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What are the precautions that diabetics
should take during illness?
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I am
diabetics for 5 years & my weight is 105 kg. My doctor has advised me
diet. If I follow diet advice, I feel hungry and want to eat more. If
I do not follow the advice, my sugar levels are going high. What
should I do?
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My
father had serious diabetic foot problem & had to amputate his left
leg. Unfortunately he died after 3 years of the amputation. Now, I
have been diagnosed with diabetes. What precautions should I take to
prevent leg problem?
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I am
a diabetic for last 4 years have been treated by my physician for the
same. But my medication is increasing day by day, which makes me
worried. How can I reduce medication?
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How
can a diabetic remain an active sportsman?
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Why
do diabetics need to take good care of their feet?
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My
age is 54 & I have diabetes for 12 years. My doctor has advised me a
special test called HbA1c. What is the HbA1c test?
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Can diabetics observe fast?
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How
can yoga helps my diabetes?
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What are the factors that increase blood sugar level?
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What kind of exercise can a diabetic do?
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Is
it better for a diabetic to spread his meals so that the same intake
can be taken slowly?
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What precautions do diabetics need to take to prevent hypoglycemia?
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What precautions do diabetics need to take during long hours of
travel?
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What is the accuracy of blood sugar testing machines available these
days? Is there still need to go to a lab to get your blood sugar
levels tested?
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Which fruits are okay for diabetics to eat? (Which are the fruits that
diabetes can have)
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My
10 year son is type 1 diabetic, goes to a good school in Ahmedabad.
What kind of precaution a teacher can take to avoid any complications
in school.
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My
age is 35 years. My both parents are diabetic. How can I prevent
diabetes?
During illness, it is usual with diabetics to reduce or
stop eating and the medicines. In fact, even if he does not take the
food, his Blood Glucose (BG) level increases. In turn tablets/insulin
doses are be adjusted. Failing it, may develop ketones in the blood
which may lead to serious condition like ketoacedosis & coma. To avoid
the condition, as far as possible, try to eat food at every 2-3 hours
interval. if you are unable to take regular food, drink plenty of
liquids like water, fruit juice, buttermilk, limewater, skimmed milk,
soup without cream, soda etc. If drinking liquid is not possible,
consult doctor. Don't stop the medicine/insulin. The dose may be reduced
if needed. Those only on tablets may require insulin during illness.
Investigate for the cause of the illness and take the appropriate
treatment. Take rest and keep the body warm. Monitor urine & blood sugar
at every 6 hours. If urine sugar is high or the BG level is more than
250 mg%, check the urine for acetone. Change the tablets/insulin dose as
per the report and doctor's advice. It is advisable to keep one person
at home to assist you.
It is
important to remember that if your BG level is more than 300mg%, you
can't eat for two days, you are vomiting for two days, your illness is
prolonged for more than two days and you develop high grade fever,
consult diabetologist immediately.
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Following proper diet is an essential part of the
diabetic management. With the help of diet planned by an expert along
with modified life style, nearly 30% of people with diabetes can be
controlled without medication, in remaining 70%, dose of medication can
be reduced by 30-40%.
If
you feel hungry after eating your permissible quota, you may have foods
which are low in calories. These are called “Free Foods” like salads
i.e. cucumber, cabbage, lettuce, onion, tomato, capsicum, radish etc.
plain tea or coffee without sugar, lemon juice without sugar, clear
soups without seasoning, rasam,
butter milk, skimmed milk. Free foods can be taken over and above your
permitted diet.
Another
cause of feeling hungry is delayed or missed meal leading to low blood
sugar level and excessive hunger. Therefore diabetics should consume
frequent (five to six) small meals spread over the day.
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You have rightly observed - 50 per cent of amputees
either die or lose another leg within three years of amputation.
Diabetic
foot problems are caused due to neuropathy (nerve damage), biomechanical
abnormalities (frequently a consequence of neuropathy, leading to
abnormal plantar foot pressure), reduced blood circulation to the lower
limb and super-added infection.
To
prevent
foot problems, control your diabetes very
meticulously. Achieve and maintain HbA1c (indicates BG control over last
90 days) level below 7%. Stop smoking & consumption of alcohol.
You
should inspect your feet every day, if needed use a mirror or ask your
family members or friends to assist. Report to foot care specialist
(Podiatrist), if there is hard skin, corns, colour change, ulcer, breaks
in the skin or infection. Keep feet clean with luke warm water & soap.
