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Diabetes Diet

Diabetic Food Pyramid

(From previous issue)

Fats (Limit to 1 serving per meal) A serving can be:-

· 10 Peanuts.

· 1 Tbsp Salad Dresssing

· 2 Tbsp light salad dressing or saur cream.

· 1 Tsp margarine, Oil or mayonnaise.

· 1/8 Avocado.

Sweets (Substitute for starch or fruit serving occasionally) A serving can be:-

· 2 Small Cookies.

· 1 Small Cupcake or Muffin

· ½ Cup Ice cream.

· 1/3 Cup Frozen Yoghurt.

· ¼ Cup Sherbet.

· 1 tsp Syrup or Honey.

Milk (2-3 Servings per day) A serving can be:

· 1 cup Milk.

· 1 Cup Low Fat.

· 1 Cup Artificially Sweetened yogurt (No sugar)

Meat / Fish/Chicken (2-3 Serving per day) A serving can be:

· 2 oz Cooked Lean Meat/Poultry/Fish.

· ½ - ¾ Cup Tuna or Cottage Cheese.

· 1 Egg or 4 oz Tofu or 1 oz cheese.

· 2 Tbsp peanut Butter.

Vegetables (3-5 Serving Per day) A Serving can be:

· 1 Cup Raw Vegetables.

· ½ Cup Cooked Vegetables.

· ½ Cup Tomato or Vegetable Juice.

Fruits (3 Serving per Day) A Serving Can be:

· 70 gm small fruit.

· ½ Cup canned fruit.

· ¼ cup Dried Fruit.

· ½ Cup Fruit Juice. (No sugar)

Grains, Starchy Vegetables and Beans. (6 plus Servings Per Day) A Serving Can be:-

· 1 Slice of 1 oz bread or ½ (1 oz) Bagel or 5 Crackers or 1 Granola bar.

· ½ Hamburger or Hot dog Bun or a tortilla of 6 inch or 2 tacos.

· ½ Cup Cooked Cereal, Cooked beans, Lentils, Corn, Peas, S. Potato, Potato or Pasta.

· 1 Cup winter Squash, 1 Cup Soup.

· 1/3 Cup Rice or 3 Cup Plain Popcorn (Fat free)

Diet Management During Diabetes

Most of the food items contain carbohydrate, protein and fat. Cereals are rich in carbohydrate, lentils, lean meat, chicken and fish are rich in protein while oils, nuts and milk creams are rich in fat. Fat foods are high in calories; 1g of it provides 9 calories, while 1g carbohydrate or 1g protein gives only 4 calories.

Carbohydrate is easily digested than fat and protein. The rise in blood glucose after a meal is due to absorption of glucose from a carbohydrate digestion and increase in production of glucose by liver. Sucrose (cane sugar), sweets and syrups cause a rapid rise in blood glucose than whole cereals like finger millet and wheat products.

In people with no diabetes, the rise in blood glucose after a meal comes down to the pre-meal level with in 2 hrs. In diabetes, the rise in blood glucose after a meal is not only higher but the fall to pre-meal level is slower (3-4 hrs). Therefore, snacks in between meals or frequent meals at short intervals tend to cause progressive increase in blood glucose in people with diabetes.

Glucose is constantly needed to provide ready energy for the proper functioning of brain, heart, kidneys, liver and blood cells. When glucose is not available from ingested food, our liver produces from its store of carbohydrate (glycocen) and body stores of fats and proteins. The liver produces about 0.1058 oz of glucose/lbs body weight in a day. For example the liver of a man or woman weighing 154 lbs produces 7.0547 oz of glucose in a day. The production of glucose by the liver is kept in a check by small amounts of insulin secreted by the pancreas.

These considerations and the modality of your treatment (tablets/insulin) are taken into account for formulating your diet management during diabetes and meal timings. The dietician would give your information on your diet.

The general guidelines on diet are:

In a typical day’s meals and snacks, you should have 1500-1800 calories with – 60% contribution from the carbohydrate, 20% from fat and 20% from proteins. You may need extra weight reduction. If you are on calorie-restricted diet, make sure to take 50-60% of calories as complex carbohydrate (whole cereals) to prevent any feeling of weakness.

