Here’s what patients with diabetes should do to reduce risk of heart attacks

From hindustantimes.com

Study reveals measures for patients diagnosed with type 2 diabetes so as to prevent cardiovascular disease and premature death

An increase in the use of preventive medication for diabetes may reduce the risk of heart attacks in patients. This is the finding of a research study presented today at the ESC Congress 2020.
“Our results suggest that when patients are diagnosed with type 2 diabetes, starting medications to prevent cardiovascular disease has a substantial impact on the risk of heart attacks and premature death,” said principal investigator Dr Christine Gyldenkerne of Aarhus University Hospital, Denmark.

People with type 2 diabetes are twice as likely to have a heart attack or die from heart disease compared to people without diabetes.

Management of patients with type 2 diabetes has changed considerably over the last two decades, with an increased focus on the prevention of cardiovascular disease. This was the first study to examine how these changes may have affected the risk of heart attacks and premature death in patients with newly diagnosed type 2 diabetes and no previous cardiovascular disease.

The researchers identified all patients in Denmark initiating therapy for type 2 diabetes from 1996 to 2011-- a total of 211,278 patients. Each patient with diabetes was matched on age and sex with five people without diabetes from the general population. Those with previous cardiovascular disease were excluded.

All participants were followed for seven years. Using data from national health registries, the researchers recorded heart attacks and death during follow-up. They also noted the use of medications to prevent cardiovascular disease at the time of diabetes diagnosis.

The researchers found that patients with newly diagnosed type 2 diabetes and no previous cardiovascular disease experienced major reductions in the risk of heart attack and death. From 1996 to 2011, the relative risk was reduced by 61% for heart attack and by 41% for death. During the same period, the absolute risks of heart attack and death reduced by 4% and 12%, respectively.

When comparing patients with diabetes to the general population, the initially large differences in risk narrowed over time. By the end of the study, the risk of heart attack among patients with diabetes was only marginally-- 0.6%-- higher than in the general population.

In those with diabetes, use of cholesterol-lowering medications increased more than 10-fold, aspirin increased by 50%, and blood pressure-lowering medications increased up to four times during the study period.

Dr Gyldenkerne said: “The risk of heart attack and premature death among patients with newly diagnosed type 2 diabetes and no previous cardiovascular disease was approximately halved from 1996 to 2011. In the same period, the difference in risk of heart attack and death for patients with diabetes, as compared to the general population, was narrowed substantially.”

She noted that this was an observational study and causation cannot be assumed. Dr Gyldenkerne said: “In addition to the use of preventive medications, other factors may have influenced the likelihood of heart attack and premature death. For example, stricter control of diabetes and lifestyle changes such as smoking cessation, physical activity, and healthier food may have contributed to the improved prognosis.”

https://www.hindustantimes.com/fitness/increase-in-medication-for-diabetes-may-reduce-risk-of-heart-attacks-suggests-study/story-ZZutp7sIJCBhVUtWA8ehJP.html

Risk of heart attacks halves in patients with Type 2 diabetes in 15 years

From escardio.org

Sophia Antipolis, France – 29 Aug 2020:  Dramatic reductions in the risk of heart attacks in patients with diabetes coincides with major increases in the use of preventive medications. That’s the finding of late breaking research presented today at ESC Congress 2020.

“Our results suggest that when patients are diagnosed with type 2 diabetes, starting medications to prevent cardiovascular disease has a substantial impact on the risk of heart attacks and premature death,” said principal investigator Dr. Christine Gyldenkerne of Aarhus University Hospital, Denmark.

People with type 2 diabetes are twice as likely to have a heart attack or die from heart disease compared to people without diabetes.

Management of patients with type 2 diabetes has changed considerably over the last two decades, with increased focus on prevention of cardiovascular disease. This was the first study to examine how these changes may have affected the risk of heart attacks and premature death in patients with newly diagnosed type 2 diabetes and no previous cardiovascular disease.

The researchers identified all patients in Denmark initiating therapy for type 2 diabetes from 1996 to 2011 – a total of 211,278 patients. Each patient with diabetes was matched on age and sex with five people without diabetes from the general population. Those with previous cardiovascular disease were excluded.

All participants were followed for seven years. Using data from national health registries, the researchers recorded heart attacks and death during follow-up. They also noted the use of medications to prevent cardiovascular disease at the time of diabetes diagnosis.

The researchers found that patients with newly diagnosed type 2 diabetes and no previous cardiovascular disease experienced major reductions in the risk of heart attack and death. From 1996 to 2011, the relative risk was reduced by 61% for heart attack and by 41% for death. During the same period, the absolute risks of heart attack and death reduced by 4% and 12%, respectively.

When comparing patients with diabetes to the general population, the initially large differences in risk narrowed over time. By the end of the study, the risk of heart attack among patients with diabetes was only marginally – 0.6% – higher than in the general population.

In those with diabetes, use of cholesterol-lowering medications increased more than 10-fold, aspirin increased by 50%, and blood pressure-lowering medications increased up to four times during the study period.

Dr. Gyldenkerne said: “The risk of heart attack and premature death among patients with newly diagnosed type 2 diabetes and no previous cardiovascular disease was approximately halved from 1996 to 2011. In the same period, the difference in risk of heart attack and death for patients with diabetes, as compared to the general population, was narrowed substantially.”

She noted that this was an observational study and causation cannot be assumed. Dr. Gyldenkerne said: “In addition to the use of preventive medications, other factors may have influenced the likelihood of heart attack and premature death. For example, stricter control of diabetes and lifestyle changes such as smoking cessation, physical activity, and healthier food may have contributed to the improved prognosis.”

https://www.escardio.org/The-ESC/Press-Office/Press-releases/Risk-of-heart-attacks-halves-in-patients-with-diabetes-in-15-years

Fasting Safely with Diabetes

From niddk.nih.gov
With Martin M. Grajower, MD

People with diabetes may wish to fast for dietary, medical, or religious reasons. Advance planning with a health care professional may reduce complications

When Martin M. Grajower, MD, encountered patients with diabetes through his clinical practice who were committed to fasting for religious and other reasons, he was inspired to support them in finding ways to fast safely. Here, he discusses strategies that can help people with diabetes avoid health complications while fasting.

Q: What is a fast?
A: A fast is any defined period of time in which someone chooses not to eat. That could be six hours, eight hours, or 24 hours or more. A fast can mean no intake of food, or it can mean nothing at all by mouth, including no liquids.

Q: Why do people with diabetes fast?
A: People with diabetes fast for a variety of reasons, just like people without diabetes do. Most commonly today, people fast for dietary reasons. They want to lose weight, and so they may engage in calorie restriction by means of intermittent fasting.

People also fast for spiritual or religious reasons. For example, various religious practices call for fasting over a 24-hour period, over a certain number of hours per day for an entire month, or for one day a month throughout the year, or on some other schedule.
People may also fast because they have been told to do so before going into surgery. For example, sometimes people are told to eat nothing after midnight, but their surgery may not be until 3 o’clock in the afternoon the next day, so that’s a 15-hour fast. Some people going in for procedures, such as a bowel procedure, may be told to consume only liquids for 24 hours, which is also a form of fasting.

Q: What are the risks from fasting for people with diabetes?
A: Hypoglycaemia is the number one risk. Hyperglycaemia can also become an issue because people will cut back on their diabetes medicine, especially if they’re on insulin, to avoid hypoglycaemia. But if they cut back too much, then their blood glucose will go too high and they’re at risk of hyperglycaemia, and even potentially diabetic ketoacidosis.

Dehydration is another risk and depends on the nature of the fast. If it’s a complete fast where the person fasting can’t take in liquids or has been instructed not to take anything orally to prepare for surgery, then dehydration becomes a major risk. The dehydration could be due to not drinking or because some diabetes medicines, such as the SGLT-2 inhibitors and diuretic medicines, induce diuresis. Furthermore, hyperglycaemia induces diuresis.

