he other diabetes
Your Health
DR GITA MATHAI
Diabetes, which affects eight to nine per cent of the urban population in India, is perceived to be a lifestyle disease of overweight, sedentary and middle-aged people. These patients do not require insulin injections. In this type of diabetes, the body either loses its sensitivity to insulin (the natural hormone needed to reduce blood sugar) or the pancreas (which produces insulin) fails to produce enough of the stuff. A judicious combination of restricted diet, exercise and tablets are usually enough to keep the sugar level in check and complications at bay.
Few people, however, realise that one per cent of newly diagnosed diabetics are thin and young. They have type 1 diabetes. The disease was previously called juvenile diabetes as sufferers were usually young but now the nomenclature has been changed to “insulin dependent diabetes”. In these patients, the pancreas fails to produce insulin. It can occur at any age, from infancy, childhood, and adolescence to adults, as both genetic factors and environmental triggers are involved. Once it has set in, it cannot be prevented, delayed or cured, it can only be treated.
Type 1 diabetes may be inherited or occur suddenly after an infection. The mumps, Epstein-Barr and coxsackie virus in particular have been implicated. The body itself may also produce antibodies to the islet cells (which produce insulin) in the pancreas, destroying them. A relative deficiency of vitamin D has been linked to an increased risk of type 1 diabetes. Drinking water contaminated with nitrates may also increase the risk. Early weaning (before the recommended 4-6 months) increases the risk. Exclusive breast feeding until the age of one reduces the risk.
Diagnosing insulin dependent diabetes in a child is difficult. There has to be a high index of suspicion on the part of the parent and the doctor. The typical symptoms of increased thirst, frequent urination, a relapse of bedwetting after successful toilet training, voracious appetite and overeating with loss of weight or fatigue may be accepted and dismissed as a “normal” part of childhood. Often the diagnosis is only made by accident or after uncontrolled infections or other complications set in.
Blood tests are needed to confirm the diagnosis. A random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher, Glycated hemoglobin (A1C) of 6.5 per cent or more, a fasting blood sugar of 126 mg/dL indicates diabetes.
Treatment for insulin dependent diabetes requires a judicious combination of diet, exercise and insulin. The diet should be nutritious with plenty of fresh fruits and vegetables. The total calories required depends on the age and level of physical activity. Blood sugar levels should be checked three times a day (with a glucometer) before meals so that the quantity of food eaten can be adjusted. Some young people do well if food is split into six mini meals instead of three big ones. Control is often difficult for parents when the children are fussy eaters.
Unfortunately there is no oral medication or miracle drug as yet which can replace insulin. So insulin has to be given as injections — often several times a day — depending on blood sugar values and the quantity of food about to be eaten. It becomes difficult for parents when the child refuses to eat after the calculated dose of insulin has been given, or the child vomits. Flexibility in the diet and dosage of insulin has to be maintained.
Low blood sugar can be dangerous. It can cause sweating, shivering, hunger, giddiness, tiredness, headache, irritability, palpitations, tremors, sweating, convulsions and loss of consciousness. Some form of sugar should be given as soon as such symptoms occur. Affected children need to always carry sweets. Blood sugar can become low at night and cause sweating and morning headache.
In the absence of insulin, even when blood sugar levels are high, cells are unable to process the sugar and face starvation. The body begins to break down fat stores. This leads to a dangerous condition called ketoacidosis. There may be nausea, vomiting, abdominal pain, a fruity odour and eventually loss of consciousness or seizures.
Uncontrolled high blood sugar can over the years cause complications in the eyes, heart, kidney, skin, and nerves. Infections become difficult to control and wounds may not heal. In later life, dementia and Alzheimer’s can set in.
If the sugars are controlled with diet, exercise and insulin, patients can lead normal lives and have standard life expectancy.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Thursday, March 29, 2012
Monday, March 19, 2012
move it
Let’s move it
Your Health
DR GITA MATHAI
Whenever exercise is mentioned, “I don’t have time,” is the common refrain across all age groups — from school students to teenagers to housewives to working professionals and even retirees. Twenty-four hours do not seem to be enough to work, study, eat, sleep and squeeze in TV viewing, which is given priority over exercise. The saying “no time for exercise, a lot of time for illness” has not yet hit home.
How much exercise do we need? The ideal is one hour of aerobic activity — such as running, jogging, cycling or swimming — every day, the minimum is 30 minutes three days a week. You can even split the 30 minutes into two or three segments. And this still seems an impossible target for many.
So now doctors have come up with a workout that takes only 20 minutes. High intensity interval training (HIIT) is suitable for all age groups and is beneficial for heart patients and those with hypertension. However, check with your physician before you start this regime.
