Diabetes

Diabetes mellitus is a common disease in the United States. It is estimated that over
16 million Americans are already caught with diabetes, and 5.4 million diabetics are
not aware of the existing disease. Diabetes prevalence has increased steadily in the
last half of this century and will continue rising among U.S. population. It is believed
to be one of the main criterions for deaths in United States, every year. This diabetes
information hub projects on the necessary steps and precautions to control and
eradicate diabetes, completely.

Diabetes is a metabolic disorder where in human body does not produce or properly
uses insulin, a hormone that is required to convert sugar, starches, and other food into
energy. Diabetes mellitus is characterized by constant high levels of blood glucose
(sugar). Human body has to maintain the blood glucose level at a very narrow range,
which is done with insulin and glucagon. The function of glucagon is causing the liver
to release glucose from its cells into the blood, for the production of energy.

There are three main types of diabetes:

• Type 1 diabetes
• Type 2 diabetes
• Gestational diabetes

Type 1 and Type 2 diabetes impede a person’s carefree life. When breakdown of glucose is
stopped completely, body uses fat and protein for producing the energy. Due to this
mechanism symptoms like polydipsia, polyuria, polyphegia, and excessive weightloss can be
observed in a diabetic. Desired blood sugar of human body should be between 70 mg/dl -110
mg/dl at fasting state. If blood sugar is less than 70 mg/dl, it is termed as hypoglycemia and if
more than 110 mg /dl, it’s hyperglycemia.

Diabetes is the primary reason for adult blindness, end-stage renal disease (ESRD),
gangrene and amputations. Overweight, lack of exercise, family history and stress increase
the likelihood of diabetes. When blood sugar level is constantly high it leads to kidney failure,
cardiovascular problems and neuropathy. Patients with diabetes are 4 times more likely to
have coronary heart disease and stroke. In addition, Gestational diabetes is more dangerous
for pregnant women and their fetus.

Though, Diabetes mellitus is not completely curable but, it is controllable to a great extent. So,
you need to have thorough diabetes information to manage this it successfully. The control of
diabetes mostly depends on the patient and it is his/her responsibility to take care of their diet,
exercise and medication. Advances in diabetes research have led to better ways of controlling
diabetes and treating its complications. Hence they include:-

• New improved Insulin and its therapy, (external and implantable insulin pumps) have
advanced well to manage elevated blood sugars without any allergic reactions.
• Oral hypoglycemic drug, controls diabetes type 2.
• New improved blood glucose monitor (new device for self blood glucose monitoring),
and hemoglobin A1c laboratory test to measure blood glucose control during previous
3 months.
• Effective availability of the treatments for affected body organs due to diabetes.
• Better ways to manage mother and its fetus health during the gestational diabetes
phase.
Symptoms of Diabetes

In both types of diabetes, signs and symptoms are more likely to be similar as the
blood sugar is high, either due to less or no production of insulin, or insulin
resistance. In any case, if there is inadequate glucose in the cells, it is identifiable
through certain signs and symptoms. These symptoms are quickly relieved once the
Diabetes is treated and also reduce the chances of developing serious health problems.

Diabetes Type 1:

In type 1, the pancreas stop producing insulin due to autuimmune response or possibly
viral attack on pancreas. In absence of insulin, body cells don’t get the required
glucose for producing ATP (Adenosin Triphosphate) units which results into primary
symptom in the form of nausea and vomiting. In later stage, which leads to
ketoacidosis, the body starts breaking down the muscle tissue and fat for producing
energy hence, causing fast weight loss. Dehydration is also usually observed due to
electrolyte disturbance. In advanced stages, coma and death is witnessed.

Diabetes Type 2:

• Increased fatigue : Due to inefficiency of the cell to metabolize glucose, reserve fat
of body is metabolized to gain energy. When fat is broken down in the body, it uses
more energy as compared to glucose, hence body goes in negative calorie effect,
which results in fatigue.
• Polydipsia : As the concentration of glucose increases in the blood, brain receives
signal for diluting it and, in its counteraction we feel thirsty.
• Polyuria: Increase in urine production is due to excess glucose present in body.
Body gets rid of the extra sugar in the blood by excreting it through urine. This leads
to dehydration because along with the sugar, a large amount of water is excreted out
of the body.
• Polyphegia : The hormone insulin is also responsible for stimulating hunger. In order
to cope up with high sugar levels in blood, body produces insulin which leads to
increased hunger.
• Weight flactuation : Factors like loss of water (polyuria), glucosuria , metabolism of
body fat and protein may lead to weight loss. Few cases may show weight gain due
to increased appetite.
• Blurry vision : Hyperosmolar hyperglycemia nonketotic syndrome is the condition
when body fluid is pulled out of tissues including lenses of the eye, which affects its
ability to focus, resulting blurry vision.
• Irritability : It is a sign of high blood sugar because of the inefficient glucose supply
to the brain and other body organs, which makes us feel tired and uneasy.
• Infections : The body gives few signals whenever there is fluctuation in blood sugar
(due to suppression of immune system) by frequent skin infections like fungal or
bacterial or UTI (urinary tract infection).
• Poor wound healing : High blood sugar resists the flourishing of WBC, (white blood
cell) which are responsible for body immune system. When these cells do not
function accordingly, wound healing is not at good pace. Secondly, long standing
diabetes leads to thickening of blood vessels which affect proper circulation of blood
in different body parts.
Signs and Symptoms of Prediabetes
Prediabetes can take a long time to transform finally as diabetes. It has been generally
observed that prediabetes will eventually convert to diabetes but, at the same time, there are
greater possibilities to revert back to normal if, taken care seriously. People suffering from
prediabetes may show same symptoms as in diabetes but, they will be erupting occasionally
like:

• Excessive thirst
• Tingling sensations in feet and fingers
• Excess Hunger
• Frequent Urination
• Irritability
• Frequent infections
• Blurred vision
• Skin itching

People - In Risk Zone : Some individuals are at more risk of prediabetes than others due to
presence of these factors -

• Being overweight
• Family history of prediabetes
• Waist hip ratio - The person with 'fat tire'
• Depression and stress
• Causes: Prediabetic is a person suffering from little high sugar than normal patients.
The reason behind high sugar is entry of glucose into the blood cells due to
disturbance in the mechanism of insulin. Thus, sugar is circulating in the blood stream
but unable to penetrate into cells and tissue, to produce energy. The exact reason for
this is uncertain but it is considered that overweight and fatty tissues along with
sedentary lifestyle are the correlating factors.

Screening and Diagnosis of Prediabetes

Prediabetics will never know by their own about their high blood sugar. If they are suffering
from the mentioned factors which indicates risk zone, they should periodically go for routine
check up and should be cautious enough about the given signs and symptoms. Once they
crossed the age of 45, they must routinely visit a doctor and ask for its diagnosis.

There are two types of blood tests to determine whether you are suffering from prediabetes
or not, they are as follows:

• Fasting blood glucose test : A fasting blood sugar level under 100 milligrams of
glucose per deciliter of blood (mg/dl) is considered normal. If your blood sugar level
is 100 to 125mg/dL, you have prediabetes - also called impaired fasting glucose
(IFG). If you are suffering from prediabetes then the fasting blood sugar as well as
post postprandial blood sugar will fluctuate easily.
• Oral Glucose Tolerance Test (OGTT) : After fasting for at least eight hours, FBS
(fasting blood sugar) is checked and then an oral dose of 8 ounce sugary syrup is
administered. The blood glucose level is checked after an hour and if it reaches 144-
199 mg/dl after two hours, you have impaired glucose tolerance.
What Causes Diabetes
The precise Etiology of most cases of diabetes is uncertain, although certain contributing
factors are as follows:

Type 1 diabetes

Type 1 Diabetes is autoimmune disease that affects 0.3% on average. It is result of

destruction of beta cells due to aggressive nature of cells present in the body. Researchers
believe that some of the Etiology and Risk factors which may trigger type 1 diabetes may
be genetic, poor diet (malnutrition) and environment (virus affecting pancreas). Secondly, in
most of the cases, diabetes occurs because there is abnormal secretion of some hormones
in blood which act as antagonists to insulin. Example- Adrenocortical hormone, Adrenaline
hormone and Thyroid hormone.

Type 2 diabetes

Type 2 Diabetes is also called non insulin-dependent diabetes mellitus (NIDDM) or adult-
onset diabetes. It occurs when the body produces enough insulin but cannot utilize it
effectively. This type of diabetes usually develops in middle age. A general observation says
that about 90-95 % of people suffering with diabetes are type 2; about 80 percent are
overweight. It is more common among people who are older; obese; have a family history of
diabetes; have had gestational diabetes. There are number of risk factors found to be
responsible for type 2 diabetes like, the more the Etiology and Risk factors carried by an
individual, the higher the risk for developing diabetes.

