Glycemic index- it’s role in Diabetes.

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The glycemic index (GI) is a scale in units assigned to a food for carbohydrates, with pure glucose value of 100, which represents the relative increase of carbohydrates in the blood sugar levels 2 hours after consuming that food. Low GI foods increase glucose levels gradually. High GI foods increase glucose levels instantly.

The GI scale ranges from 0 to 100. Pure glucose contains highest GI and is given a value of 100.

Having low GI foods can help you attain better control over your blood sugar. Monitoring the GI of foods can be another tool to manage diabetes, along with carbohydrate control and counting.  A low-GI diet also helps with weight loss program.

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Glycemic Index of Certain Foods discussed below:

Low GI foods (0 to 50):

  • Barley
  • Pasta, parboiled (converted) rice
  • High-fiber bran cereal
  • Oatmeal
  • Quinoa
  • Carrots, non-starchy vegetables, green vegetables
  •  Oranges, grapefruit, apples and many other fruits
  • Legumes, nuts and beans
  • Milk, yogurt and milk products.

Moderate GI foods (50 to 65):

  • Pita bread
  • Raisins
  • Rye
  • Brown rice
  • Chapatti (whole wheat)

High GI foods (65 and higher):

  • White bread
  • Processed cereals and instant oatmeal, including bran flakes
  • Roasted snack foods
  • Potatoes(boiled, mashed)
  • White rice
  • Honey
  • Pineapple, watermelon

For glycemic load, below 10 is said to be low, 11 to 20 is said to be medium, and above 20 is considered high.

Several factors are taken into consideration while assigning a food a glycemic rating.

These factors are stated below:

Acidity

Foods that are highly acidic, such as pickles, citric fruits tend to be lower on the GI than foods that are not. Hence the fact proves that breads made with lactic acid, such as sourdough bread, are lower on the GI than white bread.

Cooking Time

The longer a food is cooked, the higher its GI. When a food is cooked, the carbohydrates begin to break down more quickly.

Fiber Content

In general, foods that are high in fiber have lower glycemic index. The fibrous coatings around seeds and beans reveals that the body breaks them down more slowly and gradually.

Process

As a general rule, the more the food is  processed, the higher it is on the glycemic scale. For example, fruit juice has a higher GI scale than fresh fruits.

Ripeness

The more the fruit or vegetable is ripe, the higher it tends to be on the GI.

Importance of GI in Diabetes:

The main purpose of GI is it helps us in monitoring the post meal blood glucose levels. This helps the patient to eat the choice of combinations of foods an individual can eat.

Effects of eating low GI foods:

  • It helps in natural weight loss
  • Helps keep cholesterol level under control
  • It increases the body’s sensitivity to insulin
  • Help refuel carbohydrate stores after intense exercise
  • Reduces the risk of cardiac diseases

Effects of eating high GI foods:

  • It can lead to interference with cell function
  • It can increase the production of insulin
  • Increases the risk for obesity and  type 2 diabetes and it’s complications in uncontrolled Diabetes.
  • Helps in accumulation of free fatty acid in the body

Hope this clarifies the importance of GI in our day to day life and also it’s role in Diabetes. Thus GI helps an individual especially suffering from Diabetes to chose the food wisely and monitor the blood glucose levels post lunch or dinner.

Glycemic Load : This is the actual value of GI x portion size.

Even if you eat low GI food but the portion size is more then your blood sugar levels will rise.  In diabetes portion size per serving plays a very important role. so every diabetic should focus of Glycemic load rather than Glycemic Index only.

You can ask any doubts in comments. i will love to explain them

Have a great day

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Diabetes and Hypertension

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Diabetes and Hypertension both are linked with each other. Both hypertension and Diabetes are metabolic disorders and correlated with each other. Diabetes damage the blood vessels and arteries resulting in increase in atherosclerosis which leads to hypertension, renal disorders and cardiovascular diseases. Hypertension is usually caused in elderly population but off late it is seen in mid 40’s population in India.

hypertension&diabetes_deadly_combination

Common Factors causing both Hypertension and Diabetes:

  • Obesity
  • Stress
  • Bad lifestyle
  • Increased cholesterol
  • Hypothyroidism
  • Improper Diet: Junk food, sweets
  • Smoking
  • Alcoholism

All these are some common factors which one needs to work upon. Type 1 Diabetes occurs in younger age and adolescence. But it can also occur in later age. In type 1 diabetes, immune system hampers the pancreas which produces insulin.

