Category Archives: Diabetes Articles

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THE BITTER TRUTH ABOUT SWEET JUICES

Fruits form an important part of our diet. The range and variety of fruits ensures that practically every vitamin, minerals and trace minerals as well as a good calorie source can be obtained. Fruits have simple sugar and complex carbohydrates. They have good amount of fibers which also contribute to good bowel health. And most interestingly fruits have different types of sugars and not just glucose and sucrose. So different fruits will have different proportions of glucose, fructose, galactose, mannose or sucrose etc.

Sugars other than glucose and sucrose do not increase blood sugar. But they add to the taste component of the fruit. Colored fruits like Jamun or black plum have polyphenols, antioxidants and falvanoids which actually benefits lowering of blood sugars. Colored fruits and its flavors due to naturally occurring ingredients (unlike artificial colors and flavors) can be nutritionally beneficial as well as protective against many illnesses. The bioactive phytochemicals present in various fruits can fight against many chronic illnesses and also has been shown to prevent certain cancers.

Vitamin A and carotenes and various anti oxidants in fruits can help prevent different cancers. Thus fruits definitely should be a regular part of our diet.

So what happens when you make a juice out of these fruits?

  • First for a single glass of juice you may require 2-3 fruits.
  • This will concentrate and greatly increase the amounts of sugars in it.
  • A low calorie fruit gets converted to a high calorie fruit juice.
  • All the fibers get removed taking with it many essential and useful phytophenols, carotenes and antioxidants.
  • Many add additional sugars to fruit juices further increasing its sugar and calorie content.
  • An average glycemic index fruit gets converted to a high glycemic index juice thereby increasing blood sugars in diabetics.
  • Juices are generally stored and preserved by addition of preservatives.Chemically active antioxidants can lose its properties if stored for a long time.
  • Ever wondered how each and every canned fruit juice looks and tastes the same? Wheras fresh fruit juices made at  home will have a different taste each and every time. This is because hoteliers and juice stalls and companies adds artificial colors and flavors to the juices .
  • A single or even 2-3 glass of juices doesn’t fill your stomach but will add 200-600 calories. And you are like to snack or have a whole meal after that thereby greatly increasing calorie intake.

If you have grasped the above facts you would realize that it is better to eat fresh fruits, not so good to have fresh fruit juices and probably bad to have preserved fruit juices.

The high calorie count with high gycemic index increase blood sugars and weight. Increase in weight indirectly cause rise in cholesterol levels. The lack of protective elements of natural fruits coupled with harmful effects of added chemicals directly and indirectly increases risks of heart attacks, strokes and probably of cancers .


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FIRST TIME DIAGNOSED WITH DIABETES.WHAT SHOULD YOU DO?

A seemingly illness free life suddenly gets a rude shock and a reality check when a routine laboratory report shows blood sugar readings high. Many people may be absolutely asymptomatic at the time of diagnosis. Many others may have some minor symptoms like 2-3 kg weight loss, excess thirst or excess urination or night time urination. Or may suffer from a mild urinary, skin or chest infection.

Disbelief: The initial reaction of most patients is one of disbelief. Most will tend to say that the lab report is wrong. Or may even say that blood may have got mixed up. Although this can remotely be a possibility, testing blood sugars is very easy and generally mistakes are not made. And it is checked twice i.e. the urine sugar is also checked simultaneously. Hence mostly the report may be right.

Denial: this is generally the second reaction. Most will go to some other lab and recheck. This may be advisable. But some fast for more than 12 hours and recheck and a borderline high sugar may come normal. They then feel that the first lab report was wrong.

Rationalization: when they get 2-3 lab reports high, most start rationalizing and explain high sugars as related to recent stress or “mango” season or diwali sweets etc. and feel that once this phase is gone the diabetes will disappear forever.

Acceptance: many finally accept the fact that they have DIABETES and they need to initiate life style modifications and maybe drug therapy. Some people however remain in denial and they stop rechecking their sugars for many months. (Leading to complications in many.)

