Stay Fit – 6 Exercise Tips for People with Diabetes

Exercise-diabetes-Pakistan
Exercise-diabetes-Pakistan
Aerobic exercise is best for diabetes.

Stay Fit – 6 Exercise Tips for People with Diabetes

Few things can help with both weight loss and diabetes management like exercise. Short bursts of intense activity force the liver to burn glucose for energy, and regular moderate exercise for over 30 minutes at a time, like walking or jogging, helps with long-term blood sugar control. While the general guidelines are the same for everyone, here are some additional exercise tips for people with diabetes to help them get the most out of their daily fitness routine:

Discuss with Your Doctor

Aside from a daily brisk walk, always consult with your doctor before starting a new exercise regime. Your doctor will assess you for any cardiovascular or nervous complications, provide feedback and recommendations on suitable activities based on your health condition, and adjust your meal plan, insulin, or diabetes medication dosage accordingly. This is particularly important to minimize the risk of hypoglycemia because blood glucose levels generally lower with physical activity.

Check Your Blood Sugar

Make it a habit to check your blood sugar before and after every workout, or every half hour if the workouts are longer than an hour, to help gauge any future medication, insulin, and dietary adjustments, and let you know if a snack is required to stabilize glucose levels. However, some people may experience temporary spikes right after exercise due to increased adrenaline production; particularly for short, intensive workouts.

For most people with diabetes, a reading below 4.0 mmol/l after exercising indicates low blood sugar, in which case a fast-acting carbohydrate source like raisins or lifesaver candies should be consumed. However, avoid exercising later in the day to prevent overnight hypoglycemia if you have type 1 diabetes.

Be Foot Wise

Wear cotton or cotton-polyester socks and supportive athletic shoes to prevent blisters and accidental foot injuries, particularly if you have diabetic neuropathy. Also, choose the right shoes for the right activity to provide adequate foot support and minimize the risk of injury. Check and clean your feet daily, and inform your doctor in case of any new foot injuries.

Carry Carb Fuel

Blood sugar drops during exercise increase the risk of hypoglycemia and sudden fainting, so always pack an emergency carbohydrate snack, fruit juice, or glucose tablets and keep them within reach. Consume immediately if you notice signs of hypoglycemia; like dizziness, lightheadedness, chest tightness, pain or discomfort, and/or nausea.

Hydrate

Your exercise pack should also contain at least one 275 ml bottle of water to remain appropriately hydrated and avoid dry mouth, chest tightness, and cardiac stress. While the general recommendation is drinking before, during, and right after exercise, increase intake if exercising in hot weather.

Strength Train Twice a Week

As previously mentioned, short and intense bursts of exercise burn glucose at a faster and higher rate. So incorporate some amount of strength training, like push-ups, weightlifting, resistance training, lunges, and squats in your daily exercise regime twice a week.

For Diabetic Neuropathy, Retinopathy and Nephropathy

  • People with diabetic nerve damage, particularly in the legs and feet, should avoid prolonged walking, jogging, and stepping exercises as they increase the risk of falling and injuries. Opt instead for short duration swimming and stationary cycling. However, refrain from swimming in case of foot ulcers.
  • People in the early or intermediate stages of diabetic eye damage should choose low-impact exercises like walking, swimming, and stationary cycling over strenuous high-impact activity as it may promote further eye damage by increasing blood pressure.
  • Similarly, those with diabetes-induced kidney damage should avoid all activities that raise systolic blood pressure to over 180-200 mmHg, unless blood pressure is continuously monitored by a professional during exercise.

Although mild soreness is normal, stop exercising immediately if you experience any hypoglycemic symptoms, check your blood sugar, heart rate and blood pressure, and take a glucose-raising snack if needed. Resume exercise only if your condition stabilizes to pre-exercise level, or discontinue until a proper medical consultation if your condition remains the same.

Image Source: https://www.pexels.com/photo/color-colour-fitness-health-39671/

Sweet Tooth: The Link Between Diabetes and Oral Health

Diabetes and oral health.
Diabetes and oral health.
Diabetes and oral health.. Image credit: https://pixabay.com/photos/woman-smile-tooth-health-mouth-3498849/

Sweet Tooth: The Link Between Diabetes and Oral Health.

Improperly managed diabetes invites a host of health complications whose effects reverberate throughout the body, and the oral cavity is one of them. In fact, periodontal disease is the 6th leading diabetes complication worldwide. This is particularly concerning because inflammation caused by periodontal disease, or periodontitis, can lead to persistently swollen and bleeding gums, and even tooth loss. Here we examine the link between diabetes and oral health, and what you can do to maintain it:

A Two-Way Street

A weakened immune system due to diabetes makes the body, including the teeth and gums, more prone to infections as compared to someone without diabetes; and poorly controlled blood sugar further weakens the white blood cells responsible for defending against invading bacteria. Moreover, the decelerated healing due to diabetes can also interfere with periodontitis treatment if and when it occurs.

Conversely, A periodontitis infection, and bad oral hygiene in general, contribute towards elevating blood sugar levels and fueling diabetes progression, which then leads to other health complications.

