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Shroff Eye Hospital is India's First Eye Hospital accredited by the Joint Commission International (USA) since 2006. Shroff Eye is also India's first and only Wavelight Concerto 500 Hz LASIK center. Shroff Eye has stood for excellence in eye care since 1919. A firm commitment to quality is at the heart of all services provided at our centers at Bandra(W) and Marine Drive, Mumbai.

Diabetics

If you have diabetes you should know that you are more vulnerable to eye diseases like cataracts, retinopathy and blindness. Several factors influence whether you get retinopathy. These include your blood sugar control, your blood pressure levels and the duration of time that you have had diabetes.

The longer you’ve had diabetes, the more likely you are to have retinopathy. Almost everyone with type 1 diabetes will eventually have non-proliferative retinopathy. Most people with type 2 uncontrolled diabetes will also get it.

But you can take charge and prevent such troubles.

Here are some tips that can help fight these eye disorders.

  • All diabetics must have their eyes examined by dilating their eyes, in order to check the retina thoroughly.
  • Be aware of the symptoms such as blurred vision, shadows, and spots, flashes of light, floaters, seeing double and partial or complete loss of vision in one or both eyes. These are signs for you to schedule a visit with the eye specialist at once.
  • Even with proliferative retinopathy, the more dangerous form, people sometimes have no symptoms until it is too late to treat them. So, do visit your eye specialist regularly even if not experiencing any symptoms.
  • Keep a yearly appointment with the ophthalmologist. “Taking just an hour or so to have a dilated eye examination, at least once a year can save people with diabetes from a lifetime of complications and even blindness,” said Dr Rahul Shroff, Vitreo-retinal and Diabetic Retinopathy specialist at Shroff Eye Hospital, Mumbai.
  • Do not settle for an optician. Only an eye specialist can dilate the pupils and detect any changes that suggest retinopathy.
  • Keep your blood sugar levels in control. Avoid sugary snacks and foods that are highly processed and made from white flour. Your diet must include a lot of high fiber food, unsalted nuts, fruits and vegetables.
  • Keep your blood pressure in control. High blood pressure by itself can lead to eye disease, so if you have high blood pressure as well as diabetes, it is especially important that you take steps to control both conditions as you are at a higher risk than others.
  • Vast advances have been made in the treatment of diabetic retinopathy. Keep yourself updated with this knowledge.
  • The earlier problems are diagnosed, the more successful the treatments can be.
  • Treatments such as laser photocoagulation, done in time, prevent blindness in most people.

The past two decades have seen an explosive increase in the incidence of diabetes mellitus worldwide, making it one of the most common non-communicable diseases today. According to the World Health Organization (WHO), there were an estimated 135 million diabetics in the world in 2000, and this number is expected to increase to 300 million by 2025.

What is of more consequence is that India has the largest number of diabetics in the world. In 1994, 19.4 million suffered from diabetes mellitus, 32 million were diabetics by 2000 and the number is expected to increase to 57.2 million by 2025. Moreover, according to current estimates, diabetics will increase by 42 per cent in developed nations and by 170 per cent in developing nations. According to an ICMR study, prevalence of diabetes mellitus, which was 2.3 per cent in urban population in 1970, increased to 12.1 per cent in 2001.

The increase in incidence of diabetes mellitus and its complications has been attributed to change in life style caused by increased urbanization, high calorie diet, decrease physical activity and stress. Other important factors are genetic factors, family history and increased longevity. And what is worrying that diabetes is striking at an early age among the urban population.

Types of Diabetes:

Diabetes mellitus occurs in two forms:

Type 1 (Insulin dependent) – Also called juvenile diabetes, this is seen in younger people and is characterized by absolute insulin deficiency due to which these patients are completely dependent on insulin treatment. The incidence of this form of diabetes is doubling every decade.

Type 2 (Non-Insulin dependent) – This is seen in older people and is characterized by insulin resistance or abnormal insulin secretion. These patients can be treated with tablets or may require insulin. This form accounts for 90 per cent of all cases seen globally, but its increasing incidence in India is due to changing diet, from traditional Indian food to modern diet caused by a more stressful life-style and increased urbanization. This type is being seen in younger people due to obesity. Moreover, type 2 diabetics have a greater tendency to develop hypertension and heart disease.

It’s not just the disease itself that is a cause for concern. Diabetics are more prone to develop systemic complications. They are also 25 times more likely to develop blindness, twice as likely to have a stroke, 2-4 times more likely to have myocardial infarction and much more likely to develop kidney disease or undergo amputation.