HIIT involves achieving 90 per cent of your target heart rate (220-age). The exercises are running, walking, jumping jacks, stair climbing, skipping, or toe tapping. You exercise vigorously for 30 seconds, followed by 30 seconds of rest, repeated 10 times. You need to work up to one minute followed by a minute of rest. This 20-minute workout gives the same benefits as the hour-long run or walk.
Regular physical activity promotes health, prevents disease and helps reduce stress. It keeps students alert and active, despite fatigue. It also retards cognitive decline, memory loss and dementia in older people so annual medical costs are much reduced.
Inactivity eventually results in obesity, which causes relative infertility, arthritis, precipitates diabetes, elevates blood sugar values in those already diabetic, results in hypertension, heart disease, and abnormal lipid profiles. It is also linked to the development of certain cancers like that of the colon.
The chronic medical conditions associated with physical inactivity are expensive. Diagnostic tests, doctor’s consultations and medicines cost money. Workdays are lost as a result of illness. People may not realise their full potential as they are unable to work to their full capacity, limited by the pain of arthritis or the side effects of medications. Enforced premature retirement or untimely death cuts short the earning potential.
As we honour our women achievers this month, we should remember that women find it more difficult to be physically active. The constraints may be social, cultural or environmental. They require greater encouragement and motivation. And the biggest benefit (a reduction in illness and medical costs) is seen in women over 55 who are encouraged to be physically active.
Another thing physical activity improves is balance, which is important to prevent falls and expensive treatment for fractures. Weight bearing aerobic activity is essential for normal skeletal development in childhood and adolescence. It is needed to maintain peak bone mass in young adults. The decline in bone mass that occurs in older people can be slowed and averted with exercise. Conservative estimates say that in India 20 per cent of women over 55 and 15 per cent of men have decreased bone density. Medications (vitamin D supplements, alendronate and calcium) for this group are expensive and usually have to be added to medicines for diabetes, hypertension, lipids and heart disease and the cost increases with every new budget.
“I cannot sleep,” is a common complaint in older people. It may be due to many factors including depression. Many are on antidepressants, anxiolytics or sleeping pills, often in increasing dosages as habituation sets in. Exercise obviates the necessity for these medications.
All you really need to get started is a good pair of sports shoes (costing Rs 600 to Rs 10,000) a pair of socks (Rs100-150) and 20-60 minutes of your time, depending on whether you are going in for traditional exercise or HIIT. People spend far more to buy a car! Yet regular exercise will be far more cost effective in the long run.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Your Health
DR GITA MATHAI
Whenever exercise is mentioned, “I don’t have time,” is the common refrain across all age groups — from school students to teenagers to housewives to working professionals and even retirees. Twenty-four hours do not seem to be enough to work, study, eat, sleep and squeeze in TV viewing, which is given priority over exercise. The saying “no time for exercise, a lot of time for illness” has not yet hit home.
How much exercise do we need? The ideal is one hour of aerobic activity — such as running, jogging, cycling or swimming — every day, the minimum is 30 minutes three days a week. You can even split the 30 minutes into two or three segments. And this still seems an impossible target for many.
So now doctors have come up with a workout that takes only 20 minutes. High intensity interval training (HIIT) is suitable for all age groups and is beneficial for heart patients and those with hypertension. However, check with your physician before you start this regime.
HIIT involves achieving 90 per cent of your target heart rate (220-age). The exercises are running, walking, jumping jacks, stair climbing, skipping, or toe tapping. You exercise vigorously for 30 seconds, followed by 30 seconds of rest, repeated 10 times. You need to work up to one minute followed by a minute of rest. This 20-minute workout gives the same benefits as the hour-long run or walk.
Regular physical activity promotes health, prevents disease and helps reduce stress. It keeps students alert and active, despite fatigue. It also retards cognitive decline, memory loss and dementia in older people so annual medical costs are much reduced.
Inactivity eventually results in obesity, which causes relative infertility, arthritis, precipitates diabetes, elevates blood sugar values in those already diabetic, results in hypertension, heart disease, and abnormal lipid profiles. It is also linked to the development of certain cancers like that of the colon.
The chronic medical conditions associated with physical inactivity are expensive. Diagnostic tests, doctor’s consultations and medicines cost money. Workdays are lost as a result of illness. People may not realise their full potential as they are unable to work to their full capacity, limited by the pain of arthritis or the side effects of medications. Enforced premature retirement or untimely death cuts short the earning potential.
As we honour our women achievers this month, we should remember that women find it more difficult to be physically active. The constraints may be social, cultural or environmental. They require greater encouragement and motivation. And the biggest benefit (a reduction in illness and medical costs) is seen in women over 55 who are encouraged to be physically active.
