for products, and browse categories to find foods you’re shopping for. By selecting a food, you’ll get a list of health pros (100 percent whole grain!) and cons (loaded with high-fructose corn syrup!) and can compare it to similar products. Keep track of products you eat regularly by “liking” a food. Then, next time you hit the store, you can pull up a “my likes” list of foods you might want to buy again. Devices: iPhone, iPod Touch, iPad
7 MINUTE WORKOUT

7 minute workout app

This is an app which can fit into any routine, has 12 simple exercises which are scientifically formulated.
SWORKIT –

sworkit-app-e1360796738997

This has exercises for strength training, yoga, cardio and stretching. All one has to do is to select a workout category, and how long the exercise plan should be for. Accompanying videos will help show how to perform the exercises properly with minimum injury and maximum effect.

 

 

 

 

 

 

 

RUNKEEPER-

run keeper app

This is an app which is ideal for those interested in cycling, running, swimming and biking. This has an in built Goal Coach which sets a realistic goal to follow.
ManageBGL is an app that offers a simulated insulin pump. This is of use among those who are having Type 1 diabetes or those having type 2 diabetes with multiple doses of insulin.This needs some input such as current and previous blood sugar levels, carbohydrate intake, insulin dose and this will predict the future glucose readings and aid in auto calculation of bolus insulin dose.

To help those who are handicapped with poor eyesight, some glucometers have come with a voice readout.
Sharing the data through social media such as WhatsApp, TalkRay , Viber, Instagram and Facebook have made the modes of sending across data almost instantaneously. If you ever noticed, a once upon a time luxury called email, has now almost become mandatory. There have been instances when patients have even used the above to send me snaps of the medicines they wish to have refilled or even to send me snaps of some ulcers on their foot to help monitor the progress and even to help with their appointments. Scanning and sending their test results from the far corners of the world can be sent across through one of these portals.

 

 

 

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Smoking and Diabetes

Smoking and Diabetes

smoking 1                                                                                            smoking 2

 

Smoking has been the passion of many though the prevalence has come down from a lofty 40% in 1965 to 20.9% in 2006. 90 % of the smokers were below 20 years of age. 18.1% of the adult females and 23.9% of the adult males smoked in a survey conducted across some continents in 2008. It sure must be higher now.
Peer pressure, stress at work, status symbol, a recreation, a pastime, copying their role models all are causes of initiating smoking.
All are aware that smoking is associated with reduced life span, higher risk of different types of cancers, digestive problems, staining of the teeth, leg problems and also problems during pregnancy.
Those who remain in the company of smokers are equally at risk for developing complications– called environmental tobacco smoke. Children whose parent/s smoke had a higher chance of being an asthmatic , having recurrent respiratory infections or even ear infections.

Diabetes and smoking
Among those with diabetes who smoked , the risks were greater than those who did not smoke and had diabetes.
Metabolic control was poor among the diabetic patients who smoked. The following were noted among the diabetic patients who smoked:
• Increased fluctuations in sugar levels and HbA1c, the 3 month average of sugar
• Increased blood pressure and retinal blood flow
• Increased bad cholesterol- LDL and triglyceride
• Associated increase in adrenaline, growth hormone or cortisol which could increase glucose levels.
• There could be associated alcohol intake with an increased high fat diet consumption.
• Less likelihood of exercising.
• There may be a progression of complications such as retinopathy, neuropathy and nephropathy.
Cessation of smoking is an important step in the management of diabetes management. This is associated with less chances of developing a heart related disorder, stroke, cancer or leg vascular disease and improving life expectancy. Those who benefit most are those who quit at a younger age, those who have lesser tobacco pack years. Smoking cessation has health benefits for all ages even after the age of 65 years or even after smoking related complications develop. Mortality rates of those smokers who have abstained for more than 15 years closely approach that of those non smokers.
Withdrawal symptoms -craving, depression, anger, frustration, irritability and sleep disorders.
The treatment of withdrawal includes psychological treatment, positive reinforcement and medicines which help to replace nicotine such as nicotine patches kept on the skin ,nicotine containing chewing gums, lozenges, nasal sprays or even inhalers.
Menthol cigarettes or low tar cigarettes do not reduce the risk for hazards to smoking.
Electronic cigarettes have not yet been approved for withdrawal, though many claim to find them beneficial.
Benefits of cessation of smoking

Half of the excess cardiovascular risk is eliminated in first year of quitting. There is 30- 50% excess risk for lung cancer even after quitting for almost 10 years.

The highest risk for the development of type 2 diabetes occurred in the first 3 years after quitting but this risk gradually declined to 0 at 12 years.

In lighter vein…….