Effect of diabetes on the eye:

Diabetes can cause eye complications such as:

  • Diabetic Retinopathy: This is the most common complication and it has been seen that 25 per cent of all diabetics develop this complication after 10 years of diabetes and 50 per cent develop it after 20 years of diabetes. Diabetic Retinopathy is also more common in the upper socio-economic group.

    Diabetic Retinopathy has two types –

    Non-Proliferative Diabetic Retinopathy – This is the early stage in which tiny blood vessels in the retina get damaged and leak blood or fluid, which cause the retina to swell or form deposits called exudates. 90 per cent of Diabetic Retinopathy cases are of this type. This stage often has no symptoms.

    Proliferative Diabetic Retinopathy – This is the advanced stage. Abnormal new blood vessels grow on the surface of the retina and often bleed into the jelly in front of the retina, giving rise to floaters, dots or lines or sometimes loss of vision. These new vessels can eventually pull the retina causing a traction retinal detachment. 10 per cent of Diabetic Retinopathy is of this type.

    Maculopathy – Leaking fluid collects in the centre of the retina called the Macula giving rise to blurring of vision.

    Studies have shown that there has been a 3-fold increase in the incidence of Diabetic Retinopathy in India in the last 10 years.

  • Cataract – This is more commonly seen in diabetics at a younger age and more commonly in the lower socio-economic group. Important causes are exposure to ultraviolet light and oxidative stress.
  • Glaucoma – This involves increase in intra-ocular pressure within eye and is more commonly seen in persons afflicted with diabetics.
  • Diabetics are also more prone to develop paralysis of the nerves of the eyes due to obstruction of the blood supply.

Incidence of vision loss:

The following categories of individuals are at a higher risk of losing vision in diabetes:

  • Those who have had diabetes from a younger age
  • Those who have had diabetes for many years
  • Those who have poorly controlled blood sugar
  • Those who have poorly controlled blood pressure
  • Those who smoke

Improving diet:

Diet plays an important role in the control of diabetes and diabetic retinopathy. Studies have shown a much lower incidence of diabetic retinopathy in persons who follow a healthy diet. A good diet consists of

  • Ghee as the cooking medium
  • Fish and fish-oil capsules, which are rich in selenium and zinc. Fish is considered to be one of the best foods for diabetics
  • Green leafy vegetables
  • Vitamin A rich foods like carrot and green leafy vegetables
  • Vitamin E rich foods like cereals and grains

Diabetics must avoid fried food, animal food (except milk and fish), processed food and preserved food.

Regular eye examination

All diabetics must have the eyes examined regularly with dilated pupils. Juvenile diabetics must have their eyes examined at least once a year after the age of 12 years because diabetic retinopathy is rarely known to occur before puberty. Those with diabetes at an older age must have the eye examination done once at the time of diagnosis and then at least every 6 months to one year thereafter.

If Diabetic Retinopathy has been diagnosed, they should have the eyes examined as often as recommended by their eye doctor.

Laser treatment:

A special test called fluorescein angiography may be required to identify areas that require laser treatment. If leakages or new vessels are detected, laser treatment must be promptly given. Sometimes there is leakage of blood from the retina of the eye into the jelly in front of the retina, which may cause blurring of vision. An operation called vitrectomy may be required to remove the bleeding and replace it with clear fluid.

Studies have shown that vision can be preserved in 90 per cent of diabetics if laser treatment in done in time.

Newer treatment modalities:

Anti-VEGF Injections for Diabetic Retinopathy

Injection treatments (Lucentis™, Avastine™) used commonly for macular degeneration have also proven to be effective for diabetic eye disease, in some cases better than laser treatment.

Results from a large clinical trial conducted by the Diabetic Retinopathy Clinical Research Network, or DRCR.net, demonstrated that patients receiving a combination of anti-VEGF treatments and laser treatments had greater gains in visual acuity as compared to others.

A newer injection viz. EYLEA™ (aflibercept), known in the scientific literature as VEGF Trap-Eye, is also being used as an injection into the eye to provide a therapeutic effect in patients suffering from various eye disorders including in some cases of diabetic retinopathy.

