You are on page 1of 84

APR-MAY 2017 Vol 7 No 1 70

Happy Sexual Life


with Diabetes

Marriage and Diabetes


Managing Obesity
Importance of Insulin
Why Good Posture
Matters

www.diabeteshealth.co.in
Apr-May17

Editor
Dr Unnikrishnan AG

Publisher
W P Vasandani
MISSION
Editorial Consultants to spread awareness and knowledge of diabetes
Dr M K Mandal
Mr Vandan Agrawal 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 preventive measures
Dr Suganthi Kumaran
Dr Ashok Gavande
Foot Care Specialist:
K V Kavitha
to empower all those affected
Dr Shubhangi Tathare
to participate in their own
Diet & Nutrition:
Priya Chaudhari
Rutuja Mahajan
healthcare management
Fitness & Lifestyle:
Dr Richa Kulkarni PT

Assistant Editor
Printed and published by W P Vasandani on behalf of Chellaram
Sunila Kelkar
Foundation. Owned by Chellaram Foundation, Gazdar House, Third Floor,
629-A, J. Shankar Sheth Road, Mumbai - 400002. Printed at Print House
Sub Editor India Private Limited, R-847/2, T.T.C, MIDC, Rabale, Navi Mumbai
Ch V Mridula 400701. Distributed by Living Media India Limited.
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
routine. The views expressed in the articles are of the authors, and not of
Contacts: the Publisher. No representation is made or warranty given (either
Editorial : expressed or implied) as to the completeness or accuracy of the
Sunila Kelkar information contained. Readers should verify the information and
editorial@diabeteshealth.co.in / 020 6683 9777 Ext: 714 wherever necessary consult with their doctor before they act on it. Diabetes
Health does not necessarily endorse the products advertised in the
Advertising : magazine and accepts no liability for any direct or indirect loss arising
Dr Ashok Gavande from the use of the information and the material contained in the
advt@diabeteshealth.co.in / 022 6635 5600 Ext: 106 magazine.
Send your stories, questions, opinions
and suggestion to editorial@diabeteshealth.co.in

Relevant Information Interesting Recipes


I found the Diabetes Health I have found Diabetes Health
magazine to be accurate and magazine to be educative and very
informative about Diabetes and helping. There is a lot of information
its varied complications. The present on Diabetes and other
articles address known and complications explained in a very
unknown medical issues in simple and comprehensive manner.
easy to understand language, Reading the article on The big fat
making it an interesting read. theory helped me understand the
All the articles in Diabetes importance of fat in daily diet. I really
Health, being written by do hope more and more people read
medical practitioners, offer such articles so that things change for
accurate and ethical the better. The recipes compiled in
information. This makes each issue are easy and interesting to
it reliable and try out. I would love to see more of
easy-to-follow. Could such innovative recipes for people who
you advise on the best love to try new delicacies.
way to continue my subscription?
- Suman Nair, Mumbai
- Col. Borah, Pune
Suman,
Col. Borah,
Thank you for your words of
Thank you for your feedback. Your words have appreciation. We are glad to hear that
certainly encouraged us to strive more to our articles are of help to you. We
create awareness about Diabetes and its would be happy to bring more
related complications. Please fill up the information on Diabetes and other
subscription form in the magazine and send it conditions. We will certainly try and
to us along with the requisite payment add more such interesting recipes with
amount. We will continue to include relevant minimal and effortless preparation. If
information with every issue. Also please feel you wish to ask any query or
free to get in touch with us through email for information, please feel free to get in
further queries. touch with us through mail.
- The Diabetes Health Team - The Diabetes Health Team

02 DIABETES HEALTH APR-MAY 17


Another Titanic
The night was cold, the water freezing and the ocean dark. The
stars refused to look down. The sinking ship stood vertical,
silhouetted against the moonlight. The Titanic then, made her
final descent. Jack left her hand willingly, even wilfully. The
screen shows him drowning, face upward, hands
outstretched - about to meet his destiny of death and possibly,
beyond. This scene is from the movie made on the sinking of the
ship called Titanic. The star-crossed fictional lovers, Jack and
Rose, part ways, a moment in time that is frozen in every
moviegoer's mind.
What if the Titanic (in the movie) had never sunk? Probably, Jack
and Rose would have reached the shores of America, the promised land and may have married. It
is also possible that Jack, given the pluck that he showed in the movie, could have been a stock
broker in NYSE. It is also not difficult to picture Rose as his wife - a working mother with
children - an ideal couple living the American Dream.
It is here that I must ask you to take a greater leap of imagination. It is likely that as a stockbroker
in the USA, Jack would have developed lifestyle related illnesses. Prosperity brings obesity and
stress leads to smoking - and it is not too difficult to picture Jack as a high-profile stock broker
with Diabetes, obesity, high cholesterol, hypertension and even heart disease. And Rose too, with
increasing prosperity and the stress of bringing up children in a fast-changing America, could have
obesity with Diabetes and sleep apnoea.
I apologise for disturbing your romantic impressions of the movie Titanic and suggesting the
eventual decline of the Jack-Rose relationship. I apologise, yet there have been others with similar
theories. Indeed, there is a Hollywood movie called The Revolutionary Road, which postulates
such a decline and the lead roles are played by the same actors as in the Titanic.
However, my point is different. The rosy promise that marriage begins with is soon
weather-beaten into a more realistic picture by the harsh realities of modern life. And when lifestyle
related diseases like Diabetes complicate the picture, life and health can be affected in several
ways. Fortunately, as always, there are solutions.
The eventual occurrence of lifestyle diseases complicating a family's life is but one of the
narratives in the feature-rich cover story in this special issue of Diabetes Health. We also cover
other issues relating to marriage and Diabetes. Shouldn't Diabetes be disclosed prior to marriage?
Diabetes, via several mechanisms, leads to sexual dysfunction. Certain medications too can cause
erectile dysfunction. In such a scenario, how should patients deal with all these? After all, matters
of the heart are already complicated, and a marriage must not sink like another Titanic.
Take heart (pun not intended!) - as we try to answer all these questions and more in this special
issue of Diabetes Health!
Dr Unnikrishnan AG
Editor

APR-MAY 17 DIABETES HEALTH 03


32 Managing Obesity
COVER STORY
Should surgery be considered for tackling obesity?
Safeguard your bond by better managing your sugar
levels 50 The Basics of Insulin Therapy
Understanding the fluid for a better glucose control

PEOPLE
Coming to terms with your diagnosis
40 Stress-free Management of Diabetes
Don't let Diabetes take control of your life

10 Marriage and Diabetes Mellitus


Let Diabetes not decide the course of your married life
16 Diabetes and Intimacy
Keep your glucose control close and your partner
closer
22 Happy Sexual Life with Diabetes
DIABETES CARE
Know Diabetes to enrich your intimate moments Managing Diabetes in your day-to-day life...

26 Womanly Woes 70 Yo-yo Dieting: A Road Not to Be Taken

Balancing the matters of the heart with Diabetes Keep away from the prohibited lanes of dieting

EDUCATION
Because knowledge is your best ally in dealing with
Diabetes

04 DIABETES HEALTH APR-MAY 17


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

REGULAR
2 Diabetes Health Forum
Letters from Diabetes Health readers
6 News
56 Importance of Insulin Needle Care
The latest updates from the world of Diabetes
Know your weapon better for fighting Diabetes
31 Medicine Cabinet - Omeprazole
NUTRITION Our feature keeps you updated on your meds

Eat smart, eat healthy and enjoy life! 48 Testing Room - Retinal Fundoscopy

42 Substitute Sugar to Better Manage Your Know your tests and their implications
Health 39 Ask Diabetes Health
Appease your taste buds without troubling the sugar Our experts answer your queries on Diabetes
levels
76 Answers to Diabetes Health Quiz
Recipes Answers to the Feb-Mar'17 Diabetes Health Quiz and
45 Gajar Halwa the lucky winners

46 Basundi 78 Health Predictions

47 Besan Laddoo What's on the cards for the coming months?

FITNESS b e tes Health


e e D ia
Win fr nd T-shirts
!
Because physical activity is important too!
c r ip t io n a
subs
62 The Science behind Accurate Posture at
Workplace
Why workplace posture matters!

69
D ia b e te s H e a lth Quiz - Page
The
o u r D ia b e te s Story - Page 80
Share y

APR-MAY 17 DIABETES HEALTH 05


NEWS

Diabetes experts conclave held in Pune


International The international
Diabetes Summit Diabetes Summit
2017, organised by offered a unique
Chellaram Diabetes platform where
Institute, Western experts from various
India's leading specialties interacted
tertiary care with medical
Diabetes hospital, researchers and
was a resounding delegates to present
success. The the best practices in
summit organised basic and advanced
from Diabetes care. A
10th to 12th March in variety of topics
Pune was attended by over 1500 doctors, world related to Diabetes were discussed such as the US and
renowned Diabetes experts from Mayo clinic, USA and Indian perspective of managing sugar levels in a
Karolinska Institute, Sweden and researchers. The hospital setting, Diabetes and technology, setting up a
summit was accredited by Maharashtra Medical Diabetes clinic, the future of bariatric therapies,
Council with artificial pancreas device system that helps people with
7 credit points for the delegates. The summit was Diabetes to automatically monitor and provide insulin
presided over by Mr Lal L. Chellaram, the Patron and to correct the increased blood glucose levels,
Chairman of Chellaram Diabetes Institute. The chief cardiovascular risk and Diabetes, continuous glucose
guest Prof. K. Srinath Reddy, the current President of monitoring in Diabetes care. The three day
Public Health Foundation of India (PHFI), was conferences offered a unique platform for researchers
felicitated with the Lifetime Achievement award. to present papers and participate in oral presentations.
Across three days, numerous workshops, debates, The International Diabetes Summit 2017 brought
satellite symposia, presentation of interactive case together leading personalities from the world over who
discussions and key note lectures were focused on have been studying the increasing problem of Diabetes
addressing how best to tackle the growing threat of and are contributing effectively to the growth of
Diabetes in India. Better management of Diabetes and knowledge. Their participation in the summit enriched
its complications is the need of the hour because over the discussion and added to the knowledge of all the
69 million people have Diabetes in India and this participants.
number is expected to rise to 140 million by 2040.

06 DIABETES HEALTH APR-MAY 17


NEWS

Eat While You Succeed!


A recent report from Central Board of Apart from
Secondary Education (CBSE) has come up exams, the
as relief for children with Type 1 Diabetes. CBSE
Concerned about the blood sugar levels of Committee is
the students dipping to low levels during the also planning to
exams, CBSE has decided to allow X and XII advise schools
standard students with Diabetes to take to allow
mid-snack break during the exams. The students with
initiative has been taken after a study Type 1 Diabetes
conducted by Delhi Diabetes Research taking snacks in
Centre lead by Dr Ashok Jhingan on between their
students of four Kendriya Vidyalaya schools. regular classes.
As a part of the study, the participant According to
schools permitted their students to take recent statistics,
mid-snacks during the exam. India has
witnessed a rise
Children with Type 1 Diabetes require
in the incidence
lifelong administration of insulin. Once they
of Diabetes in
take insulin injection in the morning, they
the last few
are likely to get hypoglycaemia (low blood
years and is
sugar) during exams. This can lead to
currently the
sweating, trembling, confusion and fainting.
third highest
Hence it is important for children to take
country with incidences of Diabetes.
mid-time snacks. Considering that the
Keeping in view the current numbers, such
students need to be consistent through the
steps can pave way in spreading awareness
three hours of the exam duration, a mid-
and better managing the condition.
snack break can be a good way to keep up
their performance level.

APR-MAY 17 DIABETES HEALTH 07


NEWS

Sambar Helps Prevent


Colon Cancer

Colon cancer is the third most commonly dietary agents such as turmeric, saffron and
diagnosed type of cancer, especially in the flaxseed contain carotenoids which are
western countries. One contributing factor known to prevent certain types of cancer
to this is the kind of food consumed in the and eye diseases. They also possess
western countries. Apart from factors such elements like catechins that are known for
as obesity, sedentary lifestyle and old age, their antioxidant properties and help prevent
erratic dietary choices can also wreak havoc heart disease, cancer and brain-related
on health. Significant studies have shown degenerative diseases such as dementia.
that countries which follow low fibre and
A recent preclinical study has shown that
high fat diet are more at risk of being
sambar, an Indian dish, has therapeutic
diagnosed with colon cancer than countries
effects in colon cancer. The spices used in
which do not. Also consumption of foods
sambar are dried, finely powdered and
high in calories, red meat and processed
added in a specific manner to give the dish
meat increase the chances of colon cancer.
its rich, exotic taste. The spices include
Many studies have shown the traditional and fenugreek seeds, coriander seeds, dried
scientific value of spices in food. Not only do chilli, asafoetida, curry leaves, black pepper
spices make the food taste better, they also and turmeric. All these ingredients were
contain various therapeutic benefits that found to be anti-carcinogenic in the study.
help in keeping several chronic diseases at Another finding of the study was that
bay. Commonly used herbs such as black sambar prevents demethylhydrazine
cumin (kaala jeera), garlic (lahsun), cloves (DMH)-induced oxidation in the tissues of
(laung), cinnamon (daalcheeni), thyme colon, which means that it has antioxidant
(ajvaayan), black pepper (kaali mirch), bay elements.
leaves (tej patta) and mustard seeds (sarson)
possess antimicrobial and anticarcinogen Source: Pharmacognosy Magazine Journal
elements that help prevent cancer. Minor

08 DIABETES HEALTH APR-MAY 17


NEWS

Injection
Port in
Diabetes
Management
The most common apprehension that to insulin and do not know how to
people with Diabetes share is the fear of administer through pump can easily use this
needles. The regular jabbing and insertion device. It is also comfortable to use by
makes it painful and stressful. With i-Port, people who are scared or stressed with the
managing blood sugar levels has now frequent jabbing. The device is easy to use
become very easy. i-Port is a disposable and requires minimal training. It is
injection patch that is worn on the skin for a comfortable to wear and fits flexibly with
smooth insulin injecting process. It is small, daily activities as well as rigorous activities
discreet and one can barely feel its presence such as exercising, sleeping and bathing.
on their body. I-Port sits comfortably on the
skin and once inserted, the port can be used
for many days and does not require site
rotation. This helps reduce the number of
insertions an insulin user has to make for his
daily administration of insulin.
The port acts as a reservoir
delivering insulin into the
blood, thereby avoiding
insulin injection. The
user can administer
insulin either through a
syringe or a pen. It is
safe for use in both
Type 1 and Type 2
Diabetes. People who are new

APR-MAY 17 DIABETES HEALTH 09


Marriage
and Diabetes
Mellitus
These patients fear that they will transmit the
Introduction disease to the progeny. In addition, they fear
Can people with Diabetes get married? This a quality of life that is so dangerous that they
is a question that burns in the mind of every find it difficult to imagine the future care of
young person with Diabetes, whether it is a their spouse and children. They feel that
14 year old adolescent or a 25 year old once they develop blindness or kidney
professional. The reason for this worry can disease, they will no longer be able to care
be easily explained. Most of the people for their families. Last, but not the least is
harbouring such worries are either the unspoken fear of sexual dysfunction. It is
insulin-dependent or have Type 1 Diabetes. well-known that long standing, uncontrolled

