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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

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

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

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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 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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Hypertension & Diabetes

Blood pressure is the force of blood against your blood vessels as it circulates. This force is necessary to make the blood flow, delivering nutrients and oxygen throughout your body. High blood pressure, also called hypertension, means there is too much pressure in your blood vessels. It may precede the onset of diabetes mellitus (DM). In many of the cases, both hypertension and diabetes mellitus may be diagnosed together. Diabetic population has almost doubled occurrence of hypertension as compared to non-diabetic general population.

Diabetes and high blood pressure are considered as major cardiovascular risk factors, which mean these can lead to coronary artery disease, stroke, left ventricular hypertrophy, and nephropathy. Patients suffering from both diabetes and high blood pressure have greater risk of atherosclerosis.

What are causes of high blood pressure?2

Are you diagnosed with blood pressure & diabetes?

If yes, then monitor yourself regularly

Learn how to measure blood pressure & blood sugar at home, keep record of these.

What are the recommendations for starting anti-hypertensives?

British Hypertension Society, British Hyperlipidaemia Association and British Cardiac Society have jointly suggested the initiations of treatment of hypertension in diabetics when BP is equal to or more than 140/90 mm Hg. According to the WHO Expert Committee Recommendation in Hypertension Control treatment may be instituted at BP 130/85 mm Hg in a patient with diabetic nephropathy

Are lifestyle modifications recommended for Diabetic hypertensives?

Lifestyle modifications are must for diabetic hypertensive patients. These modifications also correct obesity, hyperglycaemia, hyperinsulinaemia, and act as primary prevention against cardiovascular risks. These will reduce blood pressure and control blood glucose levels.

Regular physical activity

It has been observed that regular physical activity has an independent cardioprotective effect.  Regular aerobic exercise can reduce systolic BP by an average of 4 mmHg and diastolic BP by an average of 2.5 mmHg. It is advised to all patients to become physically active, as part of a comprehensive plan to control hypertension and diabetes, regardless of drug treatment. Aim for 30 minutes of moderate-intensity physical activity on most, if not all, days of the week.

3

Quitting smoking

Quitting smoking may not directly reduce BP, but markedly reduces overall cardiovascular risk. The risk of myocardial infarction is 2–6 times higher and the risk of stroke is 3 times higher in people who smoke than in non-smokers.

Quitting smoking also helps in better management of blood glucose and HbA1c levels.4

Dietary Modification

Adequate intake of dietary-fibre, and K+, Ca++, Mg++ from fresh fruit, green vegetables, and dairy products should be ensured. Mg++ is provided by chlorophyll of green leafy vegetables. Anti-obesity diet should not contain more than 1/3rd of total calories from fat. Of the fat calories, 1/3rd should be derived from saturated fat and 2/3 from poly- or monounsaturated fat.

5

Weight reduction

Every 1% reduction in body weight lowers systolic BP by an average of 1 mmHg. Weight reduction by as little as 4.5 kg reduces BP and/or prevents hypertension in a large proportion of overweight people. Weight loss of 10 kg can reduce systolic BP by 6–10 mmHg.

 6 

 

Reducing Alcohol Intake

Reducing alcohol intake may reduce BP in many patients and also contributes in better management of blood sugar levels.

Co-existence of diabetes mellitus and hypertension increases the risk of macro – and micro-vascular complications. Blood pressure should be measured in supine, sitting, and standing postures in a diabetic patient to detect existence of autonomic neuropathy and drug induced postural hypotension. A good BP control (130/80 or below) prevents or retards the progress of both micro and macro-vascular complications. Tight control of blood glucose levels prevents or delays the progress of micro-vascular complications.

It is very important and must of diabetic hypertensive patients to modify their lifestyle to lead a healthy and happy life.

