Professional Documents
Culture Documents
Editor
Dr A G Unnikrishnan
Publisher
W P Vasandani
MISSION
Editorial Consultants to spread awareness and knowledge of diabetes
Dr M K Mandal
Mr Vandan Agarwal and its consequences throughout India
Dr Imtiaz Hasan
Dr Rajesh Javherani
Dr Vedavati Purandare
to motivate the population to take
Dr Anjali Bhatt
Dr Manish Bothale
Dr Abhijit Joshi
preventive measures
Dr Shalbha Tiwari
Dr D Devi Pratyush
Dr Ashok Gavande to empower all those affected
Foot Care Specialist:
K V Kavitha to participate in their own
Diet & Nutrition:
Gauri Kukade
healthcare management
Priya Chaudhari
Fitness & Lifestyle:
Gouri Choundikar PT
Assistant Editor
Printed and published by W P Vasandani on behalf of Chellaram
Sunila Kelkar
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629-A, J. Shankar Sheth Road, Mumbai - 400002. Printed at Nectar
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Reproduction of content, in part or whole is prohibited.
Designer
This magazine provides general news, opinions, information and tips for
Milind Joshi
health and well-being pertaining to Diabetes. It is advisable to consult with
a practicing physician before making any changes to your healthcare
Contacts: routine. The views expressed in the articles are of the authors, and not of
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Editor
DIABETES CARE
Managing Diabetes in your day-to-day life...
42 Medications that raise blood glucose
Medicines too can raise blood glucose levels
54 Total knee replacement and Diabetes
All you need to know about knee replacement
surgeries
DIAB-E-TECH
A special column detailing the latest technology to
EDUCATION improve fitness
PEOPLE
Coming to terms with your diagnosis
32 Life is God's gift
Strength and determination is all it takes
Recipes
70 Melon soup and parmesan chips
71 Poached apple, vanilla yoghurt, sugar-free
granola
72 Pottage of vegetable, poached egg, sour
6 News
cream, herbs
The latest updates from the world of Diabetes
73 Sugarfree Sitafal Kulfi
36 Testing Room - Urine routine test
74 Garlic chicken
Know your tests and their implications
75 Non-veg Dolma
47 Medicine Cabinet - Rosuvastatin
Our new feature keeps you updated on your meds
65 Ask Diabetes Health
Our experts answer your queries on Diabetes
76 Answers to Diabetes Health Quiz
Answers to the Dec'15-Jan'16 Diabetes Health Quiz
and the lucky winners
78 Health Predictions
What's on the cards for the coming months?
80 Health Bytes
People share their fitness mantra
e e D ia b e tes Health
Win fr nd T-shirts
!
FITNESS subs c r ip t io n a
Staying active is one of the essential mantras to good
glycaemic control
58 Changing your exercise routine
Cause muscle training helps control blood glucose
REGULAR
27
2 Diabetes Health Forum y o u r D ia b e te s Story - Page
Share
b e te s H e a lt h Quiz - Page 69
Letters from Diabetes Health readers The Dia
This device was assessed in 34 overweight and obese subjects who lost
an average of 22 pounds after four months - roughly 37 per cent of their
excess weight. Moreover, there was an improvement in their triglycerides
and hemoglobin A1C levels - a key measure of metabolic function. This
was a very preliminary research and the study needs to be carried out on
a larger scale to assess the effectiveness of such a device. In addition,
though it is a better option than undergoing surgery it is yet to be
approved by the FDA.
Stubborn belly
If you have central obesity (apple
shaped body) and your body mass
index (BMI) says that you are barely
overweight, then having a lax attitude
won't help. A recent study published
in the Annals of Internal Medicine
studied the risks that come with
having an apple-shaped body. It also
showed that having an apple-shaped
body increased the risk of early
death, particularly from heart
disease. Moreover, those with wider
hips (pear-shaped body) were less
likely to die prematurely than those
with similar BMI who were
apple-shaped.
