Physical activity and Diabetes

Physical activity and diabetes :-

• In the absence of co-existing condition which may  require limitation of physical activity, exercise play an important role in facilitating a good control of diabetes.
• Physical inactivity and obesity are strongly associated with the development of type 2 diabetes.
• Efficiency of pumping action of heart improves and blood vessels open up to accommodate increased amount of blood being pumped by heart. Walking, bicycling, swimming, and jumping rope are good examples of such an exercise.
• The short term effects of exercise include lowering of blood glucose.
• An imbalance between caloric intake and physical activity can lead to obesity, which causes insulin resistance and is common in people with type 2 diabetes.
• Exercise benefits diabetes by enhancing the action of insulin through an increased number of insulin receptor sites particularly in type 2 diabetes.
• Central obesity, in which a person has excess abdominal fat, is a major risk factor not only for insulin 7resistance and type 2 diabetes but also for heart and blood vessel disease.

Treatment for Diabetes

Treatment of Diabetes:-

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• Early on in type 2 diabetes, you may be able to reverse the disease with lifestyle changes. Also, some cases of type 2 diabetes can be cured with weight-loss surgery.
• There is no cure for type 1 diabetes.
• Treating both type 1 diabetes and type 2 diabetes involves medicines, diet, and exercise to control blood sugar levels and prevent symptoms and problems.

Getting better control over your blood sugar, cholesterol, and blood pressure levels helps reduce the risk of kidney disease, eye disease, nervous system disease, heart attack, and stroke.  

Complications :-

Acute complications :-

1.       Hypoglycaemia or Insulin Shock

2.       Ketoacidosis

 Long term complications ;-

1.       Infections

2.       Diabetes and heart disease

Diagnosis:-

Several tests are used in the diagnosis  of diabetes :-

1.       Glycosuria :- it is necessary to observe the following procedure to detect  early diabetes :

Urine is voided just before the meal.

Breakfast or lunch is taken with usual helpings of carbohydrate rich foods such as bread, chapathis, rice, fruits.

Two or three hours after the meal  urine is voided and examined for sugar.

2.       Ketonuria

3.       Random blood sugar :- a random blood glucose exceeding 200 mg/dl is almost certain to indicate diabetes.

4.      Glucose tolerance test  :- glucose tolerance test is a confirmatory test.

      WHO recommends for the test that  75g to be used as the glucose load for adults and 1.75 g/kg body weight for children with maximum of 75g.

herbal remedies for diabetes

Fenugreek or MethiFenugreek or Methi

• Used in paranthas and various Indian curries, Methi has many health benefits. 
• It has been used as a galactogogue – a substance used to increase the secretion of milk in breast-feeding mothers.

Tips :-

• Soak the methi seeds in water overnight and drink this water and chew on the seeds first thing in the morning.
• Place methi seeds in a skillet and dry roast using medium heat for about two minutes, with constant stirring. 
• Allow the seeds to cool and then powder; add one teaspoon of this powder to hot or cold water and take once or twice in a day.
• Boil one cup of water and add 2 tablespoons of methi seeds, steep for about 10 minutes and then strain and consume the liquid. 
• Do this twice every day to see a reduction of blood glucose levels.

Bitter Gourd or Karela

• Most people are familiar with bitter gourd – an unpalatable yet healthy vegetable that is typically cooked in tangy gravy to offset the bitterness.

Tips:-

• Select a green bitter gourd, slice it lengthwise, and scrape away the flesh to remove the seeds. 
• Then add the vegetable to a blender and run it to obtain a juice.  
• Drink one small glass of this juice first thing every morning.
• Take some pieces of dried bitter gourd, boil in one cup of water and consume this tea once or twice in a day. 
• This tea is not as bitter as the fresh juice and easier to consume.
• Cut a few slices of bitter gourd and add to stir-fry dishes, especially in combination with vegetables that have a sweetish taste of their own – this will help mask their bitter taste.

Plant-based therapies that have been shown in some studies to have anti-diabetic properties include: 

• Aloe vera
• Bilberry extract
• Bitter melon
• Cinnamon
• Fenugreek
• Ginger

Exams and Tests

• A urine analysis may show high blood sugar. However, a urine test alone does not diagnose diabetes.

Your health care provider may suspect that you have diabetes if your blood sugar level is higher than 200 mg/dL. To confirm the diagnosis, one or more of the following tests must be done.

• Blood tests:

Fasting blood glucose level :- diabetes is diagnosed if it is higher than 126 mg/dL twice. Levels between 100 and 126 mg/dL are called impaired fasting glucose or pre-diabetes. These levels are risk factors for type 2 diabetes.

Hemoglobin A1c test :-

•                         Normal: Less than 5.7%
•                         Pre-diabetes: 5.7% - 6.4%
•                         Diabetes: 6.5% or higher

Oral glucose tolerance test :-

•             Diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours of drinking a glucose drink. (This test is used more often for type 2 diabetes.)

Screening for type 2 diabetes in people who have no symptoms is recommended   for:

•           Overweight children who have other risk factors for diabetes, starting at age 10 and repeated every 2 years
•            Overweight adults (BMI greater than 25) who have other risk factor Adults over age 45, repeated every 3 years.