Prevention of complications:

All diabetics must adhere to the following to prevent complications:

  • Avoid obesity and have regular physical exercise
  • Control the blood sugar and blood pressure at all times
  • Avoid self-medication. It is better to follow the advise of a physician
  • Maintain a healthy diet. Insulin or pills is not a substitute for a proper diet
  • Have your eyes examined at least once every 6 months to a year by an eye doctor

Being a diabetic does not mean that you cannot enjoy a happy and healthy life. Follow the above-mentioned simple rules with a positive attitude, and you will see the change in your life.

Issued in public interest by Shroff Eye Hospital, Mumbai, India India’s first LASIK Centre to launch the 500 Hz Wavelight Concerto laser India’s first Eye Hospital to be awarded the JCI- Joint Commission International certification (USA), the Gold standard of Healthcare Internationally.

GOALS and Pathway

  • How to manage diabetes if you have it?
  • How to prevent diabetes if you are prone to it?
  • The right nutrient balance by understanding carbohydrates, protein, fats and fiber
  • The do’s and don’ts for diabetics
  • Life style changes
  • Right exercise
  • The truth about artificial sweeteners
  • Helpful Herbs
  • Benefit of magnesium
  • Guidelines for Juvenile and Gestational diabetes
  • Case Studies

MANAGEMENT OF DIABETES

This requires inputs mainly from 4 spheres:

  • Diet
  • Right Exercise
  • Lifestyle Changes
  • Medications

And mind you all are equally important.

CORRECT DISTRIBUTION OF NUTRIENTS FOR DIABETICS

Maintaining a healthy diet is important for everyone, but it is especially important for people with diabetes. Following the right meal plan can make all the difference to a person struggling to keep their blood sugar under control. But what is the right meal plan and how much of which food group should you eat?

Understanding Carbohydrates

Carbohydrates provide fuel for the body in the form of glucose. Glucose is a sugar that is the primary means of energy for all of the body’s cells. There are two types of carbohydrates — simple and complex. Simple carbohydrates are sugars — they are found in refined sugar, and in fruits. So the first step is to avoid all simple sugars but excluding fruits. Fruits are only to be had after meals and not on its own. Complex carbohydrates are the starches — they are found in beans, nuts, vegetables and whole grains. They are considered very healthy mostly because they are digested by the body slowly and provide a steady source of energy. Carbohydrates have the most immediate effect on your blood glucose since they are broken down into sugar early during digestion. It is important to eat the right amount of carbohydrate at each meal, along with some protein and fat. This is not only important for diabetics but also for maintenance of right weight as well as for weight loss. So if somebody is looking for weight loss, pay attention. All the three main meals must have the balance of all the three basic nutrients.

Carbohydrates are mainly found in three food groups: fruit; milk and yogurt; bread, cereal, rice, pasta, and starchy vegetables. You will need to consider the total amount of carbohydrates when working out your daily meal plan. A nutritionist or an RD will help you figure out a carbohydrate counting plan that meets your specific needs.

Understanding Fat

Since diabetes raises your risk of developing heart disease, eating foods lower in fat – especially saturated fat – is particularly important to keep that risk as low as possible. In addition, limiting calories from fat will help you lose any extra weight, especially when combined with an exercise program.

But as I mentioned that some amount of fats are extremely essential for all the three main meals so the question is how, what and how much?

As we all know that saturated fats, and tans fatty acids found in ghee, butter, coconut and commercially baked foods such as cakes, biscuits, pastries, etc are to avoided. These fats are bad as well as not essential for our body.

There is a particular group of fats that are important and as well as essential for our body called essential fatty acids. They are required by the body for hormonal balance, immunity and maintenance of healthy skin. They are found in all vegetable oils such as peanut, sunfower, safflower, soyanut, til, and all nuts except coconut.

Ideally 3 to 5 teaspoon of oil is to be consumed in a day and to be distributed evenly between all three major meals.

The essential fatty acids also affect the ability of the body’s cells to respond to insulin. The Omega-3fatty acids are found in some fishes, walnut, flaxseeds etc and Omega-6 fatty acids are found in most vegetable oils. In a 1993 study, Australian researchers learned that insulin resistance is related to what kinds of fatty acids make up the cell membranes. The more Omega-3 and Omega-6 fatty acids there are in the cell membranes of adult diabetics, the more their tissues respond to insulin.

Understanding proteins

Though this group is smaller as compared to carbs but dependency is maximum for nutritional aspects. We all know that for vegetarians, the only source for proteins are pulses and milk products but non-vegetarians have additional sources such as egg, fish, meat and chicken.

