मधुमेह धोका

7674 इसमाच्या पाहणीतून

मधुमेहाच्या धोक्यावर प्रकाश पडला

1 वजनात वाढ  

2 शारीरिक हालचाली कमी 

3 मधुमेहाचे प्रमाण अधिक भारतात चीन आणि अमेरिकेत

4 वय 45 -ते 64 मधुमेह भारतीय या आणि चिनी लोकात

आढळतो.

5 BMI उच्च

6 भारतात BMI ची पातळी कमी असली तरी

मधुमेह आढळतो

7 मधुमेहाचे प्रमुख कारण शरीरातील फॅट उदर पोकळीत

(पोटात जमा होणे ).

8 हाय  कॅलरीज साखर प्राणिजन्य चरबी

   

 9 महाराष्ट्रात आणि आंध्र प्रदेशात मधुमेहाचे प्रमाण अधिक आहे

BMI  (माझा लेख पहा 26 मार्च 2019 ब्लॉग 

drsgv.blogspot.com)

ही वाढतो

10    श्रीमंत लोकांनी पारंपारिक खाणे सोडून  त्यांचा कडे

      पैसे असल्या ने आधिक पोषण मूल्य

  अन्न विकत घेतात

11 खूप वैद्यकीय चाचणी त आढले की जीवन

पद्धतीत बदल झाला की मधुमेह च्या पूर्व  pl

तुन मधुमेह चा बदल 50% कमी होतो.

12 शारीरिक हालचालींसाठी प्रोत्साहित

 केल्यास BMI maintain करून  मधुमेह burden

कमी होतो.

13 पारंपरिक भोजन खेडयात प्राधान्याने आणल्यास

अधिक पोषण मूल्याच्या जागी तर ते हिताचे मधुमेह

रोखण्यात.

14 स्मोकिंग मुळे 45% मधुमेही वाढतात

स्मोकिंग न करणाऱ्या च्या तुलनेत.

15 अधिक प्रमाणात मद्य प्राशन केल्यास अधिक

 कॅलरीज घेतल्या जातात . या मुळे वजन वाढते

आणि मधुमेह होण्या कडे कल जातो

Ref.   BMJ Open Diabetes Res Care

:2016:4(1) :e000255

     Anamitra  Barik

      Sumit Mazumdar (---–) and

      Rajesh Kumar Rai

  

Diabetes & Risk Factors 

Using a cross Sectional

Data of 7674 individuals

Drawn from health and demographic surveillance

  (HDSS) 

In rural India this study assesses the The physiological

and behavioral risk  Factors associated with Type 2 Diabetes.

Being over weight /obese and low level  Of physical activity ,are potential risk factors.

India Chinta and USA are known for largest

Number of patients with diabetes.

India and china diabetes occurs in the age 

Group of 45 to 64 years.

 High Body Mass Index (BMI) Refer my

Article BMI (Body Mass Index) March 26

2019 drsgv.bloger.com)

 for over weight

/Obesity increases the probability

Of diabetes.

       Diabetes starts to increase at very low

Levels of BMI for Indians.

         Higher percentage of body fat that is

Concentrated in the abdominal area is a

Key risk factor for developing diabetes.

      Foods high in calories sugar and animal fat

But low in vitamins and minerals derived

From fruits and vegetables.

       Maharashtra and Andhra Pradesh

Report high prevalence of diabetes along

With BMI.

        More commonly ,rich and privileged

Groups have abandoned the traditional

Diet,and as their purchasing power is

High they are inclined to buy high calorie

Foods.

  Several randomised  control

Trials have shown that life style modification

Can reduced conversion from pre --diabetes

To type 2 diabetes by 50 %.

  Interventions

1 Encourage Physical activity

2 which in turn will maintain BMI and

Ultimately reduced burden of diabetes.

3 Restoration of traditional diet in Rural

India over food with high high calorie

Concentration.

Key factors to be noted

1 Meta---analysis revealed that smokers

Had a 45% increase risk of developing

Diabetes compaired with non---Smokers.

2 Accumulations of visceral adipose tissue

Among smokers.

3 High consumption of alcohol leads to

   excess caloric intake and obesity which

In turn accelerates propensity for diabetes.

