Shoes and Diabetes

What's on your feet matters
When you have diabetes, it is important to take special care of feet. It is very important to check feet daily and choose the shoes wisely.
Shoes should be well-fitting and comfortable so that small problems like corn, blister or callus may not turn into severe ones. 
Shoes should be of right size. Don't wear tight shoes. Instead, shoes should be for comfortable support.
Choose shoes with a spacious "toe box" instead of choosing shoes with pointed toes.
Avoid high heel shoes, because they will put pressure on the ball of your foot. In the presence of nerve damage it might not be realised that area is getting sore or calluses.High heels may also cause balance issues especially in the presence of nerve damage.
Avoid using sandals, flip-flop or other open-toe shoes.Straps can put pressure on some part of foot.Open-toe shoes can make you prone to to injuries like cuts.It's also easier for gravel or small stones to get inside them.
Consider laced shoes instead of slip-ons. They are often more comfortable and provide more support. 
Try to buy two pair of shoes. Both of them will have different pressure point on feet. Use them alternatively. They will dry and air in them will be pushed out.
Try not to be bare-foot even around the house or pool area. A numb patient may walk on glass and even don't know it. 
Enjoy occasional fancy feet
Having diabetes doesn't mean you will have to wear sensible shoes for rest of your life. It depends upon stage of neuropathy and condition of circulation. If the neuropathy is not advanced and circulation is good, even high heels and pointy wing-tips can be worn for short periods of time.

Gestational Diabetes.

What is gestational diabetes?

Gestational diabetes is the diabetes which develops during pregnancy.

What causes gestational diabetes?

During pregnancy some hormonal changes occur which put almost all women on some impaired blood sugar levels. These levels are not so high but in later part of pregnancy that is 3rd trimester it may lead to development of diabetes.
During pregnancy, placenta (organ that connects baby to uterus via umbilical cord), produce some hormones which help to shift nutrients from mother to developing fetus. Certain other hormones are also produced by placenta which prevent the blood sugar levels of mother to go down. They act by resisting the action of insulin.
Over the course of pregnancy, these hormones lead to progressive impaired glucose intolerance(high blood sugar levels). Body tries to decrease these elevated blood sugar levels by making increased amounts of insulin. Usually the mother's pancreas is able to produce three times more insulin to overcome the effects of these placental hormones. If however, pancreas is not able to produce enough insulin, blood sugar levels will rise, resulting in gestational diabetes.

Complications of gestational diabetes.

Diabetes can affect the developing fetus throughout the course of pregnancy. In early pregnancy, mother's diabetes can result in increased birth defects and increased chances of miscarriage. Many of the birth defect which occur usually affect major organs such as heart and brain.
During the second and third trimester, a mother's diabetes can lead to over-nutrition and excess growth of baby which will pose danger at the time of labor and delivery.
In addition, high level of insulin from mother may cause sudden fall in blood sugar levels of newborn at the time of birth as it won't get enough glucose. 

Who is at risk? 

• Over weight prior to get pregnant
• Having sugar in urine
• Impaired glucose tolerance or impaired fasting sugar levels
• Family history of diabetes
• Previous history of giving birth to baby of weight more than 9 pounds
• Previous history of giving birth to a stillborn(dead at the time of birth) baby
• Gestational diabetes in a previous pregnancy
• Having too much of amniotic fluid(a condition called polyhydramnios)
• Many women who develop gestational diabetes don't have any risk factor

Diabetes and adopting a healthy life style

A balanced diet which is high in fiber, low in trans fats and saturated fats and low in salt, should be the aim of healthy eating. This way one can not only nourish his body well but can also maintain a good health. 
Use fresh fruits and vegetables, and whole grain bread and cereals. Avoid packaged and prepared food which are usually high in fat and sodium. 
Choose low-calorie, filling foods such as an apple, a handful of almond or fat free yogurt. Don't use sugar while preparing sweet dishes, instead use sugar substitute. 
Don't eat to fill the whole stomach. Stop eating while you are still having some hunger. 
Beverages and soft drinks are big source of sugar and calories and they don't do any good to our health. So avoid them. Diluted fruit juices are better alternative.
Physical activity on regular basis pays dividends. We may have a sunnier outlook of life, less stress, more energy, better sleep, decreased stiffness and pain, increased strength and flexibility, healthier heart and lungs and a boost in metabolism that can help with losing extra pounds and maintaining a healthy weight. Regular exercise and improved fitness can also lower risk of heart attack and stroke, certain type of cancers, and osteoporosis ( bone loss). 
Adults should have 20 to 30 minutes of physical activity daily. This may comprise of brisk waking, jogging or swimming. 
  

