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Dr. Anant is practicing as a consultant physician at Tej Hospital which is conveniently located near Vastrapur lake, Ahmedabad. Dr. Anant yadav is practicing as a consultant diabetologist, cardiac physician and run daibetes education programme on regular basis. we not only cure but prevent diabetes.
Our primary integrative medicine goal is the maintenance of your health and wellness, and we are committed to safe and effective healthcare. We aim to provide a wide range of comprehensive medical services with quick results without the unnecessarily long and tedious hours of waiting. We provide consultations, diagnosis and treatment services for a wide range of medical and surgical specialities to patients.
Diabetes is a major health problem to the society. Day by day the numbers of cases of diabetes are increasing. India is known as the capital of diabetes in the world. We all are at risk of diabetes. Thus it is high time to act. Better understanding of diabetes will help not only for treatment but also for preventing it.
Dr. Anant Yadav’s depth of specialized medical knowledge and experience ensures that you are in the safe, secure hands of a medical professional who is skilled in the latest techniques and is at the top of his field.
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Diabetes Complications Of Dm
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(Q.) What could be the complications of diabetes?

As we already know that many of the patients of diabetes are asymptomatic. Then why should they be treated. Here comes the role of complications of diabetes. Long term uncontrolled diabetes leads to complications. The diabetic individual must know the complications of diabetes. The complications of diabetes can be divided into (1) Acute (short term) (2) Chronic (long term).:
Chronic:
  • Heart disease
  • Kidney disease
  • Eye problems
  • Nerve damages
Acute:
  • Diabetic ketoacidosis
  • Hyperglycemic hyperosmolar state
  • Hypoglycemia
  • Infections

(Q.) Why do complications occur?

  • Diabetes leads to increase blood sugar level. The glucose is converted to sorbitol (tissue toxin). This toxic substance causes damage to organs/body cells leading to complication. High blood sugar also causes glycation (structural change) of proteins. This modified proteins form cross linked proteins termed advanced glycation end products through a series of biochemical reactions. These end products cause cellular damage leading to diabetic complications.

 

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Diabetes Heart
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Diabetes Heart

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(Q.) Why are we worried of heart diseases in patient of diabetes?
Diabetes is major risk factor for heart disease:
  • Diabetic man as Compared to Non-diabetic-Heart disease: Two times
  • Diabetic man as Compared to Non-diabetic-Heart attack: 27% more
  • Diabetic woman as Compared to Non-diabetic-Heart disease: Four times
  • Diabetic woman as Compared to Non-diabetic-Heart attack: 19% more
  • Thus heart disease is more frequent in diabetic people.
(Q.) Who are at risk of heart disease?
Diabetes is major risk factor for heart disease :
  • Diabetes
  • High cholesterol
  • High blood pressure
  • Family history of heart disease
  • Smoking habits
  • Obesity
  • Sedentary lifestyle
  • Male gender
(Q.) How does diabetes affect heart?
  • A-Diabetes leads to increase in bad cholesterol. The bad cholesterol gets deposited on the blood vessel wall. This process is called atherosclerosis (figure 7). It results in narrowing of blood vessels leading to diminished blood flow and many a times the blood vessel is totally blocked. This results in ischemic heart disease (heart attack).

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Diabetes Feet Medical Treatment Services
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(Q.) What are the common foot problems seen in a diabetic?
The common problems are:
  • Skin Changes: Diabetes can cause changes in the skin of your feet. The skin becomes very dry and may peel and crack. The route cause is loss of nerves in your feet that control sweating. This dries up the skin making it prone to crack. This may lead to infections and/or ulcers. It can be avoided by applying cream on feet.
  • Foot Ulcers: Ulcers occur most often over the ball of the foot or at the bottom of the big toe. Ulcers on the sides of the foot are usually due to poorly fitting shoes. Remember, even though some ulcers do not hurt, every ulcer should be shown to your doctor. Neglecting foot ulcers can result in infections, which in turn can lead to the loss of limb.
  • Neuropathy: Diabetes causes nerve damage. Nerves carry sensation to the brain. Any sensations like pain, touch, vibration are carried by nerves from parts of body (like feet and hand). Nerve damage causes impaired sensations in the extremities. This is called diabetic neuropathy.
  • Poor Blood Flow: Diabetes causes atherosclerosis (narrowing and hardening of blood vessel due to deposition of cholesterol). The narrow blood vessels result in poor blood flow in extremities including legs. This renders your feet less capable of fighting infection and affect wound healing. Exercise improves circulation and helps stimulate blood flow in the legs and feet.
  • Amputation: Many diabetic patients have diabetic neuropathy and/or poor blood flow in limbs. This results in non-healing infected ulcer and also some may develop gangrene (blackening of body part). This requires amputation. Proper foot care coupled with regular check-ups can help save your feet.