All the 3 major meals should have proteins coming in along with the carbohydrates

How Much Fiber Should I Eat?

Fiber helps move foods along the digestive tract and promotes regular bowel movements. Fiber also delays sugar absorption, helping to better control blood glucose levels.

The best way to increase your fiber intake is to eat more of these fiber-rich foods:

Fresh fruits and vegetables

Fruits like guava, pomegranate, figs, berries, apples (raw, with skin), peaches, pears, kiwi and grapes are high in fiber.

In vegetables cabbage, cauliflower, beans, peas, ladyfinger and lettuce have high fiber content.

  • Cooked dried beans and peas
  • Whole grain breads, cereals, and crackers
  • Chickpea, kidney beans, black pulse are some, which are high in fiber.
  • Brown rice
  • Bran products

DIETARY RECOMMENDATIONS

DONTS

Cut down totally on table sugar and all the food made with sugar like chocolates, mithais, aerated drinks, ice creams etc.

Avoid all types of fatty food as you are at greater risk of heart diseases and also fat metabolism is affected due to inactive pancreas (besides insulin pancreas also secretes lipase to break down fat).

Avoid fruits like mango, banana, grapes, cantaloupe (musk melon) and chickoo. Limit yourself on fruits like pineapple and custard apple.

Avoid dry fruits like apricots and raisins.

Avoid vegetables like potato, pumpkin, beet, carrot, colocasia (arwi), yam (sooran), jackfruit etc.

Avoid snacky foods like French fries, corn chips, pretzels etc.

No alcohol as it has high sugar content.

No honey or glucose.

Limit your coffee or tea intake to 1 or 2 cups a day (without sugar). Try lemon tea.

DO’s

  • Protein requirement is more for you compared to non-diabetic, thus make sure to include enough milk and milk product (skimmed), dals and pulses. Non-vegetarians can also opt for egg whites (not the yolk), lean meat and fish.
  • Steamed, baked, boiled preparations are preferable to fried foods.
  • Fruits like grapefruit (papnus), Indian gooseberry (amla), kala jamun are especially recommended.
  • Vegetables like tomato, bitter gourd (karela), gourd (doodhi), garlic, and lettuce have curative properties for diabetes.
  • Onions are especially good as they contain some sugar lowering chemicals, similar to the oral sulfonylureas (anti-diabetic drugs).
  • Broccoli is highly recommended for diabetics. It can be partly due to its high chromium content (chromium helps in glucose metabolism), and also the fact that it is rich in complex carbohydrate.
  • Soybean, and Bengal gram (chana dal) are also beneficial in diabetes.
  • Methi seeds are very beneficial for the treatment of diabetes. 2 teaspoon of methi seed should be soaked overnight and to be had first thing in the morning.

LIFESTYLE CHANGES

Obesity is a major cause of life style related diabetes, thus if you are over weight or obese your first step should be to bring your weight to ideal body weight.

Secondly, never miss a meal no matter how busy you are.

You should have frequent meal at regular intervals.

Try to have fixed meal timings.

Overeating at any meal should be avoided.

A small biting before sleeping is advisable. It helps controlling the fasting sugar.

Get your sugar levels tested every 3 monthly.

Avoid stressful life and control stress by practicing meditation every day.

Take care of your dental health, as you are most prone to bacterial infections and gum diseases. This means amore frequent visits to dentist and especially conscientious brushing and flossing to control plaque and tartar.

EXERCISE AND DIABETES

Regular exercise is an important part of managing Type II diabetes, and it helps to keep weight down. When patients don’t exercise, “it’s a vicious cycle. You don’t exercise; you gain weight. You get deconditioned. The weight and the deconditioning make it harder to exercise.” So,

  • It is very essential for you to brisk walk for 30 to 45 minutes or any other exercise program, 4 to 5 times a week, to keep a check on your sugar levels.
  • Even the exercise time is very important. It has been observed that evening time for exercising gives better results than morning. Nevertheless, it is just a preferred timing, fact remains that exercising is most important than the time.
  • Yoga has profound impact on pancreas stimulation. Regular practice of certain yoga asanas gives unbelievable benefits.

Asanas like Ardha- matsyendrasan; Pavanmuktasan, Shalabhasan, Bhujangasan, Yogmudra, Naukasan, Janushirasan, Pashchimottanasan, Dhanurasan, etc. are recommended but should be learnt under guidance of an experienced yoga instructor.