Following are the Causes of Diabetes

• Hereditary or Inherited Traits : It is strongly believed that due to some genes which
passes from one generation to another, a person can inherit diabetes. It depends
upon closeness of blood relationship as mother is diabetic, the risk is 2 to 3%,
father is diabetic, the risk is more than the previous case and if both the parents are
diabetic, the child has much greater risk for diabetes.
• Age : Increased age is a factor which gives more possibility than in younger age. This
disease may occur at any age, but 80% of cases occur after 50 year, incidences
increase with the age factor.
• Poor Diet (Malnutrition Related Diabetes) : Improper nutrition, low protein and fiber
intake, high intake of refined products are the expected reasons for developing
diabetes.
• Obesity and Fat Distribution : Being overweight means increased insulin
resistance, that is if body fat is more than 30%, BMI 25+, waist grith 35 inches in
women or 40 inches in males.
• Sedentary Lifestyle : People with sedentary lifestyle are more prone to diabetes,
when compared to those who exercise thrice a week, are at low risk of falling prey to
diabetes.
• Stress : Either physical injury or emotional disturbance is frequently blamed as the
initial cause of the disease. Any disturbance in Cortiosteroid or ACTH therapy may
lead to clinical signs of the disease.
• Drug Induced: Clozapine (Clozaril), olanzapine (Zyprexa), risperidone (Risperdal),
quetiapine (Seroquel) and ziprasidone (Geodon) are known to induce this lethal
disease.
• Infection : Some of the strephylococci is suppose to be responsible factor for
infection in pancreas.
 • Sex : Diabetes is commonly seen in elderly especially males but, strongly in women
and those females with multiple pregnancy or suffering from (PCOS) Polycystic
Ovarian Syndrome.
• Hypertension : It had been reported in many studies that there is direct relation
between high systolic pressure and diabetes.
• Serum lipids and lipoproteins : High triglyceride and cholesterol level in the blood is
related to high blood sugars, in some cases it has been studied that risk is involved
even with low HDL levels in circulating blood

Prevention of Prediabetes
Unlike diabetes, prediabetes is a reversible condition with the administration of proper
medication and life style modification. Thus prediabetes can be prevented with right diet and
exercise.

Healthy Choices Of Food : The selection of right type of food is extremely important at this
stage. One should restrict to food with low fat and low calories, and on the other side, fresh
fruits and vegetables with lots of antioxidant should be the preferred choice.

• Life-style modification : The person with less physical activity and sedentary life are
at the risk of falling prey to prediabetes. The best way to keep ourselves active is by,
walking, using stairs as far as possible, and spending daily 30 mins for some specific
exercise like yoga.
• Maintain ideal body weight : The persons who are overweight may develop more
complications in the maintenance of normal blood sugar level, thus it is advised to
maintain ideal body weight. To reduce excess of weight they should see a registered
dietitian, and by working with your doctor, follow your treatment plan. It can help you
to keep your prediabetes from worsening and developing into type 2 diabetes.

Diabetes Diet
Diet plays a significant role in controlling the diabetes. The diabetic diet may be used alone
or else in combination with insulin doses or with oral hypoglycemic drugs. Main objective of
diabetic diet is to maintain ideal body weight, by providing adequate nutrition along with
normal blood sugar levels in blood. The diet plan for a diabetic is based on height, weight,
age, sex, physical activity and nature of diabetes. While planning diet, the dietician has to
consider complications such as high blood pressure, high cholesterol levels.

With respect to the above factors, a dietician will assess calories to be given, like scheming
the carbohydrates, proteins, fats, type of carbohydrate, amount of fiber and so on.

Exchange meal plan is a diet program which balances the amount of carbohydrate that we
intake per day. Glucose is a sugar released from carbohydrate so, if we want to control
blood sugar we have to limit the consumption of simple carbohydrate. Carbohydrate foods
are given as value per portion, known as the exchange. This plan helps us to decide on the
type of food to be taken, the amount of food and also the time to eat. You can plan for more
flexible meals as you get more knowledge about the diet for a diabetic, may be like the
counting carbohydrate meal plan or constant carbohydrate. But there is no common diet
that works for everyone. Nor is there any particular diet that works perfectly for any diabetic
over a long period. While planning diabetes diet we should adhere to certain important
factors, they are as follows:

• Fiber should be at least 1.4 oz / day

• Instead of 3 heavy meals, we should go for 4-5 small mid intervals
• Replace bakery products and fast foods by simple whole cooked cereals, and don't
eat carbohydrates 2 hours before bedtime
• Consume fresh fruit and vegetables at least 5 exchange/ day
Diabetics always need to take care of their diet and also about the food they eat. Care has to
be taken because all foods contain not only carbohydrate, but also some energy value.
Protein and fat available in the food are converted to glucose in the body. This glucose has
some effect on the blood sugar level, which has to be taken care of. Furthermore, you
needn’t have to eat only the bland boring diet. Instead, you can eat more fruits, vegetables
and whole grains. All it means is that you need to select foods that are high in nutrition and
low in calories.

