Diabetes - Diet, exercise and glucometers

In market, these days some machines are available to test blood sugar and blood pressure. We can use them at home. How effective are such machines? Do they pin point accurately or only give the trend?
They are called as Glucometers. They are excellent tool to have for those who are on anti-diabetic medications to check the blood sugar trends during various times in a day. People on insulins or tablets also use it if they have dizziness just to document hypoglycemia so that the dose of the medication could be altered. They are not very accurate but the difference is just 10-15 which is acceptable for monitoring the trend.

For those who are not yet diagnosed to be diabetic, lab blood test should be the one to confirm the diagnosis, not a glucometer.

If I do not walk in park / open area, can i use threadmill? Is threadmill equally effective as walking. For how much duration should I use the threadmill to keep my self fit?
Treadmill can definitely be used. In the end it is a muscle exercise, which demands calorie burning. For first 10-15 mins of exercise, body glucose is used. Only after first 15-20 mins body starts using fat for exercise. One must start gradually and step up from 15 mins on first day to 30-40 mins till your body gets used to it. It must be a gradual process over a month or so. If one is a heart patient, he must exercise only till the limit in which he feels comfortable and is not breathless.

So one can burn 200 to 300 calories with this exercise. This can be easily nullified by immediately eating a samosa or a vadapav just after the exercise! So you see, its not that easy as it sounds. It will need a lot of self control and motivation.

Whether diabetic patient should avoid milk (I read somewhere that milk contains lots of Glucose)?
No. Milk can be consumed provided you don't add too much of sugar and as long as it is within your daily calorie limit. Infact milk is a good source of first class proteins especially in those who don't eat nonveg. Cow's milk should be preferred over buffalo’s milk.

You can calculate your daily calorie consumption from this link. If consuming that many calories is making you overweight, you must try to cut down upon your calories by 200-300 using the same chart. The best person to guide you through this would be a qualified dietician though.

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Early heart attacks in diabetes

It would be better if you post the details on the human heart - its structure and functions.

Heart as a pump and something about its structure and function:

The human heart could be compared to an electric motor, which pumps blood (oxygen) supplying whole body. Imagine a machine pumping 5 liters of blood with an adequate pressure every minute, round-the-clock for years together without a pause without any maintenance. This is really something phenomenal! The electric current for pumping comes from the internal pacemaker in the heart itself and that current is carried to the whole heart with the concealed wiring (conducting system) within its wall. Thats how the heart pumps. The pumping also needs oxygen, which comes from 3 major blood vessels supplying blood (oxygenated) to the heart walls.

As long as the above mechanisms are intact, pumping is good and the body functions well.

Heart attack:

With the age, there is deposition of fat in the blood vessels, due to which they go on narrowing. A stage comes late in the life when a blood vessel of the heart is completely blocked. Thats when the blood supply to the heart wall is hampered and pumping gets affected. This could be angina, or heart attack (permanent damage). If it is a heart attack, the specific portion of the heart supplied by that blood vessel is permanently damaged affecting the pumping (Ejection fraction).

The severity of the heart attack depends on which vessel out of the three is blocked. When the heart wall is damaged permanently, it could also affect the wiring (conducting system) causing failure to pump the blood.

Implications due to daily habits:

Now, with normal ageing an average person would live till 80-90 yrs (try to recall grandfather's age). Suddenly in last 50 yrs, there has been an amazing progress. The economies grew at exponential rates. There was easy money with less effort. By less efforts, I mean the physical efforts. Machines, computers and automobiles replaced physical efforts. But mental stress levels increased. Food intake remained the same! Hoteling and frequently eating out (everything has excess fats) was added to the lifestyle.

So when our grandfathers worked in the farms, they spent whatever they ate (calories) in the form of physical work and remained healthy. We instead eat the same amount (maybe more) and the only exercise we do probably is to run to catch a lift! So where do those extra calories we eat go? They are converted into the fat under the skin. When those stores are full, they deposit as fat around the organs in the abdomen (big tummy). And when even those stores are full, the fat start getting deposited in the blood vessels including those of heart and brain leading to premature blocking.

So when our grandfathers got heart attacks at 90-95 yrs of age, our fathers got them at 60-70 yrs. And these days we see them 45-60 yrs! Some as young as 35 yrs too are not that rare. So its quite a scary situation. So we seriously need to rethink about our current lifestyle. Good news is, it can still be altered! Its never too late. Even if we start acting NOW, we can still easily add a good 15-20 yrs to our lives!

If you add diabetes to the above situation:

The increased sugar in the blood enhances everything at the faster pace! Worse is, diabetes causes multiple blocks in all the 3 heart vessels instead of just one, so a person has to undergo a bypass operation, which is a major surgery. Diabetes also makes the heart walls weak (diabetic cardiomyopathy) affecting its pumping.

To sum it up, things which would enhance the blocking process causing early heart attacks or Brain attacks (Stroke, paralysis):

Hypertension-Damage to blood vessels- early blockage

Raised lipids (commonly called as cholesterol)-Early blocks

Diabetes

Lack of awareness (One of the purposes of staring this thread)

Smoking

Alcohol

Mental stress-Probably one of the most important factor

Misuse of food and oils

Overeating

Frequently eating fried foods

Excess use of cooking oils (more than ½ liter per person per month)

Lack of physical exercise

What tests should one undergo to find out his conditions of the heart?

