Travelling and packing tips for Diabetes Patients

In  holiday season, it’s important to know about few tips for travelling safely so that you can have a relaxing vacation. Studies show that about 10 percent of people with diabetes experience problems with diabetes control when travelling.

A little extra homework will let a person with Diabetes have a healthy and hassle-free trip.

Travelling tips:

  • See the doctor before you plan your trip. If you’ll be crossing time zones, ask him/her about how to adjust your insulin doses.  
  • Check your blood glucose level as soon as possible after landing or reaching your destiny.
  • Plan the timing of your injections according to the time zone changes.
  • Learn some diabetes-specific phrases in the local language of the place of your trip, such as “I have diabetes” and “I need sugar” etc.
  • You may substitute another brand’s equivalent formulation
  • Wear your ID card all the time.
  • Let people around you know that your diabetic.
  • It’s better to avoid, drinking alcohol in your trip.
  • Keep all your medical supplies with you.
  • Stick to your regular diet plan and timings as much as possible.
  • Be prepared to treat low sugars.
  • Know the location of nearby pharmacies and hospitals in the place you are going to visit.
  • Wear comfortable shoes and don’t go barefoot. Check your feet every day.
  • Try to be active in your journey, doing simple stretching exercises in your seat or moving your ankles in circles and raising your legs occasionally. This will improve your circulation.

Packing tips:

The important rule of travel for a person with diabetes is packing at least twice as much medication and blood-testing tools. Pack all of them in your personal bag so that your medication is always with you.

Whether you are travelling by car, bus, plane, boat, or foot, you’ll want to keep this in “carry-on” bag with you at all times.

List of things to pack:

  • The insulin cartridge and syringes if you take Insulin
  • Glucometer.
  • Your doctors prescriptions (clearly mentioning the content of medicine, so that you can take substitutes if needed)
  • All oral medications (an extra supply)
  • Other medications or medical supplies, such as glucagon, anti diarrhea medication, antibiotic ointment, antiemetic drugs
  • Your ID card and diabetes identity card
  • A well-wrapped, air-tight snack pack, fruit, a juice box, and some form of sugar candies or glucose tablets to treat low blood glucose if need arises.

Have a happy and healthy vacation…!

-Dr.Bhavani Sagar Surampally

INSULIN INJECTIONS – DO’S & DON’TS

Insulin is used for the treatment of Diabetes Mellitus 1 and 2 to lower and maintain raised blood sugar levels in normal range for a period of time.

Insulin can be administered through injections and pens.

Insulin injections taken through insulin pens may help in taking the shot easily and also in easier loading of the dose.

Storage:

Insulin vials can be stored at room temperature (around 25 C) for about a month. It can be stored in refrigerator, but should be avoided in the freezer, extreme cold and extreme heat. It should not be stored in car cabinets, near hot items and freezer. It is always the best practice to check for the expiration date and to keep all the vials at the same place and box after use during storage.

Dos:

  • Keep the vial that is in use at room temperature.
  • Always wash hands with plain water and gentle soap or a sanitizer before and after taking the shot to avoid an infection from hands.
  • Load adequate amount of prescribed dose in syringe and double check the same.
  • Push the air out with plunger before taking the shot.
  • Choose a soft area of skin in regions such as abdomen around belly, front or side of thigh, buttocks, arms as layer of fat under skin is good and nerve endings are less in this region causing less pain and also helps with an easier shot.
  • Relax the chosen area for shot and the muscle underneath for better absorption of insulin, less pain.
  • Pinch the area of skin with clear, good amount of tissue between thumb and fingers for the shot.
  • Insert the needle of injection, pen only in subcutaneous fat (fat tissue under skin) by holding it straight (90degree). It can be held at 45degree angle in thin individuals to avoid injection into muscle, as the layer of fat is thin.
  • Keep the hand and insulin injection/pen steady without quivering, shivering to avoid injury around, injury to a blood capillary under skin, bruise, etc.
  • Push the plunger quickly but steadily and leave it in place holding it steady for about 10 seconds after shot to avoid escape of more amount of insulin outside skin.
  • Apply mild pressure over the shot area with a cotton swab.
  • Always clip the needle by buying a device that clips, catches the needle. If not, consulting the local concerned personnel regarding ways of disposing the needle, medical waste specific to that area may be a good idea. However, it should always be capped.
  • Always put an insulin reminder to ensure shots are taken at regular intervals, correct time, as per prescription.
  • Always carry small snacks along as a precaution for hypoglycemic attack after an insulin shot.
  • Eat healthy, small regular meals, take insulin shots at prescribed time and amount to avoid fluctuations of blood sugar levels between high and low but to maintain at normal range.