Oral Effects of Diabetes

Improper diabetes management can have the following effects on the oral ecosystem:

  • Dry mouth and increased cavity risk due to reduced saliva production
  • Bleeding from gums
  • Problems tasting food
  • Delayed wound healing
  • Premature teeth eruption (growth) in children

Common Oral Health Problems with Diabetes

  • Dry Mouth (Xerostomia): Reduced saliva production due to high blood sugar and regular antibiotic use causes soreness and inflammation in the mouth tissues, which can make chewing, tasting, and swallowing difficult. In progressive stages, Xerostomia can lead to soreness, ulcers, infection and tooth decay.
  • Fungal Infection/Thrush: Reduced saliva production allows the otherwise harmless resident mouth fungus Candida albicans to grow unchecked, resulting in a fungal infection ‘Thrush’ characterized by sore white or red patches. People with type 1 or type 2 diabetes who regularly wear dentures are also at higher risk.
  • Burning Mouth Syndrome: A side-effect of diabetes-induced thrush, burning mouth syndrome results in severe and persistent pain and burning in the mouth.
  • Periodontal Disease: Thickening of blood vessels due to diabetes is worsened with poor management, which further reduces nutrient supply and waste removal to and from the mouth and other body tissues. This results in frequent and severe bacterial infections like periodontal or gum disease.

Prevention

Controlling blood sugar by adhering to your medication, diet, and exercise plan along with regularly monitoring blood glucose levels with the help of your Glu-Sage blood glucose meter is highly essential for preventing diabetic oral health complications. Other preventative measures include:

  • Avoid or quit smoking, as it further amplifies the risk of developing oral infections by 20 times more than non-smokers with diabetes.
  • If you wear braces, consult your orthodontist immediately if a wire or bracket cuts your tongue or mouth.
  • Use a soft-bristled toothbrush for your twice-daily brushing routine, and brush after every meal.
  • Drink water and chew sugar-free gum to increase saliva production and avoid dry mouth.
  • Get regular dental checkups and cleanings at least twice a year
  • Use dental floss once a day to prevent plaque buildup
  • If you wear dentures, remove and clean them daily

Gum Disease Treatment

For well-controlled diabetes, periodontitis treatment is usually the same as for someone without diabetes. Early stage treatment generally involves plaque and calculus removal from the teeth and surrounding pockets.
For uncontrolled diabetes, however, treatment may be tailored to specific individual conditions, with more frequent dental cleanings, scaling, root planning, and even surgery in some extreme cases.

Diabetes and Oral Surgery

Diabetes may complicate any form of oral surgery, from minor corrections to complex procedures; with increased difficulty in blood sugar control after surgery. Moreover, the healing time is also delayed with diabetes. This is why you should inform your dentist of your condition and work closely with both your endocrinologist and dentist to minimize complications in case a surgery is needed.

For oral surgeries, the American Diabetes Association Recommends:

  • Eating before the visit to ensure normal-range blood glucose.
  • Consulting with your dentist and endocrinologist on any diabetes medication adjustment and infection-preventing antibiotic post-procedure.
  • Eat soft or liquid foods to avoid pain and healing disruption in case a surgery leaves your mouth sore.
  • Immediately receive treatment for acute infections like abscesses to avoid further infection, but postpone non-emergency dental procedures until blood sugar control is regained.

As with all bodily conditions, careful attention to diabetes and dental health can help with maintaining a healthy oral cavity. However, remember to visit your dentist regularly, and discuss the details of your condition, including medication, symptoms, and previous glucose results for optimal oral health and diabetes management.

Diabetes Self-Care: A Comprehensive Guide To Self-Monitoring Your Blood Glucose

why-self-monitor-blood-glucose

A Comprehensive Guide To Self-Monitoring Your Blood Glucose

Blood glucose and diabetes go hand in hand. High blood glucose levels (hyperglycemia) exponentially increase the risk for diabetic damage to the heart, liver, kidneys, and eyes, whereas severely low glucose levels (hypoglycemia) can leave you feeling confused and unable to function normally. This is why blood glucose monitoring and management is so important. However, bi-annual or quarter-yearly A1C tests only give collective glucose readings of the past months. To really understand your diabetes and manage it fully, daily SMBG, or self-monitoring blood glucose is required.

What is the Importance of Self-Monitoring of Blood Glucose?

Daily blood glucose readings provide a wealth of information related to your condition, and can help you and your doctor make progressive decisions about how to best manage your condition and help you live an active, complication-free lifestyle. Here’s why SMBG is so important for anyone with type 1 and type 2 diabetes:

  • It helps gauge the effectiveness of, and your body’s response to, a new diet plan, exercise routine, medication and insulin dosage alterations, and make any necessary adjustments.
  • Helps in achieving and maintaining target A1C and blood sugar levels.
  • Helps prematurely detect, treat, and/or prevent hypoglycemia, hyperglycemia, Diabetic Ketoacidosis (acid/ketone buildup), and Hyperosmolar Hyperglycemic State (urination problems and dehydration due to hyperglycemia).
  • Prevention or deceleration of numerous diabetic complications.
  • Induces feelings of control, safety, and confidence.
  • Helps reduce the number of blood sugar fluctuations throughout the day via careful monitoring and adjustment.

However, simply observing the changes in your blood sugar levels isn’t enough. All of this data has to be recorded either digitally or manually, and evaluated both by you and your doctor to be truly effective in optimal diabetes management. For this purpose, establishing a regular check-and-record routine is imperative.

What are Standard Blood Glucose Targets?

