DIACARE DIABETES SPECIALITIES CENTER
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Author: arun karthik

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GESTATIONAL DIABETES MELLITUS :

GESTATIONAL DIABETES MELLITUS :

Gestational diabetes mellitus or GDM is a term used to describe diabetes which occurs during pregnancy. GDM can be detrimental to the health of both the mother and the child if not addressed early on.

When a pregnant woman develops diabetes, the sugar levels in her blood goes up. Now, this is the same blood which circulates in the womb and therefore the baby. Depending on the timing of pregnancy,eg, first trimester,second or third , the fetus may develop several complications ranging from neural tube defects ( nerve damages) ,spontaneous abortions,still birth to big baby syndrome and neonatal hypoglycemia( low blood sugar at birth). In order to prevent such complications ,all care must be ensured to maintain strict diabetes control,and at the same time ensuring adequate nutrition to the mother and the baby, to achieve healthy growth of the foetus .

1) Who are at risk of getting GDM?

  • All women above the age of 30
  • Family history of diabetes
  • PCOD
  • Obesity
  • Hypothyroidism( low functioning thyroid gland)
  • Insulin resistance syndromes

2)When does it occur?

Typically GDM occurs in 7 th month .Almost 80-90%of the cases are diagnosed by the end of 28 weeks. But in some cases the mother may develop diabetes as early as 1st trimester.

3)How is gestational diabetes diagnosed?

The diagnosis of GDM is done by a Glucose Tolerance Test or the GTT. There are 2 methods being followed . One is by giving 75 gms of glucose to the and measuring blood sugar in 2 hours .A value above 140 mg/dl is indicative of GDM

The second method is a little extensive , by giving 100gm glucose and measuring every half an hour for 2 hours.

4) What is the treatment?

Just like other types of diabetes, the treatment includes diet,exercise and medications. Diet is an integral part of management of GDM. Gestational diabetes diet plan includes avoiding all junk and refined foods..We encourage mothers to eat right,not eat less.3 major meals including complex carbohydrates ,protein and healthy fats,and 2-3 minor low carb high protein snack, a lot of fruits and vegetables and lean meat ensuring a balanced calorie intake of 2000-2500 kcal/day.

5) Do we have to take insulin ?

We recommend frequent monitoring of blood sugar levels at home using a glucometer and maintaining a log. This is used to decide on the medications. According to gestational diabetes guidelines, a lot of oral medicines are not approved for use in pregnancy, Insulin is the mainstay of treatment, when it comes to GDM

6) Will the diabetes continue after delivery?

Depends on the time of onset.Most cases of GDM, become normal after delivery.However a majority of the mothers develop over diabetes in middle age.And no, the child will not contract diabetes after delivery,although the chances of childhood obesity and future diabetes are higher for children born to GDM mothers .

7) How to prevent developing GDM?

The same methods recommended to prevent any diabetes apply here too.

  • Maintain an ideal pre pregnancy weight,especially if you have a family history
  • Exercise regularly. It will improve insulin resistance
  • If possible, complete your family before 30 yrs. Chances of GDM increases after 30 yrs
  • Reduce stress levels.

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DIABETIC HEART DISEASE:

DIABETIC HEART DISEASE:

Heart is one of the four major organs affected by diabetes , apart from nerves ,eye,and the kidneys. Conversely,diabetes is one of the seven major risk factors that have been attributed to heart disease. Therefore, both diabetes and heart disease share a common origin ,which is poor lifestyle choices,( diet and lack of exercise ) and therefore obesity .

Although one might get a heart attack out of the blue ,the changes that lead to this event do not happen overnight.Research shows that damages to the heart tissues start to develop much earlier to the onset of diabetes itself ! Microscopic changes occur in the blood vessels of the heart ,called endothelium ,due to a process called inflammation. This inflammation is caused due to high blood sugar, high BP, high cholesterol levels,smoking or stress, among others.In our centre, we do certain blood tests to measure the levels of these inflammatory markers like CRP,Apo A ,ApoB,Lp a and lipid profile to identify the risk early and suggest methods to mitigate it.This is the first line of defence.

However , since the actual symptoms of heart disease,such as chest pain,shortness of breath, pain in the arm or jaw and swelling of the feet, present very late ,the only way to prevent the heart problems is by regular ECG screening and blood testing. To complicate matters, diabetics have a peculiar problem of silent ischemia. Due to the damage to the nerves by diabetes, the sensation of chest pain might not reach the brain during the attack , leading to late presentation to the hospital,until it is too late.Therefore we strongly recommend all diabetic patients to undergo cardiac testing at least once a year.

