Wednesday, 22 October 2014

Delicious Diwali & Dangers of Diabetes

Diwali - a celebration of good over evil is here. We wish that the colourful and bright night of happiness may wash away all the darkness, hatred and immorality from our society and our life.

Unfortunately, diabetes is one evil in life which can’t be just treated away. Once acquired it has to be managed either by painful insulin syringes, periodic check of blood sugar levels, controlling the kind of food and how much we eat of it and regular exercises. After doing all this we still will have to suffer from the complexities of diabetes.

Anyways, but this is not we want to talk about in this blog.  We are just a day away from the grand finale of the festival season. Diwali is already burning bright in Indian homes and fireworks will add to the haze in the air. This is that time of the year when we are ready to get sugar high instead of being high the other way round. Boxes of sweets and chocolates would have already started piling up in your refrigerators which will be distributed to wish our near and dear ones. Well, just like the beauty of this festival this time we decided to present our high on content (usually) blog into a riot of colour and try to bring out the problems of Diwali in a more easy on eye format.

Unfortunately, for many diabetics Diwali isn’t all about happiness but they do feel sad on this occasion. Thinking why? Well, because a diabetic always has to take utmost care of their diet pattern. Since Diwali involves a lot of delicious food and sweets it becomes very difficult to refuse everything or anything, for a pre-diabetic and a diabetic it becomes a tussle of health over desire. At such times diabetics feel slightly depressed as they cannot have rich food items and sweets, fearing sudden increase in their blood sugar levels. So how can a patient of diabetes still enjoy some Diwali festivity? We at would like to suggest following few actions which can help you to enjoy Diwali as well as keep a tab on your blood sugar levels.

Prepare for the Diwali Evening 
Along with preparing sweets and other rich-in-calories food items with natural sweeteners, you can prepare your body for the evening, which means eating food with very low or minimum calories from the morning till evening so that your body can easily digest one or two sweets which aren’t avoidable.

Diwali isn’t the excuse for skipping exercise
We all know festivals are the time to have fun and relax on your own pace taking it easy on things as it comes. Well-well that’s what a lethargic person may say but for a diabetic person festivals are the time to renew the energy towards living a healthier life. Use this good occasion to bring double the positive energies within yourself, think of it as fighting evil. Dedicate your time in the morning to exercise - either walk, jog, go gym, dance or swim and if possible spend an extra hour on Diwali day doing household chorus (cleaning, dusting, mopping etc.) - this will give you a few extra points for not only controlling diabetes but getting admired by family members for the time you’ve spent in doing household chorus. Diwali is also time for shopping, you can try parking your car little away from the mall/ shopping area, this will help you to break the stereotype routine exercises avoiding monotony.

Try Natural Sweeteners instead of artificial sweeteners
Artificial sweeteners should be avoided at all. Ofcourse you won’t add sugar in your sweets to make them sweet but try to completely avoid artificial sweeteners too, instead add dates or raisins or natural fruits to sweeten your sweets. It will certainly need a little effort to come up with exciting recipes that will keep you happy at the longer run, but you will certainly gain many brownie points in next get together where you can claim to find sweet recipes without compromising on their sweetness.

Upgrade for good - From regular Cooking Oil to Healthier Cooking Oils
Add a dramatic twist in your diabetic healthcare by just replacing your regular refined/ mustard oils to more lighter and nutrient rich avocado or olive oil. These new age oils largely found in European continent contain monounsaturated fats, polyunsaturated fats and Omega 3 fats which are gifted with natural tendency of lowering the blood sugar levels. The goodness of healthy facts can be further explored in food groups such as salmon, tuna and flax seeds.

The “If-This-Then-Do-That” rule - Let’s say if you have a Diwali dinner planned with friends and family which is bound to be loaded with calories (along with their love), then try to eat a below average meal during the day. You can just have fresh salads or drink buttermilk in your lunch menu, so that you can maintain the harmony in your sugar levels.

Alcohol is bad in everyday life as well as Diabetes -
Avoid consuming alcohol mostly but at festive occasions certainly. The moment you will get high, all the plans of celebrating diabetes friendly Diabetes will go for a toss, you may end up eating those fried items easily available. The other reason is quite obvious; alcohol tends to increase your weight leading to uncontrolled blood sugar. If it is must for you to have it for social obligations:  sip slowly on your drink so that your host doesn't quickly refill your glass. 
We can go on and on for different lifestyle and festival friendly tips which may help you to celebrate Diwali with Love and not with Diabetes but hope you got the crux of this blog -
Self-Control, Moderation and Dedication to fight Diabetes” - this is what you need. If you need any help in understanding the complexities of diabetes, please feel free to reach us any time.