Type 2 Diabetes occurs in later age of life and so does hypertension. Usually there is accidental detection of Diabetes and hypertension by the physician. When a middle aged patient complains of severe headache and goes to the physician where he  actually finds out with the physician.

Epidemiology:

In the US population, hypertension occurs in approximately 35% of patients with type 1 diabetes and in 40% to 90% of patients with type 2 diabetes. A cohort study in the United States revealed that type 2 diabetes mellitus was almost 3 times likely to develop in population with hypertension as in subjects with normal blood pressure.

According to the AHA, blood vessels in the brain are more susceptible to damage due to high blood pressure. This makes it a major risk factor for dementia and stroke.

Gestational Diabetes usually occurs in pregnancy where the blood pressure rises. A lady who manages to maintain her blood sugar levels maintains her blood pressure.

White-coat hypertension is defined as increased office blood pressure (≥140/90 mmHg) usually at doctor’s clinic and normal home blood pressure (<135/85 mmHg).

Role of hyperglycemia:

The biochemical changes of diabetes of both microvascular and macrovascular complications is well established. Hyperglycemia-induced abnormalities in the hexosamine, polyol and protein kinase C pathways have revealed to cause tissue damage in diabetes. In addition to this, hyperglycemia helps the formation of toxic advanced glycated end products and induces glomerular hyperfiltration, growth factor expression, and free radical damage from reactive oxygen genre.

The pathophysiologic link between hyperglycemia and hypertension includes direct effects of glucose, activation of protein kinase C, activation of athero-inflammatory cytokines, endothelial dysfunction from oxidative stress, and epigenetic changes and others. The imposing factor of hypertension on diabetes further aggravates microvascular and macrovascular complications through additive mechanisms that include artery and capillary damage in renal, retinal, cerebral, coronary and peripheral vascular territories.

Management of Diabetes and Hypertension:

  • Diet: Avoid junk food, smoking, alcohol, limit salt intake, sweets, fried, and potatoes. Use plate diet method. Have fruits instead of juices.
  • Improve your lifestyle.
  • Exercising regularly keeps you fit to prevent obesity.
  • Monitor regularly your blood pressure and blood sugar levels to keep a check.
  • Keep yourself well hydrated.

Treatment and Medication:

Most of the diabetologist use ACE inhibitors (angiotensin converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers). Even though other medicines treat high blood pressure, these medicines also prevent or slow kidney disease in patients with diabetes.

Metformin and it’s combination are used to control Diabetes. Insulin injections are used usually in uncontrolled Diabetes and type 1 Diabetes.

Hence both Diabetes with superimposed hypertension raises an alarming signal if not well treated.

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Diabetes and Aloplecia

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Diabetes and Aloplecia are usually linked but very rarely discussed. Nearly 45% of the Indian population faces Aloplecia areata due to Diabetes and other causes.

There are various causes of Aloplecia as follows:

  • Diabetes Mellitus especially type 1.
  • Hypothyroidism
  • Stress
  • Hormonal imbalance
  • Iron deficiency anaemia
  • Hereditary

alopeciaanddiabetes

image credits: yalemedicine,org

Diabetes:

Usually Type 1 Diabetes leads to significant hair loss. When blood sugar levels in your body are uncontrolled, it results in significant changes and damage to the blood vessels. This results in poor oxygen supply to smaller blood vessels leading to damage to the hair follicles. Usually, in normal hair growth cycle, due to anagen catagen activity, the hair falls in the final cycle after which the new hair grows from the hair follicles. But due to uncontrolled Diabetes, the immunity hampers the growth of new hair follicles and thus resulting in patches of baldness. In Type 2 Diabetes similar effects do occur but generally are less extensive.

Hypothyroidism:

Due to endocrine imbalance, there is increased TSH levels and decreased thyroxine production leading to imbalance in hormonal levels. Thus leading to hair loss.