Target ranges vary individually depending upon certain factors like age, time from initial diagnosis, presence of any cardiovascular disease and other underlying conditions, and hypoglycemic tendencies. However, the following A1C and glycemic goals have been suggested by the American Diabetes Association (ADA) for most people with diabetes:

  • Daily Checks
  • A1C-Less than 7%
  • eAG (alternate unit of A1C)-Less than 154 mg/dL
  • Preprandial glucose (before meals)-80-130 mg/dL
  • Postprandial Glucose  (1-2 hours after meals)-Less than 180 mg/dL
  • Before Sleeping-100-150 mg/dL

Blood sugar may have to be monitored more frequently, with emphasis on certain points for the following situations:

For Type 1 or Insulin-Treated Type 2 Diabetes

  • 6-8 times a day
  • Before and after meals
  • When hypoglycemia is suspected
  • After treating low blood glucose on attaining normal sugar levels (normoglycemia)
  • After medication adjustments
  • Before driving, exercising, and sleeping
  • During pregnancy or illness

For Single Daily Basal Insulin Doses

Fasting blood glucose to help determine the initial, or basal, insulin dose.

For Type 2 Diabetes, Low Hypoglycemia Risk, and Non-intensive Regimens

Glucose self-monitoring is generally less critical. Once daily checks are sufficient, although A1C readings are taken as the primary scale for making treatment adjustments.

Who Should Check Blood Glucose?

While glucose self-monitoring is beneficial for everyone with type 1 or type 2 diabetes, the following individuals require monitoring who:

  • have had a recent diabetes diagnosis
  • have type 1 diabetes and use and insulin pump (like the Insulato Insulin Pump)
  • take insulin
  • are starting a new treatment
  • are pregnant or planning to
  • have difficulty controlling blood glucose levels
  • are at risk of hypoglycemia
  • experience hypoglycemic episodes without any symptoms
  • have ketones due to severe hyperglycemia
  • have a medical condition that may affect blood glucose levels

How to Self-Test Your Blood Glucose

Regular glucose self-monitoring is usually done manually via lancets (needles), test strips and glucose meters. Here is how you can monitor your blood glucose using a glucose meter:

  • Wash your hands thoroughly and dry them well.
  • Insert a test strip into the meter.
  • Prick the side of your fingertip with the lancing device to draw blood (no more than one drop). Gently squeeze the end of your finger, if needed.
  • Gently press and hold the test strip’s edge to your finger until the glucose reading is displayed in the meter screen. (normal waiting time is a few seconds, though it varies by meter).
  • Note the results in a logbook.
  • If you use the Glu-Sage Blood Glucose Meter, plug it into the headphone jack of your phone before pressing onto the test strip to simultaneously store your readings into your phone as well as the specialized cloud-synced app.
  • Examine your recordings for the past few days or weeks, and consult with your doctor on treatment plan adjustments in case of no improvement.

Note: Always consult your users’ manual for specific instructions as all meters are slightly different.

How should I reduce the pain I feel when testing blood glucose levels?

  • Use a new lancet for each test as used lancets are blunter and can cause pain and injury.
  • Choose a lancet device with the smallest gauge, i.e. larger number.
  • Alternate between fingers and poke the sides instead of the end or middle.
  • Squeeze from palm to fingertip when trying to push out blood.
  • Consider alternate-site testing, like the arm, although results may not be as accurate in case of rapid blood sugar fluctuations.

How Should I Avoid False Blood Glucose Readings?

  • Ensure the test strips have not expired, are in their original container, and that the container was not left open after taking out a strip.
  • Ensure that there is no dried blood on the test strips’ opening.
  • Keep test strips away from moisture, dirt, dust, and other substances, and store between 4-30 degree Celsius
  • Keep the glucose meter away from direct sunlight, moisture, or temperatures under 4 degree Celsius or over 30 degree Celsius
  • Avoid dropping the glucose meter.

What is Continuous Glucose Monitoring (CGM)?

CGM monitors are alternate glucose monitoring devices commonly used by people with type 1 and type 2 diabetes who take multiple daily insulin injections and/or use insulin pumps, or those with frequent hypoglycemic episodes who have difficulty recognizing the symptoms.

They generally consist of sticky patches containing glucose sensors that are attached to the skin. These patches wirelessly transmit glucose readings to a small recording device nearby-usually attached under clothes, in handbags, or on side-tables.

A CGM regularly updates and displays glucose readings which can be downloaded and viewed on any digital device, hence minimizing the need for constant checking and painful pricking. It can also be set to trigger an alarm if blood glucose levels get too high or low, making it highly effective for emergency care and treatment, especially in young children and older individuals.

However, the CGM patch/sensor has to be replaced over a different body part every week, and may require occasional fingersticks due to less accurate readings in case of glucose fluctuations.

Although SMBG is primarily an individual process, do not hesitate to discuss the proper procedures with your care team along with your personal target blood glucose ranges, and always share your collective findings to ensure optimal management.

Understanding Insulin: Everything You Need to Know About the Diabetes Essential

Understanding Insulin: Everything You Need to Know About the Diabetes Essential

Insulin is the hormone that keeps blood sugar from going too high or too low. Produced by the pancreas-a large gland located behind the stomach-insulin helps the body use sugar, or glucose, obtained from food in order to provide the energy required for optimum body functioning. Here is your guide to understanding insulin:

How Insulin Works

Food is broken down into sugar/glucose in the digestive tract, where it then enters the bloodstream. The pancreas detects this surge in blood glucose levels, and responds by producing insulin within its specialized beta cells and releasing it into the bloodstream. Since sugar cannot enter most cells directly, insulin hormones attach to these molecules and ‘unlock’ the gates to different cells.

