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, May 28, 2012

Glycemic Index


PART 1

Shruti Kumari –Research Dietitian

Diabetes Research Centre,

M.V Hospital for Diabetes, Royapuram


‘Glycemic Index is about the quality of carbohydrates, not the quantity’

What is Glycemic Index?

Glycemic Index or GI is a measure of the effects of carbohydrates on blood sugar levels. It is a scientifically proven way of ranking carbohydrates in foods. It tells you how fast a particular food raises blood sugar . Foods that contain carbohydrates that break down quickly (simple carbohydrates) have a high GI and will result in a rapid rise in blood glucose . Foods containing carbohydrates that break down slowly, (complex carbohydrates) have a low GI and will raise blood glucose much slower.

People with diabetes should consume small meals and snack regularly on low GI foods (foods that contain complex carbohydrates, protein and extra dietary fibre).Three large meals a day can cause the release of too much sugar t a time and this may lead to wide fluctuations in blood glucose levels.



GI values are commonly interpreted as follows:

Low GI - 55 or less:

* Low Glycemic Index foods are those that bring out a low postprandial glucose response and include legumes (ex. chickpeas, lentils, etc.), whole grains, nuts, most of the fresh fruits (apple, orange, blue berries...) and vegetables.



Medium GI - 56–69:

* Whole wheat products, basmati rice, sweet potato, sucrose, baked potatoes .....



High GI - 70 and above:

* Foods that break down quickly and flood your body with a lot of glucose require a lot of insulin to process them. These foods are called high glycemic foods. These include fried foods, white breads and cereals, bananas, dried fruits, fruit juices, starchy root vegetables, processed meats, full-fat dairy products, most alcoholic drinks and candy.













Choose low, stay fit...!

* Recent scientific evidence has shown that individuals who followed a low-GI diet over many years were at a significantly lower risk for developing both Type 2 diabetes, coronary heart disease, and age-related macular degeneration than others.

* Recent studies suggest that a high carbohydrate diet (High GI food) may promote acne through changes in the hormonal concentration, particularly, increased levels of insulin which in turn causes an increase in androgen levels.


GI of some common foods

LOW GLYCEMIC FOODS


MODERATE-GLYCEMIC FOODS: (LIMIT CONSUMPTION)


HIGH-GLYCEMIC FOODS: (EAT AT YOUR OWN RISK)



Health benefits of low GI eating



Healthy low GI diets:

* Help to fill you up and keep you feeling satisfied for longer, avoiding over- eating or too much snacking.
* Lower your insulin levels which makes fat easier to burn and less likely to be stored.
* Help you lose body fat and maintain lean muscle tissue.
* Reduce your triglycerides, total and 'bad' (LDL) cholesterol.
* Increase your levels of 'good' (HDL) cholesterol.
* Reduce your risk of developing Type 2 diabetes.
* Help to manage your blood glucose levels and reduce your risk of developing diabetes complications.
* Reduce your risk of developing cardiovascular disease.
* Reduce your risk of developing certain eye diseases.
* Improve your skin
* Sustain your energy levels longer, improving both mental and physical performance.

Thursday, May 17, 2012

Hypoglycemia

What You Need To Know About


Hypoglycemia (low blood glucose) is a condition where the level of blood glucose drops below acceptable limits. Glucose, an important source of energy for the body comes from food. Carbohydrates such as potato, cereals, milk, other roots and tubers, certain fruit and sweets are the main source of glucose in the diet.

Physiology: After a meal, glucose is absorbed into the blood stream and carried to the various cells. Insulin, a hormone made by the pancreas, helps to transfer the glucose to the cells for energy. Extra glucose is either stored in the liver as glycogen or in the fat cells as fat. Both these are sources of energy in times of need. When the level of glucose in the blood starts to drop, glucagon, another hormone made by the pancreas, brings it back to normal by breaking down glycogen.

In some people with diabetes, glucagon does not provide the normal response. In addition, other hormones such as adrenaline may raise the blood glucose level. In diabetics who are on insulin or pills, glucose levels cannot return easily to the normal range. Hypoglycemia can occur suddenly.

Hypoglycemia can also be a result of other medications or diseases, hormone or enzyme deficiencies or tumors.

Symptoms of Hypoglycemia...


Hypoglycemia causes symptoms such as hunger, shakiness, nervousness, sweating, dizziness or light-headedness, sleepiness, confusion, difficulty in speaking, anxiety or weakness.

It can also happen at night when a person cries out or has nightmares, finds nightclothes or sheets damp from perspiration or feels tired, irritable or confused on waking up.

Causes of Hypoglycemia:

Hypoglycemia can occur as a side effect of some diabetes medicines, insulin or pills that increase insulin production or when meals or snacks are too small , delayed or skipped; increased physical activity, or consumption of alcoholic beverages.

Preventing hypoglycemia

Remember that diabetes management plans are designed to match the dose and timing of medication to the usual routine of meals and activities.



Take your medication in the recommended doses at the recommended times.

Ask your doctor to tell you which medications can cause hypoglycemia.

