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Travel and Diabetes

Travel and Diabetes

Aeroplane-In-Sky-Wallpaper                                        cruise-ship


In todays world,one needs to relax in between to recharge ones mental and physical faculties. Just being a diabetic should not ruin your chances for a pleasurable trip.

See Your Doctor Before You Go
Before a long trip, have a medical exam to make sure your diabetes is in good control. Schedule the exam with enough time to work on your control before you depart. Get immunization shots — if you need them — at least one month before you leave. If the shots make you sick, you’ll have time to recover before your trip. Some countries do insist on some vaccinations which are mandatory. Most of the vaccines are available at the Tertiary care centers here in the Sultanate. They will issue a vaccination card as well which you may have to produce at the port of entry.

You might be needing a letter stating you are carrying the insulin shots, the glucometer kits, syringes and the pump in your carry bag. The site will help. The site  also helps in knowing rules at airports around the world.

Before any trip, get two papers from your doctor: a letter and a prescription. The letter should explain what you need to do for your diabetes, such as take diabetes pills or insulin shots. It should list insulin, syringes, and any other medications or devices you use. The letter should also list any allergies you have or any foods or medications to which you are sensitive.

The prescription should be for insulin or diabetes pills. You should have more than enough insulin and syringes or pills to last through the trip. But the prescription may help in case of emergency. It may be useful to have a prescription in the language of the country you are visiting as English is not widely spoken or understood in some parts of the world.  The sites as well as give an idea how to do this translation.

It is safer to have enough stock of the medicines with you. It will be cumbersome to hunt for a doctor and schedule an appointment in the middle of enjoyment. This can even ruin your vacation. Carry enough stock of batteries for the glucometer or pump.

Prepare for an Emergency Abroad
No matter where you go, wear a medical ID bracelet or necklace that shows you have diabetes. If you’re leaving the country, also learn how to say “I have diabetes” and “sugar or orange juice, please” in the language or languages of the countries you’ll visit.

Insure yourself if need be. InsureMy can help.

Medical IDs
Many people with diabetes, particularly those who use insulin, should have a medical ID with them at all times.
In the event of a severe hypoglycemic episode, a car accident, or other emergency, the medical ID can provide critical information about the person’s health status, such as the fact that they have diabetes, whether or not they use insulin, whether they have any allergies, etc. Emergency medical personnel are trained to look for a medical ID when they are caring for someone who can’t speak for themselves.
Packing Tips
The second rule of travel for a person with diabetes: pack at least twice as much medication and blood-testing supplies as you think you need. Pack all of them in your carry-on bag so that your medication is always with you (checked luggage can get lost). Keep a photograph of the medicines you are on in your smartphone. This will help in case the prescription is lost.
Whether you travel by car, plane, boat, bike, or foot, you’ll want to keep this “carry-on” bag with you at all times. Pack this bag with:
• all the insulin and syringes you will need for the trip
• blood  testing supplies (include extra batteries for your glucose meter)
• all oral medications (an extra supply is a good idea)
• other medications or medical supplies, such as glucagon, antidiarrhoeal medication, antibiotic ointment,  drugs for motion sickness.
• your ID and diabetes identity card
• a well-wrapped, air-tight snack pack of crackers or cheese, peanut butter, fruit, a juice box, and some form of sugar (hard candy or glucose tablets) to treat low blood glucose.
Eating in the Air
When you fly, you can request a special meal low in sugar, fat, or cholesterol. Make your request at least two days before the flight.
If you take insulin, wait until you see your food coming down the aisle before you take your shot. Otherwise, a delay in the meal could lead to low blood glucose. To be safe, always carry some food with you. If your meal is delayed or an order is mixed up, you won’t be stuck with an empty stomach.
I am on insulin

  • When you travel with insulin, give some thought to where you’ll be storing your supplies. Insulin does not need to be refrigerated, but insulin stored in very hot or very cold temperatures may lose strength.
  • Do not store your insulin in the glove compartment or trunk of your car. Backpacks and cycle bags can get quite hot in the direct sunlight. If you plan to travel by car or bike or to be out in the elements, take steps to protect your insulin. Many travel packs are available to keep your insulin cool.
  • In general, you should stick with the exact brand and formulation of insulin that you have been prescribed by your doctor.
  • However, if you run out while you are on the road, and your regular brand is unavailable, you may substitute another brand’s equivalent formulation (for example, NovoLog for Humalog, Humulin R for Novolin R). Changes in formulation (for example, from rapid-acting Humalog to to short-acting Humulin R) require medical supervision.

Insulin can come as U-40, U-80 U-100 and U-500. This means one ml of that insulin could have either 40 units or 80 units or 100 units or 500 units.
If you need to use these insulin preparations, you must buy new syringes to match the new insulin to avoid a mistake in your insulin dose. If you use U-100 syringes for U-40 or U-80 insulin, you will take much less insulin than your correct dose. If you use U-100 insulin in a U-40 or U-80 syringe, you will take too much insulin. However, the pen devices do not have these problems.

Crossing Time Zones
If you take insulin shots and will be crossing time zones, talk to your doctor or diabetes educator before your trip. Bring your flight schedule and information on time zone changes. Your doctor or educator can help you plan the timing of your injections while you travel.

Remember: eastward travel means a shorter day. If you inject insulin, less may be needed. Westward travel means a longer day, so more insulin may be needed.Visit for insulin dose calculation while going on long hours. One may also need to adjust the insulin dosages when going on trekking or climbing mountains when abroad.

