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Dr K K Aggarwal

Shoe Hygiene

By Dr K K Aggarwal
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• Avoid poorly fitting shoes.

• Diabetic patients should avoid walking bare feet. • Shoes that are too tight can cause pressure ulcers.

• High heels are okay for occasions but if you wear them all the time, significant foot pain and other problems can develop ranging from bunions, corns and calluses to more complex problems like misshapen hammer toes or worsening excruciating pain in the ball of the foot.

• Whenever you wear shoes that are tight, they will cause foot pain.

• Whenever you wear shoes that constrict the natural shape of the foot, they are bound to cause foot pain.

• Women, who regularly wear high heels, walk with shorter, more forceful strides and require more muscles to walk.

• Shoes can be classified under following three categories: o Good shoes or low risk shoes: athletic and casual sneakers. o Average mid risk shoes: hard or rubber–soled shoes – special shoes and work boots. o Poor or high risk shoes are the ones that do not have support or structure such as high heels, sandals, sleepers.

• Pointed toed shoes are equally bad as they disrupt the natural shape of the feet.

• If you love to wear heels, then choose heels that are not higher than 2″ and are wide.

• It is always better to buy shoes in the evening as the foot swells up by evening. If you buy them in the morning, the shoes may feel tight in evening hours.

• Always try both shoes as one foot may be smaller or larger than the other one in some people.

• Always wear the shoes that are wider than your foot.

• The actual size of the shoe may vary between different manufactures.

• The selected shoe should be wider than broadest part of the foot.

• Your foot tends to become longer and wider as you age, always check the size of your shoes every two years.

• Narrow shoes with heels should only be used for a function, dinner or a formal party, specially a party where you do not have to stand for a longer time.

Pumpkin Extract Beneficial for Diabetic Patients

By Dr K K Aggarwal
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Pumpkin extract has insulin–like effects. It can help people with diabetes keep their blood sugar under control.

Quoting Chinese researchers that animals with drug–induced diabetes treated with pumpkin extract had lower blood glucose levels, greater insulin secretion, and more insulin–producing beta cells than diabetic rats that weren’t given the extract. This action may be due to the presence of both antioxidants and D–chiro–inositol, a molecule that mediates insulin activity.

Pumpkin extract is potentially a very good product for pre–diabetic persons, as well as those who have already developed diabetes.

Pumpkin is frequently used to treat diabetes and high blood glucose in Asia.

The results of an animal study have shown that rats with diabetes had 41 percent less insulin in their blood than normal rates; giving them pumpkin extract for 30 days boosted levels of the blood sugar–regulating hormone by 36 percent. And after 30 days of being fed pumpkin extract, diabetic rats had blood glucose levels similar to those of non-diabetic rats.

Pumpkin extract beneficial for diabetic patients

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Filed Under Wellness | Tagged With: , , , | | Comments Off on Pumpkin extract beneficial for diabetic patients

Pumpkin extract has insulin–like effects. It can help people with diabetes keep their blood sugar under control.

Quoting Chinese researchers that animals with drug–induced diabetes treated with pumpkin extract had lower blood glucose levels, greater insulin secretion, and more insulin–producing beta cells than diabetic rats that weren’t given the extract. This action may be due to the presence of both antioxidants and D–chiro-inositol, a molecule that mediates insulin activity.

Pumpkin extract is potentially a very good product for pre–diabetic persons, as well as those who have already developed diabetes.

Pumpkin is frequently used to treat diabetes and high blood glucose in Asia.

The results of an animal study have shown that rats with diabetes had 41 percent less insulin in their blood than normal rates; giving them pumpkin extract for 30 days boosted levels of the blood sugar–regulating hormone by 36 percent. And after 30 days of being fed pumpkin extract, diabetic rats had blood glucose levels similar to those of non–diabetic rats.

1.  Type 1 diabetics should not fast

2. Type 1 diabetics with recurrent episodes of low blood sugar or low blood sugar unawareness or who are poorly controlled are at very high risk for developing severe episodes of low blood sugar. An excessive reduction in the insulin dosage in these patients (to prevent low blood sugar) may place them at risk for very high blood sugar and diabetic ketoacidosis.

3.      Diabetics must always and immediately end their fast if blood glucose falls <60 mg/dl).

4.      The fast should also be broken if blood glucose reaches <70 mg/dl in the first few hours after the start of the fast, especially if insulin, sulfonylurea drugs, or meglitinide are taken at predawn.

5. The fast should be broken if blood glucose exceeds 300 mg/dl.

6. Patients should avoid fasting on “sick days.”

7. Low and high blood sugar episodes may occur in type 2 diabetics but generally less frequently and with less severe consequences compared with type 1 diabetics.

8.  A patient’s decision to fast should be made in consultation with the doctor. Patients who insist on fasting should undergo pre-Ramadan assessment and receive appropriate education and instructions related to physical activity, meal planning, glucose monitoring, and dosage and timing of medications. The management plan must be highly individualized with close follow ups.

9.  In type 2 diabetics well controlled with diet alone, the risk associated with fasting is quite low. But there is a potential risk for post food high blood sugar after the predawn and sunset meals if patients overindulge in eating. One should distribute calories over two to three smaller meals during the non-fasting interval to prevent excessive post food high blood sugar.

10. Type 2 diabetics on diet control usually do so with a regular daily exercise program. The exercise program should be modified in its intensity and timing to avoid low blood sugar episodes; the timing of the exercise could be changed to 2 h after the sunset meal.

11. In the elderly with presence of high BP and high cholesterol fluid restriction and dehydration may increase the risk of thrombotic events.

12. The choice of oral anti diabetic drugs should be individualized. Drugs that act by increasing insulin sensitivity are associated with a significantly lower risk of low blood sugar than compounds that act by increasing insulin secretion.

13. Patients on Metformin alone may safely fast because the possibility of low blood sugar is minimal. Two thirds of the total daily dose should be given immediately before the sunset meal and the other third before the predawn meal.

14. Patients on pioglitazone have a low risk of hypoglycemia and require no change in the dose.

15. Sulfonylurea drugs are unsuitable for use during fasting because of the inherent risk of low blood sugar. Their use should be individualized and they should be utilized with caution.

16. Chlorpropamide is absolutely contraindicated during Ramadan because of the high possibility of prolonged and unpredictable low blood sugar.

17. Gliclazide or glimeperide, are newer drugs and can be used with caution as they have lower risk of hypoglycemia.

18. Short-acting insulin secretagogues, repaglinide and nateglinide, are useful because of their short duration of action. They could be taken twice daily before the sunset and predawn meals.

19. Problems facing patients with type 2 diabetes who administer insulin are similar to those with type 1 diabetes, except that the incidence of hypoglycemia is less.

20. Judicious use of intermediate- or long-acting insulin preparations plus a short-acting insulin administered before meals is an effective strategy.

21. Using one injection of a long-acting insulin analog, such as insulin glargine, or two injections of NPH, lente, or detemir insulin before the sunset and predawn meals may provide adequate coverage as long as the dosage of each injection is individualized.

22. A single injection of intermediate-acting insulin administered before the sunset meal may be sufficient to provide acceptable glycemic control in patients with reasonable basal insulin secretion.

23. Most patients will require short-acting insulin administered in combination with the intermediate- or long-acting insulin at the sunset meal to cover the large caloric load of Iftar. Moreover, many will need an additional dose of short-acting insulin at predawn.

24.   Use of insulin lispro instead of regular insulin before meals in patients with type 2 diabetes who fast during Ramadan is associated with less hypoglycemia and smaller postprandial glucose excursions.