MV Hospital

Welcome to M.V Hospital for Diabetes, established by late Prof. M.Viswanathan, Doyen of Diabetology in India in 1954 as a general hospital. In 1971 it became a hospital exclusively for Diabetes care. It has, at present,100 beds for the treatment of diabetes and its complications.

Monday, December 5, 2016

Meralgia paresthetica (lateral femoral cutaneous nerve entrapment) in Diabetes

Meralgia paresthetica is a condition that have the following symptoms.
•    Burning, stinging or “pins and needles” sensation in the outer thig
•    Numbness & tingling in the outer (lateral) part of your thigh
•    Less commonly, dull pain in your groin area or across your buttocks
These symptoms commonly occur only on one side of the body and may increase after walking or standing.

How does this happen?
 
•    The lateral femoral cutaneous nerve is entrapped as it passes under the inguinal ligament.
•    Obesity
•    Diabetes mellitus
•    Old age
•    Large  bulging abdomen 

•    Tight belts or garments around the waist
    
    
 •    Scar tissue near the lateral aspect of the inguinal ligament
•    Pregnancy
•    Injury during local or regional surgery
•    Seat belt injury following motor vehicle accident
•    Meralgia has also been reported after long-distance walking and cycling.

Risk factors:
The following conditions may increase your risk of meralgia paresthetica:

•    Extra weight - Being overweight or obese may increase the pressure on your lateral femoral cutaneous nerve.
•    Pregnancy - A growing belly adds extra pressure on the groin, through which the lateral femoral cutaneous nerve passes.
•    Diabetes - Diabetes-related nerve injury can lead to Meralgiaparesthetica.
•    Age - People between the ages of 40 and 60 are at a higher risk.

Treatment:

There are several categories of treatment for Meralgia paresthetica according to the cause  and severity of the problem.

•    The most immediate response to Meralgia paresthetica should be rest.
•    Conservative management- Wearing loose clothing and losing weight.
•     Making lifestyle changes.
•    Medicines
•    Creams containing capsaicin.
•    A mainstay of treatment (which could be curative) are nerve blocks.

Rehabilitation Program: Physical Therapy

•    Fitness program to assist in weight reduction to reduce abdominal girth, as well as proper biomechanics and postural re- education
•    Heat application
•    Transcutaneous electrical nerve stimulation
•    Interferential current
•    Low-intensity phonophoresis.
•    Soft-tissue techniques (e.g, trigger point therapy) also may be beneficial for pain and tightness in the hip and thigh muscle
•    Deep tissue massage/myofascial release
•    Joint mobilization/Joint manipulation
•    Exercise programs to stretch, self- treat and improve proprioception, balance, strength and core stability
•    Neural mobilisation
•    Activity modification advice
•    Taping

Outer Thigh Meralgia paresthetica Exercises:
         
Hip Exercises: 

Bridging consists of lying flat on the floor and lifting your bottom up while tightening your gluteal muscles.


  Hip extensions involve lying on your belly and lifting your leg up while tightening the gluteals.


Standing hip abduction requires standing upright while slowly lifting each leg to one side, keeping the knee straight.Reducing hip tightness is one way to reduce the symptoms of Meralgia Paresthetica by improving flexibility and building strength. 
Such exercises should not cause any thigh pain.

Quadriceps Stretches:



Quad stretch involves pulling the heel of your foot back toward your buttocks while standing, stretching the length of the upper thigh. Stretching should cease if pain occurs.

Lunges:


Lunges strengthen both the hips and quadriceps muscles to help prevent thigh pain. Stand upright and step forward with one foot, lowering the body until the opposite knee touches the ground at a right angle.

Summary:

The simplest treatment is to get the pressure off the nerve by losing weight and/or not wearing tight fitting pants or belts. If there is pressure on the nerve, decreasing that pressure in any manner will improve symptoms.

If the pain is severe, operative decompression should be considered.