  • To keep track of shots and meals through changing time zones, keep a watch on the home time zone until the morning after arrival.
  • Keep the home time in the watch for half a day after arriving so that you take the shots of insulin at the normal time as back home. The time can be set after 8 hours.
  • If on an insulin pump, change the time to new country before take off and program the pumpaccor
  • If one injects insulin while in flight, those traveling frequently suggest you be careful not to inject air into the insulin bottle. In the pressurized cabin, pressure differences can cause the plunger to “fight you.” This can make it hard to measure insulin accurately.
  • Checking the blood glucose while traveling is as important as when at home. Also, check the blood glucose level as soon as possible after landing.
  • Jet lag can make it hard to tell if one have very low or very high blood glucose.

Welcome to a new place
After a long flight, take it easy for a few days. Check your blood glucose often. If you take insulin, plan your activities so you can work in your insulin and meals.

  • If you are more active than usual, your blood glucose could go too low. Take along snacks when hiking or sightseeing. Don’t assume you will be able to find food wherever you are.
  • No matter what kind of diabetes you have, it’s smart to watch what you eat and drink when traveling. Avoid tap water overseas. This includes ice cubes made from tap water.
  • Ask for a list of ingredients for unfamiliar foods. Some foods may upset your stomach and hurt your diabetes control. But you will also find foods that give you a healthy taste of culture.
  • Wear comfortable shoes and never go barefoot. Check your feet every day. You should look for blisters, cuts, redness, swelling, and scratches. Get medical care at the first sign of infection or inflammation.
  • Go wherever your heart leads you. Just remember that you take your diabetes with you. Take your self-care along, too.
  • It is always refreshing to have soda, slushies or coffee when traveling. Remember that these can have a lot of calories and carbohydrates.Try to have plain coffee with low fat milk rather than the fancy Cuppa Mocha, Starbucks or Latte which can pack quite a lot of calories. You must enjoy the vacation and so even if you wish to have all these, go for a stroll after the meals or these beverages.
  • Those planning on visiting a beach, must remember to carry some cool fluids and keep the medicines cool. Those who wish to have their blood sugar checked by pricking must remember to wash their hands well before doing so. Some have alcohol while in the pool or on a beach.
  • The effects of alcohol can be blunted while in water and so many may consume more to get the “kick”. Alcohol can increase the sugar levels. Cocktails can be pretty dangerous in terms of calories and sugar levels.
  • Please do not walk barefoot however beautiful the beach may be.
  • For those on an insulin pump, have the pump disconnected while taking off or landing as the pressure changes can sometimes deliver more insulin than needed. During the reconnection, remember that small air bubbles must be removed or else less insulin will be delivered. The extreme heat can sometimes damage the insulin in the infusion tubing which can work less effectively.

Carry the following with you to avoid problems at the airport
• Some document from the doctor mentioning you are diabetic
• A document to explain why carrying an insulin pump, glucometer, lancets for pricking blood, test strips, insulin pens and the needles, insulin storage cans or packs.
• Carry enough stock of insulin
• Quick acting carbohydrates such as glucose powder.( remember that chocolates, juices may get damaged with travel and the glucose tablet may harden)
• Slow acting carbohydrates such as biscuits or cereal bars.
• Let the flight attendant know of your diabetes as low sugar can mimic drunken behavior!
• Inform the flight attendant or airlines of your diabetes status, so they know what to do if traveling long distances. They may give you extra leg room seats.
• You can also request for a special menu which comes with some of the leading airlines.
• While flying, never aim for perfect glucose control ( keep the levels between 8 – 13 mmol/L or 144 – 203 mg/dL)
• Check the sugar levels in between if long haul flights( more than 4 hours)


Summer and Diabetes

Summer and Diabetes

summer                                                 summer-t2


Summer is here again. Here, in the Middle east, there are just 2 seasons, summer and a cool season ( not exactly winter). The months from October to March are the months when the mercury drops to pleasant levels. The remaining part of the year is generally quite hot and dry. There are areas in the Middle East where the winter months can be at sub zero temperatures. Many people flock to such places to enjoy the temperature during those times. There are a lot of people from around the globe who constantly live in very cold climates and they look forward to the summer here to get a good tan or just bask in the sun. Vitamin D levels are linked to the exposure to effective sunlight. Though there is plenty of sunshine in some parts of the world , people do not go out in the sun or even if they do, they are covered in their traditional dress so that the exposed areas are minimised. Liberal usage of sunscreen lotions also plays an important role in the development of Vitamin D deficiency.
Sun screen lotions have been marketed by many companies. It is useful to know all these lotions come with a Sun Protection factor (SPF). This number measures how well that lotion will protect from harmful UVB sun rays. These do not protect from harmful UVA rays of the sun. If your skin will burn in 10 minutes of exposure to bright sunlight, a lotion of SPF 15 will protect from sunburns for 150 minutes approximately( 10 x 15). This will of course, depend on the skin type and also the activity being done in the outdoors. Please also note that a lotion of SPF 50 will not mean it will protect 2/3 times more than a lotion with SPF 30. All these lotions may be allergic for those with sensitive skin. Try out a small sample on your wrist and see if okay before purchasing. For effective sunscreen, douse on the lotion at least 30 minutes before going outdoors. Rub in a good measure till the white color of the lotion disappears. Coconut butter (available from the germinating coconut) is a good natural sunscreen. One can periodically apply the sunscreen depending on how long one will be outdoors and also depending on skin type. Cold yoghurt can help in removing the itching and irritation after getting sunburns. The skin becomes red soon after it is burnt and may start peeling off the next day. Many remain in the swimming pool to be away from the heat. But, if in an outdoor swimming pool, the part of the skin exposed may get burnt without ones knowledge until he or she gets out of water. Use wide hats, remain in the shade from time to time and hydrate well also help.
Tips handling the summer:

