Forgetting things has always been a matter of concern for most of the people. Most are concerned about the scare of Alzheimer’s as well. It has to be emphasized that our forefathers had been much better off during their days. Just as the body ages, the brain too ages and so also a decline in cognitive power can ensue. That is inevitable, but one can delay the onset and slow the progress of the decline with some efforts.
Now- a- days with the advent of improved technology, people are able to communicate better and faster and people from across the globe can be connected easily, but it has caused other problems as well. People are so busy peering into their mobile phones or electronic gadgets, they get frequent eye strain issues and dry eyes, neck and back pain due to the hunched posture, finger pain and wrist pain due to punching the buttons and have the lost of communication and eye contact. There are, however, a lot of people who use the mobile devices as an organizer which stores telephone numbers or helps schedule their appointments or remind them of things to be done. It has reached a point where people have almost stopped taxing their brain or mental capabilities to a point where they do not even recollect their families phone numbers !!! Strangely, many pharmaceutical companies have started capitalizing on this weakness and have brought about “magic cures” to help boost memory. Some medicines being taken for regular ailments have also been implicated in loss of memory !
Most of the time, the brain is not stretched to use its full potential causing it to be dull and lazy.
There are some good and harmless ways to get over this handicap before it gets out of control.
Reading a book
Learning a new language
Visiting a museum
There are good steps which can be done to help wake up the “sleeping brain”. There are the right handed and the left handed people. For the right handed people the right side of the brain is not used much and likewise for those who are left handed.
Neurobics is a type coined for the exercises which help the brain.
Playing Sudoku, chess, solving crosswords or the Rubiks cube are effective neurobics. Writing or drawing with the non dominant hand helps wake up and fire the sleeping side of the brain.
Trying to guess the dish by tasting it while blindfolded also helps to stretch ones imagination. You can add up fun by asking to guess the ingredients used in the cooking of the dish.
Playing exergames ( video games which involve exercise as in X box, play station, Kinect or Wii Fit ) helps creative skills and burns calories as well. These are particularly useful for those staying in places of extremes of climate, for the aged, for those shy to go outdoors and for those who do not have many friends. These also help the younger generation to bond well with the elders and people with joint problems can get moving as well. I do agree a walk in garden or beach side or a park will have its own benefits, but if unfavorable, this is a good alternative.
It goes without mentioning that adequate sleep, getting enough sunshine, exercise, having a good social support and a healthydiet all help in boosting brain power.
Try remembering phone numbers or appointments without the help of the mobile gadgets or the organizer.
Socialising and staying calm also help boost the brain functioning. Being stressed out does jolt your brain to standstill. When you are stressed, the brain refuses to think straight.
Though there are medicines which do claim improvement of brain ability, I am not competent enough to comment on those. I would rather you try boosting the mental power the natural way.
You must have been tired listening to doctors mentioning do some exercises …… but not many go into details of how to exercise, which exercises to do, how frequently one is to exercise or about the intensity. The important thing is to get started in case you have not. Any small step is better than no step at all.
Before embarking on a fitness program, especially if you have never done exercises regularly, get a medical checkup done by the doctor which will include an assessment of the heart as well. Though exercises are beneficial, they can cause problems for some with certain problems like eye, kidney, joint, nerve or heart problems.
If all is okay, assess how fit you are by these simple steps:
Check pulse rate before and immediately after walking 1. 6 km or a mile. The pulse rate should not be racing away. The time taken for the heart rate to come back to normal level before you started walking is equally important.
How long does it take you to walk a mile or run 2.41 km or 1.5 miles.
Body mass index
Once you have assessed how fit you are, then design a plan:
Define the need for the exercise plan- to don dresses that had been in the shelves for long, to look and feel good, for weight reduction, to do a marathon or to look good at a function.
The activity must be of at least 150 minutes of moderate aerobic activity a week
Include different activities so you do not get bored. You can walk, cycle, jog, do water exercises, skip the rope, do the hula hoop, aerobics, zumba dance and so forth.
Remember to start slow and progress slowly.
Stretching before exercises is very important.
Allow time for recovery.
You need not do all the activities at one go. You can conveniently space them out in intervals.
Be flexible. Do not punish your body.
Now that all is set, get the right footwear , get the right apparel, use a fitness app in your smartphone or use a fitness watch. The apps in the smartphone now-a-days gets one to be motivated to carry on.
