Category: Diabetes

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PATIENT EMPOWERMENT: TAKING CHARGE OF DIABETES

Nowadays, diabetes, particularly type 2 diabetes, is one of the fastest growing chronic diseases in the society. Tight blood glucose control, dietary requirements and intake of regular medication are only few things that a diabetic patient needs to manage in order to prevent long-term complications. Assured continuity of care does not only create many challenges for the patient but also for the treating physician who will need to support the patient’s management strategies.

PATIENT EMPOWERMENT refers to a process that enables and facilitates behaviour change. The key to empowerment does not necessarily means better compliance to what the doctor says or prescribes but rather in the opportunity to increase patients’ self-sufficiency to improve their decision-making capabilities.

Research has shown that diabetes education is central to effective self-management behaviour, which in the long term can influence clinical and psychological outcomes.

Approaches have now moved from purely educational interventions to those that empower patients based on the assumption that they are managers of their own health. Diabetes education together with patient empowerment has shown to be the key for effective self-management behaviour. When delivered through information and communication technologies (ICT), this solution has shown to lead to better health outcomes.

KEY ELEMENTS OF EMPOWERMENT

 1

 

CHARACTERISTICS OF AN EMPOWERED ACTIVATED PATIENT

 2

  •  He understands his health condition and its effect on his body.
  • He feels able to participate in decision-making with his healthcare professionals.
  • He actively seeks out, evaluates and makes use of information.
  • He feels able to make informed choices about treatment.
  • He is able to challenge and ask questions of the healthcare professionals providing their care.
  • He takes responsibility for his health and actively seeks care only when necessary.
  • He understands the need to make necessary changes to his lifestyle for managing their conditions.

HOW TO EMPOWER PATIENTS?

 3

Diabetes education for the nurses is vital in forming solid knowledge that will equip them to be able to properly educate their patients.

Poor education not only reflects in poor health for the patient but also leads to serious complications and early death imposing a large economic burden on the individual and healthcare systems.

Benefit: This would reduce excess costs for emergency department care and care needed for complications concerning uncontrolled diabetes. A lot of the complications that diabetics face could be prevented easily.

There is a large amount in the community of diabetics that simply do not care about their nutrition or health and are unwilling to make any sort of lifestyle change, those people aside; there is no excuse for the overwhelming amount of complications that some diabetics suffer from due to the lack of knowledge.

A patient with uncontrolled diabetes deals with physical ailments; people with uncontrolled type 1 diabetes often feel ill, experience cognitive dysfunction, have difficulty maintaining their weight at a desired level, and experience fluctuating moods.

Diabetes education can greatly decrease hypoglycemic events in patients with diabetes.

  • SELF MANAGEMENT

4Self-management is seen as a key capability for Patient Empowerment and emphasises that persons with chronic diseases has the central role in managing their health.

Self-management is what people do to manage their diabetes or other chronic condition and its effects on their physical health, daily activities, social relationships and emotions.

Mindful eating: Mindful eating empowers the patient to make flexible decisions through the challenges of life. Mindful eating is one way to get closer to meeting the true needs and in the process gradually allows a person to live the life more fully.

Putting someone on a diet that says to avoid rice, “sweets”, “anything white” or “everything fried” automatically creates cravings and (even worse) guilt if they finally respond to their cravings. When a person gives into their cravings, the patient takes the wrong way & fails to manage diabetes.

  • INTERNET

5Only the internet allows us to set up an independent global diabetological service. The only thing users would need a computer and access to the internet. This service can serve unlimited number of people in the world along with medical consultation.

The key issue for patients & healthcare professionals is how to deliver personalised behavioural support in ways that are affordable and can reach to maximum number of patients. The internet offers several advantages in this regard because it is available 24 hours a day with very low cost.

Benefits

  • It does not require large investments.
  • It does not imply high fees.
  • It can easily be enriched with new information which immediately becomes available to the target group of users in any location in the world.
  • Help patients to monitor their diet and medicinal doses
  • Help both the patient and doctor to monitor the long term effect of the interventions

We cannot empower patients!

We only can provide a framework (tools, services, etc.) that makes it easier for patients to empower themselves.

REFERENCES

Categories
blog Diabetes Fenfuro Blogs

BE ATTENTIVE: DIABETES COULD TRIGGER YOUR BRAIN TOO!

 

Diabetic encephalopathy is the damage to brain which is caused due to uncontrolled long term blood glucose. Encephalopathy is becoming more widely recognized as more people are diagnosed with type 1 and type 2 diabetes.

Diabetic encephalopathy presents itself both mentally and physically. It can induce an altered mental state, cognitive decline, changes in personality, memory lapses or severe impairment like dementia. The complication can also cause tremors, lack of coordination and even seizures.

 

HOW BRAIN GETS AFFECTED? 

2

Diabetic encephalopathy is largely due to acute hypoglycemia (blood sugar levels are too low) or severe hyperglycemia (blood sugar levels are too high). 

In case of type 2 diabetes, there are many different factors contributing in the development of this complication. It could be caused by the body’s resistance to insulin, which makes it difficult for the brain to break down amyloid, a protein that forms brain plaques. Brain plaques are abnormal clusters of this protein that block cell-to-cell signaling at the synapses – a symptom infamous for contributing to the development of Alzheimer’s disease.

Type 2 diabetic encephalopathy can also be generated from hyperglycemia or the conditions that commonly accompany type 2 diabetes like high blood pressure, obesity, or high cholesterol.