Q: How do the different types of diabetes affect fasting risks?
A: People with type 1 diabetes are at greater risk when fasting compared to people with type 2 diabetes, because they are on insulin. The amount of insulin they take when fasting needs to be adjusted. If they don’t cut back enough, they risk hypoglycaemia, but if it is cut back too much, they can develop hyperglycaemia. People with type 1 diabetes also face increased risk of dehydration and diabetic ketoacidosis, compared to people with type 2 diabetes. However, there are more people with type 2 diabetes, so at the population level there are more people at risk when fasting.

For women with gestational diabetes, if they’re not on medicine, especially if they’re not
on insulin, fasting is the best insulin sensitizer that we have. So, I never hesitate to let women with gestational diabetes restrict calories for a short period. Pregnant women do have to factor in the risk of dehydration, taking into consideration their blood pressure and any edema. For women with gestational diabetes who wish to partake in the longer fasting regimen of certain religious practices, that’s a separate discussion.

Q: What challenges does intermittent fasting pose for people with diabetes?
A: There are two types of intermittent fasting. There’s the type that you do every day—for example, every day you eat for only eight hours during the day. I don't necessarily recommend it, but I have no problem with a person with diabetes following this eating pattern, because they're doing the same thing every day and you can just adjust their medications accordingly. The intermittent fasting where you fast two days a week or every other day is more problematic because it can become very complicated to adjust the medication. It can be done, but it requires the time and the expertise of the physician and it requires the compliance of the patient. So, I don't recommend patients do it on their own, but it can be done safely under medical supervision.

Q: What is your approach with patients who wish to fast for religious or spiritual reasons?
A: I became interested in this subject because of a couple of patients. A member of my religious community went to the rabbi and said, “Last year my doctor said anyone with diabetes shouldn’t fast, but I did anyway, on my own, and my sugar dropped low. So, what do I do this year?” The rabbi called me up and asked what I should tell him. I found out that the only medicine this person was taking was a sulfonylurea, so I told him to stop taking his medicine 36 hours before Yom Kippur, and he did fine.

I also had an elderly Orthodox Jewish woman as my patient. I said to her, “I don’t think you should fast on Yom Kippur because you’re elderly, you’re on heart medicines, and you’re on a complicated insulin regimen of three shots a day.” She looked me straight in the eye and said, “Doctor, I fasted on Yom Kippur in the concentration camps, so don’t tell me not to fast now. I’m going to fast with or without your help, but I’m going to fast.”

This was a powerful lesson. The determination to fast is found not just in the Jewish religion, but also in the Muslim faith. People hold Ramadan to be a very holy time, and they’re going to fast either with or without their doctor’s help. People of other faiths or who adhere to other spiritual or meditative traditions fast as well. That’s why I've become a very big proponent of allowing people with diabetes to fast, but under medical supervision.

It’s our obligation as health care professionals to adapt diabetes to our patients’ religious beliefs. I did my fellowship under Dr. Harold Rifkin, who co-wrote the first textbook on diabetes. He taught me that you need to adjust the management of diabetes to the patient’s lifestyle, not the other way around.

I really think nurse practitioners and nutritionists could take the lead on this, because doctors unfortunately don’t always have the time. If you have patients who are Jewish, Muslim, or a member of the Church of the Latter-day Saints, you can ask, “Do you fast for religious reasons?” And if they do, talk with them about how they’re going to manage it. Because if you don’t ask the question, patients will do it on their own, and that’s when they’re going to run into problems.

Q: What are the concerns when people must fast prior to surgery?
A: The major concerns are hypoglycaemia and dehydration, both of which can be avoided by adjustment of medication and scheduling the surgery, for early in the day when possible.

Q: How do you help manage the patient who wants to fast?
A: Health care professionals need to consider the pharmacodynamics (mechanism of action) and pharmacokinetics (the onset and duration of action) of the diabetes medicine a patient is on. How long does the medicine work? How long does it stay in the system? Does the medicine increase hypoglycaemia risk or is its action glucose dependent?

Sulfonylureas, the short-acting meglitinides, and insulin, are associated with hypoglycaemia. The sulfonylureas have a 24- or 36-hour duration of action, so those need to be stopped at least 24 and preferably 36 hours before the patient is going to fast. Meglitinide and Nateglinide generally are taken three times a day before each meal because it has a duration of action of only 4-6 hours. Patients should not take a glinide medicine if they’re not eating or if they’re not going to eat carbohydrates.

Insulin requires a major adjustment, so the health care professional should understand the duration of action for the kind of insulin that the patient is on. For example, certain long-acting insulins are taken every day and have a duration of action of 36 to 42 hours. If a patient takes insulin on Monday, the effect is going to last until Wednesday. If I have a patient with this kind of insulin going in for a medical procedure on Tuesday, I advise him or her to reduce their dose of insulin on Sunday, two days prior, as well as on Monday, one day prior. I provide detailed instructions on how much to reduce the dosage, as described in the article on medication adjustment referenced below.

The older NPH (isophane) insulin has a duration of action of about 12 to 16 hours, and other forms of long-acting insulins have a duration of between 16 and 24 hours. For these medicines, you would have to help the patient adjust dosages mostly the day before the procedure.

Metformin, pioglitazone, and DPP-4 inhibitors rarely cause hypoglycaemia, so health care professionals don’t have to adjust them. But the patient should not take it on the day of fasting if it’s a 24-hour fast. With patients doing intermittent fasting, where they are eating during 8 hours of the day and going on a 16-hour fast, I don’t tell them to stop taking the medicine, because they rarely cause hypoglycaemia, and the medicine should be in their system for those 6 or 8 hours while they are eating to prevent hyperglycaemia.

Q: What about dehydration concerns?
A: As far as dehydration goes, it really depends on the kind of fast. With intermittent fasting, fluid intake is never restricted; just calories are restricted. So, people with diabetes can drink water, diet soda, tea, or black coffee without hesitating, and dehydration should generally not be an issue.

However, patients who normally get a lot of their liquids from foods like soups, shakes, jello, and yogurt may not realize that three-quarters of their fluid intake is really coming through food. Even if they drink as much while fasting as they do at other times, they will not be consuming enough liquid and they could run into a problem with dehydration.

Health care professionals also need to keep in mind that the SGLT-2s, besides lowering blood sugar, have a diuretic effect. Both aspects of the medicine must be considered when adjusting the dosages. I generally will stop the SGLT-2 two days before a patient begins a fast because of the dehydration aspect.

Health care professionals should also consider other medicines the patient is on, especially diuretics. These may also require adjusting. We also keep in mind the patient’s other medical conditions. A patient who has had a heart attack or a stroke within the last three months is at increased risk from dehydration and the resultant drop in blood pressure. If the patient becomes hypotensive from dehydration, this could lead to another heart attack or another stroke.

If A1C is not controlled, the patient is also at increased risk for dehydration, because glucose in the urine acts as a diuretic. If a patient has an A1C of 9 or greater, I will strongly discourage fasting due to the risk of dehydration from the high blood sugar or, if the patient has type 1 diabetes, the risk of going into diabetic ketoacidosis.

A patient who is running any fever in the last week or so should not be fasting, again because of the risk of dehydration resulting from fluid loss due to sweating. Health care professionals need to be conscious of these other issues before going ahead and giving a blanket recommendation regarding fasting.

Q: How do you advise patients regarding glucose monitoring during a fast?
A: Patients who are on insulin and fasting should do even more frequent glucose monitoring than usual until they get a sense of the safety of their revised insulin regimen. For example, the patient on a long-acting insulin who decides to intermittently fast two days a week, with the help of a health care professional, should adjust the insulin the day before the start of the fast. Then over the first two or three fasting periods, the patient should check glucose levels even more frequently than normal, until it can be established that the lower dose of insulin is correct. Subsequently, the normal frequency of testing can be resumed.

Someone who’s not on a sulfonylurea or insulin doesn’t have to test any more frequently than normal because the risk of hypoglycaemia is extremely low.