Stress and hormonal imbalance:

Both stress and hormonal imbalance goes hand in hand. Increased stress levels results in Anxiety which in turn disturbs sleeping pattern of an individual resulting in imbalance in hormonal levels . This affects the growth of hair follicles and leads to hair fall.

Iron deficiency Anaemia:

Due to decreased iron in haemoglobin, decreased hemoglobin count resulting in anaemia.

Heriditary:

Genetic cause is ofcourse not ruled out. Aloplecia in early aged population is usually hereditary.

Thus all these factors affect the hair follicle resulting in hairfall and leaving patches of baldness.

But Type 1 Diabetes, usually affects the anagen catagen phase in a more severe manner, affecting the immune response. So there is loss of hair overall like the scalp, over eyebrows, over chest etc. In Insulin resistant cases, hairfall occurs faster due to damage to the hair follicles.

Management and treatment of  Diabetes and Aloplecia:

  • One must monitor and control Diabetes so as to keep the cause under control to control hairfall. In type 1 Diabetes, insulin injections along with medication usually help to control autoimmune Diabetes. Regular checkup with your diabetologist usually helps in monitoring your blood glucose levels.
  • Patches of Aloplecia are usually tackled with Minoxidil tab orally and also local application.
  • Apply onion juice or aloe vera juice locally over the affected area for months together is often of great help (I don’t recommend but some found it useful).
  • Improvement in lifestyle changes benefits an individual to avoid stress and improve good quality sleep.
  • Keeping a check on thyroid hormones, like treatment for Hypothyroidism helps. Eltroxin (Levothyroxin) tab orally helps to keep a check on Hypothyroidism and obesity.
  • Using proper sulphate free shampoo and regular oiling your hair helps to a certain extent for hair growth and prevents dandruff.
  • Ofcourse Tricology has advanced souch in this field of hair grafting which is of help to cover certain patches of hair.
  • Multivitamins like B complex, Vitamin E and Biotin helps in growth of the hair follicle and prevents hairfall.
  • Trace elements like selenium, zinc, etc and vitamin D suppliments found out to be having a good effect on hair growth.

I’m sure most of the Diabetics especially type 1 must be facing this problem but is hesitant to discuss it due to scalp shaming and ignore it unless very severe patches are shown. Hope the significance of hairfall, it’s causes is well understood and it’s correlation with Diabetes!!!

Have a great day!

 

 

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Diabetic Foot – Facts Complications and Management

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A diabetic foot is any pathology caused due to peripheral arterial disease (PAD) affecting the feet in diabetes mellitus. It is a long-term complication of diabetes mellitus. An uncontrolled Diabetes leads to various complications like sensory neuropathy, osteoarthropathy diabetic foot ulcer and changes in the arch of foot. Loss of sensation in foot is the key to diagnose diabetic foot syndrome in diabetic patient.

The feet’s insensitivity to pain can easily be established by 512 mN pinprick stimulation. Research revealed that the lifetime incidence of foot ulcers within the diabetic community is around 18% and may become as high as 30%. In uncontrolled diabetes, peripheral nerve dysfunction causes poor blood circulation to the extremities.

Vitamin D deficiency is related with diabetic foot infections which in turn has increased the risk of amputations and deaths.

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Peripheral Vascular disease:

Due to less sensitivity to pain, the wound or the injury may go unnoticed resulting in diabetic foot ulcer. When wounds take a long time to heal, infection may spread to bones and joints and lower limb wherein amputation may be necessary.

Foot infection is the most common cause due to poor circulation leading to gangrene and further amputation of foot in people with diabetes. There may be excess pressure on one part of the foot resulting in deviation of the arch of foot and arthropathy.

Athlete’s foot:

In Athlete foot, fungus causes itching, inflammation, redness, and cracking. Germs penetrate through the cracks in your skin and cause an infection. Medicines destroying the fungus can treat athlete’s foot.