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DIABETIC RETINOPATHY

DIABETIC RETINOPATHY

Diabetic retinopathy is a condition where suboptimal control of diabetes leads to damages in the retina. Basically, the eye is like a camera. The images which pass through the eye,land on the retina or the screen at the back of the eye. These images are sent to the brain to be processed. In diabetic retinopathy, this screen starts to get damaged,gradually. Initially small points of blood vessels start to appear on the ritina,called microaneurysms.These aneurysms are however weak blood vessels,which over passage of time start to rupture and bleed into the retina. Also, fluid starts to accumulate on the retina ,known as diabetic macular edema.However ,although all these changes keep occurring in your eyes, diabetic retinopathy symptoms occur very late.You would not notice any changes in your vision until about 70-80% of the retina is damaged. All of a sudden one fine day you might experience blurred vision or black spots in the eye, or more commonly,small speck or insect-like spots floating in front of you ,called floaters.In severe cases, you might wake up with part of your vision in one of the eyes lost. What would have probably happened is that there would have been significant bleeding inside the eye. In short, once there is a loss of visiondue to diabetes ,it might be difficult to recover the vision.In advanced cases , the retina or the screen gets detached or pulled off from the wall, with a considerable vision loss.This is called retinal detachment.

So how do we prevent this from happening?

  • First and foremost, good diabetes control.
  • Secondly, we check your eyes yearly once ,to make sure that your retina is ok. We use a special digital device , called a fundus camera, which captures the image of your retina through your eyes. This is called digital retinal photography. With this we grade the eye into categories like,non proliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR). Depending on the severity, patients are sent to an eye doctor for laser treatment, which involves caurterising the leaking blood vessels using a laser light.In some cases injections are given in the retina
  • This is extremely helpful in identifying the extent of damage due to diabetes, not only inside the eyes,but also these results can be extrapolated to other organs, like the kidneys. For example,if your retina is damaged, so will be your kidneys,since essentially ,it is in the same body.

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LOW BLOOD SUGAR OR HYPOGLYCEMIA

LOW BLOOD SUGAR OR HYPOGLYCEMIA

Low blood sugar or hypoglycemia is the most important side effect of diabetes treatment. Any blood sugar value of less than 70 mg /dl is called low sugar.For any doctor, the biggest challenge is in getting the sugar levels under good control ,that is between 90 to 160 mg/dl at any given time of the day ,without letting it go below 70. This becomes more tricky in elderly people, because any giddiness and subsequent fall might land them in the hospital.

What are the symptoms of low sugar ?

Giddiness,palpitations,sweating,tremors or shivering of the hands ,and extreme hunger are the common symptoms of low sugar. In elderly people confusion, incoherent and unrelated talking (blabbering), passing urine in their paint without their knowledge,are some symptoms that can occcur. In rare cases p,the patient can go into a hypogycemic coma.

How do we minimise the chances of hypoglycemia in our patients ?

  • Educating about low sugar. This is the single most important step in managing or avoiding low sugar.We educate patients regarding low sugar symptoms and several tips to avoid low sugar.Low sugar snacks for correcting , in case of hypoglycemia.
  • Discussing with patients about the nature of their job (night shifts ,for instance), and suggesting the most comfortable and right time to plan their meals
  • Choosing the right foods. Foods that are digested slowly so that glucose is released slowly into the blood.This way we can avoid sudden spikes and sudden drops in blood sugar.
  • Choosing the right medicines. Some medicines are very mild and have a lower tendency of causing low sugar, even if food is delayed. Such medicines work well for older people. But some medicines can be a little more potent,and have to be chosen for patients with very high blood sugar, atleast for a short period .The key is in choosing the right mix, like adding salt in a delicious dish. Not too little, not too much.

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DIABETIC FOOT DISEASE & DIABETES FOOT CARE IMPORTANCE

DIABETIC FOOT DISEASE & DIABETES FOOT CARE IMPORTANCE

One of the major complications of diabetes is that it affects the feet , leading to non healing wounds ,called TROPHIC ULCERS in the bottom of the feet. In severe cases, this can even lead to amputation at the knee level !.

Let’s understand the diabetic foot symptoms . Now this process happens in 4 stages.

1. DIABETIC NEUROPATHY/ (DIABETIC NERVE DISEASE):

Firstly, the nerves of the feet get damaged due to uncontrolled sugar levels. At this stage, patients may have symptoms like burning sensation in the feet , numbness or cramps in the feet,especially at night . At times, this can be unbearable. At this stage proper control of sugar levels ,and certain medicines to alleviate the pain can remarkably reverse the damage due to diabetic neuropathy.