If skin is very dry - use cream, if humid - use powder. File your nail
instead of cutting. Wear soft, comfortable & well fitting shoes. Wear
new shoes just for half an hour in the beginning. Inspect your shoes
regularly for crack or foreign body. Use proper sized cotton socks &
change it daily. Walk regularly to improve blood circulation.
It is
important to avoid walking barefoot. Do not apply nail polish and
mehndi over toes. Do not use strong astringent lotions and corn
cures. Save your foot from extremes of temperature (hot or cold). Avoid
bathroom surgery.
With advances in the technology and
yearly foot check-ups by foot care specialist, diabetic foot problems
can be detected at an early stage. Diabetic having foot problems, if
they take good care of their feet, nearly 80% of foot ulcers & 90% of
lower limb amputations can be prevented.
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With better understanding of the disease & advances in
the management, better quality of life can be achieved with minimum
medication.
Life
style modification is essential for the successful management of
diabetes.About 30 percent of diabetics can control the disease without
medication if they follow diet
planned
by an expert, performing exercise/Yoga for at least 20-30 minutes –
minimum 4 days a week, maintaining ideal body weight and living stress
free life. In remaining 70%, dose of medication can be reduced by
30-40%.
Rise in
the blood glucose (BG) level in diabetes may be due to insulin
deficiency, insulin resistance or varied combination of both. With the
help of basic physical examination and primary investigations, a
diabetologist can diagnose the defect in the disease. Administering
appropriate therapy for the defect will control diabetes with minimum
medication.
It is
advisable to monitor BG levels through out the day (before & 2 hours
after each major meals, occasionally 3 am) & correcting major swings in
the BG levels with appropriate adjustment in the therapy, will reduce
medications.
Look for
other conditions responsible for elevation in BG levels like some
medical conditions, certain drugs, stress etc. Correction of these
conditions will reduce medications.
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Preparing the individual
with diabetes for a safe and enjoyable exercise program is as
important as exercise itself. Before initiating an exercise program, one
should see doctor for a physical examination. The checkup will help
ensure that the exercise program will not increase the risk for diabetes
complication. For example diabetic eye disease could become more severe
by exercise that involves jumping or jogging.
In a sports person with diabetes
especially Type 1 diabetes, blood glucose (BG) levels can fluctuate
considerably during exercise. For the best performance and safety BG
should be between 100 and 150 mg/dl during exercise.
Everyone’s BG response to exercise is
different. Checking BG before and after exercise can show one’s BG
response to exercise. One can use the results of BG checks to prevent
low BG or high BG. The excitement of a competitive event can cause the
BG to spike due to hormonal activity in the body. Anaerobic or strenuous
exercise (e.g. sprinting, weight lifting) can raise the BG. If BG is
high before exercise, physical activity can make it go even higher. It
is best to avoid exercise if fasting BG levels are >250 mg/dl and
ketosis is present, and use caution if glucose levels are >300
mg/dl and no ketosis is present. It is advisable to keep track of
the progress. One may find it motivating to write down physical
activity done on each day.
During activity, if you notice symptoms
such as hunger, nervousness, shakiness, or sweating (symptoms suggestive
of low BG), check BG. Low BG is most likely after exercising for a long
time, strenuous exercise or skipping a meal. Unless you are exercising
for an hour or more, you probably will not need to eat anything during
or after your exercise session. Learn how to avoid low BG
(hypoglycemia). Keep in mind that low BG can occur during or long after
physical activity. If low BG is interfering with exercise routine,
eating a snack before exercise or adjusting medication may help. If you
do need a snack, prefer fast acting carbohydrate like fruits or yogurt.
While exercising, carry hard candy, such as mints, in case BG drops too
low.
Carry
identification such as a medical ID (Hypoglycemia card) displaying your
photo, name, address & contact number as well as name & contact number
of the treating doctor. The card must mention the instruction to tackle
hypoglycemia.
Stay well hydrated especially when you
are out in the sun. Exercise can cause significant fluid loss.
Whether the sport is cricket, tennis,
marathon-running, swimming, martial arts or rugby, the fear every young
person raises after being diagnosed with diabetes is whether they will
be able to carry on competing. Until recently, the outlook wasn't good,
they could continue to enjoy sport but they could hardly expect to be
record-breakers and award-winners.