Keep a diary to record the progress you made.
Reassess yourself every month.
Set new goals
Push outside your comfort zone as the body gets adjusted to the exercise quite soon and you will notice that the body needs to be pushed further to achieve more.
Do “listen” to your body. If weak or paining, do give a break and make sure all is okay. The injuries related to exercise too had been detailed in an earlier newsletter.
It is a welcome change in the climate after months of scorching heat in the middle East. This might last for a couple of months before the scorching heat picks up again. It is the time for outdoor partying, smell of inviting barbeques and probably increase in bad cholesterol levels !!!!! It is also the time for contracting viral fevers. Have you had your annual flu shot? The Flu Vaccine at least helps against many of the strains of virus which are getting more complex with each passing year.
Losing weight is something the doctor always stresses on. Interestingly, you might notice that the males are generally reluctant to address the obesity as well as their female counterparts. Moreover, weight loss is slower among those with diabetes due to the medicines they are on and also due to diabetic dysregulation. But , that cannot be used as an excuse for losing weight or even trying to.!!!! There is always a weight loss plateau that is to be expected and that should not deter yourself from continuing, but will need a self assessment as how to overcome the plateau.
Many now blame the cold weather and cold breeze and wish to remain cuddled under the blankets or remain indoors and try eating more to keep the body heat.
Impulsive eating can occur when stressed ( positive stress is during a vacation and negative stress during a personal tragedy) , when angry, when depressed or when worried about an upcoming event or even when stewing over a conflict at office or work. This often leads to impulsive eating followed by the guilt and again feeling low followed by eating again which gets you nowhere healthy !!!
Bed time snacking
People might keep on snacking to give them the so called energy while staying up awake while working late hours. There are certain occasions when you are allowed to snack especially when having an early light dinner and sleeping late. But, there are certain things to be known while snacking.
Warm milk contains tryptophan and helps in sleep
A bowl of cereal with milk or a glass of labaan( butter milk) , crackers or bread and cheese all can cause sleep due to the carbohydrate content.
Sources of hidden caffeine and fatty food such as burgers can impair with sleep.
Alcohol ( nightcap) might cause nightmares, frequent awakening, night sweats and headache for some which can impair with sleep. Drink plenty of water after the sleep.
Protein rich and high fat food will cause problems in digestion which can impair sleep.
Spicy food and smoking can impair with digestion.
So make healthy choices while snacking. Snack is just a small meal and not another meal.
The winter months are a cause for celebrations and family outings . The smell of barbeque fills the air after the sun sets. People might eat more of meat and prawns which might increase the cholesterol levels. You can however go a walk outside as the climate is much better than the hot humid summer climate.
Generally sugar levels and cholesterol levels rise with the increased food and alcohol consumption during the winter months.
You can safely exercise indoors if the weather outside is not to your liking. Tai Chi, Pilates, using the Hula Hoop, dancing to music, yoga, skipping rope or just spot jumping helps burn calories. Zumba or kick boxing are options that needs a trainer to help you out. For the fitness freaks who like to sweat it out in a gym, try something new at the gym or use resistance bands. You can swim or do any exercise in the pool as water is kind to the joints. Aqua aerobics is catching up in a big way as it is entertaining and kind on the joints as well. One can enjoy shopping by walking in the malls and doing window shopping !!!! Walking is still a good exercise. Take care of your footwear and use proper clothing if walking outdoors. Cover your head and neck if very chilly. The new form of play station using the X box helps you engage in interactive games and helps you combine entertainment with exercise and it can be enjoyable when performed with either family of friends.
For those who are interested in resistance training using small weights, remember to always warm up, stretch and do repetitions of ten to twelve in a smooth controlled motion. The muscles might ache at the beginning, Give a rest in a between and try these on alternate days to help the muscles to recover.
How to overcome barriers to exercise?
Break the times of exercise to smaller periods if it not practical to spend 30 minutes a day for five days a week.
Identify causes of waste of time such as watching the television, lying on the sofa. See if these can be overcome.
Reframe the concept of exercise such as walking the dog or taking the kids for playing, playing ball on the beach or even dancing, walking in a mall, walking around a large airport terminal while waiting for the flight.
Join a group who can motivate you.
Watch the television or listen to music while exercising.
Take stairs instead of the lift or escalators.
