FAQ

People might keep on snacking to give them the so called energy while staying up awake while working late hours. There are certain occasions when you are allowed to snack especially when having an early light dinner and sleeping late. But, there are certain things to be known while snacking.

• Warm milk contains tryptophan and helps in sleep
• A bowl of cereal with milk or a glass of labaan( butter milk) , crackers or bread and cheese all can cause sleep due to the carbohydrate content.
• Sources of hidden caffeine and fatty food such as burgers can impair with sleep.
• Alcohol ( nightcap) might cause nightmares, frequent awakening, night sweats  and headache for some which can impair with sleep. Drink plenty of water after the sleep.
• Protein rich and high fat food will cause problems in digestion which can impair sleep.
• Spicy food and smoking can impair with digestion.
• So make healthy choices while snacking. Snack is just a small meal and not another meal.
• The winter months are a cause for celebrations and family outings . The smell of barbeque fills the air after the sun sets. People might eat more of meat and prawns which might increase the cholesterol levels. You can however go a walk outside as the climate is much better than the hot humid summer climate.
• Generally sugar levels rise with the increased consumption of food associated during the winter months. But, so also can the cholesterol levels with the increased consumption of meat, prawns, crabs and alcohol.

Lifestyle changes have been the backbone in the management of the famous three- high blood pressure, high blood sugar and cholesterol. Lifestyle changes include diet changes, cessation of smoking, avoiding alcohol, exercise and proper sleep.
But too much of anything is just as bad as not doing anything at all. Overuse injuries are a common phenomenon among those who are physically active or even among the so called weekend warriors!

What causes overuse injuries?
Excessive repeated stress on the tendons, joints, bones and muscles over periods of time can lead to this. Trying to do too much or too hard or too soon also contributes. Not getting enough rest or use of poor technique or poor equipment can also play a major role.

 
What are the common injuries?
• Tennis elbow – pain and swelling of the outer aspect of the elbow
• Golfers elbow – pain and swelling of the inner aspect of the elbow
• Swimmers shoulder – pain on the shoulder with overhead activity or while sleeping on shoulder.
• Runners knee– pain just below the knee cap aggravated by running, jumping, cycling, going up or down the stairs, sitting for prolonged time with knees acutely bent.
• Achilles tendon pain– behind t ankle due to running, jumping or cycling.
• Heel or foot pain

How does on prevent such injuries?
• Make sure you are physically fit to undergo exercises.
• Ask either a trainer or your health care provider regarding which exercises are good.
• Adequate warm up, slow stretches and cooling down are equally important.
• Use the proper technique, the proper equipment including well padded shoes and dresses.
• Always strengthen both sides of the body equally to prevent an imbalance.
When the body does not feel right, please ask your trainer or health care provider if this is okay. It is normal to have pain and stiffness soon after starting a new exercise program. But , it can also be the be the beginning of a trouble. It is better to make sure before it becomes too bad and makes you bed ridden.

Menopause is the period in a woman`s life when the cyclical bleeding stops. The age depends from person to person. This can be naturally occurring or is stopped prematurely by removing the uterus and or ovaries for various medical reasons. For many women it is relief to be off the inconvenience caused by the monthly flow. But, there are some problems that crop up soon thereafter. The woman is blessed against the heart attacks and some cancers while still mentruating.
The following are possible after attaining menopause:
• Fluctuating sugar levels
• Weight gain
• Hot flushes and night sweats
• Emotional lability
• Sexual problems
• Infections of vagina due to bacteria or yeast caused by lack of a hormone called estrogen
• Weaker bones and increased risk of developing a fracture
• Increased risk for heart attacks.
• Gastritis can increase with increased medications.

How to prevent the associated phenomena?
One cannot prevent menopause. That is to happen. But, the following can be observed to reduce the bad effects of menopause:
• Healthy lifestyle habits- physical activity, diet and good sleep
• Frequent blood sugar check
• Adjusting the doses by consulting the Dr
• Hormonal treatment is advised for some.
• Check the bone mineral density, the vitamin D, calcium, lipids, kidney, thyroid profile and heart regularly besides having an annual dental and eye check.
• Check the feet as well.