Sample Diabetic Diet - Diabetes Plate Method

A simple step to eat low carbohydrate and low fat diet is to follow Sample Diabetic Diet or
Diabetes Plate Method. In order to follow the food guide pyramid for diabetes in all the meals
it is essential to visualize the diabetes plate. A sample diabetic diet produces a picture in our
brain for the ideal proportion of nutrient intake. This lies especially true for type 2 diabetics,
who are in most cases overweight. The problem does not lie is what you eat but off course in
the quantity you eat. The diabetes portion plate helps a diabetic to see how much
quantity/space the particular food group should occupy on his meal plate. It is nothing but a
balanced diabetes diet. This Diet can be used by all the individuals who are overweight and
willing to keep diabetes and other heart problems at bay.

How to make Diabetic Portion/Sample Plate

1. Divide your plate in ½, and the second half into two equal ¼.

2. Fill the first half with your favorite non starchy Veggies like Lettuce, Broccoli, Spinach,
Peppers, Carrots, Green beans, Tomatoes, Celery, Cabbage, and Mushrooms etc. (Note:
Restrict the quantity of corn, peas, potatoes, yams and winter squash.)

3. The ¼ of plate with Meat/Protein like Chicken, Beef, fish, Eggs, Tofu, Cottage cheese,
Lamb, Turkey etc.
4. The remaining ¼ with brown rice, bread, Potatoes, Crackers, Peas Soup, Cereal, Tortillas,
Beans, Yams, Lentils etc.

5. One serving of non fat, sugar-free yoghurt or milk.

6. One serving of fruit like Guava, Apple, Berries or any Citrus.

Why Sample Diabetic Diet?

• Even Distribution of carbohydrate throughout the day to maintain your blood sugar
level in target range.
• It helps to lower down the intake of carbohydrate i.e starches, fat/cholesterol.
• Contains more Fibre, antioxidants, photochemical s and quality protein which are
essential part of nutritionally sound diet. This would eventually show complete
breakdown of starches.
• It is an easy way to promote weight loss with no extra efforts. Weight loss leads to
increase insulin sensitivity.

Sample Diabetic Diet or Diabetes plate method can be beneficial for :-

• Working professionals with busy lifestyles.

• Adult or Senior citizens
• Newly diagnosed diabetics or diabetics with depression.
• Low literate diabetics who understand only thumb rule.
• A diabetic with uncontrolled or dancing blood sugar levels.
• Overweight, obese or anyone willing to loss body weight.
• Person with Cognitive difficulty or mentally challenged.
• Rigid or stubborn person who don’t believe in diet planning.

Diabetic Diet Dos

• For breakfast, take cholesterol-lowering oatmeal
• Have nuts rich in mono unsaturated fat, such as pecans, walnuts, and almonds
• Eat pasta, stews and leafy salads along with beans-- kidney beans, chick peas, and
dry beans, navy beans and peas which can reduce LDL "bad"; cholesterol
• Fat free milk, yogurt, and cheese to be taken
• Eggs whites to be included
• White meat chicken and Fish and shellfish (not battered) are good
• Increase intake of dry beans and peas
• Have at least 20 to 25 grams of raw onion daily
• Add wheat bran to your wheat flour (50% wheat flour + 50% wheat bran). This helps
increase fiber in your diet
• You can also add flaxseed and fenugreek seeds into the wheat flour
• Increase fiber intake in the form of raw fruits, vegetables, whole cereals etc
• Intake of cinnamon, garlic, onion, bitter melon, guar gum is known to considerably
reduce blood glucose level

Diet Diabetic Diet Don'ts

• Don't fry foods instead bake, boil, poach or sauté in a nonstick pan. Steam or
microwave vegetables. Buy tuna packed in water, not oil
• Eat less high-fat red meat and more low-fat turkey and fish. Avoid organ meats
 • Limit the use of condiments such as ketchup, mustard and salad dress ion--they're
high in salt and can be high in sugar, too
• Rinse processed foods in water and, wherever possible, choose fresh foods over
canned
• Limit your salt (sodium content)
• Read labels carefully. Soy sauce, brine and MSG, for example, contain a lot of
sodium
• Don't select ready to eat and junk foods items available to you
• Don't smoke and stop alcohol consumption
• Don't skip meals and medicine times

Management During Diabetes

Most of the food items contain carbohydrate, protein and fat. Cereals are rich in carbohydrate,
lentils, lean meat, chicken and fish are rich in protein while oils, nuts and milk creams are rich
in fat. Fat foods are high in calories; 1g of it provides 9 calories, while 1g carbohydrate or 1g
protein gives only 4 calories.