Another thing physical activity improves is balance, which is important to prevent falls and expensive treatment for fractures. Weight bearing aerobic activity is essential for normal skeletal development in childhood and adolescence. It is needed to maintain peak bone mass in young adults. The decline in bone mass that occurs in older people can be slowed and averted with exercise. Conservative estimates say that in India 20 per cent of women over 55 and 15 per cent of men have decreased bone density. Medications (vitamin D supplements, alendronate and calcium) for this group are expensive and usually have to be added to medicines for diabetes, hypertension, lipids and heart disease and the cost increases with every new budget.
“I cannot sleep,” is a common complaint in older people. It may be due to many factors including depression. Many are on antidepressants, anxiolytics or sleeping pills, often in increasing dosages as habituation sets in. Exercise obviates the necessity for these medications.
All you really need to get started is a good pair of sports shoes (costing Rs 600 to Rs 10,000) a pair of socks (Rs100-150) and 20-60 minutes of your time, depending on whether you are going in for traditional exercise or HIIT. People spend far more to buy a car! Yet regular exercise will be far more cost effective in the long run.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Saturday, March 10, 2012
constipation
ruit a day keeps constipation away
Your Health
DR GITA MATHAI
“If you don’t clear your bowels every morning,” explained the grandmother, “the poisons from the stool will get absorbed in your blood.” She paused dramatically for effect. “That is what is happening to me.”
Now that statement is not strictly true. If you are constipated, the rectum continues to absorb water from the stool, making it hard. It can then become impacted (stuck) and cause painful excoriations and fissures at the anal opening. No toxins, however, are released into the blood stream.
There is no real "normal" for bowel movements; it varies from person to person. Fewer than three movements a week, however, may indicate constipation and more than three a day diarrhoea. Only about 50 per cent of the population regularly clears its bowels every morning.
Pooping has both voluntary and involuntary components. As faecal matter enters the rectum, it causes it to stretch. Nerves from the rectum carry the message to the brain. The anal sphincters relax, the abdominal and pelvic muscles contract. This increases the pressure and the motion is forced out. If the signal is ignored, the signal ceases. The motion remains in the rectum. If the signal is consistently ignored, the motion becomes hard and then gets impacted or stuck.
The stool should be well formed, sausage shaped, brown and passed painlessly. If there is a sudden change in the frequency, consistency and colour of the stool, if it is mixed with blood or mucous, if diarrhoea suddenly begins to alternate with constipation or there is significant weight loss, there is reason to be concerned. Consult a doctor at once.
Sudden acute constipation is also a worrisome symptom. It may signify a serious medical illness like an obstructive tumour. Constipation also requires an immediate assessment if it is accompanied by pain, vomiting and abdominal pain.
Chronic constipation occurs over a period of months. It is always caused by the slow movement of the stool through the colon. This may be due to hormonal imbalances, particularly deficiency of the thyroid hormone. It may be due to medicines like painkillers (codeine), cough medication, antidepressants, antacids that contain aluminium and even laxatives. Laxatives can be habit forming. The dosage has to be gradually increased for the same benefit. The intestinal nerves and musculature may cease to respond, aggravating the problem. If constipation is due to abuse, side effects or misuse of medication, the constipation disappears when the offending medication is discontinued.
Fibre is required to provide bulk to the stool. Many diets are deficient, particularly in people who consume mainly refined flour (maida) and do not eat the recommended 4-5 helpings of fruits and vegetables. (Juices do not count as the dietary fibre is strained out.). This results in constipation.
The pelvic floor musculature has to function efficiently to push out the stool. The nerves may be inefficient as a result of old age, uncontrolled diabetes or some other neuropathy. This can result in inertia of the large intestine. The nerves and muscles may be damaged as a result of repeated childbirth or surgery. Both colonic inertia and pelvic floor dysfunction can cause constipation.
If the medical evaluation for constipation does not reveal any specific treatable cause, some non specific modifications of diet, life style and simple medications can help. The goal of treatment is to achieve one bowel movement every two to three days without straining.
8 Increase you physical activity. A sedentary lifestyle slows all the muscles in the body, including abdominal and pelvic muscles.
8Modify your diet to include 4-5 helpings of food and vegetables a day. Drink enough water (not juices, colas, tea or coffee).
8Try to sit on the toilet at a specific time every day. Your body will eventually get the message.
8Women are more prone to constipation during the premenstrual phase and pregnancy. They need to increase their intake of dietary fibre at this time.
8Ipsagol husk dissolved in water increases the bulk of the stool and is safe and effective.