Hydration with fluids:

• Be well hydrated with non sugary drinks
• Stay off alcohol, caffeinated drinks, fizzy drinks and sports drinks
• Plain water is a good source of fluids- which has no calories
• Tender coconut water is good for hydration
• Pocari sweat can increase the sugar levels for many
• Watermelon juice will increase the sugar levels
• Take small frequent sips from time to time rather than a large quantity at one time.
• There are excellent mocktails made with seasonal fruits such as Pappaya, pomegranate, banana, berries with some milk and sugar if needed. People add a squeeze of lemon with mint leaves to enhance the flavor and cool the body. It need not be chilled to give a cool feeling. The throat may get inflammed by taking too cool drinks while climate is hot.
• Buttermilk is a healthy drink. Adding ginger or chillies will enhance the flavor.
• Dark sago seeds is cooling. These can be soaked for an hour or so and they swell to form light black small jelly soft globules. These can be added to the juices made at home.


Heat Exhaustion

This happens when one does vigorous exercise or heavy work outdoors in the sun. Muscle cramps, feeling nauseated, dizzy, having rapid heart rates and feeling very feverish can be markers pointing towards exhaustion. Some collapse due to the heat (called Heat stroke). This can be avoided by exercising in a cool place or indoors or before the temperature climbs up. Have sips of water to cool down, some even wrap a wet towel on their head or face to cool down. Have a bath in normal temperature water. Exercise at times when the sun is not hot- maybe early in the day or late in the evening.

Proper clothing

Wear cotton based clothes which are airy and help evaporate the sweat. Dress in loose sized dress and not using skin tight clothes.

• Carry on yourself plenty of water and snacks. Carry a glucometer as well. Do check the sugar if feeling dizzy.

• Store the glucometer, test strips and insulin in cool places. Never leave them in the car in the summer. There are even times when the medicines stored in blisters do get damaged when left in the car in the heat.

• One can use an umbrella or a wide hat to shade away the heat while walking.

• The eyes and skin can become very dry due to the excess use of air conditioners especially when the draft is aimed towards the face. Use a soothening eye drops which can be prescribed by the eye doctor and moisturizing creams to make the skin moist. One may have to use these quite frequently during the day.

• Remember to keep the windows of the car down a little especially when parked in the sun and also use screens to ward off the direct sunlight.

• Normally the water coming from the water taps or that stored in the overhead tanks will be quite hot. Some even get burnt due the extreme heat of the water. This can be a problem especially among those who are diabetic and who have nerve problems which prevent them from realising the water is hot. Scalds of the private areas are even seen when washing after toilet. It is best to store water overnight in large containers to prevent this from happening.



Insulin in diabetes

Insulin in diabetes

download                            insulin pen device parts Indications for insulin usage:

  • When oral medicines fail to control the sugar in maximum doses
  • when there are complications to the eyes, kidney or heart,
  • when the sugars are very high,
  • when there is pregnancy associated with diabetes,
  • when intolerant to oral medicines ,
  • when diagnosed with latent auto immune diabetes of adults
  • when being planned for surgery.
  • If diagnosed with type 1 diabetes.