Don’ts:

  • Do not use the vial that has a color change, presence of particles, looks frozen, after expiry date, etc.
  • Do not use a needle that is dull, bent, discolored, with blood stain.
  • Do not use the same needle of pen without cleaning the needle with alcohol swab.
  • Do not share the needle, syringe, pen with others or for any other purpose but for insulin shot.
  • Do not leave the needle open without cap.
  • Do not place or leave the needle anywhere, never let the needle touch anything apart from skin and the top of insulin bottle for loading the syringe.
  • Do not reuse the syringe or needle when one may have any ongoing infection, low immunity, wounds or cuts in hands, etc. due to more risk of infection.
  • Do not keep the skin, muscle of the chosen area for shot tensed as it may hamper good absorption of insulin and may cause pain.
  • Avoid rubbing the area after the shot.
  • Do not cut the needle after the shot with scissors, etc. as the broken part of needle may pop up, fly and land anywhere around. There may be high chances of losing it and a risk of someone stepping on it and get injured.

References:

http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/insulin/insulin-storage-and-syringe-safety.html

https://www.diabetes.org.uk/guide-to-diabetes/teens/me-and-my-diabetes/getting-my-glucose-right/insulin/storage

https://www.diabetes.co.uk/festivals-and-diabetes.html

https://www.cdc.gov/hiv/risk/idu.html

https://www.diabetes.co.uk/insulin/how-to-inject-insulin.html

https://www.diabetes.co.uk/insulin/diabetes-and-insulin-pens.html

https://www.diabetes.co.uk/insulin/diabetes-and-injecting-insulin.html

-Dr. Divya Teja Pasupuleti

 

HYPOGLYCEMIA IN DIABETES, ITS RECOGNITION & MANAGEMENT

Hypoglycemia is quite common in diabetic individuals who take insulin, certain medications for the treatment of Diabetes.

It can also be called “insulin shock” or “insulin reaction”.

Hypoglycemia = blood glucose levels less than 70 mg/dl (3.9mmol/L)

Causes:

  • Overdose of insulin, medications for Diabetes, not taking medications and insulin as prescribed.
  • Irregular, infrequent meals, fasting for long duration, skipping of meals, especially breakfast.
  • Strenuous physical activity, exercises more than usual or routine level.
  • Exercises, physical exertion after fasting.
  • Drinking alcohol, especially on an empty stomach.

Symptoms:

It is very important for the person and their family members, closed ones to be able to recognize the symptoms of hypoglycemia. This may help in easier management of the situation when one may not be in a state of helping self.

Most common and early symptoms are

 

  • Dizziness.
  • Fatigue/weakness.
  • Excessive sweating, perspiration.
  • Shivering, shaking of hands, legs.
  • Sudden hunger.
  • Irritability, nervousness.
  • Pounding heart due to raised heart rate.
  • Headache.

 

Hypoglycemia during sleep may cause excessive sweating, nightmares, confusion on waking up.

Severe symptoms are

  • Blurred vision.
  • Slurred speech.
  • Drowsiness.
  • Confusion.
  • Convulsions.
  • Coma.
  • Death.

It is important to understand that brain needs glucose for normal function.

Hypoglycemia unawareness is a condition, wherein early signs of hypoglycemia may be absent, but may start with severe symptoms when the levels are dangerously low. This may be experienced in people with frequent episodes of low blood sugar levels, with Diabetes for a very long time. Hence, it may be best for them to be extra careful and check blood sugar levels very often (about once every alternate day or every week).

Treatment:

Treatment includes safety measures as well, that may be best applied as soon as one may start experiencing symptoms.

Step 1: Measure blood glucose levels.

Step 2: If blood glucose levels are low or if there is no access to the measurement of blood glucose levels, intake of 15-20 gm of simple carbohydrate may help. This can be attained with below items.