           

Clinical criteria :-

•           Relief from symptoms
•           Reduction in obesity and maintenance of normal body weight depending upon height and built.
•           Prevention  or retardation of both acute and chronic complications of diabetes.
•           Presence of adequate energy and endurance for work performance.
•           In childhood diabetes, normal or near normal growth and development including physical, mental, emotional, and sexual development.
•           In pregnancy with diabetes, delivery of a normal baby without any medical complications in the mother.

Blood Glucose level

Normal Blood Sugars

• •  A normal fasting (no food for eight hours) blood sugar level is between 70 and 99 mg/dL

•         A normal blood sugar level two hours after eating is less than 140 mg/dL

      

Recommended target blood glucose level ranges

Target level  by type	Before meals	2 hours after meals
Non – Diabetic	4.0 to 5.0 mmol/ L	Under 7.8 mmol/ L
Type 2 diabetes	4 to 7 mmol/L	Under 8.5 mmol/ L
Type 1 diabetes	4 to  7 mmol/L	Under  9 mmol/L
Children w/ type 1 diabetes	4 to 8 mmol/L	Under 10 mmol/ L

Blood Glucose level

High blood sugar

If blood sugar levels remain too high the body suppresses appetite over the short term. Long-term hyperglycemia causes many of the long-term health problems including heart disease, eye, kidney, and nerve damage.

Low blood sugar

If blood sugar levels drop too low, a potentially fatal condition called hypoglycemia develops. Symptoms may include lethargy, impaired mental functioning; irritability; shaking, twitching, weakness in arm and leg muscles; pale complexion; sweating; paranoid or aggressive mentality and loss of consciousness.

Degree of control of diabetes:-

Status	Degree of control
	Good	Fair	Poor
		Blood glucose in          mg/dl
Fasting	<110	110-130	>130
2 hours after meal	<130	130-150	>150

Dietary Guidelines

Dietary Guidelines :-

• Daily energy intake must be estimated after considering such as age, sex, actual weight in relation to desirable weight, activity, and occupation.
• The patient should maintain body weight 10% lower than ideal/ desirable body weight.
• The total intake of calories is more important for a diabetic than the exact proportions of protein, fat, and carbohydrate in the diet.
• A diabetic should be 60-70 percent from carbohydrates, 15-20 percent from protein and 15-25 percent from fat. 
• high protein intake helps to increase insulin production and pulses are rich in protein and fibre.
• Vitamins and minerals are supplemented if needed. 
• Complex carbohydrates and fibre should be included in the diet. 25-40 g of dietary fibre can be included for each 1000 kcal consumed.
• Patients should avoid fasting and feasting.
• Sodium intake is to be no more than 6g daily. Sodium is restricted to 3 g in hypertensive diabetic diets.
• Hypoglycaemic foods like fenugreek can be included in the diet.
• Junk food should be avoided.

  

Foods to be avoided	Eaten in moderation	Foods permitted
Simple sugars (glucose, honey, syrup, sweets, dried fruits, cake, candy, fried foods, alcohol, nuts, jaggery, sweetened, juices.)	Fats, cereal, pulses, egg, nuts, roots, artificial sweetener.	Green leafy vegetables, fruits, fruits except banana, lemon, clear soups, onion, mint, spices, salads, plain coffee or tea, skimmed and butter milk.

Diabetes Nutrition

• Nutrition is crucial in managing blood sugar levels Nutrition is a critical part of diabetes care. 
• Balancing the right amount of carbohydrates, fat, protein along with fibre, vitamins and minerals helps us to maintain a healthy diet and a healthy lifestyle.

Nutritional Requirements for Diabetics

Carbohydrates - 

• High carbohydrate and high fiber diet improve insulin binding and increase in monocyte insulin receptor binding. 
• High carbohydrate diet is likely to elevate serum triglyceride levels). Hence carbohydrate is maintained to about 50% of total calories. Most carbohydrates should be in form of polysaccharides such as bread, cereals, beans, etc. 
• Rapidly absorbed mono and disaccharides such as sweets, chocolates and sweetened drink should be avoided.
• According to the American Diabetes Association, "Foods that contain carbohydrates raise blood glucose. "However, a diabetic patient is not necessarily restricted from any type of carbohydrates as long as it conforms to the accepted daily intake level. 
• Carbohydrate counting is a technique for estimating the required daily intake of glucose-containing foods such as rice, bread, cereal, pasta and starchy foods.
• Carbohydrate management also includes diets with low glycemic index such as whole oats, whole grains and beans.

Proteins - 

• A diet high in protein is good for the health of diabetics because it supplies the essential amino acids needed for tissue repair.  
• Protein does not raise blood sugar during absorption as do carbohydrates and it does not supply as much calories as fat.  
• Protein-rich foods help replenish the loss of nitrogen in the body.. Proteins do not directly affect the cause of diabetes but could trigger the release of insulin.

