Emcure_Diabetes Matters express_20pages

VOLUME VI

express

With Best Compliments

For Medical Practitioners only

Are You At

Risk For

Peripheral

Neuropathy?

Nutrition

Warriors:

Vitamin D,

B12 &

Folic Acid

Focus On

Anaemia In

Diabetes

Diabetes

Management

wellness nutrition // lifestyle wellness // emotional wellness

Publisher, Editor & Printer

Rakesh Dharavat

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express

diabetes

focus

Ride The Beast:

Manage

Diabetes

Yourself

According to the International Diabetes Federation, India is home to over

65.1 million diabetics, and this number is set to touch 100 million in less

than two decades. However, in spite of advancements in understanding

the illness, and newer approaches to treatment, achieving optimal

glucose control remains elusive for many, resulting in diabetes-related

complications. Despite patients' best attempts, managing diabetes continues

to be a challenging, daily-balancing act that needs constant awareness and

vigilance. But this is a beast that you’d rather ride than fall prey to!

3

- Joshua J. Marine

Challenges are what

make life interesting

and overcoming

them is what makes

life meaningful.

diabetesmatters - express

4

diabetes

So, You Have

Diabetes…

Diabetes self-management

education (DSME) is the ongoing

process of accessing and absorbing

the knowledge, skill, and ability

necessary for diabetes self-care.

Guided by evidence-based standards,

it incorporates the needs, goals, and

life experiences of the person who has

diabetes. This includes

Understanding diabetes

and its treatment: According

to the NIH-NIDDK (National Institute

of Diabetes and Digestive and Kidney

Diseases), USA, diabetes is serious,

but you can learn to manage it. If

you have diabetes you need to make

healthy food choices, stay at a healthy

weight, move more every day, and

not skip medicines even when you

feel fine. If your blood sugar gets

too high (hyperglycemia), take your

medication and talk to your doctor. A

brisk walk can also help. On the other

hand, if your blood sugar gets too low

(hypoglycaemia), carry supplies for

treating low blood sugar with you –

like an energy bar, candy or fruit juice.

Eating healthy: When

you have diabetes, keeping your

blood glucose in a healthy range is

essential. Carbohydrate counting

or ‘carb counting’ can help you

understand how your food choices

affect your blood glucose level. Any

carbohydrates that you eat (rice,

bread, milk, pasta) is digested into

glucose, causing your blood glucose

level to rise. However, it’s important

to eat some carbohydrates throughout

the day because they provide energy

for your body. To better manage your

blood glucose, energy levels and

weight, pay attention to how much

carbohydrate you eat. Maintaining the

right balance between carbohydrate

and insulin helps to regulate your

blood glucose level. Consult a

nutrition expert to plan your daily

food intake based on your lifestyle,

medications and health goals. They

could also help you look into


Dr. Sujit

Chandratreya

MD (Medicine)

(Gold Medallist),

DM (Endocrinologist),

DND (Endocrinologist),

Nashik, Maharashtra.

• Portion control

• Learning to read food labels

• Making better carb choices.

It is important to eat balanced

meals with an emphasis on vegetables

and fruits. Have enough protein and

healthy fats. Protein foods like meat,

poultry and fish don’t directly affect

blood glucose and can help you feel

satisfied. To keep your heart healthy,

choose healthy fats (like in nuts, seeds

and fish) in appropriate portions.

Taking medicines

regularly: Work with your doctor

and nutritionist to understand when

your diabetes medications peak, if

your medication schedule matches

your meal plan and activity, and how

to treat hypoglycaemia when it occurs.

The amount of carbohydrate you need

may vary with age and activity.

Being physically active:

Exercise lowers blood sugar by

increasing insulin sensitivity, as also

stimulates body mechanism that

allows your muscles to absorb and

use sugar for energy. Recommends

the American Diabetes Association,

“Become familiar with how your

blood glucose responds to exercise.

Checking your blood glucose level

more often before and after

exercise can help you see the

benefits of activity. You also can

use the results of your blood

glucose checks to see how your

body to reacts to different activities.

Understanding these patterns can help

you prevent your blood glucose from

going too high or too low.”