Carbohydrate is easily digested than fat and protein. The rise in blood glucose after a meal is
due to absorption of glucose from a carbohydrate digestion and increase in production of
glucose by liver. Sucrose (cane sugar), sweets and syrups cause a rapid rise in blood glucose
than whole cereals like finger millet and wheat products.

In people with no diabetes, the rise in blood glucose after a meal comes down to the pre-
meal level with in 2 hrs. In diabetes, the rise in blood glucose after a meal is not only higher
but the fall to pre-meal level is slower (3-4 hrs). Therefore, snacks in between meals or
frequent meals at short intervals tend to cause progressive increase in blood glucose in
people with diabetes.

Glucose is constantly needed to provide ready energy for the proper functioning of brain,
heart, kidneys, liver and blood cells. When glucose is not available from ingested food, our
liver produces from its store of carbohydrate (glycocen) and body stores of fats and proteins.
The liver produces about 0.1058 oz of glucose/lbs body weight in a day. For example the liver
of a man or woman weighing 154 lbs produces 7.0547 oz of glucose in a day. The production
of glucose by the liver is kept in a check by small amounts of insulin secreted by the
pancreas.

These considerations and the modality of your treatment (tablets/insulin) are taken into
account for formulating your diet management during diabetes and meal timings. The
dietician would give your information on your diet.

The general guidelines on diet are:

In a typical day’s meals and snacks, you should have 1500-1800 calories with – 60%
contribution from the carbohydrate, 20% from fat and 20% from proteins. You may need extra
weight reduction. If you are on calorie-restricted diet, make sure to take 50-60% of calories as
complex carbohydrate (whole cereals) to prevent any feeling of weakness.

• You should eat a variety of food items everyday. Do not skip meals. Avoid snacks,
unless you are advised to (example during insulin treatment). Don’t over eat.
• Eat fruits and vegetables. Use less oil in cooking. Avoid fried foods, milk cream or
food items cooked in coconut milk.
• Avoid ready to eat food preparations, sweets and sugary drinks (canned beverages)
that provide empty calories (no vitamin or essential minerals).
• Keep a regular check on your weight – maintain it within the estimated limit.
 • Check your hemoglobin and proteins in blood samples at 6 months or 1 year’s
interval, Suitable correction in diet format or supplementation may become
necessary.
• Despite a good control of blood glucose, if your blood lipids are high, you will need
lipid lowering drugs regularly. Some times your doctor may advice you lipid-lowering
drugs from the beginning of your diabetes treatment.
• Match your mealtime to the form of insulin and insulin injection schedules as
explained by your doctor or the diabetes nurse.

Diabetic Food Pyramid

Fats (Limit to 1 serving per meal) A serving can be:-

• 10 Peanuts.
• 1 Tbsp Salad Dresssing
• 2 Tbsp light salad dressing or saur cream.
• 1 Tsp margarine, Oil or mayonnaise.
• 1/8 Avocado.

Sweets (Substitute for starch or fruit serving occasionally) A serving can be:-

• 2 Small Cookies.
• 1 Small Cupcake or Muffin
• ½ Cup Ice cream.
• 1/3 Cup Frozen Yoghurt.
• ¼ Cup Sherbet.
• 1 tsp Syrup or Honey.
Milk (2-3 Servings per day) A serving can be:

• 1 cup Milk.
• 1 Cup Low Fat.
• 1 Cup Artificially Sweetened yogurt (No sugar)

Meat / Fish/Chicken (2-3 Serving per day) A serving can be:

• 2 oz Cooked Lean Meat/Poultry/Fish.

• ½ - ¾ Cup Tuna or Cottage Cheese.
• 1 Egg or 4 oz Tofu or 1 oz cheese.
• 2 Tbsp peanut Butter.

Vegetables (3-5 Serving Per day) A Serving can be:

• 1 Cup Raw Vegetables.

• ½ Cup Cooked Vegetables.
• ½ Cup Tomato or Vegetable Juice.

Fruits (3 Serving per Day) A Serving Can be:

• 70 gm small fruit.
• ½ Cup canned fruit.
• ¼ cup Dried Fruit.
• ½ Cup Fruit Juice. (No sugar)

Grains, Starchy Vegetables and Beans. (6 plus Servings Per Day) A Serving Can be:-

• 1 Slice of 1 oz bread or ½ (1 oz) Bagel or 5 Crackers or 1 Granola bar.