Insulin preparation: There are 3 main types of insulin based on duration of action- short acting, intermediate acting and long acting. • Short acting insulin acts for a short time and peaks fast. This is why this has to be administered with the main meals at least three times a day. • Intermediate acting insulin acts for close to 10 hours and so needs twice daily dosing • The long acting insulin can last for 16-24 hours and thus, needs one or two shots a day • There are premix insulin which comprise short and intermediate acting insulin in one. • Ultra short acting and ultra long acting insulin preparations are now available. • Non injection forms of insulin are now becoming available- studies are on. Nasal, inhaled forms, patches, pills, oral sprays are all forms being researched into to avoid the needle prick. The doses of insulin are usually tailored by the doctor or nurse initially and then adjusted by the patient depending on the sugar reading. Insulin delivery devices are now- a days by pen devices or by continuous subcutaneous devices. The old method of using a vial and syringe is still present. Insulin can be safely administered if used sensibly. Store the insulin in fridges ( not in the freezer) or in a cool room, lightly shake the pen before use if pre mix insulin and roll the insulin pen between the palms of the hand to prevent injecting cold insulin and inject at different sites each time. The needles are to ideally thrown after each injection( though some can use up to 3 injections with a needle) .   Sites for injecting: where_to_inject • The thighs on inner side, the outer side and front side are the most preferred sites. • The abdomen wall can be used- but remember not to inject just around the belly button ( umbilicus) inject any place on the flanks more than two finger breaths on either side of the umbilicus. • The arms are not commonly used in adults. • The buttocks and back are used for small children insulin injection How to inject: • Have the needles changed before injecting • Roll the insulin between the palms of the hands if insulin is cold. • Select the site for injection. It is not mandatory to wipe the area with a spirit wipe. However, if you do, make sure the alcohol or spirit dries out before injecting. • Feel for any thickening or induration. If present, avoid injecting into that site. • If skin is dark at that site avoid injecting there. • Do not inject into dilated veins on the thigh, if present. • Dial the required dose. • There are people who pinch a fold of skin before injecting. It is not necessary to. • Plunge the needle vertically into the site ( perpendicular to skin and not at an angle). Needles are fine and almost painless • Depress the plunger down. The meter will return to zero. • Count to five slowly and remove the pen. • It is common to see a drop of blood after removing the needle. • There is no need for a vigorous massage as is done after deep intramuscular injections. • Do not inject soon before or after an exercise regime. • Rapid acting ( short acting) insulin can be injected in the abdominal wall. The absorption from the thighs is ideal for intermediate and long acting insulin as the absorption is not so fast. The absorption of insulin is slowest if injected in the buttocks. The arm is not ideal for self injection. • The pen device has a spring device which can get worn out over a period of time, maybe after an year or two. Change the delivery system when this happens. The needles after use are to be discarded in a proper manner after putting them in a sharps container. There are places around the world where the used needles are sold again in a fresh pack thus helping spread of disease such as AIDS, Hepatitis B and Hepatitis C. Side effects of insulin: • Hypoglycemia- low sugar • Allergy to the preservative or type of insulin( this is quite rare these days with the advent of purified and human varieties of insulin) • Weight gainThickening of the subcutaneous tissue at injection site • Neuropathy- sometimes insulin can cause nerve pain which can be very depressing. Being started on insulin does not mean the end of the road. It is used by the doctor when the sugar levels are very high to bring I down, or when you are undergoing an operation or when you are pregnant or when you have complications affecting the eyes, kidney or heart. It does not mean that insulin once started remains so for the rest of your life. There are needless insulin delivery systems which are present elsewhere. There are other insulin routes available which had been researched, but fell out of favor due to the less efficiency. . While traveling long distances, use a temperature controlled pouch or ice box for keeping the insulin at a cool temperature. If you party, take a small dose before the party, have a snack before you leave, and have the rapid acting insulin after the dinner .Meet your doctor for advice on the dose. Alcohol intake can cause a delayed hypoglycemia(low sugar) The three main insulin delivery options are a pen, syringe, or pump. There are also a few newer insulin delivery systems, including the jet injector. Here are the pros and cons of each insulin delivery method to help you get started. Most of the insurance companies do not approve of these delivery systems which are new and innovative. The pen delivery system is, of course, approved and effective. Pen, Pump, or Syringe? Here’s a rundown of the three different insulin delivery systems, how they work, and their pros and cons. Insulin Syringe You use an insulin syringe to inject insulin into your body with a very fine needle. Pros: • Flexibility. You can choose from many different brands and types of syringes, and you can use them with just about any kind of insulin. • Cost savings. These work more economical than the latest medicines which could be very costly. • People with very regular schedules and consistent meal patterns can do well using this method. Cons: • Time. You have to be meticulous in loading the syringe, remember to warm the insulin if cold , by rolling the cartridge in the palm three or four times. Before injecting you need to check there is no air bubble, attach the needle, and draw the correct dose of insulin into the syringe. • Dosing mistakes. Sometimes error while loading the dose can lead to problems. Insulin Pen An insulin pen works much like a syringe, but it looks like the type of pen you use to write. Insulin pens come in disposable and reusable versions. • Disposable pens come pre-filled with insulin. • Reusable pens use a cartridge filled with insulin. Pros: • Ease and convenience. Pens are convenient to carry about unlike the insulin which ( and still is) comes in bottles.. To use an insulin pen, you just dial up the insulin dose on the pen. Then you press a plunger at one end to inject the insulin through a needle at the other end. • Memory storage. Insulin pens have a handy memory feature that will remind you how much insulin you took, and when you took it. Cons: • Expense. The disposable pens are costly and the ones which could be reused are more economical. However, the reusable ones may have to be changed once in a year or two as the dose dialer spring may become faulty. • Lack of options. Some types of insulin are not available in pen form. Insulin Pump An insulin pump is a device that’s about the same size as a pager. You wear it on your belt or in a pocket, and it delivers a steady stream of rapid acting  insulin to your body 24 hours a day through a needle attached to a flexible plastic tube. Whenever you eat, you press a button on the pump to give yourself an extra boost of insulin, called a bolus. The pump is an option for people with type 1 diabetes who have not reached their target blood sugar level using other delivery methods. It’s also a good option for people with diabetes that have very active lifestyles. It’s not clear whether people with type 2 diabetes benefit from using a pump. However among those with type 2 diabetes, who have failed to achieve good sugar control with maximum doses and have to take multiple doses of insulin instead, this is a convenient option. Pros: • Steady insulin release. The pump releases insulin as if mimicking the pancreas. The dose of insulin used will be quite less as it will be delivering tiny doses at pre fixed times. Only short acting insulin is used in this. Pumps are so efficient that you can use less insulin than you would with a syringe or pen. • Ease of use. You’ll no longer have to give yourself injections of insulin throughout the day–the pump will do it for you automatically. You can also eat whenever you choose. • Better blood sugar control. Because it delivers insulin steadily like your pancreas, the pump helps prevent blood sugar swings. • Ease of monitoring. Your pump can communicate with your glucose monitoring system so you can track your blood sugar over time and make changes to your routine as needed. Cons: • Constant wear. You’re going to be attached to this pump nearly all of the time — even when you sleep. • Risks. You need to be very careful about changing the needle every couple of days because there is a slight risk for infection. You also have to monitor your blood sugar levels, because you may be more likely to have a drop in blood sugar (hypoglycemia) with the pump than with a syringe or pen. If the catheter slips out or the pump fails, you might not get the insulin you need and over time your sugars can increase and you could develop a dangerous complication called diabetic ketoacidosis. • Cost. Pumps are costly and so also are the infusion tubing and reservoir. Some of the new ones come with inbuilt sensors as well which are costly. Insurance companies do not approve of this usually. • The infusion tubing and reservoir have to changed once every three days • Sometimes the tubing gets kinked without delivering the insulin which could cause problems • One has to feed in the carbohydrate consumption at the start to prime the pump. • The insulin will not be delivered if there is air in the tubing or if the insulin remaining in the cartridge is very low.   Jet Injector Jet injectors don’t have a needle. Instead, they use very high pressure to push a fine spray of insulin through the pores in your skin. Pros: • Needle-free. If you hate needles, a jet injector is an alternative to the insulin syringe or pen. Cons: • Pain. Though needle less, they can cause more pain in some of those with sensitive skin as the insulin is driven inside the body by sheer force. You have a high concentration of nerves close to the surface of your skin. Trying to push insulin through the skin can hurt more than injecting — especially considering how thin needles are. • Uneven insulin delivery. Because they send insulin into the body through the pores, jet injectors may not always deliver an accurate dose. Other options include an insulin patch. Work closely with your doctor to choose the option that best fits your budget, health needs, and lifestyle. Not all the above are available here in Oman. Afreeza is a powder form of insulin which is an ultra rapid acting insulin. The powder is used by an inhaler called the Dreamboat inhaler. Peak levels are reported in 12-14 minutes of inhalation. This is especially beneficial for those with type 1 diabetes who are dependent on insulin for life and also for those with type 2 who become insulin dependent with failure of the pancreas. Close to 5300 patients have been studied in trails across the world and the results so far are promising, but needs further time to be found effective. This has been found to reduce the post meal sugar levels, fasting levels, have less incidence of hypoglycemia( term used for low sugar levels) , reduced weight gain as when compared to rapid acting insulin. However, this may need to be combined with long acting insulin or with oral medicines as the case may be for a better effect. The side effect so far noted has been a non productive cough ( dry cough) Degludec insulin is a new ultra long acting insulin which is still on research programs to test its efficacy. Though it is being marketed for injection once in 3 days or once a week ( which sounds like sweet music) , the effects of the insulin wear off after a day or two. Which means it is still better to have the shots of insulin daily for better control. The sugar control and episodes of low sugar have not shown any improvement over the insulin preparations available in the market today.   Continuous glucose monitoring CGM                                              CGM 2 Continuous Glucose monitoring (CGM) devices are in the market for quite some time. These are small gadgets the size of a pager which help to monitor the sugar levels throughout the day and night. On an average a child between the ages 5 and 14 may have to poke the finger for sugar checking at least 50000 times and about 15000 injections of insulin during that time. This is quite phenomenal and frightening. For people on intensive insulin therapy as among those with type 1 diabetes or among those with frequent dips or spikes in their sugar levels which could be related to either food, alcohol or exercise. These machines detect the glucose level just under skin with the help of sensors. These levels are transmitted to a receiver. Pros: • This will give a constant reading and you can adjust the doses accordingly with the help of the health care provider. If the blood glucose reading is 7 mmol/L or 126 mg/dL, it could mean the sugar is going up or down and that is the reading at that time. The machine gives an arrow mark which will give the trend based on the readings just before.. • The tracings can be downloaded and interpreted • The tracings are given for every day in different color lines for easy interpretation • It also gives the average and how many lows one had experienced in the interim. • Alarms are there which could be programmed into the machine which could go on either when sugar swings too low or too high. Cons: • The cost is quite high • Normally the insurance companies do not approve of this unless in certain cases. • The sensors will have to be changed once in 3-7 days. This is costly • This is to be worn at all times. • May not be feasible for children below the age of 12. • One will have to calibrate the machine from time to time so that the readings are accurate. Needle less devices Frequent puncturing of the delicate skin at finger tips and also the insulin shots which are so frequent especially among those with type 1 diabetes are a cause of frustration. Now-a-days needle free CGM devices are coming out. Some are awaiting patents. There will be sensors, a transmitter and receiver. The signals can be sent to smart phones, computers or even laptops. This can be useful for working mothers who have children at home and can remotely access the sugar levels and send information to make corrective steps. The sensors are to be changed once in 3 days which helps prevent skin irritation. The skin top layer which comprises dead cells is painlessly removed and leaves a small abrasion not visible to the naked eye. The Symphony is one brand making such needle free CGM. Dexcom G4 Platinum is awaiting patents rights. This is sleek and hardly noticeable