FenfuroTM is a clinically evaluated dietary supplement for effective management of blood glucose levels. It is supported by 6 international patents.

fenfuro@

References

 

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INSULIN: HEALTH RISKS

Insulin hormone is a chemical messenger secreted by the beta cells of pancreas, which allows the body to utilize glucose from carbohydrates and convert the extra glucose into energy for future use. Insulin maintains the sugar balance in the body by keeping blood sugar level from getting too high (hyperglycemia) or too low (hypoglycemia). Glucose obtained from the food does not directly convert into energy. When we eat food, the blood sugar levels rise and beta cells of the pancreas are then signaled to release insulin into the blood stream. Then the released insulin absorbs the sugar by binding to insulin receptors and converts excess of the sugar in glycogen (energy), which get stored in the liver. It has dual mode of action i.e. an excitatory one and an inhibitory one:

  • It stimulates glucose uptake and lipid synthesis.
  • It inhibits the breakdown of lipids, proteins and glycogen, and inhibits the glucose pathway (gluconeogenesis) and production of ketone bodies (ketogenesis).

Sometimes glucose metabolism gets impaired, characterized by hyperglycemia which may be due to either pancreas does not secrete insulin or insulin receptors do not respond to the insulin properly. This condition is also known as diabetes mellitus. So it becomes essential to take the insulin externally.

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Endogenous insulin (that which is found naturally in the body) acts on the principle of feedback. If glucose levels rise when eating something sweet, insulin secretion is increasing, too.

Exogenous insulin Patients suffering from Type I Diabetes are treated by doses of insulin produced by sources external to the body of the patient and administered in addition to the endogenous insulin. This type of insulin produced by sources other than human body is called exogenous insulin.

RISKS OF INSULIN INTAKE

When the insulin metabolism in the body gets impaired, then sometimes it becomes necessary to provide it externally. But there are certain side effects of insulin therapy. These are:

Hypoglycemia: It is the most serious problem associated with insulin therapy and it is also called as insulin reaction. It occurs 2

when blood sugar levels fall below the normal limits. If the insulin dose is high, then the blood glucose levels may decrease abruptly and if remain untreated may lead to seizure, death or coma. Hypoglycemia is associated with increased plasma dopamine, epinephrine and plasma renin activity. Signs and symptoms of low blood sugar are feeling weak, drowsy, or dizzy, experiencing shakiness, confusion, anxiety, nausea, or headache, blurred vision and loss of consciousness.

Weight gain

Weight gain during insulin therapy is the common problem that may be presented as edema. Weight gain may be associated with abrupt restoration of glucose control in a patient whose control was poor previously. It may be due to more efficient use of calories during insulin therapy, suggesting additional benefits of dietary and exercise modifications. Insulin therapy leads to increase in body fat as a result of the elimination of glycosuria and reduction in 24-hour energy expenditure which results in an insulin-associated decrease in triglyceride or free fatty acid cycling, glucose and protein metabolism and hence weight gain.

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Renal problems

Insulin therapy may also cause renal complications such as decreased renal plasma flow, glomerular filtration rate and significantly increased urinary albumin excretion rate. However, these changes are reversible upon resolution of hypoglycemia. Therefore changes in kidney function during insulin-induced hypoglycemia may result from direct stimulation of the efferent sympathetic nerves to the kidney and hormonal counter regulatory mechanisms.

Allergic reactions

Patients on insulin therapy may experience allergic reactions in response to insulin. Sometimes these reactions may be minor like hives or itchiness, but sometimes may be life threatening such as swollen tongue, tightness in chest, difficulty breathing, dizziness or fainting and may need hospitalization. These reactions may be localized (such as rashes at the injection site) or systemic (itching, redness, muscle cramps.).

Hypophosphatemia

Hypophosphatemia is one of the major metabolic complications of insulin therapy, particularly in the patients who are on treatment of diabetic ketoacidosis (DKA) as insulin increases intracellular phosphate transport. Sometimes hypokalemia and hypomagnesaemia may also occur during insulin therapy.

Skin related complications

Other adverse effects of insulin include loss or overgrowth of fat tissue at injection sites. Repeated use of the same injection site increases the risk of lipoatrophy — with time, patients learn that these areas are relatively pain free and continue to use them. However, the absorption of insulin from lipoatrophic areas is erratic leading to frequent difficulties in achieving ideal blood glucose control.

Lipohypertrophy is the most common cutaneous complication of insulin therapy.

Drug interactions

Exogenous insulin interactions include alpha and beta-blockers and other high blood pressure drugs, steroids, hormone-based contraceptive pills, asthma and cold medications, aspirin, thyroid medications, and even other diabetes drugs.