As Mr Raj has Diabetes, he needs to bring Small dense LDL - is a form of LDL that
his LDL cholesterol, now at 180 mg/dL, is even more dangerous than the already
down to at least 30 per cent or below 120 bad LDL - and measuring their levels and
mg/ dL, as per newer guideline by the controlling them would be expected to
American College of Cardiology. Some bring down heart disease related deaths.
doctors would insist that he brings LDL However, this expectation has to be
down to below 100 mg/dL to be on the safer confirmed by well conducted studies. For
side. He also needs to increase his HDL; but the moment this remains an experimental
more about this is covered in the coming test.
pages. Finally, there is this test for lipoprotein (a),
also called lipoprotein little "a". This is
How not to test cholesterol! said to be a marker for how soon a clot
that is formed in an artery can dissolve or
Many experts today suggest a fasting blood
even not form at all. Some studies have
lipid profile test - and this is the ideal way to
shown this to be raised in persons of
test. However, people continue to order
Indian origin. However this remains an
unusual tests like - apolipoprotein A & B,
experimental test.
small dense LDL and lipoprotein(a) to
FEB-MAR 16 DIABETES HEALTH 17
A lipid profile typically includes:
Total cholesterol - this test measures all of the cholesterol in all the lipoprotein particles.
High-density lipoprotein cholesterol (HDL-C) - measures the cholesterol in HDL particles; often called
"good cholesterol" because it removes excess cholesterol and carries it to the liver for removal.
Low-density lipoprotein cholesterol (LDL-C)- calculates the cholesterol in LDL particles; often called "bad
cholesterol" because it deposits excess cholesterol in walls of blood vessels, which can contribute to
atherosclerosis. Usually, the amount of LDL-C is calculated using the results of total cholesterol, HDL-C
and triglycerides.
Triglycerides - measures all the triglycerides in all the lipoprotein particles; most is in the very low-density
lipoproteins (VLDL).
Very low-density lipoprotein cholesterol (VLDL-C) -
calculated from triglycerides/5; this formula is based on
the typical composition of VLDL particles.
Non-HDL-C - calculated from total cholesterol minus
HDL-C.
Cholesterol/HDL ratio - calculated ratio of total
cholesterol to HDL-C.
An extended profile (or advanced lipid testing) may also
include low-density lipoprotein particle
number/concentration (LDL-P). This test measures the
number of LDL particles, rather than measuring the
amount of LDL-cholesterol. It is thought that this value may more accurately reflect heart disease risk in
certain people.
What is Cholesterol?
Cholesterol is oil-based and is a soft waxy substance found in every cell of
your body. High cholesterol has no symptoms. There are 2 types of
cholesterol:
LDL (low density lipoprotein) (bad cholesterol) contributes to plaque
(a thick or hard deposit) that can clog arteries.
HDL (high density lipoprotein) (good cholesterol) removes harmful
bad cholesterol. High HDL levels reduce the risk for heart disease.
Total Cholesterol the sum of your blood's cholesterol content, including
HDL, LDL and very low density lipoprotein (VLDL)
The need for statin therapy Risk factors for CVD include:
Type 2 Diabetes is characterized by Smoking
metabolic syndrome, abdominal obesity,
hypertension, high triglycerides and low HDL High LDL cholesterol
and high blood glucose levels. One of the High blood pressure
most serious complications is Coronary
Diabetes
Vascular Disease (CVD). An examination of
blood lipids (in the form of lipid profile) Lack of exercise
would help your physician highlight the Poor stress management
underlying cause of the CVD. Often it may
be as: Being overweight or obese
Statins explained
Statins are a family of
medications that not only lower
cholesterol levels but also lower
the chances of having a heart
attack or stroke. Plaque (a waxy
substance consisting mainly of
cholesterol deposits that can
build up within the walls of the
arteries) interferes with blood
Dr AS Netalkar talks about how he manages his Diabetes and how yoga and meditation have
made him stronger and a focused person. He shares his story with the Diabetes Health Team.
