Diabetes Magazine (Diabetes Free Life) by santosh kumar bagla

DIABETES FREE LIFE Volume 1

Issue 1

UNITED WORLD DIABETES FEDERATION

Principal Advisor Dr. Santosh Kumar Bagla Medical Advisor Dr. Manish Gupta Patron Bharat Singh Editor Dushyant Kumar Sharma Editorial Co-ordinator V.K.Rohilla

The mission of “Diabetes Free Life” is to promote diabetes care, awareness and preven on. The ac vi es aim to inﬂuence policy, increase public awareness and encourage health improvement, promote the exchange of high-quality informa on about diabetes by organizing debates, conferences, seminars to provide educa on for people with diabetes and their healthcare providers.

Publisher Rohit Bagla Legal Analyst Sushil Kumar Antal Pub. Assistance Global Wellness Founda on Legal Advisor Law Jurix Produc on & Development Rahul Kakapuri Editorial Sec on Deepak Singh Media Co-ordinator Rahul Bhatnagar

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Copyright Any form of reproduc on of any content on this publica on without the wri en permission of the publisher is strictly prohibited. United World Diabetes Federa on is a trademarked company. © 2016 Diabetes Free Life Magazine.

Imprint Line Printed by M/s GRAPHIC PRINT and Published by ROHIT BAGLA on behalf of M/s IONIC MSM LIMITED and printed at 383, FIE GROUND FLOOR, PATPARGANJ INDUSTRIAL AREA, P.SMADHU VIHAR DELHI -110091. And Published at 52 – BABAR ROAD NEW DELHI -110001. Editor DUSHYANT KUMAR SHARMA

Co-ordinator Asia Region Rehan Khurshid

Supported by: UN

Advisor USA & Canada Dr. Yogi Bhardwaj

Global Wellness Foundation

E-mail:

info@diabetesfreelife.in Follow us

EDITORIAL F

rom the Editor Dear readers Gree ngs from United World Diabetes Federa on!

Dushyant Kumar Sharma Editor

It gives me immense pleasure on the release of the inaugural issue of our magazine Diabetes Free Life under the banner of United World Diabetes Federa on (UWDF). Before ge ng into the details of what our magazine oﬀers to our readers, let me share in brief what is UWDF and why we are here.

We are a non-profit organiza on dedicated to eradica on of diabetes, aiming to influence policy making, increase public awareness on the disease, its risk factors and how a pa ent can cope with and overcome the disease by adop ng a healthy life style through sustained campaigns, support pa ent care where it is not available and promote exchange of informa on by working in associa on with various stake holders: policy makers, government agencies, NGOs, local governing bodies, healthcare providers and pharmaceu cal industry. The prevalence of diabetes is es mated to double globally to a staggering figure of 366 million in 2030, with India registering the largest increase in the numbers of diabe cs among its popula on of which 62 million, that is, 7 per cent, is diabe c. For this sheer size of its diabe c popula on, no wonder India is dubbed as the Diabetes Capital of the World. Why? One reason I can perceive why India has gained this dubious dis nc on is lack of informa on and awareness. For instance, around 44 million Indians in their most produc ve years do not know that they are diabe c and that they are at risk of heart a acks, strokes, blindness, kidney failure and other serious complica ons that arise due to this disease. According to the Interna onal Diabe c Federa on, more than 51% of Indians are not aware of diabetes for lack of access to diagnosis let alone treatment. The launch of Diabetes Free Life is a humble effort to plug this gap by spreading awareness about diabetes, its control and management. As part of our mission, UWDF is going to undertake the following ini a ves in near future: Ÿ Launch India's first Diabetes Awareness Mobile Van. This van will operate ini ally in five

states, namely, Delhi, Haryana, Rajasthan, Maharashtra and U ar Pradesh, to conduct free check-ups, conduct free screen tests and diagnosis and provide free medical advice and medicine.

Ÿ Formulate a Skill Development Curriculum in associa on with Na onal Skill Development

Programme of the Government of India, to train and educate diabetes pa ents on survival skills and control and management of diabetes. Ÿ Launch a Diabetes Educator Programme to spread awareness, educate people about preven on and control of diabetes by organizing seminars and symposium, covering all ci es and rural areas. Ÿ Launch a personalized health care app designed to provide chronic diabe c and heart pa ents a single dashboard to manage all their requirements and track progress. However, publishing a dedicated magazine and working toward fulﬁlling these avowed aims are an onerous undertaking demanding huge resources. Hence, on this occasion, it will not be out of place if we ask the larger corporate world including hospitals, equipment and accessories manufacturers, pharmaceu cal industry and public sector undertakings to liberally support this noble cause and discharge their corporate social responsibility. On this occasion, we also call upon all medical experts, researchers and scien sts working on diabetes to contribute informa ve ar cles and share their experiences with us to make Diabetes Free Life an interac ve vehicle of informa on sharing. Readers, too, can join this mission and share their own experiences by wri ng to us. Together, I believe, we can keep this scourge under our thumb! Let's join hands to make India and the larger world free of diabetes! Yours truly Dushyant Kumar Sharma,

Editor

Supported by

UWDF TM

UNITED WORLD DIABETES FEDERATION

OUR VISION TM

Diabetes Free Life OUR MISSION

The mission of the United World Diabetes Federation to promote diabetes care, awareness and prevention United World Diabetes Federation, is a section 8 company registered in India under the provision of Companies Act, 2013.Having its registered office at 52 Babar Road, New Delhi-110001. The company was registered on 27/09/2016 with Registrar of Companies, New Delhi with CIN No. U74999DL2016NPL306481

UNITED WORLD DIABETES FEDERATION

United World Diabetes Federation is a non-prot organization registered with Government of India, The mission of the United World Diabetes Federation to promote diabetes care, awareness and prevention. We are ghting against diabetes Globally. The United World Diabetes Federation activities aim to inuence policy, increase public awareness and encourage health improvement, promote the exchange of high-quality information about diabetes, and provide education for people with diabetes and their healthcare providers.

