27Sep

Diabetes Ayurvedic Treatment

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Ayurveda is a natural way to stimulate adult stem cells to regenerate damaged tissues is explained as “KSHEERA DADHI NYAYA” in ayurveda,5000years back.

Body-senses-mind & soul are the integral parts of human biological system. And body is a complex of Doshas-Dhatus & Malas; these are grosser manifestations of Panchamahabhuta.

The dhatus form the basic stuff of the body – tissues. These are of two categories –Sthayee & Asthayee & generic types of these dhatus are 7. The presence of Sthayee dhatus controls the architecting of Asthayee dhatus throughout life from the available nutrients in the human system with the help of Agni, transporting mechanisms.

If due to deficiency of any nutrition/ in any chronic disease condition any kinds of dhatu get depleted then with the help of Rasayana therapy the process of formation of that particular dhatu/ dhatus is stimulated.

These Sthayee dhatus are stem cell in modern terms & in Ayurveda system of medicines the applied aspect of this concept is elaborately discussed & used therapeutically & as preventive measures for various diseases & as an anti-ageing modality.

Rejuvenation, The Panchakarma therapeutic techniques and Traditional treatments that were used by kings-queens & allied persons in Olden Days are the most powerful methods to utilize the nutrients available within the body systems, to preserve physical-vital-energy and to save the body from decay & rejuvenation as well. Latest scientific research has confirmed findings of stem cells at the routes/systems that are touched/ reactivated following the Panchakarma technique.for more log on www.vedantayurveda.com

The physiological-psychological- nature can be transformed to retard the ageing process,health state for ever & steping towards immortility by revealing spritituality .

24Sep

Treating Diabetic Ketoacidosis

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Diabetes is one of the most common diseases faced with people these days. Diabetes needs a lot more care than other diseases so as to see that the blood sugar level is controlled in the body at regular intervals. If the blood sugar gets so high that ones body starts burning fats stored for energy, one may start producing ketones bodies which build up and spill over in to the urine. Ketoacidosis is a condition which is commonly found in Type 1 diabetes, where the combination of high blood glucose, ketones bodies, dehydration, and various chemical imbalances and when not taken care of results in the same. But studies have shown this is not found in Type 2 diabetes.

One has to be more careful and more aware, if one is suffering with other illness along with diabetes, as ketoacidosis have more chances to attack the body system, therefore it is vital to check ones blood glucose frequently. One should be very careful when home sick, one should always be prepared with one’s spouse or a close friend in case if emergency occurs. One should make them instruct that if in any case one may not answer the phone after frequent rings they should come to the house, give a check and if found in conscious state should be referred to hospital or they should call an ambulance without any delay.

Intravenous fluids are used to treat diabetic ketoacidosis, as they dilute the blood glucose and rehydrate you. Chemicals like potassium and sodium are used with intravenous fluid in order to balance the boy’s imbalances. Insulin is also used to push glucose out of the bloodstreams and eventually into the cells. As soon as the blood glucose level comes down to normal, the body immediately needs some fuel in the form of glucose to prevent the formation of ketones. That is why glucose is added to the intravenous fluid. In emergency situations, you will be stabilized in the emergency room by physicians and later they keep you in hospital for a day or two to make sure that your have passed the crisis period safely and there is no threat left over.

Mathew is a diabetic child and he got food poisoning or stomach flu for some reasons and began to vomit. As far as insulin is concerned, he knew nothing, but to take prescribed dose of insulin. Besides this, he had no idea about it. His condition became severe and his mother called for doctor help. Doctor suggested her to take her son immediately to emergency. Mathew was dehydrated. Doctors took some blood and began intravenous fluid treatment. He was admitted to intensive care unit as he was so dehydrated, he took eight liters of fluid before e had to urinate.

The purpose of giving this example here is to let you know that how important is your immediate response to diabetic ketoacidosis. If you show any carelessness, the things get worse for you. So, if you feel that the things are getting worse rather than improving, contact your doctor immediately.

23Sep

How to Balance Blood Sugar

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Diabetes is a growing problem in the population: according to Diabetes UK there are 3% (1.8 million) diagnosed cases (approximately 250 thousand with type 1 and over 1.5 million with type 2) and another estimated 750 thousand to 1 million undiagnosed cases of type 2 diabetes. No statistics are available for the athletic population.

What is diabetes?

Diabetes is a syndrome or group of symptoms arising from failure to regulate the metabolism of glucose by means of the pancreatic hormone, insulin. This occurs due to a lack of insulin because the pancreas does not produce enough, fails to produce any or the body fails to make proper use of the insulin that is available. Diabetes is classified as insulin-dependent (type 1) and non-insulin-dependent (type 2). This paper will focus on the latter and will ignore any genetic predisposition to the disease.

The glycaemic index and diabetes

The Glycaemic Index (GI) can be considered as a measure of carbohydrate quality. It measures the postprandial (after a meal) glycaemia (plasma glucose) raising potential of a single food by expressing the rise in glycaemia in response to a 50g available carbohydrate portion of that food as a percentage of the rise in response to a 50g available carbohydrate portion of a reference food (white bread or glucose).

Foods high on the GI result in a sharp rise of plasma glucose, with a high demand for insulin, followed by a more or less rapid fall of glucose. Foods that are low to moderate on the GI produce a slower rise, with a lower demand for insulin, and a more gradual decline in plasma glucose.