10 DIABETES HEALTH APR-MAY 17


COVER STORY

Case no 1. The mystery of the


thin bridegroom
While sitting in my outpatient clinic and
seeing patients, my phone rang. It had been
continuously ringing for the last 10 minutes.
As a rule, I do not like to pick up the phone
whenever I am seeing patients. However, it
was 2 pm and I had completed seeing my
patients and was about to leave for lunch.
I picked up the phone. It was Dr Gupta who
had been trying to call me. Dr Gupta is a
well-known family doctor practicing in a
nearby town. He is also a close friend of
mine.
Dr Gupta sounded agitated. I have a
problem case, he said. Dr Gupta explained
to me that the case was about Mr Thomas,
an executive, who had recently married
Ms Jane. Dr Gupta knew Jane and her father
Mr George very well, as they stayed near his
house. Thomas got married to Jane about
40 days ago. Since marriage, Thomas had
been losing weight. In fact his weight which
It is well-known
had been 84 kg before marriage, now stood
at 65 kg. The whole family was worried. that long
Dr Unnikrishnan AG Consequently the couple, Jane and standing,
discusses three marriages Thomas, came to meet Dr Gupta, who had
uncontrolled
examined Thomas and ordered some blood
that kept their vow tests. The results showed that Thomas had Diabetes can lead
a random blood sugar level of 658 mg/dL! to sexual
in sickness and in health. The test was repeated on the next day and
dysfunction and
the results were strikingly similar. Dr Gupta
wanted to know if Diabetes could have infertility.
Diabetes can lead to sexual dysfunction and started after marriage. On my suggestion,
infertility. These questions disturb the mind Dr Gupta prescribed another test called the
of every young person with Diabetes. In HBA1c test. This test gives the average
order to simplify this issue and make things blood glucose values over the last 3 months.
clearer, I have decided to narrate my views A value of greater than 6.5 per cent suggests
on this matter in the form of three stories. Diabetes. In the case of Thomas, the HbA1c
All three stories offer different perspectives value was 13.2 per cent. Dr Gupta discussed
to this issue. The lessons learnt from the the implications of the test results with me. I
stories will give a reassuring go-ahead to the informed Dr Gupta that the results
idea of marriage for the young, healthy and suggested that Mr Thomas had been having
motivated adults with Diabetes mellitus. Diabetes over the last 3 months and that it

APR-MAY 17 DIABETES HEALTH 11


was unlikely to have begun after marriage.
I suggested Dr Gupta to call Thomas aside
Case no 2. The reluctant bride
and have a chat with him. Rakhi had been diagnosed of Type 1
A few weeks later, I received a phone call Diabetes when she was 8 years old. Being of
from Dr Gupta, who had called Thomas over a systematic and meticulous nature, she had
to have a discussion with him. When been taking insulin regularly since the
confronted with the facts that his HbA1c was diagnosis and maintained regular records of
high, Thomas confessed that he had been her sugar levels and medical visits. She
having juvenile, that is, insulin-dependent studied hard and passed her exams with
Diabetes for the last eight years. He had not flying colours. She was now working as a
disclosed this with his wife or her family. teacher in a government school in a small
With the hectic travelling and visiting that town. Soon, she became worried. She felt it
came soon after marriage, Thomas was not was unlikely that she would have a married
able to take the insulin injections on time. life. Who would marry her? For she felt, it
Also, he could not take the injections as he was not a simple case of marriage alone that
was afraid that his wife would see him taking was involved. To any husband, she came
them. As a result, his blood sugar levels rose with the additional baggage of Diabetes, its
and he began to lose more and more checkups, medicines and complications.
weight. By the time the weight loss was This thought made her very depressed.
severe and he was taken for testing, he no Her parents spared no effort in looking for a
longer had the courage to come out with the groom for her. One day, they received a
truth. positive reply. Dr Ramesh and his family
Dr Gupta had counseled Thomas and at his were interested in the proposal. They came
suggestion, Thomas confided the news (that to see her. Rakhi immediately asked Ramesh
he had been having Diabetes for the last whether he was aware of the fact that she
several years) to Jane. To his utter surprise, has Diabetes. Ramesh said that he is a
Jane accepted the news with a lot of doctor and that he truly does not mind if his
calmness, compassion and poise. She even wife had Diabetes. He had successfully
started helping Thomas with his insulin treated several patients with the condition
injections and glucometer testing. The and instinctively knew that it was only a
problem had been eventually solved. matter of keeping the sugar levels under
control. Soon they got married. Rakhi and
Ramesh are both successful professionals
today and they are the proud parents of
Durga, a little girl who, like her mother,
always comes first in her class.

Case no 3. The cautious couple


One day, Ms Farida came to see me. Farida
had been my patient for several years. I had
first seen her eight years ago, when she, a
seventeen year old twelfth standard student,
had got admitted with a dangerous
condition called diabetic ketoacidosis.
Following that, she was diagnosed to have
juvenile Diabetes and she had been taking
insulin injections for many years. Her
glucose levels were controlled and her appointment and after a few days, the two
HbA1c was at fantastic 6.3 per cent. young, soon-to-be-newly-weds walked into
my clinic. Mustaq was a smart young
Now Farida is 23 years old and as she stood
Information Technology professional and
before me, I was wondering what medical
listened to my statements with great
problem she is facing now. As if sensing my
attention. I explained that Type 1 Diabetes
unspoken question, she extended an
can be controlled with diet, exercise and
invitation card to me. Her nikaah was fixed
for the next month. After congratulating her,
insulin. I also explained that both her These days, most
glucose and the thyroid hormone levels
I asked her about her tests. This time too, people are aware
needed to be controlled prior to planning
her glucose levels were perfect. About of Diabetes, its
pregnancy. I reassured them when they
25 per cent of subjects with Type 1 Diabetes
have thyroid gland failure and last year,
asked me if their progeny would have any diagnosis and
chance of developing Diabetes. I explained
Farida too was diagnosed to have thyroid treatment. Hence,
them that over the long run, if glucose levels
gland failure, for which she was taking a it is always
are well controlled, Farida would have a
small dose of thyroxine tablet. Going
through her test reports, I found that her
lesser risk of developing Diabetes-related important to
complications.
thyroid hormone levels were also under share the truth
good control.
Three cases and three with the spouse
What was her future husband's profession, with regard to
I enquired. That is why I came to see you, messages Diabetes.
doctor, said Farida, I want to bring him
over to meet you. You must counsel him I have included three illustrative cases to
about my illness. I have told him all about summarise my views on Diabetes and
Diabetes and my need for insulin. Still, he is marriage. Firstly, I feel that the thin
not a medical professional and I would like bridegroom did not do the right thing by
him to aware of the medical aspects of my hiding the fact that he had Diabetes.
condition. Marriage is an institution based on mutual
trust and with regard to the diagnosis of
I immediately gave them both an Diabetes, honesty is the best policy. These

APR-MAY 17 DIABETES HEALTH 13


important and useful as
they bring clarity and
also confidence into
the minds of couples,
where one among the
couples is having
Diabetes. Many aspects
can be clarified in
advance. For instance,
if the thyroid functions
are checked and
controlled in advance,
pregnancy and
childbirth will have a
more successful
outcome. Taking
adequate vitamins and
controlling blood
glucose levels before
pregnancy is very
important and it is
important that both
partners realise the
days, most people are aware of Diabetes, its importance of better
diagnosis and treatment. Hence, it is always glucose control for a successful pregnancy
important to share the truth with the spouse outcome and married life.
with regard to Diabetes.
Uncontrolled Diabetes in the mother is bad
In the second case, Rakhi was indeed lucky for pregnancy. There is a risk of foetal
In addition to to get a doctor as her husband. For a malformation and abnormally large sized
infertility, medical professional would immediately babies. Also, mothers with Diabetes are at
Diabetes can know that if the blood glucose, blood risk of medical complications. In addition to
pressure and cholesterol are within normal infertility, Diabetes can lead to sexual
lead to sexual limits, a person with Diabetes stands an dysfunction too. For example, damage to
dysfunction too. excellent chance of leading a normal life. nerves and blood supplies to the sexual
Marriage and motherhood are not out of organs can cause erectile dysfunction in
bounds for diabetic mothers, provided that men. If Diabetes is well controlled, all such
they are motivated enough to keep their problems can be prevented.
blood glucose levels under control.
If blood glucose is well controlled before and
Of all the approaches however, it is the third after marriage and if all associated diseases
case, that is, Farida's that has the most ideal and problems treated, the person with
chance of a successful marital outcome. Diabetes will have a successful life that is
For here is a lady who not only disclosed the free of any sexual dysfunction or
diagnosis of Diabetes to her future husband infertility-related problems.
but also brought him to hospital for a
counseling session. Such sessions are Dr Unnikrishnan AG is a consultant
Endocrinologist.

14 DIABETES HEALTH APR-MAY 17


i a b e t e s a c y and
D I n t i m
Dr Manish Bothale explains how blood sugar control is crucial
for better sexual functioning.
16 DIABETES HEALTH APR-MAY 17
COVER STORY

highs and lows of Diabetes cause sexual


Diabetes and its complications dysfunction in men and women.
Diabetes mellitus refers to a group of
diseases that affect your bodys blood Sexual dysfunction and
glucose consumption. Glucose is vital to
your health because it is an important Diabetes
source of energy for the cells that make up
Sexual dysfunction is common in people
your muscles and tissues. It is also your
with Diabetes but is rarely discussed. Lack of
brain's main source of fuel. If you have
blood glucose control causes damage to the
Diabetes, no matter what type, it means you
blood vessels and nervous system. This
have too much glucose in your blood and Glucose is vital to
leads to lowered blood circulation and loss
this in turn can lead to serious health
problems. In simple words, Diabetes mellitus
of stimulation in sexual organs. As a result, your health
affected men have difficulty in maintaining
means elevated blood glucose (sugar) levels
an erection and affected women suffer from
because it is an
resulting from disturbed carbohydrate, important source
vaginal dryness.
protein and fat metabolism due to insulin
resistance or insulin deficiency. Sexual dysfunction is also seen in people of energy for the
Diabetes related complications arise when
with Diabetes as a result of medication cells that make
prescribed to manage heart disease or
sugar levels are high (hyperglycaemia) or low up your muscles
depression. Surgery of the bladder, bowel or
(hypoglycaemia). and tissues.
prostrate can increase the risk of sexual
Hyperglycaemia (high sugar levels) occurs dysfunction.
when the sugar levels are above the normal
High blood sugar levels are also known to
levels. The common symptoms include
lower body immunity thereby increasing the
blurred vision, dry and itchy skin, weight loss
risk of infection. This further increases the
and increase in appetite and thirst.
risk of yeast infections like thrush which
Hypoglycaemia (low sugar levels) occurs affect areas like vagina and penis.
when the sugar levels dip below the
normal levels. The common
symptoms include dizziness, anxiety,
sweating and nervousness.
If left untreated, Diabetes has the
potential to cause serious health
issues which include eye problems,
kidney disease, nerve damage,
cardiac problems, blood vessels
disease and skeleto-muscular issues.
The above mentioned are most
commonly discussed by people with
their doctors. But there are some
problems which people don't want to
discuss or feel some kind of
resistance to discuss with their doctor.
What is rarely discussed is how these

APR-MAY 17 DIABETES HEALTH 17


Urinary tract infections are seen in people
with Diabetes with poor blood sugar control.
It is important - This can cause discomfort for women
during intercourse and for men during
The presence of sexual dysfunction means that urination and ejaculation.
there may be co-existing Diabetes
Persistent high blood sugar levels can lower
complications affecting the eyes, kidney, heart
testosterone levels and decrease sexual
and feet. Thus, screening for these
desire or libido.
complications may be important.
High blood sugar levels can also result in the
To not delay your diagnosis or treatment of
skin being too sensitive even to simple
sexual dysfunction for an excessively long
touch. This increased degree of sensitivity
period.
can make sexual functioning painful.

Seek medical help


A lot of conditions mentioned above can be
managed with pills to treat lowered or
increased levels of hormones such as
prolactin, oestrogen, testosterone or thyroid
hormone. Sometimes medication prescribed
to manage heart problems, high blood
pressure, anxiety and depression could
hamper sexual functioning. Discussing your
sexual functioning with your doctor is
essential. This may help the doctor modify
the dosage or change medication to
alleviate the problem.
Seeking counselling is also necessary at
times. Sexual dysfunction related problems
may not only be physical but could also be
associated with low self-esteem,
embarrassment and guilt. Psychiatrists,
psychologists and sexologists are involved in
treating sexual dysfunction along with
physicians, andrologists and gynaecologists.
Timely medical intervention can help
minimise or alleviate sexual dysfunction
complications. Medication like sildenafil and
tadalafil both relax muscles found in the
walls of blood vessels and increases blood
flow to particular areas of the body. They are
used to treat erectile dysfunction in men.

18 DIABETES HEALTH APR-MAY 17


Reduce your risk
! Eat a balanced diet that includes at least five
portions of fruits and vegetables a day, and oily fish
like Mackerel twice a week.
! Cut down on harmful fats found in butter, cream,
meat products and biscuits. Reduce salt intake.
! Aim for at least 30 minutes of physical activity for at
least five days a week.
! Stop drinking alcohol or limit to recommended
levels, that is, 21 units a week for men and 14 units
per week for women.
! Don't smoke. Try to keep stress levels to a minimum.
! Ensure you undergo your annual Diabetes medical
check-ups and tests on time.

Healthy eating - Diet should ideally consist


Managing blood sugar levels of fruits, vegetables and whole grains (foods
The age old saying prevention is better than that are high in nutrition and fibre and low in
cure stresses on the need to keep a regular fat and calories. You will also need to make
check on Diabetes which is often termed as conscious efforts to cut down on sweets and
the silent killer. Maintaining a healthy weight refined carbohydrates. Depending on your
through healthy diet and exercise plays a blood glucose readings, your nutritionist
pivotal role in managing blood sugar levels. may allow you a sweet treat once in a while.
Blood sugar monitoring, insulin or A dietician will help you in developing a meal
plan that fits your health goals, food
Highs and lows
medications can help in managing Diabetes.
Equally important are healthy diet and preferences and lifestyle. Another concept of Diabetes
exercise. called 'carbohydrate counting' may also be cause sexual
taught to you, especially if you have
Monitoring your blood sugar - Careful
Type 1 Diabetes.
dysfunction in
monitoring of blood sugar is the only way to
men and women.
ensure that your blood sugar levels remain Physical activity - Exercise not only lowers
within the target range. Despite a rigid meal your blood sugar levels by transporting
plan, the amount of sugar in your blood can sugar to cells which is then used as energy
change unpredictably. With the aid of your but also increases insulin sensitivity, that is,
Diabetes healthcare team, you will learn how the body requires less insulin to transport
to recognise blood sugar level changes in sugar to cells. It is best advised to get your
response to food, physical activity, doctors approval before starting any activity
medications, illness, alcohol and stress; and if you haven't exercised in a while, then
and for women, fluctuations in hormone to start slow and increase the intensity
levels. In addition to normal blood sugar test gradually.
your doctor may advise you to do the HbA1c Medical management of blood sugar levels
test.

APR-MAY 17 DIABETES HEALTH 19


is possible by -
To conclude
Oral or other medications - Sometimes
oral or injected medications are prescribed. It is very common to feel sad, overwhelmed
Some Diabetes medications stimulate your or angry when you are living with Diabetes.
pancreas to produce and release more Managing your Diabetes, making changes
insulin. Others inhibit the production and and fitting the demands of Diabetes into
release of glucose from your liver, which your lifestyle can be challenging at times.
means you need less insulin to transport But you must remember that effective
sugar into your cells. Still others block the Diabetes management can only be achieved
action of stomach or intestinal enzymes that through working closely with your Diabetes
break down carbohydrates or make your healthcare team. Although they are there to
tissues more responsive to insulin. support you, you are the key player as the
decision you make will affect you in the
Insulin - People with Type 1 Diabetes require long-term. It is not an easy task but at the
insulin. In addition, some people with Type 2 same time it's not impossible. You have to
may also need insulin. Often insulin is make conscious efforts to make healthy
injected using a fine needle with a syringe or food choices, keep your weight within a
an insulin pen (a device that looks like an ink healthy range, exercise every day and take
pen, except the cartridge is filled with medicines even if you feel good. It's a lot to
insulin). Many types of insulin are available, do, but it's worth it! Taking care of yourself
including rapid-acting insulin, long-acting and your Diabetes can help you feel good
insulin and intermediate options. Depending today and in the future.
on your needs, your doctor may prescribe a
mixture of insulin types to use throughout Dr Manish Bothale is a consultant Diabetologist.
the day and night.