THE TRUTH ABOUT ARTIFICIAL SWEETNERS

Sugar substitutes may “fool” the body calorie-wise, but they cannot deceive the body’s insulin response. Though they are short on calories they can, nevertheless, cause an excess release of insulin and the cravings and weight gain that usually follow.

The rule of thumb is this: if it tastes sweet, your body thinks it is getting sugar. If your body thinks that it is getting sugar, your body releases insulin, and if you are prone to releasing too much insulin, then anything that tastes sweet, no matter how “low-calorie” it is, can lead to increased cravings and weight gain.

If you think that diet sodas and “sugarless” gums, mints, and candies can give you a “free ride” on the road to weight loss, you are in for a bumpy ride to nowhere. Sugar substitutes may seem to cut calories at the moment you consume them, but if you are carbohydrate addicted, they can trigger a heightened insulin response that will soon drive you to high-carbohydrate, high-calorie foods.

Even if you are somehow able to successfully and repeatedly fight off your carbohydrate cravings, we have found that frequent intake of sugar substitutes may put your body in a fat-making mode, making it easier to gain and more difficult to lose weight.

Ounce for ounce, fructose (fruit sugars) and high-fructose sweeteners (which, despite their name, can be made from glucose) carry the same calorie value as table sugar and, when consumed often, appear to cause the same insulin response.

For now, be aware that anything that tastes sweet, high-calorie or low-, can set off your insulin trigger.

You must determine which artificial sweeteners agree with you, but the following are allowed: sucralose (marketed at Splenda®), saccharin, cyclamate, acesulfame-K. Natural sweeteners ending in the suffix “-ose,” such as maltose, fructose, etc., should be avoided. However, certain sugar alcohols such as maltitol do not affect blood sugar and are acceptable.

Saccharin has been extensively studied, and harmful effects were produced in the lab when fed to rats only in extremely high doses. The Food and Drug Administration (FDA) has removed saccharin from its list of carcinogens. It can be safely consumed in moderation, meaning no more than three packets a day. Saccharin is marketed as Sweet ‘N Low®. We discourage the use of aspartame (marketed as NutraSweet® and Equal®).

My preference, however, is sucralose (Splenda®), the only sweetener made from sugar. Sucralose is safe, non-caloric and does not raise blood sugar. It has been used in Canada for years, and the FDA recently approved it after reviewing more than one hundred studies conducted over the past twenty years.

HELPFUL HERBS:

Cinnamon: The Spice That Cuts Cholesterol and Blood Sugar

A dash of cinnamon could significantly lower your cholesterol, triglycerides, and blood sugar.

As per one research conducted, when some men and women with type 2 diabetes added a sprinkle of cinnamon to their meals, their blood sugar, total cholesterol and triglycerides, fell from 12 to 30% in just 40 days.

Cinnamon also makes muscle and liver cells more sensitive to signals from insulin.

Have a little, say a daily total of about 1/2 teaspoon a day , would make a diffrence. Since cinnamon may reduce your need for diabetes or cholesterol medication, ask your doc if you need to adjust your dose.

Fenugreek – Enhances Carb Metabolism for Diabetics

A new complex of amino acids derived from the herb Fenugreek promises to facilitate glucose and insulin management for those with diabetes. It helps control blood sugar swings and therefore, cravings. Thus enhances weight-loss efforts.

Fenugreek extract has the potential to speed the process of blood glucose being utilized for energy, thereby preventing unhealthy levels of glucose continuing to circulate in the blood. By this action, it can help to break the vicious cycle of impaired carb metabolism, which controls insulin resistance and weight gain.

The Benefits of Magnesium for Diabetics

An exciting body of research strongly suggests that supplementation with magnesium can help prevent or treat insulin resistance and other cardiovascular problems in people with diabetes.

Magnesium can help people with diabetes in a number of ways.

Magnesium is not likely to change blood sugar very much, but it may improve insulin sensitivity, which may improve long-term prospects of avoiding a heart attack or stroke in people with diabetes.

Magnesium can reduce blood clotting. People with diabetes are prone to excessive blood clotting, a risk factor for dangerous plaque buildup and artery blockages.

The Nurses’ Health Study found that the more magnesium these women took in, the lower their risk of getting diabetes.

Clearly, it could be in your interest to keep your magnesium levels up, particularly if you have a family history of diabetes.