Alternative therapy: immediately as soon as the diagnosis is made much start seeking alternative therapies. Some standard and some bizarre alternative therapies are:

  • Ayurveda, homeopathy, herbal,
  • A special grass grown in Himalayas
  • Put karela(bitter gourd) in a tub and mash it with your feet everyday till bitter taste comes in your mouth

The list is endless.

However since diabetes is a lifelong disease and easily diagnosed and can be very well controlled, it is better that patients come to terms with it as soon as possible. Upon acceptance patient should educate himself about various aspects of diabetes. When patient has better understanding of diabetes, they generally do not follow mindless alternative therapy. E.g. there is definitely some therapeutic advantage in Ayurvedic medications. But to date there is no cure. Also some ayurvedic medications may have heavy metals which may harm the kidneys.

Hence it is important to initiate lifestyle changes, daily exercise regimen, low sugar and low calorie diet as soon as diagnosis is made. If the sugars still remain high, it is better to go on medications. And also regularly monitor the blood sugars. And as per doctor’s advice do a yearly detailed health checkup.

 

Dr JACOB THOMAS


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I WILL CONTROL MY DIABETES MYSELF WITH DIET CONTROL AN EXERCISE

After a brief period of intense motivation to exercise and following a set pattern of diet, most patients become satisfied to see the normal blood sugar levels. Once achieved a period of complacency sets in. routine compulsions of life and liabilities makes illness recede to the remote recess of mind .This is generally followed by a prolonged period of persisting with same medications, however, with a much diluted diet and exercise schedule. And also a variable period of delay in checking and monitoring blood sugars.
Generally, however, DIABETES catches up and manifests itself with some symptoms, like infections, or feet numbness and tingling, chest discomfort etc. And upon rechecking, blood sugars are found to be unacceptably high. The sugars have been probably high for a long time. And during this period all the target organs like the heart, kidneys, nerves, eyes are continuously undergoing slow damage. Now even if we control the sugars the target organs have got a little more damaged. But most patients at this point tell me that they will control their sugars on their own. Repeated episodes of control and lack of control of blood sugars occurs throughout the life of the person. And each period of uncontrolled blood sugars leades to a further deterioration of function of key organs like heart, brain , eyes , kidneys etc.
Although some patients may be able to control their sugars with good exercise and diet, most will not be able to sustain their extra efforts. And the sugars invariably will go off control after a few weeks. Hence, in such situations, it is advisable to control blood sugars by lifestyle changes in addition to slight up titration of doses.
Since DIABTETES is a chronic disease, there always comes a phase of poor control wherein the diet and exercise schedule gets disturbed due to various reasons. The effort should be to minimize such period to minimum and maintain a sustained good control of blood sugars. Because, it is now proven beyond doubt that better control in initial years leads to lesser complications like kidney and heart problems in later life.

DR JACOB THOMAS


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FOOT CARE IN DIABETES TEN TIPS FOR HEALTHY FEET IN DIABETES

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Our feet are the area which bears the total weight of the body. The surface area of feet is very small and hence the pressure over feet is tremendous. Over heel area the pressure is as high as 400 kpa ad over toe joint area around 100-130 kpa.The feet are well adapted to withstand such enormous pressure so long as it is healthy.

DIABETES affects feet in many ways if uncontrolled. DIABETES may cause micro vascular disease (i.e. the very small vessels supplying blood are blocked) leading to decreased blood flow to skin, muscles and bones. This leads to weak skin, dryness and loss of skin hair. The muscles become weak and ligaments holding the bones become frail. Hence bones are not supported that well. The nerves supplying feet may develop DIABETIC PERIPHERAL NEUROPATHY and hence sensations of feet may become less. This makes feet more prone to injuries as person does not get pain. The blood flow in small arteries is compromised due to peripheral vascular disease leading to blockages of arteries. This decrease blood supply causes tissue injury.