· You should eat a variety of food items everyday. Do not skip meals. Avoid snacks, unless you are advised to (example during insulin treatment). Don’t over eat.

· Eat fruits and vegetables. Use less oil in cooking. Avoid fried foods, milk cream or food items cooked in coconut milk.

· Avoid ready to eat food preparations, sweets and sugary drinks (canned beverages) that provide empty calories (no vitamin or essential minerals).

· Keep a regular check on your weight – maintain it within the estimated limit.

· Check your hemoglobin and proteins in blood samples at 6 months or 1 year’s interval, Suitable correction in diet format or supplementation may become necessary.

· Despite a good control of blood glucose, if your blood lipids are high, you will need lipid lowering drugs regularly. Some times your doctor may advice you lipid-lowering drugs from the beginning of your diabetes treatment.

·Match your mealtime to the form of insulin and insulin injection schedules as explained by your doctor or the diabetes nurse.

Diabetic Diet Dos

·For breakfast, take cholesterol-lowering oatmeal

·Have nuts rich in mono unsaturated fat, such as pecans, walnuts, and almonds

·Eat pasta, stews and leafy salads along with beans— kidney beans, chick peas, and dry beans, navy beans and peas which can reduce LDL “bad”; cholesterol

·Fat free milk, yogurt, and cheese to be taken

·Eggs whites to be included

·White meat chicken and Fish and shellfish (not battered) are good

·Increase intake of dry beans and peas

·Have at least 20 to 25 grams of raw onion daily

·Add wheat bran to your wheat flour (50% wheat flour + 50% wheat bran). This helps increase fiber in your diet

·You can also add flaxseed and fenugreek seeds into the wheat flour

·Increase fiber intake in the form of raw fruits, vegetables, whole cereals etc

·Intake of cinnamon, garlic, onion, bitter melon, guar gum is known to considerably reduce blood glucose level

Sample Diabetic Diet - Diabetes Plate Method

A simple step to eat low carbohydrate and low fat diet is to follow Sample Diabetic Diet or Diabetes Plate Method. In order to follow the food guide pyramid for diabetes in all the meals it is essential to visualize the diabetes plate. A sample diabetic diet produces a picture in our brain for the ideal proportion of nutrient intake. This lies especially true for type 2 diabetics, who are in most cases overweight. The problem does not lie is what you eat but off course in the quantity you eat. The diabetes portion plate helps a diabetic to see how much quantity/space the particular food group should occupy on his meal plate. It is nothing but a balanced diabetes diet. This Diet can be used by all the individuals who are overweight and willing to keep diabetes and other heart problems at bay.

How to make Diabetic Portion/Sample Plate

1. Divide your plate in ½, and the second half into two equal ¼.

2. Fill the first half with your favorite non starchy Veggies like Lettuce, Broccoli, Spinach, Peppers, Carrots, Green beans, Tomatoes, Celery, Cabbage, and Mushrooms etc. (Note: Restrict the quantity of corn, peas, potatoes, yams and winter squash.)

3. The ¼ of plate with Meat/Protein like Chicken, Beef, fish, Eggs, Tofu, Cottage cheese, Lamb, Turkey etc.

4. The remaining ¼ with brown rice, bread, Potatoes, Crackers, Peas Soup, Cereal, Tortillas, Beans, Yams, Lentils etc.

5. One serving of non fat, sugar-free yoghurt or milk.

6. One serving of fruit like Guava, Apple, Berries or any Citrus.

Why Sample Diabetic Diet?

·Even Distribution of carbohydrate throughout the day to maintain your blood sugar level in target range.

·It helps to lower down the intake of carbohydrate i.e starches, fat/cholesterol.

·Contains more Fibre, antioxidants, photochemical s and quality protein which are essential part of nutritionally sound diet. This would eventually show complete breakdown of starches.

·It is an easy way to promote weight loss with no extra efforts. Weight loss leads to increase insulin sensitivity.

Sample Diabetic Diet or Diabetes plate method can be beneficial for :-

·Working professionals with busy lifestyles.

