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Not All Surgery

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Shock was writ all over her face and her husband’s. “How can I have diabetes,” asked the young woman. “When I saw the result of the blood sugar test, I thought it was a mistake. No one in my family has diabetes!” Well, that may be true, but it is also a fact that 2 per cent of the Indian population has diabetes and 15 per cent of pregnant women have abnormal blood glucose values.

Despite the epidemic of diabetes in our young urban adults, statistics about the exact prevalence of the disease in pregnancy are difficult to obtain. Many pregnant women are not tested. In centres offering antenatal care, the presence or absence of “sugar” in the urine — an unreliable test at best — is used to diagnose diabetes.

Blood should be tested as part of routine antenatal care. A fasting glucose level of more than 126mg/dL or 7mmols/L in pregnancy is considered abnormal. A blood sample can also be drawn one hour after ingesting 50g of glucose. A normal value is less than 140mg/dL or 7.8mmols/L. If it is higher, it needs to be followed by a three-hour OGTT (oral glucose tolerance test) with a 100g glucose load. A positive diagnosis is made if the fasting value is 105mg/dl, the one-hour value 190 mg/dL, the two-hour value 165mg/dL and the three-hour value 145 mg/dL or more.

Some of the women with these values are diabetics who are asymptomatic and unaware of their condition. Others have relative insulin insufficiency, or MODY (maturity onset diabetes of the young), and are already on oral diabetic medications. Women with polycystic ovarian syndrome may be on the oral diabetic drug metformin. They may become overtly diabetic during pregnancy.

Others with abnormal blood sugar levels have gestational diabetes mellitus (GDM), a peculiar type of glucose intolerance which first appears during pregnancy in an otherwise normal woman. It can occur at any time during the pregnancy, though it is more likely to occur after 24 weeks. The exact reason for gestational diabetes is not known.

Women at risk are those who:-

* Have a family history of diabetes,

* Have a BMI (body mass index — that is, weight in kilogram divided by height in metre squared) of more than 30,

* Are older than 25,

* Have previously had large babies (more than 4kg) or still births.

The glucose in the mother’s blood crosses over via the placenta to the baby. The excess sugar supplied makes the baby grow rapidly. The baby’s pancreas starts to work overtime to lower the sugar to normal by secreting insulin. The excess calories are stored as fat. This gives rise to a large baby (macrosomia) weighing more than 4kg. This in itself increases mortality by 50 per cent. The size may cause the baby to get stuck in the birth canal. Forceful extraction can result in fractures of the collarbone or paralysis of the nerves to the arm. After birth, the baby’s pancreas continues to produce high levels of insulin as it is acclimatised to do so. This may cause the blood sugar levels in the baby to drop precipitously. The baby may then have seizures. In addition, it may develop other problems such as low blood levels of calcium and magnesium. Many babies also die (that is, are still born) while others (up to 50 per cent) may have breathing difficulties.

About 33 per cent may have polycythemia (excess blood) and 16 per cent develop jaundice at birth or soon after.

Mothers with GDM are also prone to develop other complications during the pregnancy such as hypertension. Almost 60 per cent of these women develop GDM in subsequent pregnancies, particularly if there has been maternal weight gain between the two pregnancies. Around 35 per cent will go on to develop diabetes in the next 15 years. The blood sugar in mothers with GDM should be well controlled to prevent complications in her as well as the baby. Diet regulation is needed to keep the sugars under control. Since not all women with GDM are obese, the diet has to be adjusted in accordance with the mother’s BMI. The diet should consist of 40 per cent carbohydrate, 20 per cent protein and 40 per cent fat.

Pregnant women do not really “have to eat for two”. The calorie requirements are

*35kcal/kg/ 24hour for a woman of normal weight (BMI 25).

* 24kcal/kg/ 24hour for overweight women (BMI 25-30).

* 12 to 15 kcal/kg/24hour for morbidly obese women (BMI 30-40).

