The winter is coming and it is time for special care for your body. This is a time where one tends to have more parties and celebrations, will definitely eat and drink without guilt and sleep well due to the cold weather. But there are certain things to be careful of- the water intake might go less which can result in urinary infection or stones, indigestion due to excess spicy food, and dry skin especially on the exposed parts of the body. People might exercise less outdoors in view of the cold climate. You could still exercise indoors and can go outside dressing appropriately for the climate conditions outside.
Moisturizers help in treatment and prevention of dry skin. Besides this, it also protects sensitive skin and improves skin tone and texture. The moisturizers act by trapping water in the outermost layers of the skin and acts as a temporary barrier to water loss.
Moisturizers usually contain humectants and emollients which help retain moisture. They also claim to contain peels of fruits and fragrances to make it smell pleasing. But, for those with sensitive skin, these adulterants can cause irritation and allergy. The expensive moisturizer does not always mean it is the best.
For those with normal skin, apply water based creams which are non greasy ( non oily)
For those with dry skin, use one with a heavier oil base. Petrolatum based one s are ideal.
For those with oily acne prone skin, use lotions and must be noncomedogenic( not closing the pores which can worsen the acne). Most of the soaps and face washes can dehydrate the skin further. Use of foam free face wash is recommended.
For those with sensitive skin prone for rashes, allergy and irritation, look for ones with soothing ingredients such as aloe or chamomile. These are non perfumes usually.
Use moisturizers soon after bathing.
Heavy creams are used in areas where dry skin is there and hence the face is spared of heavier creams.
Some of the brands of moisturizers come with a sun protection as well.
If the skin dryness does not improve, please do consult a skin doctor.
Hydration and eating healthy are essential to retain the glow and moisture of the skin.
Diabetes is on the rise the world over. Just about anybody can become a diabetic whether you are rich or poor or a male or female or whether your parents are diabetic or not. It is largely attributed to the disordered lifestyle habits and increased stress levels in day to day life that has caused this to blow out of proportion.
People turn to shortcuts such as the great number of diets available each one claiming superiority over the others, a great number of holistic medications or alternate medicines and of course, sugar free substitutes. It has taken the markets by storm and you have so many available in the market today which has been incorporated into carbonated soft drinks, chewing gums, baked goods, cakes, fruit juices, candies, ice cream and even yogurt.
There are natural sweeteners such as Agave nectar, date sugar, fruit juice concentrate, honey, maple syrup and molasses which are available in the market.
The artificial sweeteners are always artificial though some products such as those containing stevia are claiming themselves to be natural. But it has to be either refined or processed to be marketed. These are intensely sweet and are many times sweeter than natural sugar. All the sweeteners leave an aftertaste.
There are different types of sweeteners such as :
- Low calorie or no calorie sweeteners
- Non nutritive sweeteners
- Sugar substitutes
- Reduced calorie sweeteners
Some of the sweeteners can be used for either baking or cooking as well. These can come in different forms such as tablets, or sachets containing powder or in liquid forms.
Sugar alcohols do not contain alcohol and do not contain ethanol which is seen in alcoholic drinks. These are naturally seen in certain vegetables and fruits, but can also be manufactured. These help to increase the bulk and improve texture when added during cooking or baking. These are seen in toothpastes, mouthwashes, chewing gums, frozen desserts, fruit spreads and chocolate. It is labeled as Xylitol or sugar alcohol in the nutrition labels.
When consumed in large quantities the use of sugar alcohols can cause a bloated up feeling, loose stools and abdominal fullness
I have seen many people who had a craving for sweets after consumption of the artificial sweeteners which in turn, causes the sugar levels to fluctuate. This in turn, leads to an increase in either the doses of medicines or injectables with the hope to control sugar levels. Just being off the artificial sweeteners bring about so many changes and reduces the cravings as well.
Some of the common brands available in the market are:
- Sweet N low® contains sachharin
- Equal® contains aspartame
- Sweet one® contains Acesulfame potassium
- Splenda® contains Sucralose
- Fruit juice concentrates contain Neotame
How sweet are these artificial sweeteners?
Sachharin is 300 times sweeter than sugar, aspartame is 180 times sweeter, acesulfame is 200 times sweeter, sucarlose is 300 times sweeter and Neotame is 7000 times sweeter than sugar.
When artificial sweeteners are used there are some health concerns to be careful of- these can attribute to weight gain, tooth decay, probable increase in incidence of diabetes, cancer and troublesome numbness of the hands and feet, muscle spasms, giddiness and cramps. Generally people who are diabetic or those at risk to develop diabetes tend to rely more on ingestion of the so called sugar free containing food items. Besides having a lot of artificial sweeteners, the rest of the ingredients are the same which do add to the calories. Also it is worth bearing in mind that the taste has to be modified to enhance the flavor and also help it being sold off the racks at the supermarkets. The enhancement of flavor is done with the help of adding more hydrogenated oils or butter or fats which leave an excellent buttery taste and can help increase cholesterol levels !!!! People in this mad frenzy, tend to overeat their portions because of the false security given by the artificial sweeteners.
Being a diabetic does not mean you should be off sugar in totality. Your body needs a balance of sugar, salt, fats, carbohydrates, proteins and fat to make a complete meal which can be taken as small frequent meals to prevent cravings later on. Combine this with adequate physical activity and all will be well.
The solution to sugar needs:
You can substitute the white sugar with brown sugar or cane sugar which is the unrefined version of sugar. It is extremely hygroscopic and hence absorbs water from the atmosphere once the cover if opened. Store this in air tight containers. Roughly 3 spoons of brown sugar equals one spoon of white sugar.
