For people with diabetes and COVID-19, blood sugar control is key

From sciencedaily.com

A study reported in the journal Cell Metabolism on April 30 adds to the evidence that people with type 2 diabetes (T2D) are at greater risk of a poor outcome should they become infected with the virus that causes COVID-19. But there is some encouraging news: people with T2D whose blood sugar is well controlled fare much better than those with more poorly controlled blood sugar.

"We were surprised to see such favourable outcomes in well-controlled blood glucose group among patients with COVID-19 and pre-existing type 2 diabetes," says senior author Hongliang Li of Renmin Hospital of Wuhan University. "Considering that people with diabetes had much higher risk for death and various complications, and there are no specific drugs for COVID-19, our findings indicate that controlling blood glucose well may act as an effective auxiliary approach to improve the prognosis of patients with COVID-19 and pre-existing diabetes."

More than 500 million people around the world have T2D. While it was clear that people with this condition fare worse with COVID-19, Li and colleagues wondered what role a person's blood glucose control might have on those outcomes.

To find out, they conducted a retrospective longitudinal multi-centred study including 7,337 confirmed COVID-19 cases enrolled among 19 hospitals in Hubei Province, China. Of those, 952 people had T2D and the other 6,385 did not. Among those with diabetes, 282 had well-controlled blood glucose; the other 528 did not.

The data showed that people admitted to the hospital with COVID-19 and T2D required more medical interventions. Despite those interventions, they also had significantly higher mortality (7.8% vs. 2.7%) as well as a greater incidence of multiple organ injury.

However, those with well-controlled blood sugar and COVID-19 were less likely to die than those whose blood glucose was poorly controlled. Meanwhile, those with well-managed T2D also received less of other medical interventions including supplemental oxygen and/or ventilation, and had fewer health complications.

The researchers say the new findings offer three main messages for people with diabetes:

• People with diabetes have a higher risk to die from COVID-19 and develop more severe complications after infection. Therefore, they should take extra precautions to avoid becoming infected.
• People with diabetes should take extra care to keep their blood sugar under good control during the pandemic.
• Once infected, patients with diabetes should have their blood glucose level controlled to maintain it in the right range, in addition to any other needed treatments.

The researchers say they will continue to study the relationship between T2D and COVID-19 outcomes. The hope is to learn more about the underlying biology that is leading to poorer outcomes for people with T2D and high blood sugar.

This work was supported by grants from the National Key R&D Program of China, the National Science Foundation of China, the Major Research Plan of the National Natural Science Foundation of China, the Hubei Science and Technology Support Project, and Medical Flight Plan of Wuhan University.

https://www.sciencedaily.com/releases/2020/05/200501120102.htm

Healthy Ramadan meals for people with diabetes

From gulftoday.ae/news

People with diabetes may still fast during the Holy Month of Ramadan with proper consultation and guidance with their diabetologists and/or endocrinologists.

This is to prevent four acute conditions brought about by “metabolic consequences of prolonged fasting combined with dietary changes and alterations to the dosage and timing of the medications,” Al Zahra Hospital-Dubai Endocrinology & Diabetes specialist Dr. Vikram Hundia said in an interview on Wednesday.

Hundia identified the complications as hyperglycaemia (high blood sugars), hypoglycaemia (mildly low blood sugars), severe hypoglycaemia, and diabetic ketoacidosis (characterized by the insufficient amount of insulin to produce glucose and a warning sign that the diabetes is getting out of control and may lead to body poisoning).

“It is never too late to consult with your doctor on what to do and not to do for the rest of the Holy Month of Ramadan. But make a clear written plan with your Diabetes Team about any changes to your insulin or diabetes medication dosage and timing to maintain satisfactory diabetes control and avoid hypoglycaemia or other diabetes-related complications,” he said.

Hundia added: “Check your blood sugar levels more frequently. Drink plenty of sugar-free fluids during the non-fasting times to avoid dehydration. Avoid caffeine.”

