Arun is a 52-year-old energetic and a busy entrepreneur. With everything going his way, he has only one stumbling block – he suffers from diabetes. Although his wife keeps a watch on his diet and exercise routine, she worries about an emergency situation if Arun’s sugar level were to fall. Like Arun, there are a number of people who suffer from the disease. India is quickly becoming the diabetic capital of the world and with almost every household having one diabetic, it’s only wise that you know more about diabetic emergencies. We spoke to our expert Dr Rajiv Kovil, leading diabetologist, about what you should have at hand in the case of an emergency.

Dr Kovil says, ‘the three most common complications related to diabetes are  hypoglycaemia (low sugar), diabetic ketoacidosis (high blood sugar) and hyperosmolar non-ketotic coma, a condition where the person’s blood sugar goes above 600 units.

Again, in hypoglycaemia , there are basically three main types:

Mild hypoglycaemia is where the patient feels uneasiness, dizziness, excessive sweating etc. In such a case, all the person has to do is have an extra serving of some carbohydrates (candy, chocolate or fruit juice).

In the case of moderate hypoglycaemia, the patient experiences severe symptoms like excessive sweating, cold palms and feet, dizziness, palpitations, confusion, irritability, pale skin, trembling, weakness, anxiety, etc. In such a case, he/she will require someone to take care of him/her.  The best way to quickly raise the sugar level is to place sugar or honey under the patient’s tongue and immediately seek medical attention.

Severe hypoglycaemia is where the patient needs to be hospitalised for low sugar and treated accordingly. Symptoms include headache, poor coordination, severe confusion, fainting spells, numbness in the mouth and tongue and finally coma. In such a situation, the caretaker should immediately seek emergency medical attention.  

According to Dr Rajiv Kovil, ‘The red flag in the case of people suffering from hypoglycaemia is called the triad – display of classic symptoms, low glucose level and the indication that the person responds well after eating something sweet.’

The best way to help a patient out of a diabetic episode is to give him/her at least 15 grams, of any of the following foods:

• four to six pieces of hard candy
• half a cup of fruit juice with sugar
• half a cup of any soft drink (not the diet variety)
• one tablespoon of honey
• one tablespoon of sugar
• one tablespoon of corn starch
• one glucose tablet

Dr Kovil advises, ‘Moderate to severe hypoglycaemia should be assessed properly. Severe hypoglycaemia in elderly patients and those who suffer from hypoglycaemia unawareness (those who do not experience the symptoms of hypoglycaemia) require a thorough check up and identification of the possible risk factors. It is paramount to managing diabetes appropriately.’

The other two diabetic emergencies are due to high blood sugar. ‘High blood sugar leads to the  breakdown of fat cells and the formation of ketone or blood acids. This is an extremely dangerous condition which can lead to severe complications such as coma or death,’ says Dr Rajiv Kovil.

The symptoms of both the conditions are, excessive thirst, frequent urination, nausea and vomiting, abdominal pain, shortness of breath, fruity-scented breath and confusion. Both diabetic ketoacidosis and diabetic hyperosmolar non-ketotic coma are extremely serious conditions, which require immediate hospitalization. If a person is at risk of suffering from either of the two conditions, he/she can monitor their blood sugar levels and ketone levels in their urine through home test kits.

Lastly, Dr Kovil says, ‘It is important to realise that not all patients show similar symptoms. While some may show no symptoms at all, others might manifest the disease differently. In either case, it is essential to get regular check-ups from a good diabetologist. In case of patients who suffer from diabetic ketoacidosis or hyperosmolar  non-ketotic coma, their doctor must make it a point to check for other underlying conditions such as infections or malfunctions of organs.’

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The Federation of Obstetric and Gynaecological Societies of India (FOGSI) hopes that the 1,000 doctors, trained in endocrinology during their course, would be able to detect signs of diabetes early and counsel their patients on managing it better.