20 DIABETES HEALTH APR-MAY 17


Happy Sexual Life
with Diabetes
Dr Dhananjay Sathe explains why every physician should ask every person
with Diabetes - ''How is your sexual life?'
COVER STORY

Hunger and sex are basic human emotion. following issues -


Without food an individual cannot live and Decreased hardness of erection and
without reproduction the particular species difficulty in penetration
cannot survive. Sexual functioning is a highly Longer time to achieve erection
personal issue for every individual. Sexual Loosing erection in between coital activity
activity and basically erectile function of men Reduced night time and early morning
is a highly specialised process which involves erection
multiple elements.
No erection at all
Premature ejaculation
Key points in the mechanism of Pain during erection
erection Palpable hard mass/plaque in penis
Certain
Bending of penis upwards or downwards
To get an erection, a man needs healthy medications like
blood vessels, nerves, male hormones anti-depressants,
and a desire to be sexually stimulated.
Risk factors
tranquilizers,
Erection process starts with sensory The risk factors for erectile dysfunction
stimulation like touch, sound, smell and include obesity, smoking, Diabetes, high anti-histamines
sight. blood pressure, high cholesterol, heart and
disease, medication side effects and sleep
When the brain senses a sexual urge, anti-hypertension
disorder. Psychological factors such as
part of autonomic nervous system stress, anxiety, depression, low self-esteem, could cause ED.
transmits impulses to local nerves in the guilt and fear of sexual failure could also
penis. This causes relaxation of muscles cause ED. Certain medications like
through production of nitric oxide. anti-depressants, tranquilizers,
Increased blood flow through arteries fills anti-histamines and anti-hypertension could
the spaces in it and results in increased cause ED.
pressure, making the penis expand.
Erection ends after climax or after the Statistics
sexual arousal has passed. The incidence of erectile dysfunction is three
The muscle in penis contracts to stop times higher in men with Diabetes.
inflow of blood. Extra blood flow back
out through the veins to recirculation.

Erectile dysfunction (ED)


ED is defined as an inability to get or keep
an erection firm enough for sexual
intercourse. Although Diabetes and erectile
dysfunction (ED) are two separate
conditions, they tend to go hand-in-hand.
Diabetes affects all components of endocrine
(hormone), neurology (nerves) and vascular
(blood circulation) system.
People with Diabetes who suffer from sexual
dysfunction will have one or more of the
APR-MAY 17 DIABETES HEALTH 23
up taking over-the-counter drugs. With this,
there is loss in terms of time, money and
proper guidance and treatment.

Life style modification


Life style changes like increased physical
activity/regular exercise, healthy diet, weight
loss (if obese), quitting smoking, stopping
drinking alcohol and stopping the use of
50-75 per cent of men with Diabetes suffer over-the-counter medications are
from ED whose onset is earlier as compared recommended. Discontinuation of cigarette
to the general population who do not have smoking results in a recovery of functional
Diabetes. erection status. A beneficial role of
The presence of ED is associated with more increasing exercise for those with sedentary
than 14 times higher risk for silent heart lifestyle in men with ED has also been seen.
attack, higher risk of death due to heart
Medication
disease in men with Diabetes. This evidence
indicates that presence of ED in men with In people who have ED with Diabetes, it is
Diabetes could predict future heart attacks very important to control Diabetes which will
or strokes. These major events can be help to improve nerve condition and blood
prevented. supply. Prior to taking medication for ED,
one should do a complete evaluation for
The incidence of ED in men who have
Diabetes and related complications
Diabetes aged 20 to 29 years is 9 per cent.
especially heart-related because ED and
This increases to 95 per cent by the age of
heart disease share many risk factors. In
70 years. More than 50 per cent of men who
some cases, ED is an alarming sign of future
develop ED notice its onset within 10 years
cardiovascular diseases.
after diagnosis of Diabetes.
In people who
Psychosexual therapy
have ED with Evaluation of ED Counselling is one of the most important
Diabetes, it is parts of ED management. Counselling of
A complete medical and sexual history
very important to which includes past medical conditions and both the patient and his partner will help
them to improve understanding/satisfaction
control Diabetes any prescribed treatment is taken into
consideration. A questionnaire related to ED which cannot be achieved by any medical
which will help to management.
with questions will also be taken. A physical
improve nerve examination is conducted. A penile doppler Testosterone replacement
condition, blood study is conducted for vascular assessment
which would check the blood supply to the Diabetes is known to be associated with
supply. hypogonadism and lower levels of
penis.
testosterone. In such cases, testosterone
replacement therapy gives very good results.
Treatment Several testosterone preparations are
In spite of having tremendous development available for treatment like injectable,
in this field, due to personal embarrassment subcutaneous, transdermal (patch and gel),
and psychological pressure, people are buccal (relating to cheek and mouth) and
hesitant to discuss with an expert and end oral medications.

24 DIABETES HEALTH APR-MAY 17


effect.
Lines of therapy
In general the medication and other Third line therapy
forms of treatment represented by levels
are - In case of organic erectile dysfunction when
no other treatment works, penile prosthesis
First line therapy - oral therapy.
(artificial penis) is the final and effective
Second line therapy - self-injecting or
option. This is a surgical intervention to
vacuum erecting device.
enable a man to enjoy his normal sexual life.
Third line therapy - penile prosthesis
After 6-7 weeks the person can start his
or artificial penis.
normal sexual activity.

First line therapy Prevention is better than cure


Orally administered medication for ED is ED can be prevented by:
considered to be the ideal therapy, which
Lifestyle modification - Daily exercise
includes convenience, simplicity, and
(30-45 min/day), healthy diet, quitting
non-invasiveness. Specific medications for
smoking, stopping/limiting alcohol
ED includes phosphodiesterase 5 (PPD5)
intake.
inhibitors. PPD5 inhibitors act by enhancing
Lowering stress through stress
the action of nitric oxide, increasing blood
management.
flow to the penis and thus facilitating the
Managing blood sugar levels.
erection. The molecule known as sildenafil
and tadalafil relaxes muscles found in the Consulting an Endocrinologist/
walls of blood vessels and increases blood Andrologist/Urologist.
flow to particular areas of the body. In
Dr. Dhananjay Sathe is a consultant
general, oral therapy effectively achieves
Andrologist and Sexologist.
successful sexual intercourse rates of
approximately 70 per cent.

Second line therapy


Various locally active injections used to give
erection of sufficient rigidity for sexual
intercourse are available. But self-injection
training and education is recommended
prior to use at home.
Vacuum erection devices are mechanical
devices used for medical purpose. For
people who do not respond to or decline
oral or local vasoactive medicine, vacuum
erection device therapy is an alternative. The
principle of vacuum erection device therapy
is to mechanically create negative pressure
surrounding the penis in order to engorge it
with blood and then restrain blood outflow
from the organ to maintain the erection-like

APR-MAY 17 DIABETES HEALTH 25


Dr Asmita Potdar discusses
the most common Diabetes-related
sexual complaints in women.

Sex is such a taboo subject in the Indian


society, especially for women that in the
words of one of our most prolific writers,
Indian women go from one pregnancy to
next without ever realising that sex can be
enjoyable. We have not been taught to
communicate our feelings on the subject,
whether it is talking to the partner about
which parts of the act you enjoy or dislike,

Womanly
Womanly
or talking to your doctor about any
problems in the intimate areas. A chronic
disease like Diabetes may affect your
sexual life either directly through physical
manifestations on the reproductive
system, or indirectly via its emotional

Woes
Woes
impact of living with the added stress of
Diabetes management.

Sexual dysfunction in women


Continuous problems hampering a
women's sexual response, desire and
orgasm which recur frequently to cause
pain and strain the sexual relationship are
COVER STORY

termed as female sexual dysfunction.


Sexual response is based on a complex web
of physical and mental health, past
experiences, beliefs, lifestyle choices and
relationships. A disruption in any one of
these elements can affect sexual desire,
arousal or satisfaction. Treatment of sexual
dysfunction is often a multi-faceted
approach and treatment often involves more
than one approach.

Causes of female sexual


dysfunction
There are a variety of issues which can lead
to sexual dysfunction in women:
! Many physical or medical conditions can
affect a women's sexual well-being. These
include tiredness (fatigue), Diabetes,
heart disease, liver disease, kidney
disease, cancer, neurologic disorders,
vascular (blood flow) disorders and
hormonal imbalance.
! Emotional problems like low self-esteem,
depression and stress affect a women's
sexual function.
! Relationship problems like financial
problems and childrearing can affect Low sexual desire which results in
sexual function in women. lowered sexual interest or uninterested
sex.
! Insufficient knowledge about sexual
stimulation and response could prevent Sexual arousal disorder which involves
a woman from achieving a satisfactory inability to achieve or maintain arousal
experience. Poor communication would during sexual activity.
further hamper sexual intimacy. Orgasmic disorder which hampers
! Certain medications like anti- achieving orgasm.
depressants, chemotherapy drugs, drugs Pain during sex which is associated with
for controlling high blood pressure and sexual stimulation or vaginal contact.
antipsychotic medications are known to
lower sexual desire or arousal in women.
Diabetes makes things worse
Symptoms When Diabetes enters your life, it may loom
large over every waking hour of your day.
Symptoms of sexual dysfunction include: You may have to work extra hard to keep

APR-MAY 17 DIABETES HEALTH 27


a woman to experience the full
spectrum of intimate sensation.
This hindrance results in
circulation problems that
hamper intimacy as this leads to
nerve damage.
Diabetes takes a toll on a
women's sexual health directly
through its related
complications like nerve
damage and infections caused
by lowered immunity but often
the demands of managing and
coping with Diabetes can
influence sexual functioning.

Diabetes and
infections
By far, infections are the most
your days organised and maintain your common form of complication
routine with least disruption, always in women with Diabetes. The problem not
checking if the kitchen and the medicine only lies in its detection but also in its
cabinet are properly stocked, keeping track repetitive nature. Fungal infections thrive in
of your blood glucose, HbA1c and a horde Diabetes, so only treating the infections will
of other numbers and so much more. With not suffice. Controlling blood sugar levels is
so much on the mind, it is understandably equally important.
Fungal infections difficult to unwind and get in the mood for Another very important point is the
thrive in sex at the end of the day. The mood swings treatment of partner even if he is
and fatigue related to blood glucose level asymptomatic, as he may be the carrier.
Diabetes, so only
don't really help. And we're still just talking of Local vaginal tablets (pessaries) are very
treating the women with Diabetes. effective in treating vaginal infections.
infections will Diabetes can be hard on the partners as Vaginal infections
not suffice. well. Having a spouse with Diabetes
irreversibly changes your life and routine and High levels of blood glucose make you
Controlling blood vulnerable to microbial infections, the most
even in the most loving relationships, a little
sugar levels is resentment is not uncommon. So between common, or at least most spoken about
equally the stress, the resentment, tiresomeness and sign of this being slow healing of wounds
even the most minor forms of actual and the risk of infection from minor injuries.
important. The same problem may however manifest in
physical infections and complications of
Diabetes, the sex life may take a hit. some less discussed issues - less discussed,
because they may be embarrassing - like
When blood glucose is uncontrolled, it bad breath, and worse, vaginal infections in
hinders the functioning of the blood vessels women. If you have any of the following
that carry nutrients to our nerves which allow complaints, do consult your gynaecologist,
and also start monitoring your blood women feel embarrassed about this
glucose more closely. wetness, leading to less lubrication, less
relaxation and painful sex. Also because of
Vaginal Candidiasis
infection, a woman is always conscious and
It is a fungal infection caused by an increase hence reluctant to engage in sexual activity.
in the number of a common fungus called
Many women with Diabetes have polycystic
candida in the vagina. Small quantities of
ovary syndrome (PCOS) and may become
candida in the vagina as well as mouth,
overweight or obese. Weight issues are
digestive tract and on the skin are quite
always very sensitive and due to a
normal, but their numbers may increase
stereotypical definition of good
because of Diabetes. The signs to watch out
figure and fitness, many women
for are white discharge, itching, foul smell
go into a state of depression.
and discomfort.
Some women get so frustrated
Vaginusmus with their weight problems that
they prefer being away from the
It is a condition in which the muscles in
partner rather than face
vagina tighten and prevent a woman from
criticism and again being very
having sex. Besides the obvious physical
conscious about their weight,
hindrance in sexual performance, this may
especially while getting
give out the wrong signal to the partner,
intimate.
affecting the overall relationship. It is also a
cause for infertility.
Diagnosing the
Bacterial vaginiosis
problem
It is one of the most common problems of
the genital tract in women of reproductive In matters of sex,
age. This kind of infection in pregnant communication remains the
women increases the risk of pre-term birth. most effective yet the most
underrated tool. If a prolonged
Vulvar pain dry spell in the bedroom is
Some women with Diabetes may find their bothering you, the first person
sexual experience affected due to sensitivity you must go to is your partner.
of vulvar skin or other symptoms such as Ask yourself and answer
pain, sensitivity to touch, itching, burning, honestly:
redness and dryness. The condition is also Is it because either of you is
common in women suffering from suffering from low libido?
depression.
Is it you, or is it him?

Impact of infections on sex Is it psychological (stress,


depression, anxiety)?
Intense itching causes raw area and burning
sensation when touched, especially while Is it physical (illness,
having sex. Also due to infection, there is fatigue)?
always a feeling of 'wetness' and it is difficult Is it sexual (pain, infection,
to differentiate from normal lubrication foul smell, discomfort)?
which happens during sex. Invariably,
Visiting your gynaecologist

APR-MAY 17 DIABETES HEALTH 29


would be the first step in diagnosing any your bedtime routine, like a warm bath or an
dysfunction. An extensive medical interview aroma pedicure.
discussing your medical history including
Spend half an hour just before bedtime
any medical or mental illnesses and past
doing some daily chore together - it's a great
surgeries will be collected. You will be asked
way to bond and get comfortable with each
about your medication - over-the-counter
other before getting in bed. Do not feel shy
Think of some medications, herbs and supplements.
to seek some marriage counselling if
relaxation A physical examination will include pelvic needed. Speaking with a counsellor or
techniques that exam and sometimes referrals are made to therapist who specialises in sexual and
seek consultation of other specialists. relationship problems will help educate and
can be part of optimise your body's sexual response and
Laboratory tests are advised that will help
your bedtime your doctor determine your hormone levels
ways to enhance intimacy with your partner.
routine, like a and rule out certain conditions. X-rays and Effective treatment for sexual dysfunction
warm bath or an sonography test also could be advised. often requires managing underlying medical
condition or hormonal change. It is also
aroma pedicure.
Treatment and Management important to better manage blood sugar
levels as well as keep a check on your blood
If Diabetes-related stress seems to be the pressure. It is important to make time for
problem, talk to your partner about how you leisure activities that help distress and
may help each other organise your daily rejuvenate.
routine so you feel less tired and spent at the
Remember to consult your doctor for any
end of the day. Perhaps he can help with the
persisting problems.
shopping or kids' homework so you can
finish cooking early. Think of some
Dr Asmita Potdar is a consultant Gynaecologist
relaxation techniques that can be part of
and Obstetrician.

