5 Steps to Control High Blood Sugar- Is High Blood Sugar Affecting You

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Is High Blood Sugar Affecting Your Life? Anjali Arora. Yes No General Symptoms There is numbness oratingling sensation in your feet or hands.

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Copyright STERLING PAPERBACKS An imprint of Sterling Publishers P Ltd. A-59 Okhla Industrial Area Phase-II New Delhi-110020. Tel: 26387070 26386209 Fax: 91-11-26383788 E- mail: sterlingpublishersairt elbroadband.in ghainde.vsnl.net.in www.sterlingpublishers.com

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5 Steps to Control High Blood Sugar © 2007 Dr. Anjali Arora ISBN 978-81-207-3243-8 3/107 All rights are reserved. No part of this publication may be reproduced stored in a retrieval system or transmitted in any form or by any means mechanical photocopying recording or otherwise without prior written permission of the authors. The author and publisher specifically disclaim any liability

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loss or risk whatsoever personal or otherwise which is incurred as a consequence directly or indirectly of the use and application of any of the contents of this book.

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5/ 123 The author wishes to thank all academicians scientists and writers who have been a source of inspiration.

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6/ 123 Title

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Want to Cure Diabetes Click Here Diabetes or high blood sugar is a disease that occurs if there is a disorder in certain body functions that utilise carbohydrates fats and proteins in the food to produce energy. Lack of a hormone called insulin or inadequate production of insulin by the pancreas results in this disease. Insulin regulates the amount of sugar in the blood. An imbalance in the amount of insulin produced can lead to the onset of diabetes mellitus.

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8/ 123 01 . Test Yourself

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For Diabetes Yes No Hunger and Thirst You are often very thirsty. You feel hungry all the time.

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10/ 123 Yes No Health Problems You have an itchy skin or skin problems. You often develop boils. Your injuries take a long time to heal. You often get leg pain and cramps.

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11/ 123 Yes No Urinary Problems You have to pass urine often in the day. You get up at night to pass urine. You frequently develop urinary infections.

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12/ 123 Yes No General Symptoms There is numbness or a tingling sensation in your feet or hands. You have lost weight recently without making an effort. You feel tired and weak. You are very nauseous.

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13/ 123 The more times you answer “yes” to the above statements the greater you are at the risk of developing diabetes mellitus. Yes No Other Risk Factors You have a family history of diabetes. You are overweight.

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02 . Understand Diabetes Mellitus To Cure Diabetes Click Here 01 . What Is Diabetes Diabetes mellitus means ‘honey sweet’. Diabetes occurs due to the inability of the body to convert food into energy. It is a condition where we have high blood sugar glucose levels in our body. It is a chronic

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15/ 123 disease which can be managed well through proper guidance. 02 . The Insulin Factor Normally our body converts the food we eat into sugar or glucose which is used for the production of energy. This is done by the pancreas an organ lying near the stomach. The pancreas makes a hormone called insulin which attaches itself to the receptors on the cell wall thereby allowing glucose

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16/ 123 to enter the cells. It acts as the key unlocking the receptors for glucose to enter the cells. The cells then metabolise the glucose to give energy to the body. 03 . Insulin Resistance The pancreas makes enough insulin but due to certain factors the insulin is not effective in transferring glucose from the blood into the cells of the body. Such a disorder is referred to as insulin resistance. Factors involved can be: • The number of receptors on each cell becomes lower than normal. • Insulin is not able to attach itself to the receptor. • Insulin produced may be defective.

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17/ 123 With the passage of time the capacity of the pancreas to produce insulin declines. 04 . Types Of Diabetes Type I Diabetes

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18/ 123 Type I diabetes is a severe form of disease. It is an auto-immune disease which mostly develops in childhood or in adults under 30 years of age. Auto-immune is when the body’s immune system starts destroying itself ‘Juvenile diabetes’ develops in childhood and must be treated with insulin. It accounts for 5-10 of diabetics in the world. Inside the pancreas are cell clusters known as the

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20/ 123 islets of langerhans. There are several type of islet cells including alpha cells and beta cells. Insulin is produced by beta cells. On increase of sugar in the blood these cells manufacture insulin and then release it into the blood stream. The role of these cells is to monitor levels of blood sugar. In people withType I diabetes beta cells are attacked by the immune system and are destroyed slowly. What exactly causes the immune system to get affected is still based on a number of theories. The unfortunate part is that though