‘We hope they also establish diabetes in pregnancy (DIP) clinics for a focused and specialized care of such women. Through meal plans they may not even have to get diabetes,’ says FOGSI president Dr Hema Dhivakar. The 1000 doctors would be taught by 100 master trainers, including gynaecologists and endocrinologists. Doctors said women who develop GDM are likely to get diabetic later in life without proper care and make even their children susceptible to the disease.

What is gestational diabetes?

Pregnant women who were not diabetic before but who have high blood sugar levels during pregnancy are said to have gestational diabetes (GD). Normally, the disease affects women quite late in her pregnancy, around the 24th week. The disease does not show noticeable signs or symptoms. In some cases however, gestational diabetes may cause excessive thirst or increased urination. Read more about the disease here. 

But what is ‘diabesity’? How are obesity and diabetes related? 

According to the scientific work of Dr Neal Bernard in his ‘Program for reversing diabetes’, the cause of insulin resistance is fat in the muscle cells (intramyocellular lipids) while reduce the sensitivity of the receptors to insulin. And this is one of the major causes for diabetes.

In a healthy person, who has his insulin receptors working optimally, insulin lodges on the receptors and signals the gates to open for glucose to enter. The body then uses the glucose for all functions of the body.

However, in an obese person, the insulin receptors are less sensitive. The insulin is not effective enough to signal the uptake of glucose. This causes an increase in blood glucose levels.

Logically speaking, if one consciously works at maintaining a healthy weight, he/she can reduce their risk of diabetes. Here are a few tips:

• Eat three healthy meals a day including a nutritious breakfast. Add 2 – 3 healthy snacks per day.
• Replace processed foods with whole grain and high fiber foods.
• Limit red meats. You are at a 20 percent greater risk of getting diabetes than those who don’t eat red meat. Choose nuts, seeds, lentils (dal), fish or poultry instead.
• Consume lots of fruits and vegetables such as greens, carrot and broccoli. Choose fresh fruits instead of fruit juices.
• Swap high calorie foods for low calorie ones. For example, choose low fat cheese instead of regular ones, or skim milk instead of whole milk.
• Lose weight if you are overweight. Losing even a moderate 5 – 7 percent of the body weight can make a big difference.
• Inactivity increases diabetes risk. Studies have shown that for every 2 hours you spend watching TV or being idle, you increase the chances of diabetes by 14 percent. ‘Working your muscles more often and making them work harder improves their ability to use insulin and absorb glucose. This puts less stress on your insulin-making cells,’ according to the Harvard School of Public Health.
• Even if you are not much into gyms, brisk walking for half an hour every day can reduce diabetes risk.
• Quit smoking. Those who smoke increase their diabetes risk by 50 percent as compared with non-smokers.
• Keep your alcohol consumption under moderation. One drink a day for women and up to 2 drinks per day for men is okay. If you don’t drink, then there is no need to start.
• It is very important to monitor disease progression by getting your blood glucose levels checked as per the instructions of your healthcare provider. So, if your tests show that you have prediabetes, it is high time for you to make those diet and lifestyle changes. 
• Eat plant foods in their most natural state, without the use of refined products like oil, ghee, butter, hydrogenated fats (vanaspati).
• Processed foods are also best avoided as they are typically high in fats and refined products. Add whole foods like whole unpolished rice, whole wheat, unpeeled vegetables and fruits to your diet.

The detailed study across the country on diabesity (diabetes plus obesity) will be supported by University of Dresden, Germany and Beijing Genomics Institute of China. BLK Super Speciality Hospital in the national capital is the nodal centre in India for the study. According to the doctors, mostly affluent urban Indians are now obese and obesity is increasing rapidly among urban school children. The populations which was under-nourished for a long time are now exposed to the overnourishment of the modern world through globalisation and westernisation, which has led to increased consumption of junk food, said Praneet Kaur, CEO, BLK Super Speciality Hospital.