30 DIABETES HEALTH APR-MAY 17


MEDICINE
CABINET
Know your medication,
one dose at a time!
By Dr Vishal Bansode

Omeprazole
Omeprazole is a selective, also show signs of lowered magnesium levels such as
irreversible proton pump confusion, dizziness, uneven heart rate, tremors,
inhibitor which blocks the muscle cramps and spasms in hands and feet.
release of stomach acid and
decreases its production. It is also Who should take omeprazole?
prescribed to promote healing of
affected oesophagus due to You will be advised omeprazole if you:
stomach acid. Sometimes it can be
feel a burning sensation in the food pipe caused by
used in combination with antibiotics to treat ulcers
stomach acids (gastroesophageal reflux disease).
caused by the infection of certain bacteria.
have an ulcer.
Rx have gastritis leading to ulcers and deep sores in
the stomach lining.
The most commonly available forms of omeprazole are
tablets and capsules. It is also available in injectable have been diagnosed with tumour in the pancreas
form. Also omeprazole suspension is recommended or in the upper part of the small intestine
for use in children. (Zollinger-Ellison syndrome).
for preventing aspiration pneumonia due to
Advantages prolonged anaesthesia.

Omeprazole can be administered as a single dose per


day. Omeprazole relieves heart burn, indigestion and
Caution:
also helps prevent gastrointestinal tract bleeding. Omeprazole should be avoided by people who:
are allergic to omeprazole.
Possible side effects
have swelling in the spaces of the kidney (intestinal
The possible side effects of omeprazole are headache, nephritis) or cellular lumps inside the lining of the
flatulence, abdominal pain and gynacomastia stomach (gastric polyp).
(enlargement of male breasts). Long term use can
accelerate osteoporosis in elderly people. Also it can inform your doctor if you are already on other
affect vitamin B12 and iron absorption in the stomach. similar medication such as pantoprazole,
People who are having diarrhoea or stomach pain clopidogrel or on medication for other conditions
should avoid taking it. such as liver disease.

Omeprazole may induce convulsions, irregular kidney Dr Vishal Bansode is a consultant Diabetologist.
function such as lowered or elevated urine output and

APR-MAY 17 DIABETES HEALTH 31


Managing
Obesity
EXPERT VIEW

Dr Jonathan Purnell decodes obesity and how best it can be


avoided, in conversation with Dr Suganthi Kumaran

Dr Jonathan Purnell, an endocrinologist in Portland, Oregon, is associated with


many medical institutions including Oregon Health and Science University
Hospital and Portland Veterans Affairs Medical Centre. He is an alumni of
Oregon Health and Science University and is board certified in internal
medicine and endocrinology. His areas of interest include Diabetes, obesity,
endocrinology, metabolism and hyperlipidaemia. He specialises in Diabetes,
endocrinology and metabolism.

On the other hand, people from South


How is obesity diagnosed? and Southeast Asia manifest Type 2
Obesity can be determined by a number of Diabetes and cardiovascular risk at
ways, ranging from very high-tech machines lower body weights than European
that can precisely quantify the amount of fat populations. The World Health
and lean tissue in the body to the simple Organisation has attempted to identify
weight scale that you find at home. The two appropriate parameters of obesity in
most common ways of detecting obesity in Asian population, with data citing that
your doctor's office is by obtaining height risk for chronic diseases increases past
and weight to calculate body mass index a BMI threshold of 25 kg/m. Probably
(BMI) and using a measuring tape to more important for South Asians is the
determine waist circumference. waist circumference, indicative of
central obesity. Current consensuses
How is it graded? hold that central obesity is present in an
Asian woman with a waist
Thresholds for meeting the criteria for circumference greater than 80 cm (or
obesity based on BMI and waist 90 cm in an Asian man).
circumference vary. This is because obesity
is defined as the amount and/or distribution Can obesity be prevented or
of excess weight one carries that directly
contributes to chronic diseases such as treated with diet and
Type 2 Diabetes, obstructive sleep apnoea
and cardiovascular disease. For example, if exercise?
you are a woman of the United States or Genetic studies of families and twins have
European heritage, obesity is defined as a shown that upwards of 70 per cent of one's
BMI >= 30 kg/m or a waist circumference adult weight (whether you're thin, normal
>88 cm (a similar threshold for a man of weight or heavy) is determined by genetics
the same heritage would be a waist and other familial traits. Expression of
circumference >102 cm).

APR-MAY 17 DIABETES HEALTH 33


obesity involves an interaction between the concept to set points that regulate blood
genetic and familial potential for weight gain pressure and blood sugar levels. For roughly
and one's environment. In this regard, the 30 per cent of the US population, the body
most significant role for diet and exercise is weight set point operates in weight ranges
in the prevention of unwanted weight gain we consider to be healthy. For 70 per cent of
and expression of obesity. the US population, however, this set point
operates at levels of weight we consider
However, once obesity has become
abnormal, putting patients at risk of a
expressed, the majority of affected
number of other diseases. Corresponding
individuals will not be able to restore their
conditions related to elevations in set points
body weight to a healthier weight range and
for blood pressure and blood sugar levels
maintain in the long-term through just diet
would be hypertension and Type 2 Diabetes;
and exercise alone. This is because we now
conditions that we also consider chronic and
understand obesity to be the result of an
on which lifestyle has a modest impact.
altered 'set point' in the brain centres that
control appetite and energy Unfortunately, this set point in the majority of
expenditure. The purpose of obese patients will never spontaneously
this set point is to detect return to a lower level. Therefore, we
changes in food intake and consider obesity also to be a chronic
calories burned so as to disease in which lifestyle plays an
maintain weight within a important role but often necessitates
narrow range. It is treatment with medications
similar in or bariatric surgery as a

34 DIABETES HEALTH APR-MAY 17


part of an effective long-term weight-loss chronic diseases such as Diabetes and
maintenance strategy. Several large-scale cardiovascular disease. Summarising the
lifestyle intervention studies have been results from several recent large
conducted both in the United States as well epidemiologic studies both in the US and
as in Europe and China, all showing that the internationally, a healthy diet is considered
Obesity is defined
average amount of weight loss achieved by to be one that is primarily of the following: as the amount
overweight or obese patients through and/or
It is plant-based, including sources of oil
rigorous lifestyle programs approximates to
only 2-4 per cent of their initial body weight
that are also from plants and includes, distribution of
long-term. In fact, often people in these Fish excess weight one
trials will not lose any weight despite Nuts, and carries that
demonstration of adherence to the diet and
exercise regimes.
Whole grains directly
It is at this point of my conversation with
For a typical Indian dinner that includes rice, contributes to
the recommendation would be to choose chronic diseases
most obese patients that a look of anxiety,
less refined varieties than 'polished' rice.
frustration, disbelief or anger comes across
When animal products such as meat and such as
their face. I quickly point out that I am not
implying that they should not strive to eat a
dairy are included, they should be from lean Type 2 Diabetes,
cuts and low-fat sources. obstructive sleep
healthy diet and to be as active as possible,
including exercise regimens. The same An important consideration is to choose apnoea and
studies that showed modest to none weight foods sources that have not been processed
loss to these interventions, also showed but instead are 'whole foods', mainly those
cardiovascular
dramatic improvements in patient's health, that you would use to cook at home. disease.
including reduction in Type 2 Diabetes risk Processed foods that are characteristic of a
and cardiovascular disease. But if their sole number of 'convenience' food choices
purpose of trying a diet and exercise is to contain extra amounts of added sugars, salt,
lose weight, then the majority of people and fat that make them more desirable to
would be disappointed. I would rather eat but ultimately have been found to
convey realistic expectations regarding the promote unwanted weight gain,
impact of diet and exercise on body weight hypertension and heart diseases.
while emphasising the benefits to people's Unfortunately, in addition to being more
health, than to contribute to their being desirable, these foods are often more readily
discouraged because they could not achieve available, do not require extra effort to
their hoped-for weight loss goals. prepare and may be more affordable than
eating whole foods, making them an
What dietary tips would you increasingly more common choice for
individuals and families, as our lives become
recommend? more hectic.

Since the propensity for obesity is common Again, although consuming such healthy
among all populations and in the spirit of diet will take effort but only typically have a
prevention, what I recommend now for modest effect on some people with obesity,
everyone (lean, overweight, and obese) is to we still recommend they continue it for the
consume foods that have demonstrated to health benefits in other comorbid
be most likely to prevent weight gain and are conditions.
associated with the lowest population risk for

APR-MAY 17 DIABETES HEALTH 35


requires some creativity and overcoming
How much exercise is obstacles that often have been inadvertently
recommended? placed as a result of poor urban planning or
the adoption of newer technologies that
It is recommended that a person should try ultimately lead us to be more sedentary.
to incorporate between 30 minutes to an Examples might include installing standing
hour of moderate to high level exercise for desks for people who work in call centres or
at least five times in a week. What we are taking public transportation and getting off
recognising, however, is the importance of several blocks before you get to your work or
remaining active even during awake times home so you can walk more, rather than
when you are not exercising. These are the taking a car from your driveway to the
times when your brain and body can down parking lot.
regulate metabolism to hold onto extra
calories so as to maintain a higher body
weight, predisposed to unwanted weight
What are the metabolic risks
gain and contributed to Diabetes risk. associated with obesity?
Increasing one's activity outside the gym Traditionally, metabolic risks associated with
obesity have been high levels of cholesterol
and triglyceride, blood pressure and blood
sugars (leading to prediabetes and Type 2
Diabetes). More recently, disrupted sleep
cycle (changing work shifts, limited
sleeping time) and obstructive sleep
apnoea have also been identified as
contributing to worsened weight gain,
Diabetes control and increased rates of
cardiovascular events.

What are the


complications of obesity?
In addition to the comorbid
conditions mentioned above,
obesity is commonly associated
with oesophageal reflux,
degenerative arthritis of weight
bearing joints, infertility and
recent studies have confirmed
its importance in increased
cancer risk. This is primarily for
cancer in women, such as breast
and endometrial cancer.
Psychosocially, people who were
obese are more likely to be
depressed, to earn less in the

36 DIABETES HEALTH APR-MAY 17


market place, to experience discrimination
and are less likely to be married.
When is bariatric surgery
In addition, obesity may also have an indicated in obesity?
adverse impact on other diseases such as
Bariatric surgery has emerged as one of the
multiple sclerosis and worsens the outcome
best therapeutic options for long-term
in patients who are undergoing transplants.
weight loss treatment. If a patient undergoes
either a gastric bypass or sleeve gastrectomy
What are the medicines procedure, the average weight loss counts
closer to 25-30 per cent of their initial body
available to treat obesity? weight.
If a patient
In the United States, the FDA has approved undergoes either
Most countries consider a patient eligible for
five medicines for chronic management of bariatric surgery if their BMI is 35 kg/m or a gastric bypass
obesity. Each one of these medicines has more and they have an obesity-related or sleeve
been demonstrated to result in superior chronic condition (such as Diabetes,
weight loss than placebo and to have a gastrectomy
hypertension, arthritis, reflux, etc.) or if their
modest impact on long-term weight loss BMI is 40 kg/m2 or greater even if they don't procedure, the
maintenance, approximating 6-10 per cent have any other obesity-related conditions. In average weight
below the initial starting body weight. The Asian countries such as Japan, China and
original medications used for weight-loss loss counts closer
India, because of the increased risk for
maintenance, such as phentermine and Type 2 Diabetes and cardiovascular disease to 25-30 per cent
topiramate, were originally developed for at the lower BMI cut offs, some have of their initial
other purposes and incidentally found to suggested that patients may be offered
have sites of action in the brain that regulate body weight.
bariatric surgery if their BMI is 25 kg/m or
body weight. More recent medications have greater and they have any obesity-associated
been developed specifically because of our disorder.
new understanding of the brain pathways
that leads to obesity. Good examples of
these medications include GLP1 receptor
Which medical problems can be
agonist (liraglutide 3.0) and medications that managed after bariatric surgery?
target the serotonin receptor (lorcaserin)
within hypothalamic centres that control The medical conditions that are most likely
appetite. to improve after bariatric surgery include
Type 2 Diabetes and obstructive sleep
Outside of the US, formally approved
apnoea. A patient's chances of going into
medications for the treatment of obesity are
full Diabetes remission, meaning that their
much more limited. This might include the
HbA1c is normal and they do not need to
fat absorption blocker orlistat, or one of the
take any medications for their Diabetes, is
newer agents. The reason for this variation
when they have their surgery at the time they
in availability have more to do with cultural
are diagnosed with Diabetes or shortly
acceptances within each country for the
thereafter. If the patient has had
concept that obesity is a chronic disease
long-standing Diabetes and/or has
and therefore worthy of medical
progressed to the point where they need
management as well as concern regarding
insulin, full remission is less likely to happen
long-term safety of these drugs.
but they still may see an improvement in
Diabetes control and oftentimes will need

APR-MAY 17 DIABETES HEALTH 37


flow nutrients from the
oesophagus through the
stomach and into the intestine
with minimal impact on nutrient
absorption. Two other
procedures have also historically
been available but are now less
commonly recommended
because they are either much
less affective (the laparoscopic
gastric band) or result in greater
malabsorption-related
complications (the
biliopancreatic diversion) or
other procedures.

What are the


long-term
complications for
fewer medications or lower doses. If the bariatric surgery?
patient has severe reflux, a gastric bypass For any of the procedures, erosions or ulcers
will oftentimes cure this problem but a may arise at the site where the instruments
sleeve gastrectomy can exacerbate it. are placed or surgery is performed. For the
Long-term mortality studies that have procedures other than the laparoscopic
followed cohorts of surgery patients and gastric band, it is not uncommon to have
compared them to obese patients who have malabsorption of iron, vitamin B12, vitamin
not gone through surgery have consistently D and calcium, necessitating
shown that the likelihood of dying is less for supplementation of these vitamins and
people who've gone through bariatric minerals in the long-term. Other long-term
surgery and specifically reduces one's risk of complications will vary according to which
death between 40-90 per cent due to surgery was chosen. If a laparoscopic gastric
cardiovascular disease, cancer and band is placed, 20 per cent of the time
Diabetes. chances are that it may slip and need to be
removed. Patients who have had a sleeve
What is the best type of gastrectomy may experience worsening
gastric acid reflux and can have damage to
bariatric surgery? their lower oesophagus. Patients who've
undergone a gastric bypass may have a
The two most commonly recommended
higher rate of intestinal adhesions and
types of bariatric surgery are the gastric
unexplained abdominal pain or abdominal
bypass and sleeve gastrectomy. Both of
hernias.
these procedures can be done using
minimally invasive surgical techniques Dr Suganthi Kumaran is a consultant
(laparoscopically) and involve altering the Diabetologist.