Once every cell is replenished, insulin converts the extra blood sugar into glycogen and stores it into the liver for future use.

Glucagon: Glucagon is produced and released from the pancreas’ alpha cells to elevate low blood sugar levels. Glucagon stimulates the liver muscles and cells to reconvert the stored glycogen into glucose, which is then released into the bloodstream; signaling insulin release for facilitating glucose entry.

Insulin Resistance and the path to Diabetes

The pancreas regulates insulin secretion according to blood sugar levels. However, with insulin resistance, the liver and muscle cells stop responding properly to the unlocking action of insulin, resulting in increased insulin secretion.

Over time, this pancreatic overload starts burning out the insulin-producing beta-cells, and the body can longer produce sufficient insulin to manage blood sugar levels due to diminished beta-cell numbers (type 2 diabetes), or stops production altogether due to the complete absence of beta-cells (type 1 diabetes).

Who Insulin Doses Are For

Due to the complete damage or destruction of beta-cells, people with type 1 diabetes require insulin through painful multiple insulin injections a day or through insulin pumps , with the dosage increasing over time to ensure normal body function.

Moreover, since diabetes is a progressive condition, most people with type 2 diabetes will require insulin injections at some point for continued blood sugar control.

Types

Depending upon action time, peak time (the time when its effect is highest) and duration, medicinal insulin is divided into 4 types:

1- Rapid-acting insulin:
Activates 15 minutes after injection, peaks after 1 hour, and continues working for 2-4 hours. Due to its rapid activation time, it is usually taken right before a meal. This is the kind that is most often used in insulin pumps, such as Insulauto.
2- Short-acting insulin:
Activates 30 minutes after injection, peaks after 2-3 hours, and continues working for 3-6 hours. Unlike rapid-acting insulin, it can be taken some time before a meal.
3- Intermediate acting insulin:
Activates 2-4 hours after injection, peaks after 4-12 hours, and continues working for 12-18 hours. It is usually taken twice daily alongside rapid and short-acting insulin at mealtimes.
4- Long-acting insulin:
Activates after 3 hours or more and continues working for 24 hours. It can be combined with rapid or short-acting insulin, particularly at mealtimes.

How to Use It

Insulin can currently only be injected directly into the fatty tissues via a syringe, insulin pen, or insulin pump. This is because oral insulin tablets would be destroyed in the stomach before reaching any glucose molecules. It is usually injected in the abdomen due to fast absorption, although some may opt for the thighs, buttocks, and/or upper arms.

Your healthcare provider can teach you about the proper way to administer insulin. However, avoid injecting within 2 inches of your belly button to avoid compromising absorption. Also, vary the injection locations, like different areas on the abdomen, to prevent skin thickening from continuous insulin exposure.

Insulin Reaction

Exercise and an insufficient diet combined with insulin injections can sometimes result in hypoglycemia (low blood sugar). Hypoglycemia is also known as an insulin reaction. Signs of an insulin reaction include tiredness, sweating, confusion, muscle twitching, pale skin, inability to speak, seizures, and loss of consciousness.

Since insulin reactions can lead to a diabetic coma, always carry at least 15 grams of either fruit juice, lifesaver candies, raisins, or non-diet soda to balance sugar levels if you are prone to hypoglycemia, and take immediately on spotting any symptoms.

When administered properly, insulin can help maintain blood sugar levels. However, to ensure complete blood sugar control and prevent any diabetes-related complications, remember to regularly monitor your blood glucose levels. Consult your doctor on your specific insulin and blood sugar guidelines and schedules.

5 Healthy Low-Carb Lunch Ideas for People with Diabetes

Healthy Low-Carb Lunch Ideas for Diabetes

Carbohydrates break down into glucose once they enter the bloodstream. Therefore, they become greater contributors to high blood sugar levels than fats and protein combined. As a result, most people with type 1 and type 2 diabetes are often advised to adopt a low-carb diet. This diet presents many challenges, though, considering that most ‘health foods’ have a high carbohydrate content. Here is the solution to part of your daily dilemma, with 5 hassle-free and healthy low-carb lunch ideas for people with diabetes:

1. Two-Bean Beef Chili

Carbohydrate Content: 27 g per serving      Total Cooking Time: 1 hour
What You’ll Need:

  • Olive oil, 2 tablespoons
  • Chopped onion, 1
  • Ground lean beef, 1 ½ pounds
  • Pinto beans, 14 ounces (396 g)
  • Black beans, 14 ounces (396 g)
  • Crushed or pureed tomatoes, 14 ounces (396 g)
  • Garlic powder, 1 teaspoon
  • Table salt, ½ teaspoon
  • White vinegar, 1-2 tablespoons
  • Chili powder blend (red chili powder mixed with cumin, oregano, and garlic powder, to taste), 3 tablespoons
  • Grated cheese, sour cream, chopped red onions, and/or hot sauce (for topping)

Instructions:
After heating the oil in a pot over medium-low heat, add onions and sauté for 10 minutes or until very light brown. Now increase the flame, add the ground beef, and intermittently break the clumps with a spatula until the meat starts browning and sizzling in its own fat. Next, add chilli powder, garlic powder, salt, and white vinegar, and stir for 15 seconds on low flame. Add in the beans and tomatoes while stirring. Let the mixture simmer uncovered with occasional stirring for 30-45 minutes, or until it thickens. Take off the flame and serve while hot.

