GESTATIONAL DIABETES LEVELS AMONG PREGNANT MOTHERS - SWEET CLINICS

Introduction

Gestational diabetes mellitus (GDM) is a condition of high blood glucose levels are detected for the first trimester during pregnancy.  GDM is very common and some studies have reported that 10-20% of pregnant women in India have GDM.

Who are at risk of GDM?

Older women
Overweight or obese.
Family history of diabetes
If there was a previous history of Gestational Diabetes.
Screening and diagnosis of hyperglycemia in pregnancy

 All pregnant women should be screened at the first visit to antenatal clinic. Early in pregnancy screening is done usually at the booking visit to see if the woman already has diabetes complicating pregnancy which she did not know about. Screening can be done using either fasting plasma (FPG), glycosylated hemoglobin (A1C),or random plasma glucose(RPG). If a woman has high blood sugars early in pregnancy (FPG>7mmol/l (126 mg/dl), A1c >6.5% or RPG >11.1 mmol/l(200mg/dl) then she should be treated as having pre-existing diabetes.

All women who have normal blood glucose levels of sugar early in pregnancy should be screened again with an oral glucose tolerance test (OGTT) between 24-28 weeks of the pregnancy to rule out GDM. They should come to the centre in fasting state at least 8 hrs-10 hrs and should not consume anything except water before the test. Fasting blood and urine are collected, 75 gms of oral glucose is given to drink in 300 ml of water. Blood is then drawn at one and two hrs of the glucose load. If fasting plasma glucose is between 92-125mg/dl or 1 hr of glucose load >180mg/dl or 2 hrs level is >153mg/dl (International Association of Diabetes and Pregnancy Study Group, IADPSG criteria) the woman is said to have Gestational Diabetes.

Weight gain during pregnancy

All pregnant women should gain some weight during pregnancy and the recommended weight gain is decided by the Pre-pregnancy body mass index (BMI)

                               BMI = Weight (kg)/ Height in m2

Changes of body weight based on BMI

< 18.5 Underweight
18.5-22.9 Normal
23-24.9 Overweight
>25 Obese
(According to Asian Indian guidelines1)

Recommended weight gain according to pre pregnancy BMI

BMI Weight gain
<18.5 12.5-18 Kg
18.5-24.9 11.5-16 KG
25-29.9 7-11.5 KG
>30.0 5-7 KG
Managing Gestational Diabetes

Gestational Diabetes levels can be managed through balanced and healthy diet, medication and exercise. Medication is usually indicated if blood sugars do not come to normal with diet and exercise. Recommended levels of glucose are fasting<90mg/dl(5.0 mmol/l),1 hr<140mg/dl(<7.8 mmol/l),2 hrs <120mg/dl(<6.7 mmol/l)

General guidelines for healthy eating

Generally good nutrition is important during pregnancy and en effective way to manage gestational diabetes levels. A dietitian can guide to take portion size, right amount of protein, fat and carbohydrate.

Here are some general tips:-

Eat variety of foods distributing calories, carbohydrate and taking enough protein
4-5 serving of vegetables is recommended
Adequate fluids 2-3 liters should be taken but however water has to be restricted if there is  pedal edema.
Iron rich foods should be included. Eg: – Greens
Consume 650 ml of milk/ day to meet calcium requirements.
Avoid direct sugars, artificial sweeteners.
Avoid Alcohol and tobacco.
Use a combination of oils Eg: – Mono unsaturated fats and Poly unsaturated fats
Include plant protein like pulses, dhal etc.
Restrict animal protein like red meat.
Healthy plate

One way to decide how much to eat to divide the plate is given below. Up to half plate should contain vegetables and fruits, about one quarter of plate should be starch or grains and the reminder protein and calcium rich foods.

Physical Activity

Aerobic activity of moderate intensity for 30mins/day on most days of the week has shown benefits in metabolic control. Start with light to moderate exercise. Any simple physical activity is better than no activity.

Insulin

Insulin is indicated when target blood glucose levels are not attained with diet and physical activity. Different types of insulin is prescribed by the Diabetologist.

