How do we react to an illness?

Health is of paramount importance to us and disease is always perceived as a threat to our well being and to our life
.
Heart attack evokes a scare and fear of death.This fear remains even after successful treatment. Not only the patient but his friends and relatives are also shaken.They may consult a cardiologist and make changes in their lifestyle.

Cancer creates a fear of death.It is a sudden news and signals exit from this world in near future.The whole family is shaken. Fortunately many treatments are available now, due to the advances in medical technology. Coping with the long term suffering needs a support system. It is a major setback for the patient which changes his outlook towards life.

A sudden attack of stroke paralyses the patient in every sense. A mighty hand of destiny strikes a powerful blow to his existence. "why me?" is the question that bothers him. 
It is an ordeal to remain bed ridden and disabled throughout the life. 





Parkinson's disease evokes self pity. Patient feels trapped and helpless. He undergoes a lot of suffering and leads a very restricted life till the end.It is an agony. His family also suffers along with him.  He is haunted with the thoughts "Why me?" "Is it my past karma?"  What have I done? 

Tuberculosis causes a stigma and also the long term suffering due to the adverse effects of the medicines.He would not like others to know about it.

In most of these diseases, people turn to spirituality, perform rituals, visit the family deity. Also they may consult an astrologer, who reassures them and asks to perform some rituals (at a reasonable cost) 


What about diabetes?




Diabetes does not create a panic or a threat to life. The literature mentions that he suffers from depression but soon recovers and become normal.

There is no "why me?" feeling in diabetes because he is not the only one. Many of his friends and relatives have it. It has become so common in society that there is no shock or a surprise or a stigma (It may add to the status)

He reacts in different ways:

"So it has come, I was expecting it",

"No wonder, it is in our family"

"Now I should not eat sweets". 

"I feel nice ,no symptoms"

He does not feel the burden of the problem (which he should be feeling) There are ups and downs in the blood sugar, but he is cool. He knows various complications of diabetes, but is indifferent. His family is also cool. 

I have not seen a 'worried' diabetic yet,. 

Who is afraid of diabetes?

Diabetics should check their vitamin B12 levels

Most diabetic patients are above 60 and also taking metformin, both of which are associated with vitamin B12 deficiency.



This affects the nerves of hands and legs and there is numbness, tingling,burning sensations in hands and legs (peripheral neuropathy)




This is treated by taking the injections of vitamin B12 and folic acid

Inj. VITCOFOL 10 ml vial

2ml per injection.given once a week

Total 5 injections

These injections should be given in the buttock

Vitamin D in diabetes

Most diabetics have a deficiency of vitamin D 

This leads to 

• High Hb A1c levels (uncontrolled diabetes)

• Albumin in urine (nephropathy)

Every diabetic should have a normal level of vitamin D( 30 ng /mL)

• There is no vitamin D in foods. Only a limited amount in some foods

• If you expose to sunlight for 90 minutes per day then you get vitamin D, just enough for the day. 

• Only reliable way of getting it through the supplements which are available as sachet or tablets

Diabetics suffer from depression

Depression is both a cause and effect of diabetes

A study of 272 diabetic patients showed that 60% had depression


Following features were seen

• Physical inactivity
• smoking 
• Alcohol intake
• Albumin in urine

• Poor control of diabetes
• poor quality of life
• Neglect of proper diet

P.S.

• Depression remains unrecognized and hence untreated
• Diabetics will not take professional help
• They are not proactive  
• They do not complain 
• They just accept the problem and do nothing about it.

Diabetics should monitor their blood pressure

100 diabetics who had normal blood pressure were studied.
These patients had fluctuations in the blood pressure which are as follows

• Early morning rise
• Night time surge (Nocturnal hypertension)
• Fluctuations during the 24 hr period

Such variations were associated with

• Albumin in urine
• High HbA1C (Average blood sugar during the last 3 months

Do they need medicines to lower the blood pressure?
No. 
These patients are not hypertensives.


But they should monitor their blood pressure at home 


Ambulatory blood pressure monitoring:

Use the same arm. Place the cuff on bare skin, not over clothing. 

Rest your arm,on a table raised to the level of your heart. If needed, place a pillow under your arm to elevate it to the level of heart

P.S.

These variations in B.P. will stop when we control our diabetes.

• Reduce weight and abdominal circumference
• Reduce calories
• Stop eating out

• 
  

Skipping breakfast increases risk of diabetes

A review of existing studies looked at data from 96 000 people and concluded that skipping breakfast (even occasionally) is associated with a higher risk of developing diabetes.
Skipping breakfast once a week is associated with a 6 percent higher risk and skipping 4 or 5 times per week increased risk to 55 percent.

What happens?

• Increased blood sugar after lunch and dinner
• Impaired insulin response
• Tendency to overeat

What is the mechanism?

It is due to insulin resistance

. 

As a result, more insulin is secreted to keep the blood sugar in a normal range 

when it’s chronic, it is the onset of diabetes

Why people skip breakfast?