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21/ 123 this slow destruction takes place over a number of years 5-7 the symptoms of diabetes mellitus do not surface until about 80 of these beta cells are destroyed. Eventually insulin production comes to a halt as no beta cells remain. Islets of langerhans Theories on the Development of Type I Diabetes • Genetic Predisposition : Genetic predisposition determines entirely

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22/ 123 whether a person will develop immune reactivity against insulin producing β-cells in the pancreas. However environmental factors and infections can have a major impact on whether Type-I diabetes will manifest itself clinically. This occurs after 80- 90 of the β-cells have been destroyed. The remnants of β- cells are transported to the pancreatic draining lymph node PDLN where the ensuing auto immune is thought to be coordinated. Debris from the βcells is picked up by Antigen- Presenting Cells APC and displayed to immune cells called lymphocytes L prompting them either to kill βcells or to signal further immune reponses.

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23/ 123 • In Type I diabetes the body loses the ability to make insulin as the immune system destroys the insulinproducing cells.

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24/ 123 • When insulin is not available the glucose remains in the bloodstream and cannot be used as energy. • A person having Type I diabetes has to take insulin injections to stay alive. • Virus Infection • Cold Weather The Thrifty Gene Theory This theory was proposed by J. A. Neel in 1962. It suggested the reason as to why Indians suffered from a disproportionate high rate of Type II diabetes. According to him Indians lived a hunter gatherer existence for centuries. For their survival they developed a gene which allowed them to survive the cycles of feast and famine. Their metabolism was adequate in itself in both these conditions it

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25/ 123 utilised the calories efficiently. With an unstable food supply their survival was better as they could somehow store surplus energy in the form of fat during the time of feast. This fat was probably stored as abdominal fat and utilised during famines. Exposing this gene to abundance of food continuously in the present environment in all likelihood is proving to be detrimental. Diabetic Ketoacidosis Ketoacidosis develops mainly in people with Type I diabetes. This disease is the result of persistently high levels of blood sugar hyperglycaemia. Blood sugar builds up in the body as your cells cannot absorb glucose for energy. The glucose not available to the body starts burning body fat as fuel thus

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26/ 123 producing waste products called ketones. This accumulation of ketones in the blood is known as ketosis. When these ketone bodies are excreted in the urine the process is called ketonuria. The increase of ketones in the body over a course of some days leads to fluid being depleted from the body in the form of urine. This results in dehydration leading to the pH of the blood becoming acidic. The process of ketoacidosis sets in. Unrecognised and untreated ketoacidosis can lead to coma and death. Symptoms of Ketoacidosis

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27/ 123 • Frequent urination • Great thirst • Nausea and vomiting • Blurred vision • Drowsiness and disorientation To Detect Ketoacidosis If your blood sugar levels are over 200 mg/dl for two consecutive tests test your urine for

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28/ 123 ketones. Ketones also known as acetones can be detected in the urine by the acetone test. Ketoacidosis and Coma If a person goes into coma due to ketoacidosis it is a serious situation. Mild ketoacidosis does not lead to coma. It is only when the ketone bodies are present above a certain level that coma occurs. Any of the

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29/ 123 symptoms mentioned above and the presence of ketones in the urine are an indication of administering insulin when blood sugar is high. Type II Type II diabetes is often called noninsulin dependent diabetes mellitus. This type of diabetes develops in adulthood. It develops

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30/ 123 due to less production of insulin or ineffective use of insulin. This form of diabetes is present in 90-95 of diabetics in the world. Women during their pregnancy can develop a form of Type II diabetes called gestational diabetes. 40 of women with gestational diabetes during pregnancy develop Type II diabetes within four years.

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32/ 123 Human Foetus Impaired Glucose Tolerance Impaired glucose tolerance is a term when blood sugar levels are higher than normal but not high enough to be diagnosed as diabetes mellitus. This impairment is indicated by a fasting glucose reading ranging between 100 and 130 mg/dl. The symptoms relating to diabetes mellitus are normally absent. If a person reduces his risk factors his impaired glucose tolerance may improve.

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33/ 123 Blood sugar level therefore may become normal or stabilise. Some people with impaired glucose tolerance may go on to develop diabetes.

