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Manage & Monitor

Treatment of Diabetes - Before We Start….

Points to take note are:


Remember Diabetes is an Interplay of ‘Insulin Resistance‘, raising the needs of Insulin and on the other hand “Inability of B cells” to cope up with the demands; together called as Insulin Resistance and Secretory defect ;unless these two happen , Diabetes can not take hold in an individual, therefore, any treatment has to address these two basic problems.


1.)Secretory defects in response to raised demands are best declared by Fasting Blood Glucose levels whereas Insulin resistance causing severely increased demands is best seen as peaking blood glucose levels, in response to a normal or glucose challenge meals.In Pre-diabetes state both may present separately or together but in a full blown Diabetic both of these are present together ,as a rule


2.) No two patients are same and no single treatment can be exactly workable for two different patients even if they are twins! In other words- No medicine is going to give exactly same effects or side effects in two different individuals


3.)Every patient passesfrom different stages of disease and may fluctuate from higher levels to lower and vice versa.


4.) Over the years, Insulin producing B cells in every Pancreas go down in numbers and productivity in fact Diabetes declares on the scene when almost 50% of B cells are either non functional or dead !
Remaining B cells keep losing their Insulin making powers with the passage of time In fact over 4 to 11 % people or may be more, every year, keep losing B cells completely. At this point you need to have Insulin support from Exogenous sources!


5.) The rate of loss of B cells, though genetically determined, can be slowed for the sure, by Good weight and Diet management at Pre-Diabetes state and when Diabetes sets in, with a good control of Diabetes in addition to these two factors helps in maintaining good health of your B cells.


6.) Also note that in a Diabetic Individual, the mechanisms of slowly Increasing Insulin needs due to Insulin Resistance, after meals or Post- prandial rise in Glucose, followed by B cells “giving up” with Insulin secretion and then secretory capacities going down and down, all happen over the years and all these are stage wise progressions with many modifiable variable like Body weight, Meal size and composition, total calories per day, physical activity and stress, intercurrent diseases and medicines’ intake, are few important ones.


7.) A progressive disease like this ,needs to be matched with progressive and scientific improvisations in the treatment plans; therefore in a single individual at different times and situations we must have different strategies and plans with different Diet, Exercise and Medicinal formulations/combinations and this clearly means a treatment once prescribed ,to successfully control your blood glucose, may not remain efficient for long and sooner or later all this must be redesigned and restructured once again. Here lies the importance of Regular periodic monitoring and consultations.


8.) Metabolic Memory: Another Important fact-more aggressive you are in maintaining your Glucose levels to near normal, more benefits you will get from the treatment , an early and appropriate control is remembered by the Metabolic system in your body and rewards are sure similarly an undisciplined approach with bad controls in earlier phase ,are also similarly remembered by your system and damage control is less rewarding.


***For all Indian Individuals above 35 yrs of Age it should be mandatory to Test for Fasting Blood Glucose and for Post-Prandial Glucose at TWO hrs after 75 Gs of Glucose load and if found normal then it should be repeated at every 2 yrs!And once the age crosses 40 years ,testing should be annually.


AND Also all overweight(85th percentile weight and above) adolescents of above 10 yrs of age, should be subjected to active screening , because with “soon arriving” puberty and hormonal changes/surges ,this age group will not give you enough time for interventions while progressing from Pre-Diabetes to Diabetes, in fact within few months the damage and progress to Diabetes may be complete and the Intervention phase for Pre-diabetes gets totally missed /lost in the process !


Adolescent Overweight /Obese Children are SPECIAL HIGH RISK CATEGORY: Moreover an adolescent if develops Diabetes will pose a bigger problem for the society & the family. Let me explain you how. Let us assume that complications take 10 years to develop into the system and another 10 yrs. to cripple you. If Diabetes comes at 15 yrs of age, then by the age of 25 years, when you are getting married and settling down in a job, you start facing the music from Diabetes related complications, for example you are afraid of facing your wife because of Erection difficulty or getting transient ischemic attack while on Honeymoon! By the age of 35 yrs when your career graph is in full swing, your children are gearing up for higher classes, you are settling down with issues like property ,assets and are consolidating your final positioning in life , and then suddenly you get your first heart attack! which lands you in ICU ! You may or may not survive or survival thereafter may be just symbolic.


All energies,plans,dreams and ambitions go down the drain !


Just think what kind of life we are giving to our children. Dear all , I am really very serious about these issues.

Chosing a Drug-Considerations


As we have already pointed in earlier pages that Diabetes Type 1 occurs due to total destruction of Insulin producing B cells and since no insulin is being produced by the body, survival is only possible if enough Insulin is supplied from outside the body.


Insulin itself is a protein and if taken by Mouth, our Intestines will simply digest it like any other protein in food and no insulin will be reaching into the Blood. Therefore, to ensure that intact Insulin reaches into the Blood Stream It has to be given as Injection.


For Type 1 Diabetes Insulin is the only answer But in Type 2 Diabetes we have seen that defect is Insufficient OR nefficient Insulin,for this twin defect state we have some more answers available additional to Insulin.

New Approaches To Managing Diabetes Type 2


The convergence of a more complete understanding of the physiologic characteristics of type 2 diabetes with the availability of new therapeutic agents that target the multiple metabolic abnormalities of diabetes has led to new and innovative therapeutic strategies.


In simple terms either you increase the availability of Insulin or make better use of whatever Insulin is available; these two remain the central theme for any treatment plan.

Also, have your doctor regularly check your cholesterol and blood fat (triglyceride) levels.


Agents That Target “Insulin Resistance”(NOTE : Weight Reduction, Exercise, Diet planning are the most efficient and cost effective measures and always a part of all treatment plans)


Oral agents that specifically target insulin resistance include 1.The biguanides (metformin) and
2. TZDs or the thiazolidinediones e.g: pioglitazone and rosiglitazone. 
These agents act on insulin resistance by a different mechanism of action and provide beneficial effects beyond glucose control. Although its mechanism of action is not completely clear, metformin seems to lower fasting blood glucose by improving peripheral insulin sensitivity, reducing hepatic and renal glucose production, and slowing gastrointestinal absorption of glucose.


It does not stimulate insulin secretion or cause Hypoglycemia or weight gain..There is evidence that metformin has beneficial effects on lipids(fats), blood pressure, and pro-coagulant factors associated with the macrovascular morbidities of diabetes.


The thiazolidinediones have been shown to improve glucose control, decrease peripheral insulin resistance, and favorably affect the cardiovascular risk factors of type 2 diabetes (ie, lipid profiles, coagulation and fibrinolysis, and vascular events).


Their tendency to cause edema(water retention leading to swollen feet)and weight gain-the commonest side-effects, may limit their use in some patients.TZDs ,but with expert hands and vigilant Physician these drugs remain an important tool for glucose control.TZDs as they are also called in short can also be a cause of fractures specially in post-menopausal females i.e.in females after cessation of monthly cycles.