·Adult or Senior citizens

·Newly diagnosed diabetics or diabetics with depression.

·Low literate diabetics who understand only thumb rule.

·A diabetic with uncontrolled or dancing blood sugar levels.

·Overweight, obese or anyone willing to loss body weight.

·Person with Cognitive difficulty or mentally challenged.

·Rigid or stubborn person who don’t believe in diet planning.

Diabetes Care

·Eat food at fixed hours

·Do not overeat

·Do not eat immediately after a workout

·Make sure you have three proper meals & light snacks in between

·Eat about the same amounts of food each day

·Eat your meals and snacks at about the same times each day

·Make sure the gaps between your meals are short

·Do not eat fast; masticate and munch your food well before you swallow

·Drink a lot of water that will help flush the toxins off your system

·Avoid fried foods and sweetmeats

·Include fresh vegetable salad in every meal

·Include sprouts in the diet

·Take your medicines at the same times each day

·Exercise at about the same times each day

·Avoid smoking. Smoking leads to heart disease and poor circulation

· Check your feet for cuts, blisters, and swelling which are likely to result from diabetes-related nerve damage

·Take good sleep daily

·Check your blood sugar level regularly

·Try to stick up to the plan made up for sugar control

·Check the other tests such as kidney function, liver function, heart function, ketone level etc

·Check your weight periodically and maintain ideal body weight

Diabetic Diet Don’ts

Don’t fry foods instead bake, boil, poach or sauté in a nonstick pan. Steam or microwave vegetables. Buy tuna packed in water, not oil

·Eat less high-fat red meat and more low-fat turkey and fish. Avoid organ meats

·Limit the use of condiments such as ketchup, mustard and salad dress ion—they’re high in salt and can be high in sugar, too

· Rinse processed foods in water and, wherever possible, choose fresh foods over canned

· Limit your salt (sodium content)

· Read labels carefully. Soy sauce, brine and MSG, for example, contain a lot of sodium

· Don’t select ready to eat and junk foods items available to you

· Don’t smoke and stop alcohol consumption

· Don’t skip meals and medicine times

Gestational Diabetes

Gestational diabetes is a form of diabetes which affects pregnant women. It is believed that the hormones produced during pregnancy reduce a woman’s receptivity to insulin, leading to high blood sugar levels. Gestational diabetes affects about 4% of all pregnant women. It is estimated that about 135,000 cases of gestational diabetes arise in the United States each year.

Hormones involved in development of placenta, which helps the baby to develop also blocks, the action of the mother’s insulin in her body. This problem is called insulin resistance. During pregnancy a mother may need up to three times more insulin for glucose to leave the blood and transform to energy. When body is not able to use insulin due to insulin resistance it develops into Gestational Diabetes. Glucose builds up in the blood to high level, it is called hyperglycemia.

Gestational diabetes affects the mother in late pregnancy and the baby too. Insulin does not cross the placenta, as glucose and other nutrients do. Extra blood glucose passes through the placenta that gives the baby a high blood glucose level. It results the baby’s pancreas to make extra insulin to get rid of the blood glucose. Since the baby is getting more energy than it needs to develop and grow, the extra energy is stored as fat. It can lead to Macrosomia i.e. “Fat” baby. At birth this fat baby develops problem in breathing or may develop hypoglycemia due to over production of insulin.

Why there is a need to take care of gestational diabetes

Gestational diabetes can harm you and your baby, so you need to consider about it seriously and start caring at once. The main aim of gestational diabetes treatment is to keep blood glucose levels equal to those of normal pregnant women. It needs a planned meal and scheduled physical activity, even blood glucose testing and insulin injections if required. If gestational diabetes is taken care off properly, reduces the risk of a cesarean section birth that high weight babies may require.

Types of Gestational Diabetes

There are 2 types of gestational diabetes:

Type A1: Only diet modification is sufficient to maintain normal glucose levels.

Type A2: Insulin or other medications along with diet are required to maintain normal range of blood glucose.

Gestational diabetes is also classified into different forms of diabetes which existed prior to pregnancy:

Type B: onset at age 20 or older or with duration of less than 10 years.