38 DIABETES HEALTH APR-MAY 17


Experts at Chellaram Diabetes Institute, Pune answer your queries on Diabetes.
Send your questions to editorial@diabeteshealth.co.in

I am 54 years old. I have Diabetes since 2012 and I Regarding diet, the general rule is to eat on time.
am taking a combination of metformin, voglibose Ideally, diet should consist of three main
and glimepiride twice a day before breakfast and meals - breakfast, lunch and dinner and two healthy
dinner. My weight is 62 kg and height is 163 cms. snacks, one between breakfast and lunch and another
My fasting and post prandial (post lunch) blood between lunch and dinner. Also it is recommended to
sugar is under control but my post breakfast sugar take fruits and vegetables, mixed dry nuts and whole
levels shoot up to 200 mg/dL. Can you help me with grains. Again seeing your dietitian along with your
my diet, exercise routine and offer advice on any physician is recommended. Given the history of being
mobile apps. Should I supplement my allopathic on a combination of voglibose, glimepiride and
medicine with Ayurveda or Homeopathic medicine? metformin as a part of Diabetes therapy, you are likely
to be prone to Vitamin B12 deficiency. Your physician
Given your height of 163 cms and weight of 62 kg,
may check your Vitamin B12 level and supplement
your Body Mass Index (BMI) is 23.3 which according to
accordingly.
norms for Asians, falls under overweight category.
However if you are lifting weights and have more Regarding mobile applications, there are several. You
muscle mass, then this doesn't apply completely for can review applications such as Diabetes, Diabetes
you. I understand that your post-prandial blood sugar app before choosing.
after breakfast is high. You could try doing brisk walking
- Dr Suganthi S. Kumaran, Consultant Physician
for 15 mins, about 10 mins after your breakfast, to help
reduce your blood sugar. However, seeing your
diabetologist or your physician is strongly I'm a 39 year old obese man. I have recently been
recommended for a complete exam and further diagnosed with Type 2 Diabetes. I have heard a lot
management including medications. about meal powders and supplements. Do they
actually help? Along with weight loss, do they also
bring blood glucose levels under
control? Please advice.
Meal powders and supplements
may help reduce weight and blood
sugar levels. But again it depends
on diet and exercise. Also you
should not consume any type of
meal powder and supplement for
more than 3-4 months. If you use
these for a longer time, it may
affect your health. It is best to seek
physicians as well as dietician's
advice before you start.
- Rutuja Mahajan,
Clinical Nutritionist
and Diabetes Educator

APR-MAY 17 DIABETES HEALTH 39


Stress-free Management
of Diabetes

Ruchika Kathuria discusses how she learnt to lead a stress-free life


with longstanding Diabetes.
Name: Ruchika Kathuria Diabetes at the age of 5. My parents told me
that I started losing weight suddenly, drank
Age: 41 years
loads of water frequently and then one day,
Profession: Homemaker I fell unconscious. At the hospital, I went into
coma and eventually the doctors found out
The journey so far that my sugar levels were extremely high.
From then on, I was put on insulin. I had all
I am 41 years old and was previously
the typical symptoms of Diabetes at that
working in Chennai before moving to Pune.
time.
I have very faint memories of my life before
Diabetes. All I remember is that I used to be
very talkative, active and highly fond of
Impact of the diagnosis
sweets but apparently that didn't lead to my My parents were shocked initially because
medical condition. I was diagnosed with I was very small at that time and giving

40 DIABETES HEALTH APR-MAY 17


PEOPLE

injections to such a small child was more express. But my friends have always been
painful for them mentally than it was for me supportive and vigilant of me. They have not
physically. However, the doctors counselled just made me comfortable but also proud in
them well and explained everything so sharing anything and everything related to
clearly that all their doubts and Diabetes with people. Every time I am invited
apprehensions were removed. From then to my friends' place, they would prepare only
on, my parents accepted everything boldly, the dishes that I am permitted to eat. They
educated themselves, my sisters, me and would immediately fetch me something
everybody close to me as much as they sweet if I feel hypoglycaemic any time.
could. They conditioned me in such a
manner that I became smart enough to My Fitness regime
handle any kind of situation related to
Diabetes entirely on my own. I make sure that I eat plenty of green
vegetables and permitted fruits. I do eat
I feel that Diabetes does restrict some things
outside but with some restrictions and
which you really wish to pursue or take up in
portion control. I try to do some kind of There is a need to
life. There is a need to have a regimented
exercise but I prefer walking every day.
lifestyle. One can't afford to tamper with have a
time or diet or medicine, or else one loses I start my day with bedtime tea, one salt regimented
so much health-wise. Because of such biscuit or wheat-based biscuit. For breakfast,
restrictions, I couldn't go on long I usually take oats in milk or a toast with milk lifestyle. One can't
school/college excursions with my friends. and soaked almonds or daliya or upma or afford to tamper
I had to face some difficulties at the time of sprouts. My Mid-day meals include one fruit, with time or diet
getting admission in hostel for higher salad and nuts. For Lunch, I take 1-2
chapattis with curd and vegetable. My or medicine, or
studies as the wardens didn't want to
shoulder responsibility of someone like me. Evening tea includes 1-2 Marie biscuits or else one loses so
some other light snack. For Dinner, I take much health-wise.
Adapting my lifestyle 1-2 chapattis with daal and vegetables.
Sometimes I take a bowl of soup before
Since I have been living with Diabetes for a dinner.
long time now and also I am
married, I have to try a little My inspiration
harder to maintain a healthy
lifestyle because of many My family and friends
other responsibilities. are my greatest pillars
However with the support of strength. The fact
and co-operation of my that I love my near and
husband, who also happens dear ones and more
to have Diabetes, I am able than that they love me
to lead a happy and healthy encourages me to
life. Of course it's not easy to follow a healthy lifestyle
achieve consistent levels but and stay happy. I can
with regular monitoring, I try show my love to them
and maintain my blood only by leading a
sugar levels. healthy and happy life.

I miss some kind of freedom


at times that is difficult to

APR-MAY 17 DIABETES HEALTH 41


Substitute sugar to better
manage your health
NUTRITION

Diabetes Health Team discusses an all-natural sugar substitute


to satisfy those taste buds!
discovery more than a century ago, several
What makes sugar so bad? countries have begun cultivating it for use as
We are what we eat! This makes it important a safe sugar substitute. The addition of
to classify how every food type can help us Stevia brings down the total amount of
improve our health and maintain our sugar or glucose that is consumed while a
well-being. Proteins are building blocks and small quantity of sugar helps to retain the
used for growth and repair of various original sweet taste of the drink. This kind of
organs. Carbohydrates (carbs) are utilised as strategy helps reduce up to 90 per cent of
fuel to work the organs and fats are store the overall sugar load.
houses storing the excess carbohydrates as
well as nutrients and vitamins for a leaner Stevia in Indian cuisine
time. Fibre works as the facilitator in The addition of
digestion and absorption of the three Indian food habits are dominated by sugar
based products for every festive occasion.
Stevia brings
nutrients and helps keep the digestive
machinery unclogged. Since carbs Stevia comes very close to sugar in terms of down the total
essentially provide the energy or fuel for the taste, making it as diverse as sugar in its amount of sugar
cells we are naturally programmed to accept uses. It also resembles the stability of sugar
in terms of physical properties, such as
or glucose that is
intake of things that are sweet. And adding
sweet taste to various nutritious foods stability over wide range of temperature and consumed while
consciously can make it much more acidic/basic medium; thus, allowing Stevia a small quantity
palatable and enjoyable. to be used in almost all kinds of cooking
processes. Whether you use it in steaming
of sugar helps to
What goes wrong is the amount of refined hot beverages, cold desserts, frozen ice retain the
sugar we add to food. The dose makes the creams or heat it till it caramelises just like
poison. Large quantities (spoonful) of sugar
original sweet
sugar, it resembles both texture and flavour
taken at a time, allows higher blood sugar of sugar. Its taste complements well with
taste of the drink.
peaks and forces the body to compensate dairy and therefore, can be used for typical
which ultimately either unbalances the total Indian recipes like laddoo, halwa and barfi.
carbs you consume or overload the body
systems in trying to utilise or store them in
some way. Harmful effects of excessive
Advantages of stevia
sugar have been studied in detail and result The extract of stevia plant is purified and its
in a number of health concerns like bitterness is reduced using a unique process
resistance to insulin, rapid weight gain that ensures you can add all the sweet
ultimately leading to obesity, dental flavour, without an overdose of sugar. Its
problems and increased uric acid levels anti-oxidant nature is advantageous to all,
leading to heart and kidney disease. while its benefits against insulin resistance
and metabolic problems make it a safer
The way forward option than sugar. Stevia has no side effects
with long term use. Since its purified extract
Stevia, also known as Paraguay sugar, is is 300 to 350 times sweeter than regular
obtained from the Stevia Rebaudiana plant sugar, stevia can be used in small quantities
which is native to South America. Since its to suit our tastes, making it virtually

APR-MAY 17 DIABETES HEALTH 43


calorie- free. Stevia exhibits anti-oxidant erythritol, maltodextrin which are
properties which help in healing and repair commonly used with artificial sweeteners.
as well as maintaining smooth metabolic
Sugar in Stellar Gold is ordinary sugar and
function at cellular levels. Steviol glycosides
will be absorbed in blood in the same
Since its purified have been associated with improved insulin
manner. However the drastic reduction of
sensitivity thus proving very beneficial to the
extract is 300 to South Asian, Indian population who are
sugar required per serving ensures that
Stellar Gold does not add any significant
350 times sweeter genetically predisposed to develop insulin
glucose load to food. For instance, one
than regular resistance.
serving of Stellar Gold has a glucose load of
sugar, stevia can Formulations of Stevia can be made 0.6 whereas one serving of ordinary sugar
7-10 times sweeter than ordinary sugar. This has a glucose load of 3.75 and 20 calories.
be used in small makes it very easy to sweeten foods with just Stellar Gold provides just 0.7 gms of
quantities to suit a pinch of stevia instead of a whole spoonful carbohydrates per serving and has only
our tastes, making of sugar. As the base is standard sugar, it 3 calories.
does not add artificial or unknown
it virtually ingredients into your recipe and can be used To conclude
calorie- free. like ordinary sugar, just in much smaller
quantities. Stellar Stevia provides a useful option for
sweetening foods. The Stellar Gold blend
Stevia may be adopted into the diet as a
resembles ordinary sugar but allows to be
replacement for sugar by persons of all
used in very tiny quantities in standard
ages. It is especially beneficial to women
recipes thus easily and drastically reducing
who may be at high risk for metabolic
consumption of sugar.
dysfunction not limited to insulin resistance
Note: It is important to always consult your physician
but also including thyroid problems, and dietician prior to introducing changes and food
polycystic ovarian syndrome, osteoporosis, substitutions to your diet. Make sure you consult your
excessive weight gain and obesity. healthcare physician if Stellar Gold is suitable for
consumption, prior to intake.

Stellar Gold
Stellar Gold is a unique blend of cane sugar
and natural sweetener Stevia. One serving of
stellar blend consists of a tiny amount of
stevia powdered sugar which is as much as
7 times sweeter than ordinary cane sugar.
Stellar does not contain fillers like isomalt,

44 DIABETES HEALTH APR-MAY 17


Gajar Halwa NUTRITION

You would hardly meet a person who For garnish


doesn't like gajar halwa. The sweet, 2 tbsp almond silvers
mouth-watering flavours and tantalising aroma
of the preparation is like a therapy to the soul. Method:
Bring out your inner chef and enjoy preparing
this rich desert without worrying for calories. Heat ghee in a deep, non-stick pot (kadhai).

Preparation time: 20 minutes Add grated carrots, mix well and cook on a medium
flame for 3 to 4 minutes, while stirring continuously.
Cooking time: 20 minutes
Heat and saut mawa to make it soft and loose.
Makes about 8 servings
Add the sauted mawa to the cooked carrots, mix
Ingredients: well and cook for another 3 minutes or until the
carrots are soft.
For halwa
Add milk and cook it by covering and intermittent
6 cups grated carrot stirring till the milk is evaporated.
2 tbsp melted ghee Add Stellar Gold, mix well and cook on a medium
flame for 2 minutes, while stirring continuously.
500 ml whole milk
Add cardamom powder and mix well.
3 tbsp Stellar Gold
Garnish with almond slivers and serve warm or store
1 cup crumbled mawa (khoya)
refrigerated in an air-tight container till serving.
tsp cardamom powder

Note: It is important to
always consult your
physician and dietician
prior to introducing
changes and food
substitutions to your
diet. Make sure you
consult your healthcare
physician if Stellar
Gold is suitable for
consumption, prior to
intake.

APR-MAY 17 DIABETES HEALTH 45


Basundi
The mild, tantalising taste of this thickened For garnish
milk delicacy will not easily let you drop the
Cardamom powder or saffron soaked in
spoon after just one bite! Loaded with the
milk
goodness of dry fruits and natural flavours,
it's a popular dish enjoyed in Gujarat, Dry fruit pieces of such as cashew,
Maharashtra and Karnataka. It is also known almonds and raisins
as Rabri in North India and is prepared with
a slight variation. Enrich your taste buds with Method:
this minimal preparation desert.
Place milk on the flame and keep the
Preparation time: 10 minutes heat to the minimum.
Cooking time: 45 minutes Boil milk with continuous stirring till it is
Makes 5 servings about 1 litre.
Add Stellar Gold and let the preparation
Ingredients: boil for a minute. Turn off the flame.

For basundi Add slivers of dry fruits and stir.

2 litres of whole fat milk Add cardamom powder and saffron


soaked in milk.
2 teaspoons of Stellar Gold (8 gms) in
place of regular sugar Serve immediately or chill in the
refrigerator before serving.

Note: It is important
to always consult
your physician and
dietician prior to
introducing changes
and food
substitutions to your
diet. Make sure you
consult your
healthcare physician
if Stellar Gold is
suitable for
consumption, prior
to intake.

46 DIABETES HEALTH APR-MAY 17


Besan Laddoo
No celebration in India is complete without
having laddoos. Though the method of
Method:
preparation varies but laddoos have a Heat ghee in a deep, non-stick pot
unanimous favouritism across the (kadhai).
country - from north to south and from
Add coarse besan and stir continuously
east to west. Sweeten your special
till it is golden brown. (Dry roasting the
moments with this low calorie version of
chickpea flour and then adding it to
this traditional delicacy.
hot ghee makes the process faster).
Preparation time: 10 minutes
Turn off the flame and add 2 tbsp of
Cooking time: 15 minutes milk stirring vigorously. Leave the
Makes 15 laddoos mixture to cool down. The mixture at
this point lets ghee out and looks
Ingredients: slightly wet and shiny.
For laddoo Grind Stellar Gold as per your sugar
4 cups besan (Chick pea four) allowance and taste.
1 cup ghee Add the grinded Stellar Gold to the
2 tbsp milk mixture and knead well to make it soft
4 tbsp powdered Stellar Gold and mouldable.
Chicory root powder/Isomalt (optional) Make equal size laddoos and top each
For garnish with a cashew.
Cardamom powder
Cashew pieces

Note: It is important to
always consult your
physician and dietician
prior to introducing changes
and food substitutions to
your diet. Make sure you
consult your healthcare
physician if Stellar Gold is
suitable for consumption,
prior to intake.

APR-MAY 17 DIABETES HEALTH 47


TESTING
ROOM
Retinal
Fundoscopy

Dr Anand Palimkar guides to the basics of retinal fundoscopy.


Retinal fundoscopy is a test that allows the Note: Patient co-operation plays a vital role
doctor to see inside the back of the eye when performing the test. It is important to
(called the retina) and other regions inside minimise your movement while the bright
the eye using a magnifying instrument light shines into your eye as failing to do so
(ophthalmoscope) and a light source. will cause considerable discomfort. Also,
Retinal fundoscopy is performed to examine your doctor will allow you to rest for 10-15
the retina and detect cataract as well as seconds during the prolonged examination.
other eye diseases like glaucoma.
Retinal fundoscopy is considered to be Interpreting the results
90-95 per cent accurate and can detect the
Abnormal findings include:
early signs of many serious eye problems.
Features of glaucoma (increased
Performing the test pressure) in the optic nerve.
Diabetic retinopathy (damage to the
The patient is asked to sit comfortably or
retina due to high sugars) or
may lie in supine (face upwards) position to
hypertensive retinopathy (damage to the
minimise head movement. The patient is
retina due to high blood pressure) -
then asked to fixate on a target directly
(mild, moderate, severe).
ahead or above the face at a distance. The
best view of the fundus is obtained through Vascular occlusions (blockage of blood
a dilated pupil and this is especially true in vessel, usually by a clot).
older patients.