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34/ 123 05. Factors Causing High Blood Sugar Hyperglycaemia To Cure Diabetes Naturally Click Here Factors Causing High Blood Sugar Hyperglycaemia • Eating food containing simple sugars which are rapidly absorbed by the body e.g. sweets ice creams and pastries. • Drinking sweetened beverages such as carbonated drinks and juices.

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35/ 123 • Sedentary lifestyle – not burning the consumed sugar carbohydrates and other products. • Not enough administration of insulin or other medication. • Physical stress e.g. infections flu. • Psychological stress

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36/ 123 06. Factors Causing Low Blood Sugar Hypoglycaemia • Skipping or delaying a meal. • Taking too much of insulin or diabetic medication. • Not taking enough carbohydrates in a meal. • Sudden increase in exercise.

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03 . Measure Your Risk Cure Diabetes in 21 Days Click Here Measure Your Risk A few simple tests can help determine whether you have diabetes. 01. The Venous Sample Test

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39/ 123 This is done in the laboratory. It can be of four types: fasting F postprandial PP glycosylated haemoglobin and oral glucose tolerance test GTT. Except for postprandial all the other tests should be done 12 hours after an overnight fast without even a cup of tea. Fasting: The normal fasting blood sugar level is less than 100 mg/dl. If your reading is higher than this a diagnosis indicative of developing diabetes is made. Postprandial: The postprandial is conducted 2 hours after a heavy meal or after taking 75 gm of glucose. A reading of over 130 mg/dl along with other positive tests is indicative of diabetes.

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40/ 123 Glycosylated Haemoglobin Test: HbA1c is a measurement to assess the level of your blood sugar over the past 120 days. An HbA1c reading of over 6.1 is suggestive of diabetes. Oral Glucose Tolerance Test: After fasting overnight you are given water with 75 gm sugar in a water-sugar solution. Your blood glucose levels are tested over a 24-hour period. In a diabetic person blood glucose

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41/ 123 levels rise higher than normal and do not fall as quickly. A normal blood glucose reading two hours after drinking the solution should be less than 130 mg/dl. All readings between zero to two hours should be less than 200 mg/dl. In addition to these a random blood sugar reading can be taken any time. A reading of above 140mg/dl can be indicative of diabetes. 02. The Single Stick

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42/ 123 Blood Glcose Test To Cure Diabetes Permanently Click Here The finger is pricked with a needle. The blood sample is placed on a strip. The strip is then placed in the slot of the glucometer machine which assesses your blood sugar level. This method is to be used only to monitor your blood sugar levels at home. It is not

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43/ 123 completely reliable so a venous sample should also be assessed in the laboratory as guided by your doctor. 03 . Urine Test You may also be advised by your doctor to get a routine sample of urine tested for albumin sugar and microalbuminurea.

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44/ 123 04. Screening For Diabetes This should be done at 30 years of age. If a history of heart attack stroke or diabetes prevails in the family then a blood sugar test should be done along with a lipid profile at 20 years of age to determine the person’s baseline level. The tests can be repeated every 3 years if normal. If abnormal or borderline tests should be repeated annually or as your doctor advises.

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45/ 123 06. Risk Factors For Developing Type II Diabetes • A person having a parent or sibling with Type II diabetes. • If a person is overweight or has high blood pressure he or she is at a greater risk of developing diabetes.

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46/ 123 • A person having high levels of cholesterol and triglycerides is at a greater risk of developing diabetes. With diabetes and abnormal fat levels a person increases the risk of heart disease up to four times in comparison with the general population.

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47/ 123 • A person having a sedentary lifestyle has greater chances of developing diabetes. This risk can be reduced by exercising regularly.

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48/ 123 • A woman delivering a baby weighing over 9 lbs approx. 4 kg has a tendency to develop Type II diabetes. • If a person’s blood sugar levels are regularly above normal then he or she is becoming a prediabetic and will probably become a diabetic within 10 years. • Continuous stress is today known to be a predisposing factor for developing diabetes mellitus. • A family history of Type II diabetes particularly in a first-degree relative in presence of other risk factors can precipitate the development of diabetes. • Ethnic groups Asian or Afro- Caribbean are more prone to develop diabetes.