Type C: onset at age 10-19 or duration of 1-19 years. Type D: onset before age 10 or duration greater than 20 years.

·Type F: diabetic nephropathy.

Type R: diabetic retinopathy.

Type H: diabetes with ischemic heart disease.

Type T: diabetes requiring kidney transplant.

Symptoms of Gestational Diabetes

Often women with gestational diabetes exhibit no symptoms. Screening glucose challenge test is a preliminary screening test performed between 26-28 weeks. However, symptoms of gestational diabetes are similar as Type II diabetes. It includes increased thirst, increased urination, fatigue, nausea and vomiting, bladder and yeast infection, and blurred vision.

Gestational Diabetes – Risk of diabetes in Future:

Gestational diabetes is only a temporary phase, it disappears after pregnancy. But once you are diagnosed with gestational diabetes, your chances are 2 in 3 that it will return in future. It is hard to tell whether the particular woman has diabetes due to gestational diabetes or type 2 diabetes. There seems to be a link between the tendency to get gestational diabetes and type 2 diabetes. Gestational diabetes and type 2 diabetes both involve insulin resistance.

Risk factors for gestational diabetes include:

·Strong family history of type 2 diabetes

·Mother’s age - a woman is at higher risk if she is aged at the time of pregnancy

Obesity

·Fallen prey to gestational diabetes in previous pregnancy

·A previous pregnancy that resulted in a child with a birth weight of 9 pounds or more

·If you are diagnosed with prediabetes, impaired glucose tolerance, or impaired fasting glucose

Gestational Diabetes Test

Depending on risk factors, the doctor will decide when you need to be checked for diabetes. If you are at higher risk, the blood glucose level may be checked at your first prenatal visit. If your test results are normal, you will be checked again sometime between weeks 24 and 28 of your pregnancy.

Depending on the risk and your test results, you may have one or more of the following tests:

Fasting blood glucose or random blood glucose test: When plasma glucose level is >126 mg/dl or when random plasma glucose >200 mg/dl is confirmed on a subsequent day then the woman is at risk to develop GDM. Hence, you will be suggested by your doctor to go for some confirmatory tests. Screening glucose challenge test: It is a preliminary screening test, which is performed between 26-28 weeks. This test will diagnose whether diabetes exists or not by indicating whether or not the body is using glucose. The Glucose Challenge Screening is now considered to be a standard test performed during the second trimester of pregnancy.Oral glucose tolerance test (OGTT): Women who are considered at risk for gestational diabetes are being asked to go for this test. The glucose challenge is performed by giving 1.76 oz of glucose drink and then drawing a blood sample an hour later and measuring the level of blood glucose present. Women with a blood sugar level greater than 140 mg/dl may have gestational diabetes, and require a follow up test called a 3-hour oral glucose tolerance test (OGTT).

According to ADA following values are considered to be abnormal for the OGTT:

· Fasting Blood Glucose Levele”95 mg/dl

· 1 Hour Blood Glucose Levele”180 mg/dl

· 2 Hour Blood Glucose Levele”155 mg/dl

· 3 Hour Blood Glucose Levele”140 mg/dl

Treatment for Gestational Diabetes

Women with gestational diabetes have healthy pregnancies and healthy babies if, they follow a treatment plan from their health care provider. It is required to keep your blood glucose levels in a target range. Each woman should have a specific plan designed just for her needs, so one can follow these general tips to stay healthy with gestational diabetes:

· Know your blood sugar and keep it under control

· Eat a healthy diet

· Get regular, moderate physical activity

· Keep a healthy weight

Women with gestational diabetes should note down their blood sugar level, physical activity and everything she eats and drinks, in a daily record book. This can help track how well the treatment is working and what is to be done further to maintain the normal blood sugar level. Some women with gestational diabetes will also need to take insulin, to help manage their diabetes if blood sugar is shooting up, in spite of all this. The extra insulin can help them lower their blood sugar level.