48 DIABETES HEALTH APR-MAY 17


Infection and inflammation on the
retina or vitreous (clear gel that fills
the space between the lens and the
retina).
Evidence of cataract.
Retinal tear or detachment.
Macular degeneration (loss of vision
in the centre of the visual field).

Word of advice
Examination of the ocular fundus
(interior of the eye) is an important
component of clinical evaluation in every
individual. This is true for patients with a
strong family history of ocular diseases. In Advantages
addition, in patients with Diabetes, increased
intracranial pressure, ischemic cardiac Non-invasive procedure.
problem and glaucoma should be tested Affordable.
frequently before complications worsen. Detects the initial stages of a disease
and gives a true picture of the systemic
Also, before going for the test, it is best to
condition and functions.
inform your doctor about -
Allergic reaction to medication.
Dr Anand Palimkar is a consultant
Whether you have persisting eye Ophthalmologist.
problems e.g. glaucoma.
Your case history or whether you
have a strong family history of
glaucoma.

Disadvantages
The only drawback is that you may
develop an allergic reaction to the eye
drops. Although such reactions are
rare they may cause:
dry mouth.
flushing (the patient's skin may
become red and hot).
narrow-angle glaucoma (acute
attacks of eye pain due to rise in
intraocular pressure).
dizziness.
nausea and vomiting.

APR-MAY 17 DIABETES HEALTH 49


The
Basics of
Insulin Therapy
EDUCATION

Dr Suganthi Kumaran explains the role and importance of insulin in


managing blood sugar levels.
more reaction when given to humans than
Knowing about insulin porcine insulin.
Pancreas is an organ lying horizontally in the The human insulin is produced by a
abdomen behind the stomach between liver Insulin is a
recombinant DNA technology (the process
and spleen. Insulin is a hormone produced by which desirable fragments of DNA from polypeptide
by the beta cells in the islets of pancreas. two different species are inserted into a host, hormone
Deficiency of insulin (in Type 1 Diabetes) or where it is replicated) using yeast or E. coli
decreased responsiveness of insulin (in consisting of
bacteria. Insulin analogues are created by
Type 2 Diabetes) causes high blood sugar altering the amino acid sequences using A and B chains of
levels in the blood. genetic engineering techniques. amino acids
In 1921, Sir Fredrick Grant Banting and
(protein). Chain A
Charles Herbert Best conducted a series of Functioning of insulin
experiments to understand the role of the contains
Imagine the cells as lock and insulin as key
pancreas and to identify the secret hormone 21 amino acids
secreting from the organ that controls blood for the glucose to enter in the cells. When
food enters in the body, the glucose released and chain B
sugar levels. Banting was of the opinion that
the secretion is being hampered by the from it deposits in the blood. The beta cells contains
in the pancreas are signalled to release
pancreatic juices and if he could shut the 30 amino acids.
pancreas and keep the islets open, he could insulin (the key) for the cells (the lock) to
trace the secret substance. After consistent take in the glucose. Insulin helps to push the
trials, they succeeded in extracting the glucose from the blood into the cells so it
hormones secreting from the islets and could be used for energy.
termed it as insulin.
Insulin is a polypeptide hormone consisting
of A and B chains of amino acids (protein).
Chain A contains 21 amino acids and chain
B contains 30 amino acids. The amino acid
sequence is unique to each species. For
example, the difference in the amino acid
sequence of human, porcine (pork from pig)
and bovine (beef from cow) insulin is:

Position Human Porcine Bovine


A8 Threonine Threonine Alanine
A10 Isoleucine Isoleucine Valine
B30 Threonine Alanine Alanine

Porcine insulin differs from human insulin


only by one amino acid as opposed to
bovine insulin which differs by three amino
acids. Hence, bovine insulin will induce

APR-MAY 17 DIABETES HEALTH 51


intermediate and long-acting insulin.
Characteristics of insulin
In humans, insulin is produced continuously
Insulin cannot be taken as a pill, as it is a even when the food is not eaten to maintain
protein and will be digested by the stomach the blood sugar levels produced by liver and
enzymes. It is administered as a other organs (background insulin). When the
subcutaneous injection (in the fat below the food is consumed, sugar spikes produced
skin). Insulin is characterised by the time it from the breaking down of food particles
takes to reach the blood from the injected also cause spurts of insulin (meal time
site (onset of action), peak action at which insulin). To mimic this physiological pattern,
maximum effect of insulin is produced long-acting or intermediate acting insulin is
(peak), followed by the time it continues to given that acts as a background or basal
lower the sugar levels (duration of action). insulin and short or rapid-acting insulin is
Based on these three characteristics, insulin given with meals that acts as mealtime or
is divided into three types - short, prandial insulin.

Commonly available types of insulin


Ty pes of Generic name Brand name Description Visual
Insulin appearance
Rapid acting Lispro Humalog Onset: 5mins Clear
insulin Aspart Novorapid Peak: 1 hour
analogues Glulisine Apidra Duration of action:
2-4 hours
Human Actrapid Onset: 30mins Clear
Short-acting Regular Peak: 2-3 hours
Huminsulin R Duration of action:
3-6hours
Human Insulatard Onset: 2-4 hours Milky/Cloudy
Intermediate - NPH* Peak: 6 -10 hours
acting Huminsulin N Duration of action:
10-16 hours
Long acting Glargine Lantus Peakless action for Clear
insulin 20-24 hours
analogues Degludec Tresiba Peakless action for
more than 24 hours
Premixed Human regular Mixtard 30/70 Mixture of short and Milky/Cloudy
Human Plus Mixtard 50/50 Intermediate-acting
insulin NPH Huminsulin 30/70 insulin
Huminsulin 50/50
Premixed Aspart plus Novomix 30 Mixture of rapid-acting Milky/Cloudy
Analogue protamine Novomix 50 and intermediate-
insulin Aspart* Humalog mix 25 acting analogues
Lispro plus Humalog mix 50
Protamine
Lispro*
Degludec plus Ryzodeg (30/70) Mixture of rapid-acting Clear
Aspart and long-acting
analogues
* By adding retarding agent like protamine the time of onset and duration of insulin action can be prolonged.

52 DIABETES HEALTH APR-MAY 17


Pre-mixed insulin Administration technique
Different combinations (30 or 50) of Generally abdomen, upper and outer part of
short-acting or rapid-acting insulin with the thighs and backside of the upper arms
intermediate acting insulin are given twice a are the sites where insulin is administered.
day to mimic body's insulin production. However, abdomen is the preferred site as it All types of
(Example: Mixtard 30/70 contains helps in uniform and fast insulin absorption.
insulin are
30 per cent of regular or short-acting insulin
Any scarred tissue, muscle and other such generally
and 70 per cent of intermediate acting
areas should be avoided. Insulin can be
insulin. Similarly, Humalog mix 50 contains
given through syringes or through pens with administered
50 per cent of lispro or rapid-acting insulin
insulin cartridges. After withdrawing the right subcutaneously
and 50 per cent of intermediate acting
dose of insulin in units, the needle of the (in the fat under
protamine lispro insulin).
loaded syringe is inserted perpendicular to
Even though they are relatively economical, the skin surface and the plunger is pushed the skin).
they are not as effective as four times of gently. The syringe is held in place until a
insulin injection therapy involving one long count of 10 to make sure that the required
acting insulin therapy at bed time, followed amount has been delivered. The syringe is
by three meal times (prandial) insulin then withdrawn along with the needle. The
therapy. injected site should not be rubbed. In case
of insulin pen loaded with insulin cartridge,
Newer insulin the knob of the pen should be dialed to the
right dose before the needle attached to the
Insulin degludec, one of the newer insulin
analogues and whose effect lasts up to
42 hours, seems to cause less
hypoglycaemia. Also a premixed
combination of 30 per cent aspart or
rapid-acting insulin with 70 per cent of
degludec is available as ryzodeg (30/70).
Insulin inhaler is available in the United
States. It is taken as pre-meal or prandial
insulin. Even though it may have the
disadvantage of taking large doses to
achieve the right insulin concentration in the
blood, it has the advantage of inhalation
instead of injection. (This can be an enticing
option for people with needle apprehension.)

Mode of administration
All types of insulin are generally
administered subcutaneously (in the fat
under the skin). During hospitalisation,
regular or rapid-acting insulin is
administered intravenously depending on
the clinical situation of the person.

APR-MAY 17 DIABETES HEALTH 53


pen is inserted. The plunger has to be
pushed and after counting to 10 while
Adverse reactions
holding the plunger down, it should be With the advent of purified human insulin,
made sure that the measured dose has been chances of adverse effects are very rare.
delivered. Giving insulin in scar tissue or not rotating
It is recommended to change the needle injection site will not only result in lumps and
bumps (lipodystrophy i.e. thickening or
It is recommended after a maximum of three to four uses.
Insulin injection site should also be changed thinning of fatty layer) but also cause pain
to change the while injection and poor absorption.
after each administration to avoid lumps and
needle after a bumps.
maximum of three Caution
to four uses. Storage While taking insulin, food should be taken as
per instructions, especially with prandial
Insulin injection Insulin can be stored at a room temperature
insulin. If the person takes prandial insulin
site should also be for about a month. It should not be placed and does not take food at the right time or
under direct sunlight (like on window sills) or
changed after each in the glove compartment of the car. Insulin skips the meal, he or she may have low
sugar levels (blood sugar levels below 70 or
administration to pens can also be carried in purse.
hypoglycaemia).
avoid lumps and If the insulin is stored in the fridge, after
withdrawing insulin in the syringe, it should
bumps.
be rolled in between both hands few times
Advantages of insulin
before administration to avoid the pain from Better and faster sugar control.
injecting cold insulin. Insulin almost always works in all
While travelling, cooling packs for insulin kinds of Diabetes.
storage are also available. Insulin injection therapy is usually
designed to mimic body's insulin
production.
54 DIABETES HEALTH APR-MAY 17
people with Type 1 Diabetes, as it eliminates
Disadvantages of insulin five times per day of insulin injection pricks.
Expensive It is a pager-like device that injects insulin
Chance of weight gain 24 hours a day. A small motor pushes the
piston which delivers insulin through a tube
Candidates for insulin to an area under the skin. This tube has to
be changed in every three days. Advanced
administration models also have the facility of wireless
People with Diabetes. connection with glucose monitoring device,
People with Diabetes and who had which predicts the hypoglycaemia trends in
oral anti-diabetic medication failure. people.
Diabetes in pregnant women.
People with Diabetes hospitalised for The future of insulin therapy
surgery or for serious infection. The ultimate goal is to eliminate the need of
People with Diabetes and with renal injecting insulin from outside and restoring
failure. the ability of pancreas to secrete insulin.
Pancreatic damage related Diabetes Closed loop insulin delivery system, also
(example, chronic pancreatic damage known as artificial pancreas, is being
because of alcoholism). explored currently and hopefully soon will
become the future of insulin therapy.
Insulin pumps
Dr Suganthi Kumaran is a consultant
Insulin pump is a good option, especially for Diabetologist.

APR-MAY 17 DIABETES HEALTH 55


IMPORTANCE OF
INSULIN NEEDLE CARE
DH TECH

Sweta Naik discusses the correct way of using and storing insulin needles.

different needle sizes and are equally


Why Insulin is pivotal to human comfortable to use.
body
Insulin is a hormone secreted by the beta
Insulin pen
cells present in the pancreas. It helps the Insulin pens are of two types - the first type
body to absorb the glucose present in the can be refilled and reused by changing the
blood and thus controls blood sugar levels. insulin cartridge and the second type is the
Insulin plays a pivotal role in the smooth one which can be used only for once or for Insulin plays a
functioning of our metabolic process, failing the specified time on the package. pivotal role in
which could lead to many serious medical
the smooth
conditions. An imbalance in the level of Needle size
insulin falls under two categories - one is functioning of
Pen needle sizes range from 4 mm to
when the pancreas fails to produce enough our metabolic
insulin and second is when the pancreas 12 mm but the recommended sizes are 4, 5
and 6 mm with gauge (size of the tip of the process, failing
produces insulin but the insulin is incapable
of absorbing the sugar, thereby leading to needle) sizes of 30, 31 and 32. Short length of which could
needles reduce the risk of intramuscular
sugar deposition in the blood. Type 1 lead to many
Diabetes or Juvenile Diabetes is commonly penetration. They are long enough to pass
through the layers of the skin but are short serious health
seen in children or young people. The
second type is known as Type 2 Diabetes. enough so as to not harm the muscle tissue. conditions
Lean people are recommended to make a
To control the elevated blood glucose levels, skin-fold for injecting with a 4 mm or 5 mm
people with Diabetes are prescribed to take needle.
insulin injections according to the
requirement of the body. Insulin comes in For children and adolescents
varied types and sometimes a combination Pens with 4 mm needles are safe and
of two different types of insulin is effective for administration in children.
administered depending on the need. Adolescents can use 4, 5 or 6 mm length
needles. When injecting into the limbs of
Administering insulin in children who are slim, a skin-fold is needed
especially while using 5 and 6 mm needles.
Diabetes
If there is only an 8 mm needle available
People with Diabetes and dependent on then it is recommended to make a skin-fold
insulin are usually prescribed use of insulin and inject at a 45 angle. Seek assistance
pens and syringes. The syringe comes with a while injecting in the arms and also a
fine needle for a painless and effortless skin-fold will be required when injecting the
insulin administration. Insulin can also be insulin.
taken by insulin pen, which is similar in
appearance to an ordinary pen. Like syringe, For adults
pen needles also come with a choice of A needle length of 4 to 6 mm is safe for use

APR-MAY 17 DIABETES HEALTH 57


in adults including obese people. A skin-fold prescribed sizes are 4 mm, 5 mm and
is usually not required in adults, especially 6 mm. Insulin syringes are available in three
for needles of 4 and 5 mm length. Short gauge sizes 29, 30 and 31. Insulin comes in
length needles should be inserted at a two different types - U-40 and U-100.
90 angle to the skin. A skin-fold is required Special care should be taken while using the
when injecting into the limbs or in leaner syringe, as a U-40 syringe supports only
abdomen. People who are using a needle U-40 insulin vial and a U-100 syringe fits for
bigger than 8 mm length should either U-100 insulin vial.
switch to a shorter one or make a skin-fold
or insert it at a 45 to avoid muscle prick. Sites of injection
A U-40 syringe
Insulin Syringe Body parts with adipose fat are the
supports only recommended sites of injection for people
Syringes have been in clinical use for a long with Diabetes. The abdomen is the most
U-40 insulin vial
time. Modern syringes are fit only for a single preferred site of injection. Apart from that,
and a U-100 use. This makes insulin administration a safe the top outer region of the thighs, outer
syringe fits for affair. The syringe consists of a plastic barrel arms and buttocks are also considered fit for
that holds the insulin dosage and is marked insulin administration. Injecting close to the
U-100 insulin
with measures, a plunger to press and belly button should be avoided.
vial. deliver the content in the syringe and a
needle through which the dosage is How to avoid injuries while
delivered.
injecting
Insulin syringe size Many needle injuries can be avoided by
Insulin syringes range from size 4 mm to following these simple steps:
12.7 mm but the most commonly Use a clean, sharp new needle of the
right length for every dose.
Inspect the injection site every time for
any lumps, swellings and inflammation
before injection.
Avoid reuse. Discard the injection needle
after a single administration.
Switch the injection site every week.
Rotation of injection site prevents
causing of skin injuries.
Keep the needle at a 90 angle to the skin
for injection. Inject slowly and ensure
that the plunger is completely pressed.
Avoid injecting in the hair roots.
Use short needles to avoid bruising and
pain.
Never inject in the bumps of the skin area

58 DIABETES HEALTH APR-MAY 17


Administering insulin using a pen

Step 1- Before injecting insulin; inspect the can dial up to 60 to 80 units.


injection site for any wounds, blisters, bruises
or lumps under the skin. If the site shows any Step 6- Select a site where you want to inject.
signs of an infection, inflammation or swelling, Abdomen is the most preferred site of
switch to a fresh patch. administration. If the needle size is more than
8 mm, make a skin-fold at the injection site.
Step 2- Insulin should always be taken with
clean hands. Injection site should be cleaned Step 7- Hold your pen at a 90 angle and
prior to the administration. insert the needle straight into the skin. Release
the skin-fold if made. Press the dial button
Step 3- Keep all the supplies ready that you using the thumb and hold for 10 seconds to
will need like alcohol wipes, insulin pen, insulin ensure that the dose is completely absorbed.
cartridge, and pen needles. The dial window goes back to zero once the
dialled dose is completely administered.
Step 4- Prime the insulin pen before injecting.
Priming ensures that the pen is working well Step8- Pull the needle out of the skin after
and it tips off the air present in the needle. injecting. Place the outer cap on the needle
and twist it clockwise to remove it from the
Step 5- Dialing the dose before administration pen. Discard the used needle in a sharps
allows the pen to deliver only the amount that container.
has been set in the dose window. Insulin pens

APR-MAY 17 DIABETES HEALTH 59


Administering insulin with syringe

Step 1- Get all the necessary supplies ready Step 5- Select a clean injection site.
including alcohol wipes, a meter for checking
blood glucose levels, insulin vials and a syringe. Step 6- Gently pinch the area of the skin and
make a skin-fold with your thumb and the index
Step 2- Inspect the insulin bottle contents for any finger.
changes such as clumping, frosting or
precipitation. Roll the bottle between your hands Step 7- Pierce the needle through the skin-fold.
until it is mixed well. Slowly push the plunger to inject the insulin.