Checking your blood

sugar: When you have diabetes,

keeping your blood glucose in a

healthy range can help you feel your

best today and in the future. Keep

track of your blood sugar. Your doctor

may advise you to check it one or

more times a day. The number of times

that you check your blood sugar will

depend on the type of diabetes that

you have and the type of medicine

you take to treat your diabetes. The

common times for checking your

blood sugar are when you first wake

up (fasting), before a meal, 2 hours

after a meal, and at bedtime. Also, talk

to your doctor about what blood sugar

numbers are right for you. Normally,

the range before your meal should

be between 80 to 130 and about two

hours after the start of the meal should

be below 180.

Reducing your risk

for diabetes-related

complications: According to the

NIH-NIDDK recommendations, taking

care of yourself and your diabetes

can help you feel better as you are

likely to

– have more energy

– be less tired and thirsty

– need to pass urine less often

– heal better and

– have fewer skin or bladder

infections.

You will also have less chance of

having health problems caused by

diabetes such as

– heart attack or stroke

– eye problems that can lead to

trouble seeing or going blind

– pain, tingling, or numbness in your

hands and feet

– kidney problems that can affect the

working of your kidneys and

– teeth and gum problems.

Learning to cope with

stress, depression, and

other emotions: Stress can

raise your blood sugar. Learn ways to

lower your stress. Try deep breathing,

meditating, taking walks regularly

and cultivating hobbies. Lay off toxic

people, keep out of other people’s

drama and enjoy healthy relationships.

If need be, see a mental health

counsellor for relief strategies.

5


6

diabetes

Anaemia In Diabetes:

Stir The Blood

When someone has an

abnormally low amount of red

blood cells they are said to

be anaemic. Red blood cells

in the body transport oxygen

to different parts because of

haemoglobin. When there

are less red blood cells, the

body’s organs don’t receive

the oxygen which they need.

This causes them damage. It

also decreases an anaemic

person’s quality of life by

causing weakness, fatigue and

more. There are different types

of anaemia and some of the


Dr. Sujit

Chandratreya

MD (Medicine)

(Gold Medallist),

DM (Endocrinologist),

DND (Endocrinologist),

Nashik, Maharashtra.

7

causes would be:

• Deficiency of iron and vitamins

• Anaemia related to kidney disease

• Heavy bleeding due to wounds,

heavy menstrual bleeding, ulcers

and certain cancers.

• Chronic diseases or longstanding or

ongoing medical condition.

Relationship between

diabetes and anaemia

Diabetes does not directly cause

anaemia, but certain complications and

conditions associated with diabetes can

contribute to it. A person with diabetes

has an increasing risk of developing

anemia the longer they have the

condition. The risk develops not

directly due to diabetes but because

of its complications, like diabetesrelated

kidney disease (nephropathy)

and nerve damage (neuropathy).

Regarding the former condition, says

a 2002 study in the journal ‘The

Nephrology Dialysis Transplantation’,

“In the past complications of diabetes

such as hypertension, heart disease,

polyneuropathy, and foot problems

were so devastating, that anaemia

paled in comparison. Today, however,

we know that in diabetic nephropathy,

anaemia tends to be more severe than

in non-diabetic renal disease and is

seen in the earlier stage of chronic

kidney disease. Furthermore, since

late complications of diabetes are

ischaemic in nature, anaemia may play

an important part in the offset of those

complications.”

Says a 2017 study in the journal

‘Acta Diabetologica’, “Anaemia is

an independent risk factor of DPN

(Diabetic Peripheral Neuropathy) in

T2DM patients.”

Kidney damage

Diabetes can lead to kidney damage,

and failing kidneys can cause anemia.

The kidneys secrete a hormone called

erythropoietin, which stimulates the

bone marrow to produce red blood

cells. But as kidneys get damaged,

they make less of this hormone and,

without this hormone, the body

doesn’t make enough red blood cells,

which leads to anaemia. Chronically

high blood glucose levels can cause

kidney damage.

Heart failure

People who have diabetes are

at increased risk for heart failure -

the inability of the heart to pump

enough blood to meet the body’s

needs. Decreased heart function can

cause kidney dysfunction, which can

contribute to anaemia.

Nutritional deficiencies

Many people who have diabetes

have nutritional deficiencies that can

cause anemia. These deficiencies can

be caused by either not getting in

enough nutrients or by the body’s

inability to absorb the nutrients that

are eaten. Deficiencies in iron, vitamin

B12, vitamin B6, and folate can all

cause anaemia.