World Diabetes Day 14 Nov.

world diabetes day 14 November

orld Diabetes Day is the primary global awareness campaign of the diabetes world and is held on November 14 each year. It was introduced in 1991 by the Interna onal Diabetes Federa on and the World Health Organiza on in response to the alarming rise of diabetes around the world. World Diabetes Day is a campaign that features a new theme chosen by the Interna onal Diabetes Federa on each year to address issues facing the global diabetes community. While the campaigns last the whole year, the day itself marks the birthday of Frederick Ban ng who, along with Charles Best and John James Rickard Macleod, ďŹ rst conceived the idea which led to the discovery of insulin in 1922. Each year, World Diabetes Day is centred on a theme related to diabetes. Topics covered have included diabetes and human rights, diabetes and lifestyle, diabetes and obesity, diabetes in the disadvantaged and the vulnerable, diabetes in children and adolescents. People with diabetes get to take a day oďŹ&#x20AC; work or school on this day and talking about Diabetes. World Diabetes Day is celebrated worldwide by the over 230 member associa ons of the Interna onal Diabetes Federa on in more than 160 countries and territories, all Member States of the United Na ons, as well as by other associa ons and organiza ons, companies, healthcare professionals and people living with diabetes and their families. The global diabetes community including Interna onal Diabetes Federa on member associa ons, diabetes organiza ons, NGOs, health departments, civil society, individuals and companies develop an extensive range of ac vi es, tailored to a variety of groups.

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CELEBRITIES & DIABETES Sachin Tendulkar named brand ambassador for diabetes Fondly called the “God of Cricket” or “Master Blaster,” Sachin Tendulkar is considered one of the greatest batsmen of all time in the sport that is considered a national institution in India, cricket. But Mr Tendulkar has many feathers to his cap. He is also a member of parliament and has been involved in promoting and supporting several social causes in India relating to health care and education. Sachin Tendulkar Former Indian Cricketer

Mr Tendulkar has been associated with UNICEF for more than a decade now and has supported various of the organization's causes. In 2003, he put his weight behind an initiative to create awareness about polio and promote polio prevention in India. Since 2008, he has been significantly involved with UNICEF in creating and promoting hygiene and sanitation in communities. In 2013, he was appointed UNICEF Ambassador for South Asia to advocate this important cause all the region.decade now and has supported various of the organization's causes. In 2003, he put his weight behind an initiative to create awareness about polio and promote polio prevention in India. Since 2008, he has been significantly involved with UNICEF in creating and promoting hygiene and sanitation in communities. We admire them, we cherish them, we love them and we will be happy to be in their place. Whether you are a fan or not there is no denying that our lives have been affected by many larger than life celebrities from Bollywood and Hollywood circle. But have you thought how their lives may also get affected by diabetes? Yes, they have plenty of resources to get the best treatment, have a best dietician to manage their daily food intake which may help them manage diabetes, they can hire the best of trainers.

Tom Hanks American Actor

Amitabh Bachchan Legendary India Film Actor

When Tom Hanks announced in 2013 that he had Type 2 diabetes, he joined millions of other Americans with this diagnosis. Age 57, Hanks had elevated blood sugar levels for years before being diagnosed, a not uncommon pattern with Type 2.While weight gain is a risk factor, yo-yo dieting may have also played a part. Hanks gained 30 and lost 50 pounds for A League of Their Own and Cast Away, respectively, among other roles that required weight changes.

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CELEBRITIES & DIABETES Sonam Kapoor the famous film actress has struggled with diabetes from her teenage years. She has followed a strict diet regime with daily insulin to stay healthy. Her hectic schedule did take a toll on her but she soon learned to manage the condition, and hasn’t let it stop her from becoming one of the most sought-after actresses in B-town.

Sonam Kapoor Indian actress

The Famous & talented actor suffers from type 1 diabetes and is part of 5% of Indian diabetic population that suffers from this variety of diabetes. The actor hasn’t let the disease dampen his zest for life and has even become an advocate for diabetes awareness, promoting.

Kamal Haasan Indian film actor

The former Channel V VJ and IPL Extra Innings host was diagnosed with type 1 diabetes when he was 22. The witty actor took the diagnosis in his stride and lives a healthy lifestyle to counter the disease. He practices yoga and jogs regularly to keep fit and also follows a strict diet while abstaining from alcohol to keep his blood sugar under control. Gaurav Kapoor Indian Actor

Famous as an overweight comedian and sitcom star, Carey dropped 80pounds after being diagnosed with type 2 diabetes. He claims that after losing weight he now no longer requires diabetic medicine every day.

Billie Jean King A tennis Player

Drew Carrey American Animator

Perhaps the greatest women tennis player of all time, she was diagnosed with the condition in 2006. She lost 35 pounds to fight the disease and went on to become a spokesperson for diabetes awareness. As we can diabetes knows no class but it’s a manageable condition. All you need to do is be aware to tackle the menace.

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CELEBRITIES & DIABETES Celebrity chef Paula Deen confirmed that she had Type 2 diabetes in early 2012, at age 64. Famous for fat- and calorie-laden Southern dishes, experts speculated that a dietary overhaul would be tough for Deen. While an unhealthy diet doesn't mean you will definitely get Type 2 diabetes, excess weight, which ups the risk of insulin resistance, is a strong risk factor for this Type of diabetes. Other contributors include genes, aging, and more. Paula Deen

Actress Berry was diagnosed with Type 1 diabetes at age 22, after became ill and slipped into a week long coma. In 2007, however, Berry announced that she’d weaned herself off insulin. Doctors say that Berry likely had Type 2 diabetes all along, because there is no way to avoid insulin if you have Type 1. (Type 1s can’t survive without it.)Since Berry is healthy and fit, doctors may have initially ruled out Type 2, which usually affects young people only if they are overweight.

Paul Sorvino

Halle Berry American actress

The Goodfellas and Law & Orderactor was diagnosed with Type 2 diabetes in 2006, after feeling tired and thirsty for months. Daughter Mira, also an actor, got involved to encourage a healthier lifestyle after he almost passed out one night during dinner. Sorvino now has his diabetes under control, thanks to healthier eating, exercise, medication, and daily insulin injections.

