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Dr K K Aggarwal

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.

Cycling can cause erectile dysfunction

By Dr K K Aggarwal
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Age, diabetes, hypertension, obesity, high lipids, smoking, drugs, heart disease, upright cycling for more than 3 hours a week can cause erectile dysfunction in males. For those who ride bicycles for more than 3 hours a week should do so in a reclining position and not upright position.

A man is considered to have erectile dysfunction when he cannot acquire or sustain an erection of sufficient rigidity for sexual intercourse. Any man may, at one time or another during his life, experience periodic or isolated sexual failures.

The term “impotent” is reserved for those men who experience erectile failure during attempted intercourse more than 75 percent of the time. Heart disease increases the risk for later erectile dysfunction. Erectile dysfunction may be an early warning sign of future heart disease. Men with erectile dysfunction without an obvious cause (e.g., pelvic trauma), and who have no symptoms of heart disease, should be screened for heart disease prior to treatment since there are potential cardiac risks associated with sexual activity in patients with heart disease.

Eight of the 12 most commonly prescribed medications list impotence as a side effect and it is estimated that 25 percent of cases of erectile dysfunction are due to drugs.

Depression, stress, or the drugs used to treat depression can result in erectile dysfunction.

Neurologic causes of erectile dysfunction include stroke, spinal cord or back injury, multiple sclerosis, or dementia. In addition, pelvic trauma, prostate. Surgery or priapism may cause erectile dysfunction.

Bicycling, less obvious, but of increasing importance, has been the possible association of erectile dysfunction with bicycling. Anything that places prolonged pressure on the pudendal and cavernosal nerves or compromises blood flow to the penile artery can result in penile numbness and impotence.

Cycling-induced impotence is primarily a problem of serious cyclists and has been reported to occur in Norwegian men competing in a 540 km bicycle race.

The penile numbness is attributed to the pressure on the perineal nerves whereas the erectile dysfunction is thought to be due to a decrease in oxygen pressure in the pudendal arteries.

Recreational cyclists, those who cycle for less than 3 hours per week and men who cycle in a reclining position avoid the sustained intense pressure on the penile nerve and artery and are less likely to experience sexual side effects. Continued cycling in a seated upright position can reduce the penile oxygen levels lasting 10 minutes.

HCFI tips for fasting

By Dr K K Aggarwal
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  1. Plan your diet especially if you have medical conditions such as diabetes and hypertension. Do not skip your medication schedule. Keep a healthy snack handy for those cravings.
  2. Keep yourself hydrated by drinking water, coconut water, green tea, buttermilk, and lime juice. Avoid aerated drinks.
  3. Avoid gorging on salty ‘vrat snacks’. Eat something that is boiled or roasted instead.
  4. Use rock salt in your food instead of usual salt as it helps in better mineral absorption. It is also beneficial for those who have high or low blood pressure.
  5. Eat lighter meals as these can aid digestion.
  6. For dessert, you can try eating dates or fruit yogurt. Also, add honey instead of sugar.
  7. Eat lots of fresh fruits and vegetables.

Harvards Medical schools 4 exercising tips for people with diabetes

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , , , | | Comments Off on Harvards Medical schools 4 exercising tips for people with diabetes

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.

What type of a vegetarian are you?

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

  1. Lacto–ovo–vegetarian consumes dairy products and eggs but no meat, poultry, or seafood

  2. Lacto–vegetarian eats dairy products but not eggs, meat, poultry, or seafood

  3. Ovo–vegetarian eats eggs but no dairy products, meat, poultry, or seafood

  4. 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.

Diabetics should take pneumonia vaccine

By Dr K K Aggarwal
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Diabetes is associated with a 25–75% increase in the relative risk of hospitalization due to pneumonia. Hence, patients with diabetes, especially those who have had diabetes for a longer duration should be given flu and pneumococcal vaccine. It is equally important to control diabetes adequately to prevent pneumonia-related hospitalization among diabetic patients.

In the study Dr. Jette B. Kornum from Aarhus University Hospital, Aalborg and colleagues identified 34,239 individuals with a pneumonia–related hospital admission and 342,390 individuals from the general population who served as a control group. The study showed that individuals with diabetes had a 26% higher risk of pneumonia–related hospitalization compared with those without diabetes. The risk of pneumonia–related hospitalization was increased by 4.4–fold in subjects with type 1 diabetes and by 1.2–fold in those with type 2 diabetes.