But the biggest problem came after many years of use of Rosiglitazone,which by some researchers was reported to be associated with increased risk of Heart Attacks!For this very reason the drug has now been banned across the globe!


Now we are left with only Pioglitazone which again is being linked to Urinary Bladder Cancers but is being carefully watched!


If used wisely Glitazones are useful drugs. Remember every drug may not suit to everyone!


Agents That "Stimulate Insulin Secretion"-Secretagogues

Sulfonylureas, such as glyburide, glipizide, gliclazide and glimepiride are the agents most commonly used to treat patients with type 2diabetes. Sulfonylureas increase insulin secretion, regardless of the level of circulating glucose.


That’s why if these drugs are taken more then the prescribed dose or a meal is missed or delayed beyond your normal timings you may get abnormal reductions in your Blood Glucose known as Hypoglycemia & SMBG .Which can be potentially life threatening Glitinides:Two recently introduced short-acting insulinotropic agents, repaglinide and nateglinide, are insulin secretagogues with a relatively shorter onset and duration of action than sulfonylureas.


These agents are specifically indicated to control postprandial glucose excursions and have a low risk for Hypoglycemia & SMBG. Patients are instructed to take these agents before meals, which allows for more flexibility in varying meal patterns without compromising glycemic control.


Agents That Slow Intestinal Absorption of Carbohydrates


The alpha-glucosidase inhibitors, acarbose and miglitol, reduce postprandial glycemia by slowing intestinal glucose absorptionwithout increasing weight gain or the incidence of hypoglycemic events.However, these agents only have a modest effect onreducing blood glucose levels and their use is limited by gastrointestinal side effects.


NEW In Diabetes Treatment


INCRETINS & INCRETIN MIMETICS(Sensible Secretagogues with many more actions !):


Several newly available or emerging treatments in development for people with type 2 diabetes are based on new approaches to treating the disease. Incretin mimetics are glucagon-like peptide-1 (GLP-1) agonists.GLP-I ia an important product from the Intestines which improves Insulin production and secretion in normal persons and is grossly deficeinet in Diabetics.This hormone improve Beta Cells’ survival also. Exenatide is the one such GLP-1 agonist currently available in India as Byetta is approved by the U.S. Food and Drug Administration (FDA). Another GLP-1 agonist Victoza or liraglutide, which is a GLP-1 analog is once a day therapy and is also available now.Both are Injecctions.first one Twice a day and the second -Once a Day.That means GLP-1 which is deficient in Diabetics,it's action is replicated by these two molecules. Now in normal conditions GLP-1 once produced is destroyed in the body by an enzyme called DPP4 . Therefore the other mean by which you can increase the levels of GLP-1 in Diabetics could be by stopping it's destruction by this enzyme DPP4 .Thus came the reason for the development of yet another froup of Drugs-DPP4 Inhibitors. Dipeptidyl peptidase-IV (DPP-IV) antagonists inhibit the breakdown of GLP-1 by blocking the action of the DPP-IV enzyme and therefore raise GLP-1 (and GIP) levels 2- to 3-fold. These agents have been called incretin enhancers. Sitagliptin was the first of the DPP-IV inhibitors to have received FDA approval.Saxagliptin has now also been apprioved. Sitagliptin,Saxagliptin,Vildagliptin and Linagliptin are FOUR DPP !V inhibitors presently available in India. Other DPP-IV inhibitors are also in development.These will soon arrive in India.Alogliptin is surely going to be with us soon!
Rimonabant was a selective CB-1(cannabinoid-1) receptor blocker,addition of rimonabant to a hypocaloric diet resulted in sustained weight loss and improvements in cardiometabolic risk factors, including waist circumference, high-density lipoprotein (HDL)-cholesterol, triglycerides, glucose and measures of insulin resistance. Rimonabant has been withdrawn (all over the globe) on account of serious Neurological and Psychiatric problems .Research is going on ,however , for safer and better molecules fo CB1 pathway modulation.


Pramlintide, a synthetic analog of another islet hormone, amylin, represents a fifth class of therapy. Pramlintide reduces gastric emptying, suppresses glucagon and enhances satiety, and is FDA-approved for use as an adjunct to meal time insulin in people with type 1 and type 2 diabetes who have failed to achieve glycemic control, despite optimal insulin therapy. Finally, the first inhaled insulin was recently approved by the FDA.(Has been withdrawn fron market by the company after it’s launch. Taken together, all of these new therapeutic options -- whether they are available now or in the near future -- have created a new sense of excitement and optimism in the field of diabetes care.


LATEST DRUGS:Dapagliflozin/Canagliflozin are drugs which will not allow kidneys to hold back Glucose.Whatever Glucose will be filtered out will be allowed to flow into the Urine and will get wasted. Blood Glucose levels will therefore get reduced.In natural conditionsKidneys tend to preserve Glucose.


Bromocriptin and Cloesevelam are two more drugs which I personally find not of much use though have been approved for Diabetes treatment!


There are a few other developments and drugs which are not relevant as far as day to day Diabetes control is concerned.


MONITORING TARGETS: TREATMENT TARGETS TO BE FIXED ARE:(Non Pregnant Adults)



Fasting Blood Glucose                             < 110 mg %
Postprandial at 2H after meals               < 140 mg%
Random at any time of the Day               < 140 mg% 
Yes we are indeed TIGHT on glucose!
HbA1c                                                       < 6.5%
Total Cholesterol                                      < 180 mg  %
HDL-Cholesterol(Good one)                    > 40 mg   % in males
&                                                                > 50 mg   % in females
Triglycerides                                             < 150 mg %
LDL-Cholesterol                                        < 100 mg %


And do not care what your lab gives you as normal reference range remember only these above given levels !
BUT if your patient is fragile,elderly ,living alone, has poor reflexes, already has serious Heart Problems,Cancer or has seriously compromised quality of life,then PLEASE DO NOT TRY TO BE VERY RIGID WITH THE GLUCOSE CONTROLS.


Monitoring Your Health And Treatment


At the beginning –Get the following done (Minimum):-


Fasting and PP-after meals- Blood Glucose. Please note that if you are on treatment then glucose has to be tested with your regular dose of medicines and /or Insulin.Because the idea is to see and check how your treatmwent is working for you! CBC, Kidney Function with Electrolytes, Liver Function Tests, Lipid Profile,HbA1c,Thyroid Function Test,complete Urine Examination.

Afterwards-take time and make a habbit of all the following things:


Daily:


->Take your Body weight with minimum of clothes
->Recapitulate what misadventures you did yesterday with meals etc
->Examine your feet(sloes with mirror)
->Have a close look of your teeth, skin, nails, eyes
->Plan your exercise and activity
->Consider your days’ meal plan and provisions for any outdoor meals!
->See that you have adequate and appropriate supply of your medicines
->Make a mental chart of your days’ final schedule!
->Look if any self monitoring is to be done with your glucometer

Weekly :


->Look at your weight chart-identify trends
->Measure your BP
->Look at your blood glucose readings over the past 6-7 days
->Attend to your feet, nails, skin, exercise etc at leisure on your weekly holiday
->Track your doctors’ prescriptions, review your treatment plan, plan your next visit

Monthly:


->Consult your diabetologist
->Get an fasting and PP Blood Glucose done at your neighborhood lab and cross check with    your glucometer,
->Check if Lipids,Creatinine,TSH,HbA1c,Urine Protein/Albumin,SGPT/SGPT or any other test in    the past which needs to be re-evaluated and revalidated-as per your doctors’ advice

 

Insulin - Things You Should Know

 

What is insulin?