You can get magnesium from eating dairy products, whole-grain products, unprocessed vegetables, legumes, nuts, and soy products.

Include foods that have a high ratio of magnesium to calcium such as brown rice, bananas, oats, barley, and soy, and are high in fiber such as oat bran, psyllium seed husk, and flaxseed meal.

JUVENILE DIABETES

Type 1 diabetes

In type 1 diabetes the body does not produce enough insulin to move glucose from the blood into the cells, and blood sugar becomes high. There is no cure for type 1 diabetes, and the major form of treatment is to inject insulin into the bloodstream. Type 1 diabetes is also called juvenile diabetes because it is most often diagnosed in childhood.

In children, good blood sugar control helps to promote normal growth, development, and well-being, and allows for optimal learning. Maintaining levels as close to target range as possible can also prevent or delay the long-term complications of diabetes.

Daily eating patterns in children generally require three meals and two or three snacks. The purpose of snacks is to prevent hypoglycemia between meals and to provide adequate calories.

Until a cure is found, a person with type 1 diabetes must take insulin injections

Managing Type 1 Diabetes: Exercise

Physical activity helps the body use glucose more efficiently and helps control weight. People who have not been very active, however, should consult a doctor before beginning an exercise program

Exercise Checklist

  • Do talk with your doctor about exercise — and how to manage your total program — especially if you have eye, nerve, or vascular complications. Some exercises may not be appropriate for you.
  • Do try to exercise every day at the same time. Be as consistent with your exercise as you are with your mealtimes and insulin injections.
  • Do exercise soon after eating, when blood sugar levels are at their highest.
  • Do test yuor blood sugar levels before exercising.
  • Do exercise with a friend if possible and be on the lookout for signs of hypoglycemia.
  • Do eat a small snack 15 to 20 minutes before you exercise if yuor blood sugar levles are not too high. Carry a fast carbohydrate pick-me-up wiht you when exercising…just in case.
  • Don’t inject insulin into a part of the body you’ll be exercising. It will be absorbed faster there.
  • Don’t exercise when insulin is working at peak action. If you must, eat before you exercise.

INSULIN DOES NOT CURE IT

While insulin allows a person to stay alive, it does not cure diabetes nor does it prevent its eventual and devastating effects: kidney failure, blindness, nerve damage, amputations, heart attack and stroke.

DIFFICULT TO MANAGE

Despite rigorous attention to maintaining a meal plan and exercise regimen, and always injecting the proper amount of insulin, many other factors can adversely affect efforts to tightly control blood-sugar levels including: stress, hormonal changes, periods of growth, physical activity, medications, illness/infection, and fatigue.

What is Gestational Diabetes

Pregnant women who have never had diabetes before but who have high blood sugar (glucose) levels during pregnancy are said to have gestational diabetes.

Gestational diabetes starts when your body is not able to make and use all the insulin it needs for pregnancy. Without enough insulin, glucose cannot leave the blood and be changed to energy. Glucose builds up in the blood to high levels. This is called hyperglycemia.

Gestational diabetes usually goes away after pregnancy. But once you’ve had gestational diabetes, your chances are 2 in 3 that it will return in future pregnancies. Many women who have gestational diabetes go on to develop type 2 diabetes years later.

Certain basic lifestyle changes may help prevent diabetes after gestational diabetes.

Losing weight Are you more than 20% over your ideal body weight? Losing even a few pounds can help you avoid developing type 2 diabetes.

Making healthy food choices Follow simple daily guidelines, like eating a variety of foods including fresh fruits and vegetables, limiting fat intake to 30% or less of daily calories, and watching your portion size. Healthy eating habits can go a long way in preventing diabetes and other health problems.

Exercising Regular exercise allows your body to use glucose without extra insulin. This helps combat insulin resistance.

The safest form of exercise is one that does not cause fetal distress, uterine contractions or maternal hypertension.

Appropriate exercises use the upper body muscles or place little mechanical stress on the leg and trunk regions.

Some foods should generally be avoided. Obviously, sweets of any kind are excluded. However, for pregnant women with glucose intolerance, sugar should not be part of their intake. Pregnancy hormones cause them to be too sensitive to sweets, plus control during pregnancy has to be much more strict than non-pregnant diabetics must aim for. So sweets during pregnancy should be strictly avoided.