Cancer care for women

Cancer care for women

Cancer care for women

Cancer is one major problem these days and it has become so common to hear of someone known to you, perhaps, on treatment for cancer. It is better to avoid having a cancer than to be treated for one. I do agree that treatment modalities have improved by leaps and bounds and so also have the investigative modalities. Different cancers affecting different areas of the body are known. However, the common ones known among women are the cancer of the breast, the uterus, the ovary and cervix. The drastic changes in lifestyle and increased use of chemicals in various cosmetics and food have led to a steep rise in the prevalence of cancers.

For women above the age of 40 years should be caring for their breasts as much as probably their face ! All it needs a self examination and the earliest changes can be detected by oneself much quicker than a healthcare professional. This is called breast self examination. One can stand in front of mirror and compare the 2 breasts. If the nipple or breast size varies in relation to the other note that down. Feel the breast while lying down. Use the left hand to feel the right breast and the left hand for the right breast. Feel the whole breast from the collar bone to the top of the abdomen and from the armpit to the cleavage with the flat of the hand in a circular motion. Do not panic if you feel any lumps. All lumps need not be cancer. There are lumps which may come and go during the menstrual cycles. Normally the upper and outer part of the breast has the most of lumps. The lower half of the breast can feel like sand on a beach. The area under the nipple can feel like big grains of sand.