Administration of exogenous insulin provides a different insulin gradient than that occurring after endogenous insulin secretion. Endogenous insulin secretion acts initially on the liver where a major portion of it is taken up and <50% reaches the peripheral tissues. Exogenously administered insulin must circulate through the peripheral tissues before it can reach the liver; therefore, peripheral hyperinsulinemia is necessary to attain adequate insulin to regulate the liver. Another downside of insulin therapy is the need to increase the dose and the regimen complexity with time, the increase in severe hypoglycemia, and the potential increase in mortality as well as the potential increased risk for specific cancers.

It becomes all the more important for medical practitioner, patients and other stake holders to USE EXOGENOUS INSULIN INTELLIGENTLY, CAUTIOUSLY & JUDICIOULY.

References

http://www.iddt.org/about/gm-vs-animal-insulin/allergic-reactions-to-insulin

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DIABETES MANAGEMENT WITH DIETARY FIBER

DIABETES MELLITUS

  • Diabetes mellitus or diabetes is a condition when there is rise in blood sugar levels in the body. The body becomes unable to use blood sugar (via insulin) for energy. During type 1 diabetes mellitus, pancreas becomes unable to produce insulin due to which glucose remains in the blood instead of transferring to the cells of the body. During type 2 diabetes mellitus, either the pancreas does not produce sufficient amount of insulin or the cells become unresponsive to insulin. In both of the conditions, sugar is not transferred from blood to the cells of the body. Thus, blood sugar levels raise causing diabetes.

(http://www.diabetes.org/diabetes-basics/common-terms/)

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DIABETES MANAGEMENT

  • Epidemiology: India has the largest number of diabetic people. According to WHO, there were 32 million people diagnosed with diabetes in year 2000. It is now estimated that they will rise to 80 million by the year 2030. Thus, there is a critical need for the strategies to prevent the epidemic of diabetes.capture-3
  • Goals for management of diabetes: The goals for managing diabetes in people are to provide:
    • Relief from diabetic symptoms
    • Prevention of complications such as retinopathy, neuropathy, cardiovascular disease, cerebro-vascular disease, etc
    • Prevention of infections
  • The primary prevention criteria for diabetes by any healthcare provider include healthy life style focusing on proper balanced diet, increased physical activity and weight control. Lifestyle modification is the cornerstone for the management of diabetes.
  • For management of diabetes, dietary modifications are required. They aim to achieve and maintain ideal body weight, euglycaemia and desirable lipid profile.

(http://icmr.nic.in/guidelines_diabetes/guide_diabetes.htm)

(http://icmr.nic.in/guidelines_diabetes/section6.pdf)

ROLE OF DIETARY FIBER

  • Dietary fiber: Dietary fiber is the part of plant food, which cannot be digested by human body. Other food components such as fats, proteins & carbohydrates are broken down and absorbed by the human body. But dietary fiber passes intact through the stomach, small intestine, and colon and out of the body.
    • Availability: Dietary fiber is mainly found in the fruits, vegetables, whole grains and legumes. It provides health benefits such as maintaining blood sugar levels, healthy weight and preventing heart disease.
    • Benefits: The high-fiber diet has many benefits such as,
      • Controlling blood sugar levels by slowing the absorption of sugar
      • Achieving healthy weight by lowering blood cholesterol levels
      • Helps to maintain bowel health
      • Decreases chances of constipation

(http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/fiber/art-20043983)

  • Diabetes & dietary fiber
    • Dietary fiber is reported to lower blood glucose levels. The daily intake of soluble fiber results in the prevention of diabetes.
    • Mechanism: Soluble fiber help to control blood sugar levels by delaying gastric emptying, holding back the entry of glucose into the bloodstream and lessening the postprandial (post-meal) rise in blood sugar. Because fiber slows the digestion of foods, it helps to inhibit the sudden spike in blood glucose that may occur after a low-fiber meal. Such blood sugar peaks stimulate the pancreas to pump out more insulin. The cholesterol-lowering effect of soluble fiber may also help people with diabetes by reducing heart disease risks.capture-4

(http://www.diabetes.ca/diabetes-and-you/healthy-living-resources/diet-nutrition/fibre#sthash.dXX6pgRZ.dpuf)

  • It has also been proved by the clinical studies that high fiber diet is beneficial to improve glycaemic control, glycosylated hemoglobin and hyperinsulinemia. It has been shown in the study that increases in bile-acid excretion due to dietary fiber intake is responsible for lowering blood glucose levels. The high fiber diet also helped to lower plasma lipid concentrations.