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49/ 123 • Previous history of gestational diabetes or previous diagnosis of impaired glucose tolerance can both lead to the development of diabetes mellitus. 07. Diabetes Mellitus And Obesity Overweight and obese people keep producing the hormone insulin but it cannot act appropriately. An obese person having a high carbohydrate intake puts a strain on the body’s glucose metabolism. Also obesity reduces the insulin receptors on the surface of the cells. As the uptake of insulin is less by fewer receptors the body’s sensitivity to the insulin is reduced. Cells mainly fat or

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50/ 123 muscle requiring glucose cannot get it from the blood. There is a famine in the midst of plenty resulting in diabetes. In response to the high blood sugar present the pancreas works more to produce more insulin. Eventually this constant pumping of the pancreas exhausts the pancreatic beta cells. Insulin secretion from the pancreas starts becoming inadequate and overweight people become diabetic. 08. Diabetes Mellitus And LDL Oxidation In diabetes mellitus LDL is glycosylated by the process of glycosylation i.e. attachment of sugar to LDL-C. This modified LDL-C makes

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51/ 123 it stick to the arteries thus enhancing the process of atherosclerosis and heart disease . 09 . Secondary Diabetes It can occur due to a number of causes: • Hormonal abnormalities • Insulin receptor disorders • Pancreatic disease • Drug induced diabetes • Corticosteroid administration • Genetic syndrome

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52/ 123 Diseased Pancreas Studies show that if there is even 1 reduction in HbA1c glycosylated haemoglobin in diabetics then: • The risk of microvascular complications e.g. in kidney eye is reduced by 37. • The risk of fatal and non-fatal heart attack is also reduced by 14.

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53/ 123 10. Diabetic Complications High Blood Sugar

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54/ 123 High blood sugar levels over a period of time can lead to major health problems. • Blood vessels can get affected leading to heart attack stroke and circulatory problems. • Frequent urinary infection is due to the presence of high sugar not well controlled which results in the damage of the kidneys. • Kidney disease nephropathy may result which often leads to end-stage renal disease and kidney failure. The Kidney Malfunction Just as the kidneys lose their ability to discharge wastes they also lose their ability to retain protein and sugar. Sugar and protein are detected in urine tests often in large

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55/ 123 amounts. Blood tests detect high levels of urea nitrogen and creatinine which indicate damaged kidneys. Effects of Kidney Malfunction • IIf kidney damage nephropathy progresses a person may have to undergo kidney dialysis. Kidney transplantation might also be an option. High uncontrolled blood sugar can also lead to neuropathy.

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56/ 123 • Nerve problems neuropathy may occur causing a ‘pins and needles’ sensation in the hands and legs. • Diabetes damaging the nerves can also lead to reduced pain or loss of sensation in the feet. Skin sores or ulcers on the feet can be a result of bad footware.

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57/ 123 • Injuries or infections do not heal well. Often an injury on the foot does not heal and can lead to gangrene. Diabetic Retinopathy It can result due to some disease or damage to the small blood vessels of the retina. Eye problems get complicated and can result in retinopathy premature cataract and glaucoma. Retina is the area of the eye on which the image picture of what we see is

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58/ 123 formed by our lens system. People with long standing diabetes often develop this disease. Diabetic Retinopathy Causes Damage to Small Blood Vessels of the Retina

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60/ 123 Skin Disease

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61/ 123 Diabetic Dermopathy: It is the commonest kind of skin disease seen in diabetics. Skin develops brown scars over the shin of legs. This is due to abnormal changes in the small blood vessels of the skin. If diabetes is not kept under control the process of ageing gets faster. 11. Blood Glucose Lipids And Blood Pressure Control This is a part of diabetic care. It is important to reach target levels mentioned below. Failure to do so would lead to a deteriorated lifestyle. Blood Glucose Control and Microvascular Risks Involved

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62/ 123 • Blood Lipid Control and Risk Levels with Diabetes Assessment of blood glucose lipids and blood pressure should be done as follows: • Glycosylated haemoglobin assayed between every two to six months.

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63/ 123 • Blood lipid profile to be assayed between every two to six months If border line is high. Blood pressure measurement on each consultation. lower risk being: 14085 mmHg For the “tight” blood pressure group a mean BP of 144/82 mmHg there was a reduction of risk of diabetesrelated deaths 32 per cent stroke 44 per cent and in all the other diabetes-related end points. Also the risk of myocardial infarction was reduced.

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64/ 123 • 12. Some More Statistics • There are over 32 million diabetics in India. • Every eighth Indian is a diabetic. • 95 of these diabetics suffer from diabetes mellitus II. According to the World Health Organisation India is predicted to be the diabetic capital of the world by 2030 harbouring 79 million diabetics.