 

Insulin is a hormone produced by the pancreas to control the amount of glucose (sugar) in the blood. In people who have diabetes, the pancreas does not produce any or enough insulin, or body is unable to effectively use the insulin it does produce. As a result, glucose builds up in the bloodstream
Insulin and type 1 diabetes
People with type 1 diabetes do not naturally produce any insulin. As a result, they need to take insulin every day.
Insulin and type 2 diabetes
If you have type 2 diabetes, you may be able to keep your blood glucose levels in your target range through healthy eating, physical activity and by taking diabetes medication. Ask your doctor to refer you to a registered dietitian to learn about healthy eating. You should follow PG Medical Guidelines for Healthy Eating, which includes limiting the amount of carbohydrates and fats you eat. THERE IS NO SUCH THING AS SPECIAL DIABETIC DIET!

 

(Contact Dr. Lalwani's Clinic for diet counseling)

 

Type 2 diabetes is a progressive condition and over the years most people (in fact all-if they survice long enough !) with type 2 diabetes will need to use insulin to properly manage blood glucose. If your body is not producing enough despite drugs being taken then you will have to take Insulin from "Outside"a! as simple as that!

 

The most important thing is to manage your diabetes and prevent complications. If you’re nervous about learning to inject insulin, take heart – even young children can master this skill with practice. As well, modern injection devices, such as insulin pens, are virtually painless.

 

Types of insulin-Available Now…..

 

When insulin was first made available for people with diabetes, there was only one kind: short-acting insulin, which required several injections a day. Today, many different types of insulins are available, offering more flexibility in the number and timing of injections you may need and making it easier for you to maintain your target blood glucose levels.

 

A)Conventional Insulins:
     Regular,  NPH,  Premixed 30/70 & now best of the Insulins as:

 

B)Rapid- and Long-Acting Insulin Analogues

New rapid-acting insulin analogues have been designed to mimic the normal physiologic insulin response that occurs in nondiabetics. Three insulin analogues, insulin Lispro ,Glulisine and Aspart, show improved glycemic control over human insulin in both type 1 and type 2 disease.

 

In particular, analogues improve postprandial blood(PP) glucose control with a lower risk of Hypoglycemia. Analogs work rapidly after injection, within 5-15 minutes, peak at 60-90 minutes, and last in body for about 4 hours. Human regular insulin(older ones), by contrast, begins to act 30 minutes after injection, peaks at 2-4 hours, and lasts 6-8 hours or longer.

 

In conjunction with a long-acting insulin, such as insulin glargine ,detemir or NPH insulin(this last one is practically no more used), the rapid-acting analogues provide tight control of blood glucose levels throughout the day. NPH insulin peaks at about 4-6 hours and lasts for about10-16 hours, whereas insulin glargine has a nearly peakless profile and lasts from more than 20 hours.

 

Now a days still longer acting analogs are being talked about like "Degludec Insulin".Idea is to have once or twice a week injections of a Basal Insulin!This will reach us soon! Degludec when used daily can be injected at anytime of the day unrelated to meals and still gives a good control!

Evidence from clinical studies indicates that more aggressive early treatment is clearly a way to reduce the many complications associated with diabetes and to improve the quality of life of people with this disease.

You may need one to four injections a day for optimal management of your blood glucose.
If you take insulin, you need to monitor your blood glucose levels regularly. Regular monitoring is the best way to keep your blood glucose levels in their target range. Regular checks also give you important information about how your blood glucose levels vary during the day, how much insulin you need and if you’re on track in managing your diabetes.

 

When prescribing an insulin regimen, your doctor will consider several factors, including your treatment goals, age, lifestyle, meal plan, general health, risk of low blood glucose (Hypoglycemia & need for monitoring and testing sugars is always considered), and your financial circumstances. There is no 'one size fits all' plan.

 

At PG Medical Center Your healthcare team will talk with you about the best insulin plan to meet your needs. Remember, it will take time to fine-tune your insulin regimen, which may change over time depending on life events (such as a major illness) and changes in your lifestyle (such as a new exercise plan).

 

Talk to your doctor or diabetes educator if you have any questions or concerns about your insulin regimen, or if you aren’t sure how to handle certain situations, such as adjusting your insulin when travelling.

 

Most Popular and convenient Insulin Delivery system: Insulin Pen

 

 

An insulin pen (or just "pen") is an insulin delivery system that

 

  1. generally looks like a large pen,
  2. uses an insulin cartridge rather than a vial, and
  3. uses disposable needles.

 

Pens are the predominant insulin delivery system in most of the world. Pens in India are avaibable from Novo Nordisk, Eli Lilly, Wockhardt and Aventis. 
Some pens use replaceable insulin cartridges, and some pens use a non-replaceable cartridge and are disposed of after use. All pens use replaceable needles. Most pens use special pen needles (see discussion below), which can be extremely short and thin.

 

Pens With Replaceable Cartridges

 

Pens with replaceable cartridges are made by Novo Nordisk, Eli Lilly, Wockhardt and Aventis.

Insulin cartridges for pens come in 3.0 ml sizes. These 3.0 ml contain 300 units of Insulin. Different Insulins & different combinations are available from all the four manufacturers.

 

Prefilled Pens

 

Pens that come with a prefilled insulin cartridge are thrown away when the insulin is used up. Prefilled pens are sold by insulin makers Eli Lilly, Novo Nordisk, and Aventis. Lilly only sells prefilled pens which come with a variety of Lilly insulins, including Humalog, Regular, NPH, and various mixes, including Humalog mixes. Novo Nordisk sells both prefilled pens and pens that take replaceable insulin cartridges with Novomix and other Novo Nordisk insulins. Novo Aspart is available as Novo Rapid. Aventis sells prefilled pens with Lantus. Lantus is available as vials, prefilled pens & replaceable cartridges.Levemir is Insulin Detemir from Novo. Apidra is rapid analog from Aventis

Prefilled pens using pre-mixed insulin are usually marketed for use by people with type 2 diabetes. The fixed ratio of insulins does not provide the flexibility needed to accommodate varying food and exercise.