‘With the bad fat nutritional history of the developing world, the epidemic is exploding in developing countries. In order to address this, the study will help to explore various modalities and therapeutic interventions,’ Kaur said. Indians are more vulnerable to diabetes because genetically they have a higher percentage of body fat to muscle compared to Europeans.

As per the doctors, the fat is usually deposited around the abdomen, where it interferes with insulin and increases sugar levels in the blood, causing diabetes in people with a low body mass index. The study will also discuss about safety, durability of diabetes recovery and long- term outcome of surgical diabetes therapy.

What is diabetes?

Diabetes is a metabolic disease which is characterised by high blood sugar levels. It can be caused either due to the lack of insulin (type 1 diabetes) or because the body’s cells fail to respond to the insulin produced (type 2 diabetes). Some of the common symptoms of diabetes are hunger, frequent urination and increased thirst. While type 1 diabetes is usually genetic, type 2 diabetes is caused more by lifestyle factors. It is one of the common ‘lifestyle diseases’ which is plaguing people in the developed countries and often has a causal link to heart diseases, hypertension and obesity.

What is obesity?

Obesity is a condition where a person’s Body Mass Index or BMI (calculated by dividing height by weight) is more than 30. It is becoming a global epidemic not only in developed nations but also in developing nations like India. Obesity is usually linked to a host of disorders like diabetes, heart diseases, hypertension and strokes. Easy availability of sugars and fats, messing with our body clocks and an increased sedentary lifestyle are responsible for obesity.  Being overweight and obesity are the fifth leading risk for global deaths with at least 2.8 million adults dying each year due to them.

Source: IANS

‘It is possible that the inverse association in fasting insulin levels and insulin resistance seen among current marijuana users could be in part due to changes in usage patterns among those with a diagnosis of diabetes,’ like if people with diabetes are advised to quit smoking, study researcher Dr. Elizabeth Penner, M.D., M.P.H., said in a statement. ‘However, after we excluded those subjects with a diagnosis of diabetes mellitus, the associations between marijuana use’ and insulin, cholesterol and waist circumference still remained true.

Though the recreational use of the drug is illegal in most countries, medical marijuana is legal in 19 states in the US and other parts of the world. However, it would be prudent to remember that marijuana can be detrimental to other facets of life like mental health and IQ levels and also could lead to lung disease and other problems associated with smoking.

The new study included data from 4,657 people who were part of the National Health and Nutrition Survey from 2005 to 2010. Among all the study participants, 1,975 had used marijuana before but weren’t current users, and 579 were current marijuana users. There were 2,103 people who had never used it.

Among the subjects – users had 16 percent lower fasting insulin levels compared to never-users – but not as pronounced as those who had used marijuana before. Even taking into account the fact that marijuana users actually consume more calories than non-users, they still had smaller waist circumference. One way to get past the ‘drug stigma’ attached to marijuana and limit its abuse is to consume it in a pill form which will only have its active ingredients. A recent study at the Columbia University found that pill form was actually better at relieving pain than the smoked form and also less pleasurable so the drug would be likely to be abused. 

‘Our only concern would be that the present toddy industry and the employees in the sector should have no problems, if Neera production is taken up,’ Babu told reporters here after receiving the report. There are 29,536 toddy tappers in Kerala.

State Excise Commissioner Anil Xavier said rules have to be amended and the Abkari Act has to be revamped to promote Neera. ‘With the ASEAN agreement all set to be in force from the April 1st next year, if our Neera has to compete with similar products of our neighbouring countries, then the sanction has to come,’ said Xavier. Kerala has 180 million coconut trees and 93 of the 94 coconut-growing countries in the world make Neera-type drinks. In Thailand, a 330 ml can of coconut water is sold at around Rs.160. 

‘On an average, one litre of Neera can be sold at Rs.100,’ said V.K. Raju, a member of the committee and associate director of research at the Kerala Agricultural University. He said it has been found that from one coconut tree a farmer will be able to generate a monthly income of Rs.1,200.