  • Drink ½ cup or 4 ounces of fruit juice.
  • Eat 5-6 hard candies.
  • Take 4 glucose tablets (available over the counter).
  • 1 tube of glucose gel (available over the counter).
  • 1 cup of low fat milk.
  • 1 teaspoon of sugar, honey.

Step 3: Check blood glucose levels after 15 minutes or go to an emergency room/casualty. If the levels are normal or if one feels better, there may not be much to worry about. If the levels are still low, if one may not feel better, repeat the same as above and eat small snacks such as crackers, sandwich, etc.

Step 4: If the blood glucose levels checked again after 15 minutes are still low or if one may not feel better, calling an ambulance or going to an emergency room may be a good idea.

It may be important to note down the levels and the incident, number of similar episodes in a notepad and discuss with the treating physician, wherein medications, dose of medications may be changed, if needed.

Ideally, a shot of glucagon over the buttocks, thigh or arm may help with instant relief. Glucagon injection is available on prescription. It is a hormone that is released normally in body to raise blood glucose levels and hence acts by releasing stored glucose levels from liver into blood, giving relief from the symptoms of hypoglycemia.

Safety measures and prevention are by keeping the glucose supplements, candies, glucagon shot handy, checking blood glucose levels regularly, so that one may be prepared, when there is an episode. It may also be a good idea to carry a medical ID stating Diabetes, wearing bracelets indicating Diabetes.

References:

https://my.clevelandclinic.org/health/diseases/11647-hypoglycemia-low-blood-sugar

https://www.mayoclinic.org/diseases-conditions/diabetic-hypoglycemia/diagnosis-treatment/drc-20371529

https://www.diabetes.co.uk/Diabetes-and-Hypoglycaemia.html

http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html

https://www.ncbi.nlm.nih.gov/pubmed/12766131

– Dr. Divya Teja Pasupuleti

HARMFUL AFFECTS OF ALCOHOL IN DIABETICS

In this article we will review the association between alcohol consumption and diabetes. People who have diabetes are more susceptible to alcohol ingestion related complications than non-diabetics. As per recent studies given by American diabetes Association, Diabetes mellitus is recognized clinically as complication of alcoholism.

In what way does the alcohol effects diabetes? ( In case of chronic and heavy intake)             

  • It has excess calories and it is an appetite stimulator too which leads to obesity , a trigger to increase Diabetes
  • It causes damage of  pancreas(B cells of pancreas releases insulin and controls blood glucose),
  • Impairment of liver function (disturbances in carbohydrates and glucose digestion)
  • It may cause hypoglycemia (a state of severe drop down in sugar levels)
  • It can interfere with the positive effects of oral diabetes medicines or Insulin
  • It may also affect judgment or will power leading to poor food choices
  • It increases blood pressure

People with diabetes who drink should follow the below tips to get rid of landing up in complications:

Do’s while taking alcohol in diabetes:

  •        Wear an I.D. that notes you have diabetes, in a setting where people are drinking alcohol; hypoglycemia may be mistaken for being drunk.
  •        Drink alcohol only with food
  •        Drink slowly
  •        Mix liquor with water, club soda or diet soft drinks

Don’ts while taking alcohol in Diabetics:

  •        Do not drink on an empty stomach or when blood glucose is low, since the risk of low blood glucose increases after drinking
  •        Do not take  “sugary” mixed drinks, sweet wines, or cordials
  •        Do not drive or plan to drive for several hours after you drink alcohol.

To be considered with more cautious:

Alcohol can cause hypoglycemia shortly after drinking and for up to 24 hours after drinking. If you are going to drink alcohol, check your blood glucose,

  •         Before you drink
  •         While you drink
  •         Before bed and throughout the night
  •         More often for up to 24 hours

   So instead of checking this many times it’s better to quit drinking alcohol..!

   Finally, if you drink alcohol several times a week then makes sure your doctor knows about it before he/ she changes the diabetic drugs or changes the insulin dosages. The one way to get the help you need is to be sure that your family and friends know to be aware of your symptoms of hypoglycemia and what to do.

