Diabetes Care

For patients suffering from type II /adult onset diabetes :

In type II diabetes, diagnosis is often late (after the disease has already been present for some time). In early days T2DM (short for the adult type of diabetes) are often without symptoms. Hence the delay in diagnosis. This means complications will be seen early after diagnosis.

Foot Care :

Foot disease in diabetes may lead to difficulty in walking, pain and may lead to infections. If neglected amputation may be required.

Inspect feet with a mirror before going to sleep every night.

Use well fitting shoewear.

Do not walk bare feet even in the house.

Socks should be clean and correct size.

In case of deformities of feet, special shoes can be worn.

Eye Care :

It is nowadays the commonest cause of blindness throughout the world.

Check for refractory error at the time of diagnosis and once sugars are controlled.  In T2DM every year examination for changes in retina are required. If there are already changes, check up is required more often.

Retina is checked after dilating pupil with an ophthalmoscope.

Kidneys :

It is one of the common causes of kidney failure leading to requirement of dialysis and renal transplant. Early treatment may reverse diabetic kidney disease or slow its progression.

In early cases urine is checked for passage of extra amounts of albumin. This can be quantified to see response to therapy. This test is called urine for microalbuminuria, and urine albumin /creatinine ratio. If the disease is already present, USG, S Cr and testing for voiding function (Uroflowmetry) etc may be useful.

In those without evidence of kidney disease these tests are carried out every year. Frequency otherwise may depend on the stage of involvement. More severe involvement necessitates more frequent reviews.

Nerves :

Nerve involvement is checked by touch, pain, vibration sense.

During winters, hot water should be checked with either a thermometer or elbows. If fingers are used for checking temperature, very hot water may lead to burns.

Precautions should be taken to avoid falls.

Sugar Levels :

HbA1C level may be done every 3 months to monitor overall sugar control in blood. In most cases a level of < 7 is desirable.

If hypoglycaemia is frequent , a level of < 8 may be  all that can be achieved safely. In cases of some microvascular complications, a level < 6.5 may help but is difficult to achieve. Home sugar monitoring is done from capillary blood. The levels are different from venous blood levels tested in laboratories. Only sides of fingers should be used and not the areas used for holding functions of the hand. In T2DM once weekly sugars may be enough. In T1DM almost daily or before each meal sugars are required. Levels for control should not be done within 2 hours of meals. Check if there is uncertainty about diagnosis of hypoglycaemia. Do not wait for giving sugars, if testing takes time or symptoms are severe (loss of consciousness, confused talk, fits etc.) Treatment presumptively may prevent permanent damage to the brain. However sugar is not the treatment in diabetics for every small symptom. Record times of sugar checking and dates in a notebook for planning of drugs. Lipids and Statins : If there are more cardiovascular risk factors, age > 50 yrs in man, smoking, lower levels of LDL cholesterol are desirable. Daily 75 or 150 mg  of aspirin or statins may decrease risk of heart attacks. Bleeding complications however increase with aspirin.

Regular exercise, monitoring weight, smoking cessation all are essential parts of diabetic care.

Obesity

Obesity

Overweight is the term used when a person weighs more than the set limits for him or her. Obesity on the other hand is an excess of body fat.

Appropriateness of weight is measured by BMI (body mass index).

The formula for this is:-

Weight in Kilograms ÷ (Height in meters) 2

eg if a person weighs 80 kgs and his height is 1.6 meters than his BMI is

80/ 1.6 X 1.6 =80/2.56 =31.3.

A person with BMI > 25 but < 30 is considered overweight and > 30 obese. If BMI is > 35 a person is considered to have a severe problem.

Causes of overweight in children :

Being overweight or obese is always due to the accumulation of fat as the calories consumed are more than calories burnt by the body.

In children, obesity is often due to over indulgence in sweets, sugar in ice creams and beverages or cold drinks, lack of exercise, more fats in the diet.

Food habits in the family, genetics and overweight family members play a significant role.

Other factors are video games, TV, android phones, excess sleep etc. In some cases hormonal disorders or brain disorders may alter hunger and satiety and thus may cause obesity. These conditions are rare.

Childhood obesity persists into adulthood if the obesity is severe, if parents or other family members are obese and if no action is taken to correct the cause.

Obesity III Treatment of Obesity

Obesity III Treatment of Obesity

Obesity treatment or weight loss is important as weight loss reduces the complications of obesity. It decreases chances of heart disease, diabetes, high blood pressure, stroke or hyperlipidemias. After weight loss, the metabolism of the body slows down and fewer calories are consumed. Hence weight loss is never easy. Lost weight may be regained (Recidivism). A person has to watch his weight regularly, exercise regularly and continue diet precautions usually lifelong.

Some times losing weight rapidly by consuming a very low fat diet may result in iformation of gall bladder stones. In them increasing fat in diet may reduce the risk of gall stones.

How to reduce your weight?

There are only 2 options: either burn more calories or reduce their intake in food.

The first option is more troublesome as very little calories are consumed in daily activities. A person who is hardly doing any physical work consumes only 1200 to 1500 calories a day.

Each gram of fat provides 9 cal while proteins and carbohydrates provide about 4 cal each.

About 20 – 25 cal/kg body weight will maintain a constant body weight. In order to reduce the weight about 500 cal less than this would be sufficient.

The initial goal may be to reduce weight by 5 to 7 %. Most of the obese patients report less intake of food than they actually consume.

Fats should form only < 30 % of the calories and should preferably be polyunsaturated. Proteins can form upto 45% and remaining provided by carbohydrates. Very low calories, mediterranean and other various diets have been found to be less useful but are more fashionable in various countries.

Obesity II

Obesity II

Obesity is evaluated by screening for confirmation and assessment of risk factors. Once the BMI confirms obesity severity is divided into

Grade I BMI >30 but < 35 Grade II BMI >35 but < 40 Grade III BMI > 40 Waist circumference is measured at the highest level of the hip bone by a tape placing it horizontally.

In woman a waist circumference of > 88 cm or 35 inches and in Man >102 cm or 40 inches signifies central obesity.

Persons with central obesity are more at risk for heart disease, diabetes, Obstructive sleep apnoea and hyperlipidemia (excess lipids in blood). Coexistence of coronary artery disease, atherosclerosis elsewhere, Sleep apnoea, high BP, h/o premature heart attacks in other close relatives, smoking and lack of exercise : all these act togather to increase mortality.