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Feb - Mar 16

Editor
Dr A G Unnikrishnan

Publisher
W P Vasandani
MISSION
Editorial Consultants to spread awareness and knowledge of diabetes
Dr M K Mandal
Mr Vandan Agarwal and its consequences throughout India
Dr Imtiaz Hasan
Dr Rajesh Javherani
Dr Vedavati Purandare
to motivate the population to take
Dr Anjali Bhatt
Dr Manish Bothale
Dr Abhijit Joshi
preventive measures
Dr Shalbha Tiwari
Dr D Devi Pratyush
Dr Ashok Gavande to empower all those affected
Foot Care Specialist:
K V Kavitha to participate in their own
Diet & Nutrition:
Gauri Kukade
healthcare management
Priya Chaudhari
Fitness & Lifestyle:
Gouri Choundikar PT

Assistant Editor
Printed and published by W P Vasandani on behalf of Chellaram
Sunila Kelkar
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Sub Editor
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Reproduction of content, in part or whole is prohibited.
Designer
This magazine provides general news, opinions, information and tips for
Milind Joshi
health and well-being pertaining to Diabetes. It is advisable to consult with
a practicing physician before making any changes to your healthcare
Contacts: routine. The views expressed in the articles are of the authors, and not of
Editorial : the Publisher. No representation is made or warranty given (either
Sunila Kelkar expressed or implied) as to the completeness or accuracy of the
editorial@diabeteshealth.co.in / 020 6683 9777 Ext: 714 information contained. Readers should verify the information and
wherever necessary consult with their doctor before they act on it. Diabetes
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magazine.
Send your stories, questions, opinions
and suggestion to editorial@diabeteshealth.co.in

efforts in promoting a positive message and


Happy reader encouraging people not to be shy about their
I was very happy to read the latest condition. The interviews of people with
issue of Diabetes Health and could Diabetes are always inspiring to read. I wish the
relate to some of the articles entire team of Diabetes Health all the very best
mentioned in the magazine. I and look forward to reading your upcoming
enjoyed reading the article on issues.
Fitbit as the entire idea of Akshaya Chandra, Chennai
wearable devices and
managing your physical
activities was new to me.
Love for food
Overall the magazine was really I love reading the recipes and I personally feel
interesting and I can't wait to read the next that eating healthy and controlling your portion
issue. size is of utmost importance in people with
Shailja Parmar, Patna Diabetes. I always look forward to reading the
recipes and try to incorporate healthy food in
our daily diet. Also, the best part is that people
Spreading awareness with Diabetes have so many options to choose
I was really impressed with the last issue as it from that they can create their own meals and
explored the basics of kidney disease, make them interesting to eat. I do wish people
something which most of us tend to ignore. would take some efforts in eating healthy so
Very rarely do we pay attention to the related thathalf of their problems will be solved.
complications of Diabetes. I'm also very happy Amrita Bharwani, Delhi NCR
that your magazine has been making constant
The Great Illusionist
There is a story of a farmer, who lived in a little hut. In the corner
of the verandah of his hut lay a piece of rope. The farmer
couldn't remember when he had placed the rope there. It always
had been there, that scrawny looking piece of rope, blackened,
no doubt by years of dust and dirt.
One day, the farmer wanted a piece of rope to tie some wooden
sticks together. Remembering the rope lying on the verandah,
he went towards the rope and pulled it. It uncoiled, and woke up
with a hiss, baring its fangs. It was a snake, not a rope!
Friends, this is a story based on the classic fable narrated by the
great Advaita philosopher Adi Sankaracharya, to illustrate the tricks
that the mind can play. The world is, therefore, illusory, and the
mind is a great illusionist. Thanks to the mind, a snake can become a rope and the rope can
become a snake! As one thinks, so it is.
In medicine too, such examples abound. Take the case of cholesterol, and articles that question it as
a risk factor for heart attacks. In recent times, in print and social media, there has been a plethora of
articles that attempt to pass cholesterol off as a benign rope, and which also criticise doctors for
likening cholesterol to a dangerous snake. Moreover, these articles criticise medications called
statins, which lower the cholesterol. The truth, as always, is somewhere in between.
Let us look at the fats - sorry, the facts. Cholesterol, a type of fat, is actually a particle. There are
good cholesterols and bad cholesterols. HDL is a good cholesterol, and LDL is a bad cholesterol
particle. Studies have shown that lowering the LDL cholesterol levels with a drug called statin can
reduce one-fourth of heart attack-related deaths! Yes, statins have side effects - they cause
muscle pains and increase blood glucose too. But a heart attack is no holiday either! Statins
provide more benefit than risk, and are therefore prescribed by doctors.
Much as people like to believe that there is an international conspiracy by industries that
manufacture statins, statins have an impressive backup of scientific literature. Interestingly, the
increase in clamour against statins seems to co-incide with the imminent launch of newer, non-
statin drugs, which are newer and expensive medications that lower the LDL cholesterol even
better. But for once, dear reader, let us look at simple facts - statins, which lower the
cholesterol, seem to be inexpensive options for preventing heart attacks. If your doctor
prescribes them, do not stop or change them on your own. Discuss the benefits and risks
of any medication before choosing to be on them.
In this issue's cover story, we unfold the saga of cholesterol. Understanding the science of
cholesterol can dispel the mind's illusion, and lead us to the truth about the lipid profile test.
About what is fat and what is fiction.
Read on, to get your fats right!

Dr A G Unnikrishnan
Editor

FEB-MAR 16 DIABETES HEALTH 03


COVER STORY
Lipids: Facts and Fats
12 All about lipids
The good and bad cholesterol
24 Statin therapy: boon or bane?
A much needed choice

DIABETES CARE
Managing Diabetes in your day-to-day life...
42 Medications that raise blood glucose
Medicines too can raise blood glucose levels
54 Total knee replacement and Diabetes
All you need to know about knee replacement
surgeries

DIAB-E-TECH
A special column detailing the latest technology to
EDUCATION improve fitness

Because knowledge is your best ally in dealing with 66 Foot scan


Diabetes An essential test to diagnose foot problems
28 Metformin demystified!
The wonder drug for people with Diabetes
48 Dealing with Diabetes stigma
Coming to terms with the diagnosis

PEOPLE
Coming to terms with your diagnosis
32 Life is God's gift
Strength and determination is all it takes

04 DIABETES HEALTH FEB-MAR 16


NUTRITION
Eat smart, eat healthy and enjoy life!
38 The king of fruits
The forgotten goodness of mangoes

Recipes
70 Melon soup and parmesan chips
71 Poached apple, vanilla yoghurt, sugar-free
granola
72 Pottage of vegetable, poached egg, sour
6 News
cream, herbs
The latest updates from the world of Diabetes
73 Sugarfree Sitafal Kulfi
36 Testing Room - Urine routine test
74 Garlic chicken
Know your tests and their implications
75 Non-veg Dolma
47 Medicine Cabinet - Rosuvastatin
Our new feature keeps you updated on your meds
65 Ask Diabetes Health
Our experts answer your queries on Diabetes
76 Answers to Diabetes Health Quiz
Answers to the Dec'15-Jan'16 Diabetes Health Quiz
and the lucky winners
78 Health Predictions
What's on the cards for the coming months?
80 Health Bytes
People share their fitness mantra

e e D ia b e tes Health
Win fr nd T-shirts
!
FITNESS subs c r ip t io n a
Staying active is one of the essential mantras to good
glycaemic control
58 Changing your exercise routine
Cause muscle training helps control blood glucose

REGULAR
27
2 Diabetes Health Forum y o u r D ia b e te s Story - Page
Share
b e te s H e a lt h Quiz - Page 69
Letters from Diabetes Health readers The Dia

FEB-MAR 16 DIABETES HEALTH 05


NEWS

Weight loss pill


In double thoughts over bariatric surgery! If you thought that surgery was
the only way to lose oodles of weight then think again. The Elipse
device is a new generation
of gastric balloons that
aims at helping the obese
lose weight and improves
health related conditions
without undergoing an
invasive and permanent
replumbing of the digestive
system. Moreover, the gastric
balloon is swallowed like a pill
tethered to a tiny catheter.
Once in the stomach the
capsule dissolves, revealing a
gastric balloon that is ready
to be filled with sterile fluid
through the catheter. It fills up
roughly to the size of a
grapefruit and nestles in the
stomach for four months.
The balloon creates a sensation of fullness and helps a patient eat less
and develop habits of portion control. After four months, the balloon is
emptied and passed from the body through stools.

This device was assessed in 34 overweight and obese subjects who lost
an average of 22 pounds after four months - roughly 37 per cent of their
excess weight. Moreover, there was an improvement in their triglycerides
and hemoglobin A1C levels - a key measure of metabolic function. This
was a very preliminary research and the study needs to be carried out on
a larger scale to assess the effectiveness of such a device. In addition,
though it is a better option than undergoing surgery it is yet to be
approved by the FDA.

Source: The research was presented at


Obesity Week - a joint annual meeting of the Obesity Society and
the American Society for Metabolic & Bariatric Surgery.

06 DIABETES HEALTH FEB-MAR 16


NEWS

Stubborn belly
If you have central obesity (apple
shaped body) and your body mass
index (BMI) says that you are barely
overweight, then having a lax attitude
won't help. A recent study published
in the Annals of Internal Medicine
studied the risks that come with
having an apple-shaped body. It also
showed that having an apple-shaped
body increased the risk of early
death, particularly from heart
disease. Moreover, those with wider
hips (pear-shaped body) were less
likely to die prematurely than those
with similar BMI who were
apple-shaped.

A population of 15,184 adults (age


18-90) had their BMI and waist to hip
ratio calculated. They were followed
up with for 15 years to see how many
died of any cause. It was observed
that men and women who were
considered obese were more likely to
die during the follow-up period than
those defined as normal weight and
overweight. In every group the waist
to hip ratio trumped BMI as a
predictor of risk of death. While being
obese as defined by BMI increases
the risk of heart diseases, Diabetes
and cancer, it is not a convenient way
to gauge overall fitness. Moreover, it
is not the best predictor of health
risks that come with carrying excess
fat.

Source: Annals of Internal Medicine

FEB-MAR 16 DIABETES HEALTH 07


NEWS

High intensity exercise


Exercise is known to benefit people with Diabetes. Researchers are now
studying the effect of high intensity exercise, which involves short bursts of
high intensity workouts. A recent study presented to the American Diabetes
Association showed that short sessions of high-intensity exercise may
provide more health benefits for people with Type 2 Diabetes than
longer bouts of less intense activity. The research included 76 adults
recently diagnosed with Type 2 Diabetes. Their average age was 67. They
were randomly assigned to do either one 30-minute exercise session five
days a week at 65 percent of their target heart rate (low-intensity group), or
three 10-minute workouts a day, five days a week, at 85 percent of their
target heart rate (high-intensity group).

The participants were


assessed three months
later. It was observed that
compared to those in the
lower-intensity group,
those in the high-intensity
group did more exercise
and had larger decreases
in cholesterol and blood
sugar levels, lost more
weight, and showed
greater improvements in
heart health. Also, the
patients in the high-
intensity group showed a
more than
two-fold greater decrease
in haemoglobin A1C levels.
Moreover, it was noted that
the participants could fit in
high-intensity exercise into their schedules, making them more consistent
with their exercise regime. As a result, they ended up working out more each
week. However, a bigger study is required to validate this finding. The silver
lining is that burst exercise may become viable alternative to low intensity
sustained exercise for Diabetes rehabilitation.
Source: American Heart Association, news release

08 DIABETES HEALTH FEB-MAR 16


NEWS

Novel insulin pill


Diabetes is a metabolic disorder in which the blood sugar levels are
high either because insulin production is inadequate, or because the
body's cells do not respond properly to insulin, or both. Some
people need to take insulin injections to manage their blood sugar
levels. But those who fear
needles, taking injections
can pose a huge barrier to
compliance. This in turn
can lead to
mismanagement of
treatment and
complications that can lead
to hospitalizations.

While oral medications do


assist the body with insulin
production, a pill that
delivers insulin remains a
highly sought goal of
Diabetes medicine. The
main obstacle is getting the
medication past the hostile
proteolytic environment of
the stomach and intestine
without destroying the protein itself. But researchers have now
developed an oral insulin pill that has the ability to survive the
harmful attack of the stomach acids and delivers the payload to
the small intestine. The pill opens up to release patches that
adhere to the intestinal wall, preventing access of proteolytic
enzymes to insulin and, with the aid of a permeation enhancer,
depositing insulin that can pass through to the blood.

The pill is in its preliminary stage of development. Like any other


novel therapy it must undergo additional stages of testing and
improvement before it can be considered as a viable treatment for
Diabetes. But if all goes according to plan then insulin pill will
provide respite to millions of people who fear injections.

Source: American Chemical Society Journal

FEB-MAR 16 DIABETES HEALTH 09


NEWS

Closed loop system


The artificial beta cell or closed-loop insulin delivery system expands on the
concept of sensor responsive insulin delivery. The closed-loop system differs
from conventional pump therapy as the
former uses a control algorithm that
autonomously and continually
increases and decreases the
subcutaneous delivery of insulin on the
basis of real-time sensor glucose levels.
There have been extensive studies in a
controlled laboratory setting of a
closed system; however, the real
challenge sets in when the same device
is used by patients at home.

A study published in the New England


Journal of Medicine compared closed-
loop insulin delivery with sensor-
augmented pump therapy in 58
patients with Type 1 Diabetes. The
closed-loop system was used day and
night by 33 adults and overnight by 25
children and adolescents. Participants
used the closed loop system for a 12-
week period and sensor-augmented
pump therapy (control) for a similar
period.

At the end of the study it was observed


that the closed-loop system, as
compared with sensor-augmented
pump therapy, improved glucose
control, reduced hypoglycemia, and,
in adults, resulted in a lower glycated haemoglobin level. Hence the
extended use of a closed-loop system at home over a period of 12 weeks
without close supervision is feasible in adults, children and adolescents with
Type 1 Diabetes.