• No time (even to breath)
• Don't feel hungry in the morning
• There is no breakfast in our family

What you should eat?

Whole wheat bread
(The front label is misleading. See the list of ingredients. 
The first (not second or third) ingredient should read as whole wheat white bread or whole wheat brown bread

Potato

Banana or apple

Boiled egg (with yellow)
        
OR

Boiled Mung, or Chole or Rajma

A glass of milk

.This will help you kick-start your day, give you energy, satisfy your appetite, and set the stage for healthy eating all day long.”

How early can you get diabetes?

I had a patient coming from U.S. He is there since last 20 years.He came with his wife and two boys,14 and 12 year old. These children were born in America and so they are American children (of Indian origin)

While treating my patient I asked for the blood test of the boys for hemoglobin,vitamin B12 and D3. But my patient took the package for a number of tests, which included HbA 1c
and average blood sugar.

Both the boys were border line diabetics. I was shocked.
I had never asked for this test ( I never thought on those lines)   

Obviously, the diet they were having there was the cause.
Breakfast was cereals which have high sugar content.The lunch is in cafeteria at school which is fast food(only)

These boys did not carry lunch box from home. (their mother was also not insisting) They used to have snacks the whole day,like candy, biscuits, chips, rice crisps, coke and other sugary drinks.

The dinner was home cooked, which was just rice, dhal and a vegetable some times.

High GI foods are fast foods, breakfast cereals
Low GI foods are wheat, rice, chole,, rajmah, mung, mutter,curds, fruits

The blood glucose levels in these two boys are high due to the fast food. They are on the border line but the average blood sugar was still normal (less than 140)

This is due to high secretion of insulin in response to high blood glucose. But how long? Pancreas will get exhausted one day and insulin secretion will start falling.

There is chaos inside at present.

It is like driving the car in the first gear. How far it will go?  

I talked to the whole family and asked to change the dietary pattern as shown in these pictures.

P.S.

The family has gone back to U.S. 
Will they follow my advise? I do not have high hopes.

Eating is a behavior and behaviors do not change overnight. It needs a conscious efforts for a long time.

If they do not change, I am really afraid that these two boys will become diabetic in a few years. 

Fenugreek seeds are useful in diabetes

           
Fenugreek seeds (Methi)

It is used as a condiment for seasoning in India. 

Ayurveda has mentioned that it suppresses the excretion of glucose in urine and relieves symptoms of diabetes.

It is a rich source of fibre. It also contains an alkaloid (trigonelline) which reduces blood sugar level

National Institute of Nutrition,(hyderabad) has shown the beneficial effects of fenugreek seeds in diabetes.

Fenugreek leaves do not show such effect.

Therapeutic effects:

It has overall beneficial effect in diabetes

Reduces blood sugar and urine sugar

Improves glucose tolerance

Lowers blood levels of cholesterol and triglycerides   

Dosage:

Two teaspoonfuls, along with lunch and dinner.

The powder can be taken in water or buttermilk,15 minutes before meals.
The powder can also be used in preparation of chapati,rice, dhal or vegetables

The bitter taste of the seeds is a drawback

Precautions:

It is a supportive therapy

The dose of anti diabetic drugs can be reduced in the long term, with the advise of the physician

Dietary restrictions should be continued.

Body weight should be kept normal

Some patients may develop diarrhea and gas formation initially

Do you know Glycemic Index ?

If you ingest 100 G of glucose, your blood glucose level rises by 100%. It means, glycemic Index (GI) of glucose is 100

If you eat 100g of boiled potato blood glucose will rise by 78%. So,GI of potato is 78

In this manner GI of various foods has been determined.and
these foods are grouped in 3 categories as:

High: (65 -75%)

White wheat bread, wheat roti, boiled rice, Cornflakes,
boiled potato, french fries, sucrose (table sugar), popcorn carrots, rice crackers /crisps, honey.

Intermediate: (45 -55%)

Fruits ( banana, mango, orange, orange juice, apple,
ice cream, multigrain bread, chapatti, soft drinks ,spaghetti

Low (30 -40%)

Chole, rajmah, Mung, beans, peas, lentils, soybean milk, yogurt, dates, chocolates

All intact whole grains have a very low GI score.

Glycemic index is a number. It gives you an idea about how fast your intestines convert the carbs in a food into glucose. numbers.The smaller the number, the less impact the food has on your blood sugar. 

GI index applies only to carbs and not proteins or fats

Carbohydrates with a value less than 55 or less are more 

slowly digested, absorbed and metabolized and cause a 

lower and slower rise in blood glucose and, therefore less 

insulin levels

Individuals who followed a low-GI diet over many years were at a lower risk for developing both diabetes and coronary heart disease, age-related macular degeneration and atherosclerosis
. 
In simple words, eating low-glycemic index foods (GI value <=55) helps to control diabetes and prevention of chronic disease. 