2. CALLOUS :

But more often than not,people ignore these symptoms ,leading to the second stage, called callous formation . Callous are thickening of the skin in the bottom of the feet,especially below the great toe,due to abnormal pressure points, caused due to diabetic neuropathy. At this stage , you may develop pain in the area where the callous is present,while walking. In time,small punched out ring-like holes form in the location of callouses.These are called TROPHIC ULCERS, ,the third stage .In our centre, our podiatric (diabetic foot care) department , prevent formation of such ulcers,by a process called chiropody. What we do is,carefully remove the hard callous with special blades, so that the pressure is relieved. This process, called chiropody, is like nail cutting , and is virtually painless.

3. DIABETIC FOOT ULCER :

Once a diabetic foot ulcer develops, it is extremely difficult to get rid of it. The 2 important treatment aspects are ,sugar control and foot pressure relief.No amount of antibiotics or dressings can heal the wound.Many of you who are reading this article, may have experienced this, with your family members. The wound keeps coming back and forth,despite several dressings. Using specialised instruments ,called BIOTHESIOMETER ,DOPPLER & PODISCANNER, we scan the extent of nerve damage, blood vessel blocks and abnormal pressure points in the feet ,and ,advise specific diabetic footwear for pressure relief.Only with proper pressure relief,will the diabetic foot ulcers heal.

4. AMPUTATION :

If these ulcers are ignored, one fine day the toes (most commonly great toe ) gcan get infected, leading to amputation of the toe.This is the advanced stage, where the patient is referred for surgery. If the blood flow to the feet has been compromised due to diabetes, then people may often lose their limb as well. This is what we try to prevent at all costs.If you do not want to land in this situation , we have a simple mantra – CONTROL YOUR DIABETES FROM EARLY ON.

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DIABETES TREATMENT:

DIABETES TREATMENT:

Diabetes treatment essentially consists of 3 pillars-Diet,Exercise & medications .Unless these 3 areas are properly addressed ,it is near to impossible to control diabetes,especially in the long term. However, these three areas have to be tailor made for each individual and can never be one size fits all . For example, the dietary needs of a door to door salesman can be much higher than that of a software engineer or a banker. Similarly, exercise regimen for each of these individuals may vary. Many a times, we come across neglected diabetics,whose legs have been amputated, where the scope for exercise might be limited . To make the long story short every individual who walks into our centre gets a customised treatment plan as per his or her requirement, lifestyle and other demographics.

DIET:

Diet plan forms the crux of diabetes treatment. More disciplined your meal plan, the lower your medications. And, just like you, we don’t like medicines either, and we try to keep it to a minimum.In fact lowest possible is one of our key result areas.

Coming back to diet, every time you come to our centre, our dietitians enquire about how your diet plan was and were you successful in implementing and what are your pitfalls. Let’s face it,not many can stick to diet discipline 100%. And we know that as well. However, the fact is, you can certainly have some cheat days and still control your diabetes. How to do it, we will teach you some great hacks. Our You tube channel has some fantastic diet plans which are ready for your use. After thoroughly understanding your daily chores , we help you alter your diet with healthier options ,thus helping youget the best of both worlds.You can choose from a range of patterns like a 2 meal pattern, 3 meal pattern & a 5 meal pattern. Also,you have a choice of south indian, north indian ,vegetarian,non vegetarian and jain diet as well.

EXERCISE:

Exercise is an integral part of diabetes treatment. People who exercise regularly not only have lower chances of getting diabetes, but exercise also reduces the number of medicines which you might be taking.. A brisk walk for about 45 minutes a day is all that is required to reduce your HbA1c by about 1% roughly. For people who have arthritis we conduct physiotherapy sessions to reduce pain and increase mobility..

MEDICINES:

We know that you hate medicines,…right ? So do we. But we gotta do what we gotta do. We try our best to give you the least number of medicines required , to get your sugar under control.The game plan is to delay , or possibly defer potent medicines or insulin as much as possible .

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DIABETES PREVENTION:

DIABETES PREVENTION:

PREVENTION IS BETTER THAN CURE- THIS ADAGE CANNOT BE MORE APT FOR ANYTHING ELSE THAN DIABETES. IT IS EASIER, AND CERTAINLY POSSIBLE TO PREVENT DEVELOPING DIABETES, THAN TREATING IT. THIS IS ATTEMPTED IN EVERY STAGE OF NATURAL HISTORY OF DIABETES , IN OUR CENTRE.