Source: New England Journal of Medicine

10 DIABETES HEALTH FEB-MAR 16


All about
Lipids
COVER STORY

The story of Mr Raj


Mr Raj was a 45 year old businessman who
had Diabetes for the past 4 years. Oral
medication helped Mr Raj control his
Diabetes. Recently when his cholesterol
levels were monitored, his doctor told him
that his LDL cholesterol levels were high and
that he needed to take medication.
Additionally, the doctor also mentioned that
as per current guidelines all people with
Diabetes who were over 40 years of age
needed to take a medication called statin. Mr
Raj researched this diagnosis on the Internet
and found that there was this huge
conspiracy theory that high cholesterol was
being over diagnosed and over treated. And
that there was no benefit of lowering
cholesterol, no need to take statin - and
probably, no point in detecting heart disease
too!
Mr Raj was thoroughly confused. Let us try
to help him! Absence of
enough HDL will
First the reason cause fat
Non-communicable diseases (NCDs) are the deposits in
most commonly found, among which blood vessels,
Diabetes and heart attacks are set to
become the major killer of the next century.
leading to heart
attacks.
Consider these facts -
Every six seconds, a person dies of
Diabetes.
Heart disease-related deaths are the most
Dr Vedavati Purandare common cause of Diabetes-related
deaths.
explains how your body From these two facts alone, it is evident that
needs cholesterol to the problem of heart disease in the general
population and especially in people with
function, but excess of it Diabetes is a health problem that needs a
solution.
can also cause serious
trouble.
FEB-MAR 16 DIABETES HEALTH 13
Therefore heart disease could be described
Now, the basics by many terms -
Heart disease is a general term. Actually the Coronary Artery Disease
scientific term is atherosclerotic
cardiovascular Ischaemic Heart Disease
disease (ASCVD). Atherosclerotic Cardiovascular Disease
This term refers to a
Or simply, for convenience we will call it
condition where
"heart disease".
blood vessels are
blocked by rich Heart attack is a term used to describe a
deposits. The heart condition when the coronary artery is
pumps blood to blocked; and this leads to damage of the
various organs but heart muscles which causes chest pain and
the heart too needs can even be fatal.
regular blood supply.
This blood supply is, What is cholesterol?
interestingly, by the
heart itself. The heart Fat is a source of energy in our body. Lipid is
pumps blood another name to denote fat particles. Oil, a
through arteries to the whole body and liquid form of fat and ghee, is a semi-solid
supplies blood to its own muscles by arteries form of fat. Fat particles flow into the blood
called "coronary" arteries. in many forms. Some of these forms include
cholesterol, triglyceride and fatty acids. Of
these cholesterol and triglycerides are
important.
Though people always criticize cholesterol,
this poor molecule is not a bad thing at all!
Cholesterol is a soft, waxy, naturally
occurring substance in our cells and our
blood. We all need cholesterol for our
nerves, muscles and other cells. The body
uses cholesterol for producing certain
Vitamins (an example is Vitamin D) for
making bile, which is needed for our food
digestion and for making some hormones
(e.g. sex hormones like estrogen and
progesterone). However, we need only a tiny
quantity of cholesterol in our blood for all
these activities. Indeed, our liver, skin and
intestines produce a lot of cholesterol by
themselves. This means that even if we were
to stop eating cholesterol completely, we'd
still be fine. However, the type of cholesterol
matters: some cholesterol is good, the
others are bad.

14 DIABETES HEALTH FEB-MAR 16


Good and bad Type Of Lipids Old Approach (Target Based) Newer Approach
Total Cholesterol <180 mg/dL It is mix of good (HDL) and bad (LDL) types of
cholesterol cholesterol, so choose the right goal.
Low Density <100mg/dL, if no additional Any person with Diabetes-
High levels of cholesterol Lipoprotein (LDL) cardiovascular disease (CVD) i. without additional CVD risk factors*- the patient
Cholesterol risk factors* should aim to reduce 30-50 per cent from baseline
are bad. They are related to LDL
cardiovascular disease, <\70mg/dL , if additional ii. with additional CVD risk factors*,the patient should
cardiovascular disease risk aim to reduce >50% from baseline LDL
simply called heart factors* present
attacks. The issue is not Triglyceride (TG) <150mg/dL Lifestyle therapy intensification andglycaemic control if
TG >150
that simple, however. Think HDL <40mg/dl (for male) or
of oil when you add it to < 50mg/dl (for female)
Start TG lowering medication along with lifestyle
your fried curry. Haven't you therapy if
seen oil droplets on the TG is >204mg/dL
HDL <34mg/dL (for both male & female)
surface? This means that oil
High Density > 40mg/dl (for male) Diet + exercise
does not dissolve in water Lipoproteins > 50mg/dl (for female)
and that it tends to stay (HDL)
Cholesterol
separate.
*Additional Cardiovascular disease (CVD) risk factors include hypertension, smoking, overweight,
This also happens in the obesity, family history of CVD.
blood. The oil stays If you have Diabetes, kindly contact your doctor to assess your CVD risk factors and to
separate and cannot enter personalize your cholesterol goals.
the cells, unless it is
transported into the cells. Tiny little proteins cells and even out of the body. When the
transport the oil into the cells. Some cholesterol is attached to these proteins it is
proteins transport oil out of the cells. The called a lipoprotein.
proteins that transport the oil into the cells When lipoprotein has cholesterol attached to
will cause the cells to swell and eventually the bad protein, it is said to be bad
cause the blood vessels to clog. These are cholesterol - an example is LDL cholesterol.
the bad proteins. Then there are the good When the lipoprotein has cholesterol
proteins that take the cholesterol out of the attached to the good protein, it is called
good cholesterol - the HDL cholesterol is a
prime example.

FEB-MAR 16 DIABETES HEALTH 15


At the end of the day, LDL and HDL are just While the normal range for LDL is below
particles and the balance between these 130 mg/dL, people with Diabetes need to
particles will determine the eventual keep it below 100 mg/dL and people who
occurrence of heart attacks. Cholesterol have had a heart attack need to have a value
flows into the blood, not as a pure lipid below 70 mg/dL. However, recent guidelines
particle, but with protein, as a "Lipo-protein" say that all people with Diabetes above the
particle. Based on the type of protein bound age of 40 years need to lower LDL
and its density, the function of these cholesterol by 30-50 per cent depending on
particles vary - thus we have the various their risk status.
lipoprotein particles and their role in the
HDL cholesterol - is a good form of
body.
cholesterol. It has, like all important lipid
particles, a piece of lipid bound to a piece of
Cut-offs for various lipids in protein. This protein, called app-lipoprotein
A, is a good protein that transports
the body are: cholesterol from various tissues to the liver.
Total cholesterol (normal below 200 The liver destroys the cholesterol bringing
mg/dL) - this is a combination of good and down the cholesterol levels in body. Experts
bad cholesterol. believe that an HDL level of 55 mg/dL or
above is protective.
LDL cholesterol - is a bad form of
cholesterol. It leads to cholesterol clogging Triglycerides - are also a bad form of
the arteries supplying blood to the heart. cholesterol. However, scientists consider
them to be a bit of a mystery. While high

16 DIABETES HEALTH FEB-MAR 16


triglycerides are associated with heart ascertain their heart disease risk.
attacks, lowering them may not decrease
The first two - i.e. apolipoprotein A & B
heart attacks. However, experts believe that
are present in the good and bad types of
very high levels of triglycerides need to be
cholesterol respectively. One advantage is
lowered by medications.
that they do not have to be tested in the
fasting state. However, they remain
How to test cholesterol?
The best way to know your
cholesterol levels is to do a simple
fasting blood lipid profile test that
shows all the good and the bad
cholesterol levels as one pattern.
For instance, in the fictitious
Diabetes patient, Mr Raj, discussed
previously, let us assume he again
does a lipid profile test that shows
the following result -
Mr Raj's lipid profile
reading -
Total Cholesterol -
299 mg/dL
LDL Cholesterol -
180 mg/dL
HDL Cholesterol - 35 mg/dL largely untested and unstudied indices of
Serum Triglycerides - effectiveness of therapy and should not
197 mg/dL be tested unless specialists advise them.

As Mr Raj has Diabetes, he needs to bring Small dense LDL - is a form of LDL that
his LDL cholesterol, now at 180 mg/dL, is even more dangerous than the already
down to at least 30 per cent or below 120 bad LDL - and measuring their levels and
mg/ dL, as per newer guideline by the controlling them would be expected to
American College of Cardiology. Some bring down heart disease related deaths.
doctors would insist that he brings LDL However, this expectation has to be
down to below 100 mg/dL to be on the safer confirmed by well conducted studies. For
side. He also needs to increase his HDL; but the moment this remains an experimental
more about this is covered in the coming test.
pages. Finally, there is this test for lipoprotein (a),
also called lipoprotein little "a". This is
How not to test cholesterol! said to be a marker for how soon a clot
that is formed in an artery can dissolve or
Many experts today suggest a fasting blood
even not form at all. Some studies have
lipid profile test - and this is the ideal way to
shown this to be raised in persons of
test. However, people continue to order
Indian origin. However this remains an
unusual tests like - apolipoprotein A & B,
experimental test.
small dense LDL and lipoprotein(a) to
FEB-MAR 16 DIABETES HEALTH 17
A lipid profile typically includes:
Total cholesterol - this test measures all of the cholesterol in all the lipoprotein particles.
High-density lipoprotein cholesterol (HDL-C) - measures the cholesterol in HDL particles; often called
"good cholesterol" because it removes excess cholesterol and carries it to the liver for removal.
Low-density lipoprotein cholesterol (LDL-C)- calculates the cholesterol in LDL particles; often called "bad
cholesterol" because it deposits excess cholesterol in walls of blood vessels, which can contribute to
atherosclerosis. Usually, the amount of LDL-C is calculated using the results of total cholesterol, HDL-C
and triglycerides.
Triglycerides - measures all the triglycerides in all the lipoprotein particles; most is in the very low-density
lipoproteins (VLDL).
Very low-density lipoprotein cholesterol (VLDL-C) -
calculated from triglycerides/5; this formula is based on
the typical composition of VLDL particles.
Non-HDL-C - calculated from total cholesterol minus
HDL-C.
Cholesterol/HDL ratio - calculated ratio of total
cholesterol to HDL-C.
An extended profile (or advanced lipid testing) may also
include low-density lipoprotein particle
number/concentration (LDL-P). This test measures the
number of LDL particles, rather than measuring the
amount of LDL-cholesterol. It is thought that this value may more accurately reflect heart disease risk in
certain people.

18 DIABETES HEALTH FEB-MAR 16


Facts about Fats
1 in 6 people have high cholesterol levels

75% cholesterol in your body is What are lipids?


made by your liver. Lipids are another word for "fat".
25% cholesterol comes from Cholesterol and triglycerides are
the food you eat. lipids. Lipids are easily stored in the
body. They serve as a source of
25% of cholesterol in your body fuel and are an important
constituent of the
is found in your brain.
structure of cells.

What is Cholesterol?
Cholesterol is oil-based and is a soft waxy substance found in every cell of
your body. High cholesterol has no symptoms. There are 2 types of
cholesterol:
LDL (low density lipoprotein) (bad cholesterol) contributes to plaque
(a thick or hard deposit) that can clog arteries.
HDL (high density lipoprotein) (good cholesterol) removes harmful
bad cholesterol. High HDL levels reduce the risk for heart disease.
Total Cholesterol the sum of your blood's cholesterol content, including
HDL, LDL and very low density lipoprotein (VLDL)

Lipid profile test (lipid panel or profile)


It is a blood test that can measure the amount of cholesterol and triglycerides in your blood. It
requires a 12 hour fasting (no food, drinks, except water) prior to the test.
If you have Diabetes then you should check your cholesterol levels once every year.

FEB-MAR 16 DIABETES HEALTH 19


Lowering Cholesterol a myth: rumour or scientific journal articles or treatises) came
out for lay persons suggesting that
high
fact? cholesterol was a myth created by some
cholesterol person to sustain the industry of a
Last year, in June 2015, United States
levels to the cholesterol lowering medication called
Department of Agricultural made a startling statin. The news became viral and was
normal range announcement. They wrote that the shared on social media sites and it is a
requires diet, traditional upper limit of restricting fat intake matter of doubt whether spread of this
to below 30 per cent of total calorie intake
exercise and rumour has been harmful or good for the
be taken off. In other words, there was no public. In an age where public seems to
where need to restrict fat intake strictly, however, have lost faith in medical care, where reports
necessary, bad forms of fat such as saturated fats and of scams and controversies adorn every
medications. trans fats should be avoided. In addition newspaper or print media, people love to
these authorities suggest that taking simple believe this conspiracy theory.
carbohydrates such as sugar may be worse
However, the simple truth is that statins are
than taking fat.
not exorbitant medication and can cost as
At the same time, several books (not little as less than two rupees a day. Moreover,
statins can lower heart attack risk by
25 per cent, a fact born out of studies of
thousands of patients where people on
statins were compared to those not on
statin. On the other hand newer medicines,
which are on the anvil and will be expensive,
claim to reduce heart attacks independently
of cholesterol and this theory about
cholesterol being a myth would help these
new, expensive designer drugs.
So what's the message - well, for today the
message seems to be: don't eat too much
sugar, eat healthy fats rather than unhealthy
fats and remember that statins are
medications that have been shown to reduce
To Improve Your Lipid Levels heart attack related deaths, irrespective of
whether this action is because of only
Eat less saturated fat, trans fat and cholesterol rich food lowering cholesterol.
Lose excess weight
Be more active How to treat high cholesterol?
Eat less sugar There are two ways to treat high cholesterol
using medications and incorporating lifestyle
Find ways to relax
changes. However, before treating a high
Take medication cholesterol level it is important to rule out
Don't drink too much alcohol and quit smoking any other cause of high cholesterol. For
instance failure of the thyroid gland, called
hypothyroidism can lead to a high
cholesterol level.