Those in favour of carbohydrate quality, argue that GI is a robust measurement, predicts the relative glycaemic response to mixed meals and is easy to follow and implement. In contrast, opponents who favour giving priority to carbohydrate quantity argue that GI is highly variable, not physiological, cannot reliably predict mixed meal responses and is difficult to learn or follow.

Despite some opposition to low-GI intervention in type 2 diabetes, the interventions are clinically efficacious in diabetes therapy over the mid to long-term. The Canadian Diabetes Association, Diabetes Australia, Diabetes UK and the European Association for the Study of Diabetes all support the application of the GI concept in the management of diabetes.

Insulin resistance

Insulin resistance, a component of the Insulin Resistance Syndrome, also known as Syndrome X and the Metabolic Syndrome, is associated with type 2 diabetes. No statistics for insulin resistance are available in the UK, although, according to Diabetes UK, a national register may be set up in the future.

Obesity is the most significant factor leading to insulin resistance with visceral obesity having a particularly strong negative correlation. It can be reversed with diet modification based on a low-fat intake and limiting refined carbohydrates without the need of caloric restrictions. Physical activity is an important factor in reversing the problem.

Mechanisms leading to insulin resistance are unclear, although the abnormal accumulation of certain fats in the liver (hepatic steatosis) is a contributing factor.

In a study by Pan et al, skeletal muscle triglyceride (mTG) appeared to be another important factor in predicting insulin resistance. Trained athletes and animals show the same or higher levels of muscle triglycerides as sedentary controls but have improved insulin action. The authors postulated that this could be due to the distribution of triglyceride. Endurance exercise increases both the mitochondrial volume and distribution in skeletal muscles. In trained dogs, mitochondria appear virtually in direct contact with triglyceride droplets whereas no such association with mitochondria was found in untrained animals. As a result, trained individuals may have an improved ability to mobilise fats.

Research into sucrose and fructose on animals has consistently shown that high sucrose and fructose diets decrease insulin sensitivity. Studies on humans have been inconsistent.

In a large cohort study by Janket et al, 38,480 initially healthy postmenopausal women were followed for an average of 6 years. The researchers accrued 918 incident cases of type 2 diabetes but found no definitive influence of sugar intake on the risk of developing type 2 diabetes. It was noted, however, that the median follow-up time of 6 years might not have been long enough to detect a very subtle relationship between sugar intake and incidence of type 2 diabetes.

Assessment on humans is thought to be more complicated because of other factors affecting insulin sensitivity. Some studies found that those consuming a diet consisting of large amounts of sweets and desserts were at increased risk of developing diabetes. However, the diet also included high amounts of saturated fats (red meat, fries and dairy products) which is known to be associated with decreased insulin sensitivity.

No studies have shown a negative effect of sucrose on insulin sensitivity. One explanation for this lack of correlation could be that recruitment of volunteers for nutrition studies is notoriously difficult and many studies have a young or a highly health-orientated population. Both groups are likely to be physically active. Given the strength of the positive influence of physical exertion on insulin sensitivity, such persons are inclined to be resistant to the negative effects of diet. However, this does suggest that the promotion of physical activity may have a greater influence on insulin sensitivity than diet.

Another possible explanation is that the GI concerns only the first 2 hours of the postprandial period. It is postulated that a GI defined by a 4-6 hour postprandial period would alter the ranking of sucrose in a GI table to a higher level. Neither sucrose (a disaccharide: glucose bonded to fructose) nor fructose (a monosaccharide) is high on the GI.

Studies based on high fructose versus high glucose diets have shown that the high fructose diets produce an increase in plasma triacylglycerol, plasma cholesterol, VLDL and LDL cholesterol concentrations, all of which are a risk factor in cardiovascular disease. In addition, some of these effects were seen in men but not women. The reason for this difference is not clear. Although not all studies are consistent with these findings, the positive data cannot and should not be dismissed as it may be of considerable clinical importance. It is also important to note that some individuals are more sensitive to fructose than others.

The risk for athletes

Are athletes at risk of developing type 2 diabetes as a result of their high intake of fructose, sucrose and high glycaemic foods? Although the scientific evidence to-date does not support this notion, athletes may be at risk of developing insulin resistance which is associated not only with diabetes but also with coronary heart disease, hypercholesterolaemia, hypertension, dysglycaemia, osteoarthritis and impaired glucose tolerance.

An over-consumption of refined carbohydrates, over-processed foods, saturated fats and processed vegetable fats are all associated with insulin resistance. The majority of adult athletes we have consulted to-date, over-consume the above with the possible exception of saturated fats. However all our adolescent athletes consumed large amounts of saturated fats.

Although some athletes are becoming more informed on the importance of nutrition for both their long-term health and their performance, there are still a large number who are uninformed or misinformed on nutritional issues. Particularly distressing is the lack of knowledge amongst adolescent athletes which needs to be urgently addressed, not only by nutritionists and dieticians, but also by coaches and parents.

One procedure that can be immediately implemented by everybody is that of chewing our food thoroughly and eating more slowly: it appears that prolonging absorption time by increasing the length of time to complete a meal, consuming smaller and more frequent meals or drinking a beverage over a prolonged period of time all improve glucose tolerance.