also had Diabetes and she was detected at I also had to take special efforts in altering
the age of 60. I was detected with Diabetes my lifestyle completely. Giving up sweets was
two years ago at the age of 57. Every year I the most difficult thing to do. Also giving up
used to do a routine check-up. Maybe I was my favourite fruits like mangoes, grapes,
a pre-diabetic at the time because my banana, chickoo and pineapple was tough.
fasting was 110 mg/dL but I think that was But I substituted it with apples, pear, peach,
considered normal back then. Once I was guava and plum. I also have dry fruits.
diagnosed with Diabetes I left sugar Raisins (dried and fresh) are something I like
completely. Also I used to feel tired but never so I have them regularly. I ensure that I have
focused on it much as work commitments at least two fruits day. I was on treatment
kept me on my toes. So I could never when I was diagnosed 2 years ago and for
pinpoint that I may have Diabetes. the next year and half I took my medicine
regularly. My blood sugar level post meal
Dealing with the diagnosis was more than 160 mg/dL and fasting used
to be around 120 mg/dL. But by following a
On being diagnosed with Diabetes it did strict diet and fitness regime I was able to go
have an impact on my family, especially my off medicine; and for the past 6 months I
daughter who kept worrying that she has got have been able to manage my blood sugar
all my genes and will eventually get Diabetes levels with diet and exercise only. My fasting
in the future. She also has a sweet tooth. I sugar now is 80 mg/dL and pos3t lunch is
have told her many times that as eating too 140 mg/dL. My Hba1c level is 6.2.
much salt may cause blood pressure eating
excess sugar can put you at risk of Diabetes,
especially with a positive family history. After
My fitness regime
my diagnosis, my family and I have really Despite my busy schedule I work out on the
modified our lifestyle and diet habits to stay treadmill (speed 5.5.-6) every alternate day
fit. In addition, we do Yoga every day for for half an hour. After my workout I have two
physical and mental health. glasses of water followed by a glass of
explained
to endogenous or exogenous constituents and are breakdown
pigments. Under normal products of fatty acid metabolism
conditions the urine colour is pale in the body. They are seen in
yellow. people with Type 1 Diabetes. In a
normal report they are absent, but
Does its appearance have
may be present during starvation.
importance?
What does the presence of bile salts and
Suspended particles give urine a turbid appearance
pigments indicate?
hence the clarity is looked for. Normally urine is clear
in appearance. Presence of these indicate liver disorder. They are
normally not found in urine
What do proteins in urine indicate?
What does the presence of blood/RBC indicate?
An increase in protein (Albumin) or blood
(Haematuria) in urine is a sensitive indicator of renal They are not found in a normal test report and
disease. The normal test result is negative for required assessment.
proteins.
What does the presence of pus cells indicate?
What do glucose levels in urine indicate?
Bladder or renal infection produces pus and hence
Usually not detectable in urine, increased levels may their presence is an indicator of urinary tract
be due to high blood glucose levels or decreased infection. They are normally not found in urine.
absorption. It is an indicator of unsuspected
Diabetes.
Raw
bleeding tendencies.
Raw mango is highly
appreciated for its Kairi panha
nutritional value - they (Raw mango
are good source of
green
drink)
Vitamin C, a rich
source of pectin, and You can prepare
B vitamins. a very refreshing
drink from fresh
mangoes
Health benefits raw mangoes;
Due to the presence it's sweet and
of vitamin C, they are sour in taste
highly beneficial in Boil whole raw
strengthening the mangoes in water, take
immune system. out the pulp and mix with
It helps in removing waste cumin seeds (jeera), black
products from the body. pepper, and aniseed (saunf). Add
some rock salt to your drink. Strain and
Raw mango drink helps to overcome dehydration
serve this chill drink in sizzling summer to
in summer.
overcome dehydration.
Mangoes contain an enzyme which acts as a
Raw mangoes are also used to make mango
digestive aid, beneficial in the treatment of
pickles, which are an excellent accompaniment
gastrointestinal disorders, diarrhoea, dysentery,
with any food item.
piles, morning sickness, chronic dyspepsia,
indigestion and constipation. This fruit is also used in many forms such as
Raw mango guards you from negative effects of juices, jams, sauces, chutneys and dried powder.
heat stroke. Mix one chopped raw mango with honey and salt.