Encephalopathy could also be caused by microvascular inflammation affecting the blood vessels in the brain. This makes the brain’s vessels harden and decrease in blood flow. This diminished amount of blood paired with an excess of insulin in the brain can cause the brain to not process proteins properly.4

SIGNS & SYMPTOMS OF DIABETIC ENCEPHALOPATHY

  • Altered mental state
  • Lethargy
  • Dementia
  • Seizures
  • Tremors
  • Muscle twitching andmyalgia
  • Cheyne-Stokes respirations (an altered breathing pattern seen with brain damage and coma)
  • Coma

 

 

DIAGNOSIS OF DIABETIC ENCEPHALOPATHY

  2

Physicians may utilize several different tests at the same time to diagnose both5 the primary condition (the cause of encephalopathy) and the encephalopathy itself. The most frequently utilized tests are listed below that may help to diagnose diabetic encephalopathy:

  • Clinical tests during the physical examination including mental status test, memory test and coordination test
  • Complete blood countorCBC (infections or loss of blood)
  • Blood glucose levels
  • Blood pressure(high orlow blood pressure)7
  • Metabolic tests (blood levels ofelectrolytes,glucose, lactate, ammonia, oxygen, and liver enzymes)
  • Drugs or toxin levels (alcohol,cocaine, amphetamines, and many others)
  • Blood and body fluid cultures and analyses (infections of many types)
  • Creatinine (kidney function)
  • CT andMRIscans (brain swelling, anatomical abnormalities, or infections)
  • Dopplerultrasound(abnormal blood flow to tissues or abscesses)
  • Encephalogram orEEG(brain damage or abnormal brain wave patterns)8
  • Autoantibody analysis (dementia caused by antibodies that destroy neurons)
  • Review of the person’s medications as some medications (for example, cyclosporine) may be responsible for symptoms

CAN IT BE PREVENTED OR TREATED?

The primary measure of prevention as well as treatment of diabetic encephalopathy is the maintenance of stable blood sugar levels. It also helps to avoid further damage. Follow the prescribed diabetes management plan for preventing the development of diabetic encephalopathy which includes

  • Glucose measurements when appropriate

9

  • Take all medications as directed. Try to consume herbal Supplements such as Fenfuro (fenugreek seeds extract) which is patented and clinically proven to manage diabetes.

10

 

  • Do a Quick Body Scan from head to toe after bathing
  • Check your feet every day. Look for cuts, sores, blisters, and ingrown toenails. Don’t forget the places where moisture can hide and germs can grow.

 

11

  • High blood sugar causes your body to lose fluid and your skin can get dry. Drink plenty of water and other liquids to help your skin stay supple and healthy.

12

  • It’s important to get at least 30 minutes of exercise a day to help manage your diabetes.

13

 

WHEN TO LOOK FOR MEDICAL HELP?

 14

You should see a doctor right away if you experience symptoms of encephalopathy. If you are already receiving treatment for brain disease, be aware of the following signs:

  • Severe confusion
  • Severe disorientation
  • Coma

These can be signs of a medical urgency. They may mean that your condition is getting worse.

REFERENCES

 

Categories
blog Diabetes Fenfuro Blogs

PATIENT EMPOWERMENT: TAKING CHARGE OF DIABETES

Nowadays, diabetes, particularly type 2 diabetes, is one of the fastest growing chronic diseases in the society. Tight blood glucose control, dietary requirements and intake of regular medication are only few things that a diabetic patient needs to manage in order to prevent long-term complications. Assured continuity of care does not only create many challenges for the patient but also for the treating physician who will need to support the patient’s management strategies.

PATIENT EMPOWERMENT refers to a process that enables and facilitates behavior change. The key to empowerment does not necessarily means better compliance to what the doctor says or prescribes but rather in the opportunity to increase patients’ self-sufficiency to improve their decision-making capabilities.

Research has shown that diabetes education is central to effective self-management behavior, which in the long term can influence clinical and psychological outcomes.

Approaches have now moved from purely educational interventions to those that empower patients based on the assumption that they are managers of their own health. Diabetes education together with patient empowerment has shown to be the key for effective self-management behavior. When delivered through information and communication technologies (ICT), this solution has shown to lead to better health outcomes.

KEY ELEMENTS OF EMPOWERMENT

 2

 

  • Diabetes awareness
  • Education & training
  • Support of healthcare providers

CHARACTERISTICS OF AN EMPOWERED ACTIVATED PATIENT

 3

 

  • He understands his health condition and its effect on his body.
  • He feels able to participate in decision-making with his healthcare professionals.
  • He actively seeks out, evaluates and makes use of information.
  • He feels able to make informed choices about treatment.
  • He is able to challenge and ask questions of the healthcare professionals providing their care.
  • He takes responsibility for his health and actively seeks care only when necessary.
  • He understands the need to make necessary changes to his lifestyle for managing their conditions.

HOW TO EMPOWER PATIENTS?

 4.jpg

 

  • DIABETES EDUCATION

Diabetes education for the nurses is vital in forming solid knowledge that will equip them to be able to properly educate their patients.

Poor education not only reflects in poor health for the patient but also leads to serious complications and early death imposing a large economic burden on the individual and healthcare systems.

Benefit: This would reduce excess costs for emergency department care and care needed for complications concerning uncontrolled diabetes. A lot of the complications that diabetics face could be prevented easily.

There is a large amount in the community of diabetics that simply do not care about their nutrition or health and are unwilling to make any sort of lifestyle change, those people aside; there is no excuse for the overwhelming amount of complications that some diabetics suffer from due to the lack of knowledge.

A patient with uncontrolled diabetes deals with physical ailments; people with uncontrolled type 1 diabetes often feel ill, experience cognitive dysfunction, have difficulty maintaining their weight at a desired level, and experience fluctuating moods.

Diabetes education can greatly decrease hypoglycemic events in patients with diabetes.

  • SELF MANAGEMENT

5Self-management is seen as a key capability for Patient Empowerment and emphasizes that persons with chronic diseases has the central role in managing their health.

Self-management is what people do to manage their diabetes or other chronic condition and its effects on their physical health, daily activities, social relationships and emotions.

Mindful eating: Mindful eating empowers the patient to make flexible decisions through the challenges of life. Mindful eating is one way to get closer to meeting the true needs and in the process gradually allows a person to live the life more fully.

Putting someone on a diet that says to avoid rice, “sweets”, “anything white” or “everything fried” automatically creates cravings and (even worse) guilt if they finally respond to their cravings. When a person gives into their cravings, the patient takes the wrong way & fails to manage diabetes.

  • INTERNET

6Only the internet allows us to set up an independent global diabetological service. The only thing users would need a computer and access to the internet. This service can serve unlimited number of people in the world along with medical consultation.

The key issue for patients & healthcare professionals is how to deliver personalized behavioral support in ways that are affordable and can reach to maximum number of patients. The internet offers several advantages in this regard because it is available 24 hours a day with very low cost.