In summary, to minimise the risk of insulin resistance, the following points should be adhered to:

  • Limit sugars and high GI carbohydrates to just before, during and just after exercise.
  • At other times, consume a large variety of foods avoiding repeating the same food on any one day.
  • Try to include colourful foods at every meal.
  • Eat fresh rather than ready-made as often as possible.
  • Limit all saturated fats found in dairy products and fatty meats.
  • Avoid fried foods.
  • Avoid junk foods.
  • Dilute fruit juices.
  • 22Sep

    Living With Type 2 Diabetes

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    Type 2 diabetes is a disease characterized by high levels of sugar in the bloodstream. The most common form of diabetes, type 2 diabetes today affects over 25,000,000 Americans and in 2006 was the 7th leading cause of death in the United States. People with type 2 diabetes have what’s known as insulin resistance. This is the inability of liver, fat and muscle cells to respond normally to insulin. As a result the sugar in your blood can’t get into the cells so it can be used as energy.

    The basic fuel that the body uses is called glucose. Glucose is created when the body breaks down the sugar in your food. Insulin created by the pancreas then takes the sugar from the blood and carries it to the cells. The problem arises when there isn’t enough insulin to carry the glucose or when the cells don’t take the glucose in. When the sugar doesn’t get into the cells, the sugar in the blood starts to build up resulting in a condition called hyperglycemia. As levels of glucose in the blood increase, the pancreas responds by producing more and more insulin, but not enough to keep up with demand.

    Genetics play a big role in determining who will develop type 2 diabetes as it tends to run in families. Because excess fat interferes with the body’s ability to use insulin, being excessively overweight can greatly increase your chances of developing type 2 diabetes. Other prominent factors in developing the disease are a sedentary lifestyle and bad diet.

    Managing your weight and eating a nutritious diet are critically important to living with diabetes. If diet is brought under control some people with type 2 diabetes can even progress to the point where they can stop taking medications after the losing weight. They still must be vigilant and keep the weight off because they still have diabetes.

    Regular exercise is another important method of preventing and dealing with the effects of diabetes. Exercise lowers your blood sugar level and helps burn off excess calories and fat and helps to keep your weight under control. Even without the benefit of burning fat, exercise can help you fight diabetes by improving your blood flow and blood pressure. Increased energy, lower tension and an improvement in your ability to handle stress can also do a lot to improve your overall health.

    If diet and exercise don’t do enough to maintain normal blood glucose levels your doctor may have to prescribe medication. These drugs help to lower your blood sugar levels and often work in different ways. This means that often you may need to take more than one of them.

    You can help prevent type 2 diabetes by keeping a healthy body weight and an active lifestyle. If you have a family history of diabetes you should be especially careful about your diet and exercise and make sure you visit your doctor twice a year to monitor you blood sugar levels.

    20Sep

    Diabetes, Glycemic Control: Results

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    Baseline characteristics of the study population (n = 839) are outlined in Table 1. Mean age was 67 years, and 200 patients (23.8%) had diabetes.

    Table 1

    No diabetes Diabetes P value
    n 639 200
    Age (years) 67.4 ± 11.0 65.3 ± 10.3 0.02
    Sex, male (%) 528 (82.6) 161 (80.5) 0.49
    Race, white (%) 416 (65.2) 88 (44.0) <0.001
    BMI (kg/m2) 27.9 ± 4.7 29.9 ± 6.0 <0.001
    Smoking (%) 124 (19.4) 34 (17.0) 0.44
    Heavy alcohol use (%) 215 (33.8) 38 (19.0) <0.001
    Physical inactivity (%) 221 (33.1) 85 (42.5) 0.02
    LDL cholesterol (mg/dl) 106 (34) 100 (32) 0.03
    A1C (%) 5.5 ± 0.5 7.1 ± 1.4 <0.001
    Systolic blood pressure (mmHg) 132 ± 20 137 ± 23 0.003
    Medical history
    Myocardial infarction (%) 313 (49.1) 106 (53.8) 0.25
    Revascularization (%) 367 (57.4) 104 (52.3) 0.20
    Medication use
    ACE inhibitor/ARB (%) 261 (40.8) 136 (68.0) <0.001
    β-Blocker (%) 343 (53.7) 129 (64.5) 0.007
    Baseline LVEF (%) 62.7 ± 8.6 63.1 ± 8.8 0.59
    Diastolic function (%) 0.22
    Normal 361 (63.2) 116 (63.7)
    Impaired 151 (26.4) 40 (22.0)
    Pseudo/restricted 59 (10.3) 26 (14.3)
    Exercise-induced wall motion abnormalities (%) 128 (21.5) 44 (24.4) 0.40
    Creatinine clearance (ml/min) 82.4 ± 26.9 82.0 ± 31.2 0.87
    CRP (mg/l) 4.0 ± 6.8 4.8 ± 7.0 0.11

    Data are means ± SD unless otherwise indicated. CRP was log-transformed for statistical analysis.