Materials required for insulin injection

Insulin
Syringe or pen type needle.
Denatured spirit
Cotton.
General guidelines for patient on bottle type insulin

Insulin must be refrigerated, not frozen
Store away from heat
It must be rolled between two hands before using.
Common site for taking Insulin are upper part of thigh. You may not want to use abdomen during pregnancy, hence arms and legs are preferred.
If refrigerator not available (ex. in villages) Insulin can be stored in clay pot.
Each bottle type contains 400 units
If using 100 u insulin then use a 100u  syringe
If using 40u  insulin then use a 40u  syringe.
General guidelines for patients on pen type insulin

The pens can be stored at room temperature while in use.
Should not get exposed to direct sunlight
Pen needle can be used 4-5 times without sterilization.
Each pen contains 300 units of insulin.
Insulin pens are available in two basic types, disposable and reusable.
 Insulin pens are portable,discreet and convient to carry,

How I Keep Stress From Affecting My Diabetes - Sweet Clinics

How I Keep Stress From Affecting My Diabetes

A few health issues, a couple of family worries, general anxiety about the state of the world. And while I know I’m not alone, I also know that stress can spell particular trouble for people with type 2 diabetes, raising blood sugars and making it more difficult to stay on track with medications, diet and exercise.

It can also lead you to reach for food, alcohol, or cigarettes. Anything to calm you down.

In the old days, my anxieties turned me to food. I would do okay during the day – I counted carbs and calories and avoided sweet treats. But around midnight, stressed out and unable to sleep, I’d find myself standing before the open refrigerator, scanning the shelves for something, anything to eat. Cold pasta, left-over cheesecake, cake icing from a can.

This habit locked me in a vicious cycle: up until one or two a.m., by morning I’d rise exhausted with higher than normal sugars, which made me more irritable and anxious and even less able to cope with my stressors.

Since that time, I’ve uncovered a few tactics to help me avoid the refrigerator blues. While I don’t always succeed in managing my anxieties, I try not to let them sabotage my diabetes care. They include:

Be kind to yourself.  If you’re stressed, you’re probably also deep into self-criticism, telling yourself you should be stronger, calmer, more in control and on and on. But this is the time to see the positive, even if it means sticking Post-It affirmations on your bathroom mirror to keep you in a better frame of mind.
Up your self-care. Remember those lemon scented candles you got from your cousin for Christmas? Now is the time to put them to use, along with a foot rub from your husband or a pedicurist and a long bathtub soak. Treat yourself gently and well.

Question yourself. Before undermining your diabetes care, ask if eating that ice cream bar is truly in your best interest, and whether it is going to make you feel better. If not, try to think about what might truly help. Writing down your thoughts in a notebook might be useful, as could talking problems over with a friend or a therapist.

Get moving. By now everyone knows that exercise relieves stress. If you’re in an exercise program, don’t stop. But if you’re feeling too worked up to follow a high energy regimen, go for something that you can handle at the moment. Think slow nature walks, yoga, or tai-chi.

Consider meditation. Mindfulness meditation has been scientifically proven to lower your heart rate and cut stress.  And it’s really not hard to begin. For me, I simply remain in bed for five to ten minutes before I rise, close my eyes, relax my body and concentrate on keeping my mind clear. As stray worries drift by, I observe them neutrally, then let them go. At first it may seem strange and unfamiliar, but if you keep with it, it really can help.

Staying calm isn’t easy. Stress – good and bad -- is part of life. But if it’s getting in the way of your diabetes care, talk to your doctor. Nothing is worth more than your good health.

Taking Care of Your Diabetes Means Taking Care of Your Heart - Sweet Clinics

Taking Care of Your Diabetes Means Taking Care of Your Heart

Diabetes and Heart Disease
Woman talking to doctor
For people with diabetes, heart disease can be a serious health problem. Many people don’t know that having diabetes means that you have a greater chance of having heart problems such as a heart attack or stroke. Taking care of your diabetes can also help you take care of your heart. Use the tools in this tip sheet to help. They are:

A list of things you can do such as eating healthy foods and getting more active.
A form to write down and track your A1C, blood pressure, and cholesterol numbers.

What you can do now
Ask your health care team these questions:
What can I do to lower my chances of getting heart disease?
What should my goals be for A1C, blood pressure, and cholesterol?
What can I do to reach these goals?
Should I take medicine that can protect my heart such as aspirin or a statin?