20 DIABETES HEALTH FEB-MAR 16


Lifestyle Modifications agents. They have some side effects like
muscle pain. Therefore it is important to
If you have
Changes to lifestyle remain the cornerstone
keep seeing a doctor regularly when you're Diabetes,
of cholesterol lowering therapy. Diet control,
restricting oil intake to less than two
on a statin and make it a point to inform check your
your doctor immediately when muscles
teaspoons per day per person is a valuable lipid profile by
begin to ache. In the case of Mr Raj, a dose
step, though easier said than done. Oil
of statin could help. a simple
containing food, deep fried foods, ghee,
reused oil and any form of oily foods are to Other medications fasting blood
be avoided. Sometimes, bringing down the
Fibrates are a group of medications that can
test once every
sugar intake can lower the lipid levels, year or as
lower triglyceride levels. However their effect
especially the level of a dangerous lipid
called triglycerides. In the test alluded
on reducing heart attacks is questionable. advised by
They are inferior to statins. Statins too can
previously, Mr Raj has had very high lipid
reduce triglyceride levels, though they
your physician
levels. However diet and exercise can reduce
mainly reduce LDL levels. However,
the lipid levels by only about 10 per cent.
sometimes very high triglycerides (levels
This would not bring Mr Raj's cholesterol
above 500 mg/dL) can trigger a disease
levels to normal range. Therefore, he
called acute pancreatitis. Therefore fibrates
requires medications to bridge the gap.
In addition, Mr Raj has low HDL levels and Side effects of statins
they need to be increased. This is difficult,
as no medication can actually safely raise Some potential common side effects of statins include:
HDL levels. Exercise, red wine and a headache
medication called nicotinamide are all said gastro-intestinal problems
to be capable of raising the HDL level.
muscle and joint aches or rash
However alcohol does more harm than good
in general and taking red wine to raise HDL Some less common side effects include:
is not a beneficial approach. mental confusion
Exercise is also an adjunct to diet in lipid high blood sugar
lowering. Twenty to thirty minutes of brisk onset of Type 2 Diabetes
walking per day, amounting to a total of at
Very rare side effects are:
least 150 minutes per week is
recommended by the American Diabetes muscle damage
Association. Muscle strengthening exercises liver damage
or resistance training is also useful. Statins are also known to alter
The "Statin" Medication results of liver function tests.
Some unconfirmed side
The statin medication is covered in detail by
effects include memory
Dr Prof Anders G Olsson in this issue of
loss and cancer.
Diabetes Health. However it is important to
cover some basic aspects here.
Statins are medications that specifically
lower the bad LDL cholesterol. They reduce
the production of cholesterol. Several statins
are available in India - simvastatin,
atorvastatin and rosuvastatin are all good

FEB-MAR 16 DIABETES HEALTH 21


Drinking may be used when triglyceride levels are very Omega-3 fatty acids have been used for
grapefruit high and LDL is low. years to lower the lipid levels. These may
have mild side effect, so ask your doctor
juice (or Fibrates can raise healthy HDL cholesterol
before consuming them. They are
(10-15 per cent) and lower triglycerides (20-
eating 50 per cent). Generally, fibrates are well
poly-unsaturated fatty acids and may be
grapefruit) tolerated.
beneficial as a nutritional supplement in the
long term though their immediate relevance
with some Another medication for lowering LDL as a prescribed drug is questionable.
statins and cholesterol is ezetimibe. In a recent study,
A drug called nicotinamide or nicotinic acid
this medication has proved a valuable
ezetimibe may adjunct to statin in reducing heart attacks
is available in some areas. The drug is
lead to higher- and the American Diabetes Association's
supposed to lower triglyceride and raise the
good cholesterol i.e. HDL levels. However,
than-expected 2016 guidelines support the use of this drug.
the drug can cause flushing of the face and
Ezetimibe lowers LDL cholesterol levels by
levels of in two recent studies (called the AIM-HIGH
interfering with the absorption of cholesterol
medication in in the intestines. It is taken daily; side effects
study and the HPS-THRIVE study)
nicotinamide was shown to have no benefit
your body. can include diarrhoea, joint pain or fatigue.

22 DIABETES HEALTH FEB-MAR 16


at all. Therefore this drug should not be
used in practice.
The final word
The PACMAN Begins If you have Diabetes, check your lipid profile
by a simple fasting blood test once every
Recently the United States FDA approved year or as advised by your physician. If you
the use of a new group of drugs called do not have Diabetes and if you are above
PCSK-9 inhibitors. They lower the LDL levels 40 years or have a family history of heart
and protect against heart attacks. However, attacks then check your lipid profile annually
they are, unlike all other oral medicines for or as specified by the doctors. Lowering high
lowering lipids, necessarily to be taken by cholesterol levels to the normal range
injection. Like the PACMAN game they requires diet, exercise and where necessary,
gobble up and destroy some dangerous medications. Instead of relying on
chemicals which, through a cascade of unfounded rumours, rely on experienced
events, allow the LDL cholesterol levels to doctors, specialists and scientific journals on
come down. They even act beyond simple the internet to give you appropriate
LDL levels as they influence the LDL information to protect yourself from heart
receptors that are the pathway for LDL to disease.
act and recycle itself. These complicated
Dr Vedavati Purandare is Consultant Diabetologist
drugs are not yet available in India and are
at Chellaram Diabetes Hospital, Pune. With inputs
still being researched at present. from Dr AG Unnikrishnan, Prof Olson, Dr Sujoy
Ghosh, and Dr Manish Bothale.

FEB-MAR 16 DIABETES HEALTH 23


Statin therapy:
boon or bane?

Dr Prof Anders G Olsson


discusses with
Dr Rajesh Javherani
how statin drugs often
prescribed to safely lower
the risk of heart attacks,
stroke and hardening of
24 DIABETES HEALTH FEB-MAR 16 the arteries work.
COVER STORY

The need for statin therapy Risk factors for CVD include:
Type 2 Diabetes is characterized by Smoking
metabolic syndrome, abdominal obesity,
hypertension, high triglycerides and low HDL High LDL cholesterol
and high blood glucose levels. One of the High blood pressure
most serious complications is Coronary
Diabetes
Vascular Disease (CVD). An examination of
blood lipids (in the form of lipid profile) Lack of exercise
would help your physician highlight the Poor stress management
underlying cause of the CVD. Often it may
be as: Being overweight or obese

High amount of total cholesterol (TC) in Family history of heart disease


the blood
flow to and from the heart and leads to heart
Low amount of high-density lipoprotein
attack and stroke. Statins draw cholesterol
cholesterol (HDL-C)
out of plaque and stabilize it. Statins include
High amount of low-density lipoprotein atorvastatin, fluvastatin, lovastatin,
cholesterol (LDL-C) pitavastatin, pravastatin, rosuvastatin, and
High amounts of triglycerides simvastatin.

It could be one or more in any combination Statins are prescribed to people:


which could have resulted in CVD. Risk of having CVD, including angina (chest
CVD or of an ischaemic event is not lowered pain with exercise or stress), a previous
by simply managing your blood glucose heart attack or stroke
levels instead there is a need to lower TC,
having Diabetes (age 40-75 years) and
LDL-C and triglycerides and increase
LDL-C levels between 70 and 189
HDL-C. In such a case it is important to
mg/dL
start statin therapy. Statins reduce LDL, the
"bad" cholesterol by 50 per cent or more. with a very high level of LDL cholesterol
Statins boost HDL, the "good" cholesterol, (above 190 mg/dL)
by up to 15 per cent. Lowering of cholesterol at a high risk of having a heart attack or
levels is observed within two to four weeks stroke or developing CVD
after starting treatment.

Statins explained
Statins are a family of
medications that not only lower
cholesterol levels but also lower
the chances of having a heart
attack or stroke. Plaque (a waxy
substance consisting mainly of
cholesterol deposits that can
build up within the walls of the
arteries) interferes with blood

FEB-MAR 16 DIABETES HEALTH 25


When you take a statin, you do more than
improve your cholesterol levels. They also
Lifestyle change is key to
reduce your risk of heart attack, stroke, and prevent CVD
other heart problems. Like any medicine,
statins can have side effects. Some Lifestyle changes are essential for reducing
potential common side effects of statins your risk of CVD. Diet management and
include headache, gastrointestinal regular exercise are important irrespective
problems, muscle and joint aches or rash. of whether statin therapy is prescribed.
Some less common side effects include People with Diabetes must:
mental confusion, high blood sugar and Eat a diet that is low in saturated fat,
onset of Type 2 Diabetes. Very rare side trans fat, refined carbohydrates and salt
effects are muscle or liver damage. Statins and rich in fruits, vegetables, fish and
are also known to alter results of liver whole grains.
function tests. Some unconfirmed side
Sit less and exercise regularly
effects include memory loss and cancer.
Reduce intake of salt
Quit smoking and reduce intake of
alcohol
Statins are a long-term commitment. It is
important to continue taking statins even if
cholesterol levels have lowered. As these
levels have been managed through
medication, a person may need to stay on
statins indefinitely as once stopped the
cholesterol levels may probably increase.
Only if significant changes in the form of
diet and weight loss to lower cholesterol are
undertaken, then the dosage may be
reduced. But medications need to be
changed only on the physician's advice. The
Some questions to ask your physician fact remains that a lot is known about
statins as they have been around for a long
about statin therapy time. More than 200 million people around
the world take statin drugs for their heart
Why do I need a statin?
health. The advantages of statins clearly
How will it be beneficial for my heart health?
outweigh the issues especially in most at-
Based on my medical history, what are the benefits and risk patients.
risks of statin therapy?
How will statin interact with my medicines or
supplements?
How can I monitor to identify if this drug is working? Dr Prof Anders G Olsson is the Director of Clinical
Trials at Stockholm Heart Center. Dr Rajesh
Do I need to take a supplement along with a statin to
Javherani is Consultant Diabetologist at
improve results?
Chellaram Diabetes Institute and Hospital, Pune.
How can I reduce the risk or alleviate side effects?

26 DIABETES HEALTH FEB-MAR 16


DIABETES and ME
Do you have a diabetes story to tell?
Share your Diabetes story with us, and
we'll publish it in our next issue. One
winning story will get a year's
subscription and two more stories will
win special Diabetes Health T-shirts -
a small token of appreciation from the
Diabetes Health team.
1st prize: 2nd prize: Share. Teach. Inspire.
1 year subscription of Diabetes Health
Diabetes Health T-shirt

If you or someone you know


has Diabetes, and you'd like
to share the experience
with us, write to us along with
your name and address to
editorial@diabeteshealth.co.in
Metformin
demystified!
Dr Ameya Joshi discusses the magic of the wonder drug
Dr Ameya Joshi is Consultant Endocrinologist at Bhakti Vedanta Hospital and
KEM Hospital, Mumbai. He has carried out original research work in Type 1
Diabetes, osteoporosis and other autoimmune diseases. He is recipient of the
Young Scholar Award by International Diabetes Federation.

28 DIABETES HEALTH FEB-MAR 16


EXPERT VIEW

oxidation and decreases absorption of


glucose from the gastrointestinal tract.
Metformin controls blood sugar levels by
decreasing both the amount of glucose
absorbed through your diet and the amount
of glucose produced by your body.
Metformin improves the body's response to
insulin which in turn better manages the
amount of sugar in the blood.
Metformin is available in-
Tablet form which is usually taken with
meals twice or thrice a day
Extended-release tablet form that is
usually taken once daily with the evening
meal
Patients are advised to ingest metformin
around the same time every day to avoid
missed dosages. The metformin extended-
release tablets must be swallowed whole and
not be split or chewed or crushed.
In people with Diabetes, usually lower doses
of 500 mg-1 gram per day (divided in 1-2
doses) are started and then gradually
increased with doses up to 3 grams if Take
well-tolerated. Dose is titrated based on
blood glucose level. In people who do not
metformin
have Diabetes, doses beyond 1.5 grams are exactly as
avoided. Other drugs such as cimetidine and directed. Do
cephalexin increase concentration of
metformin and so doses may need to be
not take more
reduced accordingly. or less of it or
take it more
Benefits of metformin often than
Metformin explained
Benefits of metformin include that it is the prescribed by
Metformin (Drug class: biguanides) is an most time tested medication. It has good
oral medication that aids in managing blood
your doctor.
safety data. Doctors have a lot of experience
sugar levels in people with Diabetes. It is prescribing metformin as it is inexpensive
prescribed only to people with Type 2 and weight neutral (neither increases nor
Diabetes. It is often used along with insulin decreases weight). The confidence that
or other oral medication. Metformin clinicians have in metformin make it
increases insulin sensitivity, enhances popular. There is no proven effect of
peripheral glucose (sugar) uptake, decreases metformin on weight loss in people with
insulin-induced suppression of fatty acid Diabetes. However some studies show

FEB-MAR 16 DIABETES HEALTH 29


benefits in people who do not have Metformin and heart health
Diabetes, a fact not universally proven.
Metformin is useful in mild heart failure
Metformin and PCOD patients as it improves outcomes. However it
should be used under supervision and
Metformin has been proven to improve
should be avoided in severe heart disease
ovulation rates but has not conclusively been
If you have proven beneficial in improving conception
patients.
any of the rates. Metformin may also be useful to
symptoms of reduce miscarriages in first trimester in Side effects of metformin
pregnancies with Polycystic Ovarian Disease
B12 deficiency (PCOD). But most of the newer guidelines
There are some side effects which may
occur while on metformin such as:
be sure to get do not recommend metformin as first line
Gastrointestinal side effects like loose
the level of for managing PCOD in people who do have
Diabetes. motions, nausea and vomiting.
vitamin B12 in
Metformin and cancer prevention Lactic acidosis can be seen in patients
your blood with kidney/liver or heart disease
Metformin affects multiple pathways in
checked. patients.
cancer progression by impacting various
cellular processes. Metformin has been Hypoglycaemia which may occur when
shown to exhibit anti-proliferative (tending to used with other Diabetes medications
inhibit tumour cell growth) and like sulfonylureas or insulin
anti-neoplastic (acting to prevent, inhibit or
halt the development of a neoplasm - a Metformin and B12 deficiency
tumor) effects. These effects are associated
There has been some concern in recent
with inhibition of mammalian target of
years regarding people who take metformin
rapamycin complex-1. This pluralistic action
as they are at risk of vitamin B12 deficiency.
supports the concept of repositioning
Vitamin B12 is necessary for the
metformin in cancer. Hence currently,
development of blood cells, DNA and the
several trials combining metformin as an
nervous system. It may also help prevent
adjuvant with established anticancer agents
heart disease and possibly even Alzheimer
are also underway or planned.

Metformin is prescribed for: Metformin should be avoided in:


People with Type 2 Diabetes A person experiencing organ failure, has a high
creatinine level and eGFR (usually mentioned
Prediabetes (where it slows down progression
with serum creatinine) is less than 30 ml/min
to Type 2 Diabetes)
People with liver dysfunction
Obesity
People with severe cardiac failure
Polycystic ovarian disease
People with gastrointestinal intolerance to
Women with gestational Diabetes (one of the
metformin
few oral medications that may be prescribed
for Diabetes in pregnancy) An individual who is scheduled for surgery and
procedures like CT scan. In such a case it
Lowering blood lipid, or fat, levels (cholesterol
should be electively stopped before medical
and triglycerides)
procedures.