Monday, November 28, 2016

Beat stress

    Count backwards from 20, 000

Breathe deeply in and out through the nose to promote relaxation and calm.
Start to count backwards. The breaths and count don’t have to match.
Count for a minute and focus on your breathing
If you lose your place, start at 20,000 again.

How does it work? It changes your focus from the stress agent.


    Rub your belly

Gently massage  you belly with 2 fingers and the more you massage the greater the relief.
How does it work?

There is a sensitive pressure point two or three finger widths from the bottom rib in line with the belly button that alleviates stress when massaged.

    Eat a handful of nuts

A handful of almonds or walnuts mid- afternoon keeps stress related cravings at bay.
How’s that? Stress make your body use up certain nutrients such as Vitamin B, zinc, magnesium and omega oils faster.Nuts top up levels of these nutrients. In addition, they naturally balance sugar levels, reduce sugar craving, regulate appetite and support metabolism.

    Bring out your colouring books 

Get back to your favourite childhood activity of colouring particularly of geometric patterns.Origami or folding squares of paper into various shapes is also absorbing, relaxing and calming.
 Why? It is said to calm the part of the brain related to the fear/ stress response while stimulating the parts of the brain responsible for creativity.

    Hum a tune

Singing and chanting are great stress busters. The next time you are stressed, try humming catchy tune. It provides relief in emergency .
How does it work? A combination of vocalization and vibration has a positive effect on blood pressure ,helps relax muscles, blocks out racing thoughts and makes sure we breathe more calmly and deeply.

    List your good points.

Write down 5 things you are grateful for each day to help reduce stress. They can be as simple as enjoying a cup of coffee, or having good friends.

 Why?.The feeling of gratitude boosts serotonin and dopamine both associated with happiness and calm.

    Gaze at swimming fish

Spend time watching fish in the water.

Why? Staring at swimming fish lowers blood pressure  and reduces  the heart rate.  It has a calming effect.

    Have a warm salt bath

 How does that work? Epsom saltincreases the water’s specific gravity and makes you feel light weight  while helping muscles to relax.The body also absorbs the salts which helps replenish magnesium stores, a mineral that is reduced with stress.

    Spring clean your house 

Sell, donate or throw out unnecessary possessions.
Why? Untidy surroundings cause people to feel  stressed and depressed and can cause health problems .

    Listen to classical music

Take 5 minutes to tune in when you feel stressed. Close your eyes and immerse yourself in the sound.
    Get physical
 A brisk walk around the block is the quickest and easiest way to release stress.
    Talk to others
 To get more ideas to cope with stress ,discuss how you are feeling with family and friends.
Why? Speaking out helps psychologically

    Press to destress

Massage the inside of your right palm with your left thumb in circles Repeat on the other hand. Find the sensitive spot in the web between thumb and index finger and press down firmly, hold for10 seconds and release.

How does that help?  In hand reflexology, the middle of your palm corresponds to the solar plexus reflex point which is the main area for unwinding  and relieving tension. 
 
SO, the next time you are stressed, don’t reach out for the box of sweets or the coffee. Instead, try out these strategies and see what works best for you.

Monday, November 21, 2016

Insulin at its best!

Insulin is very sensitive to sunlight, indoor lights and to extreme hot or cold temperatures and loses its ability to function effectively.

  •     Every vial of insulin or box of insulin pens comes with instructions on proper method of storage, hence, read and follow them carefully.
  •     Store unopened vials and pens in the refrigerator until the expiration date.
  •     Store opened vials in the refrigerator at   2⁰ to  8⁰ C or at room temperature,25⁰  to 30 ⁰C.
  •     Remove Insulin vials kept in the fridge and allowed to reach room temperature before use.
  •     Opened vials of insulins and mixtures of insulin such as Insulin  Glargine, Insulin Glulisine,      Insulin Aspart, Insulin Lispro, Insulin Isophane, Human insulin,and mixtures of insulin  are stable for 28 days either at room temperature, 25⁰ to 30 ⁰C or in a refrigerator at 2⁰ to 8 ⁰ C.
  •    Opened vials of Insulin Detemir are stable upto 42 days at the recommended conditions.
  •    Transferring opened insulin vials between fridge and room temp does not appear to affect the   insulin’s potency under these conditions and time periods.
  •     Insulin pens once used for the first time should not be stored in the fridge. Instead they should be stored at room temp 25⁰ to 30⁰ C. Pens last for 7 to 28 days if stored at room temperature. How long depends on the type of pen used.