Learn how to adjust your medication to changes in routine.


Following your meal plan is an important aspect of diabetes management.

Get your meal plan designed by our dietitians to suit your personal preferences and lifestyle.

Follow it carefully.

Have regular meals, eat enough food at each meal, and don’t skip snacks or meals.

Remember to have a snack at bedtime or before you exercise.

Our dietitians will recommend snacks that are more effective in preventing hypoglycemia during the night.


Hypoglycemia can be caused by extra physical activity.

Check your blood glucose level before you exercise and have a snack if the level is below 100 mg/dl.

Adjust your medication before physical activity.

Check your blood glucose level at regular intervals if you are exercising hard or for a long time and have a snack as required.

Check your blood glucose level periodically after physical activity.

Heavy drinking, especially on an empty stomach, can be quite dangerous for people on medicines that increase insulin production. Hypoglycemia can occur even after a day or two.


If you have to, eat a snack or a meal while you are consuming alcoholic beverages.

Our educators will tell you how you can safely include alcohol in a meal plan.

If you keep blood glucose levels as close to normal as possible to prevent long-term complications, it can increase the risk of hypoglycemia.

Learn from our educators about the ways you can prevent hypoglycemia and how to treat it effectively if it does happen.

Hypoglycemia while driving is dangerous because you may have trouble concentrating on the road, or you may not react quickly enough to road hazards or to the actions of other drivers.


Check your blood glucose level before driving.

During longer trips stop to check it frequently.

Eat snacks to prevent it from dropping below 80 mg/dl.

If necessary, stop driving and get treatment.

‘Hypoglycemia unawareness’ is a condition where people with diabetes (mostly Type 1, and in some instances Type 2), do not have early warning signs of hypoglycemia. This develops when frequent episodes of hypoglycemia change the way in which the body reacts to low blood glucose levels. Studies have shown that you can restore awareness by preventing hypoglycemia for several weeks.

Check your blood glucose levels more often to know when hypoglycemia is about to happen.

You may also need to change medications and re-plan diet and physical activity routine.

How is hypoglycemia treated?

Signs and symptoms are not the same for everyone. Learn to recognize your signs and symptoms and inform your friends, colleagues and family so that they can help if required. School staff should know how to recognize the symptoms and what help is needed. If you have hypoglycemia many times in a week, contact your doctor. You may need to change your medication, increase or decrease it, or form a different meal plan or a new physical activity plan.

If you think your blood glucose level is going down, check it with your glucose meter. If the level is below 80 mg/dl, take any one of these options immediately to raise the level.

½ cup of fruit juice, or carry a fruit with you

5-6 pieces of hard candy

1 tablespoon of sugar or honey

(Use less for children. Get advice about the right amount from our educators).

Then, recheck blood glucose levels after 15 minutes to make sure it is 80 mg/dl or above. Repeat this till you reach the optimum level. Have a snack after this if your next meal is an hour away.

In severe cases of hypoglycemia, especially in Type 1 diabetes, you may lose consciousness. People around you should know what to do. Family, friends or co-workers should be aware of the gravity of the situation and get medical help.

Be ready for hypoglycemia.

Learn what can trigger low blood glucose levels.

Keep your blood glucose meter at hand at all times.

Keep several servings of quick-fix foods or drinks handy.

Carry a medical identification card.

Have a plan ready in case of severe hypoglycemia.

Tell family and friends about your signs of hypoglycemia and how they can help in case of emergency.

What to learn from your doctor:

Whether your medication can cause hypoglycemia

When you should take your medication

How much medication you should take

Whether you should continue medication if you fall sick

Whether you should adjust your medication before any physical activity

What you should do if you skip a meal.

Tuesday, May 8, 2012

Delicious Shakes for Summer





Mrs. Sheela Paul and Ms. Manonmani

Dept. of Nutrition & Dietetics

Summer is finally here! Smoothies delicious, healthy and wonderful shakes for a cool, refreshing summer. You can still have great taste while watching your calories, fats, and sugar.

Adults, with or without diabetes , need to take care of themselves and set an example to children. The best thing to do is to eat right and exercise. Remember to do your research and you can find some yummy delights that will satisfy your whole family.

There are no calories or carbohydrates in water. So drink as much water as you like.

Are you tired of drinking plain water? —Try flavored or sparkling waters that are better than plain water.

You tend to lose a lot of water due to sweating and evaporation— Drink adequate water and prevent dehydration.

Don’t forget about added sugar in the beverages you drink. It is very easy to get too much sugar from your drinks even though you are watching the sugar content and carbs in your food.

A lot of refreshing drinks are consumed during the summer. Generally, appetite decreases in hot weather and this goes in favour of Diabetes control.

Infections & Dehydration

During this season, gastrointestinal diseases like diarrhoea and vomiting lead to loss of water and salts from the body. Children are more prone to such diseases. For people with diabetes, these diseases may result in Diabetic Ketoacidosis if not treated promptly. Sometimes even diabetics on oral medicines may have to be given insulin injections to prevent such complications.