30 DIABETES HEALTH FEB-MAR 16


disease. B12 is a water-soluble vitamin and Vitamin B12 deficiency can be managed
can be stored in the liver for up to a year. with either oral or injected, or inhaled forms
Vitamin B12 is found primarily in animal of B12. Strict vegetarians or the elderly may
foods, such as beef, seafood, eggs, and require regular B12 oral supplements or
dairy products which is why some injections. However, B12 supplement must
vegetarians are at risk of B12 deficiency. only be taken as per your doctor's advice as
Elderly people are often at risk for deficiency excess of vitamin B12 may be harmful
due to problems with absorption from the because it may interact with certain
gastrointestinal tract. According to some medicines.
studies, between 10 and 30 per cent of
people who take metformin on a regular Advice to readers
basis have some evidence of decreased B12
absorption. Metformin is an old molecule, whose roles
are still expanding. It has stood the test of
Symptoms of B12 deficiency include:
being sasta, sundar and tikau (cheap but
certain types of anaemia still good and durable). However, like any
neuropathy (numbness, pain, or tingling other medicine it has its own set of
in your hands or feet) problems and it is advisable to follow your
memory loss doctor's advice with regards to its dosage.
confusion
dementia Dr Ameya Joshi is an Endocrinologist at KEM
Hospital, Mumbai.

FEB-MAR 16 DIABETES HEALTH 31


Life is God's gift

Dr AS Netalkar talks about how he manages his Diabetes and how yoga and meditation have
made him stronger and a focused person. He shares his story with the Diabetes Health Team.

Name: Dr AS Netalkar I also got into spirituality and meditation that


really helped me stabilize my hands as I used
Age: 59 years
to have hand tremors. I have done various
Profession: Neurosurgeon practicing in Goa other courses that have helped me stay
positive and more focussed in life. I also do
The journey so far Yoga every day for the last 15 years. Yoga
and meditation have really helped me stay
I'm born and brought up in Goa. I have
positive and fit in life.
come up the hard way to be where I'm
today. I have worked in hospitals like KEM,
Sir HN and Hinduja in Mumbai. I then
Before my diagnosis
worked in England for 6 years. I returned to I have a sweet tooth and I used to consume
my hometown after 25 years and currently sugar in excess. I would smear my chapatis
working in Goa. with sugar and ghee. Jalebi, sweets and milk
products were my weaknesses. My mother

32 DIABETES HEALTH FEB-MAR 16


PEOPLE

also had Diabetes and she was detected at I also had to take special efforts in altering
the age of 60. I was detected with Diabetes my lifestyle completely. Giving up sweets was
two years ago at the age of 57. Every year I the most difficult thing to do. Also giving up
used to do a routine check-up. Maybe I was my favourite fruits like mangoes, grapes,
a pre-diabetic at the time because my banana, chickoo and pineapple was tough.
fasting was 110 mg/dL but I think that was But I substituted it with apples, pear, peach,
considered normal back then. Once I was guava and plum. I also have dry fruits.
diagnosed with Diabetes I left sugar Raisins (dried and fresh) are something I like
completely. Also I used to feel tired but never so I have them regularly. I ensure that I have
focused on it much as work commitments at least two fruits day. I was on treatment
kept me on my toes. So I could never when I was diagnosed 2 years ago and for
pinpoint that I may have Diabetes. the next year and half I took my medicine
regularly. My blood sugar level post meal
Dealing with the diagnosis was more than 160 mg/dL and fasting used
to be around 120 mg/dL. But by following a
On being diagnosed with Diabetes it did strict diet and fitness regime I was able to go
have an impact on my family, especially my off medicine; and for the past 6 months I
daughter who kept worrying that she has got have been able to manage my blood sugar
all my genes and will eventually get Diabetes levels with diet and exercise only. My fasting
in the future. She also has a sweet tooth. I sugar now is 80 mg/dL and pos3t lunch is
have told her many times that as eating too 140 mg/dL. My Hba1c level is 6.2.
much salt may cause blood pressure eating
excess sugar can put you at risk of Diabetes,
especially with a positive family history. After
My fitness regime
my diagnosis, my family and I have really Despite my busy schedule I work out on the
modified our lifestyle and diet habits to stay treadmill (speed 5.5.-6) every alternate day
fit. In addition, we do Yoga every day for for half an hour. After my workout I have two
physical and mental health. glasses of water followed by a glass of

Yoga and Diabetes


Yoga and meditation have helped me understand
that Diabetes is an endocrine-based disease. It
all starts with the brain, the main centre being
the pituitary gland; and all these breathing
exercises stimulate the pituitary glands
(pranayama, bhastrika and sudarshan kriya) and
build up oxygen level in the blood. So I feel they
directly affect your hormones in the pituitary
gland and regulate their function. That is how all
your glandular functions and hormones are
controlled. I personally feel that Yoga does help
control your Diabetes and works wonders for
your body.

FEB-MAR 16 DIABETES HEALTH 33


and I don't eat anything in between, I only
have 4 glasses of water. I usually prefer not
to snack between meal times as I lose my
appetite before the next meal. So I refrain
from eating or drinking (tea or coffee) before
lunch. Also, at times my colleagues force
me to snack in between but I refrain from
doing so.
My lunch time is fixed (1.00 pm), unless I'm
busy attending patients, and consists of a
small portion of brown rice, one bowl of
sabzi which is usually a green leafy
vegetable, a bowl of vegetable salad (onion,
tomato, cucumber) and 1 cup curd. In Goa,
we usually have fish curry rice which is my
staple food. The fish is cooked in minimal
amount of olive oil in a non-stick pan. We
use only olive oil for cooking and have been
using the same since past 5 years. I eat
equal amount of everything so that I don't
consume excess rice. In short, I eat a
balanced meal. By 4.00 pm I have cup of
tea without sugar with a toast or 4 biscuits.
My dinner is by 8.30 pm and I have 2
chapatis a bowl of vegetable and a cup of
coffee to wind up my day.

coconut water. On other days, I do Yoga,


Pranayama, Bhastrika and om chanting,
My inspiration
sudarshan kriya and few other yogic My wife really takes a lot of effort with
exercises. I also do abdominal exercises for regards to my diet. So seeing her dedication
20 minutes every day and these exercises towards my well-being makes me conscious
have become a part of my daily routine. of what I should eat and what I should not.
Even when I go for conferences she keeps
My diet reminding me to watch my diet and not eat
any sweets. Also, I have always taken my life
I need only 4 hours sleep at night. I wake up
seriously since childhood. I cannot live like a
at 4.30 am and have two glasses of warm
kite which has no direction. I value my life
water. I do meditation for an hour. I have my
and I have come to this position that I'm in
breakfast at 8.30 am. My breakfast includes
today, the hard way. So I want to continue
eggs thrice a week because I need
being active so that I can look after myself
something filling in the morning. On
first. Only when I achieve that I can look
remaining days I have a bowl of diet Kellogg,
after my family well as well as my patients
which is meant for people with Diabetes or
who depend on me for saving their lives.
chappati and sabzi. I also have a cup of tea
without sugar. My lunch time is at 1.00 pm I firmly believe that this life that we live is

34 DIABETES HEALTH FEB-MAR 16


god's gift to us and we should value it. I your Diabetes well.
don't want to be handicapped by frequent
Also, Diabetes is not a disease which is
illnesses; and I pray each day that I don't
dangerous or life-threatening if you look
suffer from a paralytic stroke or a heart
after yourself well. The only way to conquer
attack and be dependable on people. Living
Diabetes is to be strict in terms of diet and
a pitiable life is something I fear; and as long
exercise. Most people have a lax attitude and
as I live, I want to live well and independent.
eat sweets and then defend themselves by
Having a good quality of life is my major
saying that their anti-diabetic medication will
driving force to stay healthy.
help them manage their sugar. That's not
correct. If you can manage your Diabetes
My advice just on diet and exercise then you have won
half the battle. Yes, it is necessary to take
Despite having a sweet tooth I stopped my
medications if diet and exercise alone don't
medications six months back. I just check
work. But if you are strict with yourself then
my fasting, post prandial (after meal) blood
you can go off medications gradually.
sugar levels every week; and for the last 6
Medicines should help you control your
months my blood sugar levels have been
blood sugar levels and not be used as a
completely normal. So the first thing that is
resort to indulge in your favourite food.
absolutely essential is a strict diet control.
Diet control does not imply that you have to
punish yourself, I personally
feel that if you can manage to
resist temptation for 90 days
then you really never feel that
you are missing out on
something. People only have
a problem when they cannot
resist the temptation for a
continuous period. As a result
of which their cycle breaks
and their diet goes for a toss.
The second thing is regular
exercise. Your fitness regime
should be such that you push
your limits. A stroll in the park
does not qualify as an
exercise. You need to burn
more calories than you
consume. Finally practising
Yoga and meditation is
important as it controls stress
levels, which is one of the
major risk factors for
Diabetes. So in short, diet
control, exercise and Yoga are
main the pillars in managing

FEB-MAR 16 DIABETES HEALTH 35


TESTING
ROOM

Urine Routine Test


Dr Imtiaz Hasan simplifies the urine routine test.
36 DIABETES HEALTH FEB-MAR 16
A urine routine test is an array of tests performed on a Note: If urine samples are improperly stored and sent
given sample of urine. The urine is then tested for a to the laboratory more than 1 hour after collection
variety of constituents, which provide valuable clues to then performing/interpreting urinalysis may be
well-being. Urine samples are easily obtainable without difficult.
causing distress to the patient. Following which, urine
analysis is carried out easily, conveniently and cost Who should undergo this test?
effectively. It also provides a plethora of information
and is one of the most commonly asked for test. Patients with renal, hepatic, hematologic and
metabolic disorders should undergo this test.
Reliability
Drawbacks of urine routine test
The urine routine test is frequently an indicator of
previously unsuspected Diabetes. There is no drawback of this test provided the sample
is properly collected and stored before analysis.
Performing the test
Dr Imtiaz Hasan is the Director of Pathology at
The test is performed using dipsticks mounted with
Chellaram Diabetes Institute, Pune.
reagent pads. The centrifuged urine deposits are then
observed under the microscope.

What does the urine colour


Your urine What does the presence of
denote?
Colour changes can be seen due test report ketone bodies in urine indicate?
These are abnormal urinary

explained
to endogenous or exogenous constituents and are breakdown
pigments. Under normal products of fatty acid metabolism
conditions the urine colour is pale in the body. They are seen in
yellow. people with Type 1 Diabetes. In a
normal report they are absent, but
Does its appearance have
may be present during starvation.
importance?
What does the presence of bile salts and
Suspended particles give urine a turbid appearance
pigments indicate?
hence the clarity is looked for. Normally urine is clear
in appearance. Presence of these indicate liver disorder. They are
normally not found in urine
What do proteins in urine indicate?
What does the presence of blood/RBC indicate?
An increase in protein (Albumin) or blood
(Haematuria) in urine is a sensitive indicator of renal They are not found in a normal test report and
disease. The normal test result is negative for required assessment.
proteins.
What does the presence of pus cells indicate?
What do glucose levels in urine indicate?
Bladder or renal infection produces pus and hence
Usually not detectable in urine, increased levels may their presence is an indicator of urinary tract
be due to high blood glucose levels or decreased infection. They are normally not found in urine.
absorption. It is an indicator of unsuspected
Diabetes.

FEB-MAR 16 DIABETES HEALTH 37


The King
of fruits
NUTRITION

Summer is around the Mangoes and Diabetes


corner and it's raining Mango is one of the most popular,
nutritionally rich fruits with a unique flavour,
mangoes. If you are in a fragrance and taste making it the numero
uno choice among fruits. A person with
dilemma about having Diabetes need not avoid mangoes entirely as
mangoes then let Priya it is not only a source of vitamin C,
potassium, fibre and other important
Chaudhari guide you on vitamins, minerals and antioxidants but also
some of the benefits of the can satisfy cravings for sugary processed
foods. The fibre content found in mangoes
forbidden fruit, especially helps to slow the rate of sugar absorption in
your bloodstream.
for people with Diabetes.
The only thing a person with Diabetes
should remember is that moderation is the
key - general dietary guidelines for a person
with Diabetes defines that a single serving of
fruit contains approximately 15 grams of
carbohydrates which you will get from one
small mango or cup of chopped mango
and you can have this in the morning or
mid-morning. Moderation
Avoid ripe mango juice or aamras. You can is the key
have mango shake prepared with the while eating
allowed quantity of mango, but you should
not add extra sugar to the mixture. Dietary
mangoes.
guidelines for people with Diabetes also
advocate limiting fruit consumption because
it's a source of fructose. Since fructose is
metabolized by your liver, too much of it can
raise your triglyceride levels.
Note: Mangoes are known to increase
levels. Check with your nutritionist/doctor
before you eat mangoes.

Nutritive value table


Mango Kcal Fat Carbohydrate Protein Beta Vit C Iron
Carotene
(100gm) (gm) (gm) (gm) (Microgram) (mg) (mg)

Ripe 74 0.4 16.9 0.6 2743 16 1.3

Raw 44 0.1 10.1 0.7 90 3 0.33

FEB-MAR 16 DIABETES HEALTH 39


Nutritional content iron and prevents

Raw
bleeding tendencies.
Raw mango is highly
appreciated for its Kairi panha
nutritional value - they (Raw mango
are good source of

green
drink)
Vitamin C, a rich
source of pectin, and You can prepare
B vitamins. a very refreshing
drink from fresh

mangoes
Health benefits raw mangoes;
Due to the presence it's sweet and
of vitamin C, they are sour in taste
highly beneficial in Boil whole raw
strengthening the mangoes in water, take
immune system. out the pulp and mix with
It helps in removing waste cumin seeds (jeera), black
products from the body. pepper, and aniseed (saunf). Add
some rock salt to your drink. Strain and
Raw mango drink helps to overcome dehydration
serve this chill drink in sizzling summer to
in summer.
overcome dehydration.
Mangoes contain an enzyme which acts as a
Raw mangoes are also used to make mango
digestive aid, beneficial in the treatment of
pickles, which are an excellent accompaniment
gastrointestinal disorders, diarrhoea, dysentery,
with any food item.
piles, morning sickness, chronic dyspepsia,
indigestion and constipation. This fruit is also used in many forms such as
Raw mango guards you from negative effects of juices, jams, sauces, chutneys and dried powder.
heat stroke. Mix one chopped raw mango with honey and salt.
Drinking raw mango juice helps in preventing from Consuming this mixture is extreemly effective in
extreme loss of sodium chloride. curing any digestive disorders

Dried powder of raw mango that is prepared after Precaution


drying in sun is highly useful in the treatment of
We know that having excess of anything is bad, so
scurvy (Scurvy is a disease
avoid eating raw mangoes in
resulting from a deficiency
excess. Their excessive
of vitamin C).
intake may cause throat
The acids contained in the irritation, indigestion,
unripe, green mango dysentery and abdominal
triggers the secretion of colic. One should, therefore,
bile and acts as an not consume more than one
intestinal antiseptic. green mango in a day. Do
It increases the elasticity not eat raw mango without
of the blood vessels and draining its sap. The intake
helps the formation of of sap may cause
new blood cells. It aids gastrointestinal, throat and
the absorption of food, mouth infection.