Know the risks of Diabetes

It can be frightening to confront the possibility of a serious and life-long disease, but you can start to tackle it by adopting life style changes. You can manage your condition and try to reduce the chances of developing complications. Even those people who are at high risk can take steps to prevent the development of diabetes.
If you have any of the following symptoms, you should immediately see your doctor and take advice.

• Increase number of urination
• Extreme thirst
• Extreme hunger
• Unexplained weight loss
• Extreme tiredness and irritability
• Frequent infections
• Blurred vision
• Bruises or cuts that heel slowly
• Tingling or numbness in your hand and feet
• Recurrent skin, gum or bladder infections

Remember, many people with diabetes don't have symptoms. If you think you are at high risk, consult your doctor, get your blood sugar levels checked. Adopt a healthy life style. You may take following actions to reduce the risk of developing diabetes or if you have diabetes, to keep it under control.
Eat a balanced diet high in fiber, low in saturated and trans fats.
Take regular exercise, maintain a healthy weight and reduce stress.
Regularly check your blood sugar levels and cholesterol levels.
Avoid smoking

Knowing About Types of Diabetes

Types of Diabetes

The two types of diabetes are different but they affect the body  the way body controls the blood glucose levels.

Type 1 diabetes

Type 1 diabetes is an autoimmune disorder: the body's autoimmune system attacks the pancreas. Eventually, the pancreas fails to produce insulin- a hormone needed to utilize glucose in the body. The person will need insulin injection or insulin pump to control his blood sugar. Close monitoring of blood sugar levels are must.

Previously type 1 diabetes was known as juvenile diabetes. It was usually diagnosed in children but now it can also show up in young adults. Genes play a part in type 1 diabetes, although environmental factors, such as exposure to a virus, may trigger destructive immune process.
Type 2 diabetes
In this type of diabetes body may produce insulin, but cells of body do not respond to insulin normally and glucose start to build up in blood stream instead of being used by cells. For energy we need glucose to be in the cells. Without glucose in the cells body feel fatigued. Elevated sugar levels in the blood may result in excessive urination -- glucose in the urine carry water with it--and patient may get dehydrated.
Even though insulin-dependent-diabetes is the other name given to type 2 diabetes but some patient may need insulin to control their blood sugar levels.
Typically when a person is diagnosed as having type 2 diabetes, he or she is advised to control it through diet, increasing physical activity weight management. Some people get improvement through these measures. For others, even with careful attention to life style, medications are needed.
They are started with oral hypoglycemic medicines, but they may require insulin. 
Doctor work with the patient to workout a regimen that works to control individual's blood sugar levels.
Contrary to common belief, eating sugar does not cause type 2 diabetes. However, consuming too many calories and becoming overweight contribute to your body becoming insulin resistant and allowing blood glucose level to increase.  

Facts About Diabetes

Diabetes is a serious condition.

• Adult diabetic patients are about two to four time more likely to die of heart disease compared to those who are non diabetic.
• About 67% have high blood pressure.

• Leading cause of kidney failure and blindness in adults is diabetes.
• Nerve problems -- such as impaired sensation in the feet or carpel tunnel syndrome -- affect 60% to 70% of patient with diabetes.
• More than 60% of lower-limb amputations that are not result of trauma are performed on people with diabetes.
• The average medical expenses of someone with diabetes are much higher than for someone without.

• Diabetic patients are at high risk of developing dental infections, foot infections and skin infections.

 

Dangers of high blood pressure

What is high blood pressure?

High blood pressure or hypertension is a common condition which usually affect older age people. Blood pressure is the force exerted by the blood on the walls of arteries. When it is too high, it increases the workload of heart and can cause serious damage to arteries. Over time, uncontrolled high blood pressure increases the heart disease, stroke and kidney disease. 

Symptoms of hypertension

Hypertension is sometime called a silent killer because it may have no symptoms for years. In fact 20 percent people with hypertension don't know they have high blood pressure. Internally, it can quietly damage heart, lungs, blood vessels, brain and kidney if left untreated. It is the major risk factor of heart attacks and strokes.

Causes of Hypertension

Normal blood pressure reading falls below 120/80mm/Hg

The top number is the systolic blood pressure which is due to the contraction of heart.

The lower number is called diastolic blood pressure and it is the pressure when heart is relaxing and being refilled with blood. In most cases, the underlying cause of hypertension is not known. Occasionally, hypertension may be result of kidney or adrenal gland disease.
Up to age of 45, more men get high blood pressure than women.As the age progresses both sexes are equally affected but at 65 more women have high blood pressure than men.  If a family member has high blood pressure, other members have higher risk of developing it. Diabetics have 60% more chances of getting high blood pressure.
Sodium, a major component of salt, can raise blood pressure by causing the body to retain fluid, which leads to a greater burden on the heart.