Remember that people of the previous generation did not rely on artificial sweeteners.
Checking the blood sugar is as common as checking ones blood pressure these days, but is not done as frequently though. There may be no symptoms at all related to high blood pressure or there maybe headache, giddiness or even shortness of breath. Some may present with severe headache or paralysis of one side of the body with a slurred speech or chest pain as part of a massive heart attack.
Having high blood pressure undetected and untreated over a long period of time, can put a strain on the important organs such as the heart, kidney, brain and eyes.
Blood pressure, diabetes mellitus and high cholesterol levels are like close friends. These all are affecting the blood vessels and having one can put you at risk for developing the other two.
Blood pressure is the pressure of the blood in the blood vessels which help propel the blood forward from the heart to different parts of the body carrying oxygen where needed and also carrying away the waste products from the kidneys and liver.
Blood pressure is recorded by a machine called sphygmomanometer in which a mercury expansion is measured. This is operated only by health care professionals as you have to hear the sounds to decide the blood pressure.
Now-a -days, digital blood pressure machines are available. The ones measuring the blood pressure by inflating the cuff around the arms is preferred. The ones measuring around the wrist is not reliable. The digital machines can be battery operated and or AC/DC operated. The batteries have to be removed after each check to prevent the leak of the batteries while kept inside for indefinite periods of time. There are two readings for the blood pressure, called systolic for the top reading and diastolic for the lower reading. So if the doctor tells your blood pressure is 130/80 mm it means, 130mm is the systolic and 80 mm is the diastolic reading.
The blood pressure can vary with the position, posture, soon after exercise, soon after driving, and even for some when they come to the hospital or clinic due to anxiety. It is wise to check the blood pressure after relaxing for some time. For those where anxiety visiting the hospital causes high readings, it is wise to have the blood pressure recorded at home with a machine and make a set of readings for a week and have the doctor analyse that. There is a devise which can be connected to the upper arm for 24 hours ( 24 Hour ambulatory Blood pressure monitoring) which will measure the blood pressure every 20 minutes even during sleep and activity and have the data downloaded. Keep the arms straight while the cuff is inflating to avoid errors in the machine reading. For some, the blood pressure is highest while at work, for some it is highest at night. Mental and physical stress plays a major role in fluctuations of blood pressure levels.
Pregnant women may get high blood pressure readings which are treated with some specific medicines as they will not cause harm to the growing baby. The blood pressure spike is usually associated with swelling of the feet and proteins in the urine. Some even get blurred vision.
Normally a doctor will not start medications for blood pressure based on one reading. An average of readings which show a persistent set of high levels will decide. The blood pressure can be high even for children in those having some diseases of the kidney. The cuff diameter is different while measuring the blood pressure for children and for those who are obese. The normal blood pressure readings are between 120-140 systolic and 70-90 diastolic. Generally the elasticity of the blood vessels is lost as one advance in age and so the blood pressure can be slightly high for the elderly and hence a level of 140/90 mm Hg is normal for the elderly.
What can be done from your side:
- Avoid stressful situations as much as possible. Learn relaxing techniques such as doing something you like or meditation or just relaxing on a rocking chair, or listening to songs or reading a book or enjoying a swim or watching a movie.
- Incorporate a healthy lifestyle which includes at least 150 minutes of physical activity a week and a diet in which salt consumption is reduced. Sausages, sauces, tinned vegetables , olives soaked in brine, potato fries all come with salt. Use of rock salt is better or low sodium salt is another option. One can use lemon or vinegar to add a salty taste without actually adding salt. Among the exercises, Tai Chi, Yoga, swimming, skipping rope, aerobics, walking, cycling, golf, playing shuttle badminton or tennis if it is okay , are good options. Enjoy the exercises sessions.
- Avoiding spicy and oily food helps.
- Take plenty of vegetables, fruits depending on diabetes levels, non roasted and non salted nuts, fish and chicken and lean meats.
- Avoid too much of caffeine
- Maintaining a normal weight is equally important.
- Limit alcohol consumption- for males 21 units a week and for women 14 units a week ( one unit is half a pint of beer, a glass of wine or a single measure of spirits)
- Cigarette smoking is another thing to be careful of. Smoking can make the blood cells stick together which can help form blocks and also increase the chances for a block in the blood vessels. There are ways to stop smoking by using various nicotine replacement techniques such as nicotine chewing gum, lozenges or patches.
- Be regular in your visits to the doctor.
- If there is a history of high blood pressure running in the close family ( parents or uncle and aunt), have the blood pressure monitored. If your parents have had either a stroke ( paralysis of one side of the body) or a heart attack at an earlier age ( below the age of 50) you have to be careful.
- If you are overweight or obese ( having a body mass index of more than 25) or having diabetes, you have to check the blood pressure.
This involves the basic essentials such as reducing stress levels, stop smoking and alcohol consumption, reducing excess salt intake, maintaining a healthy diet, exercising regularly and having a check up on time.
When the above measures do not work or if you develop some complications such as problems with the kidneys, heart or brain, medicines are prescribed.
The eye doctor looks into the eye and checks for early changes in the blood vessels on the retina which needs you to be starting treatment soon to prevent further damage to the eyes.
There are certain basic tests which are necessary such as checking the haemoglobin, sugar, cholesterol, kidney, liver, urine for leak of proteins, ECG and ECHO for the heart, an eye check up and further tests if anything is amiss and needs further evaluation. Some need a scan of the brain if there has been a stroke.