Diabetes Complications

Once we have crossed the reversible stage of prediabetes and enter diabetes stage, certain changes start developing in our body. These changes occur due to high blood sugar level with instability in the hormones as well as blood vessels and nerves. When these changes become permanent in the body it develops into serious Diabetes Complications and body indicates these changes by steady symptoms.

Symptoms of the Diabetes Complications

· Diabetic retinopathy shows symptoms of pain in the eyes and may even result in loss of vision.

· Renal (kidney) disease shows symptoms of swelling (edema) in the feet and legs. It then passes over total body and as the disease progresses, blood pressure also increases.

· Tingling, burning, numbness, tightness, shooting or stabbing pain in the hands, feet or other parts of your body, especially at night. Digestive problems also occur if, the nerves controlling internal organs get damaged (autonomic neuropathy).

· You may have scanty or profuse sweating, difficulty of sensing when your bladder is full, when there is a low blood sugar, increased sexual problems, weakness, dizziness, and fainting.

· Chest pain (angina) or shortness of breath dizziness or light headache, shoulder or stomach pain, fast heartbeat. You might not show any symptoms until having a heart attack or stroke.

When alarming symptoms given by the body are ignored and the same status is maintained, it starts damaging body organs, such as heart, kidney, eye, feet, and skin. The physiology for each and every affected organ is explained one by one.

Diabetic Retinopathy

Diabetic retinopathy is a type of micro vascular disease in which the micro vessel, supplying blood to the retina of our eye is affected. Retinopathy is related to high blood sugar level and obstructs the flow of oxygen to the cells of the retina. Retina is an ultra thin layer of blood vessel made up of rods and cones. As soon as the retina receives signals of light, it is sent to the brain and a three dimensional figure is formed and identified, this is sent back to the eye by which we can recognize the things around us. The high blood glucose level hinders its working and leaves obstacles in passing light through the retina, thus, leading to improper vision.

The early stage of this disease is called non proliferate diabetic retinopathy. The blurred and distorted vision is because of macular edema. Proliferative diabetic retinopathy is the advanced form of diabetic retinopathy; the new blood vessels break, as they are weak and leak blood into vitreous of the eye, which will lead to floating spots in the eye. The pace of damage is not similar in both the eyes but, both the eyes are affected by this disease. Some times one eye is affected more easily than the other. After some period, the swollen and scar nerve tissue of the retina is totally destroyed and pulls up the entire layer of retina and detaches it from the back of the eye. Retinal detachment is the cause behind blindness among diabetics in middle age. The other two types of eye problems usually seen earlier in the people suffering from diabetes are:

· Cataract :- A thin cloudy layer appears in front of your eye leading to unclear vision. In cataract surgery this thin layer is removed and setting of a plastic layer in front of the lens is done, thus gives you a clear vision again.

· Glaucoma :- Due to high pressure on the optic nerve, it gets damaged. The damaged optic nerve creates disturbance in clear vision. Laser surgery or simple eye drops may help in regaining the normal vision.

A diabetic must go for the regular eye checkup so that the early stages of diabetic retinopathy can be detected and treated in initial stages itself, with less harm to the eyes. Blood sugar levels should also be monitored and maintained to prevent blood vessel damage.

Diabetic Neuropathy

Nerves depend on multiple tiny vessels which carry nutrients and oxygen to keep intact all the segments of these very long nerves. Damage to one small segment can result in loss of feeling, pain or burning sensations that bother the foot and leg.

Feet:- Diabetes can decrease the blood supply to the foot and gradually damages the nerves which carry sensation. A second micro vascular disease is diabetic foot or diabetic peripheral neuropathy or distal symmetric neuropathy. Neuropathy is the common complication of diabetes, and due to high blood sugar, chemical changes occur in the nerves. It always starts in the feet as they are the longest nerves and fed with longest blood vessels of the body. Generally it is seen in the obese people with high blood sugar levels and age more than 40 years. Neuropathy can develop within a span of first few years and it affects approximately 60% of diabetics.

Signs and symptoms of Diabetic Neuropathy

· Decrease or no sweating i.e. dry scaly skin with callus formation.

· Numbness, tingling, and some sort of burning sensation.

· Weakness and loss of reflexes.