He emphasized the role of the dietician.

                                               Photo has been used for illustrative purpose.

Hundia’s colleague, Reshma Devjani was interviewed as well and while she offered healthy tips too, she also spent time dishing out menu samples for the diabetics.

Devjani pointed out seven causes why people with diabetes suffer from poor glucose control during the Holy Month of Ramadan, leading to the shoot up and/or prolonged high blood glucose levels and weight gain.

These are large meals particularly at Iftar; indulgence in processed food and refined carbohydrates; excessive consumption of empty caloric food namely dates, juices, colas, and sugary desserts; frequent snacking and inadequate meal spacing; fast-pace eating the consequence of which is over-eating; irregular blood glucose monitoring; skipping of medications, mismatching of medications or insulin to the altered “me timings.”

“Remember to keep meal portions in moderation. Choose to eat whole grains and seeds like barley, millets, oats, semolina, quinoa, wild rice, beans and lentils,” Devjani said.

Devjani’s meal sample for people with diabetes who fast during this Holy Month of Ramadan:

Iftar: one to two small dates plus one to two glasses of water; one cup of Tabbouleh Salad; 90 to 120 grams of Chicken cooked in Curry Sauce; one cup of Steamed Wild Rice; one cup of Low Fat Greek Yoghurt; and two glasses of water.

First Snack: one Baked Apple topped with Cinnamon plus 10 to 15 Walnut Halves and two glasses of water.

Second Snack: two to three tablespoons of Hummus Dip with Carrot/Cucumber/Celery Sticks as desired plus one cup of Laban and two glasses of water.

Suhour: two slices of Whole Grain Bread, Omelette with Grilled/Sautéed Vegetables on the side, one tablespoon of Peanut Butter or 30 grams of Avocado, one cup of Low Fat Greek Yoghurt or Laban, one-half cup of Strawberries, and two glasses of water.

For Ramadan Day 2:

Iftar: one to two dates plus one to two glasses of water, one cup of Homemade Lentil Soup, one cup of Green Salad topped with Lemon Dressing, 90 to 120 grams of Lean Meat, one cup of Cooked Quinoa, one cup of Low Fat Greek Yoghurt.

First Snack: one cup of Berries topped with two to three tablespoons of Low Fat Greek Yoghurt garnished with two tablespoons of Crushed Walnuts and Pumpkin Seeds and two glasses of water.

Second Snack: two Oven-Baked Chicken Spring Roll with one tablespoon Guacamole Dip plus one cup of Homemade Pumpkin Soup and two glasses of water.

Suhour: one Small Four-Inch Brown Pita Bread, one cup of Cooked Foul, two tablespoons of Low Fat Labneh with Zaatar plus three to four Olives, one cup of Low Fat Greek Yoghurt or Laban, one Small Plum and two glasses of water.

https://www.gulftoday.ae/news/2020/04/29/healthy-ramadan-meals-for-people-with-diabetes

People with diabetes encouraged to be cautious during COVID-19 pandemic

From wmcactionnews5.com

MEMPHIS, Tenn. (WMC) - People with diabetes are being encouraged to be cautious during the coronavirus pandemic.

Methodist Diabetes Care and Education Specialist Nykkia Sellers said, "Since it is an underlying condition, and if your diabetes is poorly controlled, and you have heart disease, lung disease, obesity, advanced age - those things do put you at a higher risk of contracting COVID-19."

Sellers added that there have been instances where people did not know they were diabetic until they had the virus.

“I know of one person, in particular, that was diagnosed with COVID-19 and also was newly diagnosed with diabetes. I can’t necessarily say which one came first but that has happened here recently,” Sellers said.

It is why she is recommending that people who may have a history of diabetes in their family, are overweight or are experiencing symptoms of diabetes, like excessive thirst, unexplained weight loss, and extreme fatigue, should contact a medical professional to get screened.

