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Leading Service Provider of Diabetes Complications Of Dm, Diabetes Heart, Diabetes Feet Medical Treatment Services, Diabetes Diet, Diabetes Exercise and Diabetes Education Programme from Ahmedabad.

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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(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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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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Cardiology Treatment
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Cardiology Treatment

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We specialize in diagnosing and treating diseases or conditions of the heart and blood vessels—the cardiovascular system. You might also visit a cardiologist so you can learn about your risk factors for heart disease but also in preventing diseases.
For us, getting our patients back in good health in the shortest possible time is important. Tej Hospital uses an integrated system that provides clinical consultation, sophisticated electro-cardio-graphic (ECG) services, and the latest in heart monitoring systems.
We specialize in conditions involving the heart and blood vessels and provide diagnosis and treatment for conditions such as elevated cholesterol levels, high blood pressure, cardiac chest pain and myocardial infarction – more commonly known as heart attack.
We have minimal waiting for test results and we strive to do as many of the necessary tests and procedures in one visit. Our system assures proper, immediate medical attention.
Preventive cardiology clinic
India is facing a new era of epidemics of non communicable diseases like heart disease and diabetes. It is the right time to take steps to fight against these preventable diseases. We understand our duty in not only treating heart disease but also in preventive diseases from childhood. We encourage lifestyle modification in our society and frequently do activities of awareness like arranging ‘awareness walk’, “awareness marathon’, ‘cycling rally’, ‘smoking cessation program’.
We offer an integrated approach to patient care, including comprehensive risk assessment and treatment for all cardiovascular risk factors. We have a special focus within the Preventive Cardiology Clinic for patients and family members with strong risk factors or early-onset coronary disease. Our services include:
  • Comprehensive evaluation and effective treatment strategies to slow or stop the progression of atherosclerosis
  • Individualized action plans to determine the optimal approach for each patient, including lifestyle interventions and medications, as needed
  • Counselling and education to promote a heart-healthy lifestyle
  • Comprehensive cardiac evaluation including treadmill test and echocardiography to identify the heart disease at the earliest and identify high risk population.

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Health Packages
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Health Packages

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Basic (Rs 1200)
  • Complete Blood Count
  • ESR
  • Blood group
  • Urine Examination
  • Stool Examination
  • Diabetes Check : FBR or PP2BS or RBS
  • Liver Function test : SGPT
  • Kidney Function Test : S. Creatinine
  • Lung Function Test : PFT
  • Lipid Profile
  • Cardiac Assessment : ECG
  • Chest X-Ray
  • USG Abdomen Screening
  • Physician Check Up
  • Dietician Counseling
Executive (Rs. 2100)
  • Complete Blood Count
  • ESR
  • Blood Group
  • Urine Examination
  • Stool Examination
  • Diabetes Check : FBS, PP2BS
  • Liver Function test : SGPT, SGOT, Billirubin (total, Direct, Indirect)
  • Kidney Function Test : Blood Urea, S. Creatinine
  • Lung Function Test : PFT
  • Lipid Profile :
  • Cardiac Assessment : ECG, Echo Screening
  • Chest X-Ray
  • USG Abdomen Screening
  • Physician Check Up
  • Gynec Check Up (for women)
  • Dietician Counseling
  • PAP Smear for Female
Supreme Check Up (Rs. 3000)
  • Complete Blood Count
  • ESR
  • Blood Group
  • Urine Examination
  • Stool Examination
  • Diabetes Check: FBS, PP2BS, HbA1c
  • Liver Function: Liver Function test : SGPT, SGOT, Billirubin (Total, Direct, Indirect), Alk. Phosphatase, GGT, SGOT, S. Protein
  • Kidney Function Test: Blood Urea, S. Creatinine
  • Lung Function Test: PFT
  • Lipid Profile:
  • Bone and Joint Check: S Calcium, S Phosphorus, S Uric Acid, Ionized Calcium
  • Thyroid Function Test (in female) TSH
  • Cardiac Assessment: ECG, Echo Screening, TMT,
  • Chest X-Ray
  • HIV and HBsAG
  • USG Abdomen Screening
  • Physician Check Up
  • Gynec Check Up (for women)
  • Dietician Counseling
  • PAP Smear for Female
  • Prostate in male: PSA
  • Biothesiometer Analysis For Neuropathy
Diabetes Plan (Rs. 1000)
  • FBS
  • PP2BS
  • HbA1c (Glycocylated Heamoglobin)
  • Urinary Micro-Albuminuria
  • S Creatinine
  • Biothesiometer Analysis of Foot
  • Lipid Profile
  • Expert Opinion
  • Dietician Counseling
Diabetes Supreme (Rs. 2600)
  • FBS
  • PP2BS
  • HbA1c (Glycocylated Heamoglobin)
  • Urinary Micro-Albuminuria
  • S Creatinine
  • Biothesiometer Analysis of Foot
  • Lipid Profile
  • ECG
  • Echo Screening
  • Both Leg Arterial Doppler
  • USG Kidney Screening
  • Fundus
  • Expert Opinion
  • Dietician Counseling
Cardiac Evaluation Plan (Rs. 1600)
  • FBS
  • Lipid Profile
  • ECG
  • TMT
  • Echo Screening
  • CBC
  • Urine Routine
  • Expert Opinion
  • X-Ray Chest
  • Dietician Counseling