Ref BMJ Open Diabetes Res Care 2016:4(1)

:e000255

    Anamitra Barik

    Sumit Mazumdar (------)

And Rajesh Kumar Rai

   

   

जेवणा नंतर चालणे फायदेशीर

 जेवणा नंतर चालणे फायदेशीर

असे समजले आहे की जेवणा नंतर चालणे फायदेशीर आहे

कारण सकाळ च्या नास्ता दुपारचे जेवण किंवा रात्रीच्या

जेवणानंतर   रक्तातीलसाखर वाढू लागते यास चालण्याचा चांगला

परिणाम होतो .साखर परिणाम कारक कमी होते.

रक्तातील साखर वाढ जेवणानंतरची हृदयाचे रोग (cardio

Metabolic disorders) वाढि ची चिन्हे असु शकतील

निरोगी आणि मधुमेही मध्ये.

चालणे हे जेवणानंतर रक्तातील साखर शिखरावर जाण्या 

आधी असावे .

एका पाहणीत असे आढळले की जेवणानंतर 30 मिनिटे

चालल्यास रक्तातील साखर बऱ्या प्रमाणात कमी झाली

 चालणे डॉक्टर च्या सल्याने करावे.

Ref Nutrients 2022 Mar :14(5):1080

       Alessio Bellini, 

        Andrea Nicole

        (----------) and 

        Massimo Sacchetti

Post Prandial Walking &Gucose

 Post Prandial walking

& Glucose

Post prandial walking has   

Been proven effective for improving

Glycemic response to different meals   

Of the day .(   i.e . Breakfast Lunch and

Dinner.)  

      Elevated post prandial blood glucose

Concentration and large glycemic excursions

Have been identified as better predictors

Of cardiometabolic disorders than fasting 

Hyperglycemia in both healthy individuals

And diabetic patients.

        Previous studies have been widely

demonstrated that  exercising after meal

Provides greater reduction in post meal 

Glycemia peak compare to pre meal exercise.

  Especially when exercise starts before   Peak Glucose Levels.

   Study 1   10 participants 

Assessed the effects of 30min

Of brisk walking after  meals with

Different  carbohydrates content 0.75or

1.5grams

Of carbohydrates per kg body weight.

 Post prandial Brisk walking

Substantislly reduced (P less than 0.009)

Glucose in both studies.

  Ref Nutrients 2022 Mar : 14(5):1080

   Alessio Bellini 

   Andrea Nicole (...….........)

And Massimo Sacchetti

 

 

Diabetes & Glycemic variability

Diabetes & Glycemic

Variability

Glycemic means blood glucose level 

Normal glucose tolerance

Glycemia maintained between 68.4mg

And 138.6mg,/dl

When it is low called as hypoglycemia

When high called as hyperglycemia

Glycemic variability means blood glucose

Variation that occur throughout the day.

Post prandial spikes in blood glucose

As well as hypoglycemic events are blamed 

For increase cardiovascular events in diabetes.

Gv

Includes both the above events hypoglycemia and hyperglycemia.

Hence need for minimising GV which

can prevent cardiovascular events.

GV which refers to swings in blood glucose

Levels.Blood glucose oscillations that occur

Through out the day.

Intra day glycemic excursions , includes

Episodes of hypoglycemia and hyperglycemia.

Microvascular (small blood vessels) and

Microvascular (large vessels)

Complications in diabetes is attributed to

Hyperglycemia and dysglycemia  (peaks and

Nadirs )

HbA1c :Time average glucose

Values measured .

HbA1c has become reference parameter 

For therapies aimed at reducing the risk 

Of complications from diabetes. 

Chronic hyperglycemia is almost universally

Assessed by HbA1c.

HbA1c is poor predictor

Of hypoglycemic risk,whereas GV

Is the strong predictor of hypoglycemic 

Episodes.

It is advisable  to make every effort

To maintain stable glycemic values.

Ref  Diabetes and Metabolism  Journal

         2015 Aug ; 39(4):273-282 

          Sunghwan Suh 

And Jae Hyeon Kim

Cardiovascular events.

 

Diabetes& Blood glucose variationaration

Diabetes &Blood Glucose variation

Glucose variation means glycemic variability

In scientific term

To know glycemic variability

First what is glycemic ? Glycemic means 

How fast the glucose rises in the blood

Higher the glycemia means high glucose in blood

Or hyperglycemia.