Have a wonderful, bright, environment friendly and sweetness of love this Diwali. Celebrate it with one and all; celebrate it with not so privileged ones and share a smile with them.

Happy Diwali!

Dr. MS Singhal
Managing Director -
Singhal Diabetic Clinic, Haridwar 

Tuesday, 21 October 2014

Managing Diabetes in Disasters

Modern technologies has made alarms and information made reach faster to all. We learn of hurricanes, floods, earthquakes, industrial accidents and terrorist attacks immediately. We have seen on televisions how any disaster brings chaos to people and their environments. As a person with diabetes, your daily routine involves schedules and planning. An emergency can seriously affect your health. It may be difficult to cope with a disaster when it occurs. You and your family should plan and prepare beforehand even if the event is loss of electricity for a few hours. The first 72 hours following a disaster are the most critical for families. For this reason, it is essential for you and your family to have a disaster plan and kit which should provide for all your family’s basic needs during these first hours.

In our earlier blog we tried to cover the general problems a diabetic person may face in natural disasters and a few tips on how to manage your diabetes even in such circumstances. The recent calamities like floods in Jammu and Kashmir and then the severe cyclone Hudhud that hit Vizag had a large catastrophic effect on everyone trapped in those situations. We have introduced our Diabetes Helpline number where you can call and discuss with our doctors on any doubts or clarifications on effectively managing diabetes in natural disasters.

In the current blog we are trying to expand on problems which a known diabetic person may experience. We received queries like what if in such a critical condition the patient finds to have no insulin or any other anti-diabetic drug or there is unavailability or less quantity of medication to them, then how they can maintain their blood sugar levels and other such problems.

During natural tragedies, crises and other unavoidable threats, people with diabetes face particular challenges to their health care.
  • First and foremost, if you are a refugee seeking assistance by rescue forces in an emergency situation, it is of major importance to categorize yourself as a person with diabetes and any related conditions, so that you can obtain appropriate healthcare.
  • It is also important to prevent dehydration by drinking enough fluids, which can be difficult when drinking water is in short supply.
  • Additionally, it will be very helpful to keep some food item thing containing sugar with you at all times, in case you develop hypoglycemia (low blood glucose).
  • Further, to prevent infections, which people with diabetes are more susceptible to, pay careful attention to the health of your feet, and get medical treatment for any wounds at the earliest.

Preparing Yourself Before & During the Disaster

Modern day technologies help us to predict and get information in advance for the disasters like cyclone, and hurricane or even in case of floods, with latest communication devices we can get to know if the water is increasing in our area making it flooded. Utilizing these information, get yourself prepared before disasters strike you:

Insulin Storage and Maintaining its Effectiveness

Insulin from various manufacturers is often made available to patients in an emergency and may be different from a patient's usual insulin. According to the product labels from all the major insulin manufacturers, it is recommended that insulin be stored in a refrigerator. During and immediately after a disaster, patients in the affected area may not have access to refrigeration hence the user should ensure to keep their insulin be available with them in right stock and then should try to store them as cool as possible. Unopened and properly stored insulin in this manner, it may preserve the effectiveness of medicine until the expiration date on the package. However, an insulin product that has been changed for the purpose of dilution or has been removed from the manufacturer’s original container its shelf life reduces considerably and hence should be discarded within two weeks. 

As it is generally suggested try avoiding direct heat and direct sunlight as well as freezing if placed on ice. The insulin is kept away from direct heat and out of direct sunlight. To a large extent, insulin loses some effectiveness when exposed to extreme temperatures. The longer the exposure to extreme temperatures, the less effective the insulin becomes.  This can result in loss of blood glucose control over time.  Under emergency conditions, you might still need to use insulin that has been stored even at higher temperatures. You should try to keep insulin as cool as possible. If you are using ice, avoid freezing the insulin.  Remember not to use insulin that has been frozen.  When properly stored insulin becomes available again, the insulin vials that have been exposed to these extreme conditions should be discarded and replaced as soon as possible. Additionally, insulin contained in the infusion set of a pump device like reservoir, tubing, catheters should be discarded after 48 hours.