Contracting COVID-19 while also being diabetic presents serious complications. “You may have an increased risk of respiratory failure. You may have an increased risk of kidney disease. There’s a seven-fold increase of mortality associated with persistent hyperglycaemia - which is elevated blood sugar or diabetes - with COVID-19,” Sellers explained.

Sellers said keeping a log of your weight and spending time exercising will help with managing diabetes at this time.

"Taking your blood sugar, eating healthy, and staying away from processed food. I know that during this time people will lean to their quarantine snacks, but try to choose some healthy snacks as well." Sellers said.

https://www.wmcactionnews5.com/2020/04/28/people-with-diabetes-encouraged-be-cautious-during-covid-pandemic/

From aiding digestion to controlling diabetes: Know the many health benefits of curry leaves

From indianexpress.com

Curry leaves are easily available and can also be grown at home. They don't just add to the flavour to your food, but are beneficial for your health too.

Curry leaves are commonly used in several Indian dishes, from dals and chutneys to salads. They don’t just add to the flavour but are beneficial for your health too, said holistic wellness coach and nutritionist Luke Countinho in an Instagram video.

Curry leaves are easily available and can also be grown at home. Calling it an “Indian superfood”, Countinho went on to talk about their health benefits. They are rich in iron, calcium, vitamin A and most of the spectrum of vitamin B (can aid memory and skin problems), Countinho explained.

Benefits of curry leaves

1. Diarrhoea and constipation: Boil curry leaves in water and drink the liquid. You can also make a paste of the leaves and mix it in your food or consume it with jaggery for benefits.

2. Morning sickness, nausea: Consumption of curry leaves can reduce the feeling of nausea or morning sickness, commonly experienced by pregnant women. It is also used for patients going through chemotherapy or radiation to reduce nausea. You can grind curry leaves into a powder and sprinkle it on your lentil dish or khichdi or chutney, for instance.

                              Curry leaves have many health benefits. (Source: Getty Images)

3. Diabetes: Curry leaves are rich in iron, copper and zinc which help reduce blood sugar levels. It is therefore recommended that diabetics include curry leaves in their meals.

4. Boosts immunity: Curry leaves have antibacterial properties and can help your immune system. It is suggested that you have curry leaves while undergoing an antibiotic course.

5. Good for eyes: The vitamin A in curry leaves is good for improving eyesight. Vitamin A contains carotenoids that lessen the risk of cornea damage. Vitamin A deficiency, on the other hand, could increase the risk of night blindness, loss of vision and cloud formation, according to lybrate.com.

6. Good for hair: One of the best treatments for your hair is coconut oil and curry leaves. For this, you can boil the curry leaves in coconut oil until it becomes thick and store it for three to six months. Curry leaves are great for the scalp and can treat dandruff, thinning hair, hair fall and premature greying.

7. Cholesterol: Curry leaves contain carbazole alkaloids which help control cholesterol production in the liver.

8. Digestion: Curry leaves are good for digestion because they help stimulate the production of digestive enzymes that break down carbohydrates, fats and proteins.

Moreover, they can be used extensively in the case of Alzheimer’s, dementia, Parkinson’s and cognitive brain disorders, because anything rich in the spectrum of vitamin B is good for the brain, added Coutinho.

https://indianexpress.com/article/lifestyle/health/curry-leaves-health-benefits-digestion-diabetes-eye-hair-6376088/

Diabetes Care During COVID-19 Lockdown

From medicinenet.com

APRIL 25, 2020 -- As concerns about coronavirus deter people from seeking hospital care, endocrinologists and a leading UK charity are calling for general practitioners (GPs) and the public to be aware of the signs and symptoms of type 1 diabetes.

Diabetes UK say they have heard anecdotally from clinicians that disproportionate numbers of young people are arriving for urgent care already in diabetic ketoacidosis (DKA) while the country is in lockdown.