It is wise to have the breast examined annually by a doctor who is trained to do so. The doctor will examine the breast by inspection, by feeling for any changes, feeling for any lumps in the breast or in the armpit. The doctor will confirm the presence of lumps by doing an ultrasonogram of the breast. This will detect any lumps hidden in the breast tissue. Sometimes a piece of tissue is taken with a needle which will be inserted into the suspicious lump. A mammogram, a type of X ray examination, will also be performed by the doctor which will have some radiation, but will view the breast in multiple views by pressing the breast tissue for better delineation of any masses. The doctor will look for asymmetry, inversion of the nipple, spots of calcium in the breast tissue and skin deformity. Make it a routine to have a check annually. The check up may take about an hour at the most. These tests are the most commonly performed though there are much more sophisticated tests. It is not wise to perform a mammogram in young women in her thirties as the fat content in the breast at that age is more. However the doctor will decide especially if falling in a high risk category to develop breast cancer. Remember that not all lumps can be detected by the mammogram and tests.

When should you be concerned about a breast examination:
• Family history in a close relative such as mother, sister or aunt.
• If the other breast had been treated for cancer
• If the skin becomes dimpled like an orange peel
• If any lumps are felt in the breast or armpit
• If any blood discharge is seen from the nipple

Similarly any women above the age of 50 years must be careful of the vaginal bleeding. If any bleeding occurs from below after total stoppage of bleeding, one should be concerned and should have a gynecologist examine it. A Pap smear is important and the doctor will decide if a biopsy is needed.

There are tumor markers which can be examined by blood tests at good centers. These are blood tests which show the efficacy of treatment or used for follow up to detect spread. These can also be used to suspect a cancer of the breast, ovary or cervix at an early stage. Tumor markers can be used for a whole lot of cancers besides the ones mentioned above.


Driving and diabetes

Driving and diabetes



Driving regulations vary from country to country. But, the fitness to drive especially if one is a diabetic is the same around the world .
Driving is essential for going to work, taking care of family, accessing public and private facilities and institutions, attending classes, interacting with friends and for pleasure. If practicing unsafe driving, it can be a cause of concern for those behind the wheel as well as those on the road.
Those who should not drive if having diabetes:
• Those with recurrent hypoglycemia ( low sugar)
• Those with cataract , those with retinopathy ( diabetic changes in eyes) or color blindness.
• Those with insensitive feet ( they could not feel the foot pedal)
• Those who are on multiple insulin doses
• Those with hypoglycaemia unawareness. These people do not know their sugar levels are below 3 mmol/L (54 mg/dL) as the body does not have any symptoms.
Non diabetic causes  to be denied a driving license:
• Those with obstructive sleep apnoea
• Those with unstable angina or heart pain
• Those with epilepsy
• Those who have consumed large volumes of alcohol or other recreational drugs.
• Those with color blindness


Make sure of these while planning a drive:
• Check the glucose level an hour before journey.
• If driving more than an hour, check sugar level after every hour.
• Make sure you stop frequently for hydrating yourself.
• Be careful of taking insulin before driving long hours.
• Have either a juice or sugar candy or dextrose tablet or sugar in small container in the car dashboard.

If you feel low in sugar while driving alone:
• Pull off the road and put on the hazard signal.
• Roll down the window glasses both sides.
• Remove the key off the ignition and keep on the seat nearby.
• Take either the sugar or orange juice or candy.
• Check the sugar level using glucometer.
• Call someone for help.                                                                                                        help
• Rest in the car till help arrives.
• Check sugar level after half an hour. If above 7 mmol/L, drive to nearby resting place or hospital.

When sugar levels go down, the brain gets affected and will lose its cognitive faculty. Decisions will be made at sub conscious level . If the car ignition is not turned off , one may suddenly drive and meet with an accident. If one becomes unconscious, keeping the windows open will help in accessing you.

Make sure you do check sugar level before driving. If low, correct that first and then drive.


Older drivers should note the following:


As age advances, one may notice problems with braking safely, longer response time to an emergency and problems with night vision.

Options available to overcome these in elder drivers:
• Stay physically active
• Regular vision and hearing check
• Use of some chronic medicines may cause drowsiness
• Understand limitations
• Drive under optimal conditions
• Plan ahead


Reading Nutrition labels

Reading Nutrition labels

Basic steps while reading a nutrition label:

nutrition-facts-label   how-to-read-nutrition-labels-zoom2-1024x525

  • Look at the serving size and servings per container. The label will describe the values for a serving. So, If one takes twice the serving, the values should be doubled.
  • Look at the calories per serving and the calories from fat. If the commodity contains < 40 cals, it is of low calorie, if <100 cals, it is of a moderate calorie, if <400 cals it is of high calories. Too much of calories will lead to obesity.
  • Look for the nutrients to limit- total fat, cholesterol and sodium- these are linked to heart disease, high blood pressure and some cancers. While using canned food, rinse off the liquid as it contains a lot of sodium.
  • Get enough of dietary fiber, vitamin A, Vitamin C and calcium. Usually on reading carefully, the calcium content in skimmed milk or full fat milk is the same. But, in yoghurts, the calcium will vary. Look for fiber 3 g and more.
  • Look for hidden sugars- for example,high fructose corn syrup. Look for substances ending in -ol or –ose. They are sugars. Remember that 5 g of sugar is the same as a level spoonful of sugar.
  • The footnote is the same in all labels. This shows the percentage daily values for an average American who is moderately active. He will need 2000 Kcals a day. For a more active American, 25000 Kcals or more may be needed. The values against each of the main nutrients are mentioned. This label will not change with the food.