• ½ Hamburger or Hot dog Bun or a tortilla of 6 inch or 2 tacos.
• ½ Cup Cooked Cereal, Cooked beans, Lentils, Corn, Peas, S. Potato, Potato or
Pasta.
• 1 Cup winter Squash, 1 Cup Soup.
• 1/3 Cup Rice or 3 Cup Plain Popcorn (Fat free)

Diabetic Care

Diabetes can be a tough disease to handle. There are many reasons for it, firstly, causes of
the disease are not clearly known, it is difficult to prevent. Secondly, once you get the
disease, it is not possible to cure the same and you need to take care of your health for entire
life. This task can be quite daunting; here are a few tips to help you.

Diabetic Care Tips

If you have diabetes, you need to take some precautions, in your day to day life as well and
not only at those times, when you feel sick. Here are some precautions that you can take in
your everyday life:

• You should monitor your blood glucose level regularly. Depending on the severity of
your condition, your doctor would tell you about the intervals, in which you should
take the test.
• You should take regular doses of medicine or insulin, as have been prescribed.
 • Regular exercise proves to be useful in controlling glucose levels. However, you
should avoid few exercises, that are known to cause further complications like
cardiovascular diseases, hypoglycemia etc.
• In case your glucose level drops suddenly during or after exercise, you should
consume a fruit juice or some similar drink that provides you with sugar.
• Weight reduction is a key of success in managing diabetes; hence take all the
measures of carb control, what you can.

In case you are suffering from any ailment like flu, cold or any other disease or infection,
some extra precautions need to be taken, to avoid further complications by diabetes:

• Check your blood sugar level more frequently, to ensure that no harm is being
caused by diabetes.
• The illness may force some changes in your diet; consult your doctor/endocrinologist
about the changes you need to make in your diabetes medicine accordingly.
• You should drink lots of water and other clear liquids.
• Remember not to cut yourself completely from food even if you are not experiencing
hunger.
• Consult the doctor, if you feel abnormal in any manner. For example you may be
feeling excessively sleepy, giddy, may have trouble with urination etc.

Even though diabetes is a chronic condition, the same does not mean, that you will have to
avoid every activity you enjoy, once you contract it. You can have the same amount of fun,
provided, that you take certain precautions. Remember, if you have diabetes, you cannot
ignore the precautions, nor do you need to get bogged down completely by them.

Diabetic Foot Ulcers

One can suffer from a number of foot problems like blisters, corns, calluses, warts etc. Among
the worst consequences of diabetes is the increased risk of their infection, leading to the
formation of ulcers. The high blood glucose level is the causative factor for such ulcers.
Utmost care should be taken to prevent such infections, as they may damage your foot to
such an extent, that an amputation becomes unavoidable.

There can be two types of Foot Ulcers caused due to diabetes viz. Neuropathic foot ulcers
and Neuroischaemic foot ulcers.

Neuropathic Foot Ulcers

They appear on the foot, under the toes in the planar region. They are usually caused by the
forces exerted on specific parts of the foot, due to our posture, leading to the formation of
callus. Over the time, it may get thicker and develop into penetrating into the tissue present
beneath it. This leads to ulceration.

This form of ulceration is usually indicated by a formation of a white macerated patch on the
foot that feels moist to touch. If such a patch is detected, you need to pay urgent attention to it
otherwise may develop into hematoma or formation of the ulcer beneath the callus.

Thus, if you have diabetes and detect the above-mentioned symptoms, you should consult
the doctor immediately and have the callus surgically removed.

Neuroischaemic Foot Ulcers

These are usually encountered on the margins of ones feet. They are caused due to the
friction between the foot and the shoes, we wear. They can also be encountered at the tips of
your toes or beneath toe nails, especially the ones that are thick. Their development is
characterized by the redness of skin in those areas. This red mark then develops into a
blister/ulcer.

Both of the above can lead to the loss of a person's toes or the entire foot, unless they are
properly treated at the initial stage.

Treatment of Diabetic Foot Ulcers

The treatment involves the reduction of pressure in those areas. Take prescribed medication
i.e. antibiotics given to control it. Antibiotics may vary according to the severity of the foot
ulcer. Measures that can be taken at home include, replacement of ill-fitting footwear,
washing ones feet frequently to keep them clean, use of certain gel or medications etc.

Foot ulcers caused by diabetes can be very severe, preventing them is always better, than
trying to cure after developing.