Man eating bowl of cereal
Eat well.
Eat foods that are high in fiber such as whole grain breads and cereals, brown rice, lentils, beans, fruits, and vegetables.
Eat foods with heart-healthy fats such as fish, nuts, seeds, and avocado.
Eat foods low in saturated and transfats such as lean meat, chicken without the skin, fish, and non-fat or low-fat milk, yogurt, and cheese.
Use oils when cooking food instead of butter, cream, shortening, lard, or stick margarine.
Limit desserts such as cookies and ice cream to only 1 or 2 times a week.
Eat smaller amounts of foods that are high in fat, sugar, or salt. For example, if you want french fries, order the kid-sized portion.
Bake, broil, or grill food instead of frying.
Do not add salt to food.Diabetes Heart care clinic in vashi
Stop smoking.

Be active.
Be active for 30 minutes or more each day. It’s okay to be active for 10 minutes at a time, 3 times a day.
Walk, dance, swim, or ride a bike.
Man and woman talking in park
Take your medicine.
Take medicines the way your doctor or health care team tells you to.
Do not stop taking your medicines until you talk to your doctor.
Ask your pharmacist or doctor any questions you have about your medicines.
Cope with stress as best you can.
Ask for help if you feel down. Talk to a mental health counselor, member of the clergy, friend, or family member who will listen to your concerns.
Tell your family members and friends how they can best help and support you.
Here's one more way to take care of your heart: Learn the warning signs of a heart attack and stroke.
Signs of a heart attack may include pressure, squeezing, fullness, and pain in the chest or upper body. You may also have shortness of breath.
The signs of a heart attack for a woman may be different than a man. Signs for a woman can include nausea and vomiting, being tired all the time (sometimes for days), and pain in the back, shoulders, and jaw.
Signs of a stroke may include weakness on one side and trouble walking, seeing, or speaking.
you are having a heart attack or stroke.
Acting fast can save your life.
Your Diabetes Record Form
Use this form to keep track of your A1C, blood pressure, and cholesterol numbers. These terms are explained below the Diabetes Record Form.
Write down the date and results for each test or blood pressure check you get.
Take this form with you on your health care visits. Show it to your health care team.
Talk about your goals and how you are doing.

Even naturally sweet drinks may increase diabetes risk - Sweet Clinics

Even naturally sweet drinks may increase diabetes risk

While researchers already knew that drinks with added sugar could increase a person's risk of type 2 diabetes, a new study suggests that the same may be true for naturally sweet drinks, such as 100% fruit juices, as well as artificially sweetened beverages, such as "diet" soft drinks.
bottles of fruit juice
A new study suggests that even 100% natural fruit juices may increase the risk of diabetes.
Research has shown that drinking soft drinks with added sugar can increase a person's risk of developing type 2 diabetes by affecting subtle metabolic mechanisms.

But are "diet" soda and 100% fruit juices that contain a natural level of fructose but no added sugar any healthier?

The evidence surrounding diet soda and its effect on diabetes risk has been conflicting. Some studies suggest that it might have an impact, while others report that there is no association between the two.

Most people believe that naturally sweet drinks are healthful. However, recent research has shown that they are not nearly as good for us as we think. One study that we covered on Medical News Today in July this year, for instance, indicated that they could increase a person's risk of cancer.

Now, research from an international team of investigators from Harvard T. H. Chan School of Public Health in Boston, MA and Fudan University in Shanghai, China, suggests that all sugary drinks, including natural fruit juices and artificially sweetened beverages, could increase diabetes risk.

However, the study, which appears in the journal Diabetes Care, also offers some hope. It notes that people can decrease this risk by replacing sugary drinks of any kind with non-sweetened beverages, such as water, tea, and coffee.

"The study provides further evidence demonstrating the health benefits associated with decreasing sugary beverage consumption and replacing these drinks with healthier alternatives like water, coffee, or tea."



Sugary drinks linked to 16% increase in risk

colleagues analyzed data collected over 22–26 years from 76,531 women enrolled in the Nurses' Health Study between 1986–2012, 81,597 women enrolled in the Nurses' Health Study II between 1991–2013, and 34,224 men from the Health Professionals' Follow-up Study, enrolled between 1986–2012.

The researchers gave the participants questionnaires that asked them how often they consumed certain foods and beverages. By analyzing the results, the study authors found out how often participants drank certain sugary drinks and were able to calculate any changes in their drink consumption patterns.

