30 October, 2008
20 October, 2008
Winter Tips for Diabetics
Winter is just around the corner so I thought I'll put up an excerpt
from a conversation that I had which would be helpful to diabetics
during winter time.
Q. Does climate in any way, direct or indirect, affect diabetes?
A. Warm and Cold temperatures have no direct effect on diabetes control
but can affect it indirectly. While your blood sugar doesn't go up or
down in response to hot or cold outdoor temperatures, it does have an
impact on eating and exercise habits, which is a key factor in
controlling your blood sugar levels. In warm temperatures, the body can
be stressed due to heat and high humidity. And this can throw the blood
sugar levels out of control.
For those who are on insulin, storing it becomes a problem in warm
climates as improper temperatures can destroy insulin and it won't work
effectively if it is not stored correctly.
Winter season according to some studies is a cause for depression and
anxiety, which is a stressful state for the body and stress can in
turn, affect blood-sugar levels.
Q. Generally people tend to eat more during winter. They also snack
more. In such circumstances should diabetics take special precautions?
A. Only disciplined and responsible eating can help a diabetic control
their blood sugar levels. There is no real harm with snacking when you
are hungry but the key is to snack on healthy alternatives that only a
good dietician can guide you on.
Q. During winter, it is sometimes difficult to exercise because of the
cold. Diabetics are supposed to regularly exercise. What do they do?
A. For those who find it difficult to exercise in the cold they can try
other options such as:
• Heated pools: Swimming in a heated pool is a great way to stay active
in cold weather. Swimming is an ideal full body exercise for those who
have a lot of weight as they can exercise without risking damage to
their joints. • Working out at a Gym: Gyms offer many ways to keep
moving indoors, from aerobics classes to weight machine circuits.
Winter might also be a good time to test a trial membership. Studies
have shown that weight training in diabetics helps tone muscles and
keeps bones strong and healthy.
• Exercising at home: It's easy to be active even without leaving home.
o Housework: Routine house work can be exercise, and you will end up
with a neat and tidy house in the bargain. Playing fast-paced music may
also help.
o Exercise videos: Videos can help people stay focused, teach new moves
and provide good warm-up and cool-down periods. Exercise videos made
especially for people with diabetes are available. Online videos are
available which people can easily download and use.
All people who exercise need to remember to drink clean water or
electrolyte replenishing fluids and avoid sugary drinks.
Q. In places like Delhi, Chandigarh, Jammu temperatures dip to near
zero and in south in Hyderabad and Bangalore, the temperature goes
below 10 degrees C. What are the precautions that diabetics should take
in terms of skin care, diet, sleep, protection etc.
A. Winter brings special challenges to people with diabetes.
• Keep yourself warm. Wear layers of clothes. Staying warm requires
that you trap warm, dry air next to the body.
• Watch your weight. Winter can mean an extra 2-5 kilos for many
people. This is risky as weight gain increases your risk of heart
disease.
• Diabetes-related circulation and nerve problems can mean icy cold
feet. Don't use hot-water bottles, but rather just wear layers of socks
to keep your toes warm.
• Drink lots of water as people who are dehydrated will send their
sugar levels up
• Stay relaxed as stress leads to high sugar levels. For those whom
stress is a routine occurrence, they should learn and practice
relaxation exercises to combat stress.
• Don't ever guess your sugar levels. Sometimes we all feel lazy and
guess our sugar levels instead of testing it on the glucometer. This is
not the recommended option. Always test your blood sugar levels and
then take your medicines. Every once a year show your doctor how you
test your blood sugar and confirm that you are doing it correctly.
• When the weather gets cold, old aged individuals who have a decreased
ability to control body temperature and a less body fat have more
chance to face a drop in body temperature. Such people and their care
takers should take more care to prevent this from happening.
Q. Are diabetics more vulnerable to extreme cold conditions?
A .There is not much difference in terms of vulnerability to cold for a
normal diabetic compared to a normal person. But those diabetics who
have begun to lose sensation in their hands and feet need to be very
careful as the cold can cause damage to the hands or feet areas and the
person won't even feel the damage at the time.
Q. This is also a season when people tend to consume alcohol more to
ward off cold. Is alcohol harmful to diabetics even in limited
quantity? Is there any threshold limit?
A. Contrary to popular belief alcohol does not keep you warm. It
actually makes you lose more heat than usual. This is because it
dilates blood vessels and in winter dilated blood vessels allow more
heat to escape from the body compared to normal. Another thing for
diabetics to remember is that alcohol reduces your blood sugar levels
quite quickly so always eat some healthy snacks along with your drinks.
The safe threshold limit is one drink for a woman and two drinks for a
man per day. Anything more will have cancel out any beneficial effects
of alcohol on the body.
Q. In case people eat more and also occasionally drink, how often should they go for check ups?
A. Normally the doctor who is supervising your diabetes treatment will
decide who often you have to visit him. In addition to those normal
visits that can be once in a week to once in a month or even once in 3
months, you have to visit other specialist doctors one in a year or in
case you have any problems more often.