Fats -

• Fat content in the diet should be 15-25% of total calories and higher in polyunsaturated fatty acids. 
• Fat intake for diabetics is regulated by preparing unsaturated-fat and fiber-rich foods with olive oil, canola oil and low-fat dressings. 
• The aim is to maintain high-density lipoproteins, or the so-called "good cholesterol" that comes from unsaturated fatty acids in foods. 
• Properly regulated fats help in maintaining a healthy body weight by increasing satiety and preventing the risk for heart diseases such as atherosclerosis.

Dietary Fiber - 

• Diets high in carbohydrate and fiber improve glucose metabolism without increasing insulin secretion. 
• They lower fasting serum and peripheral insulin concentrations in response to oral glucose administration in both diabetic and non-diabetic individuals.
• Fenugreek seeds which contain high fiber are useful to diabetics.

Fruits and Vegetables

• Fruits and vegetables are heavily emphasized for diabetics because they provide fiber, vitamins and minerals that are essential to a healthy diet. 
• According to the National Diabetes Education Program, diabetics consuming 2,000 calories per day should consume two cups of fruit daily.
• Dark green vegetables, such as  broccoli and spinach, as well as orange vegetables, including sweet potatoes, pumpkins and carrots, are also important sources of vitamins. 
• Beans and peas also have a prominent place in a diabetes diet.

Type 2 Diabetes

People with this disease don't produce enough insulin

Four dietary changes can have a big impact on the risk of type 2 diabetes..

1. Choose whole grains and whole grain products over highly processed carbohydrates.

2.  Skip the sugary drinks.

3   Choose good fats instead of bad fats.:----The types of fats in your diet can also affect the development of diabetes. Good fats, such as the polyunsaturated fats found in liquid vegetable oils, nuts, and seeds can help ward off type 2 diabetes.

4.Limit red meat and avoid processed meat. :----People who regularly eat red meat have roughly a 20 percent greater risk of type 2 diabetes than people who rarely or never eat red meat. (35) It may be that the high iron content of red meat diminishes insulin’s effectiveness or damages the cells that produce insulin. Eating lots of processed meat can also increase your diabetes risk. So skip the steak, bologna, and ham. Nuts, seeds, beans, tofu, or poultry are much more healthful protein choices.

 

Gestational Diabetes

·         The incidence of gestational diabetes is 15 – 17 percent in Indian pregnant women.

·         It is defined  as carbohydrate intolerance during pregnancy.

·         Pregnant  women with diabetes are more prone to preeclampsia, toxaemia, urinary tract infections  and hydromnios.

·         Uncontrolled diabetes during the first three months of pregnancy increases the risk of abortions and congenital malformations in the foetus.

·         During  pregnancy, the diabetic should be given 30-35 kcal/kg  of the desirable body weight.

·         The diet should provide 1.5-2.5 g of protein/kg body weight.

Symptoms of Diabetes

• Here is a list of the most common diabetes Symptoms :-

1. Frequest urination
2. Disproprotionate thirst
3. Intense hunger
4. Weight gain
5. Unusual weight loss
6. Increased fatigue
7. Irritability
8. Blurred vision
9. Cuts and bruises don't heal properly or quickly
10. More skin infection
11. Itchy skin
12. Gums are red and swollen – Gums pull away from teeth
13. Frequent gum disease / infection
14. Sexual dysfunction among men
15. Numbness or tingling,especially in your feet and hands

Infection :-

In Diabetes , cuts and wounds heal slowly .  Wound healing is delayed in diabetics because of neuropathy , hyperglycaemia and ischaemia. They are prone to tuberculosis and infections of theskin, urinary tract and foot. Diabetics should take special precautions and keep it clean to prevent infection of the skin and foot.

There are several key factors in the appropriate treatment of a diabetic foot ulcer :-

• Prevention of infection
• Taking the pressure off the area, called “off-loading”
• Removing dead skin and tissue, called “debridement”
• Applying medication or dressings to the ulcer
• Managing blood glucose and other health problems

Type 2 Diabetes

                                       Type 2 Diabetes

• Type 2 diabetes makes up most diabetes cases. It most often occurs in adulthood. However, because of high obesity rates, teens and young adults are now being diagnosed with it. Many people with type 2 diabetes do not know they have it.

• Type 2 diabetes occurs when the pancreas does not make enough insulin, or the body cannot properly use the insulin it does create. Eventually, the pancreas may stop producing insulin altogether. Type 2 diabetes can affect people at any age. In both men and women, the more overweight an individual is, the greater the risk of developing type 2 diabetes.

 

·         Type 2 Diabetes, known as Adult onset or noninsulin dependent diabetes.

·         Type 2 Diabetes is primarily a disorder in which the cell in the body are not responding to thehigh level of insulin circulating in the body. The body becomes increasingly resistant to insulin.

·         Type 2 diabetes , body resists the effect of insulin.

·         A hormone that regulates the movement of sugar into cells..

·   In the end type 2 diabetesthe beta cells of the pancreas are not producing enough insulin.

Risk factors of Type 2 diabetes:-

Your risk of type 2 diabetes typically increases when you are

• Older
• Less active
• Overweight or obese
• Bad Diet
• Increasing age
• Living a sedentary life style