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65/ 123 13. Food Hormones And Body Balance Some Facts • Your body has a limited capacity to store carbohydrate and protein. Your muscles and liver together cannot store more than 1800 cals of carbohydrate. After this capacity is filled food is converted into fat. • A continuously sustained rhythmic form of exercise for about 45 minutes helps burn fat. • Any food consumed affects your insulin and glucagon secretions. • When you eat carbohydrate in your food your blood sugar level rises stimulating insulin secretion. This insulin gets the tryptophan–

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66/ 123 • serotonin mechanism working in the brain. The feeling of pleasure or feeling good is a result of this serotonin production in the brain. • A recent study states that diabetics consuming 50 gms of natural fibre in their daily diet lower their glucose level by 10. It was seen that a high fibre diet also helps decrease insulin levels in the blood. In patients of diabetes mellitus II lipid levels also get lowered with the fibre. Consumption of soluble and insoluble fibre containing fruits vegetables and grains is beneficial. • Chromium a trace mineral plays an important role in insulin sensitivity. Its deficiency also promotes an imbalance in glucose metabolism.

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67/ 123 For a good body-mind balance it is important to have an even secretion of insulin. Roller coaster secretion leads to excessive mood swings hunger stress cholesterol and fat deposits. Foods Helpful in Controlling Blood Sugar Levels

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68/ 123 All these products are supportive in controlling diabetes mellitus. A balanced diet exercise and prescribed medication should not be neglected.

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04 . Diabetes And Lifestyle To Cure Diabetes Naturally Click Here General Guidelines • Avoid fatty junk fried and preserved foods. • Try and lose weight if you are overweight.

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70/ 123 • Have more high-fibre foods and complex carbohydrates. • Choose healthy snacks. • Take your prescribed medication regularly. • Monitor your blood sugar regularly.

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72/ 123 Glucometer

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73/ 123 • Be active but check with your doctor before doing strenuous exercise. • If you follow a regulated lifestyle you can indulge a little occasionally • Avoid alcohol. It has empty calories. If necessary drink in strict moderation.

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74/ 123 • Follow an organised routine. • Eat the same amount of food daily. • Eat at about the same time daily. • Exercise at the same time daily. • Take your medication at the same time daily. • Avoid stress. Destress yourself with massage yoga or meditation. • Don’t miss a meal. If you travel frequently and have long eating gaps

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75/ 123 between meals carry sweets or toffees to avoid hypoglycaemia. Monitoring of Blood Glucose Level Self-monitoring should be done by every diabetic who is concerned about managing their disease. It is especially recommended for anyone using insulin whether having Type I or Type II diabetes. Monitoring is important as... • An identical dose of insulin will be absorbed differently from day-to-day. • It also depends on factors such as exercise stress type of food taken and an individual’s insulin sensitivity. • Hormonal changes in a woman e.g. puberty the menstrual cycle and

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76/ 123 pregnancy are also factors involved with insulin absorption. • Self-monitoring of insulin dosage is also recommended when a different new type of insulin company or dosage is administered. Blood glucose monitoring is also recommended to patients on a oral hypoglycaemic drug. This is recommended to avoid hypoglycaemia low blood sugar especially if the diet has been less or the patient has been vomiting and suffering from diarrhoea.

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77/ 123 Diabetics and Illness It is important to keep your blood sugar under control when you are ill. • Drink lot of water.

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78/ 123 • If you cannot eat your regular food have sweetened lime juice crackers or soup. You need calories to avoid hypoglycaemia. • Keep taking your diabetic medicines as advised. • Monitor your blood sugar. It may still be high even if you are not eating regular meals. • Consult your doctor if you have vomited or are having diarrhoea.

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79/ 123 Injuries and Foot Care • Do not walk barefoot to avoid foot injury. • Minor injuries cuts or infections should immediately be attended to. • Foot care is of extreme importance. After having a bath in tepid water pat your feet dry with a clean towel especially between the toes. • Check your feet regularly for any cuts or bruises or rough cracks in winter. Prevent infections by applying antiseptic cream immediately. Consult a doctor for any lingering infection.