Some people need one medicine and some need more than one medicine. There are different medicines coming in different strengths. The number of mg of each tablet does not reflect upon the severity of the blood pressure. The doctors decide which medicine based upon the kind of protection needed. Some need to have additional protection to the heart and kidney, some need to have their heart rates reduced, some need to have their feet swelling reduced, some need to have the pressure in their kidney reduced and so forth. The aim is to bring down the blood pressure to normal without causing further damage.
As with all tablets, there are some side effects with the medicines for blood pressure. Some may cause slow heart rate, some cause swelling of the feet, some cause coughing and throat irritation, some cause electrolyte disturbances and some medicines are not tolerated well. The dose of medicines has to be adjusted based on individual needs. Generally, once you are on medicines it must be continued for life. But, having a metabolic surgery ( bariatric surgery) can help avoid the need for a medication. This will help control the diabetes, blood pressure as well as your weight. If the blood pressure is solely due to increased stress levels, change of job or relocation will help cure the blood pressure as well.
Many people delay the initiation of treatment despite the medical advice. This is putting your life in danger as changes once they occur, in important organs, are difficult to reverse. It is much better to control the blood pressure than having a massive heart attack or a stroke and put your family or yourself at risk.
This is a novel step in the management of diabetes. Many people, even today, fail to understand the indications for transplantation. Many assume this can be done for almost anybody with diabetes. Incidentally, as early as 1890 in England, the first transplant involving fragments of sheep pancreas was first tried on a young boy with uncontrolled diabetes. Improved surgical techniques, better immunosuppressive medicines and healthier recipients have helped improve the outcomes.
What is pancreas transplantation?
This is a surgical procedure involving transfer of a healthy pancreas from a deceased donor to a person whose pancreas no longer functions at all.
This is reserved only for those with type 1 diabetes , but does not form part of standard treatment.
- When standard insulin treatment cannot control diabetes type 1
- Poor sugar levels
- Kidney damage in those with diabetes type 1
- Frequent insulin reactions
- Pancreas only transplant
- Simultaneous pancreas- kidney transplant
- Pancreas transplant after kidney transplant
Normally the endocrinologist or the diabetologist refers the patient to the nephrologist, the specialist in kidney diseases, who will run some tests to assess extent of kidney function. Once the possibility of transplant is considered, the transplant team is consulted. The team comprises a medical transplant doctor, a transplant surgeon, diabetes educator, a social worker, a psychologist and a financial advisor.
It will be assessed if you are a healthy candidate to tolerate the procedure, if there is anything in your records to hinder the success of the procedure or if you are compliant with the advice given by the team. It is an emotional, mental, physical and financial burden on the family and the patient.
Not to be forgotten are the legal issues associated with the transplantation ( still considered a taboo in many parts of the world), availability of donor, blood group and the severity of the kidney damage. Most of the centers have a waiting period which varies. The donor must be aged between 4 and 55 years and free from diabetes and must not be obese. There are areas in the world where organ donation is a business and various trade rackets have been busted.
Do your homework well….
Find out about the transplant center- the number and type of transplants done there, survival rates, the support given, the recovery phase stay and travel arrangements. The cost of the procedure is also of importance and how much the insurance will cover.
After the transplant you can expect the following:
The surgery can last for 4 to 6hours generally.
Stay in the intensive unit for the first few days- this is for frequent monitoring and to cut back on visitors during the crucial first few days. There will be frequent blood checks. The attendants will be asked to wear a face mask and those with common cold, fever or cough should be refrained from attending on the patient. Frequent hand washing with a hand sanitizer is needed.
Insulin is no longer needed as the new pancreas starts functioning. That will be the striking change the patient notices. However, one should also bear in mind the possibility of a rejection, possibility of a bacterial, viral or fungal infection as immunity is compromised by the medicines taken to prevent the rejection.
Failure of the pancreas to function can also occur for some unfortunate people.
The side effects of the medicines to prevent rejection include:
- Weak and thin bones
- High blood pressure
- High cholesterol levels
- Puffiness of the face
- Diarrhea or constipation
- Gums can be swollen, mouth ulcers can occur
- Acne on the face
These depend on a lot of factors. Based on data from around the world, 72% of the simultaneous pancreas- kidney transplant survive after 5 years, 59% of the pancreas after kidney transplant survive after 5 years and 52% of pancreas only transplants survive after 5 years.
Neuropathy is a complication that is bothersome and not very often addressed or treated properly. This complication gradually develops over a period of time and is not always due to diabetes mellitus. This can be due to smoking or excessive alcohol intake as well. However, longer the duration of diabetes, chances of developing a neuropathy are higher. Neuropathy can be aggravated by insulin and some medicines. Rapid control of sugar is known to cause neuropathy for some people. Classically the neuropathy first affects the feet and toes and may gradually ascend.
There are four major types of neuropathy
- Peripheral neuropathy- this is the commonest form which affects the feet and hands. This can present in many forms. There may be numbness of the digits and reduced ability to feel changes in temperature or pain. Patients may complain of tingling or burning, feeling of insects crawling on the body, sharp pains at night, and some may experience extreme sensitivity to even the lightest of touches. Some may experience difficulty in walking or can have ulcers or deformity of the feet.
- Autonomic neuropathy: This part of the nervous system controls the functioning of the eyes, heart, lungs, stomach,intestines and sex organs. Thus, a dysfunction of this part of the nervous system may cause either of the following: urinary bladder problems ( too much urine or lack of control in holding the urine), constipation or diarrhoea, slow emptying of the stomach leading to fullness, difficulty swallowing, dryness of vagina, erectile dysfunction in males, reduced sweating, problems regulating body temperature, difficulty in eyes adjusting to a dark room when coming from a bright room. Some people have variations in blood pressure while getting up from lying down posture leading to imbalance.