‘The recent state budget that was presented has earmarked funds for setting up of 10 plants that will process Neera,’ Raju added. ‘The Coconut Development Board has suggested that at the grassroot-level coconut farmers should form cooperative societies and at the next level there should be a federation and at the district-level a new company should be set up to take up production,’ said Xavier.

The report would now be placed before the state cabinet.

Source: IANS

Silent heart attacks are the same as any other attack, but the person just doesn’t feel it. This is usually because  of  possible nerve damage or neuropathy around the heart due to long term diseases or narrowing of the coronary arteries (the main arteries of the heart) which impedes blood flow to the heart. Ironically, people who are at high risk for heart attack are most susceptible to suffer from a silent heart attack.

Risk factors include:

• Diabetes
• High blood pressure
• Smoking
• Family history of heart trouble
• High cholesterol

Symptoms:

A silent heart attack is when the person does not experience the usual chest pain, chest discomfort or shortness of breath, etc. and the person who experiences it may not realise he’s suffering from a heart attack. 

Some of the most common tell-tale signs are — feeling increased fatigue after normal activities, shortness of breath and sleep disturbances, persistent feeling of indigestion, burping, bloating of  the stomach with no history of gastric disorders.

Because a patient may not be able to identify the exact reason for the discomfort, most doctors cannot treat the patient within the ‘golden hour’ or golden 90 minutes’ (a term used to describe the crucial 90 minutes after the attack during which the patient is most likely to make a full recover), leading to a lower heart pumping rate. Another risk these patients face is the fact that they are susceptible to recurrent episodes which could lead to heart failure, pump failure and congestive heart failure.

Diagnosis:

In most cases a silent heart attack is not diagnosed until after it happens. Here are the tests that a doctor would use to diagnose this condition:

• An electrocardiogram (ECG),
•  2 -D ECHO-color Doppler ,
• The presence of cardiac enzymes (proteins which are released by the dead heart muscle) which are usually elevated in case of a heart attack.

Treatment:

• Medications that thin the blood and make it easier for blood to travel through the arteries.
• Anti-arrhythmics (medicines that keep a check on heart rhythm) help to decrease the formation of blood clots.
• Managing high blood pressure helps to reduce the risk of further damage to the heart and other major organs.
• Modifying lifestyle
• Control of diabetes
• Controlling  high cholesterol and triglyceride levels
• Eating a heart healthy diet of fruits, vegetables, nuts and lean meats
• Getting the proper rest and exercise

While most people don’t think they are likely to have a serious condition like a heart attack, there are a few who have a  higher risk than other people. People who have a family history of the disease, are overweight, have diabetes or  have high blood pressure tend to suffer from silent heart attacks. Doctors advice that people with heart disease should go in for early definitive test like a coronary angiography and if required an angioplasty or by-pass surgery. Multiple aggressive counselling sessions are required for a person to get convinced for definitive management. In addition to this the fear of surgery pushes people to try out short-cuts which in turn can be more dangerous.

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Unofficial medical fraternity estimates say that 60 per cent of patients suffering from diabetes and hypertension have been hit by kidney ailment. While India is said to reap the demographic dividend, doctors lament the rising incidence of kidney disease hitting Y-gen in the country. Dr. P.N Gupta, consultant, nephrology at Paras Hospital, Gurgaon, warns, ‘young people are more prone to kidney diseases because of an unhealthy diet, smoking, drinking and unnecessarily popping pills.’

India is estimated to add about 1.5 lakh new knidney patients every year. Dr. Q Hasnain, consultant, nephrology, at Moolchand Renalcare & Dialysis, Delhi, says, ‘for the diabetes capital of the world, it is alarming that sixty percent of the patients suffering from chronic kidney diseases are either diabetic or suffer from high blood pressure. One of the most serious consequences of diabetes mellitus (DM) is renal or kidney disease, also known as diabetic nephropathy. If diabetes is not well controlled, it can cause kidney damage and finally  nephropathy.’