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80/ 123 • Wear clean cotton or woollen socks which are comfortable and not skin irritants. • Wear leather or sports shoes which are not tight fitted. Be careful of shoe bite. • Do not use hot water bottles or heating pads near your feet. • Avoid cutting your toe nails too close to the skin. File them straight slightly rounding the corners.

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81/ 123 Dental Care Uncontrolled diabetes increases your risk of gum disease caries and development of more cavities. Regular dental care brushing or flossing the teeth after every meal is important in people with high blood sugar. Dental check ups should be done as advised by your dentist.

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05 . Diet Exercise And Medication To Cure Diabetes Naturally Click Here 01. Diet Exercise And Medication People having diabetes mellitus II can control their disease with the help of the following. • Diet • Exercise

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83/ 123 • Weight loss • Medication Some people with Type II diabetes may eventually become insulin dependent but most can produce enough insulin to control their sugar levels if they can look after themselves. 02 . Diet

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84/ 123 The diabetic meal should consist of high fibre low fat and protein. Fruits and vegetables are rich in minerals vitamins and antioxidants and therefore should be consumed. Salads can also be freely taken by diabetics but with limited use of oil. Total proteins: 15-20 of calories required. Fats: less than 30 of calories required.

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85/ 123 Carbohydrates: 55-60 of calories required. Fibre: 25 gms per day for women 40 gms per day for men approximately. Diet Schedule A diabetic must have three main meals and two sugar-free snacks every day. A complex high-fibre carbohydrate diet is recommended for diabetics. Also known as starches complex carbohydrates are slowly absorbed thereby keeping blood sugar levels

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86/ 123 fairly stable. Examples are wholewheat products brown rice beans oats vegetables and fruits. • To increase your fibre intake high fibre breakfast cereal with no sugar can be consumed. • Eat more vegetables. Increase the amount of beans peas nuts and other pulses in your daily diet.

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87/ 123 • Go for small amounts of food. If overweight try cutting down the calories you consume in a day. 03. Some Useful Food Tips For Diabetics

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88/ 123 Rice The calorific value of rice is very close to cereals like wheat. Rice unfortunately on consumption increases blood sugar levels rapidly. Therefore rice should be consumed in small quantities. It is also important to consume rice in combination with oats whole wheat bread dals lentils and vegetables. The high fibre content present in these foods helps prevent a rapid increase in blood sugar levels. Unpolished or brown rice is a better dietary option than polished rice. Sugar and Sweets Sugar or sweet consumption is not directly related to the development of diabetes mellitus. Inability of the body to produce

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89/ 123 insulin leads to diabetes when the body is unable to utilise sugar or carbohydrate. On consuming sugar in a person prone to diabetes mellitus there is a substantial increase in blood sugar levels leading to diabetes or aggravating the existing condition. Actually excessive consumption of sweets leads to weight gain. Weight gain in combination with sedentary habits family history of diabetes mellitus and stress are the precipitating factors for developing diabetes. Fruits and Fruit Juices Diabetics can consume fruits but in limited quantity. Jamun sweet lime papaya guava strawberry apples and oranges can be taken by diabetics as they have fibre and minerals. Also these fruits release blood sugar

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90/ 123 gradually in the body. Banana mango chiku grapes the sweet fruits are to be eaten once in a while and that too in small quantities. Fruit juices should not be taken by diabetics as instant sugar is released and there is also no benefit of fibre. Healthy Cooking Techniques Low-fat food can be tasty healthy and enjoyed by your whole family when you use healthy cooking techniques such as boiling baking stewing and roasting.

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91/ 123 • Microwave broil grill stir fry boil barbecue or • steam food with minimal salt or fat. • Cook on a low flame. • Use non-stick cookware.

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92/ 123 • Try and have low-fat recipes. • Favour the use of monounsaturated fats mustard olive rapeseed oils and polyunsaturated fats sunflower and safflower oils in place of too much saturated fat palm oil. Blend two or more oils for healthy cooking. Healthy Ways to Consume Vegetables • Use low-fat or fat-free salad dressings.

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93/ 123 • Cook or steam vegetables using very little water. Overcooking will break down the fibres. • Season food with chopped onion garlic tomato or lime juice. Healthy Ways to Consume Fruits • Consume raw fruits. Do not peel fruits like apples and pears. • Eat small portions and only consume the amount required in your diet. • Eat fruits instead of drinking fruit juice which gives you only sugar and no fibre.