- Radiculoplexus neuropathy- affects bigger nerves and hence the numbness can affect the thighs, buttocks, hip and legs. Characterestically patients complain of difficulty getting from sitting position. Some may complain of abdominal swelling and weak muscles.
- Mononeuropathy- this is the type of neuropathy affecting one single nerve. This may disappear over a period of time. No long term complications associated with this type. There maybe difficulty in focusing of the eyes, paralysis of one side of the face with deviation of angle of mouth, carpal tunnel syndrome where there is numbness of one part of the palm with weakness of muscles or loss of sensation. This can be corrected by a small surgery.
For details on how to test for neuropathy, please refer to the blog on feet.
From time immemorial, man has been walking for traveling to reach one place, to hunt and gather food for self and family and also in search of a better place to live. Those were the days when there was no transport. God gave humans the legs so they could walk upright which is a feature not common among the animals by nature, though some animals can walk upright with training. Unfortunately, with the advent of modern transportation facilities as well as time pressures and deadlines to be met, people have literally forgotten to use their legs for the use they were meant to be used.
Benefits of walking
This is probably the safest form of exercise which can be done by anybody provided the eyesight is good and there is no neuropathy ( affection of the nerves which can cause lack of sensation on the feet making the person unaware of where the feet are planted on the ground).
The farther, faster and more frequently one walks can definitely improve the benefits by many folds. Walking also improves the balance and strengthens bones and muscles besides improving circulation.
Walking is proven to prevent the onset of diabetes, depression, cancer, joint problems, osteoporosis ( fragile bones) and heart ailments. This also helps the worsening of the above. The swinging action of the arms, the strides taken while walking, the fresh air , the sights to enjoy ( one does not get these benefits while walking the treadmill in the confines of either the gymnasium or home) and change in pace while walking navigating the turns all help in improving the muscle power and co-ordination.
Walking in groups with either your colleagues or with friends and family all could be entertaining as well you could even do long distances without being aware of the distance covered at all.
Walking at a speed of 6 km/hour , which amounts to a brisk walk, can burn up to 600 Kcals. But, may be not all can walk as fast. Some may be having either knee or back problems which needs a slower pace. But walking at any given speeds whether unaided or with the help of a walking stick is much better than not walking at all. Parking the car away from where you wish to go and just walking to your destination helps. You may still park close to your destination ( especially during the summer time when the heat maybe quite strong) and take a longer route rather than choosing the shortest route or just walking along the aisles in the malls are good options.
Walking with small children and pets is also a good option.
Ensure the following before walking:
• Check the blood sugar before walking.
• Ask your health care provider if it is safe to embark on a regime.
• Go at a pace comfortable. Walking should not leave one gasping for breath.
• It is okay to rest in between.
• It is okay to take sips of water in between the walk and before the walk.
• If you experience feeling of nausea, chest discomfort, pain in the arms, jaw or back while walking, please seek medical help immediately.
Stretching before any exercise program:
Proper stretching before any exercise or even walking can help tone up the body and prevent joint problems.
Some of the commonly done stretches:
• Calf stretches-
Stand at an arms length distance from the wall. Keep one leg forward with knees slightly bent. The other leg with knee straight and heel down. Keeping back straight, move hips towards the wall and feel the stretch. Hold for 30 seconds, relax and repeat with other leg.
• Quadriceps stretch-
While supporting a fixed structure, grasp the ankle with one hand and pull the heel up and down till one feels the stretch in the front of the thighs. Hold for 30 seconds, relax and then repeat with other side.
• Hamstrings stretch-
Sit on one chair, and keep the other leg on another chair in front. Keeping the back straight, bend the pelvis forward till a stretch is felt in the back of the thighs.
• Low back stretch- lying on the back with the feet kept flat and knees bent, bend the knees ( both together or separately) towards the chest using both hands. If one has knee problems, one can hold hands behind the thighs instead.
• Chest stretches-
Clasp hands behind the head. Pull elbows gently by pinching the shoulder blades together.
How to walk?
The ideal way of walking involves walking upright, head held up eyes looking forward, chest pulled out, shoulders thrown back, landing the feet on the heel and taking the stride on their toes. Swing the arms freely slightly bent at the elbows. Walking with small weights held in the hands further enhance the calories burned.
The neck, shoulder and back must be relaxed and not stiff. While walking the treadmill one usually does not maintain these as people have to be holding onto the side railings and the back is usually arched back and stiff to prevent slipping.
Please make sure the footwear is of a good quality and have the insoles and heels checked for wear and tear. View the shoes from behind. If the shoe is tilted to one side, it is time to change the shoes. Change the shoes after it has done 400-600 km.
One should dress appropriately in attire that suits the climate, a comfortable and well padded pair of shoes, a scarf or hat as the case may be and some music if needed to be played and listened with an ear phone if needed. Generally the pavements are safe, but it still pays to look ahead and down as well.
150 minutes of any exercise a week is recommended. You can do 30 minutes 5 days a week or split that every day in some form like three sessions of ten minutes each or two sessions of fifteen minutes each.
The long term goal is to make 10000 steps a day. This is ideal for maintaining good health.
One needs to walk at least 30 minutes a day to maintain his or her weight and at least 45 minutes a day to have some weight reduction.