2. Beef Fajita

Carbohydrate Content: 11 g             Total Cooking Time: 20 minutes
What You’ll Need:

  • Beef strips, 0.4 kg (400 g)
  • Red onion, 1 (medium-sized)
  • Red and yellow bell peppers, 1 each
  • Cumin, ½ teaspoon
  • Chili powder, ½ teaspoon
  • Extra virgin olive oil, 1 tablespoon
  • Salt and pepper (to taste)
  • Freshly squeezed lime juice and chopped coriander (for garnish)

Instructions:
Wash and de-seed the bell peppers and slice them into thin, long strips. Now peel and slice the red onion, and set both vegetables aside. Heat a non-stick fry pan over medium flame and add the oil once the pan is hot. After heating the oil, add the beef strips and sprinkle salt and pepper over them. To ensure full, even frying, add the beef strips in 2-3 batches and keep the strips from touching each other.

Cook for 1 minute, flip, cook for another minute, and remove from pan. Now add the sliced vegetables, cumin, and chili powder to the residual meat juice in the frying pan and stir-fry for 5 minutes or more until desired consistency. Add to the beef strips, garnish with coriander and lemon juice, and enjoy!

3. Smoked Salmon Wrap 

Carbohydrate Content: 18 g             Total Cooking Time: 10-15 minutesWhat You’ll Need:

  • 8-inch low-carb flour tortilla/pita bread, 1
  • Smoked salmon, 2 ounces (56 g)
  • Low-fat cream cheese, 2 teaspoons
  • Finely sliced red onion, ½
  • Your choice of salad green
  • Fresh or dried basil, ½ teaspoon
  • Pepper, 1 pinch

Instructions:
Place the tortilla/pita bread between 2 pieces of a moist paper towel and warm in the microwave to keep it from drying out. Now mix the cream cheese, basil, and pepper and spread over the bread. Next, add in the salmon, onion, and salad greens. Roll up the bread, and munch away!

4. Curried Chicken Salad with Apples

Carbohydrate Content: 9 g               Total Cooking Time: 15-20 minutes
What You’ll Need:

  • Cooked and diced chicken breast, 450 g
  • Diced apple, 1
  • Diced green onions, 2
  • Chopped cashews, ½ cup
  • Plain Greek yogurt, 1 cup
  • Curry powder, 4 tablespoons
  • Ground cinnamon, 1 teaspoon

Instructions:
After mixing the yogurt, curry powder, and cinnamon in a large bowl, add chicken, green onions, apple, and cashews, and stir until properly mixed. Eat it on its own, spread over wholegrain bread (though that will increase the carb count), or scoop with cucumber or papaya slices for extra flavor.

5. Spinach Rolls

Carbohydrate Content: 20 g             Total Cooking Time: 45 minutes
What You’ll Need:

  • Spinach leaves, 450 g
  • Eggs, 3
  • Onion, 1
  • Carrot, 1
  • Low-fat mozzarella cheese, 28 g
  • Fat-free cottage cheese, 113 g
  • Parsley, ¾ cup
  • Garlic, 1 clove
  • Curry powder, 1 teaspoon
  • Chili flakes, ¼ teaspoon
  • Salt and pepper, 1 teaspoon each

Instructions:
Preheat the oven to 200oC (400oF), place a sheet of parchment paper on a baking tray and spray with cooking spray or oil lightly. Now mix the spinach, 2 eggs, mozzarella, garlic, pepper, and half the salt in a bowl. Spread the mixture evenly over the parchment and press flat to ½ inch thickness.  Bake for 15 minutes and allow to cool.

Next, sauté the onions in a pan for 1 minute, then add in the carrots and parsley and let simmer for 2 minutes. Now add in the cottage cheese, curry, chilli powder, and the remaining salt, and mix lightly. Take the pan off the flame, add 1 egg to the mixture, and mix. Evenly spread the filling mixture over the now-cooled spinach mat, but take care not to spread to the edges in order to avoid spillage. Roll up this mat carefully and bake for an additional 25 minutes. Let cool for 10 minutes, cut into round slices, and serve.

Note: All of the above recipes can be made in larger batches and refrigerated for quick lunch options on the go.

Since carbohydrate restriction when combined with insulin or blood sugar-lowering medications can result in severe drops in blood sugar, always consult with your doctor before starting a low-carb diet in case a dosage adjustment is required.

Note: Images only for reference. Food item may not look like the ones shown in the images.

Why You Need to Know About Post-Meal Glucose

Why You Need to Know About Post-Meal Glucose Levels

People diagnosed with diabetes know that checking their fasting blood glucose (glucose levels after 8 hours of not eating) is important to keeping their diabetes in check. However, just once-daily blood tests are not sufficient. To provide full information on your day-long glucose highs and lows, post-meal sugar tests are essential too. Post-meal glucose checks now make up the second half of the full glucose-monitoring equation. Here’s what you need to know about postprandial glucose:

What is Post-Meal Glucose?