Diabetic drugs

Some diabetes medications

can interfere with the absorption

of vitamin B-12. Certain other

medications can dilute haemoglobin

concentration in the blood.

Watch your numbers

Normal range for men is

haemoglobin between 13.8 and 17.2

(or haematocrit of 40.7 to 50.3). For

women, it’s between 12.1 and 15.1

(or a haematocrit of 36.1 to 44.3).

Generally, the physician will ask you

to do blood tests for iron, ferritin,

and vitamin levels, stool tests to see if

there is blood in your stool and blood

and urine tests for kidney function.

Symptoms of diabetes

related anaemia:

• Weakness and decreased energy

• Shortness of breath

• Feeling lightheaded, dizziness

• Racing heart, palpitations or

irregular beating

• Pale skin and brittle nails

• Depression and irritability

• Cold hands and feet

• Numbness and tingling of the

fingers and toes

• Trouble concentrating

• Sexual problems.

Managing anaemia and

diabetes

Since high blood sugar levels can

lead to anaemia, good glycaemic

control is a vital part of keeping

the levels red blood cells high. Iron

supplementation is the most common

treatment for anaemia. When kidney

disease is involved, this is what you

can do about it:

• Prioritise controlling your blood

sugar to keep anemia and other

symptoms at bay. Consult a dietitian

or nutritionist to determine which

specific foods are best to restore

essential nutrients to the body, as

well as recommendations for their

portions.

• Adjust your diet to include foods

rich in iron, folic acid, and vitamin

B12. Get your nutrition expert to

help you give you a meal plan to

include these nutrients.

• Incorporate iron-rich foods like lean

red meat, dark leafy greens, and

beans into your diet.

• Accompany the healthy diet with

regular exercise to prevent high

blood pressure and obesity.


8

diabetes

Pins & Needles:

Are You At Risk

For Peripheral

Neuropathy?

Peripheral neuropathy is nerve

damage caused by chronically high

blood sugar and diabetes. Despite

many recent advances in diabetes

treatment, neuropathy remains

common. According to A Position

Statement by the American Diabetes

Association as published in ‘Diabetes

Care’, approximately 50% of people

with type 2 diabetes and 20% of those

with type 1 diabetes develop this kind

of nerve damage. Diabetes-related

nerve damage worsens with age and

with advancing diabetes. According

to research published in the journal

‘Diabetologia’, about one in three

people with type 1 diabetes had signs

of diabetic neuropathy 25 years after

their diabetes. According to a 2014

University of Michigan review in the

journal ‘Current Diabetes Reports’,

half of those with type 2 diabetes

have neuropathy ten years after their

diagnosis. According to the American

Diabetes Association, 10-20% of

people with prediabetes have signs of

diabetic neuropathy.

DPN can cause burning, stabbing

or electric-shock-like pain or tingling

in your feet, legs, hands or arms. The

pain may be worse at night.

According to a 2017 review in

the ‘Journal of Diabetes Research’,

metabolic changes associated with

diabetes and related health problems

may damage nerve cells by boosting

levels of rogue oxygen molecules

called free radicals that attack

the DNA inside cells, by zapping

antioxidant compounds that normally

protect cells from free radicals and

by increasing inflammation. Diabetic

Peripheral Neuropathy (DPN) can

create disastrous and even lifethreatening

problems like foot ulcers,

amputations, heart attacks, digestion

problems and difficulty recognising

low blood sugar episodes. Despite the

complications it can cause, knowing

its risk factors and taking precautions

can go a long way.

Risk factors

• Obesity & hypertriglyceridemia:

According to 2013 research

published in the ‘Journal of

Diabetes and its Complications’,

obesity and hypertriglyceridemia

significantly increase risk

for peripheral neuropathy,

independent of glucose control.

• Smoking: Says a 2015 study

published in the ‘Journal of

Internal Medicine’, smoking may

be associated with an increased

risk of DPN in people with

diabetes. Smoking restricts blood

flow to the nerve cells. It also has

an adverse effect on your blood

sugar levels, which can lead to the

development of diabetes. Adds

a 2015 Harvard Medical School

review of 38 studies on tobacco

use and diabetic peripheral

neuropathy that included more

than 5,000 people, smoking

increased DPN risk by as much

as 42%.