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94/ 123 Healthy Ways to Consume Milk and Milk Products • Drink skimmed or non-fat or lowfat milk. • Consume low-fat or fatfree yoghurt curd . • Make cottage cheese out of fat-free or low-fat milk.

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95/ 123 Healthy Ways to Consume Meat • Eat more of fish. • Cook chicken without the skin. • Buy meat with less fat. • Trim off extra fat as far as possible. • Avoid fatty meats like bacon mutton and sausages. • Have egg white.

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96/ 123 • Flavour your food with lemon juice soya sauce vinegar or herbs. • Limit the use of condiments like mustard ketchup and salad dressing they are high in salt or sugar .

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97/ 123 Artificial Sweeteners Sugar substitutes are saccharin and aspartame. Saccharin is calorie free. Aspartame has negligible calories per serving. They can be used instead of sugar. All artificial sweeteners should be used to the minimum 04 . Exercise • Test your blood sugar levels before exercising. • If your blood sugar levels are not too high have a small snack 15-20 minutes before exercising. • Don’t inject insulin into that part of your body which you will be exercising. It gets absorbed faster from there.

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98/ 123 • While exercising watch out for signs of hypoglycaemia. Benefits of Exercise for Diabetics • Less restrictive diet: Exercise burns calories. You can eat reasonably

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99/ 123 well and still keep your blood sugar and weight at a healthy level. • Less insulin required: Exercise helps in increasing the body’s sensitivity to insulin and burns glucose more efficiently. Calories burnt by an individual in ½ hr with the following weight

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100/ 123 Diabetic Food Pyramid 05 . Medication After getting your blood sugar reports consult your doctor for the type of medication you require. Type I and Type II diabetics require different kinds of medication. Also factors such as whether you are obese or thin or have other medical problems besides

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101/ 123 diabetes will decide the dosage and the group of medicines to be taken. Medication for Diabetes Mellitus Oral antidiabetic agents are used for patients of noninsulin dependent diabetes mellitus NIDDM II. These patients should be administered this medication after they have been put on a restrictive carbohydrate diet. Administration of medication should be along with proper diet and exercise. Biguanide Metformin: It is the medication of choice today. Its action is to primarily increase the peripheral uptake of glucose. In large doses it also helps to decrease the intestinal absorption of glucose.

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102/ 123 Sulphonylureas Gilbenclamide Glimepiride and Glipizides: They produce hypoglycaemia by stimulating the release of insulin. They also help inhibit the release of glucose by the liver and increase the sensitivity of peripheral tissue to insulin. Thiazolidinediones Roziglitazone and Pioglitazone: They help enhance sensitivity to insulin in the liver adipose tissue and skeletal muscle. Post Prandial Glucose Regulators Repaglinide and Nateglinide: They help stimulate the release of insulin from pancreatic beta cells. Alpha Glucosidal Inhibitors Acarbose: When taken with a meal

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103/ 123 Acarbose reduces the post prandial glucose peaks by retarding the glucose uptake by the intestine. Acarbose can be administered as a monotherapy or in combination with other hypoglycaemics. Insulins: They are prepared as bovine procine or human insulin. Insulin preparations are classified according to their duration of action. The more common ones are: • Short acting insulins • Intermediate and long acting insulins Insulins are normally administered to patients of IDDM. The recent concept is to also put patients of NIDDM on insulin as to avoid complications of diabetes later.

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104/ 123 All diabetic medications can have side effects. No diabetic medication whether for NIDDM or IDDM should be taken or admin- istered without the doctor’s prescription. 06. Site For Insulin Injection To Cure Diabetes Naturally Click Here The most common site for an insulin injection is the abdomen. The back of upper arms the upper buttocks or hips and the outer side of thighs are also used as insulin injection

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105/ 123 sites. These sites are good for injecting insulin because: • They have a layer of fat just below the skin to absorb the insulin. • Not too many nerves are present in that area making it more comfortable compared to other parts of the body. 07 . Easily Available • Reasonably priced easy-to-use home glucometers are available.

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106/ 123 • Insulin pens which can be carried in the pocket are easy to administer and cause minimum discomfort to the patient. • Also available are insulin pumps which can be inserted under the skin. • Diabetic jam flour chocolates and ice creams are available at many outlets.