Benefits

  • It does not require large investments.
  • It does not imply high fees.
  • It can easily be enriched with new information which immediately becomes available to the target group of users in any location in the world.
  • Help patients to monitor their diet and medicinal doses
  • Help both the patient and doctor to monitor the long term effect of the interventions

We cannot empower patients!

We only can provide a framework (tools, services, etc.) that makes it easier for patients to empower themselves.

REFERENCES

 

Categories
blog Diabetes Fenfuro Blogs

BE CAREFUL WITH YOUR EYES DURING DIABETES!

DIABETIC EYE DISEASE is a serious condition to be found in the diabetic individuals who face problem in their eyes. This disease has the potential to cause severe vision loss and blindness. Diabetic eye disease has no early stage symptoms. There is no pain and vision may not change until the disease becomes severe. It is always shown when the disease starts to spread in the whole eye resulting in blurred vision.

Diabetic eye disease comprises a group of eye conditions including

  • Diabetic retinopathy
  • Diabetic macular edema (DME)
  • Cataract
  • Glaucoma
  • DIABETIC RETINOPATHY

1

As its name shows, this eye disease is related to “diabetes” and “retina”. The high blood sugar affects the tiny blood vessels in the light-sensitive tissue called the retina that lines the back of the eyes, causing diabetic retinopathy. It can cause blood vessels in the retina to leak fluid or hemorrhage (bleed), distorting vision. Thus, it is the most common cause of vision loss among people with diabetes.

It is the leading cause of vision impairment and blindness among working-age adults. Because diabetic retinopathy often goes unnoticed until vision loss occurs, people with diabetes should get a comprehensive dilated eye exam at least once a year.

Who is likely to get diabetic retinopathy?

Anyone suffering with diabetes can develop diabetic retinopathy. The longer someone has diabetes, the more likely he or she will get diabetic retinopathy. It is estimated that 40-45% of those with diagnosed diabetes have some degree of diabetic retinopathy.

How is it diagnosed?

Eye examination is done to detect diabetic retinopathy. The eyes should be dilated during the exam, which means eye drops are used to enlarge the pupils. This dilation allows the eye care professional to see more of the inside of the eyes to check for signs of the disease.

  • DIABETIC MACULAR EDEMA (DME)

 2

A consequence of diabetic retinopathy, DME is swelling in an area of the retina called the macula. This occurs due to the building-up of fluid called edema in the macula. The macula is very important for the sharp, straight-ahead vision which is important for reading, driving and recognizing faces.

DME is the most common cause of vision loss in individuals with diabetic retinopathy. About half of the people with diabetic retinopathy will develop DME. Although, it is more likely to occur as the diabetic retinopathy worsens, DME can happen at any stage of the disease.

Often, DME is associated with:

  • Diabetes for an extended amount of time
  • Severe hypertension (high blood pressure)
  • Fluid retention
  • Hypo-albuminemia (low levels of protein in body fluids)
  • Hyperlipidemia (high levels of fats in the blood)

What could be the symptoms for DME?

Common symptoms of DME are blurry vision, floaters, double vision and eventual blindness if it goes untreated.

  • CATARACT 3

Diabetic Cataract is a condition when the eye’s naturally clear lens becomes cloudy. Adults with diabetes are 2-5 times more likely than those without diabetes to develop cataract. Cataract also tends to develop at an earlier age in people with diabetes.

How diabetes contributes in developing cataract?

Light doesn’t pass through the lens as it should and isn’t properly reflected onto the retina (the light-sensitive tissue lining the back of the eye). As a result, vision becomes cloudy, distorted or blurry. 

The eye’s lens gets its nutrients from aqueous humor which is the fluid filling the front portion of the eye. Aqueous humor provides oxygen and glucose as an energy source for the body’s cells. In diabetic condition, sugar levels rise in the aqueous humor and in the lens. High levels of glucose in the lens cause it to swell, affecting clarity of the vision.

The lens also has an enzyme that converts glucose to a substance called sorbitol. When sorbitol collects in the lens, it can affect cells and naturally-occurring proteins, causing the lens to become less clear and more opaque. This condition eventually leads to cataract formation.

  • GLAUCOMA

Diabetic Glaucoma is a group of diseases that damage the eye’s optic nerve – the bundle of nerve fibers that connects the eye to the brain. Some types of glaucoma are associated with elevated pressure inside the eye. In adults, diabetes nearly doubles the risk of glaucoma.4

How diabetes contributes in developing glaucoma?

Under diabetic condition (high blood glucose), the retina becomes starved of oxygen and starts to develop new blood vessels & stimulus for these newly developed blood vessels. This triggers new blood vessel formation in the ocular anterior segment and interferes with the normal internal drainage system of the eye leading to elevated intraocular pressure, a condition referred to as glaucoma. If the pressure is high or continues for a long time, usually years, the nerve at the back of the eye may become damaged, and eventually the sight may be affected.

What are the symptoms of this eye problem (glaucoma)?

There may be no symptoms of this eye problem at all until the disease is very advanced and there is significant vision loss. In the less common form of this eye problem, symptoms can include headaches, pain in the eye, blurred vision, watering eyes, halos around lights and loss of vision.

PREVENTION & TREATMENT

  • Treatment of diabetes: If you are diabetic, you can help prevent or slow the development of diabetic retinopathy by treating diabetes through: 5
  • Taking the prescribed medication for diabetes
  • Sticking to diet
  • Exercising regularly
  • Controlling high blood pressure
  • Avoiding alcohol and smoking
  • Treatment of diabetic retinopathy varies depending on the extent of the disease. People with diabetic retinopathy may need laser surgery to seal leaking blood vessels or to inhibit other blood vessels from leaking. Your doctor might need to inject medications into the eye to decrease inflammation or stop the formation of new blood vessels.

People with advanced cases of diabetic retinopathy might need a surgical procedure to remove and replace the gel-like fluid in the back of the eye, called the vitreous. Surgery may also be needed to repair a retinal detachment. This is a separation of the light-receiving lining in the back of the eye.

  • Treatment of diabetic macular edema (DME) can be treated with several therapies that may be used alone or in combination. Anti-VEGF drugs are injected into the vitreous gel to block a protein called vascular endothelial growth factor (VEGF), which can stimulate abnormal blood vessels to grow and leak fluid. Available anti-VEGF drugs include bevacizumab, ranibizumab, and aflibercept which are approved by the U.S. Food and Drug Administration (FDA) for treating DME.