Normally people test the fasting sugar levels and assume all is well if the result is normal in fasting. In those with diabetes, the post meal sugar levels are affected much earlier than the fasting sugar levels are affected. Hence, it is prudent to check the sugar levels 2 hours after the main meal at least once a week.

Normally frequent sugar checks are adviced for :

• Those on multiple doses of insulin daily.
• Those who are pregnant and on insulin.
• Those who had been recently on a new regime of medicine.
• Those getting frequent low levels or fluctuating levels.
• Those who are sick.
• Those at extremes of age.

Sugar levels can be used to assess the progress as well as the efficiency of treatment and to decide the dosages.

There are devices called Continuous Glucose Monitors that measure the blood glucose levels for periods of 3 days to a week by the use of sensors. This will help the treating health care professional to adjust the doses,  the timings and types of medication as well.

There are many applications which could be downloaded on to smartphones which can be used for tabulation of the sugar levels. These can be periodically updated as well as even be sent to the treating health care team.

• Moderate alcohol intake before, during or after the meal is beneficial if within limits , not more than 3 for men and not more than 2 for women.

• Avoid drinking on an empty stomach

• Avoid substituting a meal with alcohol

• Severe hypoglycemia can occur with large quantity of alcohol.. Hypoglycemia can occur even after 16 hours after last drink. A hypoglycemic spell can be mistaken for drunken behavior.

• Continuous drinking could lead to increased blood pressure and damage to the liver.

• All alcoholic drinks contain calories, can help increase the body weight and can also worsen neuropathy.

• Low carbohydrate beer has higher alcohol content.

• Low alcohol wine contains more sugar.

• Avoid drinking and driving

Having sweets can increase the sugar levels. Just by being off sweets will not be enough to control diabetes.

But, there are so many other non sugary items which can get converted to glucose within the body . Control of diabetes involves maintaining a balanced diet, adequate exercise , leading a stress free life and having regular check ups with the health care provider.

Yes, one can… It needs you to accept you have diabetes. This will need you to be compliant with medicine timings, meeting with the doctors, checking the sugar levels and to be vigilant.

Carry with you the medicines, the glucometer kit, supply of glucose or carbohydrate snacks and the phone numbers to be contacted in an emergency(ICE numbers)

You can marry and have children if all is well with the reproductive organs. Some people have problems with the reproductive ability. A good gynecologist can help out.

You can take part in adventure sports such as trekking, mountain climbing, sky diving, deep sea diving,bungee jumping, and so on with the advise from your doctor. You will need to have enough stock of medicines, wear appropriate clothing, take care of the glucometer kits and have enough of glucose supply in event of low sugar levels.

Death in those with diabetes is largely due to heart problems. The heart attack is almost always silent in its presentation.  There are many who present with numbness of the left arm, jaw pain, ear ache, upper back pain or a mild difficulty in the center of the chest who are surprised they have a heart attack evolving.

It is wise to have an ECG ( electro cardiogram) taken which can show if one had an attack previously, an ECHO cardiogram to show the size of the heart, the functioning of the valves and heart chambers, a treadmill test which will show the functioning of the heart in exercise to make sure all is well. An angiogram is advised if there is an indication for the same if the tests are abnormal. This has been detailed in the web site.

Maintaining normal blood pressure, cholesterol levels, cessation of smoking, maintaining normal body weight and having at least 150 minutes of physical activity can help  a long way.

The following medicines can increase the blood pressure :

• Paracetamol in large doses
• Pain killers such as Indomethacin, Naproxen, Brufen, Piroxicam
• Anti depressants
• Oral contraceptive pills for regularising periods or for birth control.
• Coffee in excess
• Peudoephedrine in some of the common cold medicines
• Herbal medicines – ginseng, licorice, St Johns wart
• Tacrolimus for organ transplant
• Some illegal drugs

These medicines are not to be used in those with low blood pressure. Please ask your health care provider if there are other causes for low blood pressure.

The lens of the eye is bathed in a clear solution called aqeous humor. This solution gets cloudy when there is sugar fluctuation. One should check with the eye doctor before ordering new glasses. The eye takes time to adjust to the sugar levels  when the high levels become normal.Allow the body to stabilize first before ordering new glasses.

There are other problems such as increased pressure in the eye (glaucoma) or clouding of the lens ( cataract) or diseases of the retina which could also cause the problems.  Have a regular eye check making sure the eyes are good. Order new glasses only after maintaining normal sugar levels.