Oral Insulin * Every one is waiting! 
Oral insulin is at the very advanced development stage 
Oral insulin is a reality: it is simply a matter of when. Insulin injections are extremely harrowing for many diabetics. 
Alternative insulin delivery methods
Many alternative delivery systems, although they work to some extent, leave the insulin broken down by digestive juices, usually too much for it to be of significant use to the body. 
Insulin like any protein will get digested in stomach.Only if it is made undigestible,it can be absorbed into the blood stream!
Through Nose, mouth and lungs
Nasal delivery issues
Nasal delivery into the upper airway presents severe problems, primarily that the transport system is too convoluted and ineffective.Would require massive, expensive quantities of insulin to reach the target area.
Insulin delivery via lungs
Insulin into the lungs is a promising area: the insulin can be directly absorbed into the bloodstream through the thin walls of the lung. “Insulin Technosphere” holds promise!

Scientists are trying hard to develop methods through which they can make Insulin reach your Blood, bypassing your Digestive system !

Obesity Facts

Obesity means that you have an unhealthy amount of body fat. Overweight and obesity are defined using a tool called Body Mass Index (BMI). If your BMI is 25-29.9, you are in the “overweight” category. If your BMI is 30 or above, you are in the “obese” category. In general, the higher your BMI is above 25, the greater your weight-related health risks.For Indians BMI of 23 onwards is dangerous.


BUT for Indians the cut-off limit of Normal BMI is 23 ! Yes and above 26 consider yourself as Obese !


Waist Circumference of >90 cms in Indian male and > 85 cms in Indian Females is really bad


What causes being overweight and obesity ?


The main causes of being overweight or obese are eating too much and/or not being active enough. If you eat more calories than your body burns up, the extra calories are stored as fat. Other factors include your genes (obesity tends to run in families), your metabolism (how your body processes food), your racial/ethnic group, and your age. Sometimes an illness or medicine can contribute to weight gain.


What are some of the serious health problems linked to obesity?


If you are overweight or obese, you are more likely to develop health problems such as heart disease, diabetes, and some types of cancer. The good news is that losing weight can improve your health problems.


Overweight and obesity are linked to: 
Heart disease. Heart disease includes heart attack, heart failure, and angina (chest pain caused by reduced blood flow to the heart).
Stroke. Most strokes are caused by a blood clot blocking an artery that takes blood to the brain. 
Diabetes. Overweight people are twice as likely to develop type 2 diabetes as people who are not overweight.

Cancer of the gallbladder, breast, uterus, cervix, and ovaries(for women). Overweight men are at greater risk for developing cancer of the colon, rectum, and prostate. 
Gallstones or gallbladder disease. Gallbladder disease and gallstones are more common  But rapid weight loss itselfcan cause gallstones. 
Osteoarthritis (wearing away of the joints). most often affects the joints in your knees, hips, and lower back. Weight loss may improve the symptoms of osteoarthritis. 
Gout (by excess uric acid). Gout is a joint disease. Gout is common in obese people. 
Breathing problems, including sleep apnea (interrupted breathing during sleep). Sleep apnea causes a person to stop breathing for short periods during sleep and to snore heavily. Sleep apnea may cause daytime sleepiness and even heart failure. 
High blood cholesterol. High  total cholesterol, LDL cholesterol and triglycerides-all bad for heart;obesity is linked to low  HDL cholesterol (“good cholesterol”). 
High blood pressure. Obese adults are twice as likely to have high blood pressure as those who are at a healthy weight. 
Complications of pregnancy.. Obese women are more likely to have problems with labor and delivery. 
Irregular menstrual cycles and infertility. Abdominal obesity is linked to polycystic ovary syndrome, a cause of infertility in women.
Psychological and social effectssuch as depression and discrimination. One of the most painful aspects of obesity may be the emotional suffering it causes.

Starting To Exercise
The journey of a thousand leagues starts with a single step. 
You may have heard this proverb. Exercise is like that.

We all have got plenty of reasons NOT to exercise.
-Too old “Doc I am already 50! What do you expect from me?”
-Too fat, “joints not co-operating, bones are aching”
-Too weak physically or mentally 
-Too sick or Diabetes uncontrolled. 
-Too busy “Oh! All that MNC culture (with) Cruel Corporate Boss (es) extracting every breath out of you”. 
-Too tired/fatigued/exhausted.

But surely it's never too late. With very few exceptions, even if you're disabled / injured you can still improve your level of fitness. And once you get going, you'll be amazed that how quickly your excuses disappeared.

If you really want to make a change, just pack more activity into your daily routines. Park a block or two, farther away from the entrances at the office/mall. Plan an after-dinner walk with someone you want to talk to. Ride a stationary bike while you watch the morning or evening news on your idiot box.

Lots of people think of exercise programs the way they think of diets and related cosmetic reasons.

They plan to get in shape for a certain event or occasion say marriage. Or they join an exercise class hoping it will help them lose 5 or 10 pounds. Even weight loss clinics, which I call the Biggest Fraud in Medicine, propagate the Idea of a fixed quantum of weight loss for a fixed quantum of Fees!

I am dead against the very idea of saying Pay 5000 bucks and get 5Kgs weight loss! This is absurd and ridiculous. We have to sell an idea of Lifestyle change. My call is “Change your self for a better tomorrow and a better life, no short term goals or targets.

“But physical activity and healthful eating are habits we need to stay with over the long haul. That doesn't mean doing the same exercise or eating the same meals forever.This, you learn by frequent encounters at Dr.Lalwani’s Clinic. You may enjoy trying new forms of physical activity, in the same way new recipes are fun. Or you may find an activity that works for you and stay with it.

The first step to fitness is a visit to the doctor. Before you begin any exercise program, get a thorough medical exam. 
The exam should check: 
Blood pressure. 
Blood fat levels. 
Glycohemoglobin and current blood glucose level. 
Health of heart and circulatory system. 
Body composition (fat versus lean). 
Eyes. 
Feet. 
Your doctor should help determine your level of fitness. Types & level of exercise or exercise programs good for you should be carefully decided. Some complications of diabetes make certain types of physical activity bad choices. The benefits of an exercise program need to outweigh the risks.
This is an exercise plan that takes into account your current level of fitness, special health concerns, and your diabetes treatment plan. Your doctor is your best resource.

Set Goals

Goals give you something specific to work toward. Reaching a goal marks your success. Setting new goals with long term vision, keeps you going.

Ask yourself: Do you want to---

* Feel better? 
* Move easier? 
* Lose weight? 
* Get stronger? 
* Have more energy? 
* Reduce stress? 
* Stay fit while learning to live with diabetes? 
* Reduce your risk of diabetes complications such as heart disease? 
* Get your doctor or partner to stop nagging you? 
* Once you know the answers, you plan to exercise, talk with your doctor about realistic ways to reach your goals.

Your doctor and diabetes educator should help you plan:

- The best times to exercise. 
When to test your blood glucose levels and what your test results mean in terms of exercise. 
- How to avoid problems with low blood glucose levels. 
- How to inspect your feet before and after exercise. 
Other specific health concerns.

Here's how this might work. Suppose you have non-insulin-dependent (type 2) diabetes and are overweight. You work in an office and drive to work. You don't have an exercise plan. Your doctor says that if you lose some weight and start to exercise, you may be able to improve your blood glucose control.
After your physical exam and an exercise stress test, the doctor says you can start a walking program.
Your health goal: to lose 5 Kgs.
Your fitness goal: to stay with a regular walking program for 3 months, building up to 20 minutes of walking three times a week.
Current fitness level: couch potato.