Note: Never shake the insulin bottle for mixing. Wipe the Step 8- Wait for 10 seconds so that the insulin
top of the insulin bottle with an alcohol wipe. dose is properly absorbed. Release the pinch only
after taking the needle out of the injection site.
Step 3- Draw air inside the syringe equal to the
prescribed dose of the insulin. Pierce through the Step 9- Remove the syringe needle with a safe
rubber stopper of the vial in the centre at a 90 clip. Discard the needle safely in a sharps
angle and push the air in. Avoid touching the collector or a metal container.
metal rim of the bottle with the needle air inside.
Note: While keeping the syringe in the upright position,
Step 4- Draw the dose into the syringe slowly and check for the presence of any air bubbles. Air bubbles
should be removed by drawing more insulin units and re-
steadily, holding the bottle upside down. Once the
injecting the bubbles into the vial by pushing the plunger
required dose is drawn in the syringe, turn the vial back to the desired dose marking. The process should be
back over. Holding the syringe straight, carefully repeated until no air bubbles are present.
remove the needle out of the bottle.

60 DIABETES HEALTH APR-MAY 17


as it will lead to poor absorption and needle for the next dosage.
result in a fluctuation in the blood
Injecting through your clothes.
glucose levels.
Dripping of insulin while fixing the
Ensure that the cleansed patch is dry
needle.
before injecting.
Insulin leakage from the injection site.
Unsafe disposal
Common problems faced by Appearance of air bubbles in the syringe.
of needles
increase the
people with insulin injection Failing to see the insulin unit marks on
the syringe or correctly fixing units on chances of
Many a times people do not realise the the pen. exposure to
importance of taking the correct dose at
blood infections
the correct time. This skipping of the Safe disposal of the used
dose or incorrect dosage leads to such as Hepatitis
several complications. needles and HIV.
The fear of self-pricking due to lack of Safe disposal of the used needles is as
confidence sometimes leads to incorrect important as knowing the correct way of
administration of insulin.
This creates a roadblock to
better self-management of
Diabetes.
Needle injuries acquired
while recapping
the needles after
injection.
using them. Unsafe disposal of
A fluctuation in any needle increases the chances
the blood sugar of exposure to blood infections
levels due to lack such as Hepatitis and HIV. It is
of knowledge of important to dispose the used
the correct needles carefully in a sharps
method of container. If there isn't one, you
injecting insulin. can put them in a plastic container
Incision wounds that cannot be broken. Put a note
due to frequent on the container mentioning
jabbing at the 'sharps container' for easy
same place. recognition. Do not dispose the
needles in a regular dustbin or
Holding the pen flush it down the drain. Do not put
or syringe in an it in a recyclable waste bin. Collect
improper way the sharps in a container and
while injecting. contact the nearest healthcare
Removing the centre to discard them.
needle too quickly
after the incision. Ms Sweta Naik is a Dietician and
Using the same Diabetes Educator.

APR-MAY 17 DIABETES HEALTH 61


The Science
behind
Accurate Posture
at Workplace

62 DIABETES HEALTH APR-MAY 17


FITNESS

Dr Richa Kulkarni
discusses
how posture and
seating arrangement
at workplace can
Do you believe your posture enhances or
affect our portrays your sophistication?

overall health. Yes it does. Poor posture decreases efficiency


in work and maximises stress to the body,
whereas good posture increases workplace
efficiency and reduces the stress on the body.
Good posture keeps your muscles active while
you are working. So, just a little change to your
posture while sitting or standing can be
beneficial for your overall health.

Ergonomics
'Ergo' means 'work' and 'nomics' means Good posture
'natural laws'. keeps your
Ergonomics is a scientific discipline which muscles active
analyses and enhances health, safety,
efficiency, productivity and promotes
while you are
enjoyment at workplace. Ergonomics takes working. So, just
into account the employee's capabilities and a little change to
limitations to ensure that they establish a safe
and efficient association with the
your posture
environment, machines and equipment at the while sitting or
workplace; thereby achieving efficiency and standing can be
productivity. A systematic workplace
environment reduces physical and mental
beneficial for
stress and better contributes to the growth of your overall
the organisation. health.
The goal of ergonomics is to understand and
create a favourable environment that fits the
employees and the kind of task they perform.
Simple matters such as height of the
placement of machinery, the type of furniture
or the position of the stationery play a crucial
role in the physical well-being of a person.
Ergonomic studies are performed in more
than 20 disciplines and in three aspects.

APR-MAY 17 DIABETES HEALTH 63


The three aspects are: environment of the workplace - climate,
Organisational ergonomics works on temperature, pressure, vibration, light,
the betterment of man-machine moisture, air, wind, etc.
communication in an organisation and Physical ergonomics is concerned with
organisational structures, organisational the human body's response to the
policies, employee disaster training, physiological demands at the workplace
schedules, work timings and quality such as work posture, chair-desk setup,
management. material handling, machine size,
Environmental ergonomics deals with workplace injuries and repeated bodily
human interaction with the outer actions such as stooped posture while
working every day.
To understand physical ergonomics better, it
is necessary to focus on:
Posture
Chair, desk and computer structure
Fitness exercises

Posture
Posture is the intentionally or habitually
assumed position we take up while sitting,
walking, standing and sleeping. Certain
muscles of our body regulate our posture
every day without our realisation. The
muscle clusters such as hamstrings and
back muscles are responsible for keeping
the body posture upright, against the
gravitational pull. On the other hand,
ligaments are responsible for holding the
skeletal structure of the body against the

64 DIABETES HEALTH APR-MAY 17


gravity, while the posture muscles promote calorie saving and lesser physical activity.
movement and actions such as sitting or 2. Flabby abdomen/paunch: Slouching or
walking. If the body keeps taking up the stooping decreases the distance
same incorrect position every day, the between the sternum and the pelvis,
posture muscles get stressed and start which hampers the normal breathing
growing in the direction of the pressure. This pattern. Also, there is disuse of the The goal of
eventually results into bad posture. abdominal muscles which eventually ergonomics is to
Posture is basically divided in two parts - leads to obesity.
understand and
static (at rest, e.g. while sitting or standing) 3. Back muscles weakness: A
and dynamic (in motion, e.g. while walking create a
comfortable chair can lead to prolonged
or running). seating in a reclined position. This could favourable
lead to numbness in the back. Also, environment that
Causes of postural problems inactivity can lead to back muscle
fits the
Pre-historic human's ape-like anatomy used exhaustion due to prolonged sitting.
to bear all the body weight on both hands
employees and
4. Excess pressure on the spine: Obesity,
and legs. With evolution, the lower limbs slouching and back muscle weakness the kind of task
were required to bear the entire body weight can exert excess pressure on the they perform.
as the upper limbs developed to perform intervertebral disc which leads to
complex tasks. This transition has also medical conditions like herniated
dramatically changed the back (core) (slipped) disc, spondylitis etc.
bio-dynamics (movement of secondary
5. Lower back pain and tightness: The
curves). But now days, due to the changing
entire weight of the upper body falls on
lifestyle, human beings are again going back
the lower back region, hip flexor and
to an ape-like posture which is increasing
hamstring muscles. Contracting and
the incidences of postural problems.
shortening in these areas cause low
back pain and tightness.
Pros and Cons of Chair-desk
6. Pedal oedema: Pedal oedema means
Set Up: swelling in the feet, caused due to
hanging feet (not rested on the ground)
Sitting on a chair has a lot of
advantages like:
It is more hygienic.
Lesser muscular fatigue
(especially with back support,
foot rest and arm rest)
The chair-desk set up is however a
double edged sword. It has multiple
advantages but has more
disadvantages that cannot be
dismissed because sitting itself is a
poor posture. Sedentary lifestyle and
prolonged sitting can lead to a poor
posture and problems like:
1. Obesity: It is caused due to

APR-MAY 17 DIABETES HEALTH 65


and inactivity in the lower limb muscles position leads to strain and causes pain
Movement and for a prolonged time. in the neck, head and shoulder area
7. Decreased ventilation/oxygenation: while standing and sitting. For every inch
activity is that the head moves forward, it
Prolonged seating could lead to poor
necessary for oxygen exchange in lungs which leads to increases the weight of the head on the
health and fitness decreased ventilation. neck by four to five Kg. Also, the
pressure on the neck and upper back
of the muscles, 8. Vision problems: Constant looking at
muscles increases by four to five times
spine discs as the monitor causes headache, eye
as they have to stay tight to support and
strain, reduced distant vision due to
well as the whole. hold the neck.
stiffness in ciliary muscles (smooth
muscle fibres responsible for lens
adjustment in the eyes) which decreases
Wall Test to check posture
the distant focus of lens. It is to check at home if you may be
developing any postural problems. Stand
9. Forward head position: Forward head

66 DIABETES HEALTH APR-MAY 17


with your back against a wall, with your heels spine: Sit upright. Do abs exercises,
touching the wall. You should be able to back stretching and strengthening
easily touch your pelvis, mid back, exercises.
shoulders, and your head against the wall For lower back pain and stiffness:
without applying force to the body. If you are Stretching exercises for back muscles
unable to do this easily, you may have help in core strengthening. Also yoga
started to develop postural problems. and pilates are highly recommended for
flexibility and core strengthening.
Preventing Postural Problems
Static (sitting) work decreases
the blood circulation in the body Wrong posture not only affects the body externally but also internally.
which damages the metabolism Research studies have recently found that the position of the spine
of the muscles ultimately leading impacts the functioning of the liver. The nerves that supply to liver
to an insufficient supply of and arteries of liver pass through the spine right in the middle where
nutrients and causing poor it is maximum stressed while sitting. An improper spine position
collection of wastes especially blocks these nerves and affect blood supply to the liver, thereby
acids. This leads to soreness, slowing down the function of the liver. Studies have also shown that
stiffness and pain in the muscles. pressure on even a single nerve can severly affect liver functioning.
Dynamic work (physical activity)
is considered healthy. There is
contraction and relaxation of the
muscles. Movement and activity
is necessary for health and
fitness of the muscles, spine
discs as well as the whole.
So it is necessary to be active.
Walk to your workplace if it is
near to your home and
incorporate some stretching
exercises in daily life.

Tackling postural
problems
For weak abdominal
muscles and flabby
abdomen: Consciously pull
in your abdomen often. Hold
it there at least for
10 seconds and relax.
Practice this for three times a
day and five repetitions each.
Sit upright while performing
this exercise.
For excess pressure on the

APR-MAY 17 DIABETES HEALTH 67


promote activity in the back muscles as
Ergonomic solutions for a response to slight changes in posture,
chair-desk set up: allows muscles to alternate between
tension and relaxation and allows spinal
Yoga and pilates Do not tilt your head forward or back or discs to compress and decompress. If
to the sides. this cushion is not available to you, then
are highly
Your shoulders should also be kept in a you can use a small cushion from your
recommended for neutral position. home and sit on it instead.
flexibility and Your back should be erect and have Attending group exercise classes should be
core active support. encouraged as they ensure high fitness
strengthening. Make sure that your chair has armrests. If amongst employees. Core strengthening
not, there is a chance you may develop exercises like pilates improve abdominal
neck, shoulder and upper back pain. muscles strength. Yoga helps improve
flexibility. Also, braces and straps can be
Keep your sternum and chest upright.
used as an external support to correct
Your abdomen should be slightly pulled posture.
in at regular intervals.
(Note: Consult a physiotherapist prior to
Ensure that your chair has a mechanism starting any new exercise regime or fitness
to adjust seating height and also has a activity)
foot rest.
The seat of the chair should consist of an Dr Richa Kulkarni (PT) is a consultant
active inflatable cushion. This helps Physiotherapist.

In a lighter vein
Did you skip
your insulin
shot again?

68 DIABETES HEALTH APR-MAY 17


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. Strawberries are good source of -


(a) Vitamin C (b) Antioxidants (c) Folic acid (d) All of these
2. Diabetes Mellitus is associated with hypothyroidism (thyroid dysfunction) -
(a) True (b) False
3. What is fatty liver?
(a) Enlarged liver (b) Liver in all fat patients
(c) Fat deposition in the liver cells (d) Liver disease caused by eating fatty food
4. What is the most accurate laboratory test to screen for Diabetes?
(a) Fasting blood sugar levels (b) Post prandial blood sugar levels
(c) Glycosylated hemoglobin (d) Oral glucose tolerance test (OGTT)
5. Uncontrolled Diabetes over a prolonged period causes
(a) Weight gain (b) Weight loss
(c) Either a or b (d) No change in weight
6. The ideal diet for Diabetes is -
(a) High protein (b) Low carb (c) High fat (d) Balanced diet
7. Does alcohol have an impact on your blood glucose levels?
(a) Yes (b) No
8. Is it important for a person with Diabetes to see a dentist?
(a) Yes (b) No
9. Does eating white polished rice increase your blood sugar level more than chappati?
(a)Yes (b) No
10. Sweet potatoes are a good substitute for white potatoes in people with Diabetes.
(a) True (b) False

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: Jun-Jul17 issue
Answers to previous
DH Quiz [Feb-Mar17] on page 76
Yo-Yo Dieting
A Road Not To Be Taken
70 DIABETES HEALTH APR-MAY 17
NUTRITION

Ch V Mridula discusses
yo-yo dieting and how it
Case study
affects your health.
Ms Kritika Khatri (name changed) began
her diet at a very young age. She followed
an irregular diet pattern for nearly 10 years.
Every time she resumed her normal diet,
she would put on more weight than what
she had reduced. Her body weight
fluctuated every time she would stop and
begin her diet. By the age of 21, Ms Khatri
was diagnosed of polycystic ovarian
syndrome (PCOS), had developed insulin
resistance and was on the onset of
Diabetes. Ms Khatri understood that her
interpretation of 'lifestyle changes' in
successful weight loss was not appropriate.
But she was determined to get her health
back to normal. Her diagnosis acted as an
eye-opener and led her to understand the
importance of conscious eating over
starving oneself. She started taking a
balanced diet. Earlier she would consume
aerated drinks even when she quit other
foods. She stopped continuing the same
now. But her task didn't finish here. She
still had to loose 100 kg of weight that she
had gained all this long.
During her diagnosis, Ms Khatri shut herself
from the outside world. She rejected her
social life and avoided going in the public
due to her guilt. Ms Khatri wholeheartedly
wanted to turn her situation around. She
had set targets to lose her body weight. She
would religiously work out every day and
after achieving her target, she would gift
herself a pair of clothing that is a size lesser
than before. Eventually she gained her
confidence back, stepped out into the public
and joined a support group where she was
encouraged in her attempt to get fit. Slowly
with medical help, her health was brought
back to normal. She says she was never so
happier than now.