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107/ 123 08. Advancements In The Treatment Of Diabetes Diabetes is one of the most common diseases affecting people worldwide. By 2010 India is expected to become the World’s Diabetic Capital. In the United States it has affected an estimated seventeen million people. Today we have come a long way since insulin’s discovery in 1921. Smart Meters

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108/ 123 They help to regulate food intake exercise medication blood glucose readings and weight all with push-button ease. Alternate Site Testing Finger tips are the easiest site for drawing a sample for blood glucose testing. The new tester freestyle offers the opportunity to draw a blood sample from an alternate test site.

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109/ 123 Home Testing The glycated haemoglobin test is now available as a single use fingerstick test with results available within minutes. While a fingerstick provides a glucose level for a moment in time the glycated haemoglobin level reflects the glucose level in the body for the most recent two to three month period.

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110/ 123 Non-invasive Glucose Monitoring It is a well-established fact that people with diabetes who closely monitor and regulate their glucose levels have fewer complications from the disease. A recently developed device “GlucoWatch G2 Biographer” will make glucose monitoring easier. The Biographer is a glucose-monitoring device that looks like a watch. It is completely non-invasive and uses a low electrical current to pull fluids through the skin. It then measures the glucose level in the fluid. The watch can be worn for up to 13 hours and can test glucose levels as often as every ten minutes. This does not eliminate the need for standard fingersticks. The hope is that devices

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111/ 123 like these will eventually make them unnecessary. The Biographer can also show people how their bodies react to specific situations like exercise stress meals sleep and medications all of which can affect glucose levels. There is an alarm on the watch that can be set to go off if glucose level becomes too high or too low. Insulin Pump

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112/ 123 The most recent device to be introduced is a wireless insulin pump system. The system is called the Medtronic MiniMed Paradigm 512 Insulin Pump and Paradigm Link Blood Glucose Monitor. It comprises of a glucose monitor external insulin pump and dose calculator that work together to determine the amount of insulin needed. 09 . On The Horizon There are many new treatments being studied to improve the lives of people who have

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113/ 123 diabetes. Insulin is being studied in new forms including longer acting doses. New modes of delivery are also being examined including inhalers skin patch and oral insulin. Other medications under investigation hope to enhance the release of insulin from the pancreas in order to balance glucose levels by regulating other related hormones and treat complications of diabetes.

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114/ 123 Diabetic Skin Patch Test Pancreas Transplant A pancreas transplant is a surgery to implant a healthy pancreas from a donor into a patient with diabetes. Pancreas transplants give the patient a chance to become independent of insulin injections. Partial Pancreas Transplantation

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115/ 123 When a patient with diabetes receives a kidney transplant from a living relative it is usually beneficial to perform a partial pancreas transplant at the same time. Since the transplanted kidney will become damaged by diabetes over the time transplanting a partial pancreas from the same donor will help control blood glucose levels and protect the new kidney from further damage. Benefits and Risks of Pancreas Transplants • Pancreas transplants are safest in people who do not have heart or blood vessel disease. • The healthier you are the better you can withstand the physical stress of surgery.

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116/ 123 • Immunosuppressive drugs are important and hard on the body. People who have to undergo a pancreatic transplantation should avoid those who have infections such as a cold or the flu. They should not be immunised without first checking with their doctor. These drugs can also damage the kidneys. A successful pancreas transplant can benefit a Type I diabetic person in at least three ways: • Some amount of diabetes-related damage to the body can be controlled. • Insulin injections are no longer needed and the person can enjoy a regular diet.

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117/ 123 • A person can enjoy greater activity and independence. Pancreas Transplant

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06 . Myths And Fact File To Cure Diabetes Naturally Click Here Myth I do not have a history of diabetes in my family. I will never develop it. Fact

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119/ 123 Genetically you are less prone to developing diabetes. However because of sedentary lifestyle wrong eating habits excess weight and stress one can develop diabetes mellitus. Myth Alcohol does not affect diabetics adversely. Fact Consumption of alcohol can worsen the disease. It can also react with the given diabetic medication.

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120/ 123 Myth As a diabetic I get tired easily so I should rest. Fact Diabetes should be kept under control. All diabetics must be active and have a regular exercise routine. However exercise must not be strenuous.

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121/ 123 Myth Diabetics cannot eat any fat or carbohydrates. Fact Diabetics should have a minimal amount of fat and mostly keep to monounsaturated or

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122/ 123 polyunsaturated fats. Complex carbohydrates with less calories and more fibre can be taken.

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