(http://www.nejm.org/doi/full/10.1056/NEJM200005113421903#t=articleTop)

  • Epidemiological studies suggested 29% reduction in the development of diabetes due to the protective effect of high dietary fiber intake. Increase in dietary fiber intake resulted in subsequent improvements in glycaemic control, reduction in the use of oral medication and insulin doses. Thus, dietary fiber consumption without altering the energy intake from carbohydrates, proteins and fats reduces the need for medication in type 1 and type 2 diabetic patients.

(https://www.researchgate.net/profile/Stefanie_Ferreri/publication/24247618_Health_benefits_of_dietary_fiber._Nutr_Rev/links/00b495391040b77454000000.pdf)

  • Fiber-rich diet for diabetics: It is recommended that an adult male need 38g per day of fiber and female need 25g per day of fiber intake to prevent diseased state. Diabetic individuals should follow following high fiber diet to lower blood glucose levels:
    • Skins and seeds of vegetables and fruit
    • Whole grain bread, pasta, cereal, crackers and rice
    • Barley, beans and lentils
    • Canned beans, chickpeas in salads
    • Ground flax seeds to yogurt, cereal
    • Almonds
    • Fenugreek seeds

(http://www.diabetes.ca/diabetes-and-you/healthy-living-resources/diet-nutrition/fibre)

(http://www.webmd.com/diet/guide/fiber-how-much-do-you-need#1)

  • Fenugreek as dietary fiber: Fenugreek seeds are reported to be a rich source of dietary fiber. Gel fiber present in fenugreek seeds contribute towards anti-diabetic property. The fiber content of fenugreek helps to lower blood glucose levels and delay gastric emptying, thereby preventing the rise in blood sugar levels. Fenugreek seeds contain 50.2% fiber which have hypoglycemic and hypolipidemic effect in diabetic patients.
    • In an animal study, fenugreek seeds extract was administered to diabetic rats. Fenugreek seeds significantly reduced serum cholesterol levels in rats. It was very effective to reduce blood sugar levels also.
    • It is reported that consumption of 25g of fenugreek seeds per day exhibit hypoglycemic effect in diabetic patients.
    • Thus, dietary modification with fiber will be helpful to reduce blood sugar levels in diabetic patients.

(http://diabeticbar.com/fenufibers.htm)

(http://fenufibre.com/whatIsFenufibre.html)

 

FenfuroTM is a patented and clinically evaluated product for safe and effective management of blood sugar levels. Fenfuro is a first of its kind, safenutraceutical derived from fenugreek seeds through a patented process. Through its unique scientific process, FENFURO concentrates the bioactive part of plants into a manageable dose, while removing the inert parts such as cellulose. Also, since a lot of healthy botanicals are not palatable, consuming their concentrate in capsule form in small dosage is a lot easier. FENFURO contains a rich variety of saponins and flavonoids. These substances are known to lower blood lipid level and help in insulin sensitization and glucose regulation. FENFURO is the first dual action insulin sensitizer.

A clinical evaluation of FENFURO was carried out on a total of 154 Type 2 diabetics for a period of 3 months, to determine its efficacy and safety. At the end of three months 83% of the patients reported decrease in fasting sugar levels and 89% patients reported decrease in PP sugar levels. The patients also showed significant decrease in HbA1C levels as compared to respective baseline value. 48.8% of patients reported reduction in dosage of anti-diabetic therapy after regularly taking FENFURO.

The statement and product have not been evaluated by the FDA to diagnose, treat, cure or prevent any disease.