And May Ng, MBBS, PhD, a paediatric endocrinologist and associate medical director at Southport & Ormskirk Hospital NHS Trust, UK, told Medscape Medical News that in her area they have already seen two presentations of severe DKA prior to type 1 diabetes diagnosis in the past 4 weeks, which she believes reflects the picture countrywide.

There have been similar reports from clinicians in Italy and China at the peak of their outbreaks, as previously reported by Medscape Medical News.
"We have been concerned about the delayed presentation of cases where children have attended accident and emergency [A&E] very unwell as they have not been seen earlier," Ng said.

"Many families are worried about COVID-19 and the risks of infection. And while they have done the right thing by keeping minor illnesses at home, the message must go out that if your child is unwell and you are worried, do not wait — seek help early with the GP and go to [the emergency room]."

But Simon Heller, MD, professor of clinical diabetes at the University of Sheffield, UK, isn't so sure this is the case.
"I'm aware of new cases of type 1 diabetes but they've been seen promptly by children's admissions, so I think it is a theoretical risk," he commented.

He said that, at least in the case of children with undiagnosed type 1 diabetes, paediatric emergency departments are relatively protected from COVID-19. So if a parent recognizes a child is ill, "they should be able to be seen by the GP in the normal way and be sent to A&E."

Nevertheless, he says it will be important to systematically gather findings on this issue and examine the impact of COVID-19 on new diagnoses of type 1 diabetes.

Diabetes UK stress that the early signs and symptoms of type 1 diabetes are easy to mistake for a viral infection or other illness, which is why it is so important to be 4T aware. 4T refers to toilet, thirsty, tired, and thinner.

• Toilet: Going to the toilet a lot, bed wetting by a previously dry child, or heavier nappies in babies.
• Thirsty: Being really thirsty and not being able to quench thirst.
• Tired: Feeling more tired than usual.
• Thinner: Losing weight or looking thinner than usual.

"It is vital that parents are aware of the early signs of type 1 diabetes and seek help if they need it," said Dan Howarth, head of care at Diabetes UK.
"DKA can be a life-threatening complication of diabetes. If a child or young person does not receive immediate treatment for DKA, it can lead to coma, or even death," he stressed.
"The quicker children are diagnosed the less likely they are to become seriously ill," Howarth noted.
And he also urged GPs not to forget about possible diabetes symptoms.

"When patients call or visit the practice, try to ensure that the tell-tale symptoms of type 1 diabetes are not overlooked — especially as the 4Ts may not be all present at the same time," he said.
"Signs of type 1 diabetes need to be addressed as soon as possible, because if not, it will lead to further risks for the patient and can potentially lead to an acute admission to hospital."

These concerns echo comments made last week by Stephen Powis, BM BCh, PhD, national medical director of NHS England, when he highlighted the need to ensure medical attention for non-COVID-19 diseases is sought in a timely way.

"If you have any emergency condition, whether it's a sick child, whether it's a mother or a pregnant mother...you should be seeking emergency services, just as you always have done — they are there for you. And although we are focusing on coronavirus, it's important that we also continue to focus on other emergency conditions," Powis said.

Even prior to the coronavirus pandemic, it's estimated that around 600 children and young people in the UK each year receive a type 1 diabetes diagnosis only after they develop DKA, based on National Paediatric Diabetes Audit Hospital admissions and complications reports (2012-2015, 2017).

https://www.medicinenet.com/diabetes_care_during_covid-19_lockdown-news.htm

Are carrots good for those with diabetes?

From medicalnewstoday.com

Some people believe that carrots raise blood sugar levels and that people with diabetes should not eat them. However, this is not the case.

In this article, we explore the effects that carrots can have on blood sugar and describe the ways in which carrots can benefit the health of a person with diabetes.
We also look into the carrots’ glycaemic index (GI) score, the most healthful way to prepare them, and other dietary tips for people with diabetes.

Should people with diabetes eat carrots? 

Because carrots are a non-starchy vegetable, people with diabetes can eat them freely, according to the American Diabetes Association (ADA).