Q: Do you have any other tips for helping patients with diabetes manage fasting?
A: At the time of a patient’s pre-fast visit, I write down all my instructions. I hand the patient a copy (to avoid misunderstandings), and I keep a copy in the patient’s chart. In the instructions, I put down medication adjustments, how often to check blood glucose readings, and what to do if the blood glucose reading goes above or below a certain specific number (individualized for the patient depending on age, the presence of hypoglycaemia unawareness, and comorbid conditions). Soon after the fast, either at the next visit or via a follow-up telephone call, I ask the patient how he or she did. I make a note of that in the chart. The next time the fasting observance comes around, I look back at my previous note in the chart. If the patient did well, I simply make a photocopy and say, “Here are your instructions.” And for me, instead of spending 10 minutes, now it takes only 30 seconds.

Also, on the occasion when I’ve told patients that I don’t think they should be fasting, I ask permission to discuss it with their clergy. You’d be surprised how often a patient will let me do that. And then when their religious advisor tells them not to fast, they feel much more comfortable about it.

https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/fasting-safely-with-diabetes

Recipe: Conchiglie with roasted tomato and tiger prawn

From diabetes.org.uk

Light and simple, this dish is great for entertaining

Serves 3

Prep 15 minutes

Cook 30 minutes

Ingredients

200g cherry tomatoes, halved

225g dried pasta shapes, eg conchiglie

2 tbsp olive oil

2 cloves garlic, sliced

100g raw tiger prawns, shelled

handful fresh basil, torn

freshly ground black pepper

Method

1. Preheat the oven to 200ºC/gas 6.
2. Place the tomatoes into an ovenproof dish, season well then cook in the oven for 20-25 minutes until tender and beginning to char.
3. Meanwhile, cook the pasta according to the pack instructions. Drain and return to the pan.
4. Meanwhile, heat the oil in a non-stick frying pan, add the garlic and fry for 1 minute, add the prawns and fry for a further 1-2 minutes until pink.
5. Toss together all the ingredients, add the basil and season well with black pepper.

Chefs tips

• You could use frozen mixed seafood or small Atlantic prawns instead of tiger prawns, if you prefer.

https://www.diabetes.org.uk/guide-to-diabetes/recipes/conchiglie_with_roasted_tomato_and_tiger_prawn

Diabetes: Can A Plant Based Diet Help Control Blood Sugar Levels?

From ndtv.com

Diabetes Diet: Some studies suggest that plant based diet can help manage diabetes. But how far is it effective? How does this work? Read here to know what nutritionist has to say

Diabetes is a progressive condition and chronic condition which requires constant management of blood sugar levels. If diagnosed early, the progression can be slowed considerably with therapeutic diet and physical activity. But if left uncontrolled, the blood sugar levels may start affecting different organs of the body. It is advised that diabetics should keep a constant check on the blood sugar levels and follow all necessary precautions to avoid major fluctuations.

Physical activity helps in controlling progression of the condition. But what is not clear is the ideal dietary pattern to be followed. There is a lot of uncertainty in nutrition claims, what was true yesterday may have some other aspects to reconsider with emerging research studies. One such research is about how effective is a plant-based diet in managing diabetes. In this article, Mrs. Sweedal Trinidade who is a nutritionist and senior dietetics officer at P.D. Hinduja National Hospital explains in detail the pros and cons of a plant-based diet and its effect on diabetes.

Diabetes: Is plant-based diet helpful in controlling blood sugars?

A plant-based diet focuses more on eating legumes, whole grains, vegetables, fruits, nuts, and seeds with little or no animal products.

The pros of plant based diet:

1) No additives: Plant-based diets are minimally or not processed. So, no additives may contribute to insulin resistance.

2) Fibre: Plant-based diets are rich in cellulose and hemicellulose. Both are majorly responsible for maintaining glycaemic index of the meals and improving postprandial blood sugar levels.

3) Probiotics: More commonly known as food for gut-friendly bacteria. They are the type of fibre, found in fruits, vegetables and legumes are fermented by intestinal bacteria to produce short-chain fatty acids, which also improve sugar metabolism by increasing insulin sensitivity.

4) Antioxidant-rich: Plant-based diets are usually rich in various antioxidants like-
a) Polyphenols that inhibit glucose absorption and stimulate insulin secretion
b) Magnesium promotes insulin sensitivity thereby improving sugar metabolism

Glycaemic index and glycaemic load of food: Plant-based diets are rich in fibre thereby improving satiety, reducing calorie density of meals. They maintain the glycaemic index of the foods and reduce glycaemic load of the meals. A perfect balance can help in improving blood sugars considerably.

The cons of plant based diet:

Now the question is why India is known as diabetes capital when the diet followed is predominantly vegetarian? This makes it important to highlight the downside of plant-based diet:

In case you decide to rely completely on plant-based diet a lot of thought has to go in planning and balancing the diet or else you will land up in the following:

1) Plant-based diets are loaded with carbs usually: This may affect blood sugars.

2) Less of complex carbohydrates and more of simple sugars: This will greatly impact the glycaemic load of meals and ultimately the blood sugar levels.

3) Proteins deficiency: If the diet is not planned properly you may miss out on essential amino acids and also land up consuming protein-deficient diet. Hence having foods in right combination can compensate for this. Example right combination of cereals and pulses might help.

4) Vitamins and minerals: Calcium and iron, no doubt many vegetables are rich in minerals like iron and calcium but due to presence of phytates, oxalates and fibre the bioavailability is low.

5) Vitamin B12: Plant diets are deficient in vitamin B12. Hence it is important to include foods fortified in Vitamin B12.

It is very important to analyse the pros and cons before adopting any diet. Finally, striking the right balance and ensuring no nutritional deficiencies can not only promote good health but also optimal glycaemic control!

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.

https://www.ndtv.com/health/diabetes-can-plant-based-diet-help-control-blood-sugar-levels-nutritionist-reveals-with-pros-and-cons-of-this-diet-plan-2284859

4 Science-Backed Reasons People with Diabetes Can Eat Fruit Worry-Free

From msn.com

It’s true that all carbohydrates from food eventually end up as blood glucose (aka, sugar)—including the carbs in fruit. Which might make you wonder: Can people with diabetes eat fruit? Fruit has a much lower impact on blood sugar levels than other foods like candy and soda. That’s because, like vegetables, fruit is mostly water. What isn’t water is fibre, and that fibre slows the progression of fruit sugars into the bloodstream, causing a slow, steady rise in blood sugar rather than a huge spike.

"Because fruit contains sugar, many people with diabetes may be quick to assume that it’s not a healthful choice for them," says Jackie Newgent, RDN, a registered dietitian, chef, and author of The All-Natural Diabetes Cookbook and The Clean and Simple Diabetes Cookbook, New York. "But when appropriately planned into a diabetes eating plan, whole fruit can and should be included."
Bottom line: Fruit isn’t merely not bad for your diabetes. Fruit is downright good for it, and good for your waistline, too.

                                                                          © kirin/iStock 

Fruit fights inflammation

Peaches, plums, and nectarines contain special nutrients called phenolic compounds that have anti-inflammatory properties. (These nutrient-rich foods also fight off inflammation.) Research shows that these compounds travel through the bloodstream and then to your fat cells, where they affect different genes and proteins for the better. One study, published in 2016 in the British Journal of Nutrition, suggests that the phenols derived from red grapes and acai berries, among other foods, may help reduce inflammation.

Fruit may help prevent type 2 diabetes

Flavonoids are nutrients found in plant foods, and especially in many types of fruit. A review of studies published in 2018 in the journal Medicine found that these compounds can lower the risk for developing type 2 diabetes, probably because these nutrients improve insulin sensitivity. Harvard’s long-running Nurses’ Health Study found that women who consumed more anthocyanins (the pigment that makes blueberries blue and strawberries red) were less likely to develop type 2 diabetes than women who consumed fewer of these health-promoting compounds.