    Diabetes as a predictor of heart failure hospitalizations

    During a mean ± SD follow-up of 4.1 ± 1.2 years, 30 (15.0%) patients with diabetes and 47 (7.4%) patients without diabetes developed heart failure. Between baseline and end of follow-up (either heart failure event or end of study), 52 patients (6.2%) had a myocardial infarction. In Fig. 1, Kaplan-Meier analysis shows the proportion of patients with hospitalizations for heart failure divided into patients with and without diabetes. In Table 2, results of the Cox regression models are presented. Diabetes was a significant predictor of heart failure hospitalization (HR 2.17 [95% CI 1.37–3.44]; P = 0.001). Diabetes remained a strong predictor of heart failure while adjustments were made for other predefined predictors of heart failure. Thus, adjustment for age, sex, race, smoking, physical inactivity, BMI, LDL cholesterol, systolic blood pressure, myocardial infarction during follow-up, LVEF, exercise-induced wall motion abnormalities (i.e., ischemia), diastolic dysfunction, or CRP did not attenuate the strength of the relationship between diabetes and heart failure. In the fully adjusted model, diabetes was associated with an increased HR for hospitalization because of heart failure (3.34 [1.65–6.76]; P = 0.001). Other significant multivariable predictors were age (years, HR 1.06), smoking status (3.01), physical inactivity (2.18), LVEF (percent, 0.94), exercise-induced wall motion abnormalities (2.34), diastolic dysfunction (1.26–4.97, depending on the grade of diastolic dysfunction), and logCRP (2.10).

    Figure 1


    Proportions of patients free of hospitalization for heart failure divided into patients with diabetes (· · · ·) and patients without diabetes (——).

    Table 2

    Diabetes and A1C as risk factors for heart failure hospitalization (multivariable Cox regression)

    Diabetes as predictor for heart failure P value A1C ≥6.5% as predictor for heart failure P value A1C (%) as predictor for heart failure P value
    n 839 832 832
    Univariable analysis 2.17 (1.37–3.44) 0.001 1.61 (0.96–2.71) 0.071 1.36 (1.17–1.58) <0.001
    Model 1 2.50 (1.57–4.01) <0.001 1.72 (1.02–2.92) 0.043 1.46 (1.24–1.73) <0.001
    Model 2 2.65 (1.61–4.36) <0.001 1.58 (0.90–2.78) 0.114 1.50 (1.26–1.79) <0.001
    Model 3 2.53 (1.58–4.07) <0.001 1.72 (1.02–2.92) 0.043 1.48 (1.25–1.76) <0.001
    Model 4 2.79 (1.74–4.50) <0.001 2.03 (1.18–3.47) 0.010 1.46 (1.24–1.71) <0.001
    Model 5 2.19 (1.29–3.71) 0.003 1.50 (0.82–2.73) 0.189 1.33 (1.09–1.61) 0.004
    Model 6 2.60 (1.55–4.36) <0.001 2.02 (1.16–3.52) 0.014 1.48 (1.24–1.75) <0.001
    Model 7 2.42 (1.50–3.90) <0.001 1.71 (1.01–2.92) 0.047 1.39 (1.17–1.64) <0.001
    Model 8 2.49 (1.52–4.08) <0.001 1.67 (0.98–2.84) 0.061 1.45 (1.22–1.72) <0.001
    Model 9 (full) 3.34 (1.65–6.76) 0.001 2.27 (1.06–4.87) 0.036 1.40 (1.13–1.74) 0.003

    Data are HR (95% CI) unless otherwise indicated. Model 1: age, sex, and race. Model 2: age, sex, race, smoking, BMI, physical inactivity, LDL cholesterol, and systolic blood pressure. Model 3: age, sex, race, and myocardial infarction during follow-up. Model 4: age, sex, race, and LVEF. Model 5: age, sex, race, and exercise-induced wall motion abnormalities. Model 6: age, sex, race, and diastolic dysfunction. Model 7: age, sex, race, and logCRP. Model 8: age, sex, race, ACE inhibitor/ARB and β-blocker use. Model 9: age, sex, race, smoking, BMI, physical inactivity, LDL cholesterol, systolic blood pressure, myocardial infarction during follow-up, LVEF, exercise-induced wall motion abnormalities, diastolic dysfunction, logCRP, and ACE inhibitor/ARB and β-blocker use.

    16Sep

    Diabetes, Glycemic Control: Research Design and Methods

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    The Heart and Soul Study is a prospective cohort study of psychosocial factors and health outcomes in patients with stable CAD. Design of the study has been published previously. In summary, patients were recruited from outpatient clinics of 12 different centers in the San Francisco Bay area if they met one or more of the following inclusion criteria: prior myocardial infarction, angiographic evidence of ≥50% stenosis in one of the coronary arteries, prior coronary revascularization, and exercise-induced ischemia (treadmill or nuclear scintigraphy). Exclusion criteria were acute coronary syndrome within the past 6 months, the inability to walk one block, and plans to move out of the area within 3 years.

    Between September 2000 and December 2002, 1,024 patients were enrolled in the study. For the current investigation, 185 patients (18.1%) were excluded because they had a history of heart failure (n = 179) or heart failure status was unknown (n = 6).