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Diabetes Knowing The Dm
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Diabetes Knowing The Dm

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(Q.) What is diabetes?
  • Diabetes (DM) is a disease with high blood sugar level. With an increasing incidence worldwide, especially in INDIA, DM will likely continue to be leading health disorder in the foreseeable future.
  • The food we eat is eventually turned into glucose (figure 1). Glucose is the energy source of the body. Each organ, each cell of the body is dependent on glucose for survival. The pancreas, an organ near stomach, produces a substance called insulin. Insulin is necessary for the effective utilization of glucose. When we eat food our brain estimates the amount of insulin required for the proper digestion of the glucose. Based on this the brain sends signals to the pancreas to produce and deliver the required amount of insulin (figure 2). A person develops diabetes if insulin is not produced or inadequately produced or improperly utilized. This can lead to hyperglycemia (consistent high levels of glucose in the body). This condition is called diabetes.
(Q.) What are symptoms of DM?
  • Excessive thirst
  • Frequent urination
  • Unexplained weight loss
  • Irritability
  • Weakness and fatigue
  • Blurred vision
  • Tingling or numbness in feet
  • Delayed healing of wounds

(Q.) Will a diabetic have all these symptoms?

  • No! The patient may have one or more symptoms
  • Even in absence of apparent symptoms a person may be prone to diabetes. A regular check up makes it possible to detect and treat in the early stage before any damage is caused. This practice pays in the long term.

(Q.) Who are at risk of diabetes?
People Who:

  • Have family history of DM
  • Are over 40 years of age
  • Are overweight
  • Do not perform physical activities
  • Regular use of alcohol & tobacco
  • Polycystic ovary syndrome
  • Hypertension(blood pressure >140/90 mm Hg)
  • High cholesterol
  • History of gestational DM(high sugar detected during pregnancy)

(Q.) Who are called overweight ?

  • We all are probably worried of overweight. We all are interested to know our ideal body weight. This is calculated from BMI (body mass index).BMI is calculated by :
  • weight in kg/square of height in meter
  • If weight is 70 kg and height is 1.5 meters(5 feet), then BMI is 70/1.5*1.5=31kg/m2
  • BMI up to 25 is normal weight.
  • BMI from 25 to 30 is over weight.
  • BMI more than 30 is obesity.

(Q.) Can diabetes be prevented?
Yes This can be done by modifying lifestyle by :

  • Regular exercise
  • Keeping control over weight
  • Diet control – take balanced diet and avoid fast food
  • Regular health check up especially in those at high risk
  • Spreading awareness about the disease
  • Stress management

(Q.) What are the causes of DM?
The causes of high blood sugar can be divided into the following:

  • Improper functioning of the insulin factory (pancreas) - As we know that pancreas produce insulin in the body. Any defect in the pancreas like chronic pancreatitis will lead to defective production of insulin leading to high blood sugar. This condition results in insulin deficiency.
  • Though available and required, yet body unable to use the insulin (insulin resistance) - Improper use of insulin. Here insulin is produced in sufficient quantity, but due to complex defect at the cellular level the insulin does not enter the cell and remains ineffective.