How to proceed ?


Now you need to break your fitness goal down into smaller stepsMake your goals realistic, measurable, and achievable. Your long-term goal is to walk for 30 minutes three times a week. Your short-term goal is to walk 10 minutes without stopping three times a week for a month.

Write your goal down. Keep a log, or diary, of your exercise. You can buy a special notebook, write on your calendar, or make a note in your blood glucose record book/your PDA or your Smartphone. You might also want to jot down how you feel while exercising, or any problems you have.

This gives you something to look over when you're ready to make changes. When your goal period is up, look at your log. Were there good days and bad? Did you start feeling different? As you set your new goal, use your log to decide on changes.

Ask Yourself ?


Do you need to reduce your level of physical activity? Or are you ready to move up a notch?
Discuss changes with your health care team. Be sure to reward yourself when you reach a goal. Knowing that physical activity is something you'll do for the rest of your life can help. You can take the long view. If your first attempt doesn't work, try again. Do something different. Join a class or a mall walkers club. Think about what you enjoy doing and find a fitness activity that matches.

Do you like to exercise to music? To TV? Alone or with friends? Outdoors or indoors?

There are so many choices, you can find something to enjoy.

Fringe Benefits

Regular physical activity is good for your health & also brings fringe benefits such as: 
Better looks. 
Making new friends. 
Escaping from the daily monotonous drill. 
Learning new skills. 
Reducing stress & anxiety.
Bringing more resilience in your personality
Getting better agility, flexibility and reflexes
Getting to know and love yourself-this improves your overall Diabetes management and you get better treatment results! 
Still, it is humane that after you've been exercising for a while, you go through a spell where your motivation slips. Anyone who has a long term exercise program has 'off' days, times when he or she just doesn't want to stick with it. Or you may have a setback due to illness, injury or some personal loss.

When it happens to you, don't take it for failure. Give yourself a break. Review your exercise log book. Read an inspirational book. Try a new activity. Join a new class even a hobby class. Celebrate your past successes. Treat yourself to something; get a new to outfit to wear for you exercise -- a new T-shirt, even new pair of shoes. Before you know it, your exercise slump will be over and you are back on the tracks!


Health Effects of Cigarette Smoking


The adverse health effects from cigarette smoking account for 440,000 deaths, or nearly 1 of every 5 deaths, each year in the United States. More deaths are caused each year by tobacco use than by all deaths from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined.
Cancer
The risk of dying from lung cancer is more than 22 times higher among men who smoke cigarettes, and about 12 times higher among women who smoke cigarettes compared with never smokers.Cigarette smoking increases the risk for many types of cancer, including cancers of the lip, oral(mouth) cavity, and pharynx; esophagus; pancreas; larynx 
(voice box); lung; uterine cervix; urinary bladder; and kidney.

Cardiovascular Disease (Heart and Circulatory System) 
            Cigarette smokers are 2-4 times more likely to develop coronary heart disease.
            Cigarette smoking doubles a person’s risk for stroke-Brain attack & paralysis. 
           Cigarette smoking causes  narrowing of the blood vessels (arteries). 

Respiratory Disease and Other Effects
Bronchitis & Emphysema : a ten-fold increased risk of dying from chronic obstructive lung disease. About 90% of all deaths from COPD are attributable to smoking.
 
Infertility: an increased risk for infertility, preterm delivery, stillbirth, low birth weight, and sudden infant death syndrome (SIDS).Low sperm count ,Erectile Difficulty.
 
Osteoporosis : Postmenopausal women who smoke have lower bone density and increased risk for hip/spine fracture.

Smoking & Diabetes
Tobacco has many bad health effects, particularly for people with diabetes. No matter how long you've smoked, your health will improve after you quit.
Nicotine, the drug in tobacco, is one of the most addictive substances known. Besides the physical addiction, many smokers also become psychologically hooked on cigarettes.

So kicking the habit is hard - but worth the work. There are many methods you can try to help you quit and stay away from smoking for good. People keep smoking for two reasons. First, nicotine is highly addictive. Often, a person who quits smoking goes through withdrawal.

Symptoms of withdrawal include: being irritable, sweating, having headaches, diarrhea, or constipation, as well as feeling restless, tired, or dizzy. Withdrawal is usually the worst on the second day after quitting, and it gradually lessens with time.

Second, many people become psychologically tied to smoking. It is part of their daily ritual. It helps them wake up in the morning, comforts them when they are upset, and rewards them for a job well done. Smoking also has pleasurable physical effects. It relaxes people and perks them up.

These factors make it easy to smoke and hard to quit. The pleasures of smoking start within seconds of lighting up; the bad effects can take years to make themselves known. On the other hand, when you try to quit, your first experience is the bad feeling of withdrawal. Only later do you begin to enjoy the benefits of quitting, such as having more energy.

BUT ONE THING IS SURE –SMOKING HURTS YOU & KILLS SLOWLY…….!

For all your lifestyle changes ask for help at P. G. Medical Center.

 

Healthy Eating-Healthy Living

Healthy eating for people with diabetes is no different to that which is recommended for everyone. By choosing healthy foods and being active you will help manage your blood glucose (sugar) levels, avoid diabetes complications and control your weight.

THERE IS NO SUCH THING AS A SPECIAL DIABETIC DIET !
There is no need to prepare separate meals or buy special foods, so relax and enjoy healthy eating along with the whole family!

What should I eat?

To help manage your diabetes, your meals need to be:
->Regular and spread evenly throughout the day. 
->Portions should be nearly equal in 3-4 divided meals
->Lower in fat, particularly saturated fat. 
->Based on high fibre carbohydrate foods such as wholegrain breads and cereals,beans,     lentils, vegetables and fruits. An optimum mix of All The Colours In Nature including Red.     White, Green, Yellow etc has to be there.

Along with healthy eating, regular physical activity can help you to manage your blood glucose levels, reduce your blood fats (cholesterol and triglycerides) and maintain a healthy weight.


Facts about fat


Fats have the highest energy (kilo joule or calorie) content of all foods. Eating too much fat can put on weight which in the long run may make it more difficult to manage your blood glucose levels. On the other hand small amounts of healthier fats add flavour to your food, may improve your health and reduce your risk of heart disease. Therefore, the type of fat you eat is important, as well as the amount.


Saturated fat


It is important to only eat saturated fats in small amounts because it raises your LDL (‘bad’) cholesterol levels. Saturated fat is found in meat fat, processed meat, cream, butter, milk and dairy foods, coconut milk/cream, palm oil (pastries, chocolate and deep fried foods), dripping, lard and ghee. Never more than 7-8% of total fat allowance should be as Saturated Fat.