The researchers found that people who increased their total intake of soft drinks with added sugars and naturally sweet fruit drinks by over 4 ounces (oz) per day over 4 years saw an associated diabetes risk increase of 16% over the following 4 years.

However, those who increased their total intake of artificially sweetened beverages — such as diet soda — by the same quantity over the same period saw an associated 18% increase in the risk of developing type 2 diabetes.

These associations remained in place even after the researchers adjusted for confounding variables, including body mass index (BMI), different dietary changes, and relevant lifestyle habits.

The investigators caution, however, that the finding regarding artificially sweetened beverages may be unreliable because it remains unclear which way the association runs. They explain that people who know that they are already at high risk of developing diabetes may switch from sugary drinks to diet sodas to try and mitigate that risk.


10% weight loss could send type 2 diabetes into remission

New evidence suggests that moderate weight loss soon after diagnosis could send type 2 diabetes into remission.

Moreover, the study authors also point out the risk of surveillance bias in their research. This refers to the fact that people who are at high risk of developing diabetes are more likely to undergo screenings for diabetes, therefore receiving a diagnosis sooner than other individuals.Famous diabetologist in vashi

Overall, the research suggests that people might want to consider caution about their intake of sweet drinks of all kinds. It also found that switching to unsweetened drinks could help reduce diabetes risk.

More specifically, replacing one daily serving of a sweet drink with water or unsweetened coffee or tea was associated with a 2–10% lower risk of type 2 diabetes.

"The study results are in line with current recommendations to replace sugary beverages with noncaloric beverages free of artificial sweeteners".

Nor should people overestimate the benefits of natural juices. "Although fruit juices contain some nutrients, their consumption should be moderated," he stresses.

Type - 1 Diabetes - Sweet clinics

Hba1c calculator.Diabetes Definition

type 1 diabetes.diabetes diet
Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose comes from the foods you eat. Insulin is a hormone that helps the glucose get into your cells to give them energy.

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Don’t ignore these 5 lesser known signs of pre-diabetes - Sweet clinics Diabetologist in Navi Mumbai

Pre-diabetes has become a raging concern in India with an increasing number of cases being diagnosed. 60% of Prediabetics go on to develop Diabetes.

In addition, common symptoms like increased thirst and urination, increased hunger and blurry vision, may have become well known, but it is important to note that these symptoms do not arise overnight, but tend to build up gradually. Further, there are some additional symptoms that may be indicative of high blood sugar, which one would not even think to associate with pre-diabetes.

This could be a major reason why a majority of pre-diabetes cases are still undiagnosed. Here we bring you some of the lesser known symptoms of pre-diabetes that can help you with a timely diagnosis and better management of this condition.

Your vision seems to be changing

You may have heard that blurry vision is a sign of blood sugar levels being higher than normal, but did you know that a sudden improvement in your vision can also indicate abnormal sugar levels? According to research studies, high sugar levels can lead to movement in the bodily fluids including the eyes. This can lead to changes in the vision which may be blurry or more defined. However, the instant you observe any sudden changes in your eyesight, it is advisable to go in for a consultation.

UTI seems to be a frequent occurrence

UTI or Urinary Tract Infection can also be a symptom of elevated sugar levels. Especially if this condition becomes a recurrent concern, doctors advise to instantly check blood glucose levels. When sugar levels in the blood and urine are high, the genitals are more prone to bacterial and yeast infections, upping the risk for UTI.

Skin is constantly itchy

A skin condition is clearly a dermatological issue right, how can it relate to blood sugar? This is a common thought as a large number of people are still unaware of the connection of sugar levels and skin health. High sugar levels can slow down the blood and oxygen circulation in the body, leading to an increase in itchiness especially around the hands, feet and genital areas. If you notice any rashes or experience constant itchiness which doesn’t seem to subside after a couple of days, it may be time to check your sugar levels.

Your TV volume is louder than before

One of the least known symptoms of pre-diabetes is often changes in hearing levels. Without realising you may find yourself talking louder so as to encourage people to talk back at a louder volume. The volume of your music station may be set a little higher than before cause your hearing isn’t as good. In a country as noisy as India, it is easy to attribute this to external sounds.top diabetologist in Vashi However, it may also be a sign of high blood sugar which can damage the nerves of the inner ear, affecting your ability to hear.