A pedometer is a small device which can be clipped on to the belt or kept in your pocket close to your body. This will count the steps one takes during the course of your daily chores such as walking, climbing stairs, jogging and even adventure sports. But, pedometers vary in their function.
clipped on pedometer
Get to know your pedometer
Ease of use: Some of the pedometers just have to be clipped and it starts. These will be needed to be reset to zero the next day so you could count the number of steps taken.
All pedometers have a battery which needs to be replaced depending on the life.
Some pedometers need to have the data fed in such as date and time, the weight of the person, the length on ones stride which will be calculated and input fed in.
The extra benefits: Some just give the number of steps taken during the day till one resets it back to zero. Other pedometers count the calories burned during the activity, the distance walked and some even upload the data to a remote computer which will maintain a log book of the progress.
Accuracy: generally all pedometers are accurate. However change of strides such as a sudden increase in pace ( or decrease) , jogging in between or even climbing stairs in between the walk may not be counted by the machine( after all it is a machine) and so the calories counted may not be very accurate in that way.
Get a pedometer that has good back lighting so it could be easy to use both indoors and outdoors and also during either the day or night.
Some pedometers are small, others are big. Go for a size that suits you.
The pedometer must have a sturdy clip to help attach on the waistband or have a strap.
Price is also of major concern.
The recent smartphones have an app which could be downloaded for performing the same function as that of a pedometer.
Before you use the pedometer regularly the following are to be noted:
- Please attach the pedometer on yourself for three days in succession whenever you are awake. The total number of steps covered in 3 days divided by three will give the average steps in a day. This is called the baseline steps. ( This will also give you an idea how many steps you had taken in a day which might be embarrassing)
- Once you know the baseline steps, set up short term goals such as adding a thousand steps a day, for example, to your baseline number which you do target for a week.
- Once you have achieved this short term goal, you could set yourself another goal. You could reward yourself and make this interesting.
Feet are, strangely, the most neglected of all the body parts. There are many who pamper their feet, more ladies than men. The feet are an important part to be checked for while being a diabetic. Generally the problems with the feet can occur whether one has either type 1 or 2 diabetes, whether young or old and in any part of the feet though generally the under surface are affected more than any other part of the feet.
Feet are the parts of the body that keep one mobile, that maintain the balance and stance of a person, help drive us around, help us to swim, pedal a cycle, go on hikes or trekking, the list is endless.
Causes of foot problems while having diabetes mellitus:
• Trauma to the foot due to poor or ill fitting footwear, not wearing a footwear,
• Foot deformities such as an in growing toe nail caused by improper nail clipping, having flat foot when the arches of foot collapse, having claw toes, having over ridden toes.
• Poor blood flow to the feet due to small blocks in the blood vessels
• Neuropathy due to diabetes which leads to poor sensation- impaired sensation to temperature changes or pain or touch.
• Lack of proper access to proper education.
• Living alone.
• Poor socioeconomic conditions
• Poor control over blood sugar, blood pressure and cholesterol.
• Previous amputation or ulcer foot
• Poor eye sight
What can be done to prevent foot problems?
DFU- Diabetic foot ulcer
• Maintain good blood sugar and blood pressure control
• Maintain normal lipid levels
• Stop smoking
• Regular exercise
• Check the feet regularly- check for cracks or fissures on the heels. Check between the toes for any fungal infection.
• While clipping the nails make sure it is cut straight taking care not to take the corners. The corners can be filed.
• Do not cut callosities which are thickened pads of skin. Have either a trained podiatrist( who specializes in foot care and pedicure) manage it. You also use a pumice stone after bathing to rub down the thickened skin.
• Apply moisturizing creams on the feet and under surface before retiring at night. Take care not to apply moisturizing creams between the toes as they will retain moisture and favor fungal infection. Use the ones containing Aloe Vera or vitamin E.
• Use a hand held mirror to check the under surface of the feet.
• Use cotton based socks without tight bands. Some socks now come with silicone impregnated gel pads as well.
• Use shoes that are one size bigger. Buy the shoes towards the end of the day when the feet will be swollen slightly. There should be enough room for the toes to wriggle comfortably. Wear and also the sole of the footwear for any nails or sharp objects. Pointed shoes are not advisable.
• Check the inside of the footwear with the hands for any irregularity or wearing off.
• Have the feet checked at least once by a health care provider.
Ingrowing toe nail due to improper cutting of nails
Look at the difference in the left foot
This is a foot disorder that can happen to almost anybody with diabetes. The loss of deep sensation leads to destruction, degeneration and disorganization of the bones and joints of the foot. The foot can be swollen, warm to touch and be red. But, the pulses of the feet will be normal on examination. Once suspected of this, you will be referred to either a foot care team or the orthopedic doctor. Normally, the foot will be immobilized in a cast. This will be removed after a period of time as suggested by the team and protective custom made footwear will be given.
For those who are used to wearing high heel footwear, the pressure while walking is shifted to the forefoot and there will be strain on the Achilles tendon at the back of the foot ( the thickened cord felt behind the ankle)
Regular check up of the feet:
The feet will be checked for color, any cracks, any infection between the toes, any deformities, any callosities, and non healing wounds, any color changes, the skin of the feet, the hair growth and the nails.
Blisters are water filled collections ,corns are thickened skin due to repeated friction, calluses occur usually on the bottom of the feet which are due to thickened pads of skin, and bunions are those out projections seen from the joint of the big toe which is a structural deformity.
Clawing of toes
The feet will be checked for local warmth, the sensation will be checked with a monofilament, the sensation to appreciate hot and cold sensations, vibration sense will be checked. The pulse will be checked for on the feet. The ankle brachial index ( comparing the pressure of the ankle and arm BP are compared to assess blood flow) are checked in high risk feet.