In focal/grid macular laser surgery, a few to hundreds of small laser burns are made to leaking blood vessels in areas of edema near the center of the macula. Laser burns for DME slow the leakage of fluid, reducing swelling in the retina.

Corticosteroids, either injected or implanted into the eye, may be used alone or in combination with other drugs or laser surgery to treat DME. But DME patients who use corticosteroids should be monitored for increased pressure in the eye and glaucoma.

  • Treatment of glaucoma requires lowering the eye’s pressure by increasing the drainage of aqueous humor or decreasing the production of the fluid. Medications can accomplish both of these goals. The basic treatment for glaucoma in diabetes is eye drops, and the commonest is one of the beta-blocker drops such as betaxalol, teoptic (cartelol), or timolol.
  • Treatment of cataract involves surgery in which the lens is removed and replaced with an artificial one.Cataract surgery is generally safe, so the point at which an operation is undertaken depends partly on the individual.

REFERENCES

Categories
blog Diabetes Fenfuro Blogs

SPORTS & EXERCISE TO CONTROL BLOOD GLUCOSE

Maintaining the blood glucose levels under required range is always a difficult task for diabetic individuals. It is always under attention for diabetics to know what to do to keep the blood glucose (or sugar) in range, even under the most challenging circumstances.

There are many prevention and treatment strategies to lower the sudden hikes in the blood glucose levels, which are either suggested by the doctor or healthcare professional or practiced by the diabetic individual itself. The initial step taken by any diabetic individual is to increase the physical activity, which is also suggested by doctors. It is reported that physical activity contributes highly in maintaining blood glucose levels in the body.

HOW THE PHYSICAL ACTIVITY & BLOOD GLUCOSE LEVELS ARE LINKED?

  • Physical activity can lower the blood glucose for up to 24 hours or more after work out by making the body more sensitive to insulin.
  • Checking the blood glucose levels frequently before and after exercise can help to see the benefits of activity.
  • The results of blood glucose help to see how the body reacts to different activities.
  • Understanding these patterns can help to prevent the blood glucose from going too high or too low.

HOW PHYSICAL ACTIVITY ACT INSIDE BODY TO LOWER BLOOD GLUCOSE LEVELS?

Blood glucose levels are increased when either the insulin is not synthesized inside the body or the insulin is not responding to the blood glucose to transfer it to the cells (insulin resistance). Any of the two conditions can develop diabetes.1

During exercise, the demand for fuel increases inside the body and the body responds accordingly.

  • Glucose stored in the muscle is burned very quickly.
  • At about the same time, glucose stored in the liver is released into the bloodstream (like fast fuel injection).
  • Fat is released from special cells called adipocytes. This fat along with glucose makes its way through the bloodstream to the muscles to be used for fuel.
  • Once the fuel reaches the muscle, it must enter through special pathways so that the muscles can use it for energy.

By using the above given pathways, physical activity or exercise maintains blood glucose levels in any of the following ways:

  • Insulin sensitivity: Insulin sensitivity is increased with regular exercise, so the cells are better able to use available insulin to take up glucose during and after activity. This enhanced insulin sensitivity may continue for many hours after the exercise is over, depending on the extent of the activity. The more intense and prolonged the activity, the longer and greater the enhancement in insulin sensitivity.
  • Energy production: When the muscles contract during activity, it stimulates another mechanism that is completely separate of insulin. This mechanism allows the cells to take up glucose and use it for energy whether insulin is available or not.
  • Weight management: Exercise burns calories and builds muscles, which in turn helps the body burn more calories. In people with either type 1 or type 2 diabetes, having too much body fat inhibits insulin from working (to control blood glucose levels). To reach and maintain a healthy weight, just eating right isn’t enough – people need to exercise.

This is how exercise can help lower blood glucose in the short term. And when the body is active on regular basis, it can also lower the glycosylated hemoglobin.

CAREFUL SELECTION OF EXERCISE

Exercise to lower blood glucose levels should be chosen after complete advice from healthcare professional and after completely studying the pros & cons of that specific exercise.

  • Rise in blood glucose due to exercise: It has been suggested that instead of lowering blood glucose levels, some exercises or physical activities raise the glucose levels too.

Reason: It is not unusual to experience a blood glucose rise at the onset of high-intensity exercise. This is caused by a flow of stress hormones that oppose insulin’s action and cause the liver to dump extra glucose into the bloodstream. The supply of glucose becomes more than the requirement by the body. The muscles cannot burn the glucose as fast as the liver is producing it, resulting in increase in blood glucose levels.

2

Exercises, which increase blood glucose levels

  • Weight lifting (particularly when using high weight and low repetitions)
  • Sports that involve intermittent “bursts” of activity like baseball or golf
  • Sprints in events such as running, swimming and rowing
  • Events where performance is being judged, such as gymnastics or figure skating
  • Sports activities in which winning is the primary objective
  • Fall in blood glucose due to exercise: Exercise contributes quite well in maintaining blood glucose in diabetic patients. Sometimes, the blood glucose levels fall more than the required levels. This can be understandable by concentrating the mechanism of lowering blood glucose by exercise.

Reason: The muscle cells have special receptors (called insulin receptors), like doors, that allow glucose to pass from the bloodstream to the muscle. These doors do not open unless they are unlocked by insulin. The good news is that exercise has an insulin-like effect, making insulin work better in the body. During physical activity, the doors swing open easily, allowing more and more glucose to enter the muscle cells to be burned up for energy. The problem is that as you continue to exercise and glucose continues to leave the blood, you may end up with low blood glucose. Thus, the exercise to lower or maintain glucose levels should be chosen after accurate advice from health professional.

Exercises, which maintain blood glucose levels

  • Aerobic exercise: 3Aerobic exercise helps the body to useinsulin  It makes the heart and bones strong, relieves stress, improves blood circulation and reduces the risk of heart disease by lowering blood glucose and blood pressure and improving cholesterol levels.

Recommendation: 30 minutes of moderate-to-vigorous intensity aerobic exercise at least 5 days a week or a total of 150 minutes per week is recommended to maintain blood glucose.

Aerobic exercises include brisk walking, indoor cycling, dancing, low-impact aerobics, swimming, tennis, stair climbing, jogging, hiking, ice-skating, etc.