In fact, carrots may benefit people with diabetes because they contain the following compounds:

Carotenoids

Carrots are a good source of carotenoids, a type of pigment.
In the diet, these compounds primarily occur in orange and yellow fruits and vegetables.

The pigment in a person’s eyes also contains carotenoids, and their antioxidant activity helps protect the retina from damage.
Some research suggests that carotenoids may be protective against diabetic retinopathy.
Diabetic retinopathy is a disease that can lead to loss of vision, and it is a common complication of diabetes.
According to a 2015 study, diets that contain high levels of alpha and beta carotene may contribute to a reduced risk of type 2 diabetes.
Carrots are rich sources of these carotenes, containing 8,285 micrograms (mcg) of beta carotene and 3,477 mcg of alpha carotene per 100 grams (g).

Healthful carbohydrates

Managing blood glucose, or blood sugar, levels is the primary goal of diabetes treatment. The total amount of carbohydrates that person consumes has a strong influence on these levels.
A medium raw carrot contains 5.84g of carbohydrates. Although carrots are not necessarily low in carbohydrates, they are a healthful source.

According to the Centres for Disease Control and Prevention (CDC), on average, carbohydrates should make up 45% of the calorie intake for people with diabetes.
Counting carbs and keeping them within a healthful range can help a person regulate their blood sugar levels and thus prevent diabetes complications, which can include:

• heart disease
• kidney disease
• vision loss
• stroke

Vitamin A

According to a 2015 article in the journal Diabetes Management, low levels of vitamin A may be an independent risk factor for diabetes.

Another article, published the same year in Endocrine, Metabolic & Immune Disorders Drug Targets, warns that people with chronic diseases involving carbohydrate intake, such as diabetes, should be sure to consume enough vitamin A.
This may be especially good advice for people with type 1 diabetes, which causes T-cells in the body to attack insulin-producing beta cells.

Vitamin A plays a crucial role in the pancreas and in the production of these beta cells.

The vitamin also helps regulate immune functions, such as T-cell-mediated immunity, which may affect the onset of type 1 diabetes.

Carrots are a good source of vitamin A, containing 835 micrograms per 100g.

Fibre

Eating more fibre can improve blood glucose levels and boost insulin resistance and insulin sensitivity, helping to combat diabetes.
People with diabetes should consume 20-35g of fibre per day, from vegetables, fruits, and minimally processed grains.
Carrots contain 2.8g of dietary fibre per 100 g.

What is the GI score of carrots?

The GI is a tool that measures how the carbohydrates in specific foods affect a person’s blood glucose levels.
A type of food with a high GI score will raise blood sugar levels more than a food with a low GI score.
The ADA consider foods with scores of 55 or under to have low GI scores. Boiled carrots have a GI score of 33, and raw carrots score even less.
The association recommends eating at least 3-5 servings of vegetables a day. One serving is about:

• ½ cup of cooked vegetables
• 1 cup of raw vegetables

Choosing non-starchy fruits and vegetables, with GI scores of 55 or less, can help a person with diabetes manage their blood sugar levels.

Other non-starchy vegetables, which people with diabetes can eat freely, include:

• leafy greens, such as kale and spinach
• salad greens
• tomatoes
• mushrooms
• peppers
• onions
• green beans and wax beans
• celery
• cucumbers
• brussels sprouts
• cabbage
• artichokes
• asparagus
• cauliflower and broccoli
• okra
• summer squash

Healthy eating tips for diabetes 

The following strategies can help a person with diabetes follow a healthful diet:

• Choose higher-fibre, minimally processed carbohydrates: These come from whole grains, fruits, vegetables, and dairy products.
• Limit salt: A person should consume no more than 6 g of sodium per day.
• Choose healthful fats: These come from nuts, avocados, seeds, oily fish, and vegetable oils.
• Limit red and processed meats: Opt for lean sources of protein instead, such as pulses, eggs, poultry, unsalted nuts, and fish.
• Reduce sugar intake: It is important to check labels carefully for added sugar and look to fruit when sugar cravings strike.
• Choose healthful snacks: For a person with diabetes, these include yogurt, nuts, seeds, fruits, and vegetables.
• Limit alcohol consumption: The ADA recommend that males have no more than two drinks per day and females have no more than one.
• Avoid supplements: Try to obtain vitamins and minerals from the diet, unless a doctor recommends specific supplements.