Switching between Insulin Products in an Emergency

Although a physician’s close medical supervision is an important aspect along with monitoring of blood glucose levels when switching insulin products. However, if medical supervision is not possible under emergency conditions, the following recommendations may be considered: 
  • Make sure to closely monitor your blood glucose and seek medical attention as soon as possible
  • One brand of regular insulin can be substituted for another brand of regular insulin and same for rapid-acting insulin on a unit-per-unit basis in emergency conditions
  • Regular insulins should be injected approximately 30 minutes before the start of each meal. Whereas, rapid-acting insulins begin working much speedily than regular insulin and hence are to be injected 15 minutes before the start of each meal to avoid dangerously low blood glucose levels 
  • One intermediate-acting insulin product may be substituted for another intermediate-acting insulin product on a unit-per-unit basis in emergency conditions. Likewise, these intermediate insulins may also be substituted for long-acting insulins on a total unit-per-day basis, in an emergency condition. 
  • Prominently, when switching from a once a day long-acting insulin to an intermediate-acting insulin; the dose of the once a day long-acting insulin should be cut in half and given as two injections of intermediate acting insulin, one in the morning with breakfast and one in the evening with dinner to avoid dangerously low blood glucose levels 
  • When switching from an intermediate-acting to a once a day long-acting insulin, add up the total amount of intermediate-acting insulin units for one day, and give it as a single long-acting insulin dose once a day 
  • Patients should check and be aware of the instructions for use of the pump device to see if available insulins are compatible with their devices 
  • Patients using insulin pumps who must switch to injected insulin may substitute intermediate or long-acting insulin for the total “basal” dose infused over 24-hours on a unit-per-unit basis in emergency conditions.

Blood Glucose Meters and Hurricane Disasters
Heat and humidity can damage blood glucose meters and test strips. If you use a blood glucose meter, check the meter and test strip package insert for information on use during unusual heat and humidity.

Diabetes Preparedness List

Safely store following to prepare yourself in disasters: 
  • Extra copies of medical prescription
  • Insulin/ Insulin pumps or injections including any counter medicines
  • Alcohol swabs
  • Cotton balls and tissues
  • Blood sugar level meter
  • Strips for your meter
  • Glucose/ Glucose tablets/ Orange juice etc. which can provide quick carbohydrate
  • Longer lasting carbohydrate sources like cheese and crackers
  • Container with cap to dispose used syringes

Quick Health Advice
  • Wash your hands to avoid illness or infection especially when testing your blood glucose or treating a wound
  • Keep safe drinking water after disaster as a diabetic you may need more fluids
  • Keep a first aid kit for emergency wound care and foot care
  • Being sick and raise your blood sugar levels hence avoid catching cold/ flu 

Call us for any further query on how to effectively manage diabetes and prepare yourself in such natural disasters.

Best regards,
Dr. MS Singhal
Singhal Diabetic Clinic, Haridwar

Tuesday, 14 October 2014

J&K Floods | Cyclone Hud Hud - Problems for a Diabetic

Jammu & Kashmir Floods | Cyclone HudHud in Vizag
Natural Disasters & added problems for a Diabetic

Image courtesy of piyato at

It's been a month in J&K and the water has already receded but the heavy rains in last few days have added to the woes of hundreds of families living in tents after their houses were damaged by the devastating floods which swept Kashmir a month ago. Srinagar has already recorded 23.6mm of rainfall yesterday and the metrological department has predicted more in coming days. On the other hand, the Cyclone Hudhud has hit India's coastal city - Visakhapatnam (Vizag) halting the normal life. 

These natural calamities prove more fatal for young children, old and patients. Though, we have done our small effort to help the Jammu & Kashmir flood victims, we also thought of writing this article as it is will be very helpful for our diabetics’ friends to understand how they can take care of themselves in these kinds of adverse situations. As J&K is still trying to normalize, down south the collectors of all districts along the Bay of Bengal in Andhra Pradesh and Odisha are still on high alert in view of the problems that has disturbed the life due to cyclone ‘Hudhud’, which will be accompanied with heavy rains. The memory of cyclonic storm Phailin that hit Odisha in October 2013 is still fresh in the minds of people. Phailin wreaked havoc in coastal Odisha although there were fewer casualties.