· Decrease sensation to the slight change in temperature.

Diabetics need to take care of their feet especially the area between toes, and must not overlook if there is any kind of blisters, ulcer, redness or soreness or formation of callus etc. If any suspicion or doubt arises for the foot then it should be followed by immediate physical examination. The clinical examination will show the sensation in the feet and determine if it is normal or diminished.

Blood flow may be improved with good sources of vitamin E intake along with blood pressure medicine (ACE inhibitors). Although amputations are common with diabetes, about half can be prevented with simple steps that protect the feet.

Diabetes Skin Care

Diabetes affects different body parts of a person including skin. The skin disorders can be seen in normal individual too, but diabetics are more frequently prone to it. Fortunately, most of the skin infections can easily be controlled if detected in early stages. Infection can be bacterial, fungal or simple itching. Some of the specific skin infections frequently seen in the diabetic patients are Dermopathy, Necrobiosis lipoidica, Diabeticorum, Xanthomatosis and Blisters.

Diabetes Skin Infections:

Bacterial infections :- Bacterial infections are more commonly seen in people with diabetes than in normal individuals. Styes - Infection of glands and eyelids, Boils and hair follicles infections, skin and tissue are affected by carbuncles. These infections are spread by few bacterial germs but the most common is Staphylococcus bacteria.

Fungal infections :- Candida-albicans is the yeast-like fungus, responsible for red sore skin with frequent sense of itching and developing into blisters and scales. These patchy infections usually appear at skin folding, where moisture is persisting for longer period, like armpits and groin, under the foreskin, under breast, finger and toes-nail (onychomycosis), in the mouth (thrush), in the vagina etc. Some of the known fungal infections are athlete’s foot, ring worms and jock itch.

Itching :- Itching may result from poor blood circulation, dry skin, or any kind of bacterial and viral infection, mostly observed in lower extremities. Wiping your body till completely dry and using good moisturizing agent are the suggestive steps to manage simple itching.

Diabetic Dermopathy :- Dermopathy shows skin changes occurring in diabetics due to affected blood vessels (i.e. oval to circular), slightly indented dry brown to purple and scaly patches. When zinc doses are administered for several weeks it appears to help the lesions resolve over several months, especially when combined with near normal blood sugars.

Necrobiosis Lipoidica Diabeticorum :- Necrobiosis Lipodica Diabecicorum (NLD) seems similar to dermopathy, but it is more worst than the latter, as it penetrates deeply into the skin, making the spots red with a well defined purple line. See your doctor at right time or else it may crack or break.

Xanthomatosis, Sclerosis and Diabetic blisters :- High blood sugar aggravates these conditions; xanthomatosis is slight yellowish pea like pigmentation in feet, arms, legs, hands, buttocks etc. In sclerosis, skin of toe, forehead, hands becomes thick and waxy, and stiffness in the joints is observed. Sometimes painless diabetic blisters erupt in the fingers, toes, hands, forehands and feet look like burned sores. These are commonly seen in overweight, type 1 diabetic, and revert back to normal as soon as blood sugar is controlled out.

Disseminated Granuloma Annulare :- Sharp well define ring or arc shape raised area of skin is seen, then it is nothing but disseminated granuloma annulare. The common body parts where it can be seen are on the fingers or ears.

Acanthosis nigricans :- This is the condition, in which brown tanned patches appear in different parts of the body like neck, armpits and groin, hands, elbow and knees. This is usually seen in the people with overweight; especially women are more likely to be caught with this.

Allergic Reactions :- Visible allergic reaction in the area of skin is examined when insulin is injected and, it may develop rashes.

Diabetic Nephropathy

Diabetic Nephropathy is a complication in which kidneys are damaged due to persistent high blood sugar level in the blood. It’s one of the common causes of kidney failure world wide, especially in adults.