Diabetic Shoes

Diabetes can have an adverse effect on a person's body. A person's foot is one of the worst
affected parts, due to diabetes. The conditions caused by diabetes range from mild infections
to ulceration. In some cases, amputation is also inevitable. The reason for these conditions is
the nervous damage caused by diabetes and also the problems in circulation caused by it.
Thus, if you suffer from diabetes, you will always have to take care of your feet. Diabetic
Shoes have been specially designed for this purpose.

Diabetic Shoes

These shoes provide comfort to your ankles, balls of the feet, heel etc. The design of the
shoes ensures that there is no friction between the shoe and the foot. Thus, they prevent
possible haematoma, blisters, ulceration, calluses and other infections.

The shoes also decrease the amount of pressure exerted on the foot and thus, do not restrict
circulation. Providing a good air flow for the foot is also a function performed by such a shoe.

Types of Diabetic Shoes

In general, two types of diabetic shoes are available viz. Custom moulded shoes and depth
store shoes. Custom moulded shoes are usually constructed on the basis of the shape and
size of your foot and are usually made of leather or a material of a similar quality. They also
come along with accessories like wedges that can be inserted into the shoe to provide
additional support when required. Shoe closure is provided in the form of Velcro or laces.

In case of depth store shoes, the inner part of the shoe is linear from the toes to the heel.
However, these shoes usually have a higher depth (3 to 16 inches) in order to accommodate
the mould that fits the person's foot. These too are made of leather and are available in
various sizes in most stores.

Tips for Buying a Diabetic Shoe

These days, a number of different diabetic shoes are available for various occasions. You
should remember, that the protective effects of the diabetic shoe can only be availed, if you
wear the shoe. Indeed, in serious cases, an ulcer may develop within two hours, due to some
pressure on the foot.

If you use orthotics, see to it that the shoe can accommodate them. If your foot is prone to
deformities, you should change the shoes on a regular basis to prevent any excess friction.

Using diabetic shoes, do make it easier to take care of your feet, however the same does not
mean that you can neglect foot care completely.

Diabetes Control

Whether your treatment consists of diet alone, diet and tablets or diet and insulin, you need
regular blood tests to keep a check on your blood sugar. Urine sugar test is not a reliable
indicator of diabetes control.

When blood glucose remains higher than 200mg/dl for 8-10 weeks, the concentration of
glycosylated hemoglobin (HbA1c) arises. A (HbA1c) measurement therefore reflects the
blood glucose control over a preceding 2-3 months period, while the estimates of blood
glucose indicate the glucose value at the time of blood test. HbA1c values between 6-7%
indicate very good control on diabetes. You should aim at keeping your blood glucose in the
normal range i.e. between 90-130 mg/dl while fasting and less than 180 mg/dl after meals and
HbA1c around 7%. Frequent tests for blood glucose are necessary when starting treatment
with insulin.

If you are doing capillary blood glucose test using a hand held glucometer, do not squeeze
the finger to bring out a sample after you have picked. This invariably gives a low glucose
value. Ask your diabetes nurse for a demonstration of capillary blood glucose test.

Urine test for sugar is not reliable indicator of diabetes control. Although spillage of sugar in
urine occurs when the blood glucose exceeds 180 mg/dl in the majority of healthy persons,
this is not always so in a patient with diabetes. Most patients with diabetes of many years
acquire an increase in the renal threshold for glucose (capacity to prevent spillage of glucose
into urine). Hence urine test for glucose is not helpful for assessing control of diabetes. In
the presence of urinary infections, the bacteria eats up the sugar present in urine, thereby
making urine test for sugar unreliable.

Diabetes Management

To keep your blood glucose in control through out the day you need diet modifications,
regular exercise, medicine (tablets/insulin injections).

Insulin injection is not needed immediately after the diagnosis of diabetes is made (unless
your doctor feels this is an emergency).

If you are obese you need to reduce your weight through diet control and give up sedentary
habits so that your insulin’ works better. Your treatment should be started and supervised by
an expert, who should review every 3-6 months to help you keep your blood glucose in
control. You should register in a diabetic clinic for regular blood pressure check ups, ECG
and advice for care.
Treatment is aimed at maintaining the blood glucose in the normal range and HbA1c less
than 7%, by balancing food intake with oral medication or insulin and physical activity year
after year, to prevent complications of diabetes.

An emotional stress (a death in family, displeasure at work or at home) may increase and
disturb the control of diabetes. You need to discuss the problem with your doctor for suitable
adjustment in dosage of medication and stress control exercises.

By keeping a good control of diabetes at all times, you will be able to prevent the
complications of diabetes affecting the nerves, eyes, kidneys, heart and blood vessels.