In 2002, Music Producer and American Idol Judge Jackson weighed more than 300 pounds. He was diagnosed with diabetes after experiencing "flu symptoms" that turned out to be high blood sugar. (His was over 500, while normal is between 80 and 120.) Even though his father was diabetic, Jackson says, he never imagined it would happen to him. With gastric bypass surgery, he lost almost 100 pounds. He has kept the weight off—and his diabetes under control—with healthy eating and daily exercise.

Randy Jackson Music Producer

CONTENTS What is diabetes?

What is type 1 diabetes?

What is type 2 diabetes?

What is gestational diabetes?

Diabetes - the detailed diet plan

Depression and anxiety

Stress free and natural lifestyle

Beat the stress for diabetes

Obesity and diabetes

Yoga

How to lose weight and keep it off

10 Test and Exam

(Madhumeha) Diabetes

Some forms of diabetes

Recipes for diabetic

DIABETES What is Diabetes?

iabetes mellitus ( D M ), commonly referred to as diabetes, is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period. Symptoms of high blood sugar include frequent urina on, increased thirst, and increased hunger. If le untreated, diabetes can cause many complica ons. Acute complica ons can include diabe c ketoacidosis, nonketo c hyperosmolar coma, or death. Serious long-term complica ons include heart disease, stroke, chronic kidney failure, foot ulcers, and damage to the eyes. Diabetes is due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin

produced. There are three main types of diabetes mellitus: Type 1 D M results from the pancreas's failure to produce enough insulin. This form was previously referred to as "insulindependent diabetes mellitus" (IDDM) or "juvenile diabetes". The cause is unknown. Type 2 DM begins with insulin resistance, a condi on in which cells fail to respond to insulin properly. As the disease progresses a lack of insulin may also develop. This form was previously referred to as "non insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes". The most common cause is excessive body weight and not enough exercise. | 16 | DIABETES FREE LIFE JANUARY-2018

Gesta onal diabetes is the third main form and occurs when pregnant women without a previous history of diabetes develop high blood sugar levels.

Signs and symptoms The classic symptoms of untreated diabetes are weight loss, polyuria (increased urina on), polydipsia (increased thirst), and polyphagia (increased hunger). Symptoms may develop rapidly (weeks or months) in type 1 D M, while they usually develop much more slowly and may be subtle or absent in type 2 DM. Several other signs and symptoms can mark the onset of diabetes although they are not speciďŹ c to the disease. In addi on to the known

ones above, they include blurry vision, headache, fa gue, slow healing of cuts, and itchy skin. Prolonged high blood glucose can cause glucose absorp on in the lens of the eye, which leads to changes in its shape, resul ng in vision changes. A number of skin rashes that can occur in diabetes are collec vely known as diabe c dermadromes. Long term effects of diabetes on the body. In addi on to the symptoms, diabetes can cause long term damage to our body. The long term damage is commonly referred to as diabe c complica ons. Diabetes affects our blood vessels and nerves and therefore can affect any part of the body. However, certain parts of our body are affected more than other parts. Diabe c complica ons will usually take a number of years of poorly controlled diabetes to develop. Complica ons are not a certainty and can be kept at bay and prevented by maintaining a strong level of control on your diabetes, your blood pressure and cholesterol. These can

all be helped by keeping to a healthy diet, avoiding cigare es and alcohol, and incorpora ng regular ac vity into your daily regime in order to keep blood sugar levels within recommended blood glucose level guidelines.

Eﬀect of diabetes on the kidneys

Similar to how diabetes aﬀects the heart, high blood pressure and cholesterol raises the risk of strokes.

Diabe c nephropathy is the term for kidney disease as a result of diabetes.

How diabetes aﬀects the eyes A rela vely common complica on of diabetes is diabe c re nopathy. As with all complica ons, this condi on is brought on by a number of years of poorly controlled or uncontrolled diabetes. Diabe c re nopathy has a number of symptoms. Re nopathy is caused by blood vessels in the back of the eye (the re na) swelling and leaking. High blood pressure is also a contribu ng factor for diabe c re nopathy. Diabe c re nopathy can be treated so it's best to catch it as early as you can. The best way to do this is to a end a re nopathy screening appointment, provided free on the NHS, once each year.

| 17 | DIABETES FREE LIFE JANUARY-2018

The kidneys are another organ that is at par cular risk of damage as a result of diabetes and the risk is again increased by poorly controlled diabetes, high blood pressure and cholesterol.

Damage to the kidneys takes place over a period of years and can picked up by nephropathy screening before it gets too serious. Treatment includes lifestyle changes and may include medicine to treat high blood pressure and cholesterol. Diabetes and its eﬀects on the nerves The eﬀects of diabetes on the nerves can be serious as the nerves are involved in so many of our bodily func ons, from movement and d i ge s o n t h ro u g h to s ex a n d reproduc on. The presence of nerve damage (neuropathy) is commonly no ced by: 1. Numbness or ngling in the hands or feet

2. Lack of arousal in the penis or clitoris 3. Excessive swea ng or 4. Diagnosis of delayed stomach emptying Tre a t m e n t s fo r n e u ro p a t hy concentrates on reducing pain but medica on such blood pressure lowering drugs may also be p re s c r i b e d to h e l p p re ve nt development of the condi on. Diabetes and its eďŹ&#x20AC;ect on diges on Diabetes can aďŹ&#x20AC;ect diges on in a number of ways. If diabetes has caused nerve damage, this can lead to nausea, cons pa on or diarrhoea. An alterna ve cause of disturbed diges on can be the result of diabetes medica on. Some type 2 diabetes medica ons for instance are prone to causing diges ve issues, although these tend to se le down a er the body gets used to them.