 

  • 46% admitted to not eating sweets when smoking and 38% admitted smoking calmed them down…..
  • But, those who stopped smoking were found to gain 3.8 to 4 kg per year in men and among women a 2.8-3 kg increase per year. But, this increase can be prevented by good lifestyle management.
  • I even had patients tell me they felt smoking was able to control their diabetes better due to the absence of weight gain as well as by not eating sweets. But, the hazards of smoking outweigh these small “benefits”.

 

 

 

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Winter and Diabetes

Winter and Diabetes

Winter-Snowman (1)winter

 

Normally during the cold winter months, the levels of HbA1C, the 3 month average of sugar, can be higher due to higher food quantity consumed to combat the cold, the frequent outdoor barbeques and probably excess liquor consumption with the co incident Christmas and New Year festivities. People spend more time indoors in places where the weather is extreme. Lack of adequate physical activity and excess sleeping hours cuddled up under the warm blankets add more insult. It is quite natural to gain 5-6 kilos during the winter.

Blood Sugar Testing

GlucometerThe finger tips may be cold and so warm them by rubbing them together or wrapping them around a hot mug before pricking the finger for testing. In places where it snows, the glucometer kit has to be kept warm in covered bags so that errors do not come in the readings

 

 

 

Exercising

It is difficult to work up a sweat while exercising during this time and one may feel cold after the exercise due to the evaporation. Remember to dress adequately while going for outdoor exercises. Hydration with adequate amounts of fluids is still important even in the colder months. Dehydration can increase the sugar levels.

yoga       Tai Chi

 

 

Hula Hoop             swimming

Exercise such as skipping rope, doing the Hula Hoop, aerobics, dancing, yoga, swimming in thermal controlled swimming pools or working out in an indoor gymnasium do wonders. The benefits of exercise are the same whether done during winter or summer!!

Some blame the cold for exercising outdoors, but then they also blame the summer heat and humidity when that sets in.

Care of Skin

It is important to take good care of the skin as it can dry quite fast. Adequate and generous application of moisturising creams, and sunscreen if going to winter sports such as skiing or snow surfing or those just trekking in the snow laden mountains are very important. Adequate hydration keeps the skin shining and hydrated.

Those with neuropathy ( where the nerves of the feet are not working properly) may have difficulty in gauging the heat of water used for bathing.

Take care of the feet. Do not use hot water bags to keep yourself warm. Use multiple layers of clothing or socks at night to the feet. In some countries warm fireplaces keep the rooms warm, but beware the carbon monoxide accumulation.

Food & Beverages

Alcohol may cause a sense of warmth caused by dilatation of blood vessels, but the same may be lost after some time. Manage the consumption of alcohol wisely. Try to take hot beverages and easily digestible food such as soups, oats, porridge, steamed food and some fruits. Black tea with crushed ginger and black pepper is a good drink to even soothe the throat. Remember that excess red meat consumption can lead to high cholesterol levels in some races. The temperature can get quite low at night and it is natural people may eat more to raise their body temperature. Remember you do not need that much food at dinner whether it is summer or winter. It is healthier to sleep on a lighter stomach.

Frequent respiratory infections , mostly viral, are quite common. It is wise to have a Flu vaccine taken once a year rather than have to take multiple courses of antibiotics and medications to combat the infection. The elder adults should have a shot of pneumococcal vaccine once in their life.

It is also quite common to get infections due to food poisoning from eating out .

Use tissues, frequent washing of hands  using soap and water or sanitizers especially before shaking hands with others help to prevent transmission.

Gargling of the throat with warm saline helps. So also does steam inhalation.

Fizzy cool sugary drinks do not help whether it is summer or winter.

Enjoy the winter because you will wish it was like this when summer blasts in.

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Salt

Salt

Though essential, there are many bad effects with salt when taken in large amounts over a long period of time. The kidneys cannot get rid of this in time which leads to water retention, hypertension ( raised blood pressure) and studies have shown this is also important in development of osteoporosis among women even with normal calcium levels.

Processed or canned food contain salt in plenty. These may not taste salty.
Fat free or low fat food usually have high sodium content.

Tricks to give a salty taste without really adding salt are to use vinegar or to squeeze lemon on to the dish.

Rock salt gives the taste of salt but is very low on sodium content.

Sodium content in some commonly used foodstuff:

  • A teaspoon of light soya sauce has 365 mg salt.
  • Dark soya sauce has 200 mg in a teaspoon
  • Reduced salt soya sauce has 185 mg in a teaspoon.
  • A small cup of French fries has between 200 to 400 mg salt.
  • Chicken rice has a whooping 1290 mg salt !!
  • A glass of milk (250 ml) has 80-120 mg salt.

Did you know?