Fruit slims you down

Filling your plate with fruits and vegetables is always a good idea for slimming down. But a study published in 2015 in PLoS Medicine found that fruit—specifically, berries, apples, and pears—may actually be more important than vegetables when it comes to long-term weight loss. These findings aren't an anomaly. A study published in a 2016 issue of Nutrients found that the anti-obesity effects of fruit are greater than their pro-obesity effects in most cases. And if you're choosing between fruits, pick apples, berries, and pears over pineapple and bananas which, though good for you, have a high glycaemic index.

Fruit bolsters health

Along with vegetables, fruit protects against heart disease, stroke, and cancers of the stomach and colon. Incorporate these 30 new habits into your routine to reduce your risk of heart disease. Fruit also helps fend off depression, which is common in people with diabetes.
"I often recommend using fruit to offer wholesome sweetness to meals or to be the feature of dessert," says Newgent. For instance: "Tossing seasonal fruit cubes into a spicy stir fry for balanced taste and intrigue; dicing a favourite fruit and using in place of tomato for a fresh salsa on Mexican cuisine; blending equal parts berries, oil, and vinegar to create a delightful salad dressing; or grilling peach halves then topping with plain Greek yogurt and a sprinkling of no-sugar-added granola for an awesome dessert."

One way to ensure you consume more fruit: Shop local. Local produce is everywhere these days, thanks to the increasing popularity of farmers’ markets, backyard gardens, and community gardens. Just be sure you ask these five questions when shopping at your local farmers' market. This food trend can motivate you to eat more produce, reaping the big weight-control and health benefits.

https://www.msn.com/en-us/health/nutrition/4-science-backed-reasons-people-with-diabetes-can-eat-fruit-worry-free/ar-AAH8oqE?li=BBnba9O

EXCLUSIVE: How to cope with diabetes and hypertension during the pandemic era by Dr Behram Pardiwala

From pinkvilla.com

COVID-19 is a serious public health concern and people with chronic medical issues such as diabetes and hypertension are at a higher risk of getting sick from Coronavirus. Here’s how people with diabetes and hypertension should take care of themselves during the pandemic

Coronaviruses (CoV) belong to a large family of viruses that may lead to respiratory illnesses, ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). This year, a new strain of coronavirus was discovered, which has not been previously identified in human beings, also known as a novel coronavirus (nCov). COVID-19 causes respiratory disease and in serious cases, it can lead to pneumonia, and hence, the entire country is under lockdown. 

COVID can affect those with chronic illnesses such as diabetes, high blood pressure, or hypertension as they are in the ‘high-risk’ category. If one gets diabetes, not only his/her blood sugar level gets impacted and the insulin production level also gets compromised.

People with high or unmanaged blood sugar levels have less than normal blood flow and their body finds it difficult to harness nutrients and heal. People suffering from diabetes are prone to develop infections and may take a longer time to get fit and fine owing to the weakened immune system. Not only this, but uncontrolled blood sugar levels can also invite diabetes-related complications.

Similarly, people with hypertension need to be careful. Hypertension can be described as a condition wherein the long-term force of the blood against one’s artery walls is high enough that it may invite major health problems like heart disease and stroke. The risk factors can be attributed to obesity, family history, too much alcohol intake, and smoking. Since people have been advised to stay at home their blood sugar levels and hypertension may go out of control. Hence, they should take charge of their health and stay healthy.

 Foolproof tricks for people with diabetes and high blood pressure:

· Hydrate yourself by drinking enough water, and eat fresh fruits and vegetables to improve your immunity. Dietary Approaches to Stop Hypertension (DASH) diet can also be helpful for people who have hypertension. It also involves whole grains, fresh fruits, vegetables, and low-fat dairy foods. 
· Monitor your blood sugar levels and temperature from time to time.
 - Stay in contact with your doctor, and see to it that you have an adequate stock of medication and other supplies for monitoring your blood sugar level at home. If you notice fluctuations then immediately consult the doctor. Do not forget to stock up your insulin if you are advised to take it.
· Pay close attention to the changes occurring in the body as that could be a sign of infection.
· Try to exercise at home. You can walk, do yoga, or aerobics. Maintain optimum weight. Meditate every day when you feel anxious or tend to panic.
· Say NO to high-calorie foods, carbohydrates, too much salt, junk, oily, spicy, and processed foods.
· Drinking alcohol on a regular basis can be harmful to your health. It can put you at risk of hypertension. So, limit your alcohol consumption and quit smoking too.

https://www.pinkvilla.com/lifestyle/health-fitness/exclusive-how-cope-diabetes-and-hypertension-during-pandemic-era-dr-behram-pardiwala-558452

Diabetic diet: 5 breakfast options for diabetes that will help regulate blood sugar levels

From timesnownews.com
By Anushree Gupta

Breakfast is considered a very important meal of the day, especially for diabetics, since fasting for long hours can be harmful to them if they take medicines to regulate their blood sugar levels

New Delhi: Diabetes is a condition that requires constant and regular care. Someone who suffers from diabetes has to be particular about each meal they eat since it can have a direct impact on their blood sugar levels. Prolonged imbalances in blood sugar levels can lead to severe complications such as heart disease, and damage to other vital organs. People with diabetes have also been listed in the high-risk category for COVID-19, and therefore, should practice even more care when it comes to their diet.

                                                                   Photo Credits: Canva 

Breakfast is considered a very important meal of the day, especially for diabetics, since fasting for long hours can be harmful to them if they take medicines to regulate their blood sugar levels. Therefore, the breakfast that they eat needs to be nutritious, but also contain fibre, protein, and some carbs to ensure their blood sugar levels neither fall too low, nor spike too high, and their bodies receive the right nutrients it needs. Here are 5 breakfast options for diabetics that they must try to keep their blood sugar under control.

1. Poha – One of the most popular breakfasts in the country, Poha, is great for diabetics. Not only is it rich in fibre, but you can also add vegetables of your choice and make it even more fibrous and nutritious. Poha is also good probiotic food, which ensures better digestion and a healthy gut.
2. Fruit smoothies – Fruit smoothies such as those with bananas, berries, papaya, etc are great breakfast options for diabetics. They are super easy to make and provide nutrition and fibre to the body. They are also rich in natural sugars which can help provide diabetic people with the right amount of carbs, without consuming any added sugar.
3. Oatmeal – Oats are one of the most fibrous foods that you can think of. Oatmeal, adding oats to smoothies, or just having regular oats can help regulate blood sugar levels and fill you up. Oats are considered one of the healthiest breakfast options for weight loss as well.
4. Omelette – Easy to make and power-packed with protein, eggs and omelettes is a great choice for a diabetes-friendly breakfast. You can consume a slice of multi-grain bread with it. Adding nutritious veggies such as tomatoes, onions, carrots, mushrooms, etc into the omelette or on the side can not only enhance the taste but also improve the nutritional value of the meal.
5. Peanut chaat – Peanuts are a food with a low GI, which makes it great for people with diabetes. Adding veggies to the chaat can help improve the nutritional value of the meal, and may also provide more fibre to the body.

https://www.timesnownews.com/health/article/diabetic-diet-5-breakfast-options-for-diabetes-that-will-help-regulate-blood-sugar-levels/641023

Recipe: Prawn Noodles

From diabetes.org.uk

Spicy prawns make a perfect topping for rice noodles and courgette spaghetti, packed with zesty vegetables

Serves 4

Prep 15 minutes

Cook 10 minutes

Ingredients

250g broccoli, broken into florets

2 tsp rapeseed oil

6 spring onions, cut into rings

1 red pepper, sliced

2cm ginger root, grated

1 small red chilli, finely chopped

3 cloves garlic, crushed

120g pack raw king prawns

100ml water

250g courgette spaghetti

300g ready-to-use rice noodles

110g baby leaf spinach

grated zest and juice 1 lime

2 tsp reduced-salt soy sauce

Method

1. Add the broccoli to a microwave-proof dish with 1 teaspoon of water, cover with cling film, then pierce and heat on full for 1.5 minutes, then reserve.
2. Meanwhile, heat the oil in a non-stick pan or wok, then add the spring onions and pepper. Cook for 2-3 minutes over a high heat, stirring constantly.
3. Next, add the ginger, chilli and garlic to the pan and cook for 1 minute.
4. Add the king prawns, water, courgette spaghetti, noodles and reserved broccoli and mix well. Add a lid and cook for 2 minutes.
5. Add the spinach, lime juice, zest and soy sauce and mix again. &nbsp
6. Cover and heat for another 2-3 minutes.
7. Make sure the dish is heated through and the prawns are pink, then serve immediately.