A podoscan can be used to measure the pressure while walking or stepping.
Customized foot wear is often required when there is a problem to the feet which have to be designed by cobblers specialized for this.
There are tests to measure the amount of blood flow to the legs such as an ultrasound Doppler test ( which is non invasive) or an angiogram which is invasive. If blood flow is compromised ,depending on the severity, either medicines or stents or surgery are advised.
Ulcers ( breach of the skin) may heal with medicines or may remain active or in some people may progress rapidly to cause infection. In some cases, an amputation is performed to save the limb or even life. There are many comfortable prostheses available in the market to get over the handicap.
Cause of type 1 diabetes:
Type 1 Diabetes is due to an absence of insulin secretion by the pancreas from birth. Most of the cases of type 1 diabetes are caused by unknown triggers which results in varying amounts of destruction of beta cells in a genetically susceptible person. However, in some cases the pancreas can be damaged by auto immune diseases in which the body cells are destroyed by some cells due to unknown causes. A simple viral fever may cause the virus to attack the heart or pancreas leading onto diabetes.
Younger adults will show slower destruction of the β cells in comparison to younger children .
There are plenty of Type 1 Diabetic patients who are living well into the nineties. They all went through a tough time when diabetes management was at a very primitive stage. There were no sophisticated blood glucose monitors, no good hospitals or technology to support them, no education materials, no support groups or no insulin as well. People had to monitor the urine and be on a starvation diet to try and find a cure for this. Insulin changed the way these patients handled life. The people who have lived long to see the 2 world wars, have told they have learned this from life: “ Learn to live in spite of having Diabetes” and “take one step at a time” and “Live life to its fullest- enjoy every moment of it and thank the Almighty”.
Today there are so many advances in the field of science which brought about the discovery of insulin, the glucometer devices which could even store data of previous readings, smart phones which could guide one to monitor ones diet, remind to take medicines and even plot their progress, have alternate sources to deliver insulin, alternate devices to check sugar levels painlessly and stem cell therapy and transplantation of the pancreas.
Type 1 diabetes mellitus used to be called insulin dependent diabetes mellitus. It used to be associated with children alone. There are a lot of young people and adults who are being diagnosed as having type 1 diabetes.
Those people who lose weight dramatically, do not thrive properly, get admitted for vomiting and abdominal pain are found to have diabetes mellitus type 1. It is generally seen younger the patient at time of diagnosis of diabetes, higher the chances of having type 1 diabetes. There are some people who are diagnosed with diabetes when they visit the hospital with either failing vision or kidney problems. There is a higher incidence of young adult presenting with type 2 diabetes as well.
Blood tests such as GAD 65 antibodies ( Glutamate acid decarboxylase), IAA ( Insulin auto antibodies), ICA ( Islet cell antibodies) , are some of the commonly used tests run to diagnose type 1 diabetes. However, all these may not be positive in the early stages as that depends on the damage to the islet cells of pancreas. The estimation of Insulin levels and its precursor, C peptide done in fasting and after food are also used to define type 1 diabetes.
Though many genetic markers have been identified, the widespread use of genetic screening is yet to be justified and implemented
Insulin still remains the mainstay of treatment and is usually a lifelong. There is no magic cure yet for Type 1. However, research is still on to the efficacy of a stem cell therapy. Islet cell transplantation and pancreas transplantation have also been done at selected centers round the world, but the prohibitive costs, the post transplantation medications to reduce the rejection and the uncertainty of life long cure have not led to much enthusiasm.
There are advances coming up in the self monitoring devices and also novel ways to administer insulin.
Young adults or children must be informed about a partial remission of the diabetes where either a low dose of insulin or no insulin may be needed in the early phase. This is called the “honeymoon” phase of diabetes when there will be some activity of the pancreas but not enough to maintain sugar levels.
One has to take multiple injections a day to match the food intake just because the pancreas refuses to secrete insulin which keeps the sugars down. Some may need to take a combination of long acting insulin at night time and one with each main meal of the day. There different insulin preparations which have been detailed in the post titled,”insulin in diabetes”. Insulin can be given by pens which are easy to use and have small needles. Some patients may need multiple doses. Some may need insulin to be administered by a pump which delivers insulin in small doses based on food intake and physical activity.
- Insulin has to be stored in the refrigerator ( not the freezer compartment) when not in use.
- Never skip a dose of insulin as the sugars may increase and cause even an unconscious state which can kill if not treated in time.
- Likewise, if you inject too much, the sugars can drop to dangerously low levels and can make you unconscious and can kill.
- Have a sugary drink or sugar at hand always.
- When you feel sweating or shivering, it can mean the sugars are low.
- Remember to change the needles daily.
- Rotate the site of injection daily. These can be given on the thighs and abdomen. Pinch a fold of skin and inject at right angles. Do not inject if the skin is too hard on pinching or dark in color. Normally the rapid acting insulin is given on the abdomen and the long acting given on the thighs.
- When sick, it is a common mistake to either reduce the dose of insulin or omit the dose as there is reduced food intake. However when sick, the hyperglycemia demands a slightly higher dose of insulin.
- Teenage girls can have eating disorders and may omit the dose of insulin with a hope to control their weight, with grave consequences.
- As you grow up or have stress during exams, job interviews, marriage or family matters, the sugar levels can increase. As you grow up, the insulin levels will also increase.
- If having a party or attending a buffet, you are allowed to take insulin in two separate doses like 30% before the party and 70% after the party. If you take 30 units at night of rapid insulin, take 10 units before the party and 20 units after the party to cover the food intake.