(Q.) What are the symptoms of diabetic neuropathy?
It is not necessary that all patients have same symptoms. Also the symptoms vary according to the severity of nerve damage. The common symptoms are:

  • Tingling and numbness in feet.
  • Loss of sensations like pain, touch, vibration.
  • Slipping of foot-ware without any notice.
  • Pain in feet especially at night hours.
  • Foot ulcers.
  • Sometimes patient has feeling of walking on cotton wools.

(Q.) What are the do’s and don’ts for foot care?
Do'S:

  • Check the sole of your feet every day preferably using a mirror.
  • Wash your feet everyday with lukewarm water and mild soap.
  • Keep the skin of your feet smooth by applying a cream or lotion, especially on the heels.
  • Dry your feet well, especially between the toes, using a soft towel. Avoid rubbing.
  • Dust your feet with talcum powder before putting on shoes and stockings.
  • Dip your toenails in warm water to soften them before you cut them. Cut them straight across to avoid ingrown toenails.
  • To improve blood flow in your feet, put your feet up when you are sitting. A simple exercise to improve blood flow is to flex your toes for 5 minutes, 2 to 3 times a day and also move your ankles up and down and in and out.
  • Walking, dancing, swimming and bicycling are good forms of exercise.
  • Always include a short warm-up and cool-down period while exercising. Wear athletic shoes that fit well and provide good support.
  • Keep your blood pressure and blood fats under control.

Don’ts:

  • Don’t let your feet get too hot or too cold as this can affect blood flow to your feet.
  • Avoid walking barefoot to avoid even minor injuries.
  • Don’t treat cuts or corns by your self as this might result in self-injury.
  • Don’t cross your legs for long periods of time or wear tight socks and footwear as this may reduce blood flow to your feet.
  • Don’t smoke, as smoking reduces blood flow to your feet.
  • Avoid activities like running and jumping that put strain on your feet.

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Diabetes Diet
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(Q.) What are the goals of nutrition therapy?
Specific goals of nutrition therapy are to:
  • Achieve and maintain as near-normal blood glucose levels as possible by balancing food intake with physical activity, supplemented by oral hypoglycemic agents and/or insulin as needed
  • Normalize blood pressure
  • Normalize serum lipid levels
  • Help patients attain and maintain body weight
  • Promote overall health through optimal nutrition and lifestyle behaviors.
Because no single dietary approach is appropriate for all patients, meal plans and diet modifications should be individualized to meet a patient’s unique needs and lifestyle. Accordingly, any nutrition interventions should be based on a thorough assessment of a patient’s typical food intake and eating habits.
(Q.) Can diet and exercise itself control diabetes?
The diagnosis of hypoglycemia is confirmed in a symptomatic patient if blood sugar level < 60 mg/dl is found.
  • Yes, some patients with mild-to-moderate diabetes can be effectively treated with an appropriate diet modification and exercise as the sole therapeutic intervention, particularly if their fasting blood glucose level is < 140 mg/dl. It is important to note that medicines are less successful when the patient is not on some type of dietary and exercise regimen.
(Q.) How dietician/ health care professionals are helpful in dietary management?
They perform valuable functions:
Conduct initial assessment of nutritional status:
  • Diet history
  • Lifestyle
  • Eating habits
Provides guidance to the patient regarding :
  • The basic principles of diet therapy for diabetes
  • Meal planning
  • Problem-solving technique for changing eating behaviors
Develop an individualized meal plan Provide follow up assessment of the meal plan to:
  • Determine effectiveness in terms of glucose and lipid control and weight loss
  • Make necessary changes based on weight loss, activity level, or changes in medicines
(Q.) Why worry about weight in a case of diabetic?
Majority of diabetics are overweight. Weight loss can result in :
  • Improved glucose control
  • Increased sensitivity to insulin
  • Improved lipid levels and blood pressure
  • It may result in reduction of dosage of medicines (e.g., oral anti-diabetic medications and insulin).

(Q.) How weight loss can be achieved?
No single approach can achieve the goal. It requires combination of strategy like:

  • Modest calorie restriction
  • Restriction of saturated fat intake
  • Spreading calorie intake throughout the day
  • Increased physical activity
  • Behavior modification techniques for changing eating habits and attitudes and promoting healthy, long-term lifestyle behaviors
  • Psychosocial support.

(Q.) Are there any drugs for weight loss?

  • Yes, there are medicines for weight reduction. However available medicines have minimal long-term effectiveness. The medicines are used as an addition to diet and exercise and not substitute.
  • The major groups of drugs used to manage obesity are (1) centrally acting medications that impair dietary , rimonabent etc. (2) medication that act peripherally to impair dietary absorption like orlistat. (3) Medications that increase energy expenditure.

(Q.) Can I take medicines instead of diet control and exercise?