When ill, do not exercise.
There are numerous apps which can be downloaded from the app store if you have a smartphone. These can monitor the progress and can even motivate you to get moving.
Ask yourself why you want to lose weight:
Feel comfortable in clothes
Improve self image and confidence
Improve physical stamina
Improve energy levels
Be a role model for my family
Improve the blood pressure, cholesterol and diabetes
Reduce joint pain
Improve life expectancy
You might want to add more…..such as want to look good at a function or don those clothes which you outsized and so on…..
Write down the challenges and obstacles you face towards achieving the goals. The more honest you are with yourself, both in recognizing the obstacles and coming up with realistic strategies, greater are your chances at succeeding. Let that be your New Year resolution.
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.
Treadmill is the commonest equipment bought for the home gym and is also one of the commonest equipment used if one frequents the gym. It is often believed that the cardio exercises such as running, jogging or cycling help lose weight and also to keep one fit. But, it is worthwhile to note that the low intensity exercises help the body to adapt over a period of time thereby losing its efficiency at reducing the calories burned per minute.
Most of the people buy the treadmill and it soon becomes a dread mill- some use it as a storage space for books and other commodities. Some use the treadmill as a stand for hanging clothes.
There are, however, some points to ponder before buying one.
The advantages of a treadmill:
Can exercise indoors despite adverse climate
The smooth cushioned belt is kinder to the joints than when running on hard surfaces outside.
Those who have no baby sitter or those who cannot leave home can benefit having this at home.
This can be folded and kept aside if space is being compromised.
Can listen to audio or see videos while on the treadmill.
The programmable workout can be done to make the treadmill more interesting
Can be monotonous
The force of impact while stamping on the belt can cause injuries or pain to the knee, ankle or hip joints for some.
While running or walking outside, the muscles make small adjustments to improve the co-ordination and balance which is not there while on the treadmill.
While walking or running outside, the hamstring muscles ( muscles of the back of thigh and calf) help to propel the body forward. This does not take place while on the treadmill as the machine pulls the body forward.
There is no wind resistance which can be encountered while exercising outdoors.
There is nothing to match the downhill running on treadmill. While running downhill, there has to be a good co-ordination between the muscles of the front of thighs and lower leg muscles.
Can fall off the treadmill with injuries if not concentrating while on the treadmill
Adequate footwear is essential as the footwear can wear and tear easily due to the friction.
Cannot enjoy the sights outside, no fresh air and also change in pace is not possible.
Points to ponder while buying one:
There are two types- manual and motorized type. The manual needs one to use force to start it moving and some need even an inclination, but once it gets moving, the inclination cannot be adjusted unless you come off the machine. The manual one costs lesser than the motorized one.
Stand on the belt and see if there is any jerky movement or instability of the base of the machine
Look for a continuous duty rating of > 1.5 HP
The belt size must be at least 48” long and 16” wide.
The control panel must be easily accessible
There must be an emergency stop button which can be used if there is a mishap.
Look for the programmable versions available where the pace and inclination can be adjusted.
Addition of audio and video plug ins cost more
Water bottle holders are another option.
Look for the warranty period
If any other person besides you are planning on using the machine, please buy the high end machine. Those who are heavily built need a better machine.
Regular servicing or maintenance is needed.
Before using the treadmill, do the following:
Proper attire including good shoes
Make sure you are fit to undergo the exercise. If a first timer, make sure the doctor clears you of any heart, eye, kidney or nerve problems. If having back pain, ask the doctor before starting the treadmill.
Make sure the sugar levels are not too high or too low. Correct the sugar levels before the exercise.
Carry with you an ID card mentioning you are diabetic. Have fast acting carbs with you. Carry either orange juice or water which can be had midway between a heavy work out if the duration lasts more than an hour. If you feel dizzy or complain of difficulty breathing, do consult a doctor before continuing.
Adequate warm up is essential, start slow and then build up the pace or inclination and also stop slowly. Do not suddenly stop unless it is an emergency.
Leave a space behind while on the belt, it is safer you have some space behind in case you slip.
Hold on to the side railings while using an inclination or losing balance.
Swing arms if possible as in natural walking.
The short bursts of fast pace followed by slow pace improve the fitness levels as well do not exhaust the body.
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 footwearwith 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.
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 OnTrack
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 Fooducate
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. SWORKIT –
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.