-Dr.keerthiman kancherla

 

Diabetes and Kidney Disease

We all know that a kidney disease is a complication of diabetes in an uncontrolled diabetic.  This article covers the measures to be taken to avoid kidney complications in diabetes.

Uncontrolled blood glucose in diabetics damages their kidneys. The damage caused to kidney due to diabetes is called as diabetic nephropathy. The probability of suffering with diabetic nephropathy increases in cases of diabetics who smoke and if Diabetes is associated with other conditions like hypertension and elevated cholesterol levels. Diabetic nephropathy can lead to kidney diseases which requires dialysis and kidney transplantation due to Diabetes.

Catching it early:

Since the symptoms of this condition aren’t visible in its early stages, you need to undergo tests on a regular basis.  It is even more important to get checked for kidney disease if Diabetes associated with other risk factors like high blood pressure, heart disease, or a family history of kidney failure. If detected early, the effects of diabetic nephropathy can be reversed.

Common symptoms of this disease include the following:

  • Swelling in legs and feet
  • Detection of albumin in urine
  • Decline in glomerular filtration rate (GFR)
  • Elevated arterial blood pressure

Laboratory investigations:

  • Serum creatinine and urine tests – check the levels of creatinine, a waste product that your kidneys remove from your blood
  • Albumin urine test – checks for albumin, a protein that can pass into the urine if the kidneys are damaged
  • Imaging tests, such as an Ultrasound – provide pictures of the kidneys. The pictures show the size and shape of the kidneys, and will check for anything unusual.
  • Glomerular filtration rate (GFR) – one of the most common blood tests to check for chronic kidney disease. It tells how well your kidneys are filtering.

What are the treatment options?

Medication to lower the blood pressure is the most commonly prescribed form of treatment to prevent or slow the damage of kidneys. There are other lifestyle changes that have to be incorporated in order to keep a check on the condition:

  • Limit sugar intake and keep blood sugar levels within the target range
  • Exercise regularly and work towards keeping your heart healthy
  • Limit protein intake, as it could put extra pressure on your kidneys
  • Limit salt intake to control blood pressure
  • Quit smoking and drinking alcohol
  • Have regular visits to your doctor who treats your Diabetes and to the nephrologist ( a specialist doctor that treats kidney disease)

Diabetes can be managed well with an awareness about treatment and prevention of complications. Don’t let it bog you down! With the above mentioned simple lifestyle changes and taking care of your general well-being, you can beat the disease and emerge a winner!

-Dr.Bhavani Sagar Surampallly

 

Diabetes and Smoking

What Is Diabetes?

Diabetes is a group of diseases in which blood sugar levels are higher than normal. Most of the food a person eats is turned into glucose (a kind of sugar) for the body’s cells to use for energy. When you have diabetes, your body either doesn’t make enough insulin or can’t use the insulin very well. Less glucose gets into the cells and instead builds up in the blood.This leads to various risks and health issues affecting most major organs of human body.

How Is Smoking Related to Diabetes?

We now know that smoking causes type 2 diabetes. In fact, smokers are 30–40% more likely to develop type 2 diabetes than nonsmokers. And people with diabetes who smoke are more likely than nonsmokers to have trouble with insulin dosing and with controlling their disease. The more cigarettes you smoke, the higher your risk for type 2 diabetes.No matter what type of diabetes you have, smoking makes your diabetes harder to control.

If you have diabetes and you smoke, you are more likely to have serious health problems from diabetes. Smokers with diabetes have higher risks for serious complications, including:

  • Heart and kidney disease
  • Poor blood flow in the legs and feet that can lead to infections, ulcers, and possible amputation (removal of a body part by surgery, such as toes or feet)
  • Retinopathy (an eye disease that can cause blindness)
  • Peripheral neuropathy (damaged nerves to the arms and legs that causes numbness, pain, weakness, and poor coordination).
  • Many of the combined health effects of smoking and diabetes may make it more difficult to make healthful lifestyle choices.

If you are a smoker with diabetes, quitting smoking will benefit your health right away. People with diabetes who quit have better control of their blood sugar levels.

How to lower the risk of smoking and diabetes

There is no safe way to smoke, particularly with diabetes. The best way to lower the risk from smoking is to quit. Or if quitting is not possible, to dramatically cut down.