Sleep comes with loud snores

Yes, if you find your partner suddenly complaining about your loud snoring (something you swear you don’t do), it may be time to check your sugar levels. A large number of people with higher sugar levels than normal also develop a sleep disorder known as sleep apnea which leads to disturbed sleep, snoring and often tiredness during the day.

So while it is advisable to look out for common pre-diabetes symptoms, it is essential not to ignore any of the above-mentioned signs either as enable timely diagnosis, it is recommended to get a timely diagnosis and treatment from a Diabetologist, as Prediabetes with proper treatment and lifestyle changes can be reversed.

Arthroscopic Release of Frozen Shoulder Problems in Diabetics By Sweet Clinics..!!

Diabetics in India have an additional burden of joint problem in addition to their systemic problems of nerves, eyes, blood vessels, kidneys etc. Diabetics are prone to develop a condition of the shoulders called primary frozen shoulder. It can affect both shoulders in a small percentage of people. It usually resolves over a period of time but can leave behind a lasting deficit of certain movements.

Middle aged diabetics also develop tears of the rotator cuff and this can lead to a secondary frozen shoulder. Rotator cuff is group of tendons on top of the shoulder which help to stabilize the joint.

They can develop calcium deposition in the rotator cuff tendons.

They are prone to develop Gouty arthritis in their shoulders like in any other joints since Gout has an association with diabetes. Gout is a condition due to consumption of uric acid which is a by product of the digestion of red meat.

In this article I shall discuss frozen shoulder.

Definition-

Frozen shoulder (Adhesive capsulitis, periathritis) is a condition characterized by a loss all movements at the true shoulder joint. There is pain initially. Pain settles down and there remains stiffness which sets in over a short period of time. Clever people may recall a traumatic incident. In others it may come on slowly. Stiffness may be permanent. The movement that is maximally affected is external rotation (rotating the arm outwards away from the body). This results in inability to reach behind the head with the hand to tie the hair. When both shoulders are affected elderly women are in an embarrassing situation. Overhead activities are also affected as the degree of elevation of the arm is reduced.

Anatomy

The shoulder is the most mobile joint in the body. Its function is to position the arm in space to reach out to objects and deliver them to the mouth for eating and for other actions. The shoulder is a ball and socket joint formed by the upper end of the humerus (arm bone) and the socket formed by the glenoid of the shoulder blade. It is lined by a bag like capsule. The capacity of this joint is about 15- 20 cc. In frozen shoulder the capacity is reduced to 2- 3 cc. The movements at the shoulder joint occur synchronously with that at joint between the shoulder blade and the torso and are compensated to some extent by this.

History of frozen shoulder-

Only in the last few years has the ideal treatment been suggested. It is a relatively rare disorder of the shoulder and in a population of 20 shoulder patients there may be one or two with this condition.

However many doctors and orthopaedic surgeons label any painful condition as a frozen shoulder and advice physiotherapy. This can make the condition worse.

Recent advances

It has been recently discovered that the answer to frozen shoulder lies in the genes. These genes may also be associated with Diabetes mellitus. The alterations in these genes and chromosomes lead to a distorted response to wound healing and scar tissue formation. Exuberant scar tissue forms in response to trauma. The remodeling of scar tissue collagen is less. When more scar tissue forms in the capsule of the shoulder joint, the normally possible movements are grossly reduced. Diabetics also develop nodules in their palms and feet, another evidence of the exaggerated healing process.

Standard treatment-

This is a combination of physiotherapy and steroid injections when the condition is initially painful. Physio can be done at home. The standard Orthopaedic treatment has been a manipulation under anaesthesia. This carries a theoretical risk of fracture but has not been validated in practice.best diabetologist in navi mumbai

A manipulation is contraindicated when a x ray reveals that the bone is very osteoporotic. It is also contra indicated in diabetics as more exuberant scar tissue will form in response to the crude method.

Since I have pointed out that sometimes rotator cuff tears can coexist with a frozen shoulder, the ideal management for a frozen shoulder would be an arthroscopic release of the contracted structures within the joint. An arthroscope is an instrument used to look into joints through tiny key hole incisions. The benefits are less pain after surgery and faster rehabilitation. Since scar tissue formation is minimized, chances of recurrence are less and greater are the chance of retaining the full range of movement achieved during the procedure. The range of movement achieved after the release has to be maintained with physiotherapy. In case there is some tear of the rotator cuff, repair can be done at a later stage.