All the above factors coupled with a high blood sugar may cause a very trivial injury with breach of skin to get infected. And the infection will spread rapidly to surrounding tissues. Within a few hours to few days it can cause gangrene involving the skin, ligaments, muscles and bones(DIABETIC FOOT).since blood flow is poor the antibiotics given may not reach the concerned tissues properly. And hence healing can be very prolonged and delayed. Sometimes if bacteria are too virulent and there is a danger of infection spreading through blood and causing sepsis,or there is lot of tissue, muscles and bone destruction, amputation may be needed.

Having read all this you would realize that FOOT CARE is very important. Following are some suggestions.

  • Keep feet skin smooth and soft
  • Examine feet daily for dryness, callosities, corns, cracks, in growing toe nails, areas of redness, tender spots .as well as tingling , numbness or loss of sensations, black discoloration , swelling of feet , swelling of joints, shoe bites , skin texture and softness, loss of hair, flat foot .
  • Clean feet daily with mild soap and water
  • Apply small amounts of Vaseline (petrolatum jelly) at night with gentle massage.
  • Trim nails carefully
  • Wear comfortable footwear(canvas shoes) or special footwear if needed ( as advised by your doctor)
  • Keep blood sugars under good control
  • Exercise daily. This improves skin blood flow.
  • Take prompt treatment for any feet problem like infection, etc.
  • Doing pedicure may help however aggressive skin callosity trimming can leading to pinpoint bleeding and infection.

Dr JACOB THOMAS.


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THE BITTER TRUTH ABOUT SWEET JUICES

Tags : 

Fruits form an important part of our diet. The range and variety of fruits ensures that practically every vitamin, minerals and trace minerals as well as a good calorie source can be obtained. Fruits have simple sugar and complex carbohydrates. They have good amount of fibers which also contribute to good bowel health. And most interestingly fruits have different types of sugars and not just glucose and sucrose. So different fruits will have different proportions of glucose, fructose, galactose, mannose or sucrose etc.

Sugars other than glucose and sucrose do not increase blood sugar. But they add to the taste component of the fruit. Colored fruits like Jamun or black plum have polyphenols, antioxidants and falvanoids which actually benefits lowering of blood sugars. Colored fruits and its flavors due to naturally occurring ingredients (unlike artificial colors and flavors) can be nutritionally beneficial as well as protective against many illnesses. The bioactive phytochemicals present in various fruits can fight against many chronic illnesses and also has been shown to prevent certain cancers.

Vitamin A and carotenes and various anti oxidants in fruits can help prevent different cancers. Thus fruits definitely should be a regular part of our diet.

So what happens when you make a juice out of these fruits?

  • First for a single glass of juice you may require 2-3 fruits.
  • This will concentrate and greatly increase the amounts of sugars in it.
  • A low calorie fruit gets converted to a high calorie fruit juice.
  • All the fibers get removed taking with it many essential and useful phytophenols, carotenes and antioxidants.
  • Many add additional sugars to fruit juices further increasing its sugar and calorie content
  • An average glycemic index fruit gets converted to a high glycemic index juice thereby increasing blood sugars in diabetics.
  • Juices are generally stored and preserved by addition of preservatives.Chemically active antioxidants can lose its properties if stored for a long time.
  • Ever wondered how each and every canned fruit juice looks and tastes the same? Wheras fresh fruit juices made at  home will have a different taste each and every time. This is because hoteliers and juice stalls and companies adds artificial colors and flavors to the juices .
  • A single or even 2-3 glass of juices doesn’t fill your stomach but will add 200-600 calories. And you are like to snack or have a whole meal after that thereby greatly increasing calorie intake.

If you have grasped the above facts you would realize that it is better to eat fresh fruits, not so good to have fresh fruit juices and probably bad to have preserved fruit juices.

The high calorie count with high gycemic index increase blood sugars and weight. Increase in weight indirectly cause rise in cholesterol levels. The lack of protective elements of natural fruits coupled with harmful effects of added chemicals directly and indirectly increases risks of heart attacks, strokes and probably of cancers .

Hence it is always better to have a bowl of fruits once a day for a diabetic or 2-3 courses of fresh fruits if non diabetic for its entire health benefits instead of juices.

Thus sweet juices can come with a dose of bitter truth.