• Hypertension: Says a 2010

study by the University of

Birmingham, “Hypertension is

strongly associated with diabetic

neuropathy and the observed

sensory loss may be aggravated

by hypertension-induced nerve

ischaemia and hypoxia.”

• High levels of ‘bad’ cholesterol:

In a 2015 study published in the

journal ‘Medicine’ that looked at

more than 37,000 people with type

2 diabetes for up to nine years,

researchers found that low levels

of “good” HDL cholesterol and

high levels of heart-threatening

LDLs also boosted risk for diabetic

peripheral neuropathy by up to

67%.

• Inability to control blood sugar:

Says ‘Diabetic Neuropathy:

A Position Statement by the

American Diabetes Association as

carried in ‘Diabetes Care’, 2017,

“For people with type 1 diabetes,

tight glucose control can cut risk

for DPN by 78%; for those with

type 2, it may reduce risk 5-9%.”

Diabetic Neuropathy

Symptoms

• Numbness, tingling, or pain in the

toes, feet, legs, hands, arms, and

fingers

• Indigestion, nausea, or vomiting

• Diarrhea or constipation

• Dizziness or faintness due to a

drop in blood pressure, especially

when suddenly getting up to stand

• Problems with urination

• Erectile dysfunction or vaginal

dryness.

Diabetic Neuropathy

Treatment

– Over-the-counter pain medication

for mild pain. Regular use of

prescription drugs for peripheral

neuropathy

– Keep blood sugar levels in normal

range

– Get regular exercise

– Maintain a healthy weight

– Take foot care seriously; inspect

your feet daily for injuries

– Wear special therapeutic shoes.


9

Dr. Mahesh

Padsalge

MD (Medicine),

DFID (CMC,

Vellore),

Navi Mumbai.


10

diabetes

Nutrition Warriors:

Vitamin D,

B12 & Folic Acid

Good nutrition is the first line of

defence. Whether or not you have a

medical condition, eat a healthy diet

rich in fruits, vegetables, whole grains

and lean protein. Keep a food diary so

you are aware of what you’re eating

and to make sure you get all the

nutrients you need each day to stay

as healthy as possible.

An epidemiological study by

University of California and Seoul

National University suggests that

people deficient in vitamin D may be

at much greater risk of developing

diabetes. Elsewhere, research has

shown that high levels of bad

cholesterol and low levels of good

cholesterol, excess fat around the

waist, elevated blood pressure and

blood sugar, insulin resistance,

chronic inflammation, and excess

uric acid in the blood - when some or

all of these factors combine, chances

for heart disease and type 2 diabetes

rise. According to a 2011 report in

the ‘Journal of Nutrition’, researchers

found the strongest link between high

levels of visceral fat and low levels

of vitamin D, which they concluded

could contribute to insulin resistance

and metabolic syndrome. The

participants in the study weighed at

least 350 pounds, were not pregnant,

did not have cardiovascular disease,

and had normal kidney function. As

blood levels of vitamin D rose, waist

size and insulin levels fell.

Dr. Mahesh

Padsalge

MD (Medicine),

DFID (CMC,

Vellore),

Navi Mumbai.


11

The

Significant

Role Of

Vitamin D

Says a 2011 report in the journal

‘Diabetes Research and Clinical

Practice’, in a study, 67 people with

type 2 diabetes and neuropathy

took a placebo or one of two sets of

supplements. The first group took 20

mg of zinc, 250 mg of magnesium,

200 mg of vitamin C, and 150 IU

of vitamin E per day. The second

group took the same supplements

plus 10 mg each of vitamins B1, B2

and B6, plus 200 mcg of biotin, 10

mcg of vitamin B12 and 1 mg of

folic acid. After four months, the two

supplement groups reported lesssevere

symptoms than the placebo

group. Although doctors said the

difference between the placebo and

supplement groups was small, they

concluded that micronutrients may

help relieve diabetic neuropathy.

Type 1 diabetes

According to the 2018 research

that appears in the journal

‘Diabetes’, “When the body does not

produce enough insulin to regulate

blood sugar, type 1 diabetes is now

the most common metabolic

disorder in children under 10.” In

this study, doctors focused on

special cells in the pancreas that

produce insulin, called islet cells. In

some children, the immune system

mistakenly attacks islet cells, a

precursor of type 1 diabetes. Vitamin

D regulates the immune system. They

found that children that went on to

develop islet autoimmune disorder

had a genetic variant of the vitamin

D receptor gene, had lower levels

of vitamin D during infancy and

childhood, and were more likely to

later develop type 1 diabetes. Those

with higher vitamin D levels were less

likely to develop islet autoimmune

disorder.