In the midst of a natural calamity of a humongous proportion which has affected lakhs of people in Jammu and Kashmir, people suffering from various illnesses, patients in hospitals and people diabetes will have their own share of problems which would have quadrupled due to this catastrophe. The direct problems arising out of flood has more or less abridged to a large extent but simultaneously the heavy rain falls are adding woes to the lives of people. Besides, the flood ravaged J&K may be facing an explosion of various diseases and if a person suffering from diabetes doesn’t takes care of him/her-self it may deteriorate the problems.

Let us quickly list out the major health concerns which a diabetic person in such natural calamities should be aware of and be prepared to handle them effectively:
  • Frequent thirst due to lack of proper drinking water facilities
  • Lack of quality and nutritious food options which a diabetic is advised to have
  • Uncontrolled blood sugar level due to lack of regular exercises
  • Lack of proper foot-care while walking in water clogged areas resulting in blisters or fungal infection
  • Respiratory issues due to stench arising out of clogged drainage, uncontrolled garbage, and other lack of general hygienic conditions
  • Increased stress for maintaining a regular and normal life while worrying about various other personal problems like ration, important supplies, damage to personal life and/ or property
A quick glance on some helpful tips for the problems stated above:
  • First, accept that you don’t have much control on such natural calamities hence there is no point in taking excess stress. Diabetes responds very adversely in stress hence it is better to manage your stress levels. For more details you can read our specific blog on Diabetes & Stress.
  • Deep breathing - Focus on your breathe and try to concentrate on solutions and how to help yourself as well as people around you.
  • Manage the present - Don’t rush over everything and get worried of future, this attitude of thinking will do no good for your health and may adversely affect your overall plan of getting rid of problems arising out of such calamities. Break your bigger worries in smaller tasks and try resolving them step by step rather than rushing over and not able to do anything
  • Try meditation to manage stress and anxiety in these adverse situations - It sounds and looks hard to believe to do meditations and focusing only on positive things but believe in yourself and answer to your problems. Do you think by worrying over things which you didn’t had control on can help you? Definitely not. Then why not to focus on making yourself better equipped to deal in such adversity.
  • Spread your social wings - Build a good social support system in your friends & family to whom you can talk to when in stress, remember stress is one of the biggest enemies of diabetes. Control your stress and effectively manage your blood pressure which invariably affects your blood sugar levels.
  • It’s not that hard but just keep a small note of all good things in your life - look at it when stressed and feel better
  • Try some mild stretching exercises or climb up and down the staircase to keep yourself physically fit - basically, any form of exercise will help you release good chemicals to manage your diabetes
  • Take good care of your foot. Fungal infection and foot problems are very common causes of hospitalization for a diabetic person. Since there will be water logging in fluids your feet will be exposed to bruises, blisters, softening of skin etc. You may try to avoid walking barefoot in water but even if you need to go in water get it properly cleaned and dry once you are out of water. We had written a detailed blog on foot care in diabetes in March, go through that for more useful tips.
  • There may be a lot of unwanted and sharp metallic objects in flood waters, hence avoid getting yourself hurt which can bother you with need of extra care and cause delay in healing any cuts/ bruises.
  • Diabetes lowers your immune system. Many a time people have complained of breathing issues in humid environment, since floods are brought by incense rain the possibility of humidity may also increase in the area, hence people with diabetes should be cautious. The humid environment prompts respiratory tract infections and asthma. The best solution is to keep your inhalers, sprays and medications as suggested by your doctor all the time when you go out. You may also find it helpful to keep your friends and colleagues aware of your breathing problems, so that in case of a sudden or severe attack they can be of prompt help.
  • A large section of people may be going through post disaster trauma and depression due to this horrifying experience of living in such a disastrous calamity. However, look at the positive side of life and remember that there are many-many people who are worse affected and there are much more people who are ready to lend a helping hand to you and help you in continuing a new journey through rehabilitation programs.

We understand all these points are helpful only when a person keeps its calm and try to resolve the issues. For the benefit of our diabetic friends who are affected by such natural calamities we humbly propose our following diabetes help-center number on which you can call us to get any kind of advice related to managing your diabetes.

Wishing you strength and courage to fight such adversities.

Dr. MS Singhal
MD - | Singhal Diabetic Clinic, Haridwar