 

DR JACOB THOMAS

MD (MED); DNB (MED).


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IMPORTANT THINGS TO KNOW ABOUT EYE DAMAGE IN DIABETES

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Eyes are by far the most important sense organ. Hence for humans “seeing is believing”. We confirm everything only if we see it. And Diabetes can affect many aspects of the EYE. Eye is made up of a cornea through which light enters. Light passes through the lens and then falls on the retina.

Uncontrolled diabetes causes retina to not get enough glucose for utilization and hence damage to the retina. This damage is called retinopathy. Retinopathy can be mild, moderate or severe. Severe Diabetic Retinopathy can cause permanent blindness. In fact DIABETES related blindness is the most common cause of blindness in India and also the world.

Diabetes can affect the eyes in many ways. It can cause premature cataracts. Cataract occurs with age. In diabetes especially those not properly controlled, cataract can occur in much earlier. Cataract causes progressively decrease in vision. And later blindness. Immature cataract care not operated (although with new techniques they may be operated upon). Immature cataracts or partly hazy lens later becomes fully opaque and forms “mature” cataract. Mature cataracts are operated upon and removed.

Uncontrolled diabetes leads to increase chances of infection anywhere in the body. Similarly it can cause eye infections like stye, conjunctivitis, endopthalmitis etc. chances of herpes opthalmicus increases in uncontrolled diabetes resulting in damage to eyesight.

DIABETIC RETINOPATHY is diagnosed with help of a fundoscopic examination. This is done in a clinic setup. It causes blurring of vision, haziness, dark spots in vision and later near total blindness. Good control of blood sugar is essential. Later laser photocoagulation needs to be done to prevent progression of diabetic retinopathy.

DIABETIC MACULAR EDEMA and GLAUCOMA are other complications of DIABETES.

All these complications occur after many years of poor or partly controlled diabetes. Hence it is important to understand these and take appropriate medical therapy for its prevention. DIABETIC DIET, EXERCISE and medications as prescribed by your doctor will help keep blood sugars normal. Regular monitoring of blood sugars is also vital. Besides YEARLY EYE EXAMINATION and FUNDOSCOPIC examination to rule out early evidence of DIABETIC RETINOPATHY is important. It is easier to treat and prevent progression of early diabetic retinopathy.

Hence consult your doctor if you are a diabetic as to the need of EYE examination

 

DR JACOB THOMAS.

MD(MED) ;DNB(MED)


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FIVE USEFUL HEALTH TIPS FOR 15 -30 YEAR OLDS

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The first thought that must have come in the readers mind is as to why I have selected 15 to 30 years age bracket for tips .here is the explanation.

15 years is around the time when there are drastic changes in one’s life. School gets over and college starts. That means the teen gets independent. He is more matured but still impressionable. He or she can understand and grasps matters but ideas are not set and rigid. He starts eating more outside. Hence food habits change and can become bad. He may develop and nurture food fads which might lead to weight gain, obesity which can act as the precursor to getting diabetes and hypertension in future. He may develop addictions and his perfectly healthy milieu interior will get disturbed.

At the same time 15 is an age when a person’s physical endurance increases. He can exercise, start gym, run marathons and indulge in any kind of sport. And in doing so maintain good health.

The choices made during this age have a bearing on your future health just like it has a bearing on your career. Around 18-21 years of age the height stops increasing and hence whatever extra we eat just goes on to add the girth of the person. Which in Indians lead to abdominal obesity. The fat accumulation so acquired at this age group will later lead to formation of cellulite or resistant fats and also worsen the peripheral resistance of the body. This insulin resistance leads to diabetes.

Hence channelizing towards healthy lifestyle habits of this age group is very important.

Around 26 years of age is considered the peak of physical health. Hence most international sports players generally peak at this age .after 27 years generally the physical abilities start diminishing. Hence in athletics and games like lawn tennis players retire by 28-30 years.

By 30 years ideas and habits as well as ideologies becomes fixed and mostly inflexible. So whatever addictions if acquired will persists, food fads will continue, sedentary habits will carry on.