Summary

People with diabetes can eat non-starchy vegetables freely — including carrots.

Eating them raw or cooking them very lightly can help prevent the preparation from increasing the GI score.

Various compounds in carrots, such as carotenoids, fibre and vitamin A can help manage blood sugar levels and prevent complications, such as diabetes-related eye damage.

Maintaining a healthful diet, reducing the intake of carbs, and boosting levels of physical activity can all play important roles in managing diabetes.

https://www.medicalnewstoday.com/articles/are-carrots-good-for-diabetics#tips

Seniors with diabetes: Questions to ask your doctor

From signalscv.com

If you’re a senior with diabetes, you’re not alone. The statistics are eye opening — more than 25% of Americans age 65 and older have diabetes, according to the American Diabetes Association. What’s more, the Centres for Disease Control and Prevention reports diabetes as the seventh leading cause of death in the U.S.

If you’re a senior and have diabetes or help care for a loved one with diabetes, you probably have a lot of questions. Thankfully, technology has advanced incredibly over the last decade, and can now change how people manage diabetes for the better.

Building a strong relationship with your doctor is one of the best things you can do to help manage your diabetes and stay healthy. Be sure to keep an open dialogue and come with questions before any appointments.

To get you started, here are three important questions you should ask your doctor.

What is continuous glucose monitoring and how can it help me?

People with diabetes who take insulin must monitor their blood glucose levels frequently. Uncontrolled glucose can cause health complications and even death.

The traditional standard-of-care for glucose monitoring has been a blood glucose meter, which is painful and time consuming, as patients must test their blood multiple times throughout the day.
A continuous glucose monitoring (CGM) system can help people with either Type 1 or Type 2 diabetes to track glucose levels on a continuous basis. Unlike blood glucose meters, CGMs can help eliminate painful finger pricks and provide vital health information.

CGMs are discreet, easy to use and relay a user’s glucose levels instantly to a compatible smart device or dedicated receiver, providing the direction and rate of glucose change with the touch or scan of a screen.

They can help you understand the impact of physical activity and certain foods on your health and glucose levels, as well. The Dexcom G6 CGM, which is reimbursed by Medicare for eligible patients, also has an app option that gives patients the ability to share glucose information with up to 10 people who can view it through a separate Follow app.

How can I be more active?

Regular exercise is important for everyone, but it’s particularly important for people with diabetes. According to the American Diabetes Association, your cells become more sensitive to insulin when you’re active, so it works more effectively. Being active helps manage a healthy weight, which is also important.

You may think that due to your age or physical ability you can’t exercise, but talking to a physician can reveal options that fit your personal needs. Slow walks, stretching, yoga and even swimming are good, low-impact activities.

Check community centres and local gyms for classes that are geared toward seniors. When beginning an exercise regimen, talk to your doctor to discuss any concerns you have and get his or her recommendations on what will work best for you in order to exercise in a safe manner.

How can I eat healthier?

Following a nutrition plan is an important part of managing diabetes. Patients with diabetes have extra nutritional considerations to keep insulin levels in check. Doctors can provide insight into healthy eating and explain how carbohydrates impact blood glucose levels.
You can also consider speaking with a registered dietitian to help you evaluate your eating habits and create a nutrition plan with foods you enjoy that are also complementary to a healthy diabetes lifestyle.
Let these questions help guide you to a productive conversation about diabetes with your doctors and other members of your health care team.

https://signalscv.com/2020/04/seniors-with-diabetes-questions-to-ask-your-doctor/