Chef's tips

• Try adding salmon or another fish instead of prawns.
• For a vegetarian/vegan version, use mushrooms or tofu in place of prawns.

https://www.diabetes.org.uk/guide-to-diabetes/recipes/prawn-noodles

Smartphones could be used to detect Type 2 diabetes

From news-medical.net
Reviewed by Emily Henderson, B.Sc.

Researchers at UC San Francisco have developed a "digital biomarker" that would use a smartphone's built-in camera to detect Type 2 diabetes - one of the world's top causes of disease and death - potentially providing a low-cost, in-home alternative to blood draws and clinic-based screening tools.

Type 2 diabetes affects more than 32 million Americans and more than 450 million people worldwide, and can raise the risk of diseases affecting nearly every organ system, including coronary heart disease, kidney failure, blindness and stroke. In the current pandemic, it also has been found to increase the risk of severe symptoms of COVID-19.

Yet, half of the people with diabetes are unaware of their diagnosis and risks to their health.
"The ability to detect a condition like diabetes that has so many severe health consequences using a painless, smartphone-based test raises so many possibilities," said co-senior author Geoffrey H. Tison, MD, MPH, assistant professor in cardiology, of the Aug. 17, 2020, study in Nature Medicine.

"The vision would be for a tool like this to assist in identifying people at higher risk of having diabetes, ultimately helping to decrease the prevalence of undiagnosed diabetes."
Screening tools that can be deployed easily, using technology already contained in smartphones, could rapidly increase the ability to detect diabetes, the researchers said, including populations out of reach of traditional medical care.

While diabetes mellitus is the seventh highest global cause of death on its own, according to the World Health Organization, it also significantly raises the risk of heart disease, which is the leading cause of death in the United States and worldwide. The U.S. Centres for Disease Control and Prevention estimate that people with Type 2 diabetes are twice as likely to die of heart disease as those who do not have diabetes.

In developing the biomarker, the researchers hypothesized that a smartphone camera could be used to detect vascular damage due to diabetes by measuring signals called photoplethysmography (PPG), which most mobile devices, including smartwatches and fitness trackers, are capable of acquiring. The researchers used the phone flashlight and camera to measure PPGs by capturing colour changes in the fingertip corresponding with each heartbeat.

In the Nature Medicine study, UCSF researchers obtained nearly 3 million PPG recordings from 53,870 patients in the Health eHeart Study who used the Azumio Instant Heart Rate app on the iPhone and reported having been diagnosed with diabetes by a health care provider. This data was used to both develop and validate a deep-learning algorithm to detect the presence of diabetes using smartphone-measured PPG signals.

Overall, the algorithm correctly identified the presence of diabetes in up to 81 percent of patients in two separate datasets. When the algorithm was tested in an additional dataset of patients enrolled from in-person clinics, it correctly identified 82 percent of patients with diabetes.

Among the patients that the algorithm predicted did not have diabetes, 92 to 97 percent indeed did not have the disease across the validation datasets. When this PPG-derived prediction was combined with other easily obtainable patient information, such as age, gender, body mass index and race/ethnicity, predictive performance improved further.

At this level of predictive performance, the authors said the algorithm could serve a similar role to other widespread disease screening tools to reach a much broader group of people, followed by a physician's confirmation of the diabetes diagnosis and a treatment plan.

"We demonstrated that the algorithm's performance is comparable to other commonly used tests, such as mammography for breast cancer or cervical cytology for cervical cancer, and its painlessness makes it attractive for repeated testing," said study author Jeffrey Olgin, MD, a UCSF Health cardiologist and professor and chief of the UCSF Division of Cardiology. "A widely accessible smartphone-based tool like this could be used to identify and encourage individuals at higher risk of having prevalent diabetes to seek medical care and obtain a low-cost confirmatory test."

The authors recommend further study to determine the effectiveness of this approach for specific clinical applications, such as screening or therapeutic monitoring.

Source: University of California - San Francisco

https://www.news-medical.net/news/20200817/Smartphones-could-be-used-to-detect-Type-2-diabetes.aspx

Helpful foot care tips and for those living with diabetes

From thepaper24-7.com

(StatePoint) For those with diabetes, a seemingly insignificant foot problem can produce dangerous consequences. Experts say that managing this risk is an important part of diabetes care.

“Living with diabetes increases the risk of developing a wide range of foot problems, often because of two complications of the disease: nerve damage and poor circulation,” says Dr. Brett Sachs, DPM, FACFAS, a Denver foot and ankle surgeon and Fellow Member of the American College of Foot and

Ankle Surgeons (ACFAS). “However, you can play a vital role in prevention.”
To avoid serious foot problems that could result in losing a toe, foot or leg, follow these guidelines from ACFAS foot and ankle surgeons:

• Inspect feet daily. Diabetes may cause nerve damage, which takes away the feeling in your feet, so a daily visual inspection is important. Check for cuts, blisters, redness, swelling or nail problems. Use a magnifying hand mirror to look at the bottom of your feet. Call your foot and ankle surgeon if you notice any issues.

• Bathe feet gently. Wash your feet daily with a soft washcloth or sponge using only lukewarm water. Dry by blotting carefully.

• Moisturize. Use a moisturizer daily to keep dry skin from itching or cracking. But don’t moisturize between the toes -- that could encourage a fungal infection.

• Cut nails carefully. Cut nails straight across and file the edges. Don’t cut too short, as this could lead to ingrown toenails.

• Never treat corns or calluses yourself. Don’t perform “bathroom surgery” or use medicated pads. Visit your doctor for appropriate treatment.

• Wear proper socks. Always wear clean, dry socks. You may want to consider those made specifically for patients living with diabetes, which have extra cushioning, no elastic tops, are higher than the ankle and are made from moisture-wicking fibres.

• Shake out your shoes. Remember, your feet may not be able to feel a pebble or other foreign objects, so always inspect shoes before wearing them to help prevent blisters and sores that could lead to an infection or non-healing wound.

• Keep feet dry. Change your socks if they get wet. You may also consider using an antiperspirant on the soles of your feet.

• Never walk barefoot. It can be tempting to go barefoot in warmer weather. Never do so, not even at home. Always wear shoes or slippers to avoid getting scratched, cut or even burned from hot surfaces.

• Be active. Staying active is important. Just be extra careful, particularly if you play sports, to monitor your feet for related injuries.

• Treat your diabetes. Keep your blood sugar levels under control. Untreated diabetes can result in other conditions affecting the feet, including diabetic peripheral neuropathy and Charcot foot, a condition in which the bones of the foot are weakened enough to fracture. 

• Don’t smoke. Smoking restricts blood flow in your feet.

• Get periodic foot exams. Your foot and ankle surgeon works with your other healthcare providers to prevent and treat complications from diabetes. See your foot and ankle surgeon regularly, or as soon as you notice any problems, to help prevent the foot complications of diabetes.

For more resources and tips regarding foot and ankle health and conditions, visit the ACFAS patient education website, FootHealthFacts.org.

“When it comes to diabetes care, don’t neglect your feet. Proper preventive care with the help of a foot and ankle surgeon can help keep your whole body healthy,” says Dr. Sachs.

https://thepaper24-7.com/Content/News/Local-News/Article/Helpful-foot-care-tips-and-for-those-living-with-diabetes/23/22/73509

If you have a family history of diabetes, you need to make THIS dietary change

From timesofindia.indiatimes.com

In the past few decades, diabetes has become a global health concern. In India alone, over 30 million have now been diagnosed with diabetes, which mostly comprises the urban population.