Kidney functions as a filtering machine in a human body by throwing out the waste in the form of urine. It maintains electrolyte balance, blood pH level and regulates blood pressure, and also releases some of the hormones. When the kidneys start damaging, they fail to carry out these functions with proficiency. Protein molecules along with other bodies which are present in the blood, start appearing in the urine. In the initial phase of nephropathy where damage is not too severe, drugs and diet can control the condition. When protein starts leaking in the urine it is called as microalbuminuria, as the condition starts worsening, large amount of protein is thrown in the urine with heavy losses of protein from the body. Few easily noticed symptoms of kidney failure are fatigue, decreased appetite, nausea and vomiting. It has been observed that about 30 to 40 % of Type I diabetics and 20 to 30 % of Type 2 diabetics, develop moderate to severe kidney failure.

Diabetic Nephropathy can be screened in simple urine test at any diagnostic laboratory. Type 1 diabetic must check nephropathy test in fourth year of diagnosis and Type 2 at the time of diagnosis. It is always better to go for routine tests in the further years. When it shows albuminiuria, modification of diet, regular exercise with some medication for blood pressure control (an ACE inhibitor or angiotension receptor blocker [ARB]) is generally recommended, even if blood pressure is normal. Patients with elevated blood pressures and albuminuria are treated with an ACE inhibitor or ARB. These medications can reduce the percent of protein extraction in the urine and help in slowing down the progression of diabetes, nephropathy and related kidney diseases.

Diabetes myonecrosis may develop before or at the time of diagnosis of diabetes, generally it is a type of gangrene caused by Clostridium bacteria. This bacterium produces toxins, which leads to tissue diabetic mastopathy. It is a condition usually seen in pre-menopausal women suffering from Type 1 diabetes for many years with insulin therapy. Although very rare, it can be seen in men with diabetes as diabetic mastopathy, which is associated with micro-vascular complications such as damage to the eyes, kidneys and heart, or other disorders such as thyroid problem.

Suggestions for preventing Diabetic Nephropathy

· Maintain blood sugar level within normal range.

· Control blood pressure with modifying diet, relaxation techniques, and medication.

· Decrease intake of salt, fast foods, preserved and baked items to maintain blood pressure.

· Decrease animal protein, simple sugars and animal fats in the diet.

· Check urine regularly for microalbumin.

· Take care of bladder or urinary tract infections and treat them early.

Heart Disease and Stroke

It has been observed that people suffering from diabetes tend to have 50% increased heart risks like getting heart diseases or strokes. If you are a diabetic - middle aged person, you may have heart attack earlier than those who are heart patients, more aged than you. Heart complications are “micro vascular disease and “macro vascular disease”. The damage to small blood vessels leads to a microangiopathy.

Coronary artery disease (CAD) is the most common form of heart disease in diabetes. In such a condition, the arteries that supply blood to the heart get narrowed or obstructed due to fatty clots. Plaque is formed out of cholesterol, calcium, and other substances that float in blood and inside the walls of coronary arteries and other arteries. When these small vessels are blocked and start narrowing, it is named as atherosclerosis.

Arteries without Fat Arteries with Fat

A heart attack results when blood flow is completely blocked, usually by a blood clot forming over a plaque that has busted and opened (ruptured).

Heart attack (myocardial infection) causes complete death of the heart muscle cells.

The pain of heart attack is usually combined with other signs such as

· Chest discomfort - it feels like heavy load on the heart, or crushing or squeezing

· Chest pain radiating to jaws, neck, shoulders, or arms

· Sweating

· Nausea and vomiting

· Shortness of breath

· Dizziness with mild to severe headache.

· Irregular and fast heartbeats

· Loss of consciousness

People with Type 2 diabetes often have low HDL cholesterol and raised triglyceride levels, which together increases the risk of atherosclerosis. High blood pressure, smoking, obesity and physical inactivity are also risk factors for CVD. High blood sugar causes changes in the hormones and the cells that can damage your blood vessels or nerves, or both. Damaged blood vessels are more likely to build up plaque, increasing the risk of coronary artery disease, heart attack and stroke. Damage to smaller blood vessels can lead to loss of vision, kidney disease, and nerve problems.