 

 

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Diabetes Hypoglycemia

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(Q.) What is hypoglycemia?
Hypoglycemia means low blood sugar levels.
(Q.) What are the warning symptoms of hypoglycemia?
The diagnosis of hypoglycemia is confirmed in a symptomatic patient if blood sugar level < 60 mg/dl is found.
  • The initial symptoms include cold sweats, hunger, weakness, nervousness, trembling of hands and rapid heartbeat. However, if hypoglycemia persists it might affect the brain leading to headache, blurred vision, abnormal behavior, confusion, and in severe cases, even loss of consciousness.
(Q.) When does it usually occur?
  • The commonest times when hypoglycemia tends to occur are mid-morning, just before meals and during or after strenuous exercise. Sometimes hypoglycemia might even occur during the night while you are sleeping.
  • Keep your blood pressure and blood fats under control.
(Q.) What are the causes?
  • Too little food or a delayed meal
  • Delayed meal
  • Increased exercise without an additional snacks
  • An overdose of medicine
  • Stress
  • Decreased liver and kidney function
(Q.) How to treat hypoglycemia?
  • Immediate treatment will rapidly restore you to normal. As soon as the warning symptoms occur:
  • Stop whatever you are doing. This is especially important if you are doing something, which might involve risk to yourself or others, such as operating machinery or driving.
  • Immediately consume any fast acting sugar. This could be in the form of two lumps of sugar, a couple of biscuits, a glass of orange/apple juice or sweetened milk or two teaspoons of honey.
  • Speak to your doctor to help you regain a balance between food intake, exercise and medication.
(Q.) What precautions can be taken to avoid hypoglycemia?
  • Know the signs and symptoms of hypoglycemia.
  • Try to eat meals on a regular schedule.
  • Always carry some form of sugar which can be swallowed easily as soon as you experience any symptoms of hypoglycemia.
  • Perform self-monitoring blood glucose (SMBG) regularly for early detection of low blood glucose level; initiate treatment at the first signs of hypoglycemia.
  • Always carry some identification that you have diabetes. If you become unconscious, it is essential that anyone, who discovers you, should realize that you have diabetes.
  • Always inform those who might need to know, such as work-mates, relatives, teachers, etc; that there is a possibility that you could become hypoglycemic.

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(Q.) What is the role of stress on our body?
  • Stress can do what we cannot think off. Stress makes us prone to various diseases including hypertension (high blood pressure), heart disease, diabetes and what not.
  • What do you mean by STRESS? Most people believe that they have no problem at home or at work, so I do not have any stress. The important thing is how we mentally react to various events and problems happening around us and how we look at the world and life in general. If we react to various things with negative emotions (e.g. anger, fear, hatred, jealousy, revenge, worry, irritation, frustration, anxiety), we are bound to be stressed. To illustrate with a small example, suppose your vehicle suddenly goes out of order. One way is to feel highly tense as to why it has happened? Vehicle was so costly. Another mature way of looking at it is that it is a way of life; things can get out of order and I should be able to accept any eventuality in life. This type of thinking won’t create stress in you.
(Q.) How to know about our personality?
Depending on how a person reacts to various situations in life, scientists have divided people into three personality type.
Type A Personality
  • Type A personality is characterized by aggressiveness, competitiveness, over-ambition, impatience, hurry, restlessness, racing against time. Outward symptoms of such persons are accelerated and blurred speech, explosive responses, tendency to challenge and hostility.
Type B Personality
  • They are less competitive and are patient, composed, realistic and willing to come to terms with themselves, others and environment.
Type C Personality
  • They are on the other extreme as compared to Type A personality. They are depressed, sad, hopeless, and withdrawn to themselves with a feeling of helplessness and inferiority.
It is the type A persons who are an easy prey to heart diseases than the persons of type B and type C. Type B are emotionally stable. Type C persons develop other types of diseases because of their different type of negative emotions.
(Q.) How can we reduce the stress?
  • Some people have wrong notion that something or someone external to them is responsible for their stress and unless these external situations change, they can’t be happy. But this is an incorrect understanding about the laws of stress causation. Often the people and situations around you can’t be changed but it doesn’t mean that you will remain stressed throughout the life. It is not the external situations but your reactions towards them which cause stress. You may control your reactions such that you are never affected emotionally no matter what happens in the outside world. It is like insulating your mind from the impact of external situations or making mind independent of external circumstances. In this situation mind behaves as the master and the external circumstances as its servants so that mind controls the external circumstances instead of being controlled by them. Below are given some useful tips in this direction:
(1) Avoid Strain Of Perfectionism And Idealism
  • There are many people in the world, who remain under strain because they expect perfectionism in everything and they are not able to get it.