  • Strength training: 4Strength training (also called resistance training) makes the body more sensitive to insulin and can lower bloodglucose. It helps to maintain and build strong muscles and bones, reducing the risk for osteoporosis and bone fractures. The more muscle you have, the more calories you burn – even when your body is at rest.

Recommendation: It is recommended that doing some type of strength training at least 2 times per week in addition to aerobic activity is helpful in maintaining blood glucose levels.

Some of the strength training activities include weight machines, lifting light weights, heavy gardening to keep & build muscles, etc.

  • Light activities: 5If you are sitting for a long time, such as working at a desk or watching TV, do some light activity for 3 minutes or more every half hour to maintain the blood glucose levels.

Light activities include leg lifts or extensions, overhead arm stretches, walking in place, torso twists, side lunges, etc.

Thus, moderate physical activity advised by health professional should be chosen to lower blood glucose levels. If you combine physical activity with a reduced-calorie eating plan, it can lead to even more benefits. The additional benefits may include improved cholesterol levels, less sleep apnea and being able to move around more easily.

6

BE PHYSICALLY ACTIVE. BE PATIENT. BE DIABETES-FREE.

REFERENCES

Categories
blog Diabetes Fenfuro Blogs

HIGH BLOOD SUGAR UNDER PREGNANCY: WHAT TO DO!

HEALTHY PREGNANCY for a woman is the one in which she keeps her blood glucose (sugar) levels in target range i.e. both before she is pregnant and during her pregnancy.

In any case, if a woman is planning to get pregnant, it is the best time to control the blood glucose levels before getting pregnant because high blood glucose levels are harmful for the baby during the first weeks of the pregnancy (even before knowing that you are pregnant). Babies born to women with diabetes, especially women with poor diabetes control are at greater risk for birth defects.

REQUIRED BLOOD GLUCOSE TARGET IN PREGNANCY

Before eating: 60-119 mg/dL
1 hour after meal: 100-149 mg/dL

IMPORTANCE OF PLANNING PREGNANCY IN DIABETES

If you have diabetes during pregnancy, you can still manage the situation by proper planning of your pregnancy. You need to pay special attention to your health and you may need to see doctors who specialise in treating diabetes or its complications.
Pregnancy causes a number of changes in the body, so it might be a requirement to change how you manage your diabetes. Even if the woman had diabetes for years, it may still be a requirement for changing the meal plan, physical activity routine and medicines. As the woman gets closer to the delivery date, the requirements might change again. Thus, planning of the pregnancy becomes a critical task in diabetes.

PREGNANCY COMPLICATIONS DURING DIABETES

As given above, there is a risk of birth defects in the babies born under diabetes. Other complications of high blood sugar before and during pregnancy are:

In mother:

Worsening of diabetic eye problem
Worsening of diabetic kidney problem
Infections of the urinary bladder & vaginal area
Preeclampsia (high blood pressure with proteins in the urine)
Difficult delivery or C-section

In baby:

Premature delivery
Birth defects involving weighing too much or too less or having breathing problems
Increased risk of losing baby through miscarriage
Glucose in a pregnant woman’s blood passes to the baby. If your blood glucose level is too high during pregnancy, so is your baby’s glucose level before birth. In some cases, it has also been seen that after delivery, the baby’s glucose level may drop quickly and go too low.
Prolonged jaundice (yellowing of skin)

LABORATORY EXAMINATIONS REQUIRED BEFORE PREGNANCY
(Under risk of diabetes)1

Examinations before pregnancy suggested by doctor includes:

HbA1c levels (glycosylated hemoglobin)
High blood pressure
Heart disease
Kidney, eye and nerve damage testing
Thyroid test

HEALTHCARE TEAM2

Medical team containing healthcare professionals of diabetes and pregnancy will ensure for the best care. This healthcare team may include:

Medical doctor:

You will need monitoring and advice on glucose control during and after your pregnancy.

Obstetrician-gynecologist:

Has experience treating women with diabetes. You will see your OB/GYN regularly throughout your pregnancy.

Nurse:

Who provides prenatal care and advice on managing diabetes.

Dietitian:

A registered dietitian to help with meal planning. A healthy diet for glucose control and nutrition has never been more important than now.

Psychologist:

To help you cope with stress, worry, and the extra demands of pregnancy.

Pediatrician:

Doctor who will care for children

OTHER CONSIDERATIONS FOR MANAGEMENT OF DIABETIC PREGNANCY3

Exercise:

Exercise as much as possible. Take 30 minutes of walk on regular basis. It will help to control your diabetes and will help to have healthy pregnancy as well.

Healthy lifestyle:

Along with getting your blood glucose levels in your target range, it is important to establish healthy lifestyle habits as well that will reduce the risk for complications and improve the health of the baby. For women with diabetes, this lifestyle change means an HbA1c as normal as possible (less than 7%), achieving or maintaining a healthy body weight, improving diet and exercise and having a pre-pregnancy exam.

Folic acid consumption:

Women with diabetes should take a higher dose of folic acid. The normal daily dose for women trying to get pregnant and for pregnant women is 400µg. It will prevent birth defects in the brain and spinal cord.

Simultaneous medications:

If you take drugs for conditions related to your diabetes, such as high blood pressure, these may have to be altered because they may interfere with the development of the baby inside the womb.

Monitoring:

Expect to monitor your blood glucose levels more frequently during pregnancy. Your eyes and kidneys will be screened more often to check they are not deteriorating in pregnancy, as eye and kidney problems can get worse.

Breastfeeding:

It is recommended to feed the baby after birth as soon as possible– within 30 minutes – to help keep the baby’s blood glucose at a safe level.

Risk of gestational diabetes:

About 4% of all pregnant women without preexisting diabetes will develop gestational diabetes sometime around the 28-week. Gestational diabetes occurs when the mother’s body becomes resistant to insulin, causing glucose levels to build up in the blood. As with type 1 and type 2 diabetes, high blood glucose levels can cause problems for both mother and baby. Women with gestational diabetes usually get a special meal plan and are encouraged to exercise; they also have to test their blood glucose and may need to inject insulin. Gestational diabetes usually goes away after pregnancy, but brings an increased risk for the condition in pregnancy.