40 DIABETES HEALTH FEB-MAR 16


Nutritional content The combination of vitamin C, vitamin A and
25 different kinds of carotenoids keep your
Ripe mangoes are excellent source of about 20
immune system healthy.
vitamins and minerals, good source of fibre,
antioxidants, iron, vitamin A, copper, potassium. Mango is rich in iron; hence it is a great natural
solution for people suffering from anaemia.
Health benefits Menopausal and pregnant women can indulge
Antioxidants present in mango protect the body in mangoes as this will increase their iron levels
against cancer. and calcium at the same time.
Mango has high amount of fibres that help to Consuming mangoes
lower serum cholesterol levels.
One of the best ways to enjoy a mango is diced
Fresh mango is a rich source of potassium fresh.
which helps control heart rate and blood
Make a tropical fruit salad with other fruits.
pressure. Mango has a lot of vitamins and
nutrients that help the body feel fuller. Also, the Make a fresh salsa with papaya, mango,
fibrous fruit boosts the digestive jalapeno, red peppers and chipotle
function of the body by burning pepper and use as a topper

Ripe
additional calories, helping in for your dishes.
weight loss. Add a few slices of
Mango helps in frozen mango to
regulating your insulin your smoothies.
levels. Mango has a
low glycaemic index
(41-60) so having a
little will not increase
your sugar levels.
Mangoes Mango juice with
ice cubes is a
popular,
delicious drink.
Mango fruit
As mango is rich in juice blended
vitamin A, it helps in with milk as
promoting good eye "mango-milk
sight; fights dry eyes and shake."
prevents night blindness. Mango fruit is also
The fibrous nature of mango used to prepare jam, jelly,
helps in digestion and elimination. ice cream and in sweet-candy
It is rich in prebiotic dietary fibre, vitamins industries.
and minerals.
Priya Chaudhari is a Consultant Nutritionist at Chellaram
Diabetes Institute and Hospital, Pune.

FEB-MAR 16 DIABETES HEALTH 41


Medications
That Raise Blood Glucose
Battling high blood glucose? Your meds may be to blame.
Allison Tsai shares what you need to know.

When your blood glucose is trending high,


you may run through a list of questions:
Spotlight on steroids
What have I been eating over the past few In terms of prescription medications, some
weeks? Is something causing me stress? Am are strongly associated with elevated blood
I fighting off a cold? All good questions, but glucose while others have a weaker
you may also want to turn your attention association, says Oluwaranti Akiyode, an
toward your medicine cabinet: Certain associate professor at Howard University
prescription and over-the-counter drugs are College of Pharmacy. The number one
known to cause upticks in glucose levels. offender: corticosteroids, often simply

42 DIABETES HEALTH FEB-MAR 16


DIABETES CARE

University. Oral steroid medications and


injections into joints or body tissues will
almost always increase blood glucose, she
says, because this type of administration
affects the whole body what doctors refer to
as systemic absorption. We have to combat
it either by increasing what [Diabetes
medications] they are on or adding other
agents.
If you need to use a steroid inhaler for
asthma or hydrocortisone cream for a rash,
the risk of increased blood glucose is
minimal. [Hydrocortisone creams] don't
have systemic absorption and what is
absorbed would be insignificant, Collier
says. And if you use a steroid-based inhaler,
that drug is specifically designed just to work
on certain organs, such as the lungs, so you If you're
don't see the glucose spikes in those patient unsure about
populations.
the effect of
Nonetheless, while the risk may be low for
these types of steroids, blood glucose
a specific
needs to be monitored closely, irrespective medication
of whether it's inhaled, oral, topical, or you've taken,
injected, says Akiyode. When you receive a
steroid prescription, be sure to ask your
monitor your
doctor whether you should check your blood blood
glucose more often. glucose.
Dose dependent
The risk of high blood glucose also depends
on the dose of the steroid: In a large dose
of inhaled or topical, there may be some
effect, says Alan Garber, professor of
referred to as steroids, which include medicine in the Division of Diabetes,
drugs such as prednisone and Endocrinology and Metabolism at Baylor
dexamethasone. College of Medicine.
Steroids are used to treat a host of health This is especially true for people taking oral
problems. The dose, duration and how the or injected steroids the larger the dose and
steroids enter your system are all important the longer you take it, the higher the risk of
in determining how your blood glucose is hyperglycaemia, says Akiyode. Not only that,
affected and how closely your Diabetes but the increase in blood glucose will be
medications need to be monitored, says greater than if you took a smaller dose for a
Izabela Collier, clinical assistant professor of shorter amount of time.
pharmacy practice at Western New England

FEB-MAR 16 DIABETES HEALTH 43


When you feel a tickle in
your throat or the tell-tale
malaise of an impending
cold, it may be time to take
a trip to the pharmacy. But
what, if any, products should
you avoid? When you are
fighting a cold, your blood
glucose may already be

Over-the-Counter Meds elevated, says Izabela Collier


clinical assistant professor of
that Raise Blood Glucose pharmacy practice at
Western New England
University. Treating with
medications that have added
sugar may be a double
whammy. If you're unsure
about the effect of a specific medication you've taken, monitor your blood glucose.
Whenever in doubt when taking a new medication, check your sugar, says Alan
Garber, professor of medicine in the Division of Diabetes, Endocrinology and
Metabolism at Baylor College of Medicine.
Pseudoephedrine - This decongestant found in some cold and flu medications can
raise both blood glucose and blood pressure.
Cough Syrup - The big question is: regular or sugar free? While Collier suggests
always using the sugar-free variety, Garber says it may not make a big difference
unless your numbers are already high. If your illness is causing your blood glucose
to rise, treating with sugary syrup will just make matters worse. But if your glucose
is within your target range despite your sickness, taking regular cough syrup is
probably not going to have major consequences, he says.
Caffeine - Products with adrenergic (caffeine-like) effects are best avoided, says
Garber. They can cause an accelerated heart rate, increased blood pressure and
heightened anxiety or nervousness. These products include everything from
pseudoephedrine to coffee, tea and soda.
DON'T FORGET: Never change your Diabetes medications when you're sick without
checking with your care provider. You may need to reduce some medication and
rapid-acting insulin if you can't eat. But you still need basal insulin. Even though your
body is fighting and you may not be eating, you still need the maintenance
medications, Collier says. To correct high blood glucose that results from the bodily
stress of illness, you may need to use rapid-acting insulin up to several times per day.

44 DIABETES HEALTH FEB-MAR 16


If you'll be taking steroids for a longer period glucose on target. Try to make sure you're
of time, Collier says there needs to be a plan exercising. And lose weight, if necessary, to
in place to adjust your Diabetes help minimize the risk factors, Akiyode
medications. For example, a course of oral says.
prednisone may start at 40-60 milligrams Certain
and then taper over several weeks. With this Heart hang-ups prescription
dose, you may need more Diabetes
medication, though that will decrease as you Beta blockers and thiazide diuretics, which and over-the-
gradually reduce your steroid dose. Steroid are used for the treatment of high blood counter drugs
treatment and tapering may also involve pressure, have been linked to elevated blood
glucose, though the connection is not as
are known to
taking steroid every other day instead of
daily. Many times, for a patient on insulin, I strong as it is with steroids. Statins, used to cause upticks
will alter the doses of insulin on steroid days lower cholesterol, also are associated with in glucose
versus non-steroid days, Collier says. raised blood glucose.
levels.
People treated with steroids for a shorter Much of the Diabetes population will need to
period of time - less than a week or so - or take one or several of these drugs. The dose
those who rapidly taper off the drugs may and how long you take these medications
not need any adjustments to their Diabetes may also be a factor. A higher dose of
regimen. thiazide diuretics is associated with higher
blood glucose levels, but the elevation may
A wrench in the wheel not take effect for weeks or months, says
Akiyode.
While scientists aren't exactly sure why
Long-term use of beta-blockers may also
steroids raise blood glucose, there are a few
bring higher risk of elevated blood glucose,
theories. Most [steroids] tend to affect how
insulin works in the body,
Akiyode says. It is also
decreasing insulin sensitivity and
increasing the production of
glucose in the liver.
Studies also are trying to clarify
whether steroids can trigger
Type 2 Diabetes. The question:
Do they cause new Diabetes or do
they unmask underlying, pre-
existing Diabetes? Some of the
studies are showing that it seems
like steroids are actually causing
some new onset, Akiyode says.
If you have to be on long-term
steroids for your health, control
what you can - maintain a healthy
lifestyle and take medications as
directed to help keep blood

FEB-MAR 16 DIABETES HEALTH 45


but the increase usually happens during
the first few weeks of taking the
medication. Similar observations have
been made about statins. A higher dose of
statins is also more strongly associated
with elevated blood glucose than a more
moderate dose.
It doesn't mean you should not use these
medications, Akiyode says. But you should
be monitored closely. The provider can
make appropriate adjustments, if
necessary, to the Diabetes medication.
The important message, she says, is that
benefits outweigh the risks. [For people
who need them] statins, beta blockers and
diuretics are really good drugs for people
with Diabetes to use.

Less common medications


While you may need to take steroids,
statins and blood pressure medications at
some point in your life, there are several
drugs used less frequently that can elevate
blood glucose. These include drugs to
treat people with schizophrenia, HIV and
organ transplants, says Oluwaranti Akiyode
an associate professor at Howard
University College of Pharmacy.
Antipsychotics - Clozapine and olanzapine
have the strongest association with
elevated blood glucose, though not all
antipsychotic drugs do so.
Protease Inhibitors - These antiviral
drugs, used for the treatment of HIV and
hepatitis C, have been shown to increase
blood glucose.
Tacrolimus - This immunosuppressive
drug is typically used after an organ
transplant and has the added risk of
elevating blood glucose.

Courtesy: Diabetes Forecast

46 DIABETES HEALTH FEB-MAR 16


MEDICINE
CABINET
Know your medicine one dose at a time!
By Dr Manish Bothale
Rosuvastatin
constipation
Mechanism of action cough
Rosuvastatin is an HMG-CoA reductase inhibitor, also Rare side effects include rhabdomyolysis (rapid
known as statin (lipid lowering agent). It reduces high breakdown of muscles), irritability, depression,
cholesterol (total cholesterol and low density insomnia, forgetfulness, dizziness, jaundice, kidney
lipoproteins (LDL) bad cholesterol) and triglycerides. damage. Slight increase in blood glucose levels may
It also increases high density lipoproteins (HDL) or occur.
good cholesterol levels to some extent.

Who should take Rosuvastatin


Rx
Rosuvastatin is prescribed in patients with
Rosuvastatin is administered in the form of an oral
tablet. Dyslipidemia (high LDL), hypercholesterolemia (high
total cholesterol) and high triglycerides.

Advantages Other risk factors (Diabetes, obesity, sedentary life


style, smoking) - all of which contribute to increase
Lowers LDL cholesterol and triglycerides. risk of heart disease.
Increases HDL cholesterol. Note: If patients fail to maintain the desired
Slows down the process of atherosclerosis cholesterol level only with diet and exercise then
(narrowing of arteries), thus reducing the risk of rosuvastatin is prescribed.
heart attack, stroke and other heart related
complications. Should not be used by
You should not take rosuvastatin if you -
Side effects
are pregnant, planning a pregnancy or breastfeeding
Although side effects are not common it may include -
have liver disease or show an abnormal liver
muscle pain function test
weakness
fatigue are allergic to rosuvastatin
joint pain
Dr Manish Bothale is a Consultant Diabetologist at
nausea Chellaram Diabetes Institute, Pune.

FEB-MAR 16 DIABETES HEALTH 47


Dealing with
Diabetes Stigma

Lindsey Wahowiak discusses why nobody's a winner when


we play the blame game.
Sue Rericha was still reeling from her Type 2 game. Even though millions of people have
Diabetes diagnosis when she told her friend Diabetes, misconceptions surround the
about it in 2008. Her friend's response Oh, disease, making life harder for those who
it runs in our family too, but we're watching live with it. If you've heard anything about
our weight so we won't get it. Rericha, Diabetes, you've also probably heard some
whose body mass index is in the normal stereotypes about the disease and the
range, was bewildered: Did her friend just people who have it:
call her fat? And if so, did her friend believe
People with Diabetes have brought the
her diagnosis was her fault?
disease onto themselves by eating too
Welcome to one of the less-discussed much sugar or being overweight.
complications of Diabetes - the blame

48 DIABETES HEALTH FEB-MAR 16


EDUCATION

They can cure themselves by drinking having the condition. Those feelings can be
okra water or eating cinnamon. triggered by external and internal sources.
The media certainly doesn't help And such feelings can do great harm,
mentally and physically. There's definitely a
Television news stories about Diabetes often
connection between thoughts and feelings
don't differentiate between Type 1 or Type 2,
[and people's] ability to take care of their Managing
insinuating that all Diabetes could be
prevented or delayed with a healthy diet or
disease, she says. mental
exercise. They are sometimes illustrated with health is an
images of overweight people with their
You against the world
important
heads cut out of the frame. People with Negative perceptions can be perpetuated in
Diabetes are often tasked not just with the the public by the media or individuals. They
component
burden of managing their Diabetes but also can come from biased news reporting, of Diabetes
educating the people around them about inaccurate information and hurtful jokes - care
the condition. That can take an emotional I ate so much dessert that I have Diabetes
toll. So can the sense of shame that comes now.
from others' misconceptions, or a person's
Even truths about Type 2 Diabetes -
own feelings of guilt.
including the fact that excess weight,
unhealthy food choices and inactivity are
No one chooses Diabetes contributing risk factors - can be overblown,
Rericha, 45, of Macomb, Illinois, says she's shifting blame onto people with the disease.
tired of hearing people suggest that people Many of the risk factors are things that
with Diabetes could reverse the disease if people are unable to change, including age,
they would just get off the
couch. An elementary school
teacher, Rericha manages her
Diabetes with diet and exercise.
But no matter how hard she
works out, she knows she'll
always have Diabetes and it isn't
only because of her weight,
though excess weight can be a
risk factor for Type 2 Diabetes.
Type 2 runs in her family - a
major risk factor for developing
the disease. And Rericha had
gestational Diabetes (Diabetes
during pregnancy) five times.
Having it even once is a major
risk factor for developing Type 2
Diabetes later in life.
Amy Walters, a licensed
psychologist, says at least half of
her patients with Diabetes tell her
that they feel shamed about