    Baseline study variables

    All patients completed a daylong baseline study visit that included a medical history interview, physical examination, questionnaire, laboratory analysis, exercise test, and echocardiogram. Diabetes was defined as self-reported diabetes or the use of antidiabetes medication. Alcohol use was determined by questionnaire. Participants rated their physical activity during the previous month using a 6-point Likert scale. Those responding “not at all active” or “a little active” were classified as physically inactive. An estimate of chronic glycemia was provided by serum A1C measurement. Serum glucose level, A1C, LDL cholesterol, and C-reactive protein (CRP) were assessed by standard routine biochemistry analysis after an overnight fast (except for taking their regularly prescribed medication with water) using a venous blood sample, drawn via a 21-gauge butterfly needle. Subjects were considered to have metabolic syndrome if they met the criteria of the National Cholesterol Education Program. Echocardiography was performed with an Acuson Sequoia Ultrasound System (Siemens Medical Solutions USA, Malvern, PA), with a 3.5-MHz transducer. Left ventricular ejection fraction (LVEF) was calculated using the modified Simpson rule as recommended by the American Society of Echocardiography. In addition, a full description of diastolic function was performed according to predefined established criteria (normal, impaired, pseudonormal, or restrictive diastolic function). An exercise treadmill test (standard Bruce protocol) was performed. Immediately after exercise, echocardiographic analysis was performed to investigate exercise-induced wall motion abnormalities, which served as an indicator of myocardial ischemia. Details pertaining to acquisition and analyses of echocardiographic data were reported elsewhere. The institutional review board at each of the sites approved the study protocol, and all participants provided written informed consent.

    End points

    The main study outcome was time to hospitalization for heart failure, as was previously reported for the whole cohort in detail. Heart failure was diagnosed according to established criteria using clinical and radiological evaluation. Potential events were recorded annually by telephonic interviews. Additional information (e.g., medical records and death certificates) was collected and reviewed by two independent and blinded adjudicators. Discrepancies were discussed, and decisions were made by unanimity. In case of disagreement, a third blinded adjudicator was consulted. Follow-up was completed for all patients.

    Statistical analysis

    The study sample comprised 839 patients. Baseline differences between participants with diabetes and without were compared using t tests for continuous variables and χ2 tests for dichotomous variables.

    In addition to the association of diabetes per se with hospitalization for heart failure, we investigated the role of glycemic control in the development of heart failure. A1C was used as a proxy measure for glycemic control (both dichotomized and continuous, per 1% change). For the former categorization, a cutoff of ≥6.5% and <6.5% was used because this cutoff was recently used to redefine the diagnosis of diabetes. The following analyses were conducted with diabetes and A1C as independent variables. First, Kaplan-Meier analysis was used to estimate the time from baseline to heart failure hospitalization in patients with or without diabetes and in patients with low or high A1C. The log-rank test was used for bivariate significance testing. In addition, given the influence of antidiabetes medication on A1C levels, we compared the effect of glycohemoglobin on heart failure in patients taking antidiabetes medication. Second, Cox proportional hazard regression analyses were performed to investigate the impact of diabetes and A1C level, respectively, on the time to first hospitalization for heart failure. To study the impact of diabetes and A1C on heart failure in the context of several potential confounders, we made a selection of the most important risk factors for heart failure based on recent guidelines. We then applied the following series of a priori determined Cox regression models in which we sequentially controlled for the following groups of confounders: model 1: age, sex, and race; model 2: smoking, physical inactivity, BMI, LDL cholesterol, and systolic blood pressure; model 3: myocardial infarction during follow-up; model 4: LVEF; model 5: exercise-induced wall motion abnormalities (i.e., ischemia); model 6: diastolic dysfunction; model 7: logCRP; and model 8: ACE inhibitor/angiotensin receptor blocker (ARB) and β-blocker-use. All models included age, sex, and race. In the final model (model 9) we include all the variables that were used in models 1–8. Finally, in sensitivity analyses, the relationship between several other definitions of diabetes and time to onset of heart failure were tested.

    These definitions were 1) self-reported diagnosis of diabetes (irrespective of antidiabetes medication use, 2) fasting blood glucose >126 mg/dl, and 3) fasting blood glucose >126 mg/dl or use of antidiabetes medication. Moreover, the presence of metabolic syndrome was tested in sensitivity analyses. P < 0.05 was used for all tests to indicate statistical significance. Hazard ratios (HRs) with 95% CIs are reported. All statistical analyses were performed using SPSS (version 17.0 for Windows; SPSS, Chicago, IL).

    , , ,

    15Sep

    Diabetes, Glycemic Control, and New-Onset Heart Failure

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    OBJECTIVE

    Diabetes is a predictor of both coronary artery disease (CAD) and heart failure. It is unknown to what extent the association between diabetes and heart failure is influenced by other risk factors for heart failure.

    RESEARCH DESIGN AND METHODS

    We evaluated the association of diabetes and A1C with incident heart failure in outpatients with stable CAD and no history of heart failure (average follow-up 4.1 years).

    RESULTS

    Of 839 participants, 200 had diabetes (23.8%). Compared with patients who did not have diabetes, those with diabetes had an increased risk of heart failure (hazard ratio [HR] 2.17 [95% CI 1.37–3.44]). Adjustment for risk factors for CAD (age, sex, race, smoking, physical inactivity, obesity, blood pressure, and LDL cholesterol), interim myocardial infarction, and myocardial ischemia did not alter the strength of the association between diabetes and heart failure. After inclusion also of other risk factors for heart failure (left ventricular ejection fraction, diastolic dysfunction, and C-reactive protein) and medication use, diabetes remained an independent predictor of heart failure (HR 3.34 [95% CI 1.65–6.76]; P = 0.001). Each 1% increase in A1C concentration was associated with a 36% increased HR of heart failure hospitalization (HR 1.36 [95% CI 1.17–1.58]).