Q. What about juvenile diabetics and winter? Any special care or precautions to be taken?
A. Juvenile diabetic is an older term for Type 1 diabetic. There are
clinical studies that have found that environmental triggers contribute
to the onset of diabetes in people. More people are diagnosed with type
1 diabetes during winter months as well as in colder climates in
general, so cold weather is a suspected environmental trigger for
developing type 1 diabetes. Therefore to sum it up Type 1 diabetics
should follow all recommendations for the control of blood sugar levels
that all diabetics should follow.
Q. Any other comments, suggestions for our readers?
A. You have to visit other
specialist doctors once a year or more often in case you have any other problems.
from a conversation that I had which would be helpful to diabetics
during winter time.
Q. Does climate in any way, direct or indirect, affect diabetes?
A. Warm and Cold temperatures have no direct effect on diabetes control
but can affect it indirectly. While your blood sugar doesn't go up or
down in response to hot or cold outdoor temperatures, it does have an
impact on eating and exercise habits, which is a key factor in
controlling your blood sugar levels. In warm temperatures, the body can
be stressed due to heat and high humidity. And this can throw the blood
sugar levels out of control.
For those who are on insulin, storing it becomes a problem in warm
climates as improper temperatures can destroy insulin and it won't work
effectively if it is not stored correctly.
Winter season according to some studies is a cause for depression and
anxiety, which is a stressful state for the body and stress can in
turn, affect blood-sugar levels.
Q. Generally people tend to eat more during winter. They also snack
more. In such circumstances should diabetics take special precautions?
A. Only disciplined and responsible eating can help a diabetic control
their blood sugar levels. There is no real harm with snacking when you
are hungry but the key is to snack on healthy alternatives that only a
good dietician can guide you on.
Q. During winter, it is sometimes difficult to exercise because of the
cold. Diabetics are supposed to regularly exercise. What do they do?
A. For those who find it difficult to exercise in the cold they can try
other options such as:
• Heated pools: Swimming in a heated pool is a great way to stay active
in cold weather. Swimming is an ideal full body exercise for those who
have a lot of weight as they can exercise without risking damage to
their joints. • Working out at a Gym: Gyms offer many ways to keep
moving indoors, from aerobics classes to weight machine circuits.
Winter might also be a good time to test a trial membership. Studies
have shown that weight training in diabetics helps tone muscles and
keeps bones strong and healthy.
• Exercising at home: It's easy to be active even without leaving home.
o Housework: Routine house work can be exercise, and you will end up
with a neat and tidy house in the bargain. Playing fast-paced music may
also help.
o Exercise videos: Videos can help people stay focused, teach new moves
and provide good warm-up and cool-down periods. Exercise videos made
especially for people with diabetes are available. Online videos are
available which people can easily download and use.
All people who exercise need to remember to drink clean water or
electrolyte replenishing fluids and avoid sugary drinks.
Q. In places like Delhi, Chandigarh, Jammu temperatures dip to near
zero and in south in Hyderabad and Bangalore, the temperature goes
below 10 degrees C. What are the precautions that diabetics should take
in terms of skin care, diet, sleep, protection etc.
A. Winter brings special challenges to people with diabetes.
• Keep yourself warm. Wear layers of clothes. Staying warm requires
that you trap warm, dry air next to the body.
• Watch your weight. Winter can mean an extra 2-5 kilos for many
people. This is risky as weight gain increases your risk of heart
disease.
• Diabetes-related circulation and nerve problems can mean icy cold
feet. Don't use hot-water bottles, but rather just wear layers of socks
to keep your toes warm.
• Drink lots of water as people who are dehydrated will send their
sugar levels up
• Stay relaxed as stress leads to high sugar levels. For those whom
stress is a routine occurrence, they should learn and practice
relaxation exercises to combat stress.
• Don't ever guess your sugar levels. Sometimes we all feel lazy and
guess our sugar levels instead of testing it on the glucometer. This is
not the recommended option. Always test your blood sugar levels and
then take your medicines. Every once a year show your doctor how you
test your blood sugar and confirm that you are doing it correctly.
• When the weather gets cold, old aged individuals who have a decreased
ability to control body temperature and a less body fat have more
chance to face a drop in body temperature. Such people and their care
takers should take more care to prevent this from happening.
Q. Are diabetics more vulnerable to extreme cold conditions?
A .There is not much difference in terms of vulnerability to cold for a
normal diabetic compared to a normal person. But those diabetics who
have begun to lose sensation in their hands and feet need to be very
careful as the cold can cause damage to the hands or feet areas and the
person won't even feel the damage at the time.
Q. This is also a season when people tend to consume alcohol more to
ward off cold. Is alcohol harmful to diabetics even in limited
quantity? Is there any threshold limit?
A. Contrary to popular belief alcohol does not keep you warm. It
actually makes you lose more heat than usual. This is because it
dilates blood vessels and in winter dilated blood vessels allow more
heat to escape from the body compared to normal. Another thing for
diabetics to remember is that alcohol reduces your blood sugar levels
quite quickly so always eat some healthy snacks along with your drinks.