Post-meal glucose, or PMG, defines blood sugar levels after a meal. Glucose levels start increasing 10-15 minutes following a meal. They peak 1-2 hours after that. In non-diabetic individuals, this blood sugar spike usually settles to pre-meal levels (under 140 mg/dL) within 2-3 hours due to efficient insulin action.

However, the absence or underproduction of insulin in someone with type 1 or type 2 diabetes means that blood sugar remains elevated well above the American Diabetes Association (ADA) recommended 180 mg/dL. These unprecedented spikes, if left unnoticed for long, result in numerous diabetes complication over the years.

PMG and HbA1C

Hemoglobin A1C levels are top of the list in any diabetes management program. This is because high HbA1C drastically increase the incidence of diabetes-related complications, particularly diabetic neuropathy (nerve damage), retinopathy (eye damage), and nephropathy (kidney damage).
The normal A1CE for someone with diabetes is 7%. However, even the most minor and insignificant post-meal glucose spike can have an effect. If allowed to increase unchecked, post-meal spikes can elevate HbA1C to dangerous levels. This can result in gradual damage to the eyes, nerves, and kidneys.

How controlling Post-meal sugar levels Aids Diabetes Management

In addition to preventing diabetes-related complications, regularly checking postprandial blood glucose levels alongside fasting and pre-meal levels provides the following benefits:

  • Aiding the care team in find ways to normalize A1C levels in people with problems reaching their target A1C goals. The user-friendly Glu-Sage blood glucose meter helps ease the process. It stores your blood glucose data safely within your smartphone after every reading.
  • Helping to determine the effectiveness of an overall diabetes plan.
  • Helping doctors determine and adjust optimum pre-meal insulin requirements in people with type 1 diabetes.

Who Should Check Their Post-Meal Sugar Levels?

PMG requirement and frequency varies from person to person and requires consultation with one’s care team for determining individual target goals. However, certain factors may require more frequent PMG checks:

  • Trying new insulin or a new insulin dosage
  • Uncontrolled diabetes
  • A history of Postprandial glucose elevation
  • Taking multiple medications
  • High risk for hyper- or hypoglycemia
  • Pregnant women with type 1, type 2, or gestational diabetes

Ways to Keep Post-Meal Glucose in Check

  • Sugar Check

Always do a PMG check 90 minutes after a meal, as this is when the injected insulin or ‘analogue’ insulin has reached maximum effect. In people with type 1 diabetes, blood sugar levels should generally be between 90-160 mg/dL after 90 minutes. Medworks’ Glu-Sage smartphone glucose meter can aid in checking whether a person with diabetes is within these targets. It provides immediate color-based feedback.

  • Carb Counting

Carbohydrates elevate Post-Meal Glucose levels more than either fats or protein. Therefore, checking and adjusting the amount of carbohydrates in your meals can help with achieving optimum post-meal sugar levels. This is especially true for people with type 1 diabetes. Type 1 diabetics have to inject their pre-meal insulin by estimating the total calories in every meal to avoid hypo or hyperglycemia.

  • Low Carb Diet

Some people may benefit from following a low-carbohydrate diet that involves limiting whole grains and starchy vegetables and fruits to small once or twice daily portions, or replacing them with non-starchy vegetables, healthy fats, and protein.

This aids natural insulin in processing the consumed sugars (since carbohydrates convert to sugar in the bloodstream) in people with type 2 diabetes, and eases the lengthy insulin calculations for those with type 1 diabetes. You can start off with some healthy, low-carb lunch ideas. [1] However, consult with your doctor before adopting a low-carb diet, especially if you take blood sugar-reducing medications or insulin, as it may result in hypoglycemia if the dosage is not lowered.

Note: Always wash your hands before Post-Meal glucose testing as any food residue may be included in the final reading. Daily blood glucose monitoring is a positive step on your part towards diabetes management. However, checking your fasting, pre-meal, and post-meal blood glucose can help ensure that your diabetes remains controlled and free of complications.

Image Credits: BBC

Insulin Pumps in Pakistan – Is Price the Challenge?

Insulin Pumps in Pakistan – Is Price the Challenge?

Insulin Pump Therapy (IPT) is not a new term when it comes to diabetes. Although insulin pumps have been available for several years now in Pakistan, IPT has not quite taken off for a variety of factors. A key factor highlighted by numerous users and healthcare providers is the high price of insulin pumps in Pakistan.

Benefits of insulin pumps

A major advantage of insulin pumps is greater lifestyle flexibility for people with diabetes. They become more flexible with regards to meals, sleep and physical activity. The slow and steady basal infusion of rapid-acting insulin delivered through a pump means that there is no peak, thereby offering significant life-style flexibility. Insulin pumps allow people with diabetes your insulin to your daily activities, rather than the other way around. People with diabetes are also able to avoid syringe sores because with an insulin pump, they only need to change 1 infusion kit in three days.

Insulin pumps have been proven to provide less glucose variability and add a great deal of convenience to patient lives. Yet, the extreme price point in Pakistan has made it unaffordable for the vast majority of patients.

Insulauto insulin pump

Medworks has partnered with a European-approved pump manufacturer to introduce insulin pump therapy in Pakistan. Medworks is offering the Insulauto insulin pump at a fraction of the price of other comparable pumps on the market in Pakistan. Not only that, we have strived to make the cost of monthly consumables also more affordable. With support from the clinical team at Baqai Institute of Diabetology and Endocrinology (BIDE), patients can now be on-boarded for Insulin Pump Therapy, provided they meet the criterion. For patients on the fence regarding IPT, we are also offering a try-before-you-buy option that allows people with diabetes to get a flavor of the difference insulin pumps can bring to their life.

