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Dr K K Aggarwal

All about Diabetes

By Dr K K Aggarwal
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  • India is the diabetes capital of the world.
  • People with diabetes are nearly two times more likely than people without diabetes to die from heart disease, and are also at greater risk for kidney, eye and nerve diseases, among other painful and costly complications.
  • Type 2 diabetes can be delayed or prevented, and both types 1 and 2 diabetes can be managed to prevent complications.
  • In type 1 diabetes, the body does not make insulin. In type 2 diabetes, the body makes insufficient insulin or does not use insulin well.
  • Gestational diabetes occurs in some women during pregnancy. Though it usually goes away after the birth, these women and their children have a greater chance of getting type 2 diabetes later in life.
  • Type 2 diabetes has begun to affect young people.
  • Losing a modest amount of weight — about 15 pounds — through diet and exercise can actually reduce your risk of getting type 2 diabetes by as much as 58 percent in people at high risk.
  • In type 1 diabetes, tight control of blood sugar can prevent diabetes complications.
  • Choose healthy foods.
  • Take a brisk walk every day.
  • Talk with your family about your health and your family’s risk of diabetes and heart disease.
  • If you smoke, seek help to quit.
  • Make changes to reduce your risk for diabetes and its complications — for yourself, your families and for future generations.

What type of a vegetarian are you?

By Dr K K Aggarwal
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There are 4 main types of vegetarian diets:

  • Lacto–ovo–vegetarian consumes dairy products and eggs but no meat, poultry, or seafood
  • Lacto–vegetarian eats dairy products but not eggs, meat, poultry, or seafood
  • Ovo–vegetarian eats eggs but no dairy products, meat, poultry, or seafood
  • Vegan does not eat any animal products, including meat, fish, poultry, eggs, and dairy products; many vegans will also avoid honey.

Vegetarian and plant–based diets are associated with a reduced risk of obesity, diabetes, heart disease, and some types of cancer as well as increased longevity. Vegetarian diets are typically lower in fat, particularly saturated fat, and higher in dietary fiber. They are also likely to include more whole grains, legumes, nuts, and soy protein, and together with the absence of red meat, this type of eating plan may provide many benefits for the prevention and treatment of obesity and chronic health problems, including diabetes and cardiovascular disease.

Diabetes mainly linked to obesity

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  • Type 2 diabetes mellitus is strongly associated with obesity. More than 80 percent of cases of type 2 diabetes can be attributed to obesity.
  • There is a curvilinear relationship between BMI and the risk of type 2 diabetes. Lowest risk is associated with a BMI below 22 kg/m2
  • At a BMI greater than 35 kg/m2, the relative risk for diabetes adjusted for age increases to 61. The risk may further increase by a sedentary lifestyle or decrease by exercise.
  • Weight gain after age 18 years in women and after age 20 years in men increases the risk of type 2 diabetes.
  • The Nurses’ Health Study compared women with stable weight (those who gained or lost <5 kg) after the age of 18 years to women who gained weight. Those who had gained 5.0 to 7.9 kg had a relative risk of diabetes of 1.9; this risk increased to 2.7 for women who gained 8.0 to 10.9 kg.
  • Similar findings were noted in men in the Health Professionals Study. The excess risk for diabetes with even modest weight gain is substantial.
  • Weight gain precedes the onset of diabetes. Among Pima Indians (a group with a particularly high incidence of type 2 diabetes), body weight gradually increased 30 kg (from 60 kg to 90 kg) in the years preceding the diagnosis of diabetes. Conversely, weight loss is associated with a decreased risk of type 2 diabetes.
  • Insulin resistance with high insulin levels is characteristic of obesity and is present before the onset of high blood sugar levels.
  • Obesity leads to impairment in glucose removal and increased insulin resistance, which result in hyperinsulinemia. Hyperinsulinemia contributes to high lipid levels and high blood pressure.

Kidney patients more at risk for future heart attacks

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Chronic kidney disease patients with kidney function less than 60% are included in the list of criteria for defining people at highest risk for future heart attacks.

In a large cohort Canadian study published in The Lancet led by Dr Marcello Tonelli at University of Alberta, patients with only chronic kidney disease had a significantly higher rate of heart attacks than those who only had diabetes. Those who had already had a heart attack had the highest overall rate of heart attacks.

Chronic kidney disease should be regarded as a coronary heart disease risk equivalent, similar to diabetes, as patients with the condition have high rates of cardiovascular events, particularly when they also have proteinuria. When chronic kidney disease was defined more stringently with kidney function less than 45% and increased proteinuria, the rate of first heart attack was higher in those with both chronic kidney disease and diabetes than in those with either disorder alone.

Top 10 ways to keep the kidneys healthy

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  1. Monitor blood pressure and cholesterol.
  2. Control weight.
  3. Dont overuse over-the-counter painkillers.
  4. Monitor blood glucose.
  5. Get an annual physical exam.
  6. Know if chronic kidney disease (CKD), diabetes or heart disease runs in your family. If so, you may be at risk.
  7. Dont smoke.
  8. Exercise regularly.
  9. Follow a healthy diet.
  10. Get tested for chronic kidney disease if youre at risk.