Bottom Line

Diabetics are advised not to eat rice. The reason is the 
high glycemic index of rice (78) But you do not eat dry rice, it is 
It is mixed  with curds or chole or rajmah, 

 A mixture of rice with curds will bring down rice induced rise in blood sugar.(GI of curds is only 41%) 

Similarly, GI of chole, rajmah ,lentils,is only 25%, and the mixture of rice-chole or rice-dal will bring down blood glucose raised by the rice alone.

What about potato?

It is true that GI of potato is 78%. But you do not eat only potato in your meals. It is a mix of cereals, pulses, vegetables, curds which will bring down the potato induced rise in blood glucose significantly.

Protein content of potato is low(2g/100g) but its biological value is equal to that of egg protein. It is a good source of carbohydrate and it must be a part of our diet. You cannot discard it just because it has a high GI.

Potato has very low calories (80/100g), high nutritive value and fibre content.

Mango and bananas have GI of 51% which is much less than rice or potato. plus both mango and banana have adequate fiber, vitamins and minerals. and both fruits have low calories.(80/100g of mango and100 /100G of banana) 
So it is very safe to have one or two mangoes in summer and one banana every day.

Eating Marie biscuits and avoiding mango and banana is strange. 

.

A diabetic can eat rice, potato,mango and banana

 A diabetic eats wheat but not rice. The reason is that rice raises the blood sugar by 73%  and roti or chapatti raised the blood sugar by 65%. 

But do you eat dry rice?. 

you mix it with curds, A mixture of rice with curds will bring down rice induced rise in blood sugar.(Curd raises the blood sugar by 41%) 
Similarly, pulses like chole, rajmah, mung dal raise the blood sugar by only 25% and the mixture of rice-chole or rice-dal will bring down blood glucose raised by the rice alone.

Both rice and wheat have same calories and it does not matter whether you eat rice or roti as long as the amount is restricted.
Besides, the quality of the protein in rice is better than that of wheat.

What about potato?

It is true that boiled potato raises the blood sugar by 78%
But you do not eat only potato in your meals. It is a mix of cereals, pulses, vegetables, curds which will bring down the potato induced rise in blood glucose significantly.

Protein content of potato is low(2g/100g) but its biological value is equal to that of egg protein. It is a good source of carbohydrate and it must be a part of our diet. You cannot discard it just because it raised the blood glucose by 78%.
Potato has very low calories (80/100g), high nutritive value and fibre content.

Mango?

 Mango raises the blood glucose by 51% which is much less than rice or potato, which gives us an indication that it is safe to eat a mango. It has low calories (74 / 100G)

Mango has high fibre content and vitamins and 
anti oxidants.

And banana?
It raises the blood sugar only by 51%.Banana has high fibre contents and low calories (115/100g)

Both mango and banana have high fibre content  which helps blood sugar to rise gradually and not quickly. 

Regular consumption of fruit is generally associated with reduced risks of several diseases and functional declines associated with aging. It is true for a normal person as well as a diabetic. So, a diabetic has no reason to avoid fruits.

So eating 1-2 mangoes in summer and one banana daily round the year is healthy. (Don't eat 6 mangoes or bananas)

Eating Marie biscuits every day and avoiding mango or a banana is strange

Diabetic diet

           
          
It consists of cereals, pulses, fruits and vegetables.

Cereals:

wheat, rice, jowar and bajra.

Pulses:
They are of various types

Bengal gram (chole or chana)        
Black gram (udad)
Green gram (Mung)                          
Lentils (Masur)
Peas (Vatana or matar)
Rajmah
Red gram (Turdal)
Soybean 


Pulses are a rich source of fiber, which is not absorbed in intestine and it helps to reduce the rise of blood sugar after a meal

We eat cereals in large amounts but eat very little pulses.There is a need to restrict the amount of rice and wheatand increase the intake of pulses.This approach will reduce the level of blood sugar after lunch and will help in reducing the dose of insulin and oral hypoglycemic drugs over a period of time.

Add caption

Physicians of ancient India used to treat diabetes with barley and green gram(Mung) 

Please eat less and less of rice,and wheat and more and more of pulses like chole, rajmah, mung,

How much?

Chole or rajmah prepared from 50 g or more of raw portion.
The entire amount to be finished by the patient in one day

Diabetics can eat fruits

 Many diabetics feel that they are not supposed to eat fruits.This is wrong. A diabetic can eat everything that a normal man can eat, but in a less quantity because he has to restrict calories.

     Fruits have less calories, as shown below. 
    At least 3 types of fruits should be consumed every day

     In summer season, one mango should be eaten daily. So,there is no reason to avoid mango or banana. Off course,you are not eating 4 mangoes or bananas in a day.(moderation in every thing)

   People eat Marie biscuits every day, but avoid a banana.

   This is strange.

Fruit                  Calories (100 G)

Banana                 116

•Mango                  74

•Chiku                         98

•Apple                    60

•Grapes                 70

 •Papaya                  32

•Water melon         17

     Regular consumption of fruit is generally associated with reduced risks of several diseases and functional declines associated with aging.
         


Fruits have high nutritive value:

Low calories
Fructose (very delicious taste)
Vitamins
Minerals
Fiber 
Anti oxidants