FEB-MAR 16 DIABETES HEALTH 49


race and family genetics.
Self-blame is
Walters suggests that Diabetes
more a guilt advocates fight these unfair
thing and stereotypes about Type 2 by
outside blame pointing out those factors and
helping educate the public
is sort of [that] this is a highly heritable
shaming. Both disease, she says. Healthy
are negative lifestyle is certainly one
component, but it's not the
emotions that only component. And lifestyle
don't work changes are not always enough
well and to manage the disease.

shouldn't be Another source of stigma:


the Internet
part of the
Kate Cornell, 60, knows that
treatment force all too well. Cornell blogs
regimen. about her Type 2 Diabetes and
while she's never faced stigma
in person, she's seen a lot of
hate online. That has been
one of the things that I've tried
to kind of fight against and
educate people [about] - not
only those who have Type 2
Diabetes, but the general
public - [that] this is not
something that we did to
ourselves, Cornell says.
There's always someone who
makes a comment, 'It's just
because you're fat and lazy. You
just need to stop eating so
much.' It's very frustrating and usually I just to take care of yourself. "It's painful to think
have to step back. You aren't going to about, Walters says. And that can get in
change somebody's mind online. the way of treatment: testing blood sugar,
following a diet plan, [even] following a
Health blogger Mike Durbin, 31, was Diabetes [medication] regimen.
diagnosed with Type 2 Diabetes and
congestive heart failure in 2008. Online, he
says, comments can be vitriolic.
Your own worst enemy
But even the strongest person can be worn Cornell has also experienced self-blame,
down by repeated rude statements. even though she knows, logically, that her
Whenever you have a negative stigma Diabetes is not her fault. On my bad days,
association with a disease it can be very hard when my mood is not great or my numbers
are not where I want them to be, it's so easy

50 DIABETES HEALTH FEB-MAR 16


Clash among
comrades
Another source of
stigma for people with
Diabetes comes from
potential allies.
Infighting can occur
among people with Type 1
and Type 2 Diabetes.
Some people with Type 2
feel as though people with
Type 1 Diabetes do not
want to be associated with
them, says Cornell,
because they didn't
cause their Diabetes.
Cornell tries to dispel
those myths gently. A lot
of that seems to come
from parents of children
with Type 1. It's the
momma bear effect, she
says. They're protecting
their children. One of the
things I try to say nicely
[when people with Type 1
say they don't deserve
Diabetes is] 'neither do I'?
Danielle Panetta has been
on both sides of this Setting goals
divide. Panetta, 40, of
to say, 'Why didn't I do better?'? she says. Boston, was diagnosed
that are too
That's why mental health is an important with Type 2 Diabetes as a college student. tough to
component of Diabetes care, says Floyd Eight years later, a C-peptide test, a measure achieve can
of the amount of insulin the body produces,
Russak, medical director of East-West Health
led to a new diagnosis. She had Type 1
make people
Centers in Greenwood Village, Colorado. He
describes the challenging emotions that Diabetes. Panetta could have gone the route feel like
often come with Diabetes: Self-blame is of some people with Type 1, pointing out they've failed
that her Diabetes was not her fault. But
more a guilt thing and outside blame is sort and that can
of shaming, he says. Both of them are instead, she's become an advocate for
negative emotions, don't work well and people with all types of Diabetes. I just feel increase
shouldn't be part of our treatment regimen. like [I have] spent so much time being told self-blame
that I ate myself into this disease. It's not

FEB-MAR 16 DIABETES HEALTH 51


true and it's also still not true for the people was not posted. When offered the option to
[who do have Type 2], she says. take the stairs or ride an escalator,
84 per cent of attendees were likely to
Growing Empathy choose the escalator. So health care
providers often slip up on the same healthy
Empathy from health care providers can choices people with Diabetes are asked to
break down stigma make every day. The experiment researchers
In an experiment by Boehringer Ingelheim suggested that empathy from health care
and Eli Lilly and Co. conducted at the 2015 providers could lead to more positive
Empathy American Diabetes Association Scientific interactions between health care providers
Sessions in Boston, researchers looked at and patients, leading to more positive health
from health the lifestyle choices attendees - mostly outcomes.
care researchers, clinicians and Diabetes industry To move beyond blame, people with
providers can professionals - made when presented with Diabetes of all kinds can work together to
healthy and less-healthy options. When
break down offered veggies or a brownie, attendees
make life less stressful for themselves.
Walters says education is the first step:
stigma chose veggies only half of the time or even Teaching yourself about Diabetes using
less often if the caloric value of each snack reputable sources, including your Diabetes

52 DIABETES HEALTH FEB-MAR 16


care team, will arm you with the knowledge
you need to achieve great Diabetes care.
You're my type
This knowledge will also help you educate Type 1 and Type 2 Diabetes have different
people - from well-meaning family members risk factors and contributing biological
to rude strangers - who might approach you processes, but people with any type of
with myths or stigma. Diabetes have more in common than they
Beyond that, Walters urges people with might think. Sue Rericha, who lives with
Diabetes to set reasonable goals for both Type 2 Diabetes, makes an interesting
their physical and mental health. Setting comparison: I see it in the same category
goals that are too tough to achieve can as different types of cancer. They're not all
make people feel like they've failed and that the same, but they're all still cancer. How
can increase self-blame. Maintaining a Diabetes comes about and how it is treated
positive attitude and asking family members may differ for each person, but the desire for
and friends to help you to do that is the best a world without Diabetes is universal.
way to fight that feeling. Blaming just isn't
helpful, Walters says. Courtesy: Diabetes Forecast

In a lighter vein
Doctor has
What are asked me to check
you doing? the sugar levels
every eight
hours.

ugar
S

FEB-MAR 16 DIABETES HEALTH 53


Total Knee
Replacement
and Diabetes
Dr Abhijit Joshi talks about knee
replacement surgery and guides you on the
precaution that you as a patient should take to
prevent complications.
DIABETES CARE

Age related degeneration of the knee joint is part of the knee is replaced) can be
a common entity and this is technically considered. Most often in India many
known as osteoarthrosis. The degeneration patients wait too long and by the time they
(wear and tear) of the soft articular cartilage approach the surgeon both the
(the smooth tissue which is present at the compartments of the knee are grossly
end of the bones where the bones glide over damaged; and then the only solution
each other) begins in the early years; remaining to consider is a Total Knee
however, the body's repair process is more Replacement (TKR). TKR consists of
than the degeneration, as age advances the removing the degenerated cartilage and
repair process naturally reduces and the replacing it with a high quality medical grade
wear and tear remains the same. The plastic on the leg side and metal of the thigh
degeneration of the knee joint can increase bone side.
if there has been previous injury to the
People with Diabetes often require special
articular surface like a joint fracture,
care and counselling before they undergo a
tuberculosis, long term increased weight of
TKR. This surgery, like any other surgery
the person.
that comes with risks and they may be more
pronounced if one has Diabetes. This is
Diabetes and surgery particularly true if the patient undergoes
surgery when his HbA1c (average blood
Diabetes also slightly increases the risk of
glucose level for past three months) blood
early degeneration though it is very less. The
levels are more than 7.5. Studies have
early treatment of age related osteoarthrosis
shown that people with Diabetes who have
is reduction of weight in overweight people,
had uncontrolled sugar apart from
mild pain and swelling reducing
medications,
neutraceuticals (cartilage
protecting medicines,
injections), brace, and
exercises. When all of
the above fail to relieve
the knee pain and when
the knee pain makes it
too painful to walk or
climb stairs without pain
and specifically when
there is pain even at rest
then a surgical option
could be considered.
The degeneration often
produces bow legs at an
early stage in certain
people. High tibial
osteotomy (correction of
the bow legs only) or
only a unicondylar knee
replacement (only one Pre-Surgery Post-Surgery

FEB-MAR 16 DIABETES HEALTH 55


damaging the knee have concomitant blood
Dos and Don'ts vessel, kidney, eye damage. This vital organ
damage further makes the surgery fraught
Do
with risks. Other risks include more chances
Ensure HbA1c <=7 of blood clotting in the veins after surgery
Ensure that you are counselled before the surgery, to (deep vein thrombosis-DVT), deep seated
know the pros and cons and speak with your surgeon infection, a stroke (brain injury), delayed
about any concerns that you may have wound healing, heart attack. These risks
vary with every patient.
Avoid any form of tobacco
Shift to Insulin for a short period Silver lining
Adequate pre and post-operative exercise But all is not lost, and there is a rather large
Don't silver lining to some of the risks explained
above. A study in 2014, showed that in
Change medications without proper advice
comparison to people who did not have
Increase weight by food overindulgence Diabetes, the risks were nearly the same and
Fall prey to unsubstantiated advice from there was hardly any statistical difference
non-orthopaedic people between the two. So what can be done to
reduce the chances of complication of a
TKR in people with Diabetes. The foremost
is sustained sugar control, one cannot
emphasize it enough. Your doctor may shift
you on injectable insulin for a few weeks to
maintain good sugar control and avoid
hyperglycaemia which can lead to infection.
Keeping your weight under control will not
only delay TKR but also lower the risk of
overall outcome and complications are fewer
compared to overweight individuals. People
with Diabetes do not require any special
implant for their knee replacement, though
surgeons tend to give antibiotics for slightly
longer duration, again this varies with
patients and surgeons. In conclusion TKR in
people with Diabetes is relatively safe and a
reproducible surgery with a very good
outcome and if certain precautions are taken
it is a surgery which is very rewarding both to
the surgeon and the patient.

Dr Abhijit Joshi is Consultant Orthopaedic Surgeon


at Chellaram Diabetes Institute and Hospital,
Pune.

56 DIABETES HEALTH FEB-MAR 16


Changing Your
Exercise Routine
Tracey Neithercott shares fun fitness ideas for EVERY body.
FITNESS

It doesn't take much for a routine to remember to begin slowly and get your
become, well, routine. Slog away at any doctor's OK.
activity for long enough and boredom can
You probably tried it as a kid, but hula
ruin your motivation. It happens to skilled
hooping is a terrific low-impact aerobic
athletes and novices alike. "People get into
activity for adults, too. You can use a typical
an exercise program, and they fade out of
plastic hoop or choose a weighted one for a
it," says Dale Wagner, president of the
tougher workout (You can find them in many
American Society of Exercise Physiologists
sporting goods stores). The right hoop will
and an associate professor of exercise
hit at your stomach or chest when placed
physiology at Utah State University. Mixing
vertically on the ground in front of you, but
things up can help. "If they have more
pick a larger hoop if your waist is wide. It'll
activities, they won't get bored." Repeat the
take some practice to find your groove and
same moves over and over again, and you'll
that's part of the fun. Once you get a good
set yourself up for overuse injuries. "It's
rhythm, try to keep going for 10 minutes
about doing a variety of activities," says
and build from there. It's never
Wagner. "If you run over a long period of
It may seem counterintuitive, but playing
too late to
time, certain muscles tend to shorten. It's
like when you sit in a chair all the time. Your certain video games can improve your start
hip flexors shorten." fitness. A 2006 study in the journal exercising.
Pediatrics found that kids burned twice as
Trying new exercises can also keep your
many calories playing active video games as
body guessing. "If all we do is walk on a flat
they did playing more traditional ones.
surface at the same pace, not varying [our]
Dance, Dance Revolution, is another active
workout, the body becomes very efficient,"
video game (available for multiple gaming
says Cherilyn Hultquist, an assistant
systems) that's both fun and aerobically
professor of health, physical education, and
challenging.
sport science at Kennesaw (Ga.) State
University. That means that your body uses For something more low-key, try yoga. It is
less energy from food to power your workout "just a fantastic way to improve strength and
once you've mastered a skill than when you flexibility," says Hultquist. Many gyms and
first start. You don't have to introduce an local community centers offer classes for
entirely new exercise to reap the benefits,
either (though doing that can help beat
boredom). If you do pick a new activity or
make a major change to your exercise plan,
check with your doctor first. Read on to
learn about some fun exercises for seasoned
athletes and those just getting started.

If you're a BENCH WARMER


then try hula hooping, active video
games, or yoga
Let's get one thing straight: It's never too late
to start exercising. Now is the perfect time to
add bits of exercise to your day just

FEB-MAR 16 DIABETES HEALTH 59


members, but you can also try stand-alone brushing your teeth and do it all on Sunday?
yoga studios. To get the most out of a class, No.' You don't have to give up your weekend
tell the instructor right away that you're new; workouts, but you should incorporate activity
he or she will be able to better guide you into your weekday, too."
and explain how to modify difficult moves.
The great thing about golf is that you don't
And make sure you start with a beginner's
have to commit to 18 holes in order to get a
lesson some studios offer advanced classes
good workout. Leave playing the course for
as well. Certain types of yoga, such as hatha,
Sunday morning, but stay active on weekday
"gentle," "restorative," or "laughter" yoga, are
nights by hitting a bucket of balls at the
especially suited for novices.
driving range. You'll strengthen your back,
abs, legs, and arms and prep your body for
If you're a WEEKEND WARRIOR a longer golf game when you have more
time.
then try golf, dancing, or walking
Or pick something unrelated to your
Weekend workouts are a good way to fit in
weekend activities. Dancing can be free and
fun exercises you can't do after work. But
easy, regardless of skill level or age. When
you could be setting yourself up for trouble.
you get home from work, crank up the
"You get really busy during the week and
music and start moving. Take a class, and
then go out on the weekend and do a long
you'll learn a new skill while getting an
hike for four hours. You're at much greater
aerobic workout. An hour of fast dancing will
risk for injuries," says Wagner. "What I tell my
burn 394 calories for a 150-pound person.
students is, 'Would you go all week without

60 DIABETES HEALTH FEB-MAR 16


That's the same number of calories burned thing is certain: You're part of an upper
as in an hour of light pedalling on a echelon of athletes who push themselves
stationary bike. Just remember that certain day after day in pursuit of excellence. That's
dances (like, say, salsa) will work you harder all well and good, but it's smart to
than others (like ballroom). complement the mastery of one sport with
work in another to keep the muscles in
If you can't commit to pre- or post-work
balance and prevent injury.
exercise, use your lunch break to go walking.
Go solo or gather a group of fitness-minded Even if you can run 10 miles easily, start
co-workers to join in. You can start a steps- slow with mountain biking. Tackling steep
per-month challenge with other walking- inclines and rugged ground will challenge
group members to inspire motivation and you in ways other sports say, long-distance
persistence. running or swimming cannot. For one,
balance plays a major role and mountain
If you're an ENDURANCE biking forces you to focus on the terrain and
your form while attempting not to face-plant
ENTHUSIAST in the dirt. If you're a newbie, prepare by
familiarizing yourself with the trail ahead of
then try mountain biking, surfing, or
time. And wear a helmet.
canyoneering
But if you already spend most days on the
You might run marathons, or compete in
seat of a bike, try another sport that requires
triathlons, or cycle for miles on end, but one
strength and a whole lot of balance: surfing.