  • No, this is just an excuse to avoid diet control and exercise. Diet control and exercise is must and drug therapy is just an addition to it. Further, no drug for weight reduction is without side effects. The drugs are usually given for a limited period only.

 

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Diabetes Exercise
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Diabetes Exercise

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(Q.) What is role of exercises?
  • Lowers blood glucose levels quickly.
  • Improves the body’s ability to use insulin.
  • Reduces insulin requirement.
  • Better control of Diabetes.
  • Reduces the risk of heart disease.
  • Exercise helps in controlling weight.
(Q.) How do I get started for exercise?
  • The first step before you start a more active lifestyle is to begin with a thorough medical examination. This is the only way to make sure your exercise programme meets your individual needs. Everyone is different and your exercise plan needs to be based on your health and your body’s needs.
(Q.) I am elderly and it is rather hard for me to get around. Should I still try to exercise?
  • You should try to exercise regardless of your age. If it is difficult to get out, you can do various stretches at home and even while sitting down. As our body ages, warming up with stretching exercises become more and more important. You may find that by properly stretching, you can do more than what you thought you could.
(Q.) I have both diabetes and arthritis. Can I still workout?
Yes you can, but take care
  • Always do stretching before exercise
  • Plan exercises which will strengthen your muscles and make you feel better.
(Q.) Is there a limit to the types of exercise a person with diabetes can do?
  • There is no limit to what people with diabetes can do. Barring another medical condition, people with diabetes can do anything and everything. You can walk, cycle or swim. These are only examples and everyone is different. So be sure to ask your physician if you should have any limits imposed on your exercise programs.
(Q.) If I workout at the gym, what is the best machine I can use on a daily basis?
  • Stair climbers and treadmills are excellent machines to use at the gym. They stimulate walking, running and climbing which can help burn fat, build endurance, and strengthen the cardio-vascular system. Weight bearing exercises can also provide a great workout. The important thing is to find something you enjoy, and exercise safely.
(Q.) What are the recommendations for physical activity?
  • People with diabetes should be advised to perform at least 150 minutes / week of moderate – intensity aerobic physical activity (50 – 70 % of maximum heart rate).
  • In the absence of contraindications, people with type 2 diabetes should be encouraged to perform resistance training three times per week.

(Q.) What are the aerobic exercises?

  • Aerobic exercises involve rapid and continuous movements so that the rate of heart beats is increased and remains high for sometime. Exercises serving this purpose include brisk walking, running, cycling, swimming, jumping etc. These exercises increase the heart rate and put load on heart. It also helps in better glucose utilization by the body. It burns out excess calories. Thus it is useful for both heart and diabetes. Initially the increase in heart rate is achieved at low workload; gradually as one continue to exercise the capacity of the body increases. The individual can do physical strain with smaller number of beats.

Aerobic exercise is discussed in further coarse.
(Q.) What are pre-walking exercises?

  • It is always advisable to start with warm up exercises. This improves the blood circulation and also avoids undue straining/spasm of muscles. These can be simple stretching exercise like side bending, knee pull, leg curl, wall push, etc. All these postures should be held for 10 seconds and then to repeat on other limb.

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Diabetes Education Programme
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Treatment of any disease starts with understanding the disease. Your eyes see only what your mind knows. Diabetes is a disease which requires constant effort from the treating doctors and also the patient.
Our centre takes keen interest in teaching the patient. It is called as ‘diabetes education program’. This not only makes the management easy, but also helps in preventing complications of diabetes. We run ‘diabetes education program’ at our centre. We make small groups of patients with their relatives and arrange series of sessions on different aspects of diabetes. It’s very common that the patients sometimes feel that he /she forget to ask few questions or few tips. This provides platform for the patient to interact with the doctor/diabetes educator and also with others patients. Discussing the problems always brings the best of solutions.
We arrange lectures on following topics:
(1) Understanding diabetes
(2) Laboratory tests in diabetes
(3) Goals of treatment with evidence
(4) Complications of Diabetes and its prevention
(5) Diet
(6) Exercise in diabetes
(7) Stress management
(8) Medical managements

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Insulin Pump
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Insulin Pump