Foods that reduce risk

of type 2 diabetes

According to a 2016 report in

‘PLoS Medicine’, in one of the largest,

long-term diet studies, 200,727 men

and women, healthy at the beginning,

reported their diets over a 25-year

follow-up period. Doctors classified

foods according to plant or animal

source, and gave each a positive or

negative index score. Whole grains,

fruits, vegetables, nuts, and legumes

were positive, while fruit juices,

sweetened beverages, refined grains,

potatoes, and desserts were negative.

Animal foods including fats, dairy,

eggs, fish, seafood, meat, and poultry

also got a negative index rating.

Overall, the health researchers found

that those who consumed a diet

heavy in plant-based foods and light

on animal-based foods were 20% less

likely to develop type 2 diabetes.


12

diabetes

How

Vitamin B12 Helps

The human body needs vitamin

B12 to make red blood cells, nerves,

DNA, and carry out other functions.

The body cannot make B12. Instead,

you need to get it from food or

supplements. Some people don’t

consume enough vitamin B12 to meet

their needs, while others can’t absorb

enough, resulting in vitamin B12

deficiency. Vitamin B12 is an essential

dietary nutrient—a B12 deficiency can

lead to a number of serious conditions

including peripheral neuropathy. It can

be slow to develop, causing symptoms

to appear gradually and intensify

over time. Vitamin B12 deficiency

symptoms may include:

• numbness, or tingling in the hands,

legs, or feet

• difficulty walking due to lack of

balance

• anemia

• problems with thinking and

reasoning, memory loss

• weakness

• fatigue.

How it works

Having diabetes can increase

your risk of having a B12 deficiency

because it may be a side effect of

metformin, a common treatment for

type 2 diabetes mellitus. A 2009

study found that 22% of people with

type 2 diabetes were low in B12.

The study results suggest metformin,

a commonly prescribed drug for

diabetes, contributed to the deficiency.

A new study presented at the

European Society for Paediatric

Endocrinology meeting, suggests that

adolescents with type 1 diabetes might

benefit from vitamin B supplements,

as they can improve kidney function

by protecting against the progression

and development of renal diseases.

The study involved approximately 100

adolescent participants with both type

1 diabetes and vitamin B12 deficiency.


13

14

diabetes

Why Is Folic Acid

So Important?

Recommends National Institute

for Health and Care Excellence, UK,

“High‐dose folic acid supplements

(5 mg/day) should be prescribed

for women with diabetes who are

planning a pregnancy from at

least 3 months before conception

until 12 weeks of gestation. A

recommendation supported by the

American Diabetes Association,

that appears in ‘Diabetes Care’ in

2008, advices women with preexisting

diabetes to consume 400

micrograms of folic acid daily if they

are capable of becoming pregnant,

and to increase their consumption to

600 micrograms of folic acid daily

if they are pregnant or are planning

to become pregnant. The Center for

Disease Control and Prevention, USA,

seconds the use of folic acid to reduce

the number of cases of spina bifida

and other neural tube defects in

babies born to diabetic mothers. Says

a 2018 study published in ‘Annals

of Epidemiology’, homocysteine

is associated with higher risk of

diabetes. Folate, which reduces

homocysteine, is promising for the

prevention and treatment of diabetes.

The study concluded, “Our study

suggests a potential benefit of folate

on insulin resistance and glycaemic

control.”

Folate in foods

Folate can be found in leafy

green vegetables, asparagus, brussel

sprouts, avocados, oranges, papayas

and bananas. Writing in the journal

‘Diabetes Research and Clinical

Practice’, University of Phayao,

Thailand, researchers observe that

folic acid supplementation (FAS) can

significantly reduce homocysteine

levels and may therefore offer an

approach for lowering cardiovascular

(CV) risk among patients with Type 2

diabetes.