FEB-MAR 16 DIABETES HEALTH 61


It's a full-body workout: You'll paddle out to sports, not the least of which is the
sea before hopping on the board and trying camaraderie. Still, a little solo work can help
to stay upright. train muscles you might not use on the field.
Swimming, for one, strengthens you from
You can test your mind and muscles and get
fingertips to feet, and by building underused
a hefty dose of adrenaline with
muscles it can bring your body into balance.
canyoneering. Hike and wade through
Swimming is also easy on achy joints, so it's
canyons, rappel down steep walls, hurl
a good way to train between team practices.
yourself over waterfalls, and climb in and
It's not difficult to find a place to swim; many
around pools of water: You'll get a strength-
gyms and community centers have indoor
training workout in some of the most breath-
pools.
taking locations, perfect for jostling you out
of a fitness rut. You can schedule a For some people, the community aspect of
canyoneering trip through an outdoor team sports is the greatest hook. But doing
adventure group an individualized activity doesn't mean you
have to plod along in silence. Martial arts like
If you're a TEAM PLAYER karate are still social and competitive, but
they force each contender to strive for
then try swimming, karate, or indoor personal success. Karate complements
rock climbing team sports well because it builds the
There are plenty of reasons to play team strength and focus necessary to succeed on
the field.

62 DIABETES HEALTH FEB-MAR 16


Or try indoor rock climbing.
Gyms across the country try
to re-create the thrill of rock
climbing on a smaller scale,
using towering walls
studded with colorful
knobs. If you've never
climbed before, the gyms
offer beginner courses that
explain the basics of using a
harness, ropes, and other
climbing equipment.
Learning the finer points of
scaling a 40-foot wall is a
good precursor to climbing
a real mountain, and with
experts on hand, it's a safer
way to take up the sport.

If you're a GYM RAT terrain, which means your muscles are


challenged more. "On the treadmill, the belt
then try white-water rafting, Ultimate keeps the hamstrings fairly inactive," says
Frisbee, or hiking Hultquist. "Take it outside and the
There's nothing wrong with the gym per se, hamstrings get involved." You can set your
but plugging away there day after day can own pace while hiking, but no matter how
make your motivation fizzle fast. Plateaus fast you walk you'll have to tackle hills and
and boredom are sure to follow. Sometimes uneven ground.
all it takes to invigorate your routine is to Just because you're in a fitness rut doesn't
move outdoors. White-water rafting, for one, mean you have to change the type of
adds excitement unlike any gym activity. The exerciser you are. If you work out to be alone
constant paddling through white-water and clear your head, a team sport might not
rapids and still rivers works the entire upper be right for you. Instead, pick something
body, back, abs, arms, and chest. And that lets you go solo but work different
there's hardly time to slack off or get bored. muscles. And don't count on the health
Joining a sports team can also be a smart benefits alone to drive you. "In exercise,
idea. "There's the accountability built into sometimes the threat of poor health is not
that," says Hultquist. Knowing that dozens of enough," says Hultquist. Above all, find
people are relying on you to show up can activities you enjoy. "If you enjoy doing it,
help you clear the toughest exercise hurdle: you're more likely to do it," says Wagner. "I'm
getting there. If traditional sports aren't your not a runner, so I don't run. But I enjoy
thing, try Ultimate Frisbee. Many cities and riding a bike regardless of whether that'd be
towns have club teams you can join, or you healthy for me." The health boost? Consider
can play an informal pickup game. it a fringe benefit.
Another option: Go hiking. Unlike gyms,
Courtesy: Diabetes Forecast
nature doesn't provide consistently smooth

FEB-MAR 16 DIABETES HEALTH 63


Experts at Chellaram Diabetes Institute, Pune answer your queries
on Diabetes. Send your questions to editorial@diabeteshealth.co.in
I have Type 2 Diabetes but I love drinking pancreatitis (inflammation of pancreas). It also leads to weight
alcohol. What should I do? gain and reduces insulin action, which worsens blood glucose
control in patients with Diabetes. Chronic alcohol use might
If adults with Diabetes chose to drink alcohol
lead to vitamin B12 deficiency, which can worsen diabetic
they should do so in moderation (One drink per
neuropathy (nerve damage). It should be noted that alcohol
day or less for adult women and two drinks per
does not provide protection to the heart in Indians with heart
day or less for adult men). Alcohol
disease. People with Diabetes who are addicted to alcohol
consumption increases the risk of
(alcohol dependent) should also seek professional help for
hypoglycaemia (low sugar feeling); and
alcohol de-addiction.
hospitalisation is required in cases of severe
hypoglycaemia. Alcohol also increases serum Dr Vedavati Purandare
triglyceride levels (fat in the blood), which Consultant Diabetologist
increases the risk of heart disease and
I'm a 34 year old working mom and have Type 2
Diabetes. Most of the time I consume frozen fast food
and frozen meals. Is this advisable, if yes, how much
should I consume in day. Could you please advise me on
the portion size of such foods.
Eating fresh is the best as it is healthier than eating frozen
packaged foods, which contain too much fat and chemicals.
But considering today's busy lifestyle, not everyone has free
time to cook and eat fresh meals every day. But if you do
consider eating frozen foods then you should keep in mind
the following guidelines:
Check the nutrition label to understand the content of
the food.
A frozen meal has to be low in calories and fats,
especially saturated and trans fat.
Look for meals with less than 140 milligrams of sodium
per serving. Ideally it should be below 700 milligrams a
day, exceeding this limit increases your sodium intake.
The calorie count should be less than 300 calories
It should not exceed 3 grams of saturated fat/100 kcal
Frozen meals should also contain at least 2-3 grams of
fibre per serving
Try your best to avoid frozen fast food and meals as they only
worsen your pre-existing ailments. But if you do opt for such
foods then restrict their consumption to only one meal a day.
Priya Chaudhari
Consultant Nutritionist

FEB-MAR 16 DIABETES HEALTH 65


Foot scan
DIAB-E-TECH

KV Kavitha explains the foot scan and why


it is an essential test for people with Diabetes.

The foot scan is a non-invasive, state of the


art device connected to computerized
software to assess pressure (weight of an
individual) distribution over the bottom of
the foot, while you are in static (standing)
and dynamic (walking) positions.
Determining the weight distribution while
static or dynamic can help diagnose foot
problems and pinpoint the cause of pain the
lower extremity.

How the foot scan works in


diabetic foot
The foot scan works on the principle of
physics - pressure. In diabetic foot it is the
individuals weight divided by the area of
both feet bearing the pressure i.e., weight.
Usually while walking or standing the weight
of the individual is distributed evenly, except LOW PRESSURE HIGH PRESSURE
while walking there is higher pressure on 1st
MTH (Metatarsal head - a head of the bone
just below the big toe) compared to other
bony areas bearing the weight.
It is a well-known fact that repeated pressure
points or high plantar pressure exerted over
the bottom of the foot is one of the key can even spread infection in people with
factors for foot ulceration in individual with Diabetes if the pressure points are not
Diabetes. relieved or diagnosed at right time.
If there is an abnormality of the foot because
of any reason such as deformity of the foot Working of a foot scan
due to peripheral neuropathy (nerve damage
The foot scan helps in identifying high
due to Diabetes), limited joint mobility due
pressure points and other abnormalities via
to chronic Diabetes and structural deformity
a sensor and displays 2D and 3D images
due to surgical history it can all lead to
along with graphs using computerized
biomechanical defects and abnormal
software.
pressures. So repeated undue pressure over
certain areas can result in foot problems like These sensors can pick up the high pressure
pain, calluses, non-healing wounds which points emitted over the foot, overloaded foot

FEB-MAR 16 DIABETES HEALTH 67


regions, contact of each phases of walking minimize and equalize pressure
like heel contact, mid foot contact. It can distribution
pick high arch or flat foot. Flat feet have little
The use of specially designed orthotic
to no arch. High arch foot has a tendency to
insole helps to restore biomechanics
over supinate (excessive pressure over the
and can reduce or even eliminate pain.
outer border of the foot), whereas flat feet or
low arch foot has a tendency to over pronate In surgical cases - individuals with
(too much pressure over the inner border of biomechanical or structural
the foot during walking) - this leads to pain abnormalities requiring surgery, a pre-
in the arch of the foot, heel, knee, hip and and post-operative scan can be done to
lower back. assess the biomechanical results of the
surgical procedure, and to decide on
My advice orthotic devices.
It is useful for individuals with Diabetes,
I personally feel that foot scanning is
especially with neuromuscular
essential in people with Diabetes as -
abnormalities to detect the pressure
Foot scanning helps in designing - an points as high pressure points can be a
orthotic insole - that is custom made to reason for foot ulceration or recurrent
help correct the underlying problems, or non-healing ulceration.

Podiatrist Rating Patient Rating


5 4 5 4 4 4

Cost effectiveness
Test duration
Performance

Convenience
Reliability 5
Ease of use

Rate Card
1 = Poor
5 = Excellent

Disclaimer - The author and the editorial team of Diabetes Health have no conflicts of interest to disclose. They do not
endorse, support or recommend any particular product or device.

KV Kavitha is Consultant Podiatrist at Chellaram Diabetes Institute and Hospital, Pune.

68 DIABETES HEALTH FEB-MAR 16


Lucky winners will get:

TheDiabetesHealthQuiz
How well do you know your
Diabetes? Choose the correct
answer from the choices given
below, tear/scan this page and
send it to us. We have goodies
for those who get all the
answers correct. Remember,
every question has only one
correct answer!
So get set, and go! 1st prize: 2nd prize:
1 year subscription of Diabetes Health
Diabetes Health T-shirt

1. A simple urine test can help diagnose Diabetes.


(a) True (b) False
2. Which of the following is an energy-dense food?
(a) Salad (b) Fruit (c) Gulab jamun (d) None of these
3. Smoking and Diabetes increase the chance of heart diseases.
(a) True (b) False
4. People with Diabetes should consume a _________ diet.
(a) Carbohydrate rich (b) Fibre rich
(c) Balanced (d) None of these
5. Type 2 Diabetes is observed in children.
(a) True (b) False
6. Strength training helps lower blood glucose levels.
(a) True (b) False
7. Risk factors for Diabetes include -
(a) Obesity (b) Genetics
(c) Sedentary lifestyle (d) All of these
8. Monosaturated fats are healthy fats.
(a) True (b) False
9. Diabetes occurring due to excess steroid levels is called -
(a) Metabolic syndrome (b) Cushing syndrome
(c) Type 1 Diabetes (d) Gestational Diabetes
10. Which of the following factor is unknown to increase the risk of Type 2 Diabetes?
(a) Obesity (b) Family history
(c) Sedentary lifestyle (d) Cow's milk intake

Name: To participate:
Fill up the quiz and your details.
Age: Occupation:
Scan this page and mail it to:
Tel: Mobile: Editorial@diabeteshealth.co.in
Email: Answers in Diabetes Health
Mailing address: Apr-May16 issue
Answers to previous
DH Quiz [Dec15-Jan16] on page 76
Melon Soup,
parmesan chips
Recipe by Chef Liam Crotty

2. Peel both the melons and scoop out with


Ingredients: help of a teaspoon and keep aside.
50 gm watermelon 3. Mix rest of the ingredients with both melons
50 gm cantaloupe melon and put into blender to puree.

20 ml orange juice 4. Strain with a fine strainer, adjust seasoning


and keep for chilling.
5 ml white wine
5. Put melon scoops in a deep plate, pour
5 gm fresh mint leaves
soup over it and garnish with parmesan
5 gm lemon grass cheese.
10 gm parmesan cheese

Nutritive value per serving:


Method: 71.5 kcal energy
1. Heat a non-stick pan and sprinkle 13.61 gm carbohydrates
parmesan cheese over it. Once the
2.95 gm proteins
parmesan cheese melts a bit remove and
keep aside until crisp. 2.75 gm fat

70 DIABETES HEALTH FEB-MAR 16


Poached apple, vanilla yoghurt,
sugar-free granola
Recipe by Chef Liam Crotty

Ingredients:
Poached apple
200 gm apple
200 ml water
.05 gm vanilla
Vanilla yoghurt
50 gm fat free yoghurt
.05 gm vanilla
Crunch granola
10 gm pistachio
5 gm grated coconut
20 gm raisins
5 gm almonds
5 ml oil

Method:
Poached apple
1. Peel an apple, cut into eight pieces and turn them.
2. Poach in vanilla infused juice of an apple for 15 minutes.
Vanilla yoghurt
1. Hang yoghurt in a cheese cloth overnight. Mix vanilla seeds.
Granola
1. Combine all the ingredients together for crunch granola mentioned above and bake at
160 degrees Celsius for 20 minutes.
Assemble as shown in the picture.

Nutritive value per serving:


161.66 kcal energy
94 gm carbohydrates
6.84 gm proteins
6.35 gm fat

FEB-MAR 16 DIABETES HEALTH 71


Potage of vegetable,
poached egg, sour cream, herbs
Recipe by Chef Liam Crotty

Ingredients: Method:
15 gm carrot 1. Saut the carrots, celery, shallots and fennel
for 7-8 minutes. Add the leek, zucchini and
10 gm celery
saut for an additional 5 minutes.
30 ml zucchini
2. Add water, bay leaf and simmer for 10
10 ml shallot minutes on a low heat to infuse with the
20 gms fennel bulb vegetables. Separately poach the egg and
set aside.
20 gms leek
3. Serve in a soup bowl and lay the egg in the
5 gm broccoli
center and garnish with sour cream and
5 gm dill fresh fresh herbs.
5 gm basil fresh
10 ml sour cream (fat-free)
Nutritive value per serving:
1 egg 194.18 kcal energy

5 ml olive oil 11.14 gm carbohydrates

1 bay leave 10.43 gm proteins

500 ml water 12.16 gm fats

72 DIABETES HEALTH FEB-MAR 16


Sugarfree Sitafal Kulfi
Recipe by Saumitra Kulkarni

Makes: 25 portions

Ingredients:
1 litre low fat milk
500 ml single cream
100 gms milk powder
250 gms sitafal puree
40 gms sugarfree

Method:
1. Boil the milk on slow simmering till it reduces to
half. Cool for a bit and add the rest of the
ingredients. Let it cool further.
2. Put it in individual moulds and let it set it in the
blast freezer for at least 1-2 hrs.
3. Garnish and serve.