- Be careful of alcohol intake and dancing after that as the sugars can drop down.
Advantages of insulin pumps over multiple daily injections :
• Ease of calculation
• Less insulin stacking
• More reliable
• Very low doses 0.01U to 0.025 can be given in those using the pump.
• Fewer skipped doses
• Less hassles with time zones
• Discreet insulin delivery
Requirements before embarking on insulin pumps:
• Should be willing to check blood glucose many times and should be able to count carbohydrates
• In toddlers, the pump can be placed between the shoulder blades or butt.
• The tip of the cannula of the infusion tubing can be blocked by the inflammatory cells causing errors in dosing.
• The settings in a young child should have high and wider range, in those with hypo unawareness, set the hypoglycemic setting higher, and those who are pregnant, set the narrower and lower range.
The accessories have to be changed once every 3 days. This is a costly matter.
Checking the blood glucose:
You need to check sugar levels quite frequently. Ideally, a pre meal and 2 hour post meal sugar check will be needed.( 7 tests a day) This will have to be done at the initial stages till you know the “signals” your body sends. Some have to check their sugars when they have had a new food or while at a party. There are machines that require a lot of blood sample for the testing and some which need very less. The finger pricks are done at the tips ( in medical terms, the pulp) of the fingers. This is a very sensitive area and the repeated pricks for the rest of your lives can affect the sensation of these wonderful parts. You will need to have a glucometer machine that will check the blood sugar and blood ketones as well. Most of the machines have data storage facilities and also some can be connected to a network and data can be transferred to a remote system such as ones parents or doctors or nurse. ( Read more of this in the post titled, Diabetes and Digital age )
Self monitoring of blood glucose can help detect low sugar or high sugar levels, help titrate the dose of insulin, can be used to assess sugar levels when sick or pregnant and also to check how the levels are after a workout.
Earlier good control of sugar levels will delay the onset of the feared complications of diabetes such as the retinopathy ( eye) , neuropathy( nerves), nephropathy( kidney), heart disease.
The variability in sugar readings are more important than a stray high reading.
Good sugar control will lead an improvement of
• 76% in incidence of retinopathy
• 47-54% reduction in progression to severe eye problems
• 39% reduction in onset of microalbuminuria
• 54% reduction in onset of kidney diseases
• 60% reduction I onset of developing neuropathy
• 42-57% reduction in onset of heart related diseases.
Barriers to achieving good control:
• Fear of hypoglycemia ( low sugar)
• Complexity of day to day management
• Need for frequent self check of sugar levels
• Lack of social and family support
• Lack of specialized care access
• Increased costs
• Psychological factors- depression and anxiety
Educational programs such as DAFNE ( Dose Adjustment For Normal Eating habits) help in flexible plans for diet which help to overcome the rigid dietary control and fixed doses of insulin. There are many such good educational tools. The Conversation Maps© by Lilly is an interactive tool which helps understanding the disease well.
Periodic Check up:
The parents will accompany the child to get more understanding of the management. It is important to have the eyes checked, the feet checked and urine checked for microalbumin leak once annually after the age of 12 years. It is important to check the blood pressure and lipid profile if above 12 years of age. The 3 month average of sugar, HbA1C is to be done thrice a year. The most recent guidelines state a 3 month average sugar level of 7.5% for any age of child till the age of 18. The values were higher in the previous years.
The complications are the same as those which a person with type 2 diabetes can have. The success of the quality of life depends on the near normal levels one can attain. It can get frustrating and depressing at times and definitely may even lead to quarrels with parents. They are concerned about the good health, though some parents may become over protective. Having high blood glucose can poison the body and slow it down! It can affect studies as well. Diabetes can affect the kidneys, eyes, heart, nerves and sensation of the limbs. Maintaining near normal sugars is the key to success to prevent these complications. Regular check up with the doctor or nurse can help lead a near normal life. If there is a problem such as difficulty in seeing while at class, please inform the teacher or parents. They may not understand the magnitude of the problem and may think it is way of escapism. Most of the schools have a medical wing having a trained nurse. A note from the health care provider can help the school authorities to take care. The child should be allowed to snack if low sugar levels are detected while in class, must have their parents notified in an emergency, but must not be restricted from regular playing and activities.
Take care of the feet- use footwear all the time even while on the beach. You may accidentally cut yourself which can take a long time to heal. Check your feet daily. Use cotton socks and use one size extra large footwear. Use a moisturizing cream on the feet taking care not to apply it between the toes. If you cannot feel either hot or cold sensations, please mention to your doctor or nurse urgently.
Take care of the eyes and tell your parents or your teacher if there is a problem. They can guide you to the doctor or nurse. Remember that eyes can get cloudy when the sugar levels increase.
Brush the teeth well and take care of them by visiting the dentist once annually.
You can exercise like other people. You may tire easily. Before exercising, check your sugar levels , if high, check on blood ketone levels as well. Do not exercise if low sugar levels are seen on checking. If blood ketone levels are more than 1.5 mmol/L, give yourself 15% of the basal insulin with a pen separately. Drink a glass of non sugar drink every hour. Check again after an hour. If not feeling well, losing consciousness or dehydrated or vomiting with abdominal pain, go immediately to the hospital.
Do not exercise immediately after injecting insulin as it can get absorbed soon and cause low sugars. It depends on which part of the body you inject and which group of muscles you exercise. If you inject onto thighs and go for jogging, it will be absorbed faster. If sugars are low before the exercise, have a carb snack ( biscuits or juice) before the program. Do not give bolus injections for the snacks taken to prevent low sugars.