Network Support: 7 Ways Friends and Family Can Help with Diabetes Management

Network Support: 7 Ways Friends and Family Can Help with Diabetes Management

The thing about chronic conditions like Type 1 and Type 2 diabetes is that their long-term nature often induces depressive mood swings and a sort of defiance in those diagnosed with them. As a result, managing a chronic condition is often a group effort that requires the continued support and understanding of those around the patient. Here are 7 ways that friends and family can help with diabetes management alongside their loved ones:

1. Stop Policing

Most adults diagnosed with the condition have a fair idea of how to self-manage, and constant nagging and restrictions only breeds non-compliance, which opens the doors for numerous life-threatening complications; the very thing that you were trying to avoid in the first place. So, instead of nagging them about what they should and shouldn’t eat, among other things, present well-reasoned, polite arguments, and gently steer them towards a diabetes-optimized lifestyle.

2. The Buddy System

A major reason for improper diabetes management is the solitude that comes with it. Help your loved one stay on track with their diabetes plan by sharing in the lifestyle. This includes reinventing mealtimes for the whole family, and developing and maintaining an exercise routine.
Not only will this help them lose weight and lower blood glucose levels, but can also provide combined health benefits for your entire family.

3. Offer Your Assistance

Instead of the vague ‘Let me know how I can help’ (which they most probably will never take you up on), be specific about the kind of assistance you can offer. Ask if they would like you to drive them to an appointment or therapy session, picking up their medication, or taking notes during a doctor’s appointment to recall important information later on.
While you’re there, expand your knowledge of diabetes management for better assistance by asking questions; there might even be something that can be useful to the patient themselves

4. Keep an Eye on Blood Sugar Drops

Gather all possible information on Hypoglycemia or low blood sugar-a potentially serious complication if ignored-especially if your friend or loved one is at risk for it. This will help you to recognize the signs (dizziness, shakiness, nausea, blurred vision, etc.) and administer emergency aid; since low blood sugar often causes mental confusion, making someone with diabetes unable to perform the necessary steps for elevating blood sugar levels.
Encourage a medical consultation for treatment adjustment if your friend or family member is prone to multiple hypoglycemic episodes.

5. Positivity and Tact

Poorly managed diabetes can cause a host of health complications, but talking about a relative who went blind or had to undergo an amputation will only amplify the anxiety. Instead, offer positive support through motivational stories and aiding disease management.
Moreover, avoid insensitive comments like ‘it could have been worse’, or ‘I didn’t know you’re diabetic’, as it only serves to degrade and alienate them further. Moreover, refrain from giving medical advice unless you specialize in the field.

6. Talk About Any Bedroom Issues

In women, diabetes increases the frequency of UTIs and vaginal infections, while some men may suffer from Erectile Dysfunction. Sexual intercourse can also be painful due to the nerve damage and vaginal dryness. If your partner has diabetes, be sure to openly discuss their discomforts and any self-esteem issues regarding their diabetes and sexual health.
Also, encourage them to consult their doctor in case of any serious sexual issues.

7. Show You Care

What people with diabetes-or any chronic condition for that matter-need is love and continued emotional support from friends and loved ones. The occasional hug, encouraging comment, and listening to their concerns can work wonders for diabetes management motivation. Even learning about the condition and partaking in enjoyable activities together can make them feel included and cared for.
Feelings of helplessness are only natural when someone you care for is diagnosed with diabetes. However, know that every little effort counts in helping them manage their condition and live life to the fullest. Also, learn how to help your child if they also have diabetes.

Parental Guidance: Helping Your Child Manage Their Diabetes

Parental Guidance: Helping Your Child Manage Their Diabetes

Children are largely diagnosed with type 1 diabetes, previously known as Juvenile Diabetes. In type 1 diabetes, the body does not produce any insulin, hence requiring daily insulin injections to ensure normal body function. This, coupled with the fact that blood glucose levels can shoot up with even the slightest diet and lifestyle changes makes it difficult to manage; especially for children. Through the following lifestyle and behavioral changes, you can help your child manage diabetes and enjoy everything that life has to offer:

1. Acknowledge and Reduce Their Fears

This is true for all physical and mental health conditions. While it shouldn’t be encouraged, children, especially younger ones, should not be berated for fearing their daily insulin shot and told to ‘be brave’. Instead, use positive responses like ‘we’ll try to make it hurt less the next time’. Reduce the anxiety by counting down before administering the shot, and establish a ‘no-injection’ zone in the house (may be a room or a particular space) where shots aren’t given to induce a sense of security.
Also, explain to your child that administering insulin or checking their blood sugar in public is routine, like an asthma inhaler, and not an embarrassment.

2. Talk and Look Positive

Children often tend to lie about their habits and activities when faced with an out-of-range blood sugar reading, which can result in multiple short- and long-term health effects. Encourage them to be more open by controlling your facial expressions and reactions on seeing an abnormal reading.
Normalize the condition by teaching your children that there is no ‘good’ or ‘bad’ glucose. Replace them instead with ‘low’ and ‘high’.