Lower the glycemia means low glucose 

In blood or hypoglycemia.

Glycated hemoglobin or 

HbA1 c  are similar Terms

HbA1c reflects previous 3 months glycemic control.

This test HbA 1c is the gold standard for long

Term glycemic control and response to 

medical treatment in patients with diabetes.

Glycated Hemoglobin ,however doesn't 

Address fluctuations in blood glucose.

 Glycemic variation (GV) :

Is associated with increased risk 

Of hypoglycemia , microvascular ( small artery

Disease)

and 

Macrovascular complications:( large blood

Vessel disease) ,and mortality

In patients with diabetes  independently

Of HbA1c .

       The use of  continuous glucose monitoring

Devices has  markedly improved the

Assessment of GV in clinical practice.

And  facilitated the assessment  GV

Hyperglycemia ,hypoglycemia events

In patients with diabetes.

High HbA1c is risk indicator of diabetic 

Complications . 

HbA1c treatment goal 6.5% to 7.5%

Several studies have reported that reductions

In HbA1c is associated with significant 

Reduction in microvascular complications

(Retinopathy ,Nephropathy, and Neuropathy)

Retinopathy retina eye disease retina is the screen of the eye

Nephropathy;Kidney disease

Neuropathy :Nerve disorder

As well as decreased cardiovascular

and diabetes--–related mortality.

HbA1c does  not address 

short term

Glycemic variability (GV)

Or daily fluctuations in blood glucose

Levels or hypoglycemic events.

GV to help clinicians and patients to overcome

the limitations of HbA1c in diabetes management.

Glycemic variability refers to swings in

Blood glucose levels.It means oscillations

that occur throughout the day.Including

Episodes Of hypoglycemia and post prandial

Hyperglycemia.

Reduction in HbA1c leads to lower rates

In diabetic complications.

CGM : Continuous glucose monitoring

Sensors introduced in 1999

Is a better way to assess GV (Glycemic variation)

CGM measures interstial glucose every 1

To 5min

Mitigating the need of capillary SMBG(

Self Glucose monitored blood glucose

Capillary blood)

Anti diabetic strategy : 

Aim HbA1c Fasting Post prandial glucose

As well as GV by frequent blood glucose 

Concentrations measurements in 

Continuous time fashion.

Using CGM.

Measurements .

Ref BMJ Open Diabetes Res Care 

2021 : 9(1)e002032

Marcela Martinez 

 Jimena Santamarina 

Adrian Pravesi

Carla Musso 

And

Guillermo  E Umpierrez

 

       Oats use in                Diabetes

 Ref 1

Oats ancient grains cultivated and consumed

Worldwide .

      Beta glucan is an important component

Of dietary fiber found in Oats grains.

It is the major active compound in Oats

With proven cholesterol lowering and anti

Diabetic effects .

        Oat (Avena sativa L.) Is unique that

bear value for human food  ,animal feed

,Health care.

          It is annual crop cultivated for more

Than 2000 years in different parts of the 

World.

           Oat is grain in breakfast cereals

Beverages,and bread.

     

Ref  2   Carl Von Noorden

A German Physician and diabetologist 

Reported the first therapeutic effects of Oats

The attenuation of blood glucose levels in 1903.

Since then Oats have been shown to improve

Insulin sensitivity ,glucose metabolism

And blood lipid profile.

Meta analysis:using data

From 471157 participants from 8 studies.

 Overall authors finding (Ref 2)

Show that high Oats consumption is

Associated with a lower risk of Type

Two Diabetes and all -cause mortality

But not consistently with CVD (cardio 

Vascular Disease)

 European commission

(Ref 1)

Approved health claim about the potential

Of OBG (Oat Beta Glucan)

In reducing postprandial glycemia

For which one has to consume 4grams

Of OBG for each 30grams of available

Carbohydrates per meal.

        Ref 1    Foods2021 Nov :10(11)2591

      Devendra Padel

      Bandana Dhingana

       Melanie Caffe

        And Padmanabhan  Krishan 

     

         Ref 2 Nutrients 2021 Aug 13(8):2560

               Faina Wehril 

              Petek E.Taneri {------}and Hua Kern