- Routine physical examination by your family physician

- Baseline blood investigations including blood sugar and lipid levels

- ECG

- If you get chest pains or discomfort on exertion your doctor might suggest you treadmill testing (stress testing)

- Echocardiography – it's a sonography of heart

- Angiography- It shows the percentage of blocks in the heart blood vessels

- CT angiography – same as above

- Thallium scans – Tells about function of heart walls.

Any of the above tests can be done as indicated, only after the consultation with your local physician.

I hope it this would help.

Diabetes - Symptoms, Tests, Diet, Lifesyle

Please let me know how can I know if I am diabetes patient without going to the doctor. What are the symptoms?
Most of the Indians suffer from Type 2 diabetes (almost 95% of all the diabetics in india have type 2 diabetes). So I will always be discussing about type-2 diabetes here, unless type1 is specifically mentioned.
By the time you start getting symptoms, the duration of diabetes is usually 5 to 10 yrs. So if you are diagnosed after getting symptoms, there are chances that you have diabetes from 5-10 years prior!

Symptoms could be vague. They could be very subjective depending on what organ in the body is involved.
Increased frequency and amount of urinationIncreased thirst
Increased appetite
Infections like recurrent boils, urinary tract infections, chest infections
Tingling, pin-prick sensations, burning sensation over the legs (Neuropathy)
Foot- Corn, callus, cellulitis, infection, gangrene - could require amputation in late stages
Sexual Dysfunction

If diagnosed in very late stage, diabetes could present as:-
Heart attack
Paralysis(stroke)
Kidney failure which might require twice a week dialysis
Loss of eyesight - retinopathy
Very large babies are born to diabetic mothers if their sugars are not under control during pregnancy

These are just to name a few. Diabetes can complicate and exaggerate any disease present earlier.

How can I know if I am diabetes patient without going to a doctor?
You must visit a doctor ideally. There is no substitute to this for various reasons.

Ideal candidates who should get themselves checked for diabetes:
- Ones having either mother, father, brother, sister a known diabetic
- Overweight person
- Excess use of oils in cooking
- If your job involves you sitting for many hours during the day time - sedentary lifestyle, complete lack of exercise
- Pregnant woman (every pregnant woman)


Ideal test for such candidates would be
- Fasting venous plasma glucose level
- Post meal (lunch) venous plasma glucose level
- HbA1c test (reflects your bllod sugars over last 3 months)

If the above sugar levels are normal but you still suspect that you could have diabetes in future, you might want to undergo:
- GTT - Glucose tolerance test - which can give a hint whether you could develop diabetes in the near future or not.

All the above should be done only under the guidance of your local doctor. Else, things are incomplete and worthless.

What are diets i should avoid even if i am not a diabetes patient? Is sugar harmful for a normal person?

Trust me. Every doctor and dietician in this world have his own personal opinion on this.

Implementing following things could be helpful:
- Avoid overeating - Our brains have been trained from childhood to eat in excess. Remember mom telling us "Kitne Patle ho..bilkul khana nahi khate..aur jyada khao..."?
Well...it starts from that time! If you have a tummy, you are overweight. Period! You must train your brain to eat less than what you eat.

- Oils - Half Kg oil per person per month. So for a family of 5 members - its 2.5kg of oil per month. It could sound unrealistic but thats what is ideal. If you are consuming more, its getting deposited in your heart blood vessel, blocking them day by day!

- You can cut down carbohydrates (Rice, chapati), and replace them with proteins (dals, sabji, salads, sprouts etc). For those who eat nonveg, fish is supposed to be good. One must avoid red meat (mutton). Chicken occasionally is permissible. Egg white is good.

- One fruit per day is alright (even for a diabetic)

- Its a good habbit to have tea/coffee with less sugar. One or half spoon per cup. Even a diabetic can have half spoon per cup provided his blood sugars are adequately controlled with medications and he is not having excess calorie intake.

- Make it a habbit not to take extra salt on table. Have only what you have already put in the food itself.

- Most important is EXERCISE. Never use a lift. If you go to office and have no time to jog, run, walk- get down from bus one stop earlier. Then walk the way to home. The walk should be brisk. Exercise mobilizes the tummy fat which is known to cause adverse effect on heart. Exercise also decreases insulin resistance so that normal body insulin is used properly and blood sugar is kept in control. I so much wish I should be able to express the importance of daily exercise in words more effectively!

More questions are welcome. I will try my best.

Diabetes and heart

It would be my pleasure to answer any queries posted by forum members related to Diabetes and heart. By heart, I mean heart-disease related queries, not love-related. I request members to post queries on the forum and I will try to reply to them here itself so that even others can read and come to know about certain basic things. If one wishes to keep his/her info private, he can mail me personally. The only purpose of this thread is to spread health awareness. Saddest part is India has already become the diabetes-captial of the world! If the projection is correct, every home in India will have atleast one diabetic in the near future! This is a pretty scary situation.

I am happy I have taken a small step towards the health-awareness amongst the members of my beloved forums of which I am a member since long time.