The early onset of kidney disorders is taking its toll on the mental well being of youth in India. Reiterating the view, Dr. Ripan Sippy, clinical psychologist, Delhi, says, ‘most  young people suffering from diabetes and other lifestyle disorders deal with weight issues which makes them feel insecure among their peer groups. When you are overweight, it affects the confidence level which ultimately gives rise to many psychological disorders.’ According to National Kidney Foundation of India, kidney diseases rank third amongst life-threatening diseases (after cancer & cardiac ailments) in India.

Chronic kidney disease (CKD) means that the kidneys have been damaged to such an extent that they tend to start malfunctioning. They can get damaged either from a physical injury or a diseases like diabetes or high blood pressure. Once the kidneys are damaged, they cannot filter the blood nor do other jobs expected of them. Over five lakh patients in India require kidney transplants according to Indian Council of Medical Research (ICMR). However, doctors say in reality only 300-400 transplants are done annually.

Kidney treatment involves huge costs and there is need to lower them. Dr. Gupta at Paras Hospital says, ‘kidney transplant is a costly affair. India has very limited dialysis centres. In a private set–up, the cost of a kidney transplant ranges between five–six lakhs. A dialysis patient spends approximately Rupees 30, 000 per month. It’s high time that the government open more dialysis centres for people who can’t afford it.’

Suggesting measures which should be adopted to overcome kidney ailments, Dr. Hasnain at Moolchand says, ‘control your blood sugar by following a good diet for diabetes. Get regular exercise and increase your  fluid intake, especially water.’

Government of India launched the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in 2010 in 100 districts of 21 states with a focus on awareness generation for behavior and lifestyle changes, early diagnosis of persons with high levels of risk factors and their referral to higher facilities for appropriate management.

Under this programme, opportunistic screening for diabetes and hypertension has been taken up for people who are above 30 years of age. As on March 14, 2013, nearly 1.70 crore persons have been screened for Diabetes and Hypertension out of which 12.22 lakh (7.18 percent) and 11.13 lakh (6.57 percent) persons have been found to be prone to Diabetes and Hypertension respectively.

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Published in the Journal of Occupational Health Psychology, the study contributes to an ongoing body of research linking work conditions to physical and mental health, reports Science Daily. Toker says these findings paint a grim picture, with a worrying rise in the rate of diabetes in the researchers’ middle-aged study cohort, which had a mean age of 48.  ‘You don’t want to see working populations have an increasing rate of diabetes. It’s costly to both employees and employers, resulting in absenteeism and triggering expensive medical insurance,’ she explained.

Source: IANS

What drugs are used?

Several antihypertensive drugs are available and which one your doctor prescribes will depend on several factors. Diuretics, direct-acting vasodilators, anti-adrenergics, angiotensin converting enzyme (ACE) inhibitors, calcium-channel blockers, direct renin inhibitors and angiotensin receptor blockers are some of the categories of drugs commonly prescribed in hyptertensive patients.

How do they act?

Antihypertensive drugs act by different mechanisms to achieve the same result – to reduce high blood pressure to normal levels. To be able to understand how these drugs act, let us understand how the body usually regulates blood pressure. Blood pressure depends on three important factors – how fast the heart beats, the amount of blood the heart pumps out at each beat and the width of the arteries through which the blood travels.

Each of these factors can be affected by how your nervous system is functioning and the levels of particular hormones in blood. Blood pressure generally increases if

• The brain produces excess of catecholamine hormones or
• The kidneys produce too much of angiotensin hormone or
• There is an excess of sodium in the blood

Each category of antihypertensive drugs acts by regulating one of these processes to control the increase in blood pressure.

Diuretics: Drain out excess sodium and water from your body.