Smoking:

Smoking is especially harmful for people with diabetes. Smoking can increase diabetes-related health problems such as eye disease, heart disease, kidney disease and amputations. If you smoke, talk with your doctor about how to quit.

Herbal Supplementation:

Fenfuro is a first of its kind patented and clinically evaluated supplement for effective management of blood glucose levels. FENFURO is a group of furostanolic saponins, derived from fenugreek seeds (Trigonella foenum graecum) by innovative process. One of the most important properties of fenugreek seed extract is blood sugar level (BSL) lowering property. Various studies have investigated blood cholesterol-lowering and blood glucose lowering properties of fenugreek seed extract. FENFURO contains a rich variety of saponins and flavonoids. All of these substances are known to lower blood lipid levels and play valuable role in glucose regulation.fenfuro@
Thousands of women each year are able to monitor diabetes in pregnancy. Remember to manage the glucose levels, prioritize proper nutrition and exercise and stay connected to healthcare team. Medically management of diabetes is the key to the success of pregnancy.

REFERENCES

https://medlineplus.gov/diabetesandpregnancy.html
http://www.webmd.com/diabetes/pregnancy-diabetes-and-pregnancy#1
http://americanpregnancy.org/pregnancy-complications/diabetes-during-pregnancy/
http://www.nhs.uk/conditions/pregnancy-and-baby/pages/diabetes-pregnant.aspx
https://www.niddk.nih.gov/health-information/diabetes/diabetes-pregnancy
http://www.diabetesforecast.org/2010/aug/a-guide-to-pregnancy-with-diabetes.html?referrer=https://www.google.co.in/?referrer=http://www.diabetesforecast.org/2010/aug/a-guide-to-pregnancy-with-diabetes.html?referrer=http://www.diabetesforecast.org/2010/aug/a-guide-to-pregnancy-with-diabetes.html?referrer=https://www.google.co.in/?referrer=http://www.diabetesforecast.org/2010/aug/a-guide-to-pregnancy-with-diabetes.html?referrer=https://www.google.co.in/?referrer=http://www.diabetesforecast.org/2010/aug/a-guide-to-pregnancy-with-diabetes.html

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DIABETES-INDUCED ERECTILE DYSFUNCTION

ERECTILE DYSFUNCTION (ED) is the inability to get or maintain an erection firm enough for sexual activities. In India, more than 10 million cases per year originate due to erectile dysfunction. It can cause stress, relationship strain and low self-confidence.

It can originate by poor long-term blood sugar control. Erectile dysfunction can also be linked to other conditions common in men with diabetes, such as high blood pressure and coronary artery disease.

PREVALENCE

An estimated 10% of men aged 40 to 70 years have severe ED, and another 25% have moderate erectile dysfunction. ED tends to become more common as men age, though it does not usually occur on aging.

For many men, other health conditions, such as diabetes, contribute to the likelihood of developing ED. The association between Diabetes and ED was first documented in 1978.

 

It is estimated that:

  • Men who have diabetes aretwo to three timesmore likely to develop erectile dysfunction (ED).
  • Abouthalf of the menwho are diagnosed with Type 2 diabetes will develop ED within 10 years of their diagnosis.
  • Adopting a healthier lifestyle may help reduce your risk.

DIAGNOSIS OF ERECTILE DYSFUNCTION

1

There are no formal tests to diagnose erectile dysfunction. Laboratory tests can help identify the causes of ED. Initial tests should include HbA1C, free testosterone, thyroid function tests and prolactin levels. However, patients who do not respond to pharmacological therapy or who may be candidates for surgical treatment may require more in-depth testing, including nocturnal penile tumescence testing, duplex Doppler imaging, somatosensory evoked potentials, or pudendal artery angiography.

REASON FOR ERECTILE DYSFUNCTION IN DIABETES

Diabetes is associated with many serious health complications. Erectile dysfunction is one of those complications, which originates mainly due to diabetic neuropathy. Diabetic neuropathy is a condition when high blood sugar levels causes nerve damage in various parts of the body such as hands, arms, legs and feet which results in pain, tingling or numbness.2

  • Damage to penile nerves: Diabetes can cause damage to nerves (neuropathy) throughout the body including the nerves to the penis. Damage to penile nerves can interfere with the body’s ability to send messages to and from the penis, which can lead to ED.
  • Narrowing or hardening of blood vessels: Diabetes can intensify a condition known as atherosclerosis, in which the blood vessels become narrow or harden. Narrowing or hardening of these blood vessels prevents blood flow into and out of the penis, which can cause ED.
  • Nitric oxide production: Men with diabetes need to control their blood sugar levels. The body is unable to produce required Nitric Oxide (NO) in the presence of high blood sugar levels and vascular tissues don’t respond as effectively to NO. When enough blood flows into the penis, penile veins close off and block the blood from flowing out. This process results in an erection. If the body becomes unable to produce required NO or if the penile tissues do not respond to NO, the pressure of the blood flowing into the penis is not sufficient to trap the blood and penis will not get hard, resulting in ED.
  • Testosterone deficiency: About 12% of men with diabetes have low levels of the male hormone testosterone, which is required for normal erectile function.

 3

TREATMENT STRATEGIES

Diabetes is a lifetime chronic health condition, though both Type 1 and Type 2 diabetes can be well controlled through medications, proper diet, and exercise. Although ED can become a permanent condition, this typically isn’t the case for men who experience occasional erectile difficulties.