So the ability to shape your future health lies between 15 to 30 years of age. Beyond 30s the task just becomes more difficult if not impossible. Taking good care of health in childhood is important, however child health is in the hands of parents and child is generally not mature enough to understand health implications by themselves.

With this back ground, let’s see the 5 useful tips.

  1. EAT HEALTHY, well balanced diet, rich in VITAMINS, low in carbohydrates , slightly high proteins and low in fats and low calorie diet.
  2. EXERCISE DAILY. Since this is young age group and 99% will have no co-morbidities , they can indulge in any type of moderate to high intensity sporting activities like jogging, running , swimming ,cycling , hockey etc(consult doctor before doing heavy intensity exercises if any health issues)
  3. MAINTAIN IDEAL BODY WEIGHT AND BMI: stick to your ideal body weight by a combination of exercise and diet plan and never waver 2-3 kgs above ideal weight.
  4. AVOID ABDOMINAL OBESITY: many people may not become overweight but still develop abdominal obesity .This leads to prediabetes, impaired glucose tolerance and overt diabetes mellitus. Hence exercising to prevent abdominal obesity is very important.
  5. STAY AWAY FROM ADDICTIONS: consuming poison (smoking, alchohol, drugs) from one side and then resorting to fad detox programmes on the other side never helps. This is the age group where addictions develop and can become lifelong and endanger life itself. Hence staying away from all addictions is very important.

 

DR JACOB THOMAS

MD(MED);DNB(MED).


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start-walking

Physical Changes In Long Term Improperly Controlled Diabetes

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There are many minor changes in the body which occurs in an improperly controlled diabetic over a long period of time. By improperly controlled I mean not just very high blood sugars , but people with slightly high blood sugars and those with a wider hourly variations in blood sugar ( called glycemic variability).

Most people are aware only of the sugar-centric nature of diabetes care and probably that its complications extends to heart, eyes, kidneys and nerves. That diabetes can affect the skin, bones, muscles, joints, ligaments and symposium (joint coverings or capsules) is the lesser known fact.

We will concentrate on the deleterious physical changes of long term diabetes.

The skin texture is lost. The proteins in the skin become denatured ,the skin becomes wrinkled and it becomes dry .Certain areas of the body like the feet and legs show loss of hair and ageing signs appear much earlier.

The muscle bulk is lost and therefore characteristically early the person develops an enlarged abdominal girth, a broad mid segment but very thin upper Limbs and lower Limbs. This is because the muscles of the hand, forearm, arms, thighs and legs become weak and partly atrophied.

The facial skin also become wrinkled and early signs of ageing sets in making the person look biologically aged compared to his chronological age .

Early graying of the hair might also occur.

Bone and joints become weak and difficulty in walking sets off a sequence of further damage to posture, muscle atrophy, and sedentary habits leading to further worsening of biological profiles namely sugars and lipids.

Proximal myopathy denotes weakness of thigh and arm muscles leading to difficulty getting up from squatting position.

Peripheral nerve damage (nerve damage of feet and legs) leads to silent injuries to feet and ulcers, thin and weak skin and osteoporosis of feet bones.

The ligaments of the body become partially fibrosed and this can lead to problems like the frozen shoulder. Frozen shoulder causes pain over the shoulder and restriction of shoulder movements. This leads to loss of muscle mass over the deltoid area.

Repeated infections of the skin and subcutaneous tissues lead to healing by scarring and fibrosis and scarred appearance of skin of the face and body.

 

To reverse or minimize all the above changes, the best way is to maintain a normal accepted blood sugar levels, good regular exercise, muscle strengthening exercises, and proper dietary and other life style changes and vitamins and calcium supplementation as indicated, a diet with high protein when medically indicated.

With good control, most changes will be delayed if not prevented totally.

So, do not delay in initiating proper therapy as the benefits are time bound and only a sustained daily effort will yield fruitful results.

DR JACOB THOMAS

MD(MED);DNB(MED)

PHYSICIAN AND DIABETOLOGIST.