Facts about exercise

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  1. Exercise for 80 minutes a day and brisk exercise 80 minutes a week.
  2. The speed of walking should be at least 80 steps per minute.
  3. Do resistance or weight-bearing exercises twice in a week.
  4. Avoid doing strenuous exercises for the first time in life after the age of 40.
  5. Ayurveda says that one should exercise according to his or her body type.
  6. Patients with diabetes should not exercise if blood sugar is lower than 90.
  7. In conditions of smog, avoid walking early in the morning till sunlight appears.

Can Diabetes Be Warded Off?

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Adhering to Mediterranean diet, rich in fruits and vegetables and low in animal products may protect from type 2 diabetes. The Mediterranean diet gives emphasis to olive oil, vegetables, fruits, nuts, cereals, legumes and fish and de–emphasizes meat and dairy products. It is a healthy eating plan that prevents heart disease.

In the study published in the British Medical Journal, researchers tracked the diets of 13,380 Spanish university graduates with no history of diabetes. The study participants filled out a 136–item food questionnaire, which measured their entire diet (including their intake of fats), their cooking methods and their use of dietary supplements. During an average of 4.4 years of follow–up, the researchers found that people who adhered to a Mediterranean diet had a lower risk of developing type 2 diabetes. In fact, those who very closely adhered to the diet reduced their risk by 83 percent.

Moreover, the people who tended to stick closest to the diet were those with factors that put them at the highest risk for developing diabetes, such as being older, having a family history of diabetes and being an ex–smoker. These people were expected to have a higher rate of diabetes, but when they adhered to the Mediterranean diet this was not the case.

Type 2 diabetes is typically brought on by poor eating habits, too much body weight and too little exercise. One key factor that might be responsible for the protective effect of the Mediterranean diet is its emphasis on olive oil for cooking, frying, putting on bread and mixing in salad dressings.

Tips to prevent diabetes

  • Eat less
  • Omit refined carbohydrates (white sugar, white rice and white maida)
  • Use olive oil, vegetables, fruits, nuts, cereals, legumes and fish, and reduce meat and dairy products.

Diet is linked to the diabetes epidemic

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A study published in the journal Diabetes Care, highlights the importance of the whole diet rather than focusing on certain foods or food groups that might be beneficial.

A diet rich in whole grains, fruits and vegetables (leafy green), nuts and low–fat dairy may help people lower their risk of type 2 diabetes by 15% over 5 years than those who ate the lowest amounts of these foods.

In contrast, adults whose diets were high in red meat, high–fat dairy, refined grains like white bread plus beans and tomatoes, saw their diabetes risk go up by 18% as a group.

Type 2 diabetes is closely linked to obesity and it is well–known that maintaining a healthy weight through diet and exercise reduces the risk of developing the disease. Diet affects diabetes risk independent of a person’s weight.

What type of a vegetarian are you?

By Dr K K Aggarwal
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There are 4 main types of vegetarian diets:

  • Lacto–ovo–vegetarian consumes dairy products and eggs but no meat, poultry, or seafood
  • Lacto–vegetarian eats dairy products but not eggs, meat, poultry, or seafood
  • Ovo–vegetarian eats eggs but no dairy products, meat, poultry, or seafood
  • Vegan does not eat any animal products, including meat, fish, poultry, eggs, and dairy products; many vegans will also avoid honey.

Vegetarian and plant–based diets are associated with a reduced risk of obesity, diabetes, heart disease, and some types of cancer as well as increased longevity. Vegetarian diets are typically lower in fat, particularly saturated fat, and higher in dietary fiber. They are also likely to include more whole grains, legumes, nuts, and soy protein, and together with the absence of red meat, this type of eating plan may provide many benefits for the prevention and treatment of obesity and chronic health problems, including diabetes and cardiovascular disease.

Diabetes Update

By Dr K K Aggarwal
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  • Morbidity from diabetes involves both macrovascular (atherosclerosis) and microvascular disease (retinopathy, nephropathy and neuropathy).
  • Smoking cessation is essential for patients who smoke.
  • Cardiovascular morbidity can also be significantly reduced with aggressive management of hypertension, cholesterol (goal LDL less than 80 mg/dL and use of aspirin (8o mg/day) in patients with or at high risk for cardiovascular disease.
  • Glycemic control can minimize risks for retinopathy, nephropathy and neuropathy in both type 1 and type 2 diabetes, and has been shown to decrease the risk for cardiovascular disease for type 1 diabetes.
  • A1C goal is <7% for most patients.
  • More stringent control (A1c <6%) may be indicated for individual patients with type 1 diabetes and during pregnancy.
  • A higher target A1c (i.e., <8%) may be preferable for some type 2 patients with comorbidities or with an anticipated lifespan, owing to advanced age or other factors, that is too brief to benefit from the effects of intensive therapy on long–term complications.
  • The appropriate target for A1c in fit elderly patients who have a life expectancy of over 10 years should be similar to those developed for younger adults (<7.0%).
  • The risk of hypoglycemia, which may lead to impaired cognition and function, is substantially increased in the elderly. Thus, avoidance of hypoglycemia is an important consideration in establishing goals and choosing therapeutic agents in elderly adults.