Polyunsaturated and monounsaturated fat


Some fat is important for good health. Eat a variety of polyunsaturated and monounsaturated sparingly in place of saturated fats. 
Polyunsaturated fats include:
->Polyunsaturated margarines (check the label for the word ‘polyunsaturated’). 
->Sunflower, safflower, soybean, corn, cottonseed, grapeseed and sesame oils. 
->The fat found in oily fish such as herring, mackerel, sardine, salmon and tuna. 
->Walnuts, pinenuts and brazil nuts. 
->PUFA if taken in excess or as sole fat being used in your cooking , as being advertised on     Electronic and Print media can actually BE HARMFUL!!
oil ->Monounsaturated fats include:
->Canola and olive margarines. 
->Canola and olive oil. 
->Avocado. 
->Olives. 
->Peanuts, almonds, pecans and hazelnuts. 
->Nut spreads and peanut oil contain a combination of polyunsaturated and    monounsaturated fat. 
->More amounts of MUFA can be taken if you can replace any other fat from your Diet BUT a    1:1:1 Mix of Saturated: Polyunsaturated: Monounsaturated ration is best to have.
->Main cooking in Soya/Rice Bran oil, little frying in mustard oil and a dash of Desi ghee just    to add flavor to your Daal OR Tadka to your Dal will make provision for all the healthy    combinations. Total half Kg per person per month is the best idea for your Kitchens.

About Trans Fat 
There are four kinds of fats: monounsaturated fat, polyunsaturated fat, saturated fat, and trans fat. Monounsaturated fat and polyunsaturated fat are the "good" fats. It is generally accepted that consumption of saturated fat should be kept low, especially for adults. Trans fat (which means trans fatty acids) is the worst kind of fat, far worse than saturated fat. 
Partial hydrogenation is an industrial process used to make a perfectly good oil, such as soybean oil, into a perfectly bad oil. The process is used to make an oil more solid; provide longer shelf-life in baked products; provide longer fry-life for cooking oils, and provide a certain kind of texture or "mouthfeel." The big problem is that partially hydrogenated oil is laden with lethal trans fat.
It is only the trans fat created by the partial hydrogenation of vegetable oils that we are concerned about and that should be eliminated completely from your diet. We are not concerned with the kind of naturally occurring trans fat found in small amounts in pomegranates, cabbage, peas, or the type found in the meat and milk of cows, sheep and goats. 
Partially hydrogenated oils are commonly found in processed foods like commercial baked products such as cookies, cakes and crackers, and even in bread. They are also used as cooking oils (called "liquid shortening") for frying in restaurants.
Top nutritionists at Harvard have stated as follows: 
"By our most conservative estimate, replacement of partially hydrogenated fat in the U.S. diet with natural unhydrogenated vegetable oils would prevent approximately 30,000 premature coronary deaths per year, and epidemiologic evidence suggests this number is closer to 100,000 premature deaths annually."30,000 to 100,000 premature deaths each year means between 82 and 274 each day! 
The trans fatty acid molecule 
If you are interested in the science, here is a brief explanation. 


In the illustration above, the light grey rounded areas are hydrogen atoms and the dark grey areas are carbon atoms. Note the different positioning of the hydrogen atoms in the middle which is caused by partial hydrogenation. The hydrogen atoms in the middle are in a "trans" position which makes this a "trans" fatty acid. The effect is to straighten out the molecules so they can pack together more closely and make the oil less liquid and more solid.
Health effects 
One of the reasons that partially hydrogenated oils are used is to increase the product's shelf life, but they decrease your shelf life. 
Trans fats cause significant and serious lowering of HDL (good) cholesterol and a significant and serious increase in LDL (bad) cholesterol; make the arteries more rigid; cause major clogging of arteries; cause insulin resistance; cause or contribute to type 2 diabetes; and cause or contribute to other serious health problems.

Trans versus Sat

Here are some of the differences between MUFA,PUFA and saturated fat. 
contents of common oils

comparison oils


The saturated fat molecule CANNOT BEND

When we compare the biological effects of the trans fatty acids versus the saturated fatty acids, we see that 
(1) saturated fatty acids raise HDL cholesterol, the so-called good cholesterol, whereas the trans fatty acids lower HDL cholesterol; 
(2) saturated fatty acids lower the blood levels of the atherogenic lipoprotein [a], whereas trans fatty acids raise the blood levels of lipoprotein [a]; 
(3) saturated fatty acids conserve the good omega-3 fatty acids, whereas trans fatty acids cause the tissues to lose these omega-3 fatty acids;
(4) saturated fatty acids do not inhibit insulin binding, whereas trans fatty acids do inhibit insulin binding (see our page on diabetes); 
(5) saturated fatty acids do not increase C-reactive protein, but trans fatty acids do increase C-reactive protein causing arterial inflammation;
(6) saturated fatty acids are the normal fatty acids made by the body, and they do not interfere with enzyme functions such as the delta-6-desaturase, whereas trans fatty acids are not made by the body, and they interfere with many enzyme functions such as delta-6-desaturase; and 
(7) some saturated fatty acids are used by the body to fight viruses, bacteria, and protozoa, and they support the immune system, whereas trans fatty acids interfere with the function of the immune system.

 

CONCLUSION: Trans fats are WORST FATS & some little saturated fat in Diet has to be there!


 

Facts about carbohydrate


Carbohydrate foods are the best energy source for your body. When they are digested they break down to form glucose in the bloodstream. If you eat regular meals and spread your carbohydrate foods evenly throughout the day, you will help maintain your energy levels without causing large rises in your blood glucose levels. If you take insulin or diabetes tablets, you may need to eat between-meal snacks. Discuss this with your dietitian or diabetes educator.

All carbohydrate foods are digested to produce glucose but they do so at different rates – some slow, some fast. The Glycemic Index or GI is a way of describing how a carbohydrate containing food affects blood glucose levels. Foods with a low GI raise blood glucose more slowly than foods with a high GI. Including at least three low GI foods throughout the day, ideally one at each meal, can help with blood glucose management.

Not to forget Total Glycemic Load ,that means amount of prescribed ration for the day and per meals ,should not exceed.


Facts about sugar


Table sugar has a moderate GI similar to that of tropical fruits and whole meal bread. Therefore, a healthy eating plan for diabetes can include some sugar. However, it is still important to consider the nutritional value of the foods you eat.

Added sugars in nutritious foods such as breakfast cereals or low fat dairy products are preferable to food or drinks such as sweets, lollies and soft drinks, which contain little else other than kilojoules. Some sugar may also be used in cooking and many recipes can be modified to use less than the amount stated. Select recipes that are low in fat (particularly saturated fat) and contain some fibre.

Juices increase Free Fatty Acids-so, eat full fruit with pulp!
Alternative sweeteners-not 100% safe
While it is no longer necessary to always use alternative sweeteners instead of sugar, there is still a place for artificially sweetened products, particularly those that may be consumed in large amounts such as cordials and soft drinks.


Facts about protein


Choose protein foods that are also low in fat. This will help to reduce the amount of saturated fat you eat. Protein foods include lean meat, poultry without the skin, seafood, eggs (not fried), unsalted nuts, soy products such as tofu and pulses (dried beans and lentils).