* 40kcal/kg/24hour for underweight women (BMI less than 25).

A combination of diet control and aerobic exercise such as brisk walking for 45 minutes every day usually keeps the blood sugars normal. If the sugars remain high, insulin therapy may have to be started. Many of the oral diabetic medications cross the placenta and cause hypoglycaemia in the baby. Some of them are, however, used under supervision.

Unlike other forms of diabetes, which are permanent, GDM disappears after delivery. It, however, acts as a warning. Exercise for 45 minutes or more a day, reduce your weight and maintain your BMI at 23. That way, diabetes may not plague you in your later years.
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Source: The Telkegraph (Kolkata, India)

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Oxygen Heals Foot Wounds in Diabetics

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Scientists have claimed that oxygen treatment can help diabetics heal foot wounds and avoid lower limb amputation...

Every 30 seconds a person somewhere in the world loses a lower limb to amputation due to diabetic foot disease. Now, an international team has found in their study that oxygen can heal the debilitating wounds that plague people with diabetes.

In their study, the scientists have modelled the use of hyperbaric oxygen therapy (HBOT), which is the intermittent exposure of the body to pure oxygen under pressure, to heal the chronic wounds that lead to the need for amputation.

Jennifer Flegg of Queensland University of Technology, who led the team, said a small cut on the foot of a diabetic could have catastrophic effects because their wounds did not heal the same way as normal wounds.

Source: The Times Of India

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A Grapefruit Pill to Fight Obesity

Tart and tangy with an underlying sweetness, grapefruit has a juiciness which rivals that of the ever popular orange and sparkles with many  of the same health promoting benefits.And, now researchers are on track to develop a pill from a chemical compound in grapefruit, which they claim would help obese people shed the flab and diabetics control their blood sugar levels.

Researchers at University of Western Ontario have found that naringenin, the chemical compound that gives grapefruit its bitter taste, has revolutionary effect on the liver making it burn fat instead of storing it after a meal.

CLICK & SEE THE PICTURES

According to them, this means that without having to change diets or cut out particular foods, a dose of naringenin could prevent weight gain and even help to lose it as well as help those having diabetes to control blood sugar levels.

Lead researcher Murray Huff said: “The study shows naringenin, through its insulin-like properties, corrects many of the metabolic disturbances linked to insulin resistance and represents a promising approach for metabolic syndrome.”

They have based their findings on an analysis of tests which were carried out on mice — two groups of rodents were both fed the equivalent of a Western diet to speed up their “metabolic syndrome”, the process leading to Type 2 diabetes.

Source:    The Times Of India

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Exercise Cuts Negative Effects Of Belly Fat

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Moderate exercise can reduce the negative effects of belly fat, which is linked to metabolic syndrome, says a new study. Metabolic  syndrome increases the risk of developing cardiovascular disease and Type 2 diabetes.

……..CLICK & SEE THE PICTURES

“The benefits of exercise were apparent, even without a change in diet. We saw improvements in insulin sensitivity, less fat in the liver, and less inflammation in belly fat,” said Jeffrey Woods, a professor at the University of Illinois (U-I) who led the study.

Inflammation is the response of body tissues to injury or irritation; characterized by pain, swelling, redness and heat. Kinesiology is the science of human movement and it focuses on how the body functions and moves.

Belly fat is particularly dangerous because it produces inflammatory molecules that enter the bloodstream and increase the risk of heart disease and diabetes, he said.

Woods and his colleagues examined the effects of diet and exercise on the inflammation of visceral or belly fat tissue in mice. A high-fat diet was first used to induce obesity in the animals.

After six weeks, mice were assigned to either a sedentary group, an exercise group, a low-fat diet group, or a group that combined a low-fat diet with exercise for six or twelve weeks so the scientists could compare the effects in both the short and long term, said an Illinois release.

“The surprise was that the combination of diet and exercise didn’t yield dramatically different and better results than diet or exercise alone,” said Vicki Vieira, study co-author.