According to the Diabetes Council

(www.thediabetescouncil.com),

Dr. Mahesh

Padsalge

MD (Medicine) ,DFID

(CMC, Vellore),

Navi Mumbai

“At least some studies have

shown a positive relationship in

diabetes between folate/folic acid

supplementation and reducing the

rates of heart disease, blood vessel

disease and stroke in patients

with diabetes.” It adds, “We know

that in at least some studies, high

homocysteine and low folate

levels was associated with diabetic

neuropathy and retinopathy.” The

study concludes, “Overall, folate

supplementation may benefit

and may help prevent diabetic

neuropathy and diabetic retinopathy,

particularly if started early in the

course of your diabetes.”


15

Diabetic Peripheral Neuropathy:

Yays & Nays

Out-of-control blood glucose

levels are the main cause of diabetic

neuropathy. Keeping your blood

glucose in an acceptable range can

help you avoid nerve damage or

prevent it from getting worse. Here are

a few dos and don’ts of DPN:

1

Do: Eat healthy and at

regular intervals

Keeping your blood sugar level as

close to normal as possible is the best

way to prevent diabetic neuropathy.

Get diet plan for diabetes control from

your nutritionist. Cut down foods

heavy in saturated fats and trans

fats, processed meats, organ meats,

such as liver, processed snacks, salty

and fried foods, sugary drinks, and

high-fat dairy products, etc. Count

your carbs, and eat plenty of fruits

and vegetables. Make sure to have

more frequent and smaller meals

throughout the day.

Don't: Skip meals

If your sugar drops, your body

manifests a series of reactions

intended to raise its blood glucose

level. Hormones are produced

that cause the release of stored

glucose from the liver. These

hormones also produce some of the

symptoms typically associated with

hypoglycaemia, like trembling and

sweating. If you don’t recognise the

symptoms of low blood glucose and

don’t have some foods that can give

carbohydrates immediately, the blood

glucose level will drop further. If it

goes too low enough, a person may

become confused or even pass out.

If you have diabetic neuropathy, you

may not get these warning signs. The

best way to prevent hypoglycaemia is

to enjoy smaller meals more frequently

and not skip meals.

2

Do: Eat whole grains

The bran and fibre in whole

grains slow the digestion of the starch

into blood glucose, causing less of a

glycaemic impact and hence leading

to smaller blood sugar spikes than

refined grains. Plus, they’re abundant

in phytonutrients, vitamins and

minerals, making them a better for

people with type 2 diabetes. Good

choices are brown rice, dalia, whole

wheat breads, rolled and steel-cut oats,

and whole wheat flour. They have

been shown to increase the metabolic

rate, thereby burns more calories,

and because of their lower glycaemic

impact, they tend to be more filling,

making you eat less.

Don't: Eat refined grains

Refined grains are ‘white’ products,

like white rice, white bread, and white

pasta. Refining whole grains removes

their outer shell and, along with it,

important B vitamins and fibre that

is essentials for your diet. Refined

grains make it harder for you to

regulate your blood sugar, which is

bad for diabetic neuropathy. Sugary

drinks, white bread, white rice, maida

and sugar-based desserts can lead to

insulin resistance, high triglycerides,

and weight gain, especially around the

middle.

3

Do: Get your vitamin B

12 level checked

Vitamin B 12 deficiency can lead

to, or worsen, peripheral neuropathy.

You can get B 12 in your diet from red

meat, dairy, fish, eggs and poultry, but

many people need supplements. Ask

your doctor if you should have your

B 12 level checked. Having diabetes

can increase your risk of having a

B-12 deficiency because it may be a

side effect of metformin, a common


16

diabetes

treatment for type 2 diabetes.

Don’t: Ignore vitamin B12

deficiency

Vitamin B12 plays an essential

role in the production of red blood

cells and DNA, as well as the proper

functioning of your nervous system.

A lack of vitamin B12 can cause

serious anaemia, nerve damage and

degeneration of the spinal cord. A lack

of B12 damages the myelin sheath

that surrounds and protect nerves.

Without this protection, nerves cease

to function properly and peripheral

neuropathy may occur.

Do: Go easy on alcohol

4 Diabetes and alcohol don’t mix.

Hypoglycemia can occur after drinking

alcohol because the liver is too busy

processing the alcohol to release

enough glucose into the bloodstream.

A 2008 study published in the journal

‘Endocrinology’ observed that, in an

animal study on mice, alcohol sends

large amounts of blood to the beta

cells in the pancreas, stimulating them

to release insulin, and thus lowering

blood glucose levels.