  • Look for % DV ( Daily value) of 20% and above for nutrients that are good and 5% and below for those which are to be limited.

Also remember…..
• The top of the label describes a standard serving size and how many servings a package contains — critical information for interpreting the rest of the numbers on the label.
• A bottle of sweetened ice tea may only have 75 calories per serving. But if that bottle contains two and a half servings and you drink the whole bottle, you’re consuming 225 calories.
• Serving sizes are based on standard measures agreed upon by the USDA and the FDA. One serving of cereal is 3/4 cup, for instance. A single serving of macaroni and cheese is a cup. Most all of the information that follows on the nutrition label is based on that serving size, from calories to grams of fat. So it’s essential to know what a serving is, and to know how much you actually eat.
Phrase Definition ……………and………..What they actually mean

No fat or fat-free                             Contains less than 0.5 g of fat for each 100 g/ml
Lower or reduced fat                    Contains at least 25% less fat for each 100 g than original
Low fat                                                 Contains less than 3 g fat for each 100 g or 1.5 g for each 100 ml
Low in saturated fat                      Contains no more than 1.5g for each 100g or 0.75g for each 100ml
Lite or light                                        Contains 25% less kilojoules than the original or comparative product
Sugar free                                           Contains less than ½ g sugar for each 100g
Reduced sugar                           Contains at least 25% less sugar for each serving than the original product
No added sugar                                Sugar in any form has not been added as an ingredient
Unsweetened                                    No sugar or sweetener has been added
No preservatives added              Contains no added chemicals but may contain natural preservatives
Low sodium                                      Contains less than 120 mg sodium for each 100g
No salt or salt-free                        Contains 5 mg or less of sodium for each 100g
High fiber                                          Contains between 4.8 g– 6g or more fibre for each 100g
Lean                                                     Equal to or less than 10% of total fat
Extra lean                                         Equal to or less than 5% of total fat
Low chole  ol                                    Contains 20 mg for each 100g or 10 mg for each 100 ml

• Foods can only be labeled as ‘low in energy’ if it contains no more than 170 kJ for each 100 g of solid food or 80 kJ for each 100 ml of liquids.
• Foods can only be labeled as ‘high in energy’ if it contains 950 kJ for each 100 g of solid food or 250 kJ for each 100 ml of liquids.
• Food labels can no longer appear to be endorsed by a health practitioner (for example medical doctor, dietitian etc), or be associated with testimonials like ‘Mrs X has lost 20 kg by using product Y’.
The use of terms such as ‘healthy’, ‘wholesome’ or ‘nutritious’ is banned.

• Food labels are no longer allowed to state or imply that the product can cure any medical condition.
• Foods that were previously advertised as ‘no sugar added’ or ‘sugar free’ will be banned if the product contains any type of sugar form or derivative such as honey, molasses, sucrose, sugar, fruit juice concentrate, high-fructose corn syrup.
A second phase of regulations is planned and will define food advertising that is targeted at children, the glycemic index and foods that are non-essential for a healthy diet.

Did you Know?

• Fortified, enriched, added, extra and plus actually means that the nutrients such as minerals and fiber have been removed and vitamins have been added while processing. Look for 100% wheat or low sugar cereals.

• Fruit drinks may have little or no real fruit with lots of sugar. Look for 100% fruit juices.

• Natural – may have started with natural ingredients, but while processing will lose the “natural” component.

Food labels are meant for adults and not for children. Please remember that children may need > 2000 Kcals or < 2000 Kcals depending on their level of activity or whether they are boys or girls. Children however will benefit from looking at the calories per serving, the fats per serving, the fibers per serving and make good choices. Most of the children will need food containing more calcium and iron.




glucometer 1 - Copy  glucometer 4

If you have diabetes, one needs a blood glucose meter — a small  device — to measure, store and display the blood glucose level. Glucometer is commonly used in emergency rooms in hospitals, ambulatory medical care services as in ambulances, helicopters or sea transport while shifting patients. The glucometer is used for analysing sugar leels and adjust dose medication with the help of the health care professional or diabetes educator. This is not used in the diagnosis of Diabetes.

Exercise, food, medications, stress and other factors affect the blood glucose level. Using a blood glucose meter can help better manage the diabetes by tracking any fluctuations caused by these factors.
Many types of blood glucose meters are available, from basic models to more-advanced meters with multiple features and options. The cost of blood glucose meters and test strips varies. Study all the options before deciding which model to buy.. As with any electronic device, this cannot be immersed in water, should not be stored in extremes of temperature and humidity which can affect the device or even the test strips. Most of the new model glucometer devices have an in built check that does not display readings at extremes of temperature. Using a glucometer at high altitude as when climbing high mountains can give erratic readings.

The glucometer uses an enzymatic portion on a test strip which is in a dehydrated state when packed and a detector. The glucose in the blood sample reacts with the enzyme to produce the level which is detected. The commonly used enzymes are hexokinase, glucose oxidase and glucose dehydrogenase

Basics while using any glucometer


  • Check the expiration date of the kit
  • Make sure the lancets, glucometer, test strips are available globally.
  • Make sure the warranty card is filled out and handed over.
  • Ask for a demonstration if need be.
  • Some meters need a code chip to be inserted with each new box of test strips.
  • Always clean the finger tip before pricking the finger tip for the sample of blood. The sides of the non dominant hand are used as the skin is thinner at the side of the fingertips.
  • The blood should be flowing well. Do not squeeze the finger tip excessively to get the blood out- this affects the reading.
  • Do not reuse the lancets or test strips.
  • Dispose the lancets in a sharps disposal bin.
  • Remember to use the glucometer often, say at least twice a week. If not used regularly, it may cause the batteries to wear off by discharging or the IC to burn off. It is similar to a motor car that is not used for a month or two. The battery will not work at that time.
  • Get the glucometer calibrated often as well as periodic testing of the control solution is necessary.