Other foods, condiments and drinks


You can use these foods to add flavour and variety to your meals:
Herbs, spices, garlic, chilli, lemon juice, vinegar and other seasonings. 
Products labelled ‘low calorie’ eg: low calorie/diet soft drinks, low cal jelly. 
Tea, coffee, herbal tea, water, soda water, plain mineral water.


Facts about alcohol


If you enjoy alcohol, it is generally acceptable to have one or two standard drinks a day if you are a woman and between two and four a day if you are a man. It’s best to drink alcohol with a meal or some carbohydrate containing food. 
One standard drink is equal to:
100 mL wine, 
285 mL regular beer, 
30 mL spirits, 
60 mL fortified wine,
80 ml of Whisky
375 mL low-alcohol beer (less than 3% alcohol). 

It is important to remember:
->To discuss alcohol with your diabetes educator or dietitian. 
->To aim for at least two alcohol free days each week. 
->That all alcoholic drinks are high in kilojoules (calories). Each Gm gives you 7 Cal.
->That low alcohol or ‘lite’ beers are a better choice than regular or diet beers because they     are lower in alcohol. 
->When mixing drinks use low calorie/diet mixers such as diet cola, diet ginger ale, diet     tonic water. 
->That drinking a lot of alcohol can cause hypoglycaemia if you are taking insulin or certain     diabetes tablets. 
->Drink slowly, keep snacking with drink.


Weight management


Being overweight, especially around your waistline, makes it more difficult to manage your diabetes and increases your risk of heart disease. It is not essential to reach your ideal weight as a small weight loss (5-10% of body weight) can make a big difference to your health.

Measuring your waistline is a great way of checking your weight rather than weighing yourself regularly. In general, women need to aim for a waist measurement of less than 80 cm and men less than 90 cm.

If you are carrying excess weight around the middle, try to lose some of it by:
Following a diet plan lower in kilojoules and total fat (particularly saturated fat). 
Doing regular physical activity such as walking, dancing, riding a bike or swimming. 
Asking your doctor, dietitian, diabetes educator or Diabetes Australia for advice.

IMP: A word about Non Veg. choices:
Chicken without skin has 54 mg of Cholesterol per 100 Gms
Lean Mutton without fat and Blood has 45 mgs of Cholesterol per 100 Gms.

Many of us, while avoiding Red Meat go on consuming white meat ,say ,chicken but if enough quantities are consumed then you can note that hardly any real advantage is achieved in terms of Cholesterol .If you consume Half Tandoori Chicken you consume More Cholesterol then when  you consume two Mutton Seekh Kebabs which by weight contain more of Onions, Herbs and Gram Flour !

So it is clear that correct choice and quantity you eat is much more important then simply avoiding Red Meat !

Moreover, Honestly Speaking, Diet restrictions can change your Lipids Only by 10 % -as a rule !
TO CUT DOWN WEIGHT-SIMPLY REDUCE YOUR DIET BY 25% AND START BRISK WALKING 40 Min A DAY!


Remember – good food choices and regular activity will help to keep you healthy!

 

Patient Education Program: Hypoglycemia & SMBG

Q:What is Hypoglycemia ?

Ans: As you all know that normally our regulatory systems maintains Blood Glucose levels between 80-116 mg per 100 ml of Blood i.e.‘mg%”This normal level is required for the normal functioning & day to day activities for each & every cell of our Body.Whenever the Glucose levels get lower than this normal we call it technically-Hypoglycemia & SMBG. 

Q:Why at all the levels should go down ?

  • Ans As we have told you already that treatment of Diabetes mainly evolves around the increasing the Insulin levels upwards either by stimulating it’s production from pancreas if it is feasible;or by supplying Insulin from outside by Injections!in both the situations this Insulin is not under the regulatory controls of the Body!if now the Glucose levels go down say because of –

1.Delay in food intake
2.Less Food Intake-less than usual

  • 3.Excessive exertion –more than usual- consuming excess Glucose                                                            
  • 4.Accidentally larger dose of Insulin injected
  • 5.Larger dosage of Oral Pills-intentional or by mistake

In all these situations there is Relative Excess Of Insulin as compared to Glucose & the latter is consumed by cells and levels go down Dangerously!

Q: Why at all the Low Sugar levels are so dreadful ?

Ans: All our body systems need Glucose for their activity. Brain and all it’s Important areas which Govern our Alertness-i.e.wakeful sate, memory, speech, thinking or even the lower Brain functions like Breathing, BP regulation, Heart Beats etc all need CONTINUOUS supply of NORMAL levels of Glucose If these are not available all these functions will gradually Fail. Thus person can actually fall unconscious passing from various stages depending upon the speed & quantum of lowering in the Glucose levels; and this can actually happen if one fails to recognize the oncoming symptoms of reducingGlucose.

Q: How & when the Patient should suspect that stage of Hypoglycemia is approaching?

Ans: Symptoms that should make one alert of approaching Hypoglycemia & SMBG are as under:
Cold Sweats, Tremors, Goose Skin, weakness, Headache, Confusion, Memory lapses, Palpitations, Apprehensive feel, Slurred speech, Visual impairment, disturbed consciousness, Coma …and if not promptly corrected-medically or by compensatory mechanisms of the body, the person can actually pass into deep COMA. YES and this makes Hypoglycemia – dreadful & dangerous situation.

Q: How to avoid & correct Hypoglycemia ?

Ans: Simple, Avoid all the situations enumerated above, which can lead to Hypoglycemia.
If any of the warning symptoms (see above) alone or in combination appear in a patient of Diabetes he should immediately take something to eat or Drink-a biscuit, snack, cold drink-even plain sugar or a candy will do, and then immediately inform your physician. Stay calm, stop driving if in car, wait till someone arrives or you are fully fit to move.

If you have glucometer with you, check blood glucose every 20 mins. May be 2 - 3 times till it rises above 80-100 mg.

Self Monitoring of Blood Glucose OR SMBG:

INTRODUCTION — People with diabetes have an important role in their own medical care, and self-glucose monitoring is an opportunity for people with diabetes to take control of their own health, I frequently tell my patients  “My role is that of an air-traffic control tower and YOU are the pilot, controls of the plane are with you and you have to make a successful landing, I can only guide you to the runway”!
Although diabetes is a chronic condition, it can usually be controlled with lifestyle changes and medication. The main goal of treatment is to keep blood glucose levels in the normal or near-normal range. Monitoring blood glucose levels is one of the best ways of determining how well a diabetes treatment plan is working for you.
No doubt , your doctor will periodically order laboratory blood tests to determine your blood glucose levels and hemoglobin A1c (A1C). The results of these tests give an overall sense of how blood glucose levels are being controlled .However, fine-tuning of blood glucose levels and treatment also requires that patients monitor their own blood glucose levels on a day-to-day basis.