The following strategies may lower the risks associated with smoking and diabetes:

  • Exercise may lower the risk of lung cancer in people who smoke. It also supports good glucose metabolism, and can reduce the chance of obesity, which is another risk factor for diabetes.
  • Healthful eating can lower the risk of cardiovascular disease. Fiber intake is especially important for people with diabetes, because fiber helps lower blood sugar.
  • Taking diabetes medications as prescribed. People with uncontrolled diabetes are more likely to experience diabetes complications. Smoking compounds these risks.
  • Cutting back on smoking. There’s no safe number of cigarettes to smoke, but heavy smokers tend to suffer more extensive health problems.

    How to make this change?

  • To lower your risk of complications, quit smoking and avoid tobacco products. Of course, that’s easier said than done. Smoking is addictive and can be very hard to quit.
  • Start by making a list of all the reasons you want to stop smoking.
  • Then set a quit date to begin your smoke-free lifestyle.
  • Share that date with friends and family members who can support you and help hold you accountable. Some of them may even want to join you on your journey!
  • Many people find that quitting cold turkey is the best way to stop. You might find it easier to quit gradually by decreasing the amount of cigarettes you smoke each day.

Whatever method you choose, your doctor can provide tips to help you along the way. They can also prescribe medications or recommend over-the-counter aids, such nicotine patches or gum. They may also encourage you to try smoking cessation counseling.

Remember, nicotine raises your blood sugar. If you use smoking cessation aids that contain nicotine, such as nicotine patches or gum, your blood sugar will remain elevated. Over time, you can wean yourself off of these aids and enjoy the benefits of lower blood sugar.

The Takeaway

Having diabetes raises your risk of many health problems. Why add fuel to the fire by smoking? Avoiding tobacco products lowers your risk of complications from diabetes. It can help you limit the damage to your organs, blood vessels, and nerves. This can help you live a longer and healthier life.

If you currently smoke, recognizing the benefits of quitting is an important first step. Now it’s time to commit to a change. Make an appointment with your doctor to learn about the treatment and support options that can help you quit for good.

-Dr Prerna Gaur

Acknowledgements

https://www.medicalnewstoday.com/articles/317411.php

https://www.cdc.gov/tobacco/campaign/tips/diseases/diabetes.html

https://www.webmd.com/diabetes/guide/diabetes-smoking-cessation-tips#1

https://www.healthline.com/health/type-2-diabetes/smoking-diabetes

 

Diabetes and Vascular diseases

The number of people with diabetes mellitus is alarmingly increasing due to the growing prevalence of obesity, genetic susceptibility, urbanization, and ageing.One of the long term complication of diabetes is the injury to the arteries or vessels involving major organs in the body.It involves blockage of arteries of neck,arms,legs,feet,heart,brain and eyes and leads to complications like heart attack,stroke,diabetic foot and other vascular complications.

A conscious effort now can avoid any such complications which can occur in long run,as these are very well preventable and an awareness about it can help in improving quality of life and longevity.

How does  diabetes affect the arteries or vessels?

Increased or uncontrolled blood sugar by complex mechanisms lead to build up of fatty deposits in the inner linings of the artery walls of the organs like legs, heart and brain, making them narrower,hindering blood flow and can even stop blood flow to the organ  completely.

This condition can lead to stroke,heart attacks, pain especially when walking, as well as a number of other symptoms like foot wounds that are slow to heal(Diabetic foot ulcers), one foot being much colder than the other, or gangrene. In severe cases, foot or leg amputation may be needed.

What are the risks factors?

Individuals with diabetes are already at an increased risk for arterial/vascular complications. Following risk factors further increase the risks.

  • Overweight/Obesity
  • Physical inactivity
  • Smoking
  • High blood pressure (hypertension)
  • High LDL (“bad”) cholesterol
  • Family history of cardiovascular disease, stroke or vascular disease
  • Previous history of coronary artery disease (heart attack, angina, angioplasty or bypass surgery) or stroke

You can’t change your age or your family history, but taking care of your diabetes and the conditions that come with it can definitely lower your chances of developing these vascular complications.

Discuss with your doctor if you feel you have any of such complications or have these added risk factors.

How to prevent vascular complications?