The major causes of diabetes are poor eating habits and sedentary lifestyle. However, sometimes your genes also play a major role when it comes to certain health issues. If you have a family history of diabetes, you are more vulnerable to this disease. But the good news is that scientists have recently found out a way to lower the risk of diabetes and related vascular complications. All you have to do is make a small dietary change. That is to - Eat more fruits.

As per a Chinese epidemiological study carried out on half a million people and published online in PLOS Medicine, eating a portion of fruit may reduce the risk of diabetes by 12 per cent, regardless of the person's sex, age, region, family history and lifestyle habits.

However, this is not the first study where the importance of eating fresh fruits has been highlighted. Several studies conducted earlier underlined that having fruits is good for health. Some people believe that having fruits can increase their blood sugar level as it is sweet. But this is not true. Fruits contain fructose (natural sweetener), but they are not harmful like refined sugar.

How much fruit one should eat

Even if you are consuming fruits, which is healthy for your health, you should have it in moderation. The World Health Organization recommends a normal person to 400 grams of fruits and vegetables per day for diabetes prevention.

Fruits contain nutrients and minerals, which is good for health. But there are some fruits that are more preferred when we talk about diseases like diabetes. Blueberries, avocado, apple, grapes and oranges are some of them.

https://timesofindia.indiatimes.com/life-style/health-fitness/diet/if-you-have-a-family-history-of-diabetes-you-need-to-make-this-dietary-change/photostory/77550105.cms?picid=77550170

Recipe: Freshen up your lunch with this tasty sandwich

From diabetes.org.uk

Prawn & dill open sandwich

A deliciously refreshing sandwich, perfect for picnics. Thanks to WW (Weight Watchers UK) for this recipe.

Serves 1

Prep 5

Ingredients

1 brown sandwich thin, halved

80g reduced-fat natural cottage cheese

1 sprig fresh dill

1 splash Tabasco sauce (optional)

30g cucumber, thinly sliced

50g cooked and peeled king prawns

Method

1. Lightly toast the sandwich thin halves. Mix the cottage cheese with some snipped dill, a few drops of Tabasco, if using, and some black pepper. 
2. Pile the mixture on top of the sandwich thins, then add the cucumber slices, prawns, another sprinkling of dill and splash of Tabasco, then serve.

https://www.diabetes.org.uk/guide-to-diabetes/recipes/prawn-dill-open-sandwich?utm_source=bronto&utm_medium=email&utm_term=Try+the+recipe&utm_content=Try+the+recipe&utm_campaign=Enewsletter+August+2020

4 of the best ways to treat diabetes and lower blood sugar

From insider.com

To treat diabetes, you may need to take insulin, use medication like metformin, get regular exercise, and maintain a healthy diet. 

The best treatment for your diabetes depends on whether you have type 1 or type 2, but regardless, you will need to follow similar recommendations to effectively lower blood sugar. 

This article was reviewed by Jason R. McKnight, MD, MS, a family medicine physician and clinical assistant professor at Texas A&M College of Medicine

No matter what type of diabetes you have, the goal of diabetes treatment is to control blood sugars and keep them within the healthy range.

Type 1 diabetes must be treated with insulin, since the pancreas does not produce insulin naturally. People with type 2 or gestational diabetes don't always need insulin treatment, and will often focus on lifestyle changes and oral medications that encourage insulin production or decrease insulin resistance.

With proper access to healthcare, diabetes is highly treatable, says Katherine Araque, MD, an endocrinologist and director of endocrinology of the Pacific Neuroscience Institute at Providence Saint John's Health Centre in Santa Monica, California.

Here are the four main ways you can treat and manage your diabetes.

1. Take insulin

Insulin is a hormone produced in the pancreas in healthy individuals. It helps facilitate the process of converting blood sugar into fuel, so that glucose doesn't build up in the blood.
In people with type 1 diabetes, the pancreas cannot produce insulin, so they need synthetic insulin. This can happen in two ways:

• Daily insulin injections. Most people with type 1 diabetes need to take insulin at least three times a day, though this can vary. Your doctor will give you guidance and explain how and when to do injections. Injections are done at home by the patient. 
• An insulin pump. Insulin pump therapy delivers insulin through a catheter, which is a thin tube that is placed in the body semi-permanently and delivers insulin right into the tissue. The medication is the same as injections, but you won't need to give yourself daily shots.  

People with type 2 diabetes are treated with insulin when they are unable to control their blood glucose levels with lifestyle changes and medication. Overall, roughly 24% of people with diabetes are treated with insulin, according to a 2018 study published in Diabetes Care.

If you need insulin, your doctor will provide specific guidance on how much you need and when you should take it.

2. Use medication 

Although people with type 1 diabetes will need insulin, they may also be prescribed medication if they have some remaining pancreas function. The medication can encourage insulin production in the body.

People with type 2 diabetes are prescribed medication when they can't control their blood sugars through diet and exercise. Oftentimes, people with type 2 diabetes use more than one medication to control their condition.

However, medications are usually not recommended for pregnant people with gestational diabetes.

Common medications used to treat diabetes include:

Metformin 

Metformin is the most common medication used to treat type 2 diabetes. It's sometimes used to treat type 1 diabetes in people who still have some insulin production, along with insulin.
Metformin helps control blood sugar by making it easier for the body to absorb glucose. It's usually taken twice a day, with meals. Even when used alone, metformin can reduce A1C levels by 1.5% on average, which is enough to drop blood sugar levels from diabetes to prediabetes.

Sulfonylureas

Sulfonylureas are a class of drugs that encourage the pancreas to release more insulin. They're used to treat type 2 diabetes. They are often taken once or twice a day before meals.

Sulfonylureas have a similar efficacy to metformin, and can be used alongside it.

Thiazolidinediones (TZDs)

TZDs make it easier for the body to use insulin; they reduce insulin resistance. They can be used to treat type 2 diabetes. They are taken 1 to 2 times per day.
After a year of taking TZDs, people with type 2 diabetes reduced their A1C levels by 1.4%, according to a 2019 study published in Vascular Health Risk Management.

3. Get regular exercise

Exercise is important for people with all types of diabetes. "Exercise helps at multiple levels: it increases base metabolic rate, fights insulin resistance, and helps with weight loss," says Araque.

Exercise helps muscles burn glucose and reduces insulin resistance. When you exercise, your muscles burn more glucose, removing it from the bloodstream and helping to lower blood sugar levels.
For example, a 2017 study published in Biomedical Research followed 120 obese teens, who did two hours of aerobic exercise twice a day for six days a week. After five weeks, their average fasting blood sugar was reduced by 0.84 nanomoles per liter (nmol/L) for males and 1.04 nmol/L for females. The researchers described this as "an extremely significant difference."

The Centre for Disease Control and Prevention (CDC) recommends that people with diabetes get the normally recommended amount of exercise: 150 minutes of exercise each week, including two days of strength workouts that incorporate major muscle groups. The American Diabetes Association recommends starting with small changes, like walking daily. 

Any exercise will help, but some may be especially beneficial. For example, a 2019 study published in Diabetologia found that afternoon exercise decreased blood sugars more than morning exercise.

Overall, you should work with your doctor to identify an exercise program that will benefit you, Araque says.

4. Maintain a healthy diet 

Healthy eating is critical for people with diabetes. As food breaks down, it releases glucose into your blood. Some foods, including processed sugars and carbohydrates, raise blood sugars more than other foods, like proteins or leafy vegetables.
In particular, people with diabetes need to be aware of how many carbs they eat per day. They should also create an eating plan that includes the following:

• Eating lean proteins, whole grains, fruits, and vegetables
• Avoiding sugary drinks
• Limiting refined carbohydrates, like chips or cookies 

For example, the DASH diet and Mediterranean diet — which both emphasize healthy fats, lean protein, protein and vegetables — have been proven to help people with type 1 and type 2 diabetes control blood sugar.
Read more about the best ways to eat if you have diabetes:

• Best diet for diabetics
• Best snacks for diabetics  
• Can diabetics eat fruit? 
• Foods to lower blood sugar 

Takeaways 

Diabetes is a chronic but manageable condition, Araque says. People with diabetes should work with their doctor, nutritionist, and an exercise professional to design a program that meets their needs.