Don’t: Drink if you are

...pregnant, have uncontrolled

diabetes, live with liver or pancreatic

disease or those who have a history

of alcoholism. Those who take some

diabetes medicines and pain relievers

as also antibiotics, beta blockers,

antihistamines and antidepressants.

Do: Have a daily

5foot check

Research says that one in

four people with diabetes

will develop a foot condition

that requires intervention.

Neuropathy may lead to

further complications in

the feet. Because high blood

sugar damages the nerve fibers in

your body, you may not even realise

that you have a foot injury, calluses,

ulcers, infections, cuts and broken

skin. monitor their feet daily to

maintain foot health. During a daily

foot self-exam look for changes to

the feet, such as cuts, cracks, blisters,

or sores, ingrown toenails, infection,

calluses, bunions, redness, tenderness,

or swelling, changes in foot colour and

temperature or changes to the shape

of the foot.

Don’t: Ignore your feet

Peripheral neuropathy is very

common in people with diabetes and

can lead to serious foot complications

which, in turn, can lead to amputation.

If you have peripheral neuropathy,

it’s crucial that you don’t feet and to

quickly get help if you have an injury

or sore. Tight shoes and socks can

worsen pain and tingling and may lead

to sores that won’t heal. Wear soft,

loose cotton socks and padded shoes.

See your doctor for a regular foot

exam.

Do: Exercise regularly

6 It is well-established that

lifestyle changes including healthy

diet and exercise can significantly

reduce the prevalence of diabetes and

complications such as neuropathy.

A 2012 study published in

the ‘Journal of Diabetes and its

Complications’ noted that all it

took was 10 weeks of exercise

to significantly reduce pain and

symptoms in men and women with

diabetes-related neuropathy. That

wasn’t all. During that time, the

participants’ nerve health and function

also improved. Recent findings indicate

that exercise may improve balance and

trunk proprioception in people with

DPN.

Don’t: Be a couch potato

Exercise has long been recognised

as a part of therapy in the

management of diabetes, yet, research

shows that approximately 31% of type

2 diabetic patients fail to participate

in basic physical activity. Poor

circulation makes DPN even worse.

A lack of blood flow and oxygen to

hard-to-reach nerves can cause further

damage and cell death.

7

Do: Choose right shoes

and socks

Skip the high heels and flip-flops.

Before you put your shoes on, look

for wear-and-tear, especially on the

inside, and rough seams that could

irritate or injure your feet. Break in

new shoes gradually, starting with

only a few minutes of wear every day

for a few days. Trim toenails regularly

keep them from snagging hosiery and

cutting into adjacent toes.

Don’t: Go barefoot

Never walk around without shoes or

slippers, even at home. Going barefoot

may expose you to the risk of injury,

especially when the feeling in your feet

is impaired. Forget slippers, slides, and

shoes with pointy toes. Comfortable,

supportive shoes that fit well and with

dry socks will help protect your feet

from damage.

8

Do: Stop smoking

Not smoking is the best advice

for a lot of health issues, and diabetes

is certainly one of them. Smoking is

a risk factor for diabetic neuropathy.

Because it affects circulation it

increases your risk for dangerous foot

problems.

Don’t: Ignore professional help

Get help if you have trouble

quitting on your own. Your doctor

may be able to prescribe medication

to help you quit, or suggest a smoking

cessation program to boost your

motivation.


17

DPN: Whose Pain Is

It Anyway?

According to ‘American Family

Physician’, a journal of the American

Academy of Family Physicians, “Painful

diabetic peripheral neuropathy (DPN)

occurs in approximately 30% of

patients with diabetes mellitus who

are hospitalised and in 25% of patients

with diabetes who are treated in the

office setting. It develops as a late

manifestation of uncontrolled or longstanding

diabetes. As many as 12%

of patients with painful DPN do not

report symptoms, and 39% of patients

with the disorder do not receive any

treatment.” It adds, “Poorly controlled

blood glucose levels, especially greater

variation in glucose levels, contribute

to the occurrence and severity of

painful DPN.” Affirms ‘Practical Pain

Management’, “Patients with diabetic

peripheral neuropathy manifest painful

symptoms, which are commonly

characterised as burning, aching,

tingling, cold, lancinating, allodynia,

and/or numbness. Numerous

therapeutic agents are available but

there is no single therapeutic agent

available that is without adverse

effects and is completely effective for

the general diabetic population.”