One level teaspoon of salt is the equivalent of 2300 mg of sodium

Reducing the salt by 3000 mg a day can reduce the risk of developing a heart event , stroke and death by any cause by phenomenal percentages.

Salt is seen in these forms. Look for these on the nutrition labels.:
• Monosodium glutamate
• Disodium phosphate
• Sodium citrate
• Sodium nitrite
• Sodium nitrate
• Sodium benzoate
• Sodium ascorbate
• Baking powder
• Baking soda

These are salty…….

  • Salt and seasoned salt (or salt seasonings)
  • Boxed mixes of potatoes, rice, or pasta
  • Canned meats
  • Canned soups and vegetables (with salt)
  • Cured or processed foods
  • Ketchup, mustard, salad dressings, other spreads and canned sauces
  • Packaged soups, gravies, or sauces
  • Pickled foods
  • Processed meats: lunch meat, sausage, bacon, and ham
  • Olives
  • Salty snack foods
  • Monosodium glutamate or MSG
  • Soy and steak sauces
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Diabetes burnout

Diabetes burnout

burned out 1 depression-quotes-sayings

This is a state of disillusion, frustration and a meek submission to diabetes which results in complete disregard to blood sugar level management. This is regarded as “freedom” from this confusing , frustrating and ever demanding condition. This is often seen many years after commencement of treatment.

This burnout is usually accompanied by varying levels of stress, anxiety, depression and labile emotions.

Precipitating factors:

  • Scared of living with diabetes
  • uncomfortable social situations- cannot swim, cannot party, cannot be out for late night meetings, cannot do this or that…
  • overwhelmed and angry with diabetes
  • feeling “alone”
  • Feeling diabetes is taking too much of mental and physical energy
  • Food deprivation
  • concerns about the future- “Can I marry?”, “Will I be able to conceive or have a normal sexual life”, “How long can I live?”

The commonest modes of presenting can be:

  • Self destructive behavior
  • Eating or drinking whatever one wants knowing fully well it is not good for those with diabetes.
  • Improper insulin shots or lying about medicine intake
  • Improper maintenance of log books
  • Fabricating glucometer readings
  • Complications of diabetes can set in which in turn makes things worse to a point of suicidal behavior.

How to overcome a burnout?

  • Stay focused and motivated. Do not attempt to be perfect- forgive those occasional high sugar levels if other readings are fine.
  • Identify barriers to care of diabetes and resolve them.
  • Edit negative thoughts
  • Enroll into support groups
  • Speak with a friend or health care professional
  • Rethink exercise schedule
  • take a break
  • Laugh it off

A check list:

check listAsk yourself whether you have done the following:
• Enough medicines are there with you.
• Have you had the blood tests for cholesterol, liver, kidney, hemoglobin , urine for protein, sugar and 3 month average of sugar at least once in the past 6 months.
• Have you had a foot check , an eye check by eye doctor and a heart check such as having an ECHO cardiogram and Treadmill test in the past one year. There are instances when the treadmill could not be done due either being overweight or having knee or back problems.
• If an elderly male, have you had a PSA test done in the past one year ( this is a blood test for the prostate) Alternatively, you could meet with a Urologist, the specialist for these problems.
• If an elderly male or female, have you had the calcium, vitamin D levels checked in the past year and a bone mineral density which is a scan for the bones showing if they are prone for fractures. Vitamin D levels, if very low, will need a correction with medicines and a recheck done depending on the doctors advice.
• Women after the age of menopause or those with a strong family history of cancer of the breast should have a mammogram ( special X ray of the breast) done once yearly.
• Thyroid levels can be checked yearly once , unless on treatment.
• Distended abdomen, “gaseous feeling” and belching with a mild upper chest discomfort can sometimes be a marker for something sinister. Have a gastroscopy done to make sure there are no ulcers.
• All bleeding from below is not from ‘piles”. It may also be worthwhile to have a colonoscopy done.
• Have you been monitoring your progress and if you can see no improvement in either the sugar levels or weight, you must seriously reconsider your options. Please do not always find fault with the doctor or the medicines, the reason could be elsewhere.
• Have you got the glucometer serviced or checked out especially if more than an year old
• Have you shown the Insulin delivery devise to the doctor once a year if the refilled pens are being used. Faulty devices can lead to errors in dosing.
• All said and done, there is no point in doing an annual whole body scan to make sure all is well. There are so many things which may go unnoticed and also will be risk of too much of radiation.
• Please check the footwear daily for wearing out or foreign bodies. They can prevent serious mishaps later.
• Have you had an annual Flu vaccine? This will reduce the flu which occurs while traveling a lot
• For those above 65 years of age a pneumococcal vaccine is useful. This is to be taken just once in a lifetime.

 

 

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