    CONCLUSIONS

    In patients with stable CAD who are free from heart failure at baseline, diabetes and glycemic control are independent risk factors for new-onset heart failure. The mechanisms by which diabetes and hyperglycemia lead to heart failure deserve further study, as the association is independent of baseline functional assessment of ischemia, systolic and diastolic function, and interim myocardial infarction.

    Heart failure is an enormous burden of disease, leading to substantial health care costs. Despite advances in treatment, the number of heart failure hospitalizations has increased steadily. The 2005 Heart Failure Guidelines of the American College of Cardiology/American Heart Association and European Society of Cardiology emphasized the importance of identification and treatment of risk factors. Among the patients classified in the highest risk group are patients with diabetes. Diabetes is associated with incident heart failure in the general population  and with adverse outcomes among patients with already existing heart failure. Diabetes also predicts heart failure in patients with acute coronary syndromes. Whether diabetes predicts heart failure in patients with stable coronary artery disease (CAD) has not been evaluated in detail.

    The precise underlying mechanism by which diabetes portends heart failure is unclear. In fact, it remains to be elucidated whether in this context the diagnosis of diabetes per se is more important than just the presence of inadequate glycemic control. CAD is the number one risk factor for heart failure in the developed world. Because diabetes is strongly associated with CAD, it is plausible to attribute the risk of heart failure associated with diabetes to the effects of CAD. However, although it is known that hyperglycemia predicts heart failure among diabetic patients with CAD (7), it is not known whether this risk is independent of CAD severity, CAD progression, or the presence of myocardial ischemia. Even in the absence of CAD, patients with diabetes show changes in myocardial performance that put them at risk for heart failure (diabetic cardiomyopathy).

    To determine to what extent the association between diabetes and heart failure is influenced by other risk factors for heart failure (including interim myocardial infarction and the presence of baseline myocardial ischemia), we evaluated the risk of heart failure associated with diabetes in a cohort of outpatients with stable CAD. The cohort is derived from the Heart and Soul Study, which allows thorough investigation of the strength of the association between diabetes (both the diagnosis per se and the level of glycemic control) and future heart failure episodes, while taking into account the above-mentioned established and presumed risk factors.

    , ,

    14Sep

    Fighting Diabetes With Diet

    FILED IN Dieting No Comments

    We live in a world where preventable diseases are affecting more people every year. In fact 24 million Americans have diabetes. At the current rate, one out of every three people born in 2000 will develop diabetes, putting them at higher risk for other medical problems. What is going on? It cannot be all about genetics. Something in our day-to-day lives is making us sicker.

    Before pointing fingers, let’s look at what diabetes is. It’s a disease in which the body does not produce or properly use insulin-a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. A common precursor to diabetes is hypoglycemia-the body’s inability to handle large amounts of sugar. Hypoglycemia can be caused by an overload of sugar, alcohol, caffeine, tobacco and stress. This condition is triggered when the pancreas secretes too much insulin in response to a rapid rise in blood sugar, which in turn causes blood sugar levels to plummet, starving the body’s cells of needed fuel. When we need fuel, our body’s natural response is to crave something sweet, and that is where we get into trouble.

    Most people’s reaction when they crave something sweet is to run to the vending machine for a candy bar or soda. This fix may provide instant gratification, but it can cause your blood sugar levels to spike right after a meal and then crash to abnormally low levels several hours after a meal. This roller-coaster effect is implicated in the onset of type 2 diabetes. It may take years for hypoglycemia to develop into full-blown diabetes, so the earlier you intervene the better.

    Since overconsumption of refined sweets and added sugars has led to the increase in obesity, hypoglycemia and diabetes, diet is an important preventative measure. We’ve got to literally clean up the junk in our diets. I like to say, eat less sugar and chemical-filled artificial junk food, more vegetables, whole grains and fruit. Instead of that doughnut for breakfast, try a complex carbohydrate like oatmeal for sustainable energy. By eating something without added sugar your body will be able to maintain its natural balance and you will be less likely to crave those processed sweets. Another way to think about it is to eat less food in brightly colored packages and boxes and more colorful foods from the produce section.

    Sugar cravings are as natural as our desire for air, so let’s not fight our body’s natural instincts. Instead of hitting the vending machine for sweets, alleviate your cravings with these naturally sweet foods:

    • Corn
    • Carrots
    • Onions
    • Beets
    • Sweet potatoes
    • Yams
    • Turnips
    • Red cabbage

    Doctors are realizing the importance of exercise in preventing disease as well. Exercise doesn’t have to be going to the gym every night. It could be taking a walk, parking at the back of a parking lot, taking the stairs, or going out dancing. Find ways you like to move and you will also help prevent your body from breaking down. By incorporating more movement into your daily routine, as well as more whole foods, you will be less likely to need operations and medications later on in life.