A number of the risk factors mentioned here can be controlled to minimize the likelihood of developing vascular complications and to slow its progression. For people with diabetes, it’s especially important to keep blood glucose levels as normal as possible. Also, regular physical activity is important, and and medications need to be taken regularly.

Taking steps to reduce the risk of vascular diseases also helps reduce the chances of a heart attack, stroke or foot ulcers while enhancing quality of life.

Therefore you may wish to do the following:

  • Keep active
  • Eat a healthy diet and control your blood sugar levels
  • Lose weight if you are overweight
  • If you smoke, make an effort to quit
  • Keep an eye on your blood pressure
  • Be aware of any new conditions or changes in your body
  • Have regular medical examinations, at least once a year
  • Take your medication as prescribed by your doctor

Despite how prevalent diabetes is, it is an invisible disease – and it affects women and men, young and old, people of all races, shapes and sizes. Unfortunately, those with diabetes are also at risk for other health concerns, including vascular diseases. Prevention is the key to avoid these complications as age advances.
-Dr Prerna Gaur

Acknowledgements

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743069/

https://www.webmd.com/heart-disease/peripheral-vascular-disease#1

https://www.healthline.com/health/diabetic-foot-pain-and-ulcers-causes-treatments

 

Importance of checking blood pressure and managing it in Diabetics

When you were diagnosed with diabetes it is common for you to check your blood glucose regularly, but have you heard about checking blood pressure regularly is as important as checking blood glucose levels. Yes, it is very important in preventing long term complications of diabetes.

High blood pressure is one of the most important risk factors for stroke, heart attack, and kidney failure in people with diabetes.

Blood pressure is very dynamic, meaning that it can change instantaneously in response to the internal or external environment. For example, if you have an injury that causes severe bleeding, your blood pressure drops rapidly. But your body also responds to that drop within seconds by squeezing and narrowing the blood vessels and increasing heart activity to bring the pressure back up. Even if you are nervous at the time of your doctor’s visit, your blood pressure will be high and this will mislead. So, regular monitoring of your blood pressure at your home can avoid such problems and this will also alert you to be healthy.

How to check blood pressure at home:

When your blood pressure is measured, your arm should be at the level of your heart, and the blood pressure cuff should be sized appropriately for your arm. If the cuff just barely fits around your arm or pops off once it is in place, it may be too small, and you are likely to get a falsely elevated reading. A good time to monitor at home is in the morning before you take any medicines. Early morning is when blood pressure tends to be highest and when the effects of some drugs are wearing off. It is also the highest risk period for stroke and heart attack.

Management:

  1. Lifestyle modifications plays a significant role in the management of blood pressure and diabetes.
  2. Performing regular exercise, losing excess weight and keeping it off, and getting adequate sleep are a start.
  3. If you are excess in weight then you must be more concerned about weight loss. A sensible reduction in calorie intake along with a regular exercise program is the best way to gradually reduce your weight. Moderate-intensity exercise such as brisk walking is felt to be safer than very vigorous exercise.
  4. Reducing salt intake is also helpful.
  5. Avoid smoking and drinking alcohol as they will lead to so many other health issues which are not good for you
  6. Scientific studies using multiple home readings have found that home blood pressure readings predict cardiovascular risk better than medical office readings.
  7. In people with diabetes diagnosed with high blood pressure, drug therapy is initiated along with lifestyle changes.
  8. It can take several weeks to several months to find the right dose of a drug or combination of drugs along with lifestyle changes to achieve consistent blood pressure measurements below 140/90 mm Hg.

References:

https://www.diabetesselfmanagement.com/managing-diabetes/complications-prevention/home-blood-pressure-monitoring/

https://www.webmd.com/hypertension-high-blood-pressure/guide/high-blood-pressure

– Dr.Y.Alekhya.

12 SYMPTOMS INDICATIVE OF TYPE 2 DIABETES MELLITUS

Our body needs insulin to metabolize sugars which are the end product of carbohydrate breakdown. Insulin, produced by a gland called pancreas, helps the body to use glucose for energy. In type 2 diabetes the individual’s pancreas do not produce enough insulin i.e enough to meet the increased demand, due to the fact their body doesn’t respond properly to insulin.  