Fungal infection of nail:

Nails that are infected with a fungus may become discolored (yellowish-brown), brittle and thick may separate from the rest of your nail. The dark and moist environment of shoes can help a fungus grow. Any injury to your nail can also lead to a fungal infection. Fungal nail infections are stubborn to treat. in such cases antifungal treatment may be required for over couple of months.

Callosities and corns:

Corns and callosities are also possible in Diabetic foot resulting in infections. Bunions result when the greater toe is bending on inner side of the smaller toe, thus resulting in difficulty in walking.

Ingrown toenails:

They occur when the edges of the nail grows into your skin. They cause lot of pressure and pain along the nail edges, redness, swelling, pain, drainage, and infection.

Hammertoe:

This is yet another condition where the muscles of the area become so weak that the toe curls below the foot.

All these above mentioned infections are trigger to uncontrolled diabetes.

Complications of diabetic foot problem:

  • Skin and bone infections. A small cut or wound or any injury can lead to infections. Nerve and blood vessel damage are more likely. Infections are usually treated with antibiotics.
  • Abscess. Infections penetrate into bones or tissue and create a small bag of pus called an abscess. The most common treatment is to remove the abscess. It may require removal of some bone or tissue, but newer methods, like oxygen therapy, are also very helpful.
  • Gangrene. There is poor blood supply to your fingers and toes. When blood flow is cut off, tissue dies. Treatment given is usually oxygen therapy or surgery to remove the affected area.
  • Deformities. Nerve damage can weaken the muscles in your feet and lead to deformities like hammertoes, prominent metatarsal heads, claw feet and pes cavus.
  • Charcot foot. Diabetes weaken the bones in your foot to the extend that they break. Nerve damage can reduce the sensation and prevent you from realizing it. You keep walking on broken bones unaware and your foot will change shape.

Signs of diabetic foot:

  • Changes in skin colour of foot
  • Changes in temperature of foot
  • Bad odour from the foot
  • Corns and callosities
  • Gangrene
  • Foot ulcer
  • Ingrown nail.
  • Fungal changes between the toes

Management of Diabetic foot:

  • Take care of yourself and diabetes. Follow up with your Diabetologist‘s advice regarding plate diet, nutrition, exercise and medication. Monitor your blood sugar levels regularly once every week.
  • Wash your feet with warm water using a mild soap. Dry your feet well properly between your toes.
  • Check your feet for sores, blisters, redness, calluses, or any other problems. If you have poor blood flow, it is important to check your feet daily.
  • Moisturizer: If the skin on your feet is dry, try keeping it moist by applying lotion after you wash and dry your feet.

Nail hygiene:

  • Use corn caps for removal of corns or callosities. Trim your toenails with a nail cutter or clipper. After clipping, smooth the toenails with a nail filer.
  • Always wear closed-toed shoes or slippers. Do not wear open sandals and do not walk barefoot.
  • Always wear socks or stockings. Wear socks/ stockings which  are soft and elastic and can fit your feet well.
  • Wear shoes that fit well. Buy Canvas or leather shoes which are comfortable for use. Extra wide shoes are usually preferred due to foot deformity for the comfort level.
  • Always check the inside of shoes to make sure so that no objects are left inside.
  • Protect your feet from extreme heat and cold.
  • Keep the blood flowing to your feet. Keep your feet up while sitting, move or wiggle your toes and ankles several times a day, and don’t cross your legs for long periods to avoid numbness of foot as circulation reduces.
  • Avoid smoking. Smoking can interfere with blood flow making it worse.
  • If you have a foot problem that gets worse or won’t heal, contact your diabetologist.
  • Improving lifestyle helps in reducing Diabetes and stress. Proper sleeping pattern helps reduce anxiety and depression in Diabetes.
  • Medicines like metformin, glimeperide, gliclazide, insulin injections must be taken in timely manner to avoid complications.
  • Avoid drinking alcohol.
  • Mantain your bodyweight. Obesity is one of the factors resulting in diabetes complications.

Conclusion:

Taking care of your foot is so very important as foot is integral part for walking. Hope the significance of maintaining foot hygiene is conveyed to you in a simple manner and it’s complications. Diabetic foot needs utmost care so as to avoid ulcers, injuries and other complaints. Hence always take care of your foot so as your Diabetes.

 

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