    ,

    07Sep

    The Diabetes Diet Information Challenges

    FILED IN Dieting No Comments

    What a shock it was when we found out that my father has diabetes. The first thing that comes to mind is to obtain the diabetes diet information. Don’t worry if you are a loved one or a relative of a diabetic. It is scary and confusing at first but you will get better in preparing the diabetic diet after some time. Good for you and the diabetic you are looking after as there are no specific or special foods required. There are several challenges that this diet poses and those will be tackled in the following paragraphs.

    When I first helped in preparing my father’s food, it was quite difficult for me. Everything has to be measured. Every detail should not be overlooked. One mistake can sky-rocket the patient’s blood sugar levels so everything should be well thought of. The following are just some of the worries or challenges we face when preparing a diabetic diet.

    • Monotonous – yes, it is a dull and monotonous task. The important thing is that you are preparing for a diabetic loved one. Controlling food intake is not really the most exciting task in the world but you are helping in saving a life. You can vary the meal contents from time to time to make this task interesting for you. Who knows? You might like the diet too.

    • Limitations – people say that carbohydrates should not be taken in by diabetics. This is a myth. Actually, physicians suggest about 40 to 60 percent of carbohydrate intake daily.

    • Eating out – being a diabetic does not mean that your diabetic loved one cannot eat out with you. All you need to do is ask his or her doctor for any healthy alternatives in the menu. Usually, restaurants have large servings. You can take it home and make the patient eat it on a later time or on his or her next meal.

    • Family meals – the diabetic diet can be enjoyed by everyone since it is healthy. You and your family can eat with your diabetic loved one because the diet fits just about everyone.

    • Snacks – your diabetic loved one can eat two snacks per day. A bedtime snack is okay too. This way, energy from food is spread over a period of time. And food intake is more controlled since the patient is not hungry all the time.

    • Sugar intake – you’re diabetic loved one is still allowed foods with sugar. That is if he or she knows how to manage your blood sugar well.
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    You can easily obtain the diabetes diet information from your physician or from your dietitian. After you visit your health professional, you will learn to manage, control or limit your diabetic loved one’s eating habits and food intake. Don’t worry my friend. You’ll get used to all the measuring and managing. You’ll also get to memorize the nutritional values and the diabetic food pyramid after some time. In no time, all this will be but a routine that you can apply to yourself as well. I am sure you will get through the challenge.

    01Sep

    Diabetes Management

    FILED IN Other No Comments

    The importance of diabetic nutrition in blood sugar control

    As diabetes is heightened when diabetes blood sugar levels become raised, the advice is to balance these levels by avoiding highs and lows. Sugar, salt, caffeine, alcohol, cigarettes and refined and processed foods such as white bread, cakes and pastries cause a rush of sugar into the bloodstream and should be avoided. After this initial surge, diabetes blood sugar levels can then drop dramatically, even causing hypoglycemia, with symptoms such as sweating, hunger, anxiety, irritability, rapid heart rate, palpitations, blurred vision, tingling lips and turning pale. Hypoglycemia can also be caused by too much medication (consult your doctor) or alcohol, which inhibits glucose production by the liver. To avoid these sudden dips in diabetes blood sugar levels, try to keep them even by not missing meals and following the dietary advice given here. This can help stop imbalances that lead to vicious cycles, as foods that raise blood sugar levels can create cravings for more of the same.

    Many other conditions such as depression, headaches, fatigue and insomnia are affected by fluctuating diabetes blood sugar levels, and as they lead to high cholesterol and heart disease risk, this dietary advice is appropriate for everyone.

    With diabetes, the balance of macronutrients such as carbohydrates, fats, and proteins, is crucial. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and The World Health Organization (WHO) recommend a diet high in complex carbohydrates, low in saturated fat and high in fiber. This is because it is the combination of saturated fat and sugar that causes the accumulation of fat which increases insulin insensitivity, diabetes symptoms, risks and side effects.

    Carbohydrates

    Carbohydrates, found in vegetables, fruit, cereal grains and dairy products, are made from simple sugars, which all eventually break down to glucose. While carbohydrates are our main source of fuel and should make up half of our daily calorie intake, it is vital to make the right choice of the type of carbohydrate to be eaten, depending on the speed in which it breaks down into the glucose components in the body.

    Refined carbohydrates or sugars are very simple molecules. What we call “sugar” for cooking and eating is actually sucrose – just two molecules of glucose that offer a very quick supply of sugar to the bloodstream, demanding a high need for insulin that the diabetic cannot supply. Sucrose is found in processed foods, candies, cakes, soft drinks, fruit juices and very refined carbohydrates such as white bread, where the bran part of the wheat has been stripped away. This quick release of sugar can be laid down as fat if the body cannot employ insulin to use it correctly. Current research has shown that many diabetics may be eating more sugar than they think, because many have a reduced ability to taste sugar. Lowering blood sugar levels is a priority; converting sugars into fat takes place in the liver and can lead to the obesity that is often associated with diabetes.