  1. Lifestyle change

If a person has diabetes, he may still be able to overcome ED through a lifestyle change that includes sufficient sleep, no smoking and stress reduction. There are several lifestyle changes that a person can make to not only help with diabetes management, but also to lower the risk of ED. You can:

  • Blood sugar control through diet: 4Eating a diabetes-friendly diet will help to better control the blood sugar levels and lessen the amount of damage to the blood vessels and nerves. A proper diet geared at keeping the blood sugar levels in check can also improve the energy levels and mood, both of which can help reduce the risk of erectile dysfunction. It is also considered working with a dietitian who is also a certified diabetes educator to help adjust the eating style.
  • Reducing alcohol consumption: Drinking more than two drinks per day can damage the blood vessels and contribute towards ED. 5Being mildly intoxicated can also make it hard to achieve an erection and interfere with sexual function.
  • Stop smoking: Smoking narrows the blood vessels and decreases the levels of nitric oxide in the blood. This decreases blood flow to the penis, worsening erectile dysfunction.
  • Regular exercise: 6
  • Adding regular exercise to the routine not only helps to control the blood sugar levels, but it can also improve circulation, lower stress levels and improve the energy levels. All of these can help combat ED.
  • Get more sleep: Fatigue is often to blame for sexual dysfunction. Ensuring that you get enough sleep each night can lower the risk of ED.
  • Stress levels:Stress can interfere with sexual arousal and the ability to get an erection. 7Exercise, meditation and setting aside time to do the things that you enjoy can help to keep the stress levels down and lessen the risk of ED. If symptoms of anxiety or depression are starting to develop, consult the doctor.
  1. Oral medications:Erectile dysfunction medications include sildenafil (Viagra, Revatio), tadalafil (Cialis, Adcirca), vardenafil (Levitra, Staxyn) or Avanafil (Stendra). These pills can help ease the blood flow towards the penis, making it easier to get and keep an erection.

In some cases, these drugs may be unsuitable for patients with heart disease. If you are considering one of these drugs and you have heart disease, as many diabetics do, be sure to tell your doctor. In rare cases, the pills may create “priapism,” a prolonged and painful erection lasting six hours or more (although reversible with prompt medical attention).

Herbal supplementation: It has been observed that herbal supplements are proved to be safe and effective to treat erectile dysfunction. Chemforce is a strong dietary supplement for overall energy and vitality in men. Furosap®, the major ingredient in Chemforce has been clinically proven to manage testosterone deficiency in men and is supported by international patents. The active component i.e. protodioscin is known to increase the levels of the hormones such as testosterone, dihydrotestosterone and dehydroepiandrosterone. These improvements in the hormonal levels in men might be responsible to manage erectile dysfunction.

REFERENCES

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DIABETES CAN CAUSE DEPRESSION

DIABETES

Diabetes is a long-term condition that causes a person’s blood sugar level to become too high. It is a metabolic disease and chronic disorder, which results from defects in insulin secretion or action.

Insulin is a hormone, which is secreted by pancreas and lowers the blood glucose level in the body. When insulin secretion or action is disturbed, diabetes mellitus develops.

DEPRESSION

It is a mood disorder and serious medical illness, which can alter the person’s thoughts, behaviour, feelings and sense of well-being. It is a disorder of brain, which can happen at any age, especially in teens and adults.

World Health Organisation (WHO) describes depression as the major cause of disability, which is estimated to account for 12% of the global burden of disease. It is reported to affect approximately 450 million people.

RELATIONSHIP BETWEEN DIABETES AND DEPRESSION

Depression is a very drastic condition becoming common in the general population i.e. approximately 1 in 4 people experience depression in their life and people with diabetes are at more risk to develop depression i.e. up to 50% of people with diabetes are thought to have mental illness such as depression or anxiety. Depressive patients are also at higher risk of developing diabetes. It is also reported that untreated depression can make it difficult to manage diabetes.

CAUSES OF DEPRESSION IN DIABETES

  • The hardship of managing diabetes can be stressful and can lead to symptoms of depression.
  • Diabetes leads to many health complications that may worsen symptoms of depression.
  • Family history of either condition
  • Obesity
  • Hypertension
  • Inactivity
  • Coronary artery disease

According to the above data, the complications of diabetes are major reason behind the development of depression. By treating diabetes or its complications can help in the management of depression too.

SYMPTOMS OF DEPRESSION IN DIABETES

The diagnosis of depression in a diabetic individual is important, which can be done by monitoring the symptoms of depression. These include:

  • No longer finding pleasure in the activities that you once enjoyed
  • Experiencing insomnia or sleeping too much
  • Loss of appetite or binge eating
  • Inability to concentrate
  • Feeling lethargic
  • Feeling anxious or nervous all the time
  • Feeling isolated and alone
  • Feeling sadness in the morning
  • Feeling that you “never do anything right”
  • Having suicidal thoughts
  • Harming yourself

 MANAGEMENT OF DIABETES AND DEPRESSION TOGETHER

Diabetes self–management programs

Diabetes self assessment programs can focus on behaviour and help the people to improve their fitness levels and manage weight loss and other cardiovascular disease risk factors. These programs also improve the quality of life and sense of well being of the affected person.

Diabetes self-management strategies include:1

  • Monitoring blood glucose levels on regular basis
  • Monitoring weight gain/weight loss
  • Regular exercise or other physical activities
  • Healthy eating and planning of diet according to the blood glucose levels
  • Regularity with anti-diabetic medications
  • Consuming lesser carbohydrates2

Psychotherapy

Psychotherapy, particularly cognitive behavioral therapy reported to have improvements in depression patients, which has resulted in better diabetes management. Psychotherapy can be short term or long term.3

Goals of the psychotherapy include:

  • Recognition of potential triggers
  • Identification and replacement of unhealthy behaviors
  • Development of positive relationship of patient with others
  • To promote healthy problem-solving skills

Medication

  • Anti-diabetic medication: For treating depression raised from the diabetic complications, it is better to treat diabetes first. When the diabetes will be treated, depression will automatically be cured. It is better to consume herbal supplements, which can prevent and treat diabetes with much lesser complications.

One such anti-diabetic herbal supplement is Fenfuro. Fenfuro is clinically proven and supported by six international patents for effective and safe management of blood glucose levels.

If cognitive behavioural therapy and anti-diabetic supplementation is not sufficient for the treatment of depression, then, psychotherapist can be consulted to treat with anti-depressant medications. Psychotherapist can prescribe from any of the following anti-depressant categories:

  • Tricyclic anti-depressants: They work by boosting the levels of certain chemicals in the brain that help nerve cells to communicate with each other. If these chemicals are out of balance or don’t work like they should, messages might not make it through the brain correctly that can lead to depression.
  • Selective serotonin reuptake inhibitors (SSRI): They affect the way in which brain uses a chemical called serotonin. Changing the balance of this chemical may help the brain cells to receive messages better and boost mood.
  • Serotonin norepinephrine reuptake inhibitors (SNRI): They block the re-absorption of both serotonin and norepinephrine. Like SSRIs, they improve the way in which brain sends and receives messages.