"The most important message is if they follow these recommendations they can get this under control and decrease risk for complications," Araque says. "Patients should have hope."

https://www.insider.com/how-to-treat-diabetes

Eight tips for travelling with diabetes during a pandemic

From diabetes.org.uk

Diabetes shouldn't be a barrier to going on holiday. But as coronavirus restrictions vary across the world, there are more things to think about before you plan a trip – especially if you're going abroad

Coronavirus has meant huge changes to the way we live, including when and where we travel.
The Foreign and Commonwealth Office currently advises British nationals against all but essential international travel. But there are some countries that this doesn’t apply to, because they’re not seen as high risk anymore. Check the UK government site for all the latest updates on where and when you can travel. You could also check the TravelHealthPro website for the latest travel health guidance.

If you are still hoping to travel, you may need to do a bit more planning ahead than you’re used to. As well as your usual list of what to pack, you will need to check and follow the current guidance in the place that you live as well as the place you’re travelling to. For example, in some areas of the UK you’ll need to wear mask on the flight and at the airport.

Find out about any entry restrictions, screening or quarantine requirements for the country you’re travelling to. It’s a good idea to find out where the local UK embassy is too, in case you need help in an emergency.

And if you’re thinking of booking a cruise, the advice is to hold off for the moment.

If you're looking at holidays within the UK, you'll need to check your national government sites for the latest updates on areas with local lockdown restrictions.

Travel insurance

The UK has now left the EU so there will some changes from 1 January 2021.
Buy travel insurance that covers your healthcare fully. European Health Insurance Cards (EHIC) will only be valid until 31 December 2021 so even if you have one, we still advise that you get travel insurance. This is because the card doesn't cover certain things like emergency repatriation (if you need to come home) and not all countries give the same level of cover as the NHS.

Check that your insurance provider covers pre-existing medical conditions like diabetes, because many do not. It’s really important you ask if they cover coronavirus in case you need treatment while away.

Packing checklist

• Face masks or coverings – can be disposable or reusable. Remember, you need to wash reusable face masks after each use. 
• Hand sanitiser – 100ml for hand luggage.
• Diabetes supplies, ID and meds – keep these in your hand luggage if you’re flying, along with a letter from your doctor, in case your hold luggage gets lost. Split them between separate bags if you can.
• Extra snacks in case of delays.

In some countries, blood glucose is measured in milligrams per 100 millilitres (mg/dl) and not in millimoles per litre (mmol/l). Take a look at our blood glucose conversion chart before you go.

At the airport

Heightened airport security means that it's really important that you plan ahead if you have diabetes. This means you'll avoid running into any last-minute problems.

Airport restrictions are subject to change, so contact your airline directly or call the Department for Transport’s enquiry line on 0300 330 3000 to find out about any changes. Or, you can go to gov.uk to find out more.

Security regulations

Current security regulations state that liquid items are only allowed in your hand luggage if they are in containers 100ml or less.

There are a few exceptions including essential medicines for your trip, which may be allowed in larger quantities above the current 100ml limit. This will be subject to authentication, so always check before you go.

Passengers are also permitted to carry essential medical equipment through airport security in hand luggage, though all medication and equipment must be supported by documentation from a relevantly qualified medical professional. The doctor's letter should be shown to the airline staff, and if you do encounter any problems you should request to speak to a manager or senior member of staff.

Tablets

There is no restriction on the number of tablets you take through airport security, but you would still need to take documentation from a medical professional or your prescription for authentication.

Travelling with a pump or CGM

If you treat your diabetes with a pump or use a continuous glucose monitor (CGM), make sure you contact your airline before you travel, if possible do this a few weeks before you fly.

The Civil Aviation Authority’s Advisory Health Unit recommends that people with diabetes should always contact their airline before travelling to discuss medical devices they need to take on board an aircraft.

Some airlines will require you to notify them of your medical equipment before the flight and fill in additional paperwork. If you don't do this, you might, in some cases, not being allowed to board the aircraft with your pump or CGM.

You should also speak to your diabetes team before you go. Should you need to remove your pump for any reason, they can provide you with any extra equipment such as insulin pens and help plan your doses throughout your journey.

Caution around insulin pumps and CGM on board aircraft is because of wireless functionality. This might interfere with aircraft communication and navigation systems. If your pump or CGM cannot function without a wireless signal, then you may need to be prepared to remove your CGM and pump and treat your diabetes with an insulin pen while you're in the air. You'll also need to test your blood glucose levels manually with a standard blood glucose meter.

Is it safe to go through the X-ray machines or full-body scanners?

If you use an insulin pump or a CGM you shouldn't put them through whole-body scanners or any X-ray machine. It's important to know that airports also use X-ray machines on any luggage you check in to the aeroplane hold as well as hand luggage. This is because X-ray waves can cause your pump or CGM to stop working properly. Contact the manufacturer of your devices if you have any questions about going through X-ray machines and whole-body scanners. 

If you have diabetes and you're carrying any medical equipment, you can download a Medical Device Awareness Card.

This card has information for airport security about diabetes and the equipment you're carrying to stop any confusion.

Organise medication

Take a letter from your doctor or clinic that explains that you have diabetes, the medication you use and all the equipment you need to treat diabetes. This should include insulin, insulin delivery devices, needles, blood glucose monitors, glucose tablets or liquid and ketone test strips.

It would be helpful if the letter explains the need to carry all medications and equipment with you in your hand luggage and to avoid storing it in your luggage in the hold. This is because problems will arise if luggage goes missing or your medication is spoiled. It would also be useful to take a recent prescription with you. Cabin crew may request medication be handed over for storage during the flight.

Take twice the quantity of medical supplies you would normally use for your diabetes. If you need to quarantine or self-isolate in the country you’re visiting, you may have to stay longer than planned.

And if you test positive for coronavirus, you are likely to need treatment locally and stay there until you are better. Follow your sick day rules if you become ill.

Before travelling, find out where you can get supplies of insulin at your destination in case of emergency. Contact your insulin manufacturer before the trip to see if your insulin is supplied in the country you are travelling to. If you need a prescription whilst on holiday, and your usual medication isn’t available, you may be given an alternative that does the same thing.

Managing medication when crossing time zones

Journeys across time zones may mean that you need to adjust your insulin. All international flights eastwards or westwards involve crossing time zones and days will be shortened or lengthened. There is no need to be alarmed about this. Many people across time zones regularly, without any serious problem. Remember that “running a bit high" for up to 24 hours is unlikely to cause you any harm.

Time zones and insulin

When travelling east to west, the day is lengthened and some clinics will advise you to take an extra meal and to cover it with extra insulin. When travelling west to east, the day is shortened and the amount of insulin and carbohydrate may need to be reduced.

In general, if your time zone change is less than four hours, you will not need to make major changes to your injections. If you are on two injections of insulin a day, a greatly lengthened day may mean that you need a small amount of insulin with a meal between two main injections. This will usually be short-acting insulin, but you will need to discuss the details with your diabetes doctor or nurse.

A shortened day may mean that you need to reduce your pre-flight insulin. Again, it is important to discuss this beforehand with your diabetes care team. When discussing this, make sure that you have your flight details to hand, including your departure time, the length of the flight, and the local time of arrival.

Many people now have three short-acting injections during the day, followed by a medium or long-acting injection in the evening. Because this regime gives a great deal of flexibility over the timing of injections and meal times, it can be easily adapted to time zone travel. Many people who regularly travel by air switch to this system.

Some people may have a problem with this system because the normal sleep cycle is broken by time zone travel. As a result, the medium or long-acting insulin is being taken more than once in every 24 hours. It may then build up in the body and cause a hypo.