Diabetes Nutrition

Are you tired of taking insulin pills and injections for maintaining your blood sugar levels?
Have you ever thought about the health advantages that can be derived from the
consumption of food supplements? If not, think about it! The transition to the diabetic
lifestyle will be much easier.

Diabetes is one of the most prevalent chronic diseases in the world. It prevents the body from
using glucose in our food for taking care of its energy needs. This glucose gets accumulated
in our blood, thereby risking the well-being of our heart, eyes, kidneys and nerves.

Nutritional Supplements for Diabetics

Recent researches carried out by food industries and health experts conclude that herbal
supplements such as bitter melon, goat’s rue, nopal cactus, fenugreek, bilberry, gurmar,
onions and garlic are quite effective in lowering the blood glucose level, thereby helping the
patients to undergo less treatment distress.

Diabetics must be always cautious about the source of their calorie intake. Non starchy
veggies, skimmed milk, lean chicken, high fiber fruits and low glycemic food products are
smart choices for an informed diabetic. Oil low in saturated fats content should be preferred. It
had been proved that a balanced diabetic diet contains some important nutrients and useful
supplements to help control dancing blood sugar. Let’s see few useful diabetic nutritional
supplements we receive from our food, and their action in controlling diabetes.

• Biotin – It helps the body in metabolizing carbohydrates, proteins and fats.

• Vitamin C – It prevents sugar from getting attached to proteins. Insulin deficiency
hinders effective metabolism and transport of Vitamin C, making its increased intake
all the more important. Here, ascorbates like EmergenC is more preferred as
compared to ascorbic acid.
• Chromium – It aids the metabolism of glucose. It is most effective if consumed as
niacin.
• Vitamin E – It helps in improving insulin sensitivity.
• Magnesium – It helps in lowering blood pressure and reducing heart-attack risks by
relaxing the muscle tissues.
• CLA – It helps in protecting cells from becoming diabetic or getting damaged by
atherosclerosis, colon cancer and chronic inflammation.
• Omega 3 and Alpha Lipoic Acids - They are effective building blocks and anti-
oxidants respectively. They reduce the risks associated with nerve damages by
aiding balancing of blood sugar.
• Vitamin B6 – It helps in preventing neuropathy.
• Vitamin D – It helps in reducing insulin resistance and averting the risks of cataract.
• Zinc – It helps in improving the action of insulin.
Diabetics have greater needs of nutritional supplements for fulfilling the antioxidant and
metabolic requirements of the body. Design your food intake as per the above necessities
and living the diabetic lifestyle will be a much easier road to travel upon.

Dietary Fiber Food

Turn your diet into a fiber rich one and watch how you drive diabetes away. Yes, a healthy
diet with fruits and vegetables and grains rich enough in fiber itself can regulate your glucose
levels in the blood.

Though fiber in the form of carbohydrate does not increase the blood glucose levels, instead
controls it. Studies prove that fiber rich foods have a controlling effect on the blood sugar
levels. This is because such food helps to move other foods at a better pace in the digestive
track resulting in less calorie absorption. Dietary fiber, also known as roughage or bulk is
nothing but the part of the plant that cannot be absorbed. It can be either soluble or insoluble.
The American diabetes association recommends 24g-54g in six weeks, provided plenty of
water is taken in. Fiber not only delays glucose absorption, but also increases hepatic
extraction of insulin and insulin sensitivity and hence proves beneficial to the diabetics.

Soluble Fiber: For diabetics, soluble fiber is best suited. Most foods have soluble fiber in
fewer amounts only. Only plant foods contain fiber. It comes from the cell wall of edible plant
tissues, seeds and gummy saps of certain plants.

The dietary fiber supplements include oats, barley, whole wheat flour, fenugreek seed
powder, guar gum, brown rice, dried beans, peas, chickpeas, lentils, blue berries,
strawberries, apples, pears, apricots, dates, prunes, raisins, etc. It is also recommended that
intake of fiber along with magnesium is more effective in fighting diabetes. A normal intake of
fruits and vegetables along with the skin can provide more fiber. Locust bean gum, a
thickening agent used in the salad dressings is also rich in fiber. Glucomannan, from the roots
of the konjac plant is a rich source of soluble fiber that helps in reducing the uptake of glucose
by the body.

The Dietary fiber plays an essential role in controlling type-2 diabetes. It helps the cells in
efficiently utilizing the available insulin in the body, thus making it a natural means of cure.
Fiber also slows down the absorption of glucose, thereby reducing the levels of glucose in the
blood. It does so by preventing the glucose molecules from binding to the intestinal walls for
absorption. Not just that, it is also proved that fiber rich food also helps to lower the risk of
gestational diabetes amongst pregnant ladies.