Increased risk

Says a 2012 report in the ‘Clinical

Journal of Pain’, “Cardiovascular risk

factors, including age, tobacco use,

hypertension, obesity, dyslipidaemia,

and peripheral artery disease, are also

associated with an increased risk of

painful DPN.”

Guidelines from the American

Academy of Neurology recommend

that clinicians should consider

the following while prescribing

medication:

– patient’s age

– health-related quality-of-life goals

– physical function and presence of

one or more additional diseases or

disorders

– possible adverse effects of

medication.

Adds the 2012 report in the

‘Clinical Journal of Pain’, “Medication

dosages and the duration of therapy

should be regulated and treated based

on regular patient feedback regarding

pain relief, improved function, and

adverse effects.”

Ways to manage pain

Doctors should not just treat the

pain, but also treat the underlying

cause - hyperglycaemia. They must

manage patients on multiple levels,

using both medication and lifestyle

modification methods, in a multipronged

strategy to mitigate the

Dr. Saptarshi

Bhattacharya

Senior Consultant &

Head, Endocrinology,

Max Patparganj

DM Endocrinology

(AIIMS), MD Medicine

(MAMC), FACE (Fellow,

American Association of Clinical

Endocrinology), Specialty Certificate,

Royal College of Physicians, UK

President, Society for Promotion of

Education in Endocrinology & Diabetes

(SPEED), Guest Editor, Endocrinology

Issue, Journal of Indian Medical

association (JIMA).


18

diabetes

onset of initial pain and manage

its progression to prevent other

complications.

Good glucose control

The primary strategy for combating

DPN is prevention. Says a 2004 study

in the journal ‘American Journal

of Health System Pharmacy’, “The

progression of disease depends on

management of glucose in both type

I and type II diabetes.” According

to a 2005 report titled ‘Diabetic

Neuropathies’, published in the

journal ‘Diabetes Care’, “Controlling

hyperglycaemia not only helps prevent

the development of DPNP, but it also

delays its progression. Observational

studies suggest that good glucose

control and avoidance of extreme

blood glucose fluctuations improve

neuropathic symptoms.”

Lifestyle changes

Controlling hypertension,

normalising dyslipidemia, quitting

smoking, and losing weight go a long

way. Eat anti-inflammatory foods.

Increase your intake of omega–3

fatty acids, know your carbs, don’t

overdo salty, fried foods, drink only

moderately and, know that if you

have a gluten allergy, consuming

gluten can trigger and worsen your

symptoms. Common sources include

all food containing white, wheat, cake

or baking flour. For best results seek

guidance from your doctor.

Says the 2005 report in ‘Diabetes

Care’, “Improvement of lipid and blood

pressure indexes, smoking cessation,

and alcohol drinking reduction are

recommended.” As for the elderly

diabetic patients, says a 2003 report

in the journal ‘Clinical Geriatrics’, “The

initial approach to glucose control

is with lifestyle modifications. One

lifestyle modification is weight loss.

In the geriatric population, a 7%

reduction in weight and 150 minutes

of moderate exercise weekly is

recommended.”

For all diabetes patients one thing

remains constant: Monitor your

blood glucose daily, and talk with

your doctor if you're having trouble

managing it.

Foot care

Daily foot care is a must. Check

your feet every day, feeling for sore,

hot, cold, numb, or dry spots. Look for

bumps, cuts, sores, and swelling, and

report any concerns to your doctor.

Clean your feet and apply lotion daily.

Wear thick socks and comfortable

shoes. Make sure your doctor checks

your feet at every visit and does a

thorough foot exam once a year. Tell

your doctor right away if you have

symptoms of neuropathy, because early

treatment may delay further damage.

Pain medication

Your doctor may prescribe

antidepressants, anticonvulsants, and

opioid or opioid-like drugs to relieve

pain. Skin creams containing capsaicin

or lidocaine can also provide relief.

Other treatments may be needed for

neuropathy that affects the bladder,

bowels, or other organs.

Complementary &

Alternative therapies

• These include herbal medicines,

vitamins, minerals supplements.

• Mind and body practices that focus

on the interactions among the

brain, mind, body, and pain, like

meditation, yoga, acupuncture, deep

breathing exercises, hypnotherapy,

progressive relaxation etc.

Complementary and alternative

therapies work differently for different

people. They should not replace your

conventional care. For best results,

integrate them with your treatment.


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