Choosing the right meter
When selecting a blood glucose meter, it can help to know the basics of how they work.

  • To use most blood glucose meters, first insert one end of a test strip into the device.
  • Then, prick a clean fingertip with a special needle (lancet) to get a drop of blood.
  • Wipe away the first drop of blood.
  • Carefully touch the other end of the test strip to the drop of blood and wait for a blood glucose reading to appear on the screen. There are meters which can determine the blood glucose and blood ketone levels as well. These meters are useful for type 1 diabetic patients. It is marketed by the Freestyle under the name Freestyle Optium Xceed.

glucometer 3 - Copy                                    glucometer 2 - Copy

Blood glucose meters are usually accurate in how they measure glucose, but they differ in the type and number of features they offer. There is a difference between the values obtained by the glucometer and the blood test done at the hospital. The glucometer checks the capillary glucose level. The hospital or clinic estimates the glucose from a sample drawn from the vein.

Here are several factors to consider when choosing a blood glucose meter:
• Cost. Meters vary in price, so shop around. Be sure to factor in the cost of test strips as the insurance doesn’t pay for them. Test strips are the most expensive part of monitoring because they’re used so often. A meter may be the cheapest one on the market, but may not be a good deal if the strips cost twice as much. Also, individually packaged strips tend to cost more, but you might not use all the strips in a container before the expiration date or within the required number of days after opening the container. Figure out which type of strip is most cost-effective for you. Remember that the strips have expiration dates on the cover. Please check it out.

• Ease of use and maintenance. Some meters are easier to use than others. Are both the meter and test strips comfortable to hold? Can you easily see the numbers on the screen? How easy is it to get blood onto the strips? Does it require a small or large drop of blood?

  • Also, some brands of meters need to be coded and others have no coding. Code numbers are used to calibrate your meter with the test strips for accurate results. Make sure the strips can be bought from other parts of the world as well so that travel does not be cumbersome.

• Special features. Ask about the features to see what meets your specific needs. For example, some meters are large with strips that are easier to handle. Some are compact and easier to carry. People with impaired vision can buy a meter with a large screen or a “talking” meter that announces the results. Colorful meters that give a quick reading are available for children. Some models have a backlight, which is handy for nighttime readings. Others are manufactured to withstand extreme temperatures, which may be useful for people who spend a lot of time outdoors, such as hikers or construction workers.
• Information storage and retrieval. Consider how the meter stores and retrieves information. Some can track all the information one would normally write in a log, such as the time and date of a test, the result, and trends over time. Some meters offer the ability to download your blood glucose readings to a computer or your cell phone and then email the test results to your doctor.
• Support. Many meter manufacturers include a toll-free number on the back of the meter or packing. Look for a meter that includes clear instructions that demonstrate the correct way to use the meter. Some manufacturers offer user manuals on their websites.

Although finger pricks remain the gold standard for blood sugar monitoring, researchers are developing products designed to take the “ouch” out of the process. You might ask your doctor about these alternatives.
Alternative site monitor Allows blood samples from areas likely to be less painful than your finger, such as your arm, abdomen or thigh Not as accurate as fingertip samples when blood sugar level is rising or falling quickly.
Continuous glucose testing Uses a sensor placed under skin to measure blood sugar level; transmits each reading to a small recording device worn on your body; sounds an alarm if blood sugar level becomes too low or too high Expensive; requires sensor to be replaced every three to seven days depending on the brand; must check blood sugar level with a traditional monitor when dosing for insulin or treating low blood sugar to confirm readings

• Infrared, laser light and electric current technologies are among a few of the possible offerings on the horizon for noninvasive methods of checking blood sugar levels. But, these may cause irritation to the skin where it is placed upon.
Consider these factors that affect meter accuracy and the steps to resolve or prevent the problem:

  • Test strip problems —Throw out damaged or outdated test strips. Store strips in their sealed container; keep them away from heat, moisture and humidity. Be sure the strips are meant for your specific glucose meter.
  • Extremes of temperature —Keep your glucose meter and test strips at room temperature.
  • Alcohol, dirt or other substances on your skin— Wash your hands and the testing site with soap and water before pricking your skin.
  • Improper coding— Some meters must be coded to each container of test strips. Be sure the code number in the device matches the code number on the test strip container.
  • Monitor problems —Fully insert the test strip into the monitor. Replace the monitor batteries as needed.
  • Not enough blood applied to the test strip —Apply a generous drop of blood to the test strip. Don’t add more blood to the test strip after the first drop is applied. Some meters do not need a large drop.
  • Testing site location — Blood samples from alternate sites are not as accurate as fingertip samples when the  blood sugar level is rising or falling quickly.


Blood glucose monitor quality control tests
When  starting a new container of test strips, occasionally perform these quality control tests before using them and when the results seem unusual.
To perform a quality control test, do one or both of the following:
• Test using a control solution. Follow normal blood-testing procedure, but use a liquid control solution instead of blood. These solutions usually come with the monitor and are available at most drugstores and pharmacies. Follow package directions.
• Match the reading with lab results. Take the blood glucose monitor along when visiting the  doctor or have an appointment for lab work. Check the blood glucose with the  meter at the same time that blood is drawn for lab tests. Then compare the meter’s reading with the lab results. The meter’s result is considered accurate if it falls within 15 percent of the lab test result.