    Complex carbohydrates, known as starches, release their sugars more slowly, so are used for energy rather than laid down as fat. These are termed starches. They also contain fiber, which also helps to slow down sugar release and eliminate toxins from the body to help prevent disease. The whole-grain bran part of cereal grains that is removed in white flour and processed foods contains fiber and provides glucose molecules that are bound together in more complex structures. Vegetables and fruit in their natural, raw state provide complex carbohydrates bound in fiber. They therefore take much more time to break down into their simple sugars and provide a more slow and steady release into the bloodstream, which is much easier for someone with little insulin to deal with. Pasta, potatoes, brown rice, and brown bread can be eaten in a diabetic diet if the appropriate fat-intake guidelines are also observed and they are eaten with proteins to slow down their release of sugars. The carbohydrate issue is, however, not as simple as previously thought.

    Fiber

    Fiber can either be soluble or insoluble and a balance of both in the diet is very important for health in those with diabetes. Fiber helps to level out blood sugar by slowing down digestion and the release of sugar from food. Aim for 35 grams per day to balance blood sugar, lower cholesterol levels, clean the colon of toxins and to help prevent heart disease.

    Soluble fiber tends to be found in fruit and vegetables, such as apples, citrus fruits, carrots, cherries, avocados, beet, dried apricots and prunes and also some seed husks such as linseed, oat bran, and psyllium husks, which many people take to counter constipation. It helps digestion by absorbing water and softening stools and this can help lower cholesterol.

    Insoluble fiber remains undigested and so clears the digestive system, prevents constipation, lessens the incidence of colon and rectal cancer and speeds up the elimination of waste from the body. It is found in brown rice (the fiber is removed when processed to white), rye bread and crackers, lentils, asparagus, Brussels sprouts, cabbage, other whole-grains and fibrous vegetables.

    Oats are a complex carbohydrate, none of which turns directly into sugar in the body. They provide 10 percent of their weight in fiber and are a perfect breakfast food. Vegetables and fruit contain cellulose, an insoluble plant fiber that contains little sugar, but it is important to remember that when cooked these become broken down more readily into sugars. This is why vegetables such as carrots, bell peppers, and parsnips taste sweeter the longer they are cooked.

    Fats

    The stipulation of a high-carbohydrate, low fat diet for diabetics does not mean that all fats should be avoided. Instead, it is a matter of choosing the right fats and consuming them in moderation. Lowering your intake of refined carbohydrates that cause the accumulation of body fat is a big factor, and including a controlled amount of beneficial oils and essential fats in your diet can lower cholesterol and help blood sugar regulation.

    Saturated fats tend to be from animal sources, such as butter and meat fats. They are solid at room temperature and can form in the same way in the body if eaten in high amounts they can clog arteries and add to the risk of heart disease. In combination with sugars, they can become laid down as fat, and so foods combining both, such as pastries, are the main culprits of weight gain.

    Monounsaturated oils are vegetable in origin and those traditionally eaten in Mediterranean countries, namely olive, almond, hazelnut, peanut, and avocado oils. They contain a fatty acid called oleic acid or omega-9 and remain liquid at room temperature, but begin to solidify when refrigerated. These have been found to have a neutral effect on blood cholesterol, although an excess can raise fat levels in the blood. The exception is olive oil, which has been shown actually to reduce blood cholesterol. However, this effect is thought to be caused by unique active components rather than the monounsaturated fat content. These are less damaged by heat than oils that stay liquid when chilled and therefore can be used for cooking.

    Polyunsaturated fatty acids are always liquid and contain the essential fatty acids, the omega-6 oils, that help to produce localized hormones in the body, which are important for blood sugar regulation. These include sesame, soy, walnut, pumpkin,and hemp oils. They are termed “essential” because they are crucial to body functions and must be consumed as they cannot be made in the body. Saturated fats can actually stop essential fats being used at a cellular level.

    In the case of both polyunsaturated and monounsaturated fats, eating the nuts, seeds and vegetables from which these oils are produced can also play a vital role in the effective management of diabetes. For example, the American Diabetes Association classes avocados as a “superfood” for diabetics, since not only do they contain beneficial oils but they also contain many nutrients that are important for cholesterol management and the protection of arteries against damage. Plant sterols (sterols are types of fat) help to reduce bad cholesterol and lutein helps to protect the eyes against diabetes-related degeneration. Although avocados, olives, nuts and seeds also contain some saturated fats and should be eaten in moderation, they provide omega-6 oils, vitamin E, vitamins B3 and B6, zinc and magnesium, which all aid blood sugar management.

    Omega-3 oils are those found in oily fish such as salmon, tuna, herring, mackerel, trout and sardines. Like the omega-6 oils, these are essential fatty acids and are crucial to our health. Much research has shown how important these are for heart health. They should be eaten 3-4 times a week, in variety. Both omega-3 and omega-6 oils protect parts of the body that are rich in fats, and these areas of the body may commonly become damaged in a person with diabetes – the eyes, kidneys, liver and circulation from the heart. For vegetarians, hemp, pumpkin, soy and walnut oils contain some omega-3 oils but are higher in omega-6. Omega-3 and omega-6 should be eaten in a one-to-one ratio and flax or linseed can be added to food as a source of omega-3 oils.

    Proteins

    Proteins are the major source of building materials for the body. They can also be used as a source of energy that is released very slowly. They are therefore very good for blood sugar management and can slow down sugar release into the bloodstream if eaten with less complex carbohydrates. Caution should be taken not to obtain these only from high fat sources such as meats, but also from eggs, low fat dairy products and vegetable sources such as beans, and in small amounts from other vegetables such as broccoli and cauliflower.

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