Type 2 diabetes can affect all people, regardless of age. Early symptoms of type 2 diabetes may be missed, so those affected may not even know they have the condition. Signs and symptoms of type 2 diabetes often develop slowly. Here is a list of important symptoms to look for-

  1. Increased thirst or a Dry Mouth /polydipsia- Excess sugar building up in your bloodstream causes fluid to be pulled from the tissues. This may leave you thirsty. You may notice that you are drinking more than usual and still your mouth often feels dry and you feel thirsty.
  2.  Frequent urination/ polyuria- When there is excess glucose present in the blood, the kidneys react by flushing it out of the blood and into the urine. This results in more urine production and the need to urinate more frequently
  3. Excessive Hunger /polyphagia – since the body cannot use insulin properly to help glucose get into the cells, your pancreas (the organ that makes insulin) starts to put out a lot more of it to try and compensate. Such high insulin levels in the body send signals to the brain that your body is hungry.
  4. Unexpected weight loss – your cells don’t get enough glucose, which may cause you to lose weight.
  5. Fatigue- Since your cells are deprived of sugar, you may become tired and irritable.
  6. Blurred vision – If your blood sugar is too high, fluid may be pulled from the lenses of your eyes
  7. Headaches – occur due to persistent high blood sugar levels.
  8. Infections – both yeast and bacteria multiply more quickly when blood sugar levels are elevated so, people with diabetes are at higher risk of developing itching around the penis or vagina, or frequent episodes of thrush
  9. Slow-healing sores / cuts – diabetes affects your ability to hear
  10. Areas of darkened skin – Some people with type 2 diabetes have patches of dark, velvety skin in the folds and creases of their bodies — usually in the armpits and neck. This condition, called “acanthosis nigricans”, may be a sign of insulin resistance
  11. Pain and Numbness – a prolonged exposure to high blood sugar can damage the nerves throughout the body — a condition called diabetic neuropathy
  12. Sexual Dysfunction – diabetes can damage the blood vessels and nerves in the sex organs causing decreased sensation, potentially leading to difficulties in sexual life.

It is worthwhile to get yourself tested if you notice one of these symptoms in extreme or a combination of these symptoms especially if you already have risk factors like family history, obesity, sedentary lifestyle or if you consume alcohol or smoke regularly.

                                                                   

References

https://www.medicinenet.com/type_2_diabetes_pictures_slideshow/article.htm

https://www.everydayhealth.com/type-2-diabetes/symptoms/warning-signs-of-type-2-diabetes/#07