These anti-depressants should only be consumed after consultation with psychotherapist. Some strong anti-depressants can cause diabetes. Due to this, doctors prescribe small doses initially and increase the dose on requirement.

 

REFERENCES

https://fenfuro.com/product/fenfuro/

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Pushing diabetics to take insulin is a medical scam: Fiona Godlee

Pushing diabetics to take insulin is a medical scam: Fiona Godlee
With diabetes becoming such an epidemic in India, we need to look at the root causes and put money there rather than putting people on insulin.

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DRUG-INDUCED DIABETES

DIABETES is a well-known disease these days. It occurs when the sugar or glucose levels rise inside the human body. This rise in blood sugar levels takes place due to abnormal functioning of the cells known as β-cells of pancreas.

Under normal conditions, these cells release insulin on requirement to transfer glucose from blood to the tissues/cells for energy. This transfer balances blood sugar levels. The misconduct of these β-cells disturbs the balance of blood sugar levels and causes diabetes.

The activity of β-cells can be disturbed due to many reasons. One of those reasons is the consumption of some therapeutic agents.

THERAPEUTIC AGENTS can influence the development of diabetes, especially when pre-existing risk factors are present and these may cause glucose control to deteriorate if administered to those with existing diabetes.

It has been found that drug-induced diabetes can develop at the age of 20 years but it is more prone at the age between 40-60 years. The chances of development of drug-induced diabetes are found to be more in females (70%) as compared to males (30%).

ACTION OF DRUGS INDUCING DIABETES

Therapeutic agents causing diabetes may act either by increasing insulin resistance or by affecting the secretion of insulin or both.

 2

  • Grouping of drugs according to the mechanism of inducing diabetes
    • Drugs that cause diabetes by interfering with insulin production & secretion are:
β-receptor antagonist

(used in hypoglycemia)

 Tacrolimus

(immunosuppressant used in organ transplant)
Priminil (Vacor)

(used as rodenticide)

 Didanosine

(used as anti-retroviral therapy)
Pentamidine

(antimicrobial medication in used in pneumonia)

 L-asparaginase

(as anti-cancer agent)
Diphenylhydantoin

(used as anticonvulsant or antilepptic drug)

 Opiates

(used as pain reliever)

  • Drugs that cause diabetes by developing insulin resistance:
Glucocorticoids

(to control and treat inflammation)

 β-receptor antagonist

(used in hypoglycemia)
Megasterol acetate

(used as anti-cancer drug & appetite stimulant)

 Growth hormone

(growth stimulant)
Oral contraceptives

(used to prevent pregnancy)

 Protease inhibitors

(used as anti-retroviral therapy)
  • Drugs that act both on insulin secretion and resistance:
Thiazide diuretics

(to control blood pressure)

 Diazoxide

(used in treatment of acute hypertension)
Cyclosporine

(immunosuppressant used in organ transplant)

 Atypical antipsychotic

(used to treat psychotic conditions)
  • Treatments that induce diabetes by increasing nutrient flux:
Nicotinic acid

(used in dyslipidemia)

 Total parenteral nutrition

(used in intravenous feeding of person)
  • Grouping of drugs according to the capability of inducing diabetes

These agents may be divided into widely used medications that are weakly diabetogenic and drugs used for special indications that are more strongly diabetogenic.

  • Weakly diabetogenic medications include antihypertensive agents, statins and oral contraceptive pills.
  • Strongly diabetogenic include steroids, antipsychotics and a range of immunosuppressive agents.
  • There are also a number of known β-cell poisons including the insecticide Vacor, alloxan and streptozotocin which can cause permanent diabetes.

TREATMENT & PREVENTION STRATEGIES

  • Management of drug-induced diabetes is important as the diabetes so developed can convert into permanent diabetes for whole life. To prevent the development of diabetes, the blood glucose levels should be monitored regularly.
  • In cases in which the drug that induced diabetes must be continued, insulin therapy is the most efficacious approach. The diabetics should also try to use the lowest effective dose of therapeutic drug, if possible. Whenever is the possibility, the therapy should be altered.
  • A drug which is supposed to have adverse effect on blood glucose level should be avoided in a patient of diabetes, pre-diabetes or insulin resistance.3

Other diabetes management strategies include:

  • Healthy eating: Lifestyle management is the utmost requirement in the  management of drug-induced diabetes. The sweets and fats should be avoided as much as possible. Fruit juice should also be limited. Meals should not be taken more than 3 times a day. Alcohol intake should also be avoided (not more than 1-2 drinks/day) and blood glucose levels should be monitored before & after drinking.
  • Exercise: In drug-induced diabetes, physical activity
    contributes greatly towards the improvement in health. 30 minutes of moderate activity is recommended on regular basis by physicians. It is also required to check the glucose levels before & after the 4physical activity. The meal should also be planned according to the blood glucose levels checked previously.
  • Fenugreek supplementation: Another approach to tackle the drug-induced diabetes is by the treatment of diabetes along-with the on-going therapeutic drugs. It has been reported by many researchers that fenugreek is effective in the management of diabetes mellitus. In animal studies, the diabetes was induced in the animals with the help of alloxan or streptozotocin. Then, they were treated with fenugreek supplements. After some days of treatment on animals, improvements were noticed. There was improvement in the blood glucose levels on regular consumption of fenugreek supplements.5

In an animal study conducted by Babu KR et al., it was seen that fenugreek extract produced hypoglycemic effect in alloxan-induced diabetic rats after 7-21 days of oral administration. Their histopathological study on the rats showed that the alloxan-damaged β-cells were also restored on treatment with fenugreek extract.

It has been reported by Gaddam A et al. that fenugreek act by controlling the insulin resistance. The hypoglycemic effect of fenugreek was reported by them in their clinical study on both male and female volunteers having diabetes.

In a clinical study conducted by Verma N et al., fenugreek seed extract (Fenfuro™) exhibited anti-diabetic activity in male & female volunteers diagnosed with type 2 diabetes mellitus. On completion of their clinical study, they found reduction in both fasting plasma and post-prandial blood sugar levels in 83% of the study subjects. Fenfuro™ was also safe during & after the study treatment.fenfuro@

According to many reported animal and human studies, fenugreek is safe and effective in the management of diabetes whether induced by drugs or develops itself. Being an herbal supplement, it does not caused any side effect in any animal or human volunteer.

REFERENCES