3. Motivate and Build Independence

Encourage healthy self-care practices by offering them rewards for certain tasks, like extra allowance for checking their blood sugar a specific number of times a day, or administering insulin at the right times.
Also, along with helping them manage their diabetes, allow your child to gradually manage their condition starting from small tasks. This will help keep them from acting out by deliberately engaging in diabetes-negative activities and build much-needed confidence in the long run. Moreover, teach your child to always check their blood sugar before driving to avoid accidents once they’re old enough.

4. Eat Together

Diet is an essential part of diabetes management. However, instead of making your child feel left out and make them grow to despise their condition, implement a family-wide, diabetes-friendly diet detox. Not only will this release the burden of preparing extra meals, but also contribute towards good family health; as a diabetes diet and a regular balanced diet are often synonymous.

5. Monitor Exercise

If your child plays sports or has plans to, inform the coach of their condition beforehand and educate them on emergency protocol, especially glucagon administration in case of seizures due to low blood sugar (hypoglycemia).
Next, determine your child’s post-exercise norm, as increased physical activity can increase insulin sensitivity for up to 24 hours and impact blood glucose levels. Check their blood glucose before, during and after the activity to find out whether extra insulin or additional glucose-elevating snacks are required.

6. Be Tech-Smart

Consider using a Continuous Glucose monitor, which is placed under the skin to measure blood sugar levels every few minutes and sounds an alarm in case of out-of-range glucose via a transmitter. This can help ease the constant monitoring for parents.
Some physically active children may also prefer portable insulin pumps like the Insulato Insulin Pump, which eliminates the need for intermittent insulin self-injections by automatically providing insulin when required.

7. Involve the Circle

Diabetes doesn’t have to be a personal struggle. Work together with your child’s teachers and doctor to ensure proper diabetes management at all times. Also, encourage your child to talk about their condition with friends. Not only will it increase the condition’s acceptance by the child, but will also equip peers with necessary knowledge in case of an emergency.
Diabetes management can be difficult, but with a little perseverance, support, and the right tools and treatment, your child will soon be on their way to becoming a freely functioning, independent adult.

Sugar High: 5 Unusual Foods That Make Blood Sugar Levels High

Sugar High: 5 Unusual Foods That Make Blood Sugar Levels High

Constant hunger, irritability, and lethargy, particularly after mealtimes, are prime indicators of an elevated, uncontrolled blood sugar. Sugar has a way of sneaking into meals despite diligently following a diabetes treatment and diet plan. Here are 5 of the most unusual foods that might secretly be raising your blood sugar levels, aside from the classic white glucose-raising culprit.

1. Caffeine

While 1-2 cups of coffee a day may actually stimulate insulin production or improve its glucose-breakdown function, any more than this-even from healthy sources like black tea-can have an adverse effect on your blood glucose levels.
This is because excess caffeine stimulates the release of adrenaline (the fight-or-flight hormone), which in turn raises blood sugar levels, while also preventing its removal from the bloodstream. The rapid surge is then followed by a sudden blood sugar drop, resulting in fatigue and lethargy, which is again compensated for with more caffeine.

2. Pizza

Plain pizza has been proven to increase blood sugar levels at a faster and higher rate than it’s fully-topped counterpart. However, the carbohydrates consumed from a deluxe pizza do make their way into the bloodstream eventually, only much slower.
Dubbed as the ‘Pizza Effect’, the fat and protein-content in the toppings decelerates carbohydrate absorption, which is why the rise in blood glucose levels isn’t detectable via your Glu-Sage blood sugar monitor soon after eating. Instead, levels spike 2-5 hours later and may stay elevated for up to 2 days afterward.

3. Fruit Juice

While all pre-packaged juices are an absolute no-go for people with type 1 and type 2 diabetes due to their high sugar content, pure home squeezed fruit juices may not be any different.
Despite containing more nutrition than artificial sugary drinks, the naturally occurring fruit sugars become highly concentrated in juice form, resulting in a sharp blood sugar spike. Also, the high protein content that makes whole fruits extremely filling, and hence the perfect diabetes snack, is minimized in juice-form, resulting in excess consumption.

4. Chinese Food

Most diabetes diet plans propagate low-carbohydrate meals to control daytime and fasting blood glucose levels. Low on grease and carbohydrates, Chinese food is the perfect example of a diabetes meal plan. However, most take this as a signal to overeat, causing the intestinal cells to expand greatly. The intestinal hormones then signal the release of large amounts of insulin, which in turn drops blood glucose to dangerously low levels. Anticipating this drop, the pancreas then releases the hormone Glucagon to normalize blood sugar levels, which in diabetics results in a higher-than-expected blood sugar elevation due to insulin resistance (low or no response to insulin).

5. Excess Protein

In addition to weight loss, the appetite satiating nature of protein-rich foods like lean meats, leafy green vegetables, legumes, nuts and whole grains aids in blood sugar control by preventing needless snacking-making them highly beneficial for both type 1 and type 2 diabetics. However, like low-carbohydrate foods, consuming too much protein in a single serving or 1 day only adds to the already high concentration of blood glucose, because the body only requires 0.5-1 grams of protein per kg of body weight per day, resulting in unexpected blood sugar spikes.
While regular blood sugar monitoring and following a targeted diet plan are essential components of diabetes self-care, remember to also adhere to daily recommended amounts in order to avoid unexpected health complications.