https://www.nhs.uk/conditions/type-2-diabetes/symptoms/

https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193

   -Dr.Afroze Fatima

Know-Hows of Diabetes; this World Diabetes Day

India is often called the “Diabetes capital of the world”, ever since India became the country with highest number of people suffering with Diabetes.
Diabetes is a chronic medical condition. It affects the way body metabolizes sugar, body’s important source of fuel. Insulin is a hormone that is needed to allow sugar (glucose) to enter in to cells to produce energy. Insulin is secreted by a gland called pancreas located in our abdomen, behind the stomach.
In Type 1 Diabetes, body produces little or no Insulin. Type 1 Diabetes usually appears in young children and adolescents, but can appear in adults. Type 1 Diabetes treatment involves insulin injections from the time of diagnosis.
In Type 2 Diabetes the body resists the effects of insulin or doesn’t produce the required amount of Insulin to maintain normal glucose level. Type 2 Diabetes usually presents in adulthood, but with increasing childhood obesity, it can appear in young children and adolescents. Type 2 Diabetes can be managed by medications for some time but eventually may need insulin injections.
In the last 3 decades, number of people suffering with Diabetes is steadily increasing in India. This increase can be attributed to urbanization and change in lifestyles of people.These changes include increased caloric intake in diet and decreased physical exercise. Smoking and alcohol intake along with Diabetes are also contributing to development of complications. Diabetes along with Hypertension, abnormal lipid profiles is contributing to coronary artery disease, which is the leading cause of death for people of India.
Urban rural divide is decreasing gradually as prevalence of Diabetes is increasing in rural India. Many people are unaware of their elevated blood sugars; take no measures towards control of blood sugars which leads to long term complications that are known to occur due to Diabetes.
The impact of Diabetes is more on people of low socioeconomic status as they have poor access to medical care and lack of affordability for testing and medications.
Not all type 2 Diabetics in India are overweight. Indians have increased risk of having Diabetes at a lower BMI compared to their western counterparts. Indians also are affected with Diabetes at a younger age
November 14 th is the world diabetes day dedicated for raising awareness about diabetes all over the world. The day is marked on the birthday of  Frederick Banting one of the scientists who discovered insulin for the treatment of Diabetes, along with other scientists Charles Best and Macleod.
While type 1 Diabetes which is the less common and accounts up to less than 10% of total Diabetes, cannot be prevented with the current knowledge, we can prevent Type 2 Diabetes by taking some measures.
What can you do to decrease your risk of type 2 Diabetes?
  • Maintain a healthy weight
  • If you are overweight, take measures to lose few kilos in a steady manner.
  • Include fruits and vegetables in your diet
  • Cut down diet high in calories, like processed foods and fast foods.
  • Include physical exercise in your daily routine. To begin with any activity is better than no activity.
  • As you are increasing your physical activity gradually, aim for at least 30 minutes of moderate physical activity daily and 45 minutes of vigorous activity per week. Check with your doctor before starting any high intensity physical activity.
  • If you have a family history of type 2 diabetes, your chance of getting type 2 diabetes is more. Get your blood sugars checked at regular intervals.
  • As you age, your chance of getting type 2 diabetes goes up.
  • Women having Polycystic ovarian syndrome are at increased risk for type 2 diabetes.
  • Women who had gestational diabetes (diabetes diagnosed during pregnancy, which usually resolves after childbirth) are at increased risk for getting type 2 diabetes.
  • If you have hypertension, get your high blood pressure under control.
  • If you have lipid abnormalities, discuss with your doctor about measures to take to bring them to desired levels.
Watch for these symptoms of Diabetes and seek immediate medical care
  • Frequent urination
  • Dryness of mouth and increased thirst
  • Frequent skin infections; frequent urinary and vaginal infections in women
  • Weight loss
  • Weakness and fatigue
  • Blurry vision
  • Some people with type 2 diabetes have patches of velvety dark skin at the back of the neck and skin folds. This condition is a sign of possible insulin resistance and is called acanthosis nigricans.
Long term complications from uncontrolled blood sugars are
  • Heart problems, causing angina, heart attack
  • Brain stroke
  • Kidney problems leading to end stage kidney disease
  • Eye problems sometimes leading to vision loss
  • Damage to nerves causing causing nonhealing  ulcers of the limb leading to lower extremity amputations.
  • People with Diabetes are more prone to depression.
If you are diagnosed with Diabetes, what can you do to avoid long term complications from Diabetes
  • If you are diagnosed with Diabetes, talk to your doctor if there are concerns. This helps in accepting the diagnosis, as denial and lack of follow up can worsen blood sugars and lead to long term damage to organ systems.
  • Discuss the management plan with your doctor. Remember that you are part of the team and need to share your concerns and limitations with your doctor for him to be able to help you with all possible choices.
  • If you are started on medications by your doctor, take them regularly as suggested by the doctor.
  • Have a plan for sick days and travel days by talking to your doctor.
  • Maintain regular follow ups as advised by your doctor.
  • Schedule eye check up yearly once and more frequently if the ophthalmologist suggests so.
  • Stick to the diet plan advised by the doctor. If you have concerns about the choices and the quantity of the food items, consider asking your doctor to refer to a nutrition expert who can give you some more choices and tips.
  • Always carry a high glucose snack or a juice carton with you for those instances when you experience symptoms of low blood sugar. It is common for every diabetic to have low blood sugars at sometime or the other.
References
  1. http://diabetes.diabetesjournals.org/content/63/1/53
  2. http://www.sciencedirect.com/science/article/pii/S0168822711001161
  3. http://www.heart.org/HEARTORG/Conditions/More/Diabetes/UnderstandYourRiskforDiabetes/Understand-Your-Risk-for-Diabetes_UCM_002034_Article.jsp
  4. http://apps.who.int/iris/bitstream/10665/204871/1/9789241565257_eng.pdf

    – Dr. Lavanya Aribandi, Chief Medical Officer, eKincare