Causes for Heart Disease and Stroke

Heart or large blood vessel disease. These complications sometimes referred as macro vascular disease, which may cause peripheral arterial disease, stroke, or heart attack. PAD (peripheral arterial disease) is a condition which results due to narrowing of the arteries that supply blood to legs, abdomen, pelvis, arms, and neck. It builds up excess cholesterol, calcium, and other substances (plaque) inside the arteries, particularly in the ones which supply oxygen rich blood to legs.

General symptoms of PAD are

· Decreased leg strength, its reduced functioning and poor balance when standing.

· Cold and numb feet or toes.

· Sores that is slow to heal.

· Tight or squeezing pain in the calf, foot, thigh, or buttock

It is suggested to recognize the early stages of heart problems with routine check ups and go ahead with the treatment as early as possible. Medical treatment is needed to prevent further complications and eventually the death. The permanent damages occurring in the heart can be reduced to minimum, if treated early.

Diabetes and Eye

Diabetic retinopathy is a term used for all the abnormalities of the small blood vessels of the retina caused by diabetes, such as weakening of blood vessel walls or leakage from blood vessels.

Steps to avoid eye problems

1. Most important, keep your blood sugar levels under tight control.

2. Bring high blood pressure under control. High blood pressure can worsen the eye problems.

3. Quit smoking.

4. See your eye care professional at least once a year for a dilated eye exam.

5. See your eye care professional if:

· Your vision becomes blurry

· You have trouble reading signs or books

· You see double

· One or both the eyes hurt

· Eyes get red and stay that way

· You see spots or floaters

· Straight lines do not look straight

· You can’t see things at the side as you used to

When to see an eye care professional?

· If you are between 10 and 29 years, and suffering with diabetes for 5 years, you should have an annual dilated eye exam.

· If you are 30 or above, you should have an annual dilated eye exam, no matter how short a time you are diagnosed with diabetes. More frequent exams may be needed if you have diabetes and eye diseases.

· If you have any changes in your vision

· You should have a dilated eye exam if you are pregnant or planning to get pregnant.

Diabetes and Pregnancy

The prevalence of Type-2 diabetes mellitus is higher in women, partly related to obesity. The Type-2 diabetes typically doubles the coronary heart disease risk in men and triples in women.

Diabetes Mellitus in pregnant women poses problems for the mother and the fetus. Women with established diabetes may have menstrual problems and difficulty in conceiving. While, pregnancy itself worsens diabetic control and may cause certain diabetic complications to progress in mother. Maternal diabetes is also hazardous for the fetus and carries an increased risk for fetal loss and major congenital malformations.

However, nowadays most women of child bearing age can realistically expect to become mothers of healthy children with intensive glycemic control. Improvements have ranged from technological advances in fetal surveillance (ultrasound scanning) to home glucose monitoring and intensive insulin regimens, enabling women with multiple diabetic complications to have successful pregnancies.

Diabetes Mellitus in pregnancy is classified into pre-gestational and gestational diabetes; gestational diabetes is defined as diabetes that is discovered during pregnancy. Approximately 7% of all pregnancies are complicated by GDM. Normal pregnancy reduces insulin sensitivity because of diabetogenic effects of placental hormones. This effect is maximal in the late second and third trimester. Gestationaldiabetes resolves after delivery, but may recur in subsequent pregnancies and the lifetime risk for developing Type-2 diabetes is 30%.

Indications for detection of diabetes in pregnant women

· Family history of Diabetes

· Glucose in urine sample

· History of unexplained prenatal loss

· History of large baby

· History of congenitally malformation infant

· Maternal obesity

· Maternal age more than 25 years

· Members of ethnic/racial group with high prevalence of Diabetes Mellitus

To prevent excess spontaneous abortion and congenital malformations in infants of diabetic mothers, diabetes care and education must begin before conception. There are no contraceptive methods that are specifically contraindicated in women with diabetes. The selection of a method should focus on its proven high degrees of effectiveness. Once patient achieves stable sugar control then contraception can be discounted and hence, plan for a pregnancy.

Management during pregnancy

Quit smoking/alcohol

Home blood glucose monitoring

Diet control/Folate supplementation

Regular exercise

Fetal monitoring by ultrasound scan

Accurate insulin regimen.

(to be continued…..)

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Diabetes