The safe threshold limit is one drink for a woman and two drinks for a
man per day. Anything more will have cancel out any beneficial effects
of alcohol on the body.
Q. In case people eat more and also occasionally drink, how often should they go for check ups?
A. Normally the doctor who is supervising your diabetes treatment will
decide who often you have to visit him. In addition to those normal
visits that can be once in a week to once in a month or even once in 3
months, you have to visit other specialist doctors one in a year or in
case you have any problems more often.
Q. What about juvenile diabetics and winter? Any special care or precautions to be taken?
A. Juvenile diabetic is an older term for Type 1 diabetic. There are
clinical studies that have found that environmental triggers contribute
to the onset of diabetes in people. More people are diagnosed with type
1 diabetes during winter months as well as in colder climates in
general, so cold weather is a suspected environmental trigger for
developing type 1 diabetes. Therefore to sum it up Type 1 diabetics
should follow all recommendations for the control of blood sugar levels
that all diabetics should follow.
Q. Any other comments, suggestions for our readers?
A. You have to visit other
specialist doctors once a year or more often in case you have any other problems.
08 October, 2008
Metformin in Diabtes treatment
One of the drugs commonly used in the medical treatment of Diabetes is Metformin. I am writing this article as I wanted to help diabetics better understand this medicine.
Metformin can be used alone or in combination with other medicines to treat Type 2 Diabetes mellitus. It is not used to treat type 1 diabetes.
First of all what does this medicine do in the human body. Metformin helps to control the amount of glucose (sugar) in your blood. It does this in three main ways:
- It decreases the amount of glucose you absorb from the food you eat and
- It decreases the amount of glucose made by your liver.
- Metformin also helps your body to respond better to insulin natural or injected.
Only your doctor can tell you how much Metformin and how many times a day you need to take. Do not take more or less of it than what your doctor has prescribed. Metformin controls diabetes but does not cure it. Continue to take metformin even if you feel well. Do not stop taking metformin without talking to your doctor.
Not everyone who takes metformin is a Type 2 diabetic. Metformin may be prescribed for other uses; ask your doctor for more information regarding this.
Once you start eating metformin you cannot start eating whatever food you like and stop doing any exercise. Diabetes treatment can only work when the person who has diabetes eats the medicines on time and also eats the correct amount of the correct food at the correct time and exercises at least 30 min a day 5-7 days a week.
In case you forget to take a dose take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
Metformin may rarely cause a serious, life-threatening condition called lactic acidosis.
Drinking alcohol increases your risk of developing lactic acidosis or may cause a decrease in blood sugar. Ask your doctor how much alcohol is safe to drink while you are taking metformin.
Side effects from metformin include a change in taste, loss of appetite, nausea or vomiting, abdominal bloating or gas, diarrhea, or skin rash. These may occur during the first few weeks of taking the medication but are seldom long-lasting. Taking the medication with food and starting out with a low dose help reduce side effects. The dosage can be gradually increased as side effects diminish.
Metformin may rarely cause low blood sugar levels or hypoglycemia.
Your doctor will tell you what you should do if you develop hypoglycemia. He or she may tell you to check your blood sugar, eat or drink a food or beverage that contains sugar, such as hard candy or fruit juice, or get medical care. Follow these directions carefully.
The following are symptoms of hypoglycemia: 
- shakiness
- dizziness or lightheadedness
- sweating
- nervousness or irritability
- sudden changes in behavior or mood
- headache
- numbness or tingling around the mouth
- weakness
- pale skin
- hunger
- clumsy or jerky movements
If hypoglycemia is not treated, severe symptoms may develop. Be sure that your family, friends, and other people who spend time with you know that if you have any of the following symptoms, they should get medical treatment for you immediately:
- confusion
- seizures
- loss of consciousness
Therefore who should not use metformin? In a nut shell, it should not be used by those who use more than two ounces or two drinks of alcohol everyday day, who have congestive heart failure, or who have significant kidney, liver, or lung disease.
The advantages of metformin are that it has a much short action time and has a much lower risk for severe side effects and is quite safe for use by anyone who is otherwise healthy. In fact, in the major UKPDS study, it was the only drug that reduced diabetes-related death rates, heart attacks, and strokes.
Metformin lowers fasting blood glucose levels by an average of 25%, postprandial blood glucose up to 44.5%, and the HbA1c by an average of 1.5%. Metformin reduces raised plasma insulin levels in cases of metabolic syndrome by as much as 30% and reduces the need for injected insulin in Type 2s by 15 to 32%.
Metformin possesses some distinct advantages in treating diabetes. Excess glucose produced by the liver is the major source of high blood sugars in Type 2 diabetes and is typically the reason for high blood sugars on waking in the morning. Metformin reduces this overproduction of glucose.
Because metformin shuts off the liver’s excess production of glucose, it reduces the amount of injected insulin needed to control the blood sugar in both Type 1 and Type 2 diabetes. People with Type 2 diabetes who are on insulin usually are advised to lower their insulin doses prior to starting metformin. The full improvement in glycemic control and cholesterol levels may not be seen until 4 to 6 weeks of use have passed.
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