Nutritive value per serving (100 gms):


107.81 kcal energy
2.6 gms fats
9.7 gms carbohydrates
12.7 gms proteins

FEB-MAR 16 DIABETES HEALTH 73


Garlic Chicken
Recipe by Sheryl Salis

Serves: 1 4. Add the remaining four cloves minced garlic and


stir. Add onions, bell peppers and 1/2 cup of the
Ingredients: broth/water and cover.

5. In a small bowl, mix the remaining 1/2 cup


3-4 boneless pieces of chicken
broth/water, soy sauce and oat flour.
6 cloves of garlic
6. Add the sauce mixture to the pan and stir until
1 tsp ginger grated the chicken and vegetables are coated with the
thickened sauce. Serve immediately, over hot
cup green onions, finely chopped
rice if desired.
1 medium onion (thinly sliced)

bell peppers Nutritive value per serving:


1 cup chicken broth 124 kcal energy

- tbsp soy sauce 13 g proteins

1 tsp oat flour 6.8 g carbohydrates

1 tsp peanut oil 5 g fats

Method:
1. Heat peanut oil
in a pan. When
the oil begins to
smoke, quickly
stir in 2 cloves
minced garlic,
ginger root,
green onions
and salt.

2. Stir fry until the


onions become
translucent. This
will take about 2
minutes.

3. Add chicken and


stir until opaque.
This will take
about 3
minutes.

74 DIABETES HEALTH FEB-MAR 16


Non-Veg Dolma
Recipe by Sheryl Salis

Makes: 10-15

Ingredients:
100 g brown rice
50 g three colour peppers,
chopped
25 g onions, chopped
10-15 cabbage, boiled and
deveined
100 g chicken, roast and
minced
1 cup tomato sauce
tbsp pepper, ground
tbsp all spices (ground)
2 lemons
2 garlic cloves
2 tbsp oil 5. Then tuck in the empty sides towards the
centre. Repeat the folding procedure on the
Salt to taste rest of the mix.
Water 6. Finally, start laying the rolled cabbage in a pot.
Make sure you lay them close to each other.
Method: Put the pot on the stove and pour about two
cups water in the pot.
1. Bring water to boil with salt and lime juice, add
the cabbage leaves and after a while plunge the 7. Brush olive oil over the leaves to keep them
leaves directly into cold water. moist. Cover the pot with its lid and cook on
high temperature for about five min.
2. On a heated pan, pour a little oil to saut onion,
garlic along with 3 colour peppers. Add minced 8. Serve hot.
roast chicken to it.
3. Take out the extra oil. Add the tomato sauce
Nutritive value per serving:
and brown rice. Season the mixture and set 114 kcal energy
aside to cool.
12.4 g proteins
4. Take a tablespoon of the mix and put it in the
7 g carbohydrates
middle of the flattened cabbage leaf. Spread
the mix evenly as half cylinder. Remember to 4 g fat
leave inch space from each end of the leaf.

Ms Sheryl Salis is a registered nutritionist, a certified Diabetes educator,


a certified insulin pump trainer a naturopath, a wellness coach and a health writer.

FEB-MAR 16 DIABETES HEALTH 75


Answers to The Diabetes Health Quiz Dec'15-Jan'16
1. Amlodipine is used to treat blood pressure. have Diabetes avoid high-impact exercise, as this
may traumatise the feet - a special emphasise should
a: True - Amlodipine belongs to a group of drugs
be placed on foot care, proper shoes and cotton
called calcium channel blockers. Amlodipine relaxes
socks. It is best to seek medical advice before you
(widens) blood vessels and improves blood flow. It is
start exercising.
used to treat high blood pressure (hypertension) or
chest pain (angina) and other conditions caused by 4. Uncontrolled Diabetes over a prolonged period
coronary artery disease. It can be administered causes -
safely in patients who have other associated
b: Weight loss - This is because insufficient insulin
conditions like Diabetes mellitus and kidney disease.
prevents the body from getting glucose from blood
2. Exercising daily has beneficial effects on your - into the body's cell for energy. When this occurs the
body starts burning fat and muscle for energy
d: All of the above (blood pressure, blood sugar
causing a reduction in overall body weight.
levels, lipid levels) - Being active boosts
Unexpected weight loss is often noticed in people
high-density lipoprotein (HDL), or "good," cholesterol
prior to diagnosis of Type 1 Diabetes but it may also
and decreases unhealthy triglycerides. This keeps
affect people with Type 2 Diabetes.
your blood flowing smoothly, which decreases your
risk of heart diseases. It is a good way to beat stress 5. Hypoglycaemia can occur after several hours of
and helps lower your blood pressure. In fact, regular exercise.
physical activity can help you prevent or manage a
a: True - One of the most common causes of low
wide range of health problems and concerns,
blood glucose is too much physical activity. In fact,
including stroke, metabolic syndrome, Type 2
moderate to intense exercise may cause your blood
Diabetes, depression, certain types of cancer,
glucose to drop for the next 24 hours following
arthritis and falls. As a general goal, aim for at least
exercise. This post-exercise hypoglycaemia is often
30 minutes of physical activity daily.
referred to as the "lag effect" of exercise. Hence it is
advised that you monitor your blood glucose levels
before and after exercise.
6. GI is an abbreviation of -
a: Glycaemic index - The Glycaemic Index (GI) is a
ranking of carbohydrate-containing foods based on
the overall effect on blood glucose levels. Slowly
absorbed foods have a low GI rating, while foods
that are more quickly absorbed have a higher rating.
This is important because choosing slowly absorbed
carbohydrates, instead of quickly absorbed
carbohydrates, can help even out blood glucose
levels when you have Diabetes. Some studies have
shown people who have a high GI diet tend to have
higher HbA1c levels.
3. High impact exercise may traumatise the feet. 7. You should always check your blood sugar levels
before exercising.
a: True - High impact exercise is one of the most
effective ways to burn more calories. However, if you a: True - People with Diabetes need to check their
blood glucose levels amount of sodium in the
before exercising. diet can help many
Checking your blood people lower their blood
glucose level frequently pressure. Lowering
before and after exercise blood pressure implies
can help you see the that you are decreasing
benefits of an activity. your risk for heart attack
You also can use the or stroke, both of which
results of your blood are common Diabetes
glucose checks to see complications. Hence,
how your body reacts to people with Diabetes
different activities. should aim to consume
Understanding these less than 6g of salt
patterns can help you (2300 mg of sodium per
prevent your blood day) i.e. less than 1
glucose from going too teaspoon. Also, if you
high or too low. have high blood pressure then your health care
provider may recommend even less.
8. Frozen foods are high in -
10. Why is strength training important for people
d: All of the above (sodium, fat and carbs) - Frozen
with Diabetes?
foods are often high in sodium, especially frozen
meals. Consuming excess sodium can lead to high d: All of the above (It builds strength and agility,
blood pressure, which is linked to heart disease and improves effectiveness of insulin and regulates
stroke. You should limit your sodium consumption to blood sugar levels) - Strength training is a type of
no more than 2,300 milligrams per day. Also, frozen physical exercise specializing in the use of resistance
meals are usually starch heavy increasing the overall to induce muscular contraction which builds strength,
fat and carb content of your entire meal. Hence it is anaerobic endurance and size of skeletal muscles.
advised that you read the nutrition label carefully Strength training (also called resistance training)
before buying frozen food. makes your body more sensitive to insulin and can
lower blood glucose. It helps to maintain and build
9. How much salt should someone with Diabetes
strong muscles and bones, reducing your risk for
consume?
osteoporosis and bone fractures.
c: Less than a teaspoon a day - Decreasing the

Lucky winners
1st prize:
1 year subscription of 2nd prize:
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T-shirt

Salil Khan, Coimbatore


Sarita Fernandes, Puducherry
Mohan Kapoor, Jaipur Minal Kapadia, Lucknow
February - March 2016
Aries (Mar 20 - Apr 21) Cancer (Jun 22 - Jul 23)
Minor issues like common cold
and cough will keep bothering you You enjoy a period of good health
from time to time. Digestive problems and vitality. You may suffer from
may also trouble you. Those of you who are random bouts of cold and cough but these
middle-aged or more need to be very careful will ease with time. Changing your dietary
while indulging in physical activities; avoid habits and fitness regime will prove
heavy exercises. You would be better off beneficial for your health. You could also try
doing basic Yoga and breathing exercises in opting for fun-filled activity to channelize
order to improve your strength and stamina. your energy better and keep your mind of
unnecessary things.
Lucky numbers: 7 and 9
Lucky number: 6

Taurus (Apr 22 - May 21) Leo (Jul 24 - Aug 23)

Weak gastric system could upset Those suffering from joint


your daily routine. It is best advised problems need to be extra careful.
that you visit a doctor to avoid complications. Do not neglect old nagging health
Try changing your eating habits by consuming issues. Avoid self-medication and visit the
less oily and spicy food. Stick to homemade doctor at the earliest. It is better to get a
food to prevent further complications. routine body check up to avoid further
Respiratory problems may also crop up. Try complications. You may be prone to seasonal
opting for Yoga to help increase your changes, hence take care of your health.
breathing power. Lucky numbers: 5, 7 and 9
Lucky numbers: 1, 2 and 4

Gemini (May 22 - Jun 21) Virgo (Aug 24 - Sep 23)


Eye infections may keep
Those of you who are suffering
bothering you from time to time.
from Diabetes and high blood
Back problems are also indicated
pressure need to take their medications
hence it is necessary to maintain a good
regularly and monitor their condition. Avoid
posture and indulge in some physical activity.
eating food high in carbs and sugar.
Also, avoid eating outside food as you may
Indulging in a sport of your liking will not
suffer from stomach infections. Visit the
only help you feel better about yourself but
doctor at the earliest if you feel that something
also will aid in managing your condition.
is amiss.
Lucky numbers: 3 and 8
Lucky numbers: 1, 4, 6 and 8

78 DIABETES HEALTH FEB-MAR 16


Nandita reads the cards exclusively for the Diabetes Health magazine.

Libra (Sep 24 - Oct 23) Capricorn (Dec 22 - Jan 20)


Acidity and slow digestion may be a Health may take a backseat during
cause of concern during this period. this period. Ensure that you get
It is advised that you consult a dietician enough rest. Overburdening yourself will
and follow the prescribed diet to remain only worsen your health. Healthy diet,
healthy. Avoid sugary and fatty foods to control exercise and mind will help you conquer
your Diabetes. Prevention is better than cure so most of your ailments. You need to take extra
pay attention to your health to lead a happy precautions if you suffer from asthma and
and healthy life. respiratory related disorders.
Lucky numbers: 1 and 9 Lucky number: 1

Scorpio (Oct 24 - Nov 22) Aquarius (Jan 21 - Feb 19)


You may feel energetic and Those suffering from high blood
enthusiastic during the initial stages pressure need to be extra cautious
of the month. However, you may suffer from and refrain from eating a high salt diet.
random bouts of cold and cough. Also, it is Avoid getting into unnecessary arguments as
essential that you maintain hygiene as you this will only hamper your health and raise
are prone to ear and throat infections. your blood pressure. Exercising daily will not
Dental problems are also indicated. Do visit only strengthen your immune system but also
the doctor if you notice that something is enable you to calmly handle difficult
amiss. circumstances.

Lucky numbers: 3 and 4 Lucky numbers: 5 and 7

Sagittarius (Nov 23 - Dec 21) Pisces (Feb 20 - Mar 20)

Eye problems are indicated and Cold, cough and flu will dampen
you may experience blurry vision your spirits. Frequent headaches may
from time to time. Do not neglect this also be a cause of concern. Try
and visit the doctor at the earliest. Avoid spending some 'me' time to gain better clarity
taking extra work as you may exhaust yourself. of a situation. Practicing Yoga may bring in
Things will gradually ease out with time. some relief. Also opting for your favourite sport
Bringing some positive changes in your diet will strengthen your immunity and will keep
and exercise will help you combat the stress of your mind off unnecessary things.
daily life. Lucky numbers: 3, 4 and 9
Lucky numbers: 2, 5, 6 and 8

FEB-MAR 16 DIABETES HEALTH 79


HEALTH BYTES
My Fitness Mantra
Col (Dr) J Muthukrishnan shares his fitness tips with Spandana Birajdar.
A little about me My diet plan
I'm 45 year old and serve as an Endocrinologist in the Early Morning (6 am) - Coffee
Indian Army. I currently work as a Professor in the
Breakfast (7:30 am) - Bread, eggs, cereals
Department of Internal Medicine, AFMC, Pune. I'm an
alumnus of the same college (1988 Batch). Lunch (1:30 pm) - Roti, vegetable, dal, rice and curd
Evening Snack (5:30 pm) - Tea, fruits
Stay fit and happy Dinner (8:00 pm) - Roti, vegetable, dal, rice and curd
During my teen days, I represented my college in Any other snack time - None
basketball, and played squash and golf during the later
years. I started running since 2010 following which it
My fitness regime
has become a passion. Fitness to me is a way of living
healthy; and devoting at least an hour a day does I wake up at 4 am and take my pet dog for a walk for
wonders. about 45 min. After which I go for my run (6-12 km),
5 days a week depending on my training plan for the
As an Endocrinologist working in an academic
day. I rest on Mondays and Saturdays but I
institution, most of my time is spent in outpatient
compensate for it by running on Sunday mornings for
department, wards and taking classes for students.
20-35 km. In the evenings, I do stretching and
Although I always manage to take out time to work out
strengthening exercises which last for an hour long.
in the mornings, the time spent sitting while seeing
patients does act as a negative health activity. That's
why I try to get up and walk around once in every hour Advice to readers
to overcome that. My father has Diabetes so I know that I'm at risk too.
I'm a marathoner and due to This is why I eat healthy,
my training routine I prefer maintain my exercise schedule
running. I do strength and keep my weight in check.
training in the gym as part I monitor my blood sugar levels
of training for running. frequently and undergo regular
annual check-ups to ensure
If I had to change one habit
that I stay fit and healthy. I
in me it would be to avoid
personally believe that you have
the late-night parties and
to look after yourself well, so
consume unhealthy snacks
that you can enjoy the
that the Army and even the
remaining days that are in store
civilian social lifestyle have
for you. Following a schedule
to offer quite frequently. Also
with self-discipline, sticking to
frequent cups of tea/coffee
your regular exercise routine
consumed while at work as
followed by healthy diet and
a doctor is another sore
adequate sleep is the key to
point in my healthy routine.
good health. You should avoid
But I try my best to avoid
watching excessive TV and
indulging as much as I can.
unhealthy addictions to
continue enjoying good life.

80 DIABETES HEALTH FEB-MAR 16


Reg. No.: MAHENG/2011/38903