BENEFITS: Therefore, SMBG can aid in diabetes control by the following :

A)Since no two patients will behave exactly the same, even with similar therapies being given ,SMBG facilitates the development of an individualized blood glucose profile, which can then guide doctors in treatment planning for an individualized diabetic regimen; 
B)Helps people with diabetes and their families by giving them  the ability to make appropriate day-to-day treatment choices in terms of  diet and physical activity as well as in insulin or other agents; 
C)By improving patients’ recognition of hypoglycemia or severe hyperglycemia : LOWS & HIGHS”. Allows  them to actually co-relate their symptoms with blood glucose levels.
D)By enhancing patient education & understanding of his diabetes and  imparting patient empowerment, regarding the effects of lifestyle and pharmaceutical intervention on control. 
E)Since they can easily correlate their symptoms with actual levels of glucose in their blood and can also see themselves, how the changes in lifestyle, diet and treatment are being translated into good control 
F)They do develop a better sense of responsibility and awareness towards their ailment.
G)SMBG helps them planning out necessary changes required during different and out of routine situations ,say their travel, religious fasts, sick days etc.
H)Patients can also cross check their levels with those of laboratories and learn soon to relate them with their HbA1c –a big step towards understanding the value and need of long term complications of the disease.
I) Understanding concepts of pathogenesis of Diabetes and of glucose generation vs utilization in the body ,become much easier to them.
J)Patients can actually measure the “glucose productions” after different meal compositions as well as different meal timings and get prepared to take appropriate corrective measures well in time, having learnt from their past experiences, this saves them from un-necessary hospitalizations and reduces monetary burdens involved , in other words a great saving of resources -at individual, family and national levels! 
E.G. avoiding hospitalization on account of Hypoglycemia ,when detected in time and at home saves money and trouble of hospital admission !
K)It gives people confidence about their glucose levels at critical times, such as prior to driving or in a work context.
L)It provides reassurance and supports psychological well-being by increasing feelings of control having things in-control!
M) It enables temporary insulin use.
N)Induces positive behavioral changes

IMP: Irrespective of the debate and controversies related to use of SMBG in Type 2 Diabetes NOT using Insulin, it(SMBG) makes every Diabetic In-charge of his/her own ailment and makes him responsible for his day to day conduct-Empowerment of the patient along with development of responsibility inducing behavior ,which develops automatically and this in my opinion is a big step towards controlling the onslaught of this otherwise ever enlarging problem.

For the family and society:
Better managed diabetics, better skilled diabetics, better educated diabetics means-
-less sickness and work absenteeism ,
-less burden on hospitals & national resources-
-less expenses on diabetes management
-lesser complication rates
-Huge savings in terms of money, resources , health, man-power .
More  healthy sets of skilled and semi skilled hands and brains available for national productivity and that too for longer durations- with increased longevity.

HOW TO TEST — The following steps include general guidelines for testing blood glucose levels; specific details for individual blood glucose monitors should be obtained from the package insert or a doctor/diabetes educator.
-Wash hands with soap and warm water. Dry them. Check setting on your lancing device it should be on the lower side 1 to 3 !
-Prepare the lancing device by inserting a fresh lancet. Lancets that are used more than once are not as sharp as a new lancet, and can cause more pain and injury to the skin.BUT you can use one lancet in the same patient for as many as 6 times!
-Prepare the blood glucose meter and test strip (instructions for this depend upon the type of glucose meter used).
-Use the lancing device to obtain a small drop of blood from the fingertip or alternate site (like the skin of the forearm). Alternate sites are often less painful than the fingertip. -However, results from alternate sites are not as accurate as fingertip samples when the blood glucose is rising or falling rapidly.
-Patients who have difficulty getting a good drop of blood from the fingertip can try rinsing the fingers with warm water, shaking the hand below the waist, or squeezing (“milking”) the fingertip. Preferably before the prick.
-Apply the blood drop to the test strip in the blood glucose meter. The results will be displayed on the meter after several seconds.
-Dispose of the used lancet in a puncture-resistant sharps container (not in household garbage bin).
SCIENCE BEHIND FREQUENCY OF TESTING — Studies have proven that patients with type 1 and 2 diabetes who maintain normal or near normal blood glucose levels most of the times I n 24 hrs and on day to day basis, have a lower risk of diabetes-related complications. The frequency of monitoring will depend upon the type of diabetes (1 or 2) and treatment used (insulin versus oral medications).

MONITORING TARGETS: TREATMENT TARGETS TO BE FIXED ARE:

Fasting Blood Glucose                               100 to 120 mg %
Postprandial at 2 - 3 Hours after meals              140 to 170 mg%
Random at any time of the Day              < 140 mg%

Yes we are indeed TIGHT on glucose!

HbA1c                                                            < 6.5%
Total Cholesterol                                        < 180 mg  %
HDL-Cholesterol(Good one)                  > 45 mg   % in males & > 50 mg % in females 
Triglycerides                                                < 150 mg %
LDL-Cholesterol                                          < 100 mg %

(If you have Heart Disease/PAD/TIA/Stroke- < 70 mg%)

Blood Pressure                                            < 130 / 80

(& if you have kidney disease then less than 125 / 75

And do not care what your lab gives you as normal reference range remember only these above given levels !


Monitoring Your Health and Treatment:


At the beginning –Get the following done (Minimum):-

  • Fasting and PP-after meals- Blood Glucose.
  • Please note that if you are on treatment then glucose has to be tested with your regular dose of medicines and /or Insulin.Because the idea is to see and check how your treatment is working for you! and its should be done every 7 to 10 days and its should be fasting, pp after lunch and pp after dinner as well.
  • CBC, Kidney Function with ElectrolytesLiver Function Tests, Lipid Profile, HbA1c, Thyroid Function Test,complete Urine Examination.
  • Micral - or Microalbuminuria or Albumin in Urine - Should always be less than 30 mg per day. Should only be tested when blood glucose is normal, there is no infection, no heart failure & centainly not after the excercise.

 

Afterwards-take time and make a habbit of all the following things:
 

Daily:


Take your Body weight with minimum of clothes
Recapitulate what misadventures you did yesterday with meals etc
Examine your feet (sloes with mirror)
Have a close look of your teeth, skin, nails, eyes
Plan your exercise and activity
Consider your days’ meal plan and provisions for any outdoor meals!
See that you have adequate and appropriate supply of your medicines
Make a mental chart of your days’ final schedule!
Look if any self monitoring is to be done with your glucometer


Weekly :


Look at your weight chart-identify trends
Measure your BP
Look at your blood glucose readings over the past 6-7 days
Attend to your feet, nails, skin, exercise etc at leisure on your weekly holiday
Track your doctors’ prescriptions, review your treatment plan, plan your next visit

Monthly:


Consult your diabetologist regularly as diabetes as a progressive disease hence treatment once written will not work for ever.
Get an fasting and PP Blood Glucose done at your neighborhood lab and cross check with your glucometer,
Check if Lipids,Creatinine,TSH,HbA1c,Urine Protein/Albumin,SGPT/SGPT or any other test in the past which needs to be re-evaluated and revalidated-as per your doctors’advice