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(Q.) What are the treatment options for a diabetic individual?
This depends on the type of diabetes.
  • The people with type 1 diabetes require insulin replacement. Type 1 diabetic individual does not produce insulin (by pancreas).They depends on external insulin only.
  • The people with type 2 diabetes have two major problem- (1) produce inadequate insulin (by pancreas) (2) have insulin resistance. They can be managed with oral medicines. However those with uncontrolled blood sugar level despite adequate dose of oral medicines, require additional insulin.
(Q.) How the drugs for diabetes work?
The drugs available in the market act at following regions:
  • Beta cells of pancreas: - The beta cells of pancreas are the factory for insulin production. In diabetic people these cells get depleted. Drugs act on remaining beta cells to produce insulin.
  • Insulin resistance: - In this group of diabetic people, the insulin is produced by the beta cells. The insulin in blood is in-fact normal and/or high. However the problem is that the insulin can not enter the cell due to cellular defect. This is called insulin resistance. Drugs act at cellular level making insulin to enter the cell.
  • Liver:- Liver is store of glucose. During fasting state liver release glucose in blood. Drugs act on liver and decrease release of glucose.
  • Small intestine: - The food we eat is digested in intestine. Drugs act on intestine and decrease absorption of blood glucose.
The diabetic individual is advised to take the medicines prescribed by the concern doctor.
(Q.) Why some people who are initially on drugs may require insulin later on?
  • A-It is seen that many people with diabetes are initially controlled on oral medicines, but as the time progresses their blood sugar remain constantly high. This can be understood from the mechanism of development of diabetes. As we know insulin in our body is produced by the beta cells of the pancreas. In diabetic individual the beta cells gradually get destroyed. By the time 80 % of the cells are destroyed the blood sugar level is with in normal limits. With further depletion of beta cells the blood sugar remains high and the individual is diagnosed to have diabetes. The drugs given act on these remaining cells and make them over work to maintain blood sugar level with in normal levels. A time comes when the beta cells are depleted to 5 % or less. The drug given acts on the remaining cells, but the remaining beta cells get exhausted and are not able to maintain blood sugar level. At this stage the individual require external insulin to keep diabetes under control.
  • B-The above mechanism explains why a diabetic individual who is very regular in exercise, follow good diet control and takes medicines regularly still require higher and higher dose of oral medicines to keep blood sugar under control.
(Q.) If I take insulin once then I have to take insulin whole life?
  • A-This is a misunderstanding type 2 diabetic individuals commonly have. The very fact is that the type 2 diabetic individuals produce insulin by themselves. However the insulin produced is inadequate. The drugs given increase the insulin production. Once the insulin producing beta cells are depleted they require external insulin. It is thus the insulin is started in those who desperately require it.
  • B-The high blood sugar levels (usually above 250 mg/dl) have toxic effect over the beta cells. The glucose toxicity accelerates the destruction of beta cells. It is thus advised to rapidly control blood sugar with insulin and then to shift back to oral medicines.
  • C-During severe infection, surgery or any other acute emergency the diabetic individual are put on insulin. Once the event is over the individual is again put back on oral medicines.

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