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Type 1 Diabetes Mellitus –All You Need To Know About

Type 1 Diabetes Mellitus –All You Need To Know About

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90-95% of the people who have diabetes have type 2 diabetes. Only 5% or less will have type 1 diabetes. Type 1 diabetes typically occurs in children .before the discovery of insulin type 1 diabetes patient would not survive as oral diabetic drugs are ineffective in type 1 diabetes. For unknown reasons the incidence of type 1 diabetes is gradually increasing. Kids affected by this form of diabetes shows rapid loss of weight or contract repeated respiratory, urinary or skin infections. A diabetologist in Mumbai would on an average see one new case once a week to once a month.

Type 1 diabetes is postulated to occur due to genetic and autoimmunity reasons.type1 DM may be present in a parent or a sibling or a close relative. A genetic propensity coupled with an autoimmune destruction of the beta cells of the pancreas results in a lack of insulin production. Lack of insulin leads to rise in blood sugar levels. Insulin function to carry blood sugar inside the cells. Hence due to lack of insulin, the tissues and cells of the body do not get adequate glucose. This affects the functioning of almost all the organs of the body. Lack of energy leads to wasting of the muscles and bones leading to weight loss and emaciation. Excess urine is thrown out in the urine and hence child develops polyuria or increased urination. Excess hunger occurs due to craving for sugars called polyphagia. And loss of fluid and water from the body leads to excess thirst called polydipsia.prolonged high blood sugar also causes damage to many organs of the body. Damage to kidney occur called diabetic nephropathy. Diabetic retinopathy involves damage to the retina leading to gradually progressive blindness. It’s one of the common causes of blindness in the world. Altered fat metabolism leads to increase in the blood cholesterol which may get deposited in the arteries of the heart and brain causing heart attacks (coronary artery disease) and strokes .bacteria thrive in an environment of high blood sugar and hence a mild bacterial infection will progress exponentially and lead to severe septicemia. Thus respiratory infections and pneumonias and urinary infection and urosepsis are common .the peripheral nerves get damaged and leads to peripheral neuropathy. This leads to tingling and numbness of the feet eventually causing total numbness of the feet .this can lead to injuries of the feet leading to cellulites and gangrene.

The patient is usually a young child with either weight loss or taking excess oral liquids. Early diagnosis and prompt treatment is of utmost importance. Most of the oral diabetic drugs use the pancreatic beta cells for its action by directly or indirectly stimulating insulin secretion from the surviving beta cells. Since in type 1 diabetes there is near total lack of insulin oral drugs have no role in the therapy of type 1 diabetes mellitus. Hence the treatment is giving human insulin available in different marketed names .short acting human insulin has to be given 2-3 times a day. The dose of insulin depends on the level of blood sugar. Dose is gradually titrated so as to achieve a proper control. At the same time it is very important to counsel the family members and the patient also. Counseling helps the family and patient to come to terms with the illness. Adequate education of the patient and relatives helps to allay fears and helps patient to get motivated for adequate control and prevent long term complications.

Recent advances might greatly help in the smooth control of blood sugar .for a Diabetic specialist in Mumbai these new technology is a boon for better management of type 1 diabetes. Insulin pumps are available which has to be attached over side of abdomen and metered dose of insulin can be given to the patient. This avoids the need for multiple injections. A further advancement is the introduction of a sensor which records blood glucose every 5 minutes. Thus giving a continuous graph of the patient’s blood sugars .the sensor relays the blood sugar readings to the insulin pump and the latest approved advancement of insulin pump allows to pump to automatically inject the required amount of insulin leading to regulation of blood sugar. This is the concept of artificial pancreas. The pancreas senses minute fluctuations in blood sugar and secretes insulin thus regulating the blood sugar. Low blood sugar stimulates pancreas to shut of insulin secretion. The artificial pancreas with insulin sensor does a similar function. If the blood sugar goes below 70 gms /dl the insulin pump is shut down and a preset metered dose in injected based on the blood levels of sugar. Although at present these insulin pumps are costly, it provides a hope in future for a good and smooth control of blood sugar and thus preventing long term complications

DR JACOB THOMAS

MD(MED) ;DNB(MED).