Many diabetes doctors and nurses now recommend a variation on the above; you leave out the medium or long-acting injection entirely and rely on short-acting injections before meals until you are safely back on a 24-hour clock in your country of arrival. Many travellers find this very helpful because it allows them the flexibility they need.
Both systems allow you to adjust your dosage and timing of insulin injections as the day becomes shorter or longer.

Time zones and tablets

If you take diabetes tablets, you are unlikely to have any particular problems. Very occasionally, it may be necessary to take extra tablets to cover a longer day. Do discuss this with your diabetes care team beforehand.

You may, on occasions, need to leave out one dose of tablets on a short day, when you are travelling on a long west to east journey. Again, speak to your diabetes care team about this well in advance of the trip.

Food and travelling

Eating on a plane

Airlines can provide information on the times of most meals so you can plan your insulin.
It is best to order the standard meal, though this may not supply you with enough carbohydrate if you are on insulin or certain diabetes tablets. Cabin crew are usually able to provide fruit, crackers or rolls.

Glucose tablets and drinks used to treat hypos can be carried on board along with longer-acting carbohydrates such as biscuits. If you have any problems buying glucose tablets after going through customs, remember that any sugary non-diet drink, sugary sweets, fruit juice are all effective if you need to treat a hypo. To prevent blood glucose from dropping again eat a longer-acting carbohydrate, such as a sandwich, some fruit or biscuits.

On long flights, you may need snacks in between meals and at bedtime to prevent blood sugar levels going too low. Try to carry extra starchy carbohydrate foods, such as biscuits, cereal bars or fruit buns, on board the aircraft. If you use insulin, monitor your blood sugar levels frequently and be prepared to make changes to your dosage.

Eating abroad

The diet for people with diabetes is the same healthy diet recommended for everyone so you should be able to choose items from the regular menus. If you are travelling alone, you may like to let the staff know when you check-in just in case you become unwell during your stay.

There’s normally loads of opportunities to try different foods when you're abroad. And there’s no reason not to just because you have diabetes, but if you keep in mind the basics of healthy eating.

Since starchy carbohydrates are an important part of a healthy, balanced diet, it’s worth knowing what carbohydrates will be available locally. A good travel guide will give you an idea of the local cuisine, or you could carry a pocket dictionary or learn the words for a few basic foods.

There’s also the Carbs & Cals Pocket Counter or the Carbs & Cals app for Android or iPhone. These will help you to compare the food on your plate to the photos in the book or app, to quickly see the nutrients in your meal.

Get more about eating out when you have diabetes and healthy eating tips when you're abroad.

Allergies and intolerances

If you have food allergies or intolerances, try to find out the phrases for asking if foods are suitable for you. Allergy UK sells laminated translation cards in various languages.

Gluten-free products may not be commonly available in some countries. If you have coeliac disease, take plenty of gluten-free staples with you like bread, biscuits and crackers. For more on coeliac disease and travelling, go to Coeliac UK's website.

Whatever food allergies or intolerances you have, if you’re staying in a hotel ask when you're booking if they can cater for you. If you’re eating out and in any doubt whether food is okay, stick to plain foods where you can clearly see what you’re getting like boiled potatoes, salads, meat, fish or plain rice.

Food poisoning

Hot climates increase the risk of food poisoning, especially in countries where levels of sanitation are not as high as you’re used to.

Food cooked hot to order is the safest option and be wary of anything that may have been left standing or reheated. Watching where local people eat, or asking for recommendations, is a good way of finding the best eating places.

If you’re concerned about the safety of the local tap water, stick to bottled or sterilised water.

Remember to also avoid ice in drinks, salads that may have been washed in tap water and fruit that you can’t peel. Bottled water and sugar-free drinks are available in most places.

Hot climates

In hot countries, the biggest health threat is the sun, so keep covered.
Wear clothes that cover and protect your skin and make sure you wear high factor sunscreen. People often miss the backs of their hands and necks, so make sure you keep these covered and protected with sunscreen.

Sunglasses should also have a UV400 label to make sure they protect your eyes.

Take particular care of your feet if you have neuropathy which is the numbness
in your feet. This can mean you’re not aware skin is burning so protect them from the sun with socks or sunscreen. Make sure you wear well-fitting sandals on the beach, so they don’t burn on the hot sand.

Sunbathing

Sunbathing on the beach can make your blood sugar levels higher than normal, because you're not being very active.

Your insulin will be absorbed more quickly from the injection site in hot weather too, and this increases the risk of hypos. You’ll need to monitor your levels more often and be ready to adjust your diet or insulin dose.
Be careful of misleading test results because the extremes of temperature may affect the accuracy of your meter.

Also keep in mind that if your levels are higher, this could be because of the weather. Heat can damage your insulin and stop it from working properly.

To keep your insulin cool when travelling, it is best to store it in a hotel fridge (if there is one in your room) or in a cool bag (providing it does not freeze). A variety of cool bags and storage containers are available. If using a cool bag that uses plastic ice blocks, make sure that the insulin does not come into contact with the frozen plastic containers.

Cold climates

In cold weather, your insulin is absorbed more slowly at first, but can then be absorbed suddenly when you warm up later in the day. This can cause you to have a hypo. If your body also uses up more energy staying warm, for example shivering, this can lead to hypos too.

Hypos are more dangerous in cold conditions. This is because they interfere with your body’s attempts to stay warm and increase the risk of hypothermia.

Guarding against hypos is really important so remember your meter may not be accurate in cold conditions as well.

If you suffer
 from poor circulation
 or have neuropathy,
it’s particularly important to prevent frostbite, because the numbness in your feet can mean you don’t feel the cold.

https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/travel?utm_source=bronto&utm_medium=email&utm_term=Read+our+top+tips&utm_content=Read+our+top+tips&utm_campaign=Enewsletter+August+2020

New test may predict which newborns are most at risk of Type 1 diabetes

From ctvnews.ca

TORONTO -- A new test does the best job yet of predicting which babies are most at risk of developing Type 1 diabetes, researchers say.

Type 1 diabetes is caused when the pancreas does not produce enough insulin to regulate the body's blood-sugar levels. Unlike Type 2 diabetes, which has been linked to obesity and other lifestyle factors, Type 1 diabetes cannot be prevented.

It also primarily affects younger people; an estimated 90 per cent of Type 1 diabetes patients worldwide are under the age of 25. Approximately 40 per cent of children with Type 1 diabetes develop a complication known as ketoacidosis, which can be deadly – especially in the youngest children.

Ketoacidosis is typically only treated after diabetes is discovered. Although there are preventive treatments, they are rarely used because it is difficult to determine which children are at highest risk until the Type 1 diabetes manifests itself.

Now, researchers at the University of Exeter in the United Kingdom and the Pacific Northwest Research Institute in the United States say they have found a new, more accurate way to predict which babies will develop Type 1 diabetes – potentially opening up the possibility of preventive treatment.

"Using our new combined approach to identify which babies will develop diabetes can prevent these tragedies, and ensure children are on the right treatment pathway earlier in life," Lauric Ferrat, the lead author of the research and an applied mathematician at Exeter, said in a statement.

As outlined Friday in a letter published by the journal Nature Medicine, the researchers say they have developed a "combined risk score" test that takes into account genetics, family history of diabetes, biomarkers known to be linked to Type 1 diabetes and other factors.

When all those elements were considered together, the researchers report that they were able to "approach dramatically improved prediction of which children would develop Type 1 diabetes," forecasting whether children under the age of two would end up with Type 1 diabetes by the age of eight.

In addition, they say, their test allows far more efficient screening of newborns to prevent ketoacidosis.

The test is now being put to a trial in Washington state. The researchers say the same approach could potentially be used to predict whether newborns will develop other childhood diseases that are strongly linked to genetics, including celiac disease.

Type 1 diabetes is much less common than Type 2, affecting approximately 10 per cent of all diabetes patients worldwide.

https://www.ctvnews.ca/health/new-test-may-predict-which-newborns-are-most-at-risk-of-type-1-diabetes-1.5057172