Hypertension and Stress

Stress can have indirect effect on high blood pressure. It may lead to unhealthy habits like smoking, alcohol use, and poor diet which may affect blood pressure levels. Sometimes, it can increase blood pressure at times, but as a cause it is not directly  involved.

Weight and hypertension

Heart of people who are overweight is under strain and increases chances of hypertension. Diets to lower hypertension are also aimed at lowering the weight and to cut down calories. Fatty foods and added sugars should be cut down. Fruits, vegetables, lean proteins and fiber should be increased. 

Loosing even 10 pounds can have significant impact.

Also say absolute no to alcohol.

What about caffeine

There is no link between development of hypertension and intake of caffeine. Caffeine, sometime may have temporary jittery effect on the mood but, studies have not shown any link between two. So, one or two cups

of caffeine may be taken safely.

Pregnancy and hypertension

Sometimes blood pressure is raised in second half of pregnancy. This is called gestational hypertension. If not treated, it may lead to a condition called preeclampsia. This condition may have serious consequences both on mother and baby's health. It can deprive baby of blood and oxygen supply and can damage brain and kidney of mother.

Usually, after the baby  is born, the blood pressure returns to normal.

Medicine and high blood pressure

Cold and flu medicines that contain decongestants are one of several classes of medication that can cause blood pressure to rise. Others include NSAID (non steroidal anti inflammatory drugs) pain relievers, steroids, diet pills, birth control pills, and some antidepressants can raise blood pressure and if some one has blood pressure he should talk to his doctor about taking these medicines. 

White coat hypertension

Some nervous people may have a higher reading in doctor's chamber. This is normal, but these people may have higher chances of developing hypertension.

These people should take readings at their home, chart them and share them with their doctor.

Hypertension and children

Hypertension is usually a problem of old age, but some time children may get this problem. 

Normal blood pressure for blood pressure varies according to their age, sex and height. Children are at higher risk if they are overweight. 

Treatment

Dietary approach

The DASH Diet -- Dietary Approach to Stop Hypertension -- involving eating more fruits, vegetables, whole-grain foods, low-fat dairy, fish, poultry and nuts.

Exercise

Regular exercise could play very important role in controlling hypertension. At least 150 minutes of moderate -intensity exercise per week will have very good effect on hypertension.This could include brisk walking, gardening, bicycling or other aerobic ( in open air) exercises. 

Medications

These may include diuretics, ACE inhibitors, beta blockers, calcium channel blockers, The ARBs.

Diuretics

Diuretics, also known as "water pills" induce diuresis which result in loss of excess sodium and water resulting in reducing the load on vascular system. Some diuretics may deplete body potassium which may cause muscle weakness, leg cramps, and fatigue. Some can increase sugar levels in diabetics. Erectile dysfunction may also occur.

ACE inhibitors

Angiotesin II is a substance which narrowing or contraction of blood vessels thus result in increase of blood pressure. ACE inhibitors are substances which reduces body's supply of angiotesin II resulting in dilated and open blood vessels which result in lowering of blood pressure and reduction in effort for heart.

Side effects may include dry cough, skin rash, dizziness and high potassium. Pregnant woman should not take ACE inhibitors.

Beta-blockers

Beta-blockers reduce heart rate so work load on heart is reduced. They are also used to treat arrhythmia - conditions in which heart rate is abnormal. They may be prescribed alone or in combination with other medications. Side effects can include insomnia ( loss of sleep ), dizziness, fatigue, cold extremities (hands and feet) and erectile dysfunction.

Calcium channel blockers

Calcium channel blockers slow the movement of calcium into cells of heart and blood vessels. Since calcium causes stronger contraction of heart, these drugs ease the heart contraction and relax blood vessels which result in lowering of blood. Side effects can cause dizziness, heart palpitations, swelling of ankles, and constipation. Take them with food or milk and avoid grapefruit juice with them. 

ARBs

Instead of reducing body's supply of angiotensin II, these drugs block receptors for angiotensin II-- as if they place a shield over a lock. So angiotensin can not bind at receptor site and can not produce it artery tightening effect. ARBs can take few weeks to develop their full effect. Side effects can include dizziness, insomnia, high levels of  potassium and muscle cramps. Pregnant woman should not take this medicine.

OTHER MEDICATIONS

They may include alpha blockers, vasodilators, and central agonists. They act by dilating blood vessels. They can cause dizziness, palpitation of heart, headaches or diarrhea. They are used when other medicines are not controlling the blood pressure. 

Living With High Blood Pressure

Hypertension is often a life-long condition. It's important to take your medications and continue to monitor your blood pressure. If you keep it under control, you can reduce the risk of heart attack, stroke and kidney failure.