Artificial sweeteners in sweets may be harmful

By Dr K K Aggarwal
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In a joint statement, the American Heart Association and the American Diabetes Association have given a cautious recommendation to the use of nonnutritive sweeteners to help people maintain a healthy body weight and for diabetics to aid glucose control. These products should be considered like a nicotine patch. They are appreciably better than the real product (sugar), but not part of an optimal diet. The statement, published in both Circulation and Diabetes Care on July 9, 2012, warns that sweeteners are helpful only as long as people don’t eat additional calories later as compensation. The term nonnutritive sweeteners cover six sweeteners including aspartame, acesulfame K, neotame, saccharin, sucralose, and plant–derived stevia. These nonnutritive substances have zero calories. Two things may happen in terms of compensation

  1. Physiological, where the body might be expecting more calories and so the individual may be hungrier and therefore may eat more
  2. Psychological, where the individual thinks they are allowed to eat more sugar-rich food because they had a diet soda instead of a full–sugar soda.

When people use sweeteners there is compensation. The key is how much? Partial compensation is ok but people often completely compensate or even overcompensate, so these sweeteners have to be used smartly to be successful. Compensation seems less of a problem when these sweeteners are consumed in beverages as opposed to food. People don’t really notice the lack of calories in a diet soda and so don’t tend to eat more, whereas if they consume a low–calorie foodstuff, they do tend to eat more as compensation.

Its better when sweeteners are used in beverages and not sweets or other foods. One is not completely sure about the safety of these products, because their long–term use in humans has not been studied fully. However, the artificial sweeteners on the market are almost certainly safer than consuming large amounts of sugar, which has definite harm when consumed in large amounts. This harm, particularly when consumed in beverage form such as soda, includes increases in risks of obesity, diabetes, cardiovascular disease, and gout. A concern, though, is that just replacing sugar with artificial sweeteners leaves a person, especially children, conditioned to high levels of sweetness, which is likely to influence their food choices adversely.

Harvards Medical schools 4 exercising tips for people with diabetes

By Dr K K Aggarwal
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Get a “preflight” check

  1. Talk with your doctor before you start or change a fitness routine.
  2. Especially if you are overweight or have a history of heart disease, peripheral vascular disease, or diabetic neuropathy.
  3. Go for a complete physical exam and an exercise stress test for people if you are 35 or older and who have had diabetes for more than 10 years. The results can help determine the safest way for you to increase physical activity.

Spread your activity throughout the week

  1. Adults should aim for a weekly total of at least 160 minutes of moderate aerobic activity, or 80 minutes of vigorous activity, or an equivalent mix of the two.
  2. Be active at least 3 to 5 days a week.

Time your exercise wisely

  1. The best time to exercise is 1 to 3 hours after eating, when your blood sugar level is likely to be higher.
  2. If you use insulin, it’s important to test your blood sugar before exercising. If it is below 100 mg/dL, eat a piece of fruit or have a small snack to boost it and help you avoid hypoglycemia. Test again 30 minutes later to see if your blood sugar level is stable.
  3. Check your blood sugar after any particularly grueling workout or activity.
  4. If you use insulin, your risk of developing hypoglycemia may be highest 6 to 12 hours after exercising.
  5. Do not exercise if your blood sugar is too high (over 250).

Be prepared

  1. Should you experience a medical problem while exercising (or at any time) it is important that the people who care for you know that you have diabetes.
  2. Keep card handy or glucose tablets with you while exercising in case your blood sugar takes a sudden nosedive.

Facts about exercise

By Dr K K Aggarwal
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  • Exercise for 80 minutes a day and brisk exercise 80 minutes a week.
  • The speed of walking should be at least 80 steps per minute.
  • Do resistance or weight-bearing exercises twice in a week.
  • Avoid doing strenuous exercises for the first time in life after the age of 40.
  • Ayurveda says that one should exercise according to his or her body type.
  • Patients with diabetes should not exercise if blood sugar is lower than 90.
  • In conditions of smog, avoid walking early in the morning till sunlight appears.

Facts about exercise

By Dr K K Aggarwal
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• Exercise for 80 minutes a day and brisk exercise 80 minutes a week. • Walk with a speed of at least 80 steps per minute. • Do resistance or weight-bearing exercises twice in a week. • Avoid doing strenuous exercises for the first time in life after the age of 40. • According to Ayurveda, one should exercise to his or her body type. • Patients with diabetes who exercise should not exercise if blood sugar is lower than 90. • In conditions of smog, avoid walking early in the morning till sunlight appears.

Tips to prevent diabetes

By Dr K K Aggarwal
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  1. Do not eat white refined carbohydrates.
  2. Eat less at a time.
  3. Work out at least 30 minutes a day.
  4. Eat plenty of green bitter vegetables
  5. Eat a high fiber diet.
  6. Do not eat trans fats in food.