Other ‘forbidden’ foods that are less obvious include fruit juices and cold cereals. It doesn’t matter whether the fruit juice is sweetened or unsweetened; most people’s glycemic response to both kinds of fruit juice is so swift and strong that it’s essentially the same as drinking a regular soda-pop. Cold cereals, also, are generally not recommended, even if they are not sugar-coated. They are very carb-intensive and provoke a strong response, so they should usually be avoided. Some people can tolerate them, but they cause problems for most and so are generally not permitted. Hot cereals, on the other hand (like regular long-cooking oatmeal), generally do not cause the same quick rise and can be consumed, as long as careful attention is paid to portion-control. South Indian food.

As mentioned earlier the key is to include a protein food whenever you have a carb food, since the protein tends to slow things down and make them more even; your bG spikes less and is available as energy longer (thus preventing a dip later

One consistent recommendation involves limiting carbohydrate intake at breakfast.

PREVENTION OF DIABETES

Pre-Diabetes – Are You At Risk?

This condition (also known as border-line diabetes) is a precursor to full-blown Type II diabetes, which can cause complications ranging from high blood pressure to blindness

Health experts are recommending that people who are ages 45 and over who are 10 kgs more overweight get tested for pre-diabetes. According to the new guidelines, physicians should also test those 44 and younger, if they are overweight and also have one of the following risk factors: family history of diabetes, low HDL (good) cholesterol, high triglycerides, high blood pressure or a history of gestational diabetes.

Research has found that most people who have pre-diabetes (which is a fasting blood-sugar level that is above normal, but not high enough to be classified as diabetes) develop true diabetes within 10 years, according to the president of the American Diabetes Association. Pre-diabetes doesn’t cause symptoms, so most people who have it don’t even know it.

If you have pre-diabetes, the good news is that blood sugar levels can be improved by exercising for at least 30 minutes a day, five days a week and by losing 5 to 10% of your weight (if you are overweight). Nutritional help is also available from the minerals Chromium, Vanadium and Zinc which aid your body’s ability to normalize blood sugar

Author: Suman Agrawal

The past two decades have seen an explosive increase in the incidence of diabetes mellitus worldwide, making it one of the most common non-communicable diseases today. According to the World Health Organization (WHO), there were an estimated 135 million diabetics in the world in 2000, and this number is expected to increase to 300 million by 2025.

What is of more consequence is that India has the largest number of diabetics in the world. In 1994, 19.4 million suffered from diabetes mellitus, 32 million were diabetics by 2000 and the number is expected to increase to 57.2 million by 2025. Moreover, according to current estimates, diabetics will increase by 42 per cent in developed nations and by 170 per cent in developing nations. According to an ICMR study, prevalence of diabetes mellitus, which was 2.3 per cent in urban population in 1970, increased to 12.1 per cent in 2001.

The increase in incidence of diabetes mellitus and its complications has been attributed to change in life style caused by increased urbanization, high calorie diet, decrease physical activity and stress. Other important factors are genetic factors, family history and increased longevity. And what is worrying that diabetes is striking at an early age among the urban population.

Types of Diabetes:

Type 1 (Insulin dependent) – Also called juvenile diabetes, this is seen in younger people and is characterized by absolute insulin deficiency due to which these patients are completely dependent on insulin treatment. The incidence of this form of diabetes is doubling every decade.

Type 2 (Non-Insulin dependent) – This is seen in older people and is characterized by insulin resistance or abnormal insulin secretion. These patients can be treated with tablets or may require insulin. This form accounts for 90 per cent of all cases seen globally, but its increasing incidence in India is due to changing diet, from traditional Indian food to modern diet caused by a more stressful life-style and increased urbanization. This type is being seen in younger people due to obesity. Moreover, type 2 diabetics have a greater tendency to develop hypertension and heart disease.

It’s not just the disease itself that is a cause for concern. Diabetics are more prone to develop systemic complications. They are also 25 times more likely to develop blindness, twice as likely to have a stroke, 2-4 times more likely to have myocardial infarction and much more likely to develop kidney disease or undergo amputation.

Effect of diabetes on the eye:

Diabetes can cause eye complications such as:

Diabetic Retinopathy: This is the most common complication and it has been seen that 25 per cent of all diabetics develop this complication after 10 years of diabetes and 50 per cent develop it after 20 years of diabetes. Diabetic Retinopathy is also more common in the upper socio-economic group.