Tuesday, November 15, 2016

How Much Protein Does One Need?

 The body uses protein to build and repair bones, muscles, cartilage, skin, and blood as well as to make important chemicals in the body, including enzymes and hormones. It requires eight essential amino acids in proper proportions and in adequate quantities to synthesize tissue proteins . The other twelve amino acids present in the dietary proteins, though required for the protein synthesis, are not considered essential since the body can synthesize them from other carbon and nitrogen sources.


 Egg protein is used as a reference protein to judge the quality of other proteins.Vegetable proteins, mainly in cereals, legumes and vegetables are of poorer quality than animal proteins, not only because they are more difficult to digest but also because they   lack  one or more of the essential amino acids.





Cereal proteins are deficient in lysine, and pulses or legume proteins contain low amounts of methionine. However, when both cereal and pulses (legumes) are present in the diet in proper proportions, the  proteins from these two sources supplement each other .However, Indian diets deriving their proteins from a 5:1 combination of  cereals and pulse have a biological value of only 65% relative to egg protein. Apart from this, how efficiently food protein is used in the body  depends on its digestibility and absorption of the amino acids.

So, how much good quality protein is required a day?

How much you need is simple and straightforward.  According to ICMR, adult men of ideal weight need 60 grams of complete protein per day, adult women of ideal weight  need 50 grams of complete protein  which is about 1 gram per kg body weight per day , but pregnant women  need about 15 grams more per day and nursing mothers need 25 grams per day  more  in the first 6 months and 18 grams more per day  in the second six months.
How much protein is enough for you depends in part on whether you are vegetarian, trying to lose weight or have kidney disease. In the first two instances they need to make a special effort to get enough protein while in the third instance, ‘how much?’   is  a very important issue.
 

For vegetarians and vegans

Adjusting to a vegetarian diet is pretty easy. There are many options such as milk and milk products, lentils and pulses and eggs..But vegans, who do not eat meat, fish, and sea food , eggs or dairy products have a harder time satisfying their protein requirements.

Tofu, in its many forms, has a good amount of protein as do legumes, nuts, and seeds but they also  may have  many  carbs, which can spike blood glucose levels.

Protein increases the feeling of fullness after a meal and those who want to lose weight to manage diabetes better should increase protein intake.



Kidney disease needs:

People with diabetic kidney disease need less protein to avoid stress on kidneys. The Joslin Diabetes Center states that “Up to 40 percent of people with type 1diabetes and 20 to 30 percent of those with type 2 diabetes have some form of kidney disease.”

You may be a vegetarian or a vegan, need to lose weight, or have chronic kidney disease, or you may have none of these . In any case, you need to eat the right amount of protein if you want to be  healthy.

Monday, November 7, 2016

Foods to avoid while travelling

One of the things we look forward to while visiting places is the local cuisine which at times is a pleasant experience and at other times takes a little getting used to. People with diabetes are more susceptible to changes in their routine than those without the condition.  However, with a little research before the journey about the local cuisine and the type of carbohydrates available, they can get help from their dietitian regarding meal options, making healthy choices when eating out, charting out portion size and carbohydrate quantity as accurately as possible and about changes to be made to medication for good  diabetes control while travelling.

                                                              Here are some tips on healthy eating:
                                         

Tip of the Week

Tip of the Week
Choose the right shoe and socks