8Stimulant laxatives should be used as a last resort because of the possibility that they may permanently damage the colon and worsen constipation.
Herbal laxatives are marketed as “natural products”. Many of them contain senna and other stimulant plant-based laxatives in unregulated quantities. They should not be used without medical advice.
Mineral oils like paraffin act as lubricants. Long term use results in a deficiency of fat-soluble vitamins.
Hyperosmolar laxatives like sorbitol or lactulose, saline laxatives and stool softeners are efficient, unabsorbed and fairly safe.
Your body may take time to respond to these simple measures. Patience and persistence are required to make the treatment programme successful.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
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Your Health
DR GITA MATHAI
“If you don’t clear your bowels every morning,” explained the grandmother, “the poisons from the stool will get absorbed in your blood.” She paused dramatically for effect. “That is what is happening to me.”
Now that statement is not strictly true. If you are constipated, the rectum continues to absorb water from the stool, making it hard. It can then become impacted (stuck) and cause painful excoriations and fissures at the anal opening. No toxins, however, are released into the blood stream.
There is no real "normal" for bowel movements; it varies from person to person. Fewer than three movements a week, however, may indicate constipation and more than three a day diarrhoea. Only about 50 per cent of the population regularly clears its bowels every morning.
Pooping has both voluntary and involuntary components. As faecal matter enters the rectum, it causes it to stretch. Nerves from the rectum carry the message to the brain. The anal sphincters relax, the abdominal and pelvic muscles contract. This increases the pressure and the motion is forced out. If the signal is ignored, the signal ceases. The motion remains in the rectum. If the signal is consistently ignored, the motion becomes hard and then gets impacted or stuck.
The stool should be well formed, sausage shaped, brown and passed painlessly. If there is a sudden change in the frequency, consistency and colour of the stool, if it is mixed with blood or mucous, if diarrhoea suddenly begins to alternate with constipation or there is significant weight loss, there is reason to be concerned. Consult a doctor at once.
Sudden acute constipation is also a worrisome symptom. It may signify a serious medical illness like an obstructive tumour. Constipation also requires an immediate assessment if it is accompanied by pain, vomiting and abdominal pain.
Chronic constipation occurs over a period of months. It is always caused by the slow movement of the stool through the colon. This may be due to hormonal imbalances, particularly deficiency of the thyroid hormone. It may be due to medicines like painkillers (codeine), cough medication, antidepressants, antacids that contain aluminium and even laxatives. Laxatives can be habit forming. The dosage has to be gradually increased for the same benefit. The intestinal nerves and musculature may cease to respond, aggravating the problem. If constipation is due to abuse, side effects or misuse of medication, the constipation disappears when the offending medication is discontinued.
Fibre is required to provide bulk to the stool. Many diets are deficient, particularly in people who consume mainly refined flour (maida) and do not eat the recommended 4-5 helpings of fruits and vegetables. (Juices do not count as the dietary fibre is strained out.). This results in constipation.
The pelvic floor musculature has to function efficiently to push out the stool. The nerves may be inefficient as a result of old age, uncontrolled diabetes or some other neuropathy. This can result in inertia of the large intestine. The nerves and muscles may be damaged as a result of repeated childbirth or surgery. Both colonic inertia and pelvic floor dysfunction can cause constipation.
If the medical evaluation for constipation does not reveal any specific treatable cause, some non specific modifications of diet, life style and simple medications can help. The goal of treatment is to achieve one bowel movement every two to three days without straining.
8 Increase you physical activity. A sedentary lifestyle slows all the muscles in the body, including abdominal and pelvic muscles.
8Modify your diet to include 4-5 helpings of food and vegetables a day. Drink enough water (not juices, colas, tea or coffee).
8Try to sit on the toilet at a specific time every day. Your body will eventually get the message.
8Women are more prone to constipation during the premenstrual phase and pregnancy. They need to increase their intake of dietary fibre at this time.
8Ipsagol husk dissolved in water increases the bulk of the stool and is safe and effective.
8Stimulant laxatives should be used as a last resort because of the possibility that they may permanently damage the colon and worsen constipation.
Herbal laxatives are marketed as “natural products”. Many of them contain senna and other stimulant plant-based laxatives in unregulated quantities. They should not be used without medical advice.
Mineral oils like paraffin act as lubricants. Long term use results in a deficiency of fat-soluble vitamins.
Hyperosmolar laxatives like sorbitol or lactulose, saline laxatives and stool softeners are efficient, unabsorbed and fairly safe.
Your body may take time to respond to these simple measures. Patience and persistence are required to make the treatment programme successful.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
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