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Tips For Controlling Blood Sugar With Diet And Exercise

Tips For Controlling Blood Sugar With Diet And Exercise

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Three cardinal triad in the therapy of diabetes is

1) diet control
2) exercise
3) medications

other important aspects, of course, are regular monitoring of blood sugars periodic follow up with diabetes specialist a yearly comprehensive health check up to rule out complications of long term diabetes each of the 3 triad that we enumerated above are equally important. Thus diet and exercise will each contribute roughly 30-35% in reduction of blood sugar and medications another 30-35%. Hence if a person does not follow a proper diabetic diet plan or a regular exercise schedule, then his/her diabetic doses will have to be increased 2-3 fold. Conversely good diet and exercise can lead to a significant reduction in the doses of diabetic drugs.

No matter what stage of diabetes a patient may be , diet and exercise will significantly reduce

1) blood sugars
2) reduce blood cholesterol thereby decreasing cardiac and brain stroke complications
3) decrease the peripheral resistance and increase insulin sensitivity
4) decrease stress on beta cells of the pancreas and hence decrease beta cell death(i.e. cells which secrete insulin )
5) decrease weight of the person and hence indirectly decrease workload on the beta cells of the pancreas
6)improve blood flow to various organs( while exercising ) and hence prevent long term microvascular complications.

Thus, diet and exercise can have a very favorable effect on ones diabetes.

WHAT FOODS TO HAVE IN A DIABETIC?

As a diabetologists in Mumbai I am often faced with a situation of patients being exposed to high calorie fast foods which are easily available. And good natural foods are difficult to obtain. In general, diabetics should have a low calorie, low simple sugar, low carbohydrate, low fat, high fiber and high protein diet( provided there are no other contraindications).

All green leafy vegetables like karela, methi , methi seeds, palak , tendli etc are good for diabetes.preparations should be in raw form or boiled with minimum of oil and salt.
All salads like carrots, cucumbers, salad leaves, cabbage etc are recommended in raw form.
Pulses and sprouts provide protein in diet.

Lean meat like boneless chicken, boiled fish and egg white are also good protein source and does not increase blood sugar.

Curds made from fat free milk can be had.

As a Diabetes specialist in Mumbai, I recommend fruits commonly available with low glycemic index. Of these jamuns are good for diabetes followed by apples and pears and guava .other fruits like water melon and musk melon and papaya can also be had. Fruits should be taken about 150gms daily only.
It is important not to have heavy meals and refrain from post meal high calorie deserts.

BENEFITS OF EXERCISE IN DIABETES

There are two types of exercise

1) isotonic exercise like walking , jogging, running, swimming , badminton , foot ball etc
2) isometric exercise or weight training exercises like weight lifting and muscle building exercises
isotonic exercises causes calorie burning and glucose consumption and leads to lowering of blood glucose.
The initial response in exercise might be an increase in blood sugar as glucose may get released from liver in to the blood. After half hour or so of exercise the blood sugar starts coming down and then the fat burning starts.

This can lead to weight loss and also reduction in fat mass and improved insulin sensitivity.
Weight training exercises lead to increase in the muscle bulk and muscle mass. Increase in muscle mass leads to decrease in blood sugar. And increase in fat mass  leads to increase in blood sugar. So exercise by increasing muscle mass and decreasing fat mass leads to favorable blood sugar profile.
Exercise recommendation however will change according to the patient profile.

1) Young patient with no co morbidities can do jogging, running or any other aggressive sport.
2) 40-55 years old (if not previously conditioned to exercise) should do walking or low intensity exercise for a prolonged period of 45 min to 1 hour.
3) 60 years plus should also do walking to the limit of tolerance.
As a diabetic doctor in Mumbai, I attempt to explain and reinforce the importance of exercise and diet to patient during each visit.

The single most proven benefit of therapeutic benefits in diabetes thus is through proper diet modification and exercise.

Dr JACOB THOMAS

MD(MED)DNB(MED)

 


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