Uncontrolled Diabetes may predispose you to the frequent infections of stomach and throat, which are prevalent in summers. Dehydration, specially due to stomach infections, frequently causes hypoglycemia as people do not tolerate food and liquids Oral rehydration solutions are helpful.

Enjoy the return of the warmer months by trying these summer drinks that can fit right in with your diabetes meal plan and keep your taste buds happy. Whether you have a sweet tooth or crave something light and refreshing, you are sure to find a good fit. Here is a treasure chest of delicious healthy summer drinks.
LinkDiabetic Milkshake



Ingredients:

1 cup whole strawberries
  • 1 ripe banana
  • 1 cup milk (skim and low fat )
  • 4 packs sugar substitute (or more if required)
  • ½ teaspoon vanilla essence
  • Ice cubes, if necessary

Method:

Place all the ingredients in a blender and run it on the highest setting. The shake will take longer to blend than normal because of the strawberries.
  • However, the berries along with the banana provide the smooth thickness of this drink. Add ice cubes just before serving.

CAPPUCCINO MIX


Ingredients:

1 cup powdered non-dairy coffee creamer
  • 1 cup instant chocolate sugar-free drink mix
  • 3-4 tsps Sugarfree
  • 2/3 cup instant coffee granules
  • ½ tsp cinnamon
  • ¼ tsp nutmeg

Method:

Mix all ingredients together and store in an airtight jar.

To use: Add 3 tablespoons of the mix to 1 cup boiling hot water. Stir well. Cool the mixture and add ice cubes and serve cold.

This mix can also be used to flavor coffee by adding 1-2 teaspoons per cup of coffee.

STRAWBERRY BUTTERMILK SHAKE



Ingredients:

1 ½ cups fat-free milk
  • 1/3 cup fresh strawberries
  • 2 tbsp fresh squeezed orange juice
  • 2 tbsp Sugar free
  • ½ cup fat-free buttermilk

Method:

In the container of a blender, combine milk, strawberries, orange juice, and Sugar free

Process until the berries are pureéd and the mix is frothy. Pour into a small jug, then add buttermilk. Stir well and cool .

MANGO PINEAPPLE SHAKE

Ingredients:

1 ½ cups mangoes (fresh)
  • 1 cup pineapple juice
  • 1 lime, juice of
  • ½ cup ice, crushed (optional)

Method:

Put all the ingredients in a blender, Stir, chill it, pour into glasses & enjoy
Link
LIME-MINT COOLER
Ingredients:

  • Lemon – 2
  • Mint leaves - 8
  • Sugar free – 2tsp
  • Cold water - 300 ml

Method:

Squeeze the lemons and make the juice.

Put the mint leaves, Sugarfree, water and the lemon juice into the blender.

Blend for some time and strain the juice.

Chill the juice again if you like it very cool and serve.

WATERMELON SARBAT



Ingredients:

Watermelon (small) - 1
  • Lemon juice - 1 tbsp
  • Ginger juice - 1 tbsp
  • Pudina leaves - 2
  • Sugar free - 2 tbsp

Method:

Remove the seeds and the skin of the watermelon and cut them into small cubes.

Blend in a mixie. Add the lemon and ginger juice and blend again.

Add water if needed. Add Sugarfree and stir.

Serve chilled with mint garnish.

Wednesday, May 2, 2012

Diabetes and driving


Driving a vehicle requires complex skills, coordination, alertness and satisfactory judgement.

Diabetes affects driving mainly because of its complications: hypoglycemia, ocular and peripheral neuropathy, reduced vision, and severe peripheral vascular disease. So it is viewed as a potential disability for driving.

In most countries regulatory authorities consider people with diabetes as high risk drivers. Many diabetic drivers with advancing diabetic complications voluntarily stop driving.

Diabetic drivers should be cautious:


Newly diagnosed patients, especially insulin- treated, should not drive until glycemic control and eyesight are stable. It is better to stay off the roads if diabetic drivers have recurrent daytime hypoglycemia, impaired awareness of hypoglycemia, reduced visual acuity in both eyes or severe sensorymotor peripheral neuropathy.

Advice for diabetic drivers


* Inform licensing authority and motor insurer of diabetes and the treatment you are receiving
* Do not drive if eyesight deteriorates suddenly
* Check blood sugar before driving even on short journeys and at intervals on longer journeys
* Take frequent rests with snacks or meals; avoid alcohol
* Carry diabetes ID card
* If hypoglycemia develops, stop driving, switch off the engine, leave the driver’s seat and then treat
* Do not continue driving for 60 minutes after blood glucose has returned to normal.
* Keep a supply of fast and longer acting carbohydrates in the vehicle for emergency use
* Attend BGAT - Blood Glucose Awareness Training program - that helps to increase awareness of fuctuations in blood glucose levels.
* Get eyes screened regularly as part of assessing medical fitness to drive because retinal ischemia may severely reduce visual field, night vision or the ability to see moving objects. People who have complications with vision should also be responsible enough to report poor eyesight to licensing authority.

Reference: Diabetes and driving. Dr. Ghanshyam Agarwal

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