Now a day, with advances in the management strategies, we do not treat
diabetics in "sickness mode", but treat them in the manner in which the
best sportsmen in their particular field eat, train and exercise.
Monitoring BG levels seven or eight times a day, evaluating food intake
and adjusting medication one can dominate sport at the very highest
level. During my recent visit to abroad, I met Mr. Steve Redgrave & Mr.
Will Cross. Mr. Steve Redgrave had won five consecutive Olympic gold
medals (20 years) in rowing despite having diabetes. Mr. Will Cross had
gone to one of the most difficult tours to North Pole & was planning to
go to South Pole.
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It is said that prevention is always better than cure
because treatment is costly and many times ineffective.
Diabetic
foot problems are caused due to neuropathy (nerve damage), biomechanical
abnormalities (frequently a consequence of neuropathy, leading to
abnormal plantar foot pressure), reduced blood circulation to the lower
limb and super-added infection. Barefoot walking, inappropriate
footwear-Hawaii slippers,
lack of
awareness in patients, home surgery etc can cause or worsen diabetic
foot problems.
As we
all know, India has nearly 30 million diabetic patients and thus
60million feet are at potential risk. 25% diabetics develop foot ulcers
in their lifetime. Diabetic foot is the commonest indication for
hospitalisation & requires longest hospital stay. Risk of gangrene is 20
times higher as compared to non-diabetics. It is responsible for more
than half of non-traumatic lower limb amputations. 40,000 lower limb
amputations are known to occur in India every year. 85% of the lower
extremity amputations are preceded by trivial foot ulcer. Amputating
limb is not the end of the story. After amputation, within 3 years, 50%
of amputees either die or loose another leg. Not only that, treatment of
diabetic foot lesions is
costly…
& majority of Indians are not medically insured.
With better understanding of the disease
& advances in the technology, diabetic foot problems can be detected at
an early stage. Diabetic having foot problems, if they take good care of
their feet, nearly 80% of foot ulcers & 90% of lower limb amputations
can be prevented.
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The HbA1c test is a
laboratory test, which indicates blood glucose control over last 90
days. HbA1C is formed when glucose in the blood binds irreversibly to
hemoglobin to form a stable glycated hemoglobin complex. Since it is
irreversible, it stays through out the life span of red blood cells i.e.
90-120 days. Therefore HbA1c testing serves as a reliable indicator of
overall glucose control of previous 90 days.
Monitoring HbA1C allows doctor to assess
long-term compliance with management protocols, such as diet, exercise
and medication. The test shows whether the blood glucose is close to
normal or too high. An HbA1c test result between 4 to 6 % is considered
normal. HbA1C value less than 7% in a diabetic means blood glucose is
under control. A change in a treatment plan is almost always needed if
the test result is over 8%. Studies conducted in people with diabetes
have shown that lower the HbA1c number, greater the chance of staying
healthy & will slow or prevent the development of serious eye, kidney
and nerve disease.
People with diabetes should get the HbA1C
test at least two times a year if their blood glucose is in the target
range and stable. If they are taking insulin, if their treatment changes
or if their blood glucose stays too high, they should get the HbA1C test
at least every 3 months until their blood glucose level improves.
It is
important to note that HbA1c testing is not considered as replacement of
blood glucose testing. The blood glucose test is a real-time measurement
of glucose, while the HbA1C test value gives an idea of average blood
glucose levels over preceding 90 days.
When interpreting the test one should
keep in mind that results differ depending on the test method used.
Some labs measure hemoglobin A1 (which is different from hemoglobin
A1c).
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Diabetic person should
avoid fasting. It is important to note that in a human being all vital
organs like heart, brain, kidney, lungs etc. are working constantly &
they require energy to work. For the proper supply & utilization of
energy, diabetics must take routine diet and medicines regularly.
If they don't take food and medicines
on time, it may lead to major swings in blood sugar levels (low as well
as high) and coma. There fore, fasting is not advisable.
But if it becomes unavoidable to observe
fast, take tea/milk, fruits, buttermilk, etc. as per the advice of
dietician. Moreover, take vegetables made of cucumber, tomato, carrot or
bottle gourd; “Rajagra Bhakhri, Moraiya Khichdi, Sabudana Khichdi”
equal to your usual food. Consult doctor regarding the medication and
their dosages during this period.