Woods said that it is a promising finding. “The benefits of exercise were apparent even if the animals were still eating a high-fat diet. That tells me that exercise could decrease or prevent these life-threatening diseases by reducing inflammation even when obesity is still present.”

“The good news is that this was a very modest exercise programme. The mice ran on a treadmill only about one-fourth of a mile five days a week. For humans, that would probably translate into walking 30 to 45 minutes a day five days a week,” he noted.

Sources: The Times Of India

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Diabetic? Look Into Your Mouth

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A painless route to early diabetes detection: —

Bye bye, painful finger pricks. Now a spit is more than enough to know whether you suffer from diabetes. The news is particularly sweet for the millions who are feared to be on the verge of joining the growing global epidemic called diabetes.

The alarm for the disease may now be rung really early. A saliva test, developed by a team of researchers from the Hyderabad-based Nizam’s Institute of Medical Sciences (Nims) and their counterparts in a private US firm, may help to spot the metabolic changes associated with diabetes much before the clinical symptoms set in. An early diagnosis can help patients keep the blood sugar levels in check, thus avoiding diabetes-linked complications that afflict many organs including the kidney and eyes.

The study, which appeared online recently in the Journal of Proteome Research, reports that even in a country like the US (boasting of an efficient healthcare system) nearly seven per cent of the newly diagnosed type-2 diabetes patients had actually been diabetic for approximately 4-7 years before the diagnosis. “The ability to ascertain those individuals at risk for the development for clinically apparent diabetes is critical to effectively focus potentially limited clinical resources,” the researchers say in the paper.

The scientists have found that out of a total of 487 proteins in human saliva, in diabetics 65 are more than twice as high as compared to normal people. More significantly, such raised protein levels are found in those who are years away from being full-fledged diabetics. The scientists claim that the level of these biomarkers — which are associated with metabolism and immune response — are noticeably high even in those suffering from impaired glucose tolerance and impaired fasting glucose, which manifest much before clinical symptoms of diabetes set in.

“Our primary objective is to find an alternative to the conventional blood sugar test for diagnosis and monitoring, the latter being important to adjust drug doses,” says Paturi V. Rao, a researcher at Nims and first author of the study. “It is possible to replace blood glucose tests with urine and saliva tests,” says Rao whose team reported a similar work with urine proteins last year.

According to Dr Anoop Misra, head of internal medicine at the Fortis Group of Hospitals, New Delhi, the work is exciting as it opens a new avenue of research into early diagnosis of diabetes (which currently afflicts more than 30 million Indians). The more worrying concern for medical experts is that the number is still climbing and the curve is nowhere near taking a downward plunge.

Misra, however, doesn’t expect it to come to the realm of practical application too soon. “Blood test remains the gold standard for diabetes diagnosis. I don’t think anything can replace it soon,” he says.

If the saliva test can pick up early signals of diabetes, as the scientists claim, it can prove to be a boon — families, in which members are diabetic, can ascertain whether the disease has been handed down to the offspring. For instance, a 13-year-old in a diabetic family can be checked to see whether he or she will become diabetic, say, 10 years later, Misra hopes.

Rao, who collaborates with the Oregon-based US firm DiabetOmics in this new research, says the team has found enough urine and saliva markers in diabetes. “Our urine test device should be ready by this year end and the saliva device next year,” Rao told KnowHow from Berlin.

An additional advantage of having such a non-invasive diagnosis, according to the authors, is that it can make more diabetics comply with regular monitoring. “Compliance with glucose monitoring is poor because of the pain and inconvenience of the conventional blood collection using lancets,” the researchers say.

The saliva test is the latest among several non-invasive diagnostic methods being attempted by medical scientists. Nearly two years ago, GlucoLight, a Pennsylvania-based company, announced the availability of a painless way of measuring blood sugar levels using light beams. The technique is said to be particularly useful for those who need to check sugar levels several times a day for taking insulin jabs.

Sources: The Telegraph (Kolkata, India)

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