Diabetic Retinopathy has two types –

Non-Proliferative Diabetic Retinopathy – This is the early stage in which tiny blood vessels in the retina get damaged and leak blood or fluid, which cause the retina to swell or form deposits called exudates. 90 per cent of Diabetic Retinopathy cases are of this type. This stage often has no symptoms.

Proliferative Diabetic Retinopathy – This is the advanced stage. Abnormal new blood vessels grow on the surface of the retina and often bleed into the jelly in front of the retina, giving rise to floaters, dots or lines or sometimes loss of vision. These new vessels can eventually pull the retina causing a traction retinal detachment. 10 per cent of Diabetic Retinopathy is of this type.

Maculopathy – Leaking fluid collects in the centre of the retina called the Macula giving rise to blurring of vision.

Studies have shown that there has been a 3-fold increase in the incidence of Diabetic Retinopathy in India in the last 10 years.

Cataract – This is more commonly seen in diabetics at a younger age and more commonly in the lower socio-economic group. Important causes are exposure to ultraviolet light and oxidative stress.

Glaucoma – This involves increase in intra-ocular pressure within eye and is more commonly seen in persons afflicted with diabetics.

Diabetics are also more prone to develop paralysis of the nerves of the eyes due to obstruction of the blood supply.

Incidence of vision loss:

The following categories of individuals are at a higher risk of losing vision in diabetes:

  • Those who have had diabetes from a younger age
  • Those who have had diabetes for many years
  • Those who have poorly controlled blood sugar
  • Those who have poorly controlled blood pressure
  • Those who smoke

Improving diet:

Diet plays an important role in the control of diabetes and diabetic retinopathy. Studies have shown a much lower incidence of diabetic retinopathy in persons who follow a healthy diet. A good diet consists of

  • Ghee as the cooking medium
  • Fish and fish-oil capsules, which are rich in selenium and zinc. Fish is considered to be one of the best foods for diabetics
  • Green leafy vegetables
  • Vitamin A rich foods like carrot and green leafy vegetables

Diabetics must avoid fried food, animal food (except milk and fish), processed food and preserved food.

Regular eye examination

All diabetics must have the eyes examined regularly with dilated pupils. Juvenile diabetics must have their eyes examined at least once a year after the age of 12 years because diabetic retinopathy is rarely known to occur before puberty. Those with diabetes at an older age must have the eye examination done once at the time of diagnosis and then at least every 6 months to one year thereafter.

If Diabetic Retinopathy has been diagnosed, they should have the eyes examined as often as recommended by their eye doctor.

Laser treatment:

A special test called fluorescein angiography may be required to identify areas that require laser treatment. If leakages or new vessels are detected, laser treatment must be promptly given. Sometimes there is leakage of blood from the retina of the eye into the jelly in front of the retina, which may cause blurring of vision. An operation called vitrectomy may be required to remove the bleeding and replace it with clear fluid.

Studies have shown that vision can be preserved in 90 per cent of diabetics if laser treatment in done in time.

Newer treatment modalities:

Anti-VEGF Injections for Diabetic Retinopathy

Injection treatments (Lucentis™, Avastine™) used commonly for macular degeneration have also proven to be effective for diabetic eye disease, in some cases better than laser treatment.

Results from a large clinical trial conducted by the Diabetic Retinopathy Clinical Research Network, or DRCR.net, demonstrated that patients receiving a combination of anti-VEGF treatments and laser treatments had greater gains in visual acuity as compared to others.

A newer injection viz. EYLEA™ (aflibercept), known in the scientific literature as VEGF Trap-Eye, is also being used as an injection into the eye to provide a therapeutic effect in patients suffering from various eye disorders including in some cases of diabetic retinopathy.

Prevention of complications:

All diabetics must adhere to the following to prevent complications:

  • Avoid obesity and have regular physical exercise
  • Control the blood sugar and blood pressure at all times
  • Avoid self-medication. It is better to follow the advise of a physician
  • Maintain a healthy diet. Insulin or pills is not a substitute for a proper diet
  • Have your eyes examined at least once every 6 months to a year by an eye doctor

Being a diabetic does not mean that you cannot enjoy a happy and healthy life. Follow the above-mentioned simple rules with a positive attitude, and you will see the change in your life.

Issued in public interest by Shroff Eye Hospital, Mumbai, India India’s first LASIK Centre to launch the 500 Hz Wavelight Concerto laser India’s first Eye Hospital to be awarded the JCI- Joint Commission International certification (USA), the Gold standard of Healthcare Internationally.

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