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An insulin pump is a device used to provide insulin to help people with diabetes control their blood sugar. They are programmed to deliver tiny amounts of insulin continuously throughout the day. The insulin is delivered to the body through a tube inserted in the skin.
What Is an Insulin Pump?
An insulin pump is a small computerized device designed to precisely deliver insulin to the body through a small tube inserted in the skin. This eliminates the need for individual insulin injections. It is still necessary to check your blood sugar often, and the infusion sets (the tubing plus the needle or cannula) must be changed every two or three days. Insulin pumps provide certain benefits (see Insulin Pump Advantages),but are not right for everyone (see Insulin Pump Disadvantages). They can be a useful tool for controlling your blood sugar.
How Do Insulin Pumps Work?
There are several different types of insulin pumps, but the basic operating principles behind all of them are basically the same . An insulin pump is worn outside the body, often clipped to an item of clothing. The pump itself is fairly small (about the size of a deck of cards or smaller) and looks much like any portable electronic device. It contains insulin (usually rapid-acting or short-acting) and is connected to a small, replaceable tube. The tube can be connected to the body using various different types of systems. Some use a steel needle that remains in place the entire time; others use a steel needle only to insert the tiny plastic needle (known as a cannula), after which the needle is removed.
Insulin pumps are programmed to deliver tiny amounts of insulin continuously throughout the day (the basal rate) and can also provide additional doses as necessary (bolus doses). The basal rate can be variable. In other words, you can program it to deliver different basal rates throughout the day. For instance, you might need to have a high basal rate for early morning in order to counteract the increase in blood sugar that occurs in the early hours of the morning (the dawn phenomenon).
Recently, real-time continuous glucose monitoring systems have become available. Some of these systems can be programmed to calculate an appropriate dose based on your blood sugar reading, and some can even wirelessly send a signal to the pump to deliver the calculated dose. Even some traditional-style blood glucose monitors can communicate wirelessly with some types of insulin pumps.
What Are Possible Insulin Pump Advantages?
If you are considering an insulin pump, you may wonder about the possible advantages. Insulin pumps can offer several benefits.
For many people, they are a good option because insulin pumps can provide the following advantages:
  • Decreased needle pricks (no need for individual insulin injections)
  • The possibility to improve your HbA1C over using insulin injections
  • A decreased risk of dangerously low blood sugar
  • More flexibility with regard to meals
  • The ability to accurately dose even tiny amounts of insulin
  • No unpredictable effects from long- or intermediate-acting insulins, since the pumps use only short- or rapid-acting insulins
  • An easy way to record your insulin usage (for pumps that offer this feature)
  • A precise, consistent way to deliver a basal rate of insulin (the background rate used throughout the day)
  • The ability to program a variable basal insulin rate (different rates for different times of the day)
  • An easy way to deliver a bolus dose (to cover meals or periods when the pump is turned off)
  • The ability for a real-time continuous glucose monitoring system to calculate an appropriate dose based on your blood sugar reading and to wirelessly send a signal to the pump to deliver the calculated dose (for some pumps)
  • The peace of mind that you are doing everything within your power to manage diabetes.

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Continuous Glucose Monitoring
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What is CGM (Continous Glucose Monitoring) ?
CGM systems record your blood glucose levels 24 hours a day for three to four days at a time. Testing occurs every 1 to 5 minutes, depending upon which monitor is being used. Thus, in a 24 hour period there are 288 to 1,440 blood glucose test being done.
How does it do this? A small sensor, usually about the size of a quarter, is attached to your skin with a piece of tape. The sensor has a very small catheter which is inserted into your skin. This sensor automatically takes a sample test of your blood sugar levels at the given interval (1-5 minutes).
Users will also need to take 3-5 traditional finger stick test to supplement the continuous glucose monitoring system results. The CGM system is typically used for 3-4 days (although some are worn up to 7 days).
Throughout the day you will also record, typically by pressing a button, when you took insulin (and how much), when you exercised and when you ate a meal or snack. The meter and subsequent data analysis will factor this all together to determine how your body and treatment is performing.
Results are provided in real time on the monitor and at the end of the monitoring period (3-7 days). The test data is uploaded and shared with your health care provider for analysis. The sheer volume of information can really help your doctor formulate a successful treatment plan to work with you as an individual.
Advantages of CGM.
There are a number of advantages and benefits from doing CGM. Primarily, our blood sugar levels are not necessarily consistent or predictable.
Finger stick testing, even if done regularly, only provides the briefest of snapshots regarding your glucose levels. Imagine if you had to do a finger test every minute, or even every 5 minutes! You simply could not do this effectively.
Finger stick testing alone may miss wide fluctuations in your glucose levels, particularly when you are sleeping.
In fact, some studies have found that optimal glucose control using traditional monitoring methods is less than 30 percent.
Some Key Benefits, Advantage and Reasons to CGM:
  •  Worried about Hypoglycemia (low blood sugar) (Particularly at night).
  • Use Insulin to manage diabetes.
  • Experience fluctuating glucose levels.
  • Want to achieve better understanding and control over your diabetes.
Are Their Disadvantages to performing Continuous Glucose Monitoring?
CGM may not be right for everyone. The meters are rather expensive ranging from approximately RS 50000 and up. If you are not experiencing poor diabetes control, then this system or monitor may not be worth the extra price. Nonetheless, it is worth a conversation with your healthcare provider to determine your ultimate course of action and treatment.
We use CGM in indicated patients to manage their diabetes in a better way. We provide it at a reasonable cost, also with thorough counselling and support staff.

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