In the
month of Ramzan, Muslims are taking meal at night instead of day,
so they can take morning dose of medication at night and night dose of
medication at early morning.
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The science of yoga is an ancient one. It is a rich
heritage of Indian culture. Yoga is not merely a few postures (Asanas),
but a holistic approach towards life.
Yoga life style consists of physical, mental emotional and spiritual
well being. One cannot imagine benefits of yoga
without performing it.
Yoga
increases insulin sensitivity and decreases plasma cortisol (counter
regulatory hormone) level & normalizes glucose as well as lipids in the
blood.
By eliminating of stress, yoga normalizes
blood pressure. Person will remain cheerful & will try to keep others
cheerful.
Yoga
increases working capacity & exercise tolerance. Moreover increases
vital capacity of the lungs, boost up defense system of the body against
infections & decreases body fat and increases muscle mass.
By
performing yoga regularly, 30% of people with diabetes can control their
diabetes without any medicine and in remaining 70%, the dose of
medicines (tablets as well as insulin injections) can be reduced by
30-40%.
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In addition to food, (aspects like) mental
tension, fear, anxiety, emotional upsets, death in family etc. have been
known to increase the levels of blood sugar. Even a small infection like
a sore throat or a boil on the skin can cause dramatic increase in the
blood sugar levels. Moreover certain medicines, pregnancy, surgery and
certain unrelated diseases could all worsen existing diabetes or unmask
hidden diabetes.
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Like any non-diabetic, a diabetic without
complication, can do any exercise. It is advisable to perform aerobic
exercise like brisk walking. Other aerobics like jogging, bicycling,
swimming, gardening, dancing etc are also great ways to get some
exercise. Flexibility exercises, also called stretching, help to keep
joints flexible and reduce chances of injury during other activities.
Children
& younger people can play outdoor games like Cricket, Badminton, Tennis,
and Football.
For
diabetics having arthritis, heart disease, obesity, old age, and
corn/calluses on the feet walking may be difficult. For them, upper
body exercise involving more of upper limb and trunk is advisable.
They can also undertake non-weight bearing exercise of the lower limbs.
Those
who cannot spare time for exercise; there are many opportunities to be
active throughout the day like walk
instead of drive whenever possible, take the stairs instead of the
elevator, work in the garden or do some housecleaning every day, park
the vehicle at the far end of the shopping center lot and walk to the
store.
Choose
an activity that you enjoy and that is convenient for you, so that you
will more likely to stay with your exercise program.
It is
important to note that before initiating exercise program, diabetes
should be well under control.
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Instead of taking two2-3 major meals, diabetics should
consume five to six small meals spread (over) through out the
day. Big
heavy meals mean big changes in blood sugar
levels. Small meals will avoid major swings in blood sugar levels, which
will help in controlling diabetes with minimum medicine. By avoiding ups
& downs of blood sugars in day-to-day life, one can live an additional
15 years life free of diabetic complication and can extend life for more
than 5 years.
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Diabetes treatment plan is designed to match
medication dosage and schedule of usual meals and activities. Any
mismatch (skipping meal, unusual exercise, change in dose/ timing of
medication etc.) might result in hypoglycemia. Hypoglycemia can be
avoided by with the proper understanding and knowledge of diabetes,Some
medications can cause hypoglycemia.
Always
take medications and insulin in the recommended doses and at the
recommended times.
Consult
dietitian to plan meal that fits your preferences and lifestyle. Make a
positive effort to follow the meal plan. Eat regular meals, have enough
food at each meal, and try not to skip meals or snacks.
Discuss
with your doctor about whether you should have a snack or adjust your
medication before sports or exercise. If you know that you will be more
active than usual or will be doing something that is not part of your
normal routine—unaccustomed exercise—considers having a snack
first.Consuming alcohol especially on an empty stomach, can cause
hypoglycemia. If you drink an alcoholic beverage, always have snack or
meal along with it.
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While traveling do not remain hungry, drink plenty of
liquid and avoid drinks with sugar content.
If you
are traveling by train or road, there is possibility of you reaching
your destination late. So always carry some diabetic food (home made
breads, fruits, sugar free biscuits etc) along with you. Remember to
carry enough stock of your medicines.
The
Co-traveler should be aware about symptoms of low blood sugar levels
(excessive hunger, tiredness, perspiration, palpitation, cold
extremities, headache, blurred vision, slurred speech etc)
If you
are driving the car, low sugar level might prove dangerous. Take small
frequent meal.