Warm up for 5 minutes, stretch for 5 minutes and then go into activity for about 20 minutes and allow 5 minutes for cooling down. You are to drink non sugary fluids every half an hour. You can have a carbohydrate snack- a biscuit or a fruit juice to bring up low sugars. CHOCOLATES DO NOT INCREASE THE SUGAR LEVELS INSTANTLY DUE TO ITS HIGH FAT CONTENT. Preferably do not use heavy weights while exercising as it increases the pressure in your eyes which can cause a bleed into the eyes. If you go for a sprint( high intense exercise), the sugars will increase! This is due to the increase in some hormones which increase the sugar levels.
If the doctor says you have retinopathy ( eyes are affected by Diabetes), avoid lifting heavy weights and strenuous workouts.
Read more in the blog: Exercise and Diabetes
If having high blood sugar:
This is a medical emergency. If the blood sugars are high and if there are ketones in the blood the following can be done before going to the hospital.
Blood glucose Blood ketones Insulin dosage
>200mg% <0.6 mmol/L One unit Rapid insulin for each 50mg%above 100 Mg%
>200 mg% 0.6-1.5 mmol/L 10% of TDD of rapid insulin
>200mg% >1.5 mmol/L 20% of TDD as rapid insulin
TDD means total daily dose. To convert sugar in mg% to mmol/L divide by 18
If the blood sugar is 345 mg%, the extra insulin has to be calculated as follows:
345- 100 = 245 mg%
Give one unit for each 50mg% above 100mg%
This means you have to give 5 units of rapid acting insulin ( 245/ 50)
Check sugar and blood ketones every hour till normal. You can use the Freestyle Optium Xceed meter for this. You can place blood as for checking the sugar on the strips for ketones and sugar.
For example, if the blood glucose is 22 mmol/L, the excess is 16.5 mmol( 22-5.5) You have to give one unit rapid for each 2.7 mmol excess. This means, 16.5 / 2.7 which is equal to 6 units.
Blood sugar In mmol/L Excess sugar above 5.5 mmol/ 2.7 Extra Rapid Insulin to be given
15 9.5/2.7 3.5 units (3 u)
16 10.5/2.7 3.8 units ( 3 u)
17 11.5/2.7 4.25 ( 4 u)
18 12.5/2.7 4.6 ( 4 u)
19 13.5/2.7 5 ( 5 u)
20 14.5/2.7 5.3 ( 5 u)
21 15.5/2.7 5.7 ( 5 u)
25 19.5/ 2.7 7. 2 ( 7 u)
Remember that the first 5.5 mmol of sugar is not counted for correction. The value above that is used for calculation. So please do not give a rough 10 units for any emergency at home. The aim is to correct the excess sugar. Do not feed the child after this dose of insulin. At this dose of insulin, the child will not go into low sugar. Make the child drink water hourly. Check the sugar every 15 minutes. If vomiting or abdominal pain or losing consciousness, get the child to hospital immediately.
The TDD means the total daily dose of rapid taken in a day. If it is 6+12+8, the total is 26 units. 10% of this is 2.6 units
20% of the total daily dose is 6+12+8= 26 and 20% of this is 5.2 units.
This needs some quick calculation. The best will be to give something like 4 units insulin, then calculate the exact amount.
If hypoglycemia ( when sugar levels fall down) develops, drink orange juice or take sugar or dates. In somecountries glucose tablets are available. Wait for half an hour. Recheck and if needed take more orange juice. You can have a handful of raisins( dry grapes) also if needed.
Glucagon kits will be available in the pharmacy. This is used for treatment of low sugar levels before reaching the hospital.
If less than 8 years of age or weighing less than 25 kg give 500 mcg of glucagon Intramuscularly. If weighing more than 25 kg or more than 8 years of age, give 1 mg of glucagon intra muscularly. Check sugar levels again in 10 minutes. Take to the hospital if not better.
- Having type 1 diabetes does not prevent you from enjoying life to the fullest.
- Never go for adventure sports alone.
- If going for high altitude trekking, remember high altitude trips mimic mountain sickness ( headache, intestinal discomfort and fatigue)
- Increased blood sugar and insulin resistance can occur at high altitudes. Sugar levels can fall with the increased activity.
- Glucometers may not be accurate at cold temperature; the insulin may freeze as well.
Deep sea diving:
In those who dive deep, no unconsciousness has been reported. However, it is better to check the sugar levels an hour, half an hour and just before diving.
The transition from a child to an adult
• Kids just want to be kids. Child is a child first. Diabetes comes second.
• They strive for a little more independence each year. They do not want to stand out from the crowd. How the child accepts diabetes will depend on how, you as a parent, look at it. If you feel diabetes is a tragedy, the child will feel that way as well. However if you look at it as a fact of life that requires attention and discipline, the child will be prepared for a healthier future.
• Checking sugar frequently is painful but the child will gradually understand the importance.
• Remind them to be snacking in between playing hours.
• Remind independence comes with responsibility as they grow from a child to a teen.
• If your child reports a high blood sugar, do not scold them. They may be trying their best. Shower them with praise when they do well. Remember that nobody is perfect.
• Ups and downs of sugar levels are part of growing up and changes in body hormones as they grow into their teens.
• It is worthwhile checking how each food affects the sugar before and after eating and before and after exercise.
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.
This is a devise connected to a glucometer which can transfer data to a remote system or website.
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.
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
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
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
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
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
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
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
This is an app which can fit into any routine, has 12 simple exercises which are scientifically formulated.
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.
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.
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
The 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
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.
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.