Anti-adrenergics: Act on either the alpha or beta type of receptors and are accordingly called alpha blockers or beta blockers. Alpha blockers block the action of the nervous system on the blood vessels and this prevents the arteries from growing narrow. Beta blockers reduce the heart rate, slow down the strength of each heart contraction and also inhibit production of angiotensin, leading to a drop in blood pressure.

ACE inhibitors: Prevent formation of angiotensin by inhibiting an important enzyme in the kidney.

Calcium channel blockers: Prevent calcium from entering the muscles in the heart and blood vessels; the heart rate drops and blood vessels stay wide open, so the blood pressure does not rise.

Direct renin inhibitors: Prevent the enzyme renin from catalyzing the reactions that result in formation of angiotensin; lesser angiotensin production means blood pressure stays low.

Angiotensin receptor blockers: Prevent angiotensin from combining with its receptors and so blood pressure stays normal.

How does the doctor decide which drug to give you?

Which drug your doctor prescribes depends on the specific factor that is causing hypertension and it is difficult to state that any one class of drugs is superior to the others.

When you are first diagnosed with mild hypertension, the first line of treatment is to use a diuretic. If this does not give the desired results, the doctor may add a second drug for better results. Combination therapy is sometimes used for hypertension and some drug combinations are available as a single pill. For example, a beta blocker with a diuretic or an ACE inhibitor with a diuretic may be used. Which particular combination your doctor advises depends on whether you have some other health condition.

If you have gout, a diuretic is ruled out because it can aggravate your gout; if you have kidney disease, you may do well with ACE inhibitors, but the doctor will advise you to regularly test levels of potassium that may accumulate and worsen your kidney problems. Diabetic patients are generally prescribed ACE inhibitors or angiotensin receptor blockers. Diuretics are avoided because they may cause a rise in blood sugar levels; beta blockers are also not good because they can hide the condition of blood sugar levels dropping to an unhealthy level.

Quite a few people with hypertension also suffer from high cholesterol levels; in such cases, beta blockers are out of question because they tend to increase levels of triglycerides as well as decrease the ‘good’ HDL cholesterol. Alpha blockers are a better option because they tend to raise HDL cholesterol and also reduce total cholesterol levels. Or a doctor may choose to give you a calcium channel blocker because it does not affect blood lipid levels at all. If you have asthma or chronic bronchitis, your doctor will prescribe any anti-hypertensive other than beta blockers because these can aggravate your existing disease. Patients with coronary artery disease may be given a combination of calcium channel blockers and beta blockers.

Side-effects of anti-hypertensive drugs

Each class of antihypertensive drugs has its own unique drawbacks. Diuretics can cause loss of potassium, frequent urination, fatigue, increased blood sugar levels, gout, muscle cramps and erectile dysfunction in men. Beta blockers can cause respiratory problems to worsen and mask the dangerous decrease of blood sugar in diabetic patients. They may also lead to insomnia and depression. Alpha blockers can cause heart palpitations, headache, nasal congestion, dizziness, dry mouth and a sudden drop in blood pressure when you stand up. Calcium channel blockers are known to cause headaches, edema, constipation and dizziness.

ACE inhibitors cause some people to develop a dry cough or reduce their taste sensations; in some cases, they may also cause potassium levels to go up and therefore, should be used with caution in patients who have kidney problems. The most recent category of angiotensin receptor blocker drugs are free from most of these side effects and this had made them a popular choice in treating patients with hypertension.

When you are on anti-hypertensive drugs, it is important to remember that the drug you take may interact with other medication you take. Even a simple over the counter painkiller or cough and cold medicine can react with your anti-hypertensive medicine to cause undesirable effects that may or may not be dangerous. Therefore, before you take any other medicine make it a point to ask your doctor about whether it is safe to do so.

With the right medication taken as recommended, it is possible to control your blood pressure. However, make sure you do not miss out on a healthy diet and regular exercise – these are important in deciding how well your body copes with hypertension and can even help you get by with lowest doses of anti-hypertensive medication.

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