Drinking raw mango juice helps in preventing from Consuming this mixture is extreemly effective in
extreme loss of sodium chloride. curing any digestive disorders
Ripe
additional calories, helping in for your dishes.
weight loss. Add a few slices of
Mango helps in frozen mango to
regulating your insulin your smoothies.
levels. Mango has a
low glycaemic index
(41-60) so having a
little will not increase
your sugar levels.
Mangoes Mango juice with
ice cubes is a
popular,
delicious drink.
Mango fruit
As mango is rich in juice blended
vitamin A, it helps in with milk as
promoting good eye "mango-milk
sight; fights dry eyes and shake."
prevents night blindness. Mango fruit is also
The fibrous nature of mango used to prepare jam, jelly,
helps in digestion and elimination. ice cream and in sweet-candy
It is rich in prebiotic dietary fibre, vitamins industries.
and minerals.
Priya Chaudhari is a Consultant Nutritionist at Chellaram
Diabetes Institute and Hospital, Pune.
They can cure themselves by drinking having the condition. Those feelings can be
okra water or eating cinnamon. triggered by external and internal sources.
The media certainly doesn't help And such feelings can do great harm,
mentally and physically. There's definitely a
Television news stories about Diabetes often
connection between thoughts and feelings
don't differentiate between Type 1 or Type 2,
[and people's] ability to take care of their Managing
insinuating that all Diabetes could be
prevented or delayed with a healthy diet or
disease, she says. mental
exercise. They are sometimes illustrated with health is an
images of overweight people with their
You against the world
important
heads cut out of the frame. People with Negative perceptions can be perpetuated in
Diabetes are often tasked not just with the the public by the media or individuals. They
component
burden of managing their Diabetes but also can come from biased news reporting, of Diabetes
educating the people around them about inaccurate information and hurtful jokes - care
the condition. That can take an emotional I ate so much dessert that I have Diabetes
toll. So can the sense of shame that comes now.
from others' misconceptions, or a person's
Even truths about Type 2 Diabetes -
own feelings of guilt.
including the fact that excess weight,
unhealthy food choices and inactivity are
No one chooses Diabetes contributing risk factors - can be overblown,
Rericha, 45, of Macomb, Illinois, says she's shifting blame onto people with the disease.
tired of hearing people suggest that people Many of the risk factors are things that
with Diabetes could reverse the disease if people are unable to change, including age,
they would just get off the
couch. An elementary school
teacher, Rericha manages her
Diabetes with diet and exercise.
But no matter how hard she
works out, she knows she'll
always have Diabetes and it isn't
only because of her weight,
though excess weight can be a
risk factor for Type 2 Diabetes.
Type 2 runs in her family - a
major risk factor for developing
the disease. And Rericha had
gestational Diabetes (Diabetes
during pregnancy) five times.
Having it even once is a major
risk factor for developing Type 2
Diabetes later in life.
Amy Walters, a licensed
psychologist, says at least half of
her patients with Diabetes tell her
that they feel shamed about
In a lighter vein
Doctor has
What are asked me to check
you doing? the sugar levels
every eight
hours.
ugar
S
Age related degeneration of the knee joint is part of the knee is replaced) can be
a common entity and this is technically considered. Most often in India many
known as osteoarthrosis. The degeneration patients wait too long and by the time they
(wear and tear) of the soft articular cartilage approach the surgeon both the
(the smooth tissue which is present at the compartments of the knee are grossly
end of the bones where the bones glide over damaged; and then the only solution
each other) begins in the early years; remaining to consider is a Total Knee
however, the body's repair process is more Replacement (TKR). TKR consists of
than the degeneration, as age advances the removing the degenerated cartilage and
repair process naturally reduces and the replacing it with a high quality medical grade
wear and tear remains the same. The plastic on the leg side and metal of the thigh
degeneration of the knee joint can increase bone side.
if there has been previous injury to the
People with Diabetes often require special
articular surface like a joint fracture,
care and counselling before they undergo a
tuberculosis, long term increased weight of
TKR. This surgery, like any other surgery
the person.