It is wise to have a check once a month or two to make sure there are no problems. The eyes and kidney will work well without any problems till close to 80 % is damaged. Early detection will prevent the progression to a more serious level. This does not mean that one should do tests very frequently unless the doctor advices you to.

One will have to go quite frequently during the initial weeks to clear the doubts, if any, pertaining to diabetes. You might also be asked by your health care provider to monitor the sugar levels and have them shown as well. Normally, a follow up is advised based upon doctors decision. This helps make sure the body systems are working well.

It is generally assumed that if the sugar levels are normal, it is assumed the diabetes is under control. I shall attempt to explain by 2 case scenarios.

Scenario 1  :  You have decided to have the sugar tested and go for a strict diet for the preceding few days till the day the blood is tested . The sugar levels may come as normal. Then you go and indulge in a feast. Here the reading of fasting sugar is not representative of the status of diabetic control.

Scenario 2:    You decide to have the blood tested and unfortunately you run a fever. Normally the sugar levels are very normal till you came down with the fever.You decide to do the tests upon recovery from the fever. The sugar levels will be high due to the infection in the body. Here the readings are not reliable to judge the status of diabetes control.

To summarize, the readings of blood sugar given idea of the sugar control at that given point of time.

Thus, the glycated hemoglobin,HbA1C, is more reliable in the above scenarios. But, HbA1C is also with its problems and is always not reliable either….. especially among those with reduced red cell span, bleeding, advanced kidney disease or having different forms of hemoglobin.

Yes, this is the time to make aggressive lifestyle changes failing which type 2 diabetes can set in. Some studies have shown some medicines to be useful in treating this for those at high risk.

 Impaired Fasting glucose when sugar level is 5.6- 6.9 mmol/L or 100-125 mg/dL
Impaired Glucose tolerance when sugar level is 7.8-11.0 mmol/L or 140-199 mg/dL

Fasting sugar level of 5.6- 6.9 mmol/L or 100-125 mg/dL

OR

a random sugar level or 2 hour after meal sugar 7.8-11.0 mmol/L or 140-199 mg/dL

OR

glycated hemoglobin of 5.7-6.4 % are diagnostic of diabetes mellitus

Fasting sugar level of ≥ 7.0 mmol/L or ≥ 126 mg/dL ,

OR

a random sugar level or 2 hour after meal sugar ≥ 11.1 mmol/L or ≥ 200 mg/dL

OR

glycated hemoglobin of ≥ 6.5% are diagnostic of diabetes mellitus.

Urine sugar levels are not used these days in the diagnosis as was done in the past.

Not always. . However those with type 1 diabetes do not have any other treatment options but insulin.

If the sugar levels are very high insulin is sometimes initiated for a short time to normalize the levels and then switched over to oral medicines. There are times when maximum doses of oral medicines alone do not control the sugar levels. If one has already nephropathy ( kidneys affected by diabetes) or retinopathy ( eyes affected by diabetes) or heart problems , insulin is preferred. If a pregnant woman is diagnosed with diabetes insulin is initiated

The sugar levels are dependent on the functioning of the beta cells of the pancreas. These cells secrete insulin. The pancreas will be secreting insulin well in the beginning of the disease and later on the cells will start failing to do so.
Checking the sugar levels 2 hours after the main meal will be important to decide if diabetes has set in. However, later on fasting sugar can also be on the rise.
It is also important to check the level of glycated hemoglobin ( HbA1C) as the level of sugar is dependent on the quality and quantity of food.

The commonest symptoms such as increased thirst, increased hunger and increased urination are not always common. Most of the time there may be no symptoms at all and diabetes can be detected on a casual check.

However, the following symptoms  may be pointer: losing weight without any reason, failing eye sight, longer than usual time for wound healing, frequent respiratory or urinary infections, frequent vaginal infections among women and unexplained weakness.

If parents both are having type 1 diabetes, the chances of the offspring being diabetic are high. However, if parents have diabetes type 2, you need not become a diabetic.

If the mother had diabetes associated with pregnancy ( called gestational diabetes) the chances becoming a diabetic or obese are high, but can be prevented with sensible lifestyle.