PRIMODIAL PREVENTION:

PRIMORDIAL PREVENTION IS TREATING BEFORE ONSET. IT INVOVES IDENTIFYING PEOPLE AT RISK. FOR EXAMPLE , PEOPLE WITH STRONG FAMILY HISTORY OF DIABETES,OBESE &OVERWEIGHT INDUVIDUALS,SEDENTARY JOB PROFILE, ARE ENCOURAGED TO UNDERGO SCREENING & RISK ASSESMENT. THIS IS GENERALLY DONE TO ATTENDANTS OR FAMILY MEMBERS WHEN THEY ACCOMPANY THE PATIENTS TO OUR CENTRE (FREE OF CHARGES TOO). AND MANY A TIMES, BODERLINE CASES HAVE BEEN IDENTIFIED AND RISK FACTORS MITIGATED WITH LIFESTYLE CORRECTIONS &DIET MODIFICATIONS IN THE EARLIER STAGES ITSELF.

PRIMARY PREVENTION:

PRIMAY PREVENTION IS ,SIMPLY PUT,PREVENTING BODERLINE CASES FROM BECOMING DIABETICS. THIS IS NOT DONE WITH USING MEDICINES. BUT MEASURED, CUSTOMISED CHANGES ARE DONE TO THE DIET AND EXERCISE REGIMEN OF PREDIABETIC INDUVIDUALS , ATTEMPTING TO REVERSE THEM TO NORMAL STAGE, OR ATLEAST KEEPING THEM IN PRE DIABETES ITSELF.

SECODARY PREVENTION:

THIS IS THE MOST COMMON CATEGORY. NOW THAT YOU HAVE DEVELOPED DIABETES ,WE WORK ALONG WITH YOU,EDUCATING,MOTIVATING , AND GUIDING YOU TO MAINTAIN GOOD CONTROL OF DIABETES,THROUGHOUT YOUR LIFE , IN ORDER TO PREVENT DEVELOPING COMPLICATIONS & DAMAGING YOUR ORGANS.AND BE INFORMED, IT IS CERTAINLY DOABLE.

TERTIARY PREVENTION:

WELL,THIS IS THE STAGE WERE WE DON’T WANT YOU TO LAND IN. USUALLY SEEN IN NEGLECTED CASES OF DIABETES WHO COME TO US A BIT TOO LATE,THE ORGAN DAMAGES HAVE ALREADY BEGUN . UNFORTUNATELY, NOT ALL DAMAGES CAN BE REVERSED. WE TRY OUR BEST TO PREVENT END STAGE DAMAGE SUCH AS RENAL FAILIURE, HEART ATTACK,,BLINDNESS OR LIMB AMPUTATIONS.

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Online Consultation

ONLINE CONSULTATION:

IN THE COVID ERA, WHERE VISITING PUBLIC SPACES HAS BEEN A CAUSE FOR CONCERN,WE PROVIDE ONLINE CONSULTATION TO OUR PATIENTS AT THE COMFORT OF THEIR HOMES. ALL YOU HAVE TO DO IS BOOK AN ONLINE APPOINTMENT, FILL UP A GOOGLE FORM,MAKE A PAYMENT AND THE DOCTOR WILL GET BACK TO YOU.

WHAT’S MORE, WE CAN HOME DELIVER THE MEDICINES AS WELL. IF YOUR LOCATION IS ACCESSIBLE TO US, WE CAN HAVE YOUR BLOOD SAMPLES COLLECTED AT YOUR PREMISES TOO.IN SHORT, YOU CAN HAVE YOUR ENTIRE EXERCISE COMPLETED, WITHOUT SETTING FOOT OUTSIDE YOUR HOME.

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Pharmacy

PHARMACY:

WE HAVE A WELL STOCKED PHARMACY WHICH SELLS ALL DIABETES AND RELATED LIFESTYLE MEDICINES AND HEALTH DRINKS.ON TOP OF THAT,WE ALSO OFFER DISCOUNTS UPTO 15% .AND IT IS OPEN FROM 7 AM TO 9 PM

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Weight Loss & Obesity Management

Weight Loss & Obesity Management:

Getting more physical activity or exercise is an essential part of obesity treatment: Exercise. People with obesity need to get at least 150 minutes a week of moderate-intensity physical activity. This can help prevent further weight gain or maintain the loss of a modest amount of weight..

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