that comes with risks and they may be more
pronounced if one has Diabetes. This is
Diabetes and surgery particularly true if the patient undergoes
surgery when his HbA1c (average blood
Diabetes also slightly increases the risk of
glucose level for past three months) blood
early degeneration though it is very less. The
levels are more than 7.5. Studies have
early treatment of age related osteoarthrosis
shown that people with Diabetes who have
is reduction of weight in overweight people,
had uncontrolled sugar apart from
mild pain and swelling reducing
medications,
neutraceuticals (cartilage
protecting medicines,
injections), brace, and
exercises. When all of
the above fail to relieve
the knee pain and when
the knee pain makes it
too painful to walk or
climb stairs without pain
and specifically when
there is pain even at rest
then a surgical option
could be considered.
The degeneration often
produces bow legs at an
early stage in certain
people. High tibial
osteotomy (correction of
the bow legs only) or
only a unicondylar knee
replacement (only one Pre-Surgery Post-Surgery
It doesn't take much for a routine to remember to begin slowly and get your
become, well, routine. Slog away at any doctor's OK.
activity for long enough and boredom can
You probably tried it as a kid, but hula
ruin your motivation. It happens to skilled
hooping is a terrific low-impact aerobic
athletes and novices alike. "People get into
activity for adults, too. You can use a typical
an exercise program, and they fade out of
plastic hoop or choose a weighted one for a
it," says Dale Wagner, president of the
tougher workout (You can find them in many
American Society of Exercise Physiologists
sporting goods stores). The right hoop will
and an associate professor of exercise
hit at your stomach or chest when placed
physiology at Utah State University. Mixing
vertically on the ground in front of you, but
things up can help. "If they have more
pick a larger hoop if your waist is wide. It'll
activities, they won't get bored." Repeat the
take some practice to find your groove and
same moves over and over again, and you'll
that's part of the fun. Once you get a good
set yourself up for overuse injuries. "It's
rhythm, try to keep going for 10 minutes
about doing a variety of activities," says
and build from there. It's never
Wagner. "If you run over a long period of
It may seem counterintuitive, but playing
too late to
time, certain muscles tend to shorten. It's
like when you sit in a chair all the time. Your certain video games can improve your start
hip flexors shorten." fitness. A 2006 study in the journal exercising.
Pediatrics found that kids burned twice as
Trying new exercises can also keep your
many calories playing active video games as
body guessing. "If all we do is walk on a flat
they did playing more traditional ones.
surface at the same pace, not varying [our]
Dance, Dance Revolution, is another active
workout, the body becomes very efficient,"
video game (available for multiple gaming
says Cherilyn Hultquist, an assistant
systems) that's both fun and aerobically
professor of health, physical education, and
challenging.
sport science at Kennesaw (Ga.) State
University. That means that your body uses For something more low-key, try yoga. It is
less energy from food to power your workout "just a fantastic way to improve strength and
once you've mastered a skill than when you flexibility," says Hultquist. Many gyms and
first start. You don't have to introduce an local community centers offer classes for
entirely new exercise to reap the benefits,
either (though doing that can help beat
boredom). If you do pick a new activity or
make a major change to your exercise plan,
check with your doctor first. Read on to
learn about some fun exercises for seasoned
athletes and those just getting started.
Cost effectiveness
Test duration
Performance
Convenience
Reliability 5
Ease of use
Rate Card
1 = Poor
5 = Excellent
Disclaimer - The author and the editorial team of Diabetes Health have no conflicts of interest to disclose. They do not
endorse, support or recommend any particular product or device.