The maximum risk was related to longer duration of diabetes (more than 9 years) with poor glycemic control (A1c > 9%). The risk was 37% higher in diabetics of over 9 years duration and 60% higher when the A1c was over 9% as compared to 22% higher risk when the A1c was lower than 7%.

A1c is the measure of average blood sugar of the last three months and should be kept lower than 7%.

A mix of exercise protocol is better

By Dr K K Aggarwal
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A combination of weight training and aerobic exercise is the best prescription for overweight patients at risk for diabetes and heart disease.

Only aerobic exercise is also good as it reduces weight and inches off the waistlines. Jut weight lifting alone has very little benefit.

According to a study published in the American Journal of Cardiology, people in the weight-training group gained about 1.5 pounds and those in the aerobic group lost an average of 3 pounds and half an inch from their waists. Those who did both weight and aerobic training dropped about 4 pounds and 1 waistline inch.  This group also had lower diastolic lower blood pressure as well as a decline in metabolic syndrome score. Both the aerobic-only group and the combined-exercise group also lowered their levels of bad triglycerides.

Kidney patients more at risk for future heart attacks

By Dr K K Aggarwal
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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.

Cycling can cause erectile dysfunction

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , , , , , , , | | Comments Off on Cycling can cause erectile dysfunction

Age, diabetes, hypertension, obesity, high lipids, smoking, drugs, heart disease, upright cycling for more than 3 hours a week can cause erectile dysfunction (ED) in males. Those who ride bicycles for more than 3 hours a week should do so in a reclining position and not upright position. A man is considered to have ED when he cannot acquire or sustain an erection of sufficient rigidity for sexual intercourse. Any man may, at one time or another during his life, experience periodic or isolated sexual failures. The term “impotent” is reserved for those men who experience erectile failure during attempted intercourse more than 75% of the time. Heart disease increases the risk for later ED; ED also may be an early warning sign of future heart disease. Men with erectile dysfunction without an obvious cause (e.g., pelvic trauma), and who have no symptoms of heart disease, should be screened for heart disease prior to treatment since there are potential cardiac risks associated with sexual activity in patients with heart disease. Eight of the 12 most commonly prescribed medications list impotence as a side effect and it is estimated that 25% of cases of ED are due to drugs. Depression, stress, or the drugs used to treat depression can result in ED. Neurologic causes include stroke, spinal cord or back injury, multiple sclerosis, or dementia. In addition, pelvic trauma, prostate. Surgery or priapism may cause ED. A less obvious, but of increasing importance, has been the possible association of ED with bicycling. Anything that places prolonged pressure on the pudendal and cavernosal nerves or compromises blood flow to the penile artery can result in penile numbness and impotence. Cycling-induced impotence, is primarily a problem of serious cyclists and has been reported to occur in Norwegian men competing in a 540 km bicycle race. The penile numbness is attributed to the pressure on the perineal nerves whereas the erectile dysfunction is thought to be due to a decrease in oxygen pressure in the pudendal arteries. Recreational cyclists, those who cycle for less than 3 hours per week and men who cycle in a reclining position avoid the sustained intense pressure on the penile nerve and artery and are less likely to experience sexual side effects. Continued cycling in a seated upright position can reduce the penile oxygen levels lasting 10 minutes.

A mix of exercise protocol is better

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , , , | | Comments Off on A mix of exercise protocol is better

A combination of weight training and aerobic exercise is the best prescription for overweight patients at risk for diabetes and heart disease. Only aerobic exercise is also as good as it reduces weight and takes inches off the waistlines. Just weight lifting alone has very little benefit.

According to a study published in the American Journal of Cardiology, people in the weight–training group gained about 1.5 pounds and those in the aerobic group lost an average of 3 pounds and half an inch from their waists. Those who did both weight and aerobic training dropped about 4 pounds and 1 inch from the waistline. This group also saw a decrease in diastolic lower blood pressure and in a metabolic syndrome score. Both the aerobic–only group and the combined-exercise group also lowered their levels of bad triglycerides.