APR-MAY 17 DIABETES HEALTH 71


obese and non-obese people would often
What is yo-yo dieting? indulge in yo-yo dieting.
Remember the classic toy yo-yo and how When a person diets, the amount of
that little thing moved in and out of your carbohydrates and other vital nutrients
hand when flicked. Every time the toy is entering the body is lowered. The body
flicked with more pressure, it comes back interprets it as a period of 'famine' and
with more speed. Now replace each aspect lowers its need of calorie intake. When
Every time you of that activity with any typical dieting normal diet is resumed, the body starts
pattern. Consider the toy as your body storing as much calories as it can to sustain
diet, your body weight and your hand control as dieting
itself during the next period of 'famine'. The
regains more than pattern. So, whenever you flick your hand, effect is that we tend to eat more of
what it loses that is, when you diet, the yo-yo, meaning carbohydrate and fat rich food as they make
your body, loses weight. When you pull in us feel full. This overindulgence leads to
when normal diet your hand which signifies resuming your
weight gain.
is resumed. This normal diet, the yo-yo resumes its original
fluctuation in a position. This causes your body to regain its Risks of yo-yo dieting
lost weight. Higher the pressure exerted
person's body while flicking the hand, the faster the yo-yo Obesity is an increasing cause of concern in
weight due to bounces back. India and the world. A research undertaken
stop-and-go What is implied here is that every time you at the University of California had shown that
diet, your body regains more than what it two-third of people who had reduced their
dieting is called weight by dieting, subsequently gained more
loses when normal diet is resumed. This
yo-yo dieting. fluctuation in a person's body weight due to than before. A number of research studies
stop-and-go dieting is called yo-yo dieting. have shown that obese people who tend to
Yo-yo dieting, also called as weight cycling, yo-yo diet are at an increased risk of Type 2
is the fluctuation seen in a person's body Diabetes and heart disease. Some risks that
weight due to changes in daily diet. In this, pose a danger to the heart health are:
the person's body weight reduces when Heart problems in women
there is a cut down in the intake of calories
but increases immediately when normal diet Major case studies have established that
is resumed. Most research studies on yo-yo 66 per cent women who follow yo-yo diet
dieting have one thing in common that both are susceptible to Coronary Heart Disease
(CHD) and Sudden Cardiac Death (SCD)
than those who do not, even when their
body weight falls under the recommended
limit. Yo-yo dieting severely affects the
electrolyte levels and leads to an imbalance
in minerals and fluids. This imbalance can
lead to heart failure.

Elevated blood pressure and heart


rate
Changes in diet affect heart functioning.
Research studies have shown that increased
blood pressure levels can lead to organ
damage. When obese people diet their

72 DIABETES HEALTH APR-MAY 17


blood glucose and lowered release of
energy. When the body goes back to the
normal diet pattern, the individual tends to
overeat and there is an increased amount of
blood glucose in the body. This requires the
pancreas to release more insulin to manage
the increased levels. The insulin secreted in
this process loses its potential to absorb the
elevated glucose levels. This leads to a high
quantity but poor quality of insulin secretion
in the body (hyperinsulinaemia).
Another aspect of the condition is when the
body fails to produce enough insulin to
process the increased levels of glucose in
the bloodstream after the period of dieting.
This results in the development of insulin
blood pressure decreases. But when they resistance.
resume their normal diet pattern, after Affected lipid profile
successful weight loss, they put on more
weight than before. This elevates blood When the body goes back to normal diet
pressure and causes the heart to have to pattern, it tends to consume more of fat and
pump harder. To a lesser degree, this has carbohydrate-based foods. This leads to an
also been seen in non-obese people. imbalance in the lipid levels caused by high
Elevated heart rate makes the heart LDL (bad cholesterol) and low HDL (good
vulnerable to heart disease and even heart cholesterol). When there is an excess
attacks. deposition of bad cholesterol in the arteries
of the heart, the body is highly at risk of
Hampered kidney functioning heart disease.
Research studies have shown that yo-yo An imbalance in the lipid levels can lead to
dieting can impact kidney functioning. many health conditions such as Diabetes,
Repeated weight cycles affect the glomerular hypertension, obesity, lowered thyroid
filtration rate of the kidneys (the first stage production (hypothyroidism), polycystic
filtration in the kidneys). The glomerular ovary syndrome (PCOS) and Cushing's
filtration rate is managed by food intake. Any syndrome (deposition of fat in the
decrease or increase in the food intake midsection of the body due to high levels of
affects the kidney functioning typically within cortisol secretion).
24 hours. Increased kidney functioning
during weight gain increases the lipid levels
Situational yo-yo dieting
and in the long run, this increased pressure
affects the kidney health, leading to poor Is it always due to obesity or dissatisfaction
management of blood pressure. with their appearance that people yo-yo
diet? No. There is certainly more to yo-yo
Insulin resistance dieting that we should not ignore. People,
During dieting, the body interprets it as especially those in a profession where
'famine' and lowers its secretion of insulin. physical appearance makes a huge impact,
As a result, there is lesser consumption of have been noted to follow yo-yo diet for a

APR-MAY 17 DIABETES HEALTH 73


significant time. Professionals such as actors body has adapted. Body weight can
and models have to undergo yo-yo dieting fluctuate due to a number of reasons -
due to professional necessity which often amount of carbohydrate intake, consistent
costs them their health. Many of them travel, stress, electrolytes fluctuation, etc. In
eventually develop Type 2 Diabetes, order to reduce body fat:
polycystic ovary syndrome, hypertension and
Set realistic weight loss goals for a time
heart diseases.
frame which are possible for you to
A significant percentage of population living follow.
in economically challenged countries or who
Do not starve yourself, instead eat small
have to face a prolonged shortage of food
meals at regular intervals to avoid
are forced to undergo the pattern due to
overeating.
shortage of supplies and calamities such as
draught and famine. Socio-economic Monitor your weight every month to
constraints such as unstable government, know if you are gaining excess weight.
war and unrest force the country to undergo Seek advice from your dietician and
periodic starvation. In such cases the lipid physiotherapist to plan the right diet and
levels, blood sugar and blood pressure levels exercise regime that suits you.
fluctuate significantly.
Do not be a rebel and force your body to
perform what is not possible or
Eating healthy advisable.
Understanding the pros and cons of yo-yo After all, no battle can be won without a
dieting is the first step towards bringing a sound body and mind!
change in the habit. Knowing their body and
what is good for them is important for
people to come back from the trend that

74 DIABETES HEALTH APR-MAY 17


Answers to The Diabetes Health Quiz FEB-MAR17
1. Which anti-diabetes medication has been linked to fights itself, producing fighter cells and antibodies.
poor bone health? When the body utilises fighter cells and antibodies to
fight against external infection like they are expected
a: Pioglitazone - Pioglitazone, a medication used for
to do, the process is called an immune response.
Type 2 Diabetes may worsen osteoporosis, an
Type 1 Diabetes is an example of what happens when
age-related thinning of bones. This may heighten the
these antibodies go rogue and fight against your own
risk of fractures. Hence, the medication is to be used
body - in this case, the beta cells of the pancreas
with caution or avoided in people at high risk of
which produce insulin. Complete destruction of the
fractures: for instance postmenopausal women who
beta cells due to this autoimmune process means that
have poor bone health.
lifelong insulin support may be needed.
4. The condition where the bones of
the feet are destroyed in chronic
Diabetes is called -
d: Charcot Foot - A condition where the
foot becomes deformed. It is a result of
diabetic neuropathy. Nerves control
small blood vessels and when nerves
get damaged, the blood flow to the
bones become abnormal. This leads to
what is initially a red, painful swelling
of the foot - a condition called acute
Charcot foot. When untreated, the bones
become powdery in parts, crumble and
break down - deforming the foot. This is
called chronic Charcot Foot which is a
rare complication of Diabetes.
2. A glucometer measures glucose levels in the -
5. Hormone secreted by pancreas having action
c: Capillaries - When we use a needle and poke the
opposite as insulin is -
pulp of our fingers, the tiny little blood vessels, called
capillaries are poked - this releases a drop of blood d: Glucagon - this hormone is secreted by the alpha
from which the glucose levels are estimated. Arteries cells of the pancreas and its function is to increase
supply blood from the heart. Arteries break up into blood sugar levels. Insulin is produced by the beta
smaller vessels, which in turn divide and carry blood cells and reduces the blood sugar levels.
via thousands of thin, wiry tubes called capillaries. 6. Diabetic ketoacidosis is seen in people who have
Capillaries give blood (especially oxygen in the Diabetes along with -
blood) to the tissues and then return the remaining
blood to the heart by merging to form veins that a: High blood sugar - Diabetic ketoacidosis is mostly
combine and flow into the heart. seen in people with Type 1 Diabetes mellitus. Patients
have high blood sugar levels on the background of
3. Type 1 Diabetes can occur due to autoimmunity. absolute insulin deficiency. Therefore, body uses fat
An autoimmune disease is a disease where - as a source of energy and ketone bodies are released
b: The body fights against its own cells - as breakdown products of fat. Diabetic ketoacidosis
Autoimmune diseases are diseases where the body can be life threatening if not treated promptly.
7. In patients with diabetic neuropathy,
ulcer on the sole of feet is mostly -
b. Not painful - Patients with severe
diabetic neuropathy have insensate feet.
There are high chances of getting ulcer
over the pressure points of the feet. There
is no pain in the ulcer and hence
patients don't recognise its severity and
may fail to attend to it. As a result, these
ulcers don't heal early and in some
patients, they lead to severe infection
that necessitates amputation (loss of
limb). This is why foot care and foot
examination is very essential for people
with Diabetes.
8. How many minutes of exercise
(minimum) should a person with
Diabetes do in a week?
dry your feet well, your feet don't have wounds/ulcers
b. 150 mins/week - As per the ADA Guidelines, and you take care while coming out of pool to
people with Diabetes should be advised to perform at prevent slipping.
least 150 min/week of moderate-intensity aerobic
10. Carbohydrates are the primary source of energy
physical activity (50-70 per cent of maximum heart
in our diet.
rate), spread over at least 5 days per week with no
more than 2 consecutive days without exercise. a. True - Carbohydrates are the body's main energy
source and one of the major nutrients comprising a
9. If you have diabetic neuropathy, which is a safe
balanced diet. Your body breaks down carbohydrates
exercise?
to obtain the energy needed for sustaining daily
c. Static cycling - In diabetic neuropathy, foot activity. They are especially important because they
sensations, grip, shape, gait and form are affected. So are the primary nutrients that the brain uses for
static cycling, where you place your feet comfortably energy.
in the paddles without causing any undue pressure or
injury, is safe. Swimming too is safe, provided you

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

Shivpal Talwar, Lucknow


Anandi Shinde, Nagpur
Ananya Iyer, Madurai Mohit V. S., Bengaluru
April - May 2017
Aries (Mar 20 - Apr 21) Cancer (Jun 22 - Jul 23)
Watch out for allergic reactions as
General health will be much
these may constantly bother you
better than the past few years. Your
and dampen your spirit. Start a new
physical and mental health will also be more
fitness regime and try to ward off bad habits
stable. However, food intake needs to be
like smoking, drinking and relying on fast
monitored as you may suffer from a bout of
food to maintain the energy levels and enjoy a
food poisoning. Make sure that you set aside
fitter you. By doing this, your metabolic rate
some ME time to help yourself focus better
will be balanced and you will feel good about
on your goals.
yourself.
Lucky numbers: 7 and 8
Lucky numbers: 4 and 6

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

Do not take your health for granted, You need to work extra hard in
as negligence could prove to be maintaining your health. Avoid
detrimental. Opt for some physical activity eating and drinking outside and try to stick
that will help you tone your muscles and to homemade food. You may experience
keep you fit as a fiddle. It is advised that you frequent headaches and joint aches. These
take a balanced diet. Muscular pains and will resolve with time, however if you feel that
nervous problems are also indicated, hence something is amiss visit the doctor
visit the doctor if the need arises. immediately. Opt for yoga or meditation to
help you feel at ease.
Lucky numbers: 2 and 5
Lucky numbers: 5 and 9

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


Do not burden yourself with
Peace and harmony shall prevail unnecessary worries as this may
at home and work place. Health will take a toll on your health. Take
be satisfactory, however try not to burden ample rest and enjoy life. Try not to
yourself with excess work as this may result overindulge yourself with work as this may
in occasional fatigue and restlessness. burn your inner energy leaving you tired and
Planning a vacation with family or friends will restless. Spending quality time with family or
also prove to be beneficial. Opt for some friends will help you relax and take the burden
adventurous sports to improve your vitality. of things.
Lucky numbers: 3 and 5 Lucky numbers: 1 and 4

78 DIABETES HEALTH APR-MAY 17


Nandita reads the cards exclusively for the Diabetes Health magazine.

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


Mental anxieties and worries will
Health will take a back seat during
cause your mind to wander and will
this period, which will force you to
affect your productivity at work. Try and
change your dietary habits and adopt an
divert your mind by taking up some sport or
exercise regime. Regular health check-ups
hobby of your liking. Pay extra attention to
and medications will prevent problems from
health and hygiene. Be careful with your diet
worsening. Health management will require
and fitness regime as being lax might invite
conscious efforts. Avoid self-medication as
an array of health complications. Take care of
well as self-treatment.
yourself to keep complications at bay.
Lucky numbers: 6 and 9
Lucky numbers: 2 and 7

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


Health will be at its best. You will Guard against sugary and
have excess physical and mental unhealthy food to maintain good
stamina to perform your daily tasks. health. Avoid getting into unnecessary
Channel your energy in things that need arguments as this may increase your blood
your utmost attention. Take time to relax pressure and exhaust you. It is advised that
and feel positive about yourself. Keep a tab you undergo a thorough medical check-up
on your diet and if you are on medication. to rule out any existing ailments. Moreover,
Dental problems are likely to occur so take those suffering from blood related disorders
care. need to be extra vigilant.

Lucky numbers: 4 and 9 Lucky numbers: 3 and 6

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

Minor health ailments will crop up Try to be calm and see the positive
from time to time. Do not push side of the situation as your worries,
your body to workout excessively as anxieties and irritability will be put to
this will result in muscle or tissue injury. Rest the test. Focus on tackling the problem
and recuperate to help maintain your energy instead of brooding over it. Cold, cough and
and vitality. Pay special attention to your diet skin infections will constantly bother you,
and include lots of proteins and fibre. Take however, with timely medication and doctor's
special care of your throat and ears. advice, health problems will resolve gradually.
Lucky numbers: 3 and 9 Lucky numbers: 1 and 6

APR-MAY 17 DIABETES HEALTH 79


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
Reg. No.: MAHENG/2011/38903