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Email: Answers in Diabetes Health
Mailing address: Apr-May16 issue
Answers to previous
DH Quiz [Dec15-Jan16] on page 76
Melon Soup,
parmesan chips
Recipe by Chef Liam Crotty
Ingredients:
Poached apple
200 gm apple
200 ml water
.05 gm vanilla
Vanilla yoghurt
50 gm fat free yoghurt
.05 gm vanilla
Crunch granola
10 gm pistachio
5 gm grated coconut
20 gm raisins
5 gm almonds
5 ml oil
Method:
Poached apple
1. Peel an apple, cut into eight pieces and turn them.
2. Poach in vanilla infused juice of an apple for 15 minutes.
Vanilla yoghurt
1. Hang yoghurt in a cheese cloth overnight. Mix vanilla seeds.
Granola
1. Combine all the ingredients together for crunch granola mentioned above and bake at
160 degrees Celsius for 20 minutes.
Assemble as shown in the picture.
Ingredients: Method:
15 gm carrot 1. Saut the carrots, celery, shallots and fennel
for 7-8 minutes. Add the leek, zucchini and
10 gm celery
saut for an additional 5 minutes.
30 ml zucchini
2. Add water, bay leaf and simmer for 10
10 ml shallot minutes on a low heat to infuse with the
20 gms fennel bulb vegetables. Separately poach the egg and
set aside.
20 gms leek
3. Serve in a soup bowl and lay the egg in the
5 gm broccoli
center and garnish with sour cream and
5 gm dill fresh fresh herbs.
5 gm basil fresh
10 ml sour cream (fat-free)
Nutritive value per serving:
1 egg 194.18 kcal energy
Makes: 25 portions
Ingredients:
1 litre low fat milk
500 ml single cream
100 gms milk powder
250 gms sitafal puree
40 gms sugarfree
Method:
1. Boil the milk on slow simmering till it reduces to
half. Cool for a bit and add the rest of the
ingredients. Let it cool further.
2. Put it in individual moulds and let it set it in the
blast freezer for at least 1-2 hrs.
3. Garnish and serve.
Method:
1. Heat peanut oil
in a pan. When
the oil begins to
smoke, quickly
stir in 2 cloves
minced garlic,
ginger root,
green onions
and salt.
Makes: 10-15
Ingredients:
100 g brown rice
50 g three colour peppers,
chopped
25 g onions, chopped
10-15 cabbage, boiled and
deveined
100 g chicken, roast and
minced
1 cup tomato sauce
tbsp pepper, ground
tbsp all spices (ground)
2 lemons
2 garlic cloves
2 tbsp oil 5. Then tuck in the empty sides towards the
centre. Repeat the folding procedure on the
Salt to taste rest of the mix.
Water 6. Finally, start laying the rolled cabbage in a pot.
Make sure you lay them close to each other.
Method: Put the pot on the stove and pour about two
cups water in the pot.
1. Bring water to boil with salt and lime juice, add
the cabbage leaves and after a while plunge the 7. Brush olive oil over the leaves to keep them
leaves directly into cold water. moist. Cover the pot with its lid and cook on
high temperature for about five min.
2. On a heated pan, pour a little oil to saut onion,
garlic along with 3 colour peppers. Add minced 8. Serve hot.
roast chicken to it.
3. Take out the extra oil. Add the tomato sauce
Nutritive value per serving:
and brown rice. Season the mixture and set 114 kcal energy
aside to cool.
12.4 g proteins
4. Take a tablespoon of the mix and put it in the
7 g carbohydrates
middle of the flattened cabbage leaf. Spread
the mix evenly as half cylinder. Remember to 4 g fat
leave inch space from each end of the leaf.
Lucky winners
1st prize:
1 year subscription of 2nd prize:
Diabetes Health Diabetes Health
T-shirt
Eye problems are indicated and Cold, cough and flu will dampen
you may experience blurry vision your spirits. Frequent headaches may
from time to time. Do not neglect this also be a cause of concern. Try
and visit the doctor at the earliest. Avoid spending some 'me' time to gain better clarity
taking extra work as you may exhaust yourself. of a situation. Practicing Yoga may bring in
Things will gradually ease out with time. some relief. Also opting for your favourite sport
Bringing some positive changes in your diet will strengthen your immunity and will keep
and exercise will help you combat the stress of your mind off unnecessary things.
daily life. Lucky numbers: 3, 4 and 9
Lucky numbers: 2, 5, 6 and 8