If you
are traveling alone, always keep hypoglycemia card with you, displaying
your photo, name, address & contact number as well as name & contact
number of the treating doctor, name of medicines which you are taking,
doses, and instructions about what to do if your sugar level drops.
While
traveling by air At the time of booking tickets, insist for diabetes-meals.Keep
the insulin and syringe in your hand bag/purse. If you are going abroad
Please keep doctor's prescription stating the details of your medicines,
insulin, blood sugar testing machines, its stripes etc. with you. It
will help you to clear the "custom". This will also be helpful, in case
you need any advice from a doctor abroad.
If you
are going by "package tour", inform the tour operator about your food
preference..
If you
take over seas insurance, you may not get cover for diabetes. So inquire
whether you will get any emergency treatment or not.
Discuss
with your doctor what would be the effects of passing "time zone" and
change timing of your diet and medicine accordingly.
Perform
blood sugar testing at a regular interval. If you are ill then do it
more frequently.
While
taking sunbath, drink lot of water to avoid dehydration.
If
possible, learn some sentences of local language. For example
“ I have diabetes, please call the doctor immediately”.
“Please, give me water containing sugar”.
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A: Good quality machines are accurate & precise.If
instruction given in sugar testing machine followed properly there
should not be any problem. As there are many differences in the methods
of testing (e.g. machines uses capillary whole blood & estimate blood
glucose whereas laboratory uses venous blood for plasma glucose
estimation), one should not compare accuracy & efficacy of machines with
laboratory.
Machine
detects ups & downs of blood sugars at an early stage. It is the only
way to know how the body responds to changes in diet, exercise, tablets
& insulin and will help in adjusting the therapy to achieve specific
blood sugar goals. It is the only method of diagnosing hypoglycemia (low
sugar) at the precise time of its occurrence. It will also help in
identifying insulin doses during intercurrent illness.
It is
important to know that g
ood
machines still have a margin of error of at least 10%. Precision &
accuracy of machines need to be assessed periodically to guarantee the
quality of data with quality - control solution. Laboratory testing is
good for finer control.
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All seasonal fruits when taken in proper amount are
beneficial to people with diabetes. Fruits contain sugar in the form of
fructose. Unlike glucose, fructose doesn’t require insulin for
metabolism. Fruits are rich source vitamin C & potassium. Moreover they
Contains vitamins & minerals. They have high content of fibers as well
as water, which gives feeling of satiety very early & at a low calorie
intake. Consumption of fruit along with skin is advisable. Fruits like
mango, sapota (chiku), banana, custard apple etc. are rich in sugar &
can be taken in limited quantity when diabetes is well under good
control.
Avoid
preserved, processed & canned fruits.
It is
advisable to avoid fruit juice as it may increase blood sugar levels. It
can only be taken during illness, replacing the regular meal.
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Main objective is to avoid swings in blood sugar
levels (low as well as high) during school time. Teacher should see that
your son takes his food and insulin/medicine on time. He should not eat
food from his friend’s box.. Teacher should be trained for handling
hypoglycemic (low sugar) emergency. He/She should be aware about
symptoms of hypoglycemia (excessive hunger, tiredness, perspiration,
palpitation, cold extremities, headache, blurred vision, slurred speech
etc). During the episode any available sweet (sugar, glucose,
peppermint, biscuit etc) should be given. Preferably a box containing
sweets kept handy. Your son should always carry a hypoglycemia card
displaying the photo, name, address & contact number of your son as well
as name & contact number of the treating doctor. The card must mention
the instruction to tackle hypoglycemia, if your son found unconscious.
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You are genetically
prone to develop diabetes. The genetic component cannot be corrected but
by modifying environmental factors you can prevent/delay the onset of
diabetes. By following healthy life style environmental factors can be
modified. Take diet containing more of fibers, full of vitamins &
minerals and restrict intake of visible fat up to 15-20 ml per day.
Perform exercise regularly, preferably aerobics. If you are medically
fit, play outdoor games. Yoga (Flexibilities, Asanas & Pranayams) will
help you a lot. Try to maintain ideal body weight. If you are
overweight, reduce weight by at least 5%. Studies have shown that
available drugs are not effective in preventing diabetes. Make an honest
effort you will definitely succeed. Good luck.
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