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DEALING WITH DIABETIC FOOT

DIABETIC FOOT

  • Any ulcer or infection developed on foot during diabetic condition is termed as diabetic foot. It is one of the long-term complications of diabetes mellitus (rise in blood sugar levels). Ulcers or wounds most commonly occur at the bottom of the toe of the patient.
  • Reasons: Diabetes from very long time causes the damage in the nerves & blood vessels of the body which are the major reason behind diabetic foot.2
    • Nerve damage causes the person to lose feeling in the feet. Due to the loss of feeling, foot is exposed repeatedly to
      trauma or injury. Thus, any cut, blister or sore remains undiscovered. So, these minor foot injuries become ulcers & lead to major infections.
    • Blood vessel damage causes narrowing of the area to flow blood and oxygen throughout feet. Poor circulation of blood and oxygen in the foot area causes the wound healing process to slow down. This further worsens the condition of diabetic foot.
    • Sometimes, long-term diabetes loses normal foot arc in the patients. This causes clawed toes or hammer toes, displacement of fat cushion or foot-bottom deformity which further causes abnormal weight bearing in the foot. This changes the shape of the foot. The normal footwear becomes unable to fit properly and pushes the foot towards injury.3

 

  • People with diabetes can develop many foot problems. Neglecting these problems can cause serious conditions which lead to amputation (removal of limb by surgery).
  • According to the research data, foot ulcers within diabetic individuals are around 15% and become as high as 25%.

(http://www.diabetes.org/living-with-diabetes/complications/foot-complications/?loc=lwd-slabnav)

(https://medlineplus.gov/diabeticfoot.html)

 

PREVENTION & TREATMENT OF DIABETIC FOOT

 

  • The primary criteria for prevention and treatment of diabetic foot include the self-management. Foot care is the prime option for diabetic individuals to avoid the foot injury and minimize the chances of the development of diabetic foot.
  • Self-care activities: To keep the feet healthy in diabetic individuals, following self-care activities are recommended by healthcare personnel:4

 

  • Check your feet everyday for cuts, sores or blisters. You can also use mirror, if necessary.
  • Wash your feet everyday in warm and clean water without soaking for long time. Keep your feet dry after washing and be sure to dry your feet between toes.5
  • Keep the feet soft and smooth. Use cream or lotion to keep them soft after washing. Never use any cream or lotion in-between the toes and fingers because this will lead to infection.6
  • Corns and calluses should not be cut. Keep them smooth by rubbing gently in one direction.
  • Trim the toenails according to the requirement. In case of ingrown toenail, consult doctor. Smooth the nails after trimming. There should not be any toenail left sharp which could cause injury.7
  • Wear shoes & socks all the time. Do not walk barefoot, not even indoors because it may cause minor injury to the feet. Wear those shoes which fit comfortably in your feet.8

 

  • Protect the feet from extreme heat and cold. Put sunscreen lotion on the feet to prevent sunburn. Wear socks whenever you feel cold. Keep the feet away from open fires.
  • Physical activities which are easy on the feet should be chosen. Avoid running & jumping. Wear athletic shoes for exercise that fit well and provide good support.
  • Try to perform activities which will keep the blood flowing in the feet such as put the feet up while sitting, wiggle the toes after intervals, move the ankles up & down and do not cross legs for longer periods of time.
  • Avoid smoking because it can narrow and harden the blood vessels, thus, causes blood vessel damage.
  • Check your blood sugar levels regularly.

(http://www.healthsanaz.com/diabetic-foot-care-posters-df19.html)

(https://www.niddk.nih.gov/health-information/diabetes/preventing-diabetes-problems/keep-feet-healthy)

 

DIABETIC FOOT ASSESSMENT QUESTIONNAIRE

 

The problems given in the following questionnaire in a diabetic individual should be minutely handled because they can lead to diabetic foot:

 

  1. Is there any appearance of corn or calluses?

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  1. Is there any formation of blister on any part of the foot?

 

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  1. Are there any ingrown toenails?

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  1. Is there any formation of bunion beside the toe?

 

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  1. Is there any appearance of plantar wart at the bottom of the feet?

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  1. Is there any formation of hammer toe?

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  1. Is there any formation of dry and cracked feet skin in grey or red color?

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  1. Is there any appearance of foot toe fungal infection?

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  1. Is there any mild or severe pain in the feet?

 

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“Call or see your doctor right away if you have any of these signs to avoid diabetic foot”