What is pancrea c malfunc on and what are the types of diabetes? The pancreas is an organ that sits behind the stomach and releases hormones into the diges ve system. In the healthy body, when blood sugar levels get too high, special cells in the pancreas (called beta cells) release insulin. Insulin is a hormone and it causes cells to take in sugar to use as energy or to store as fat. This causes blood sugar levels to go back down.

| 18 | DIABETES FREE LIFE JANUARY-2018

What is type 1 diabetes?

ype 1 diabetes occurs whenthe immune system mistakenly a acks and kills the beta cells of the pancreas. No, or very li le, insulin is released into the body. As a result, sugar builds up in the blood instead of being used as energy. About ďŹ ve to 10 per cent of people with diabetes have type 1 diabetes. Type 1 diabetes generally develops in childhood or adolescence, but can develop in adulthood. Type 1 diabetes is always treated with insulin. Meal planning also helps with keeping blood sugar at the right levels. Type 1 diabetes also includes latent autoimmune diabetes in adults

(LADA), the term used to describe the small number of people with apparent type 2 diabetes who appear to have immune-mediated loss of pancrea c beta cells. Type 1 diabetes accounts for only about 5â&#x20AC;&#x201C;10% of all cases of diabetes; however, its incidence con nues to increase worldwide and it has serious short-term and long-term implica ons. The disorder has a strong gene c component, inherited mainly through the HLA complex, but the factors that trigger onset of clinical disease remain largely unknown. Management of type 1 diabetes is best undertaken in the context of a mul disciplinary health team and

| 19 | DIABETES FREE LIFE JANUARY-2018

requires con nuing a en on to many aspects, including insulin administra on, blood glucose monitoring, meal planning, and screening for comorbid condi ons and diabetes-related complica ons. These complica ons consist of microvascular and macrovascular disease, which account for the major morbidity and mortality associated with type1 diabetes. Newer treatment approaches have facilitated improved outcomes in terms of both glycaemic control and reduced risks for development of complica ons. Nonetheless, major challenges remain in the development of approaches to the preven on and management of type 1 diabetes and its complica ons.

What is type 2 diabetes?

ype 2 diabetes occurs when the body can't properly use the insulin that is released (called insulin insensi vity) or does not make enough insulin. As a result, sugar builds up in the blood instead of being used as energy. About 90 per cent of people with diabetes have type 2 diabetes. Type 2 diabetes more o en develops in adults, but children can be aﬀected.

Depending on the severity of type 2 diabetes, it may be managed through physical ac vity and meal planning, or may also require medica ons and/or insulin to control blood sugar more eﬀec vely. Type 2 diabetes is a chronic metabolic disease that has a signiﬁcant impact on the health, quality of life, and life expectancy of

| 20 | DIABETES FREE LIFE JANUARY-2018

pa ents, as well as on the health care system. Exercise, diet, and weight control con nue to be essen al and effec ve means of improving glucose homeostasis. However, lifestyle management measures may be insufficient or pa ent compliance difficult, rendering conven onal drug therapies

What is gestational diabetes? A third type of diabetes, gesta onal diabetes, is a temporary condi on that occurs during pregnancy. It aﬀects approximately two to four per cent of all pregnancies (in the nonAboriginal popula on) and involves an increased risk of developing diabetes for both mother and child. Gesta onal diabetes generally results in few symptoms; however, it does increase the risk of preeclampsia, depression, and requiring a Caesarean sec on. Babies born to m o t h e rs w i t h p o o r l y t re ate d gesta onal diabetes are at increased risk of being too large, having low blood sugar a er birth, and jaundice. If untreated, it can also result in a s llbirth. Long term, children are at higher risk of being overweight and developing type 2 diabetes.

Gesta onal diabetes is caused by not enough insulin in the se ng of insulin resistance. Risk factors include being overweight, previously having gesta onal diabetes, a family history of type 2 diabetes, and having polycys c ovarian syndrome. Diagnosis is by blood tests. For those at normal risk screening is recommended between 24 and 28 weeks gesta on. For those at high risk tes ng may occur at the ﬁrst prenatal visit. Preven on is by maintaining a healthy weight and exercising before pregnancy. Gesta onal diabetes is a treated with a diabe c diet, exercise, and possibly insulin injec ons. Most women are able to manage their blood sugar with a diet and exercise. Blood sugar

| 21 | DIABETES FREE LIFE JANUARY-2018

tes ng among those who are affected is o en recommended four m e s a d ay. B re a s e e d i n g i s recommended as soon as possible a er birth. Gesta onal diabetes affects 3–9% of pregnancies, depending on the popula on studied. It is especially common during the last three months of pregnancy. It affects 1% of those under the age of 20 and 13% of those over the age of 44. A number of ethnic groups including Asians, American Indians, Indigenous Australians, and Pacific Islanders are at higher risk. In 90% of people gesta onal diabetes will resolve a er the baby is born. Women, however, are at an increased risk of developing type 2 diabetes.

Diabetes - the detailed diet plan

eople with diabetes have nearly double the risk of heart disease and are at a greater risk of developing mental health disorders such as depression. But most cases of type 2 diabetes are preventable and some can even be reversed. Taking steps to prevent or control diabetes doesn't mean living in depriva on; it means ea ng a tasty, balanced diet that will also boost your energy and improve your mood. You don't have to give up sweets en rely or resign yourself to a life me of bland food. With these ps, you can s ll take pleasure from your meals without feeling hungry or deprived. Whether you're trying to prevent or control diabetes, your nutri onal needs are virtually the same as everyone else, so no special foods are necessary. But you do need to pay a en on to some of your food

choices—most notably the carbohydrates you eat. While following a Mediterranean or other heart-healthy diet can help with this, the most important thing you can do is to lose a li le weight. Losing just 5% to 10% of your total weight can help you lower your blood sugar, blood pressure, and cholesterol levels. Losing weight and ea ng healthier can also have a profound eﬀect on your mood, energy, and sense of wellbeing. Even if you've already developed diabetes, it's not too late to make a posi ve change. By ea ng healthier, being more physically ac ve, and losing weight, you can reduce your symptoms or even reverse diabetes. The bo om line is that you have more control over your health than you may think. The biggest risk for diabetes: belly fat | 22 | DIABETES FREE LIFE JANUARY-2018

Being overweight or obese is the biggest risk factor for type 2 diabetes. However, your risk is higher if you tend to carry your weight around your abdomen as opposed to your hips and thighs. A lot of belly fat surrounds the abdominal organs and liver and is closely linked to insulin resistance. You are at an increased risk of developing diabetes if you are: 1. A woman with a waist circumference of 35 inches or more 2. A man with a waist circumference of 40 inches or more Calories obtained from fructose (found in sugary beverages such as soda, energy and sports drinks, coﬀee drinks, and processed foods like doughnuts, muﬃns, cereal, candy and granola bars) are more likely to add weight around your abdomen. Cu ng back on sugary

foods can mean a slimmer waistline as well as a lower risk of diabetes. As with any healthy ea ng program, a diabe c diet is more about your overall dietary pa ern rather than obsessing over specific foods. Aim to eat more natural, unprocessed fo o d a n d l e s s p a c ka ge d a n d convenience foods. Eat more: 1. Healthy fats from nuts, olive oil, fish oils, flax seeds, or avocados 2.Fruits and vegetables—ideally fresh, the more colorful the be er; whole fruit rather than juices 3.High-fiber cereals and breads made from whole grains or legumes 4.Fish and shellfish, organic chicken or turkey 5.High-quality protein such as eggs, b e a n s , l o w - f a t d a i r y, a n d unsweetened yogurt Eat less: 1 . Tr a n s f a t s f r o m p a r a l l y hydrogenated or deep-fried foods 2 . Pa c ka g e d a n d fa st fo o d s ,

especially those high in sugar, baked goods, sweets, chips, desserts 3. White bread, sugary cereals, reﬁned pastas or rice 4. Processed meat and red meat 5. Low-fat products that have replaced fat with added sugar, such as fat-free yogurt Ea ng a diabe c diet doesn't mean elimina ng sugar altogether, but like most of us, chances are you consume more sugar than is healthy. If you have diabetes, you can s ll enjoy a small serving of your favorite dessert now and then. The key is modera on. Reduce your cravings for sweets by slowly reduce the sugar in your diet a li le at a me to give your taste buds me to adjust. Hold the bread (or rice or pasta) if you want dessert. Ea ng sweets at a meal adds extra carbohydrates so cut back on the other carb-heavy foods at the same meal. Add some healthy fat to your

Choosing carbs that are packed with ﬁber (and don't spike your blood sugar) Instead of…

Try these high-ﬁber op ons…

White rice

Brown or wild rice, riced cauliﬂower

White potatoes Regular pasta

Sweet potatoes, yams, cauliﬂower mash

White bread

Whole-wheat or whole-grain bread

Sugary breakfast cereal

High-ﬁber, low-sugar cereal Steel-cut or rolled oats

Instant oatmeal Cornﬂakes Corn

Whole-wheat pasta, spaghe

squash

Low-sugar bran ﬂakes Peas or leafy greens | 23 | DIABETES FREE LIFE JANUARY-2018

dessert. Fat slows down the diges ve process, meaning blood sugar levels don't spike as quickly. That doesn't mean you should reach for the donuts, though. Think healthy fats, such as peanut bu er, rico a cheese, yogurt, or nuts. Eat sweets with a meal, rather than as a stand-alone snack. When eaten on their own, sweets cause your blood sugar to spike. But if you eat them along with other healthy foods as part of your meal, your blood sugar won't rise as rapidly. When you eat dessert, truly savor each bite. How many mes have you mindlessly eaten your way through a bag of cookies or a huge piece of cake? Can you really say that you enjoyed each bite? Make your indulgence count by ea ng slowly and paying a en on to the ﬂavors and textures. You'll enjoy it more, plus you're less likely to overeat.

DEPRESSION AND ANXIETY THE SILENT KILLERS Everyone feels anxious now and then. It's a normal emo on. Many people feel nervous when faced with a problem at work, before taking a test, or making an important decision. Anxiety disorders are diﬀerent, though. They can cause such distress that it interferes with your ability to lead a normal life. This type of disorder is a serious mental illness. For people who have one, worry and fear are constant and overwhelming, and can be disabling. But with treatment, many people can manage those feelings and get back to a fulﬁlling life. What Are the Types of Anxiety Disorders?

There are several kinds, including: 1. Panic disorder. People with this condi on have feelings of terror that strike suddenly and repeatedly with no warning. Other symptoms of a panic a ack include swea ng, chest pain, palpita ons (unusually strong or irregular heartbeats), and a feeling of choking. It can feel like you're having a heart a ack or "going crazy." 2. Social anxiety disorder. Also called social phobia, this involves overwhelming worry and selfconsciousness about everyday social situa ons. The worry o en centers on a fear of being judged by others, or behaving in a way that might cause embarrassment or lead to ridicule.

3. Specific phobias. These are intense fears of a specific object or situa on, such as heights or flying. The level of fear is usually inappropriate to the situa on and may cause you to avoid common, everyday situa ons. 4. Generalized anxiety disorder. This is excessive, unrealis c worry and tension, even if there's li le or nothing to provoke the anxiety. What Are the Symptoms of Anxiety Disorders? It depends on the type of anxiety disorder, but general symptoms include: 1. Feelings of panic, fear, and uneasiness 2. Problems sleeping

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3. Cold or sweaty hands or feet 4. Shortness of breath 5. Heart palpita ons 6. Not being able to be s ll and calm 7. Dry mouth 8. Numbness or ngling in the hands or feet 9. Nausea 10. Muscle tension 11. Dizziness The exact cause of anxiety disorders is unknown, but anxiety disorders -- like other forms of mental illness -- are not the result of personal weakness, a character ﬂaw, or poor upbringing. As scien sts con nue their research on mental illness, it is becoming clear that many of these disorders are caused by a combina on of factors, including changes in the brain and environmental stress. If symptoms of an anxiety disorder are present, the doctor will begin an evalua on by asking you ques ons about your medical history and performing a physical exam. Although there are no lab tests to speciﬁcally diagnose anxiety disorders, the doctor may use various tests to look for other medical illness as the cause of the symptoms.

emo onal state to which the term refers. Depression comes from the late La n word depressare and the classical La n word deprimere. Deprimere literally means “press down”; de translates into “down” and premere translates into “to press.” In essence, the term appears to denote a feeling of heaviness, of being “pressed down,” that is also referred to as “sad,” “blue,” or simply “down.” Depression also refers to a depressed topography or the fact of being pressed down. Depression as a referent to mood or emo onal state appeared as early as 1665 and merely meant a lowering of mood or spirits. T h u s , t h e co re ex p e r i e n c e o f depression appears to be a private event tacted as depressed or in psychiatric terms as dysphoric. However, a minority of individuals will meet criteria for depression and deny depressed mood or present with irritable mood instead. These individuals may have deﬁcits in accurate tac ng of private experience, or they may represent diagnos c Type II errors and should not be classiﬁed as depressed.

If no other medical illness is found, you may be referred to a psychiatrist, psychologist, or another mental health professional who is specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for an anxiety disorder.

W h a t I s D e p r e s s i o n ? Ta c n g Depression and Its Symptoms We describe depression in radical behavioral terms, emphasizing the occasions on which the term is used and deemphasizing any underlying unitary disease, physiological, or | 25 | DIABETES FREE LIFE JANUARY-2018

It is important not to associate what is tacted as depression with a specific pa ern of physiological responding or reify it as a par cular emo onal state. The antecedent condi ons and underlying physiologies associated with the experience of depression may vary widely, and no core composi on can be assumed. Emo onal states such as sadness are simply cooccurring behavioral responses (elicited uncondi oned reflexes, c o n d i o n e d r e fl e xe s , o p e r a n t predisposi ons) that appear to be integrated because the behaviors are occasioned by common discriminanda and are controlled by common consequences. For example, a child with overbearing parents experiences an emo onal state of sadness and a co-occurring behavioral response of crying when her parents cri cize her. The crying is nega vely reinforced when her parents comfort her and stop cri cizing her, which may also result in a change of her emo onal state.

Symptoms of depression include: 1. Feelings of helplessness and hopelessness. A bleak outlook—nothing will ever get be er and there's nothing you can do to improve your situa on. 2. Loss of interest in daily ac vi es. You don't care anymore about former hobbies, pas mes, social ac vi es, or sex. You've lost your ability to feel joy and pleasure. 3. Appe te or weight changes. Signiﬁcant weight loss or weight gain—a change of more than 5% of body weight in a month. 4. Sleep changes. Either insomnia, especially waking in the early hours of the morning, or oversleeping. 5.Anger or irritability. Feeling agitated, restless, or even violent. Your tolerance level is low, your temper short, and everything and everyone gets on your nerves. 6.Loss of energy. Feeling fa gued, sluggish, and physically drained. Your whole body may feel heavy, and even

small tasks are exhaus ng or take longer to complete. 7.Self-loathing. Strong feelings of worthlessness or guilt. You harshly cri cize yourself for perceived faults and mistakes. 8.Reckless behavior. You engage in escapist behavior such as substance abuse, compulsive gambling, reckless driving, or dangerous sports. The symptoms of depression can vary with gender and age. Depression o en varies according to age and gender, with symptoms diﬀering between men and women, or young people and older adults. Depression in men. Depressed men are less likely to acknowledge feelings of self-loathing and hopelessness. Instead, they tend to complain about fa gue, irritability, sleep problems, and loss of interest in work and hobbies. They're also more likely to experience symptoms such as anger, aggression, reckless behavior, and substance abuse.

Depression in women. Women are more likely to experience symptoms such as pronounced feelings of guilt, excessive sleeping, overea ng, and weight gain. Depression in women is also impacted by hormonal factors during menstrua on, pregnancy, and menopause. Up to 1 in 7 women experience depression following childbirth, a condi on known as postpartum depression. Depression in teens. Irritability, anger, and agita on are o en the most no ceable symptoms in depressed teens—not sadness. They may also complain of headaches, stomachaches, or other physical pains. Depression in older adults. Older adults tend to complain more about the physical rather than the emo onal signs and symptoms of depression: things like fa gue, unexplained aches and pains, and memory problems. They may also neglect their personal appearance and stop taking cri cal medica ons for their health.

STRESS FREE AND NATURAL LIFESTYLE THE PERMANENT CURE FOR DIABETES

iabetes management is a lifelong process. This can add stress to your daily life. Stress can be a major barrier to effec ve glucose control. Stress hormones in your body may directly affect glucose levels. If you're experiencing stress or feeling threatened, your body reacts. This is called the fight-or-flight response. This response elevates your hormone levels and causes your nerve cells to fire. During this response, your body releases adrenaline and cor sol into your bloodstream and your respiratory rates increase. Your body directs blood to the muscles and limbs, allowing you to fight the situa on. Your body may not be able to process the glucose

released by your ﬁring nerve cells if you have diabetes. If you can't convert the glucose into energy, it builds up in the bloodstream. This causes your blood glucose levels to rise. Constant stress from long-term problems with blood glucose can also we a r yo u d o w n m e nta l l y a n d physically. This may make managing your diabetes diﬃcult.

under mental stress, they generally experience an increase in their blood glucose levels. People with type 1 diabetes may have a more varied response. This means that they can experience either an increase or a decrease in their blood glucose levels. When you're under physical stress, your blood sugar can also increase. This can happen when you're sick or injured. This can aﬀect people with type 1 or type 2 diabetes.

How can diﬀerent types of stress aﬀect your diabetes?

How to reduce your stress levels

Stress can aﬀect people diﬀerently. The type of stress that you experience can also have an impact on your body's physical response.

It's possible to lessen or limit the stressors in your life. Here are a few things that you can do to manage the eﬀects of diﬀerent forms of stress.

When people with type 2 diabetes are | 27 | DIABETES FREE LIFE JANUARY-2018

Reducing mental stress Medita ng can help remove nega ve thoughts and allow your mind to relax. Consider star ng each morning with a 15-minute medita on. This will set the tone for the rest of your day. Sit in a chair with your feet firmly planted on the floor and your eyes closed. Recite a mantra that makes sense to you, such as “I will have a good day” or “I feel at peace with the world.” Push away any other thoughts if they enter your head, and allow yourself to be present in the moment. Reducing emo onal stress If you find yourself in an unwanted emo onal state, take five minutes to be by yourself. Remove yourself from your current environment. Find a quiet space to focus on your breathing. Put your hand on your belly, and feel it rise and fall. Inhale deep breaths, and exhale slowly and loudly. This will slow your heartbeat down, and help bring you back to a stable emo onal state. This act of centering yourself may improve how you deal with whatever is causing the stress. Reducing physical stress Adding yoga to your daily rou ne can provide both physical ac vity and medita on at the same me. Prac cing yoga can lower your blood pressure, too. Whether it's yoga or another form of exercise, you should aim for 30 minutes of cardiovascular exercise per day. You can do 10 minutes of exercise when you wake up, 10 minutes in the a ernoon, and 10 minutes before you go to sleep.

ac vi es. This can include hiking, swimming, or signing up for a fun run together. Reducing work stress Stress issues at work can come home with you. Talk to your supervisor if you're having a hard me at work. There may be op ons to alleviate or work through any issues you many be having. If that doesn't help, you may want to consider transferring to a different department or even finding new job altogether. Although stress levels elevate when looking for a new job, you may find it se les down with a different posi on be er suited for your skills and personality. How to cope with diabetes-related stress If you're feeling stressed about your condi on, know that you aren't alone. You can connect with people online or in your community for solidarity and support. Online support groups If you're a Facebook user, consider liking this diabetes support group that offers helpful ps and a strong community to help you cope. Diabe c

Reducing family stress If you're feeling overwhelmed by family obliga ons, remember that it's O K to say no. Your family will understand if you can't make it to all events. If your stress stems from not seeing your family as o en as you'd like, consider having a family fun night weekly or biweekly. You can play board games or par cipate in outdoor | 28 | DIABETES FREE LIFE JANUARY-2018

Connect is also an online resource dedicated to improving your quality of life. It provides ar cles, recipes, and informa ve videos. In-person support groups For women with diabetes, Diabetes Sisters offers na onwide meetups. The group started in North Carolina and expanded due to popularity. They now offer in-person groups throughout the country. These informal mee ngs are held on weeknights and typically last for one or two hours. Defeat Diabetes Founda on provides a lis ng of peer support groups in all 50 states and the District of Columbia. You even search the directory and submit a lis ng of your own. The American Diabetes Associa on also offers local offices focused on educa on and community outreach. Although diabetes can present a different set of challenges, it's possible to manage it effec vely and lead a happy, healthy lifestyle. You can do this by adding short, medita ve sessions or small workouts to your daily rou ne. You can also look into support groups and find one that best suits your personality and lifestyle needs. Being proac ve can help ease the tension in your life.

BEAT THE STRESS FOR DIABETES FREE LIFE! Diabetes and Stress Stress has been proven to impact on blood sugar levels Stress, whether physical stress or mental stress, has been proven to ins gate changes in blood sugar levels, which for people with diabetes can be problema c. While stress can aﬀect diabetes control, both directly and indirectly, it can also be caused by various diabe c factors such as being diagnosed with diabetes, adjus ng to a diabetes treatment regimen, or dealing with psychosocial pressures of the disease.

What is stress?

What can cause stress?

Simply out, stress is a state of emo onal strain or tension that occurs when we feel that we can't cope with pressure.

We live in a very stressful society which is constantly pu ng us under pressure. This pressure can some mes be too much to handle, leading us to feel "stressed out".

When we become stressed, the body quickly responds by releasing hormones that give cells access to stored energy - fat and glucose - to help the body get away from danger. This ins nc ve physiological response to perceived threats is known as the "ﬁght-freeze, or ﬂight" response. Over me, both physical and mental stress can wear us down mentally and lead to depression and other mental health issues. | 29 | DIABETES FREE LIFE JANUARY-2018

This everyday feeling can be caused by simple things such as: Work pressure Marriage and rela onships Paren ng/children Health problems such as diabetes (see below) Financial insecurity

How does stress effect my diabetes? It is widely recognised that people with diabetes are who regularly stressed are more likely to have poor blood glucose control. One of the reasons for this is that stress hormones such as cor sol increase the amount of sugar in our blood. High levels of cor sol can lead to condi ons such as Cushing's syndrome, which is one of the lesser known causes of diabetes. Constant stress and frustra on caused by long term problems with blood glucose regula on can also wear people down and cause them to neglect their diabetes care. For example, they may start to ignore their blood sugar levels or simply forget to check them, or they may adopt poor lifestyle habits, such as exercising less, ea ng more 'junk' and processed foods, drinking more alcohol, and smoking. This is known as diabetes burnout. While stress alters blood sugar levels, the extent of its impact varies from person to person. Studies into the effects of stress on glucose levels in humans have shown that mental or psychological stress causes a rise in glucose levels in people with type 2 diabetes and in most type 1 diabe cs, although levels can drop in some individuals with type 1. How to reduce stress Once you have learnt to iden fy your stressors and the symptoms they produce, it's important to have some strategies to fight back. Remember that no ma er where your stress is coming from, your body will treat it the same.

Here are some strategies you can use at any me to manage stress: Go for a walk. An ac vity as simple as walking can provide an immediate change of scenery and body chemistry that can dras cally reduce stress. Try to add 20 minutes to the amount of me you normally spend out of the house or office every day – you'll no ce the difference. Get training. Vigorous exercise such as weightli ing or higher intensity cardio releases endorphins that make us feel good and help ba le our stress hormones. Be sure not to push exercise too hard though, especially at mes of high stress, as this will be treated as yet another stressor and added to the 'pool'. Get touchy feely. Assuming your stress is not directly related to your friends, roman c partners or family, close physical contact with other people is very good for us and can help to relieve stress. Consider i n d u l g i n g i n a wa r m e m b ra c e between friends, hug with a family member, even sex with a roman c partner. Learn to reframe nega ve situa ons. Happy people have the ability to put a posi ve spin on a nega ve situa on. Whatever you are going through, try to draw out a posi ve no ma er how hard it may be. Our last freedom as humans is the ability to decide how w e t h i n k a n d fe e l a b o u t o u r environment. Meditate. Medita on or mindfulness can help you find the mental clarity to process the nega ve scenarios that you encounter and find answers.

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Mindfulness can also help you to see the world 'as it is' so that the numerous pe y annoyances of a typical day don't bother you quite so much. Cut out the noise of other people's worries. At mes of stress, it's important that we set about a plan to free our minds of the things that are bothering us. Its important to keep in mind that as a family member, r o m a n c p a r t n e r, f r i e n d a n d colleague, others will o en share their worries with us. There is a big diﬀerence between showing empathy and compassion with someone else's worries and taking those worries on ourselves. Show that you care, but don't wear the weight of their stress around your neck. Take me out. Nothing is more important than your health. If you feel as if your stress levels are approaching boiling point, take some me for a relaxing getaway. Do the things you enjoy to do, spent me the way you want to spend it. Communicate your need to do this with those close to you and request their understanding. You may be surprised by the extent to which people are willing to help you – believe it or not, they'll have been through very stressful period of life themselves. There are certain lifestyle hacks for le ng go of all that stress forever: Rule #1: Disconnect Disconnec ng is the most important strategy on this list, because if you can't ﬁnd a way to remove yourself electronically from your work, then you've never really le work.

Making yourself available to your work 24/7 exposes you to a constant barrage of stressors that prevent you from refocusing and recharging. If ta k i n g t h e e n re we e ke n d o ff handling work e-mails and calls isn't realis c, try designa ng specific mes on Saturday and Sunday for checking e-mails and responding to voicemails. Rule #2: Minimize Chores Chores have the tendency to monopolize your free me. When this happens, you lose the opportunity to relax and reflect. What's worse is that a lot of chores feel like work, and if you spend all weekend doing them, you just put in a seven-day workweek. To keep this from happening, you need to schedule your chores like you would anything else during the week, and if you don't complete them during the allo ed me, you move on and finish them the following weekend.

recharge and relax. Weekdays are so hec c that the en re week can ﬂy by with li le quality family me. Don't let this bleed into your weekends. Take your kids to the park, take your spouse to his or her favorite restaurant, and go visit your parents. You'll be glad you did. Rule #6: Schedule Micro-Adventures Buy ckets to a concert or play, or get reserva ons for that cool new hotel that just opened downtown. Instead of running on a treadmill, plan a hike. Try something you haven't done before or perhaps something you haven't done in a long me. Studies show that an cipa ng something good to come is a signiﬁcant part of what makes the ac vity pleasurable. Rule #7: Wake Up at the Same Time

No me to exercise during the week? You have 48 hours every weekend to make it happen. Ge ng your body moving for as li le as 10 minutes releases G A BA, a soothing neurotransmi er that reduces stress. Exercise is also a great way to come up with new ideas. Innovators and other successful people know that being outdoors o en sparks crea vity.

It's temp ng to sleep in on the weekend to catch up on your sleep. Though it feels good temporarily, having an inconsistent wake-up me disturbs your circadian rhythm (and can aggravate depression). Your body cycles through an elaborate series of sleep phases in order for you to wake up rested and refreshed. One of these phases involves preparing your mind to be awake and alert, which is why people o en wake up just before their alarm clock goes oﬀ (the brain is trained and ready).

Rule #4: Pursue a Passion

Rule #8: Reﬂect

You might be surprised what happens when you pursue something you're passionate about during your me oﬀ. Indulging your passions is a great way to escape stress and to open your mind to new ways of thinking. Things like playing music, reading, wri ng, pain ng, or even playing catch with your kids can help s mulate diﬀerent modes of thought that can reap huge dividends over the coming week.

Weekly reﬂec on is a powerful tool for

Rule #3: Exercise

Rule #5: Spend Quality Time with Family Spending quality me with your family is essen al if you want to

improvement. Use the weekend to contemplate the larger forces that are s h a p i n g y o u r i n d u s t r y, y o u r organiza on, and your job. Without the distrac ons of Monday to Friday busy work, you should be able to see things in a whole new light. Use this insight to alter your approach to the coming week, improving the efficiency and efficacy of your work. It's also a great idea to reflect upon yourself. You might take an assessment, such as an emo onal intelligence test, to gain addi onal insight. Rule #9: Designate Mornings as Me Time It can be difficult to get me to yourself on the weekends, especially if you have family. Finding a way to engage in an ac vity you're passionate about first thing in the morning can pay massive dividends in happiness and cleanliness of mind. It's also a great way to perfect your circadian rhythm by forcing yourself to wake up at the same me you do on weekdays. Rule #10: Prepare for the Upcoming Week The weekend is a great me to spend a few moments planning your upcoming week. As li le as 30 minutes of planning can yield significant gains in produc vity and reduced stress. The week feels a lot more manageable when you go into it with a plan because all you have to focus on is execu on.

OBESITY AND DIABETES

iabetes is a group of disorders characterized by chronic high blood glucose levels (hyperglycemia) due to the body's failure to produce any or enough insulin to regulate high glucose levels. There are two main types of diabetes. Type 1 diabetes, which o en occurs in children or adolescents, is caused by the body's inability to make insulin or type 2 diabetes, which occurs as a result of the body's inability to react properly to insulin (insulin resistance). Type 2 diabetes is more prevalent than type 1 diabetes and is therefore seen in roughly 90% of all diabetes cases. Type 2 diabetes is predominantly diagnosed a er the age of forty, however, it is now being found in all age ranges, including children and adolescents. The impact of diabetes goes beyond chronic hyperglycemia. Diabetes is the leading cause of blindness (diabe c re nopathy), end stage

kidney diseases (diabe c nephropathy) and non-trauma c lower extremity amputa ons (diabe c neuropathy) in working-age adults. People with diabetes are also two to four mes more likely to experience cardiovascular complica ons and strokes. Diabetes and its related complica ons result in an es mated 200,000+ deaths each year, making diabetes one of the major causes of mortality in the U.S. How does my weight relate to diabetes? There are many risk factors for diabetes such as age, race, pregnancy, stress, certain medica ons, gene cs or family history, high cholesterol and obesity. However, the single best predictor of type 2 diabetes is overweight or obesity. Almost 90% of people living with type 2 diabetes are overweight or have obesity. People who are overweight or have obesity have added pressure on their body's

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ability to use insulin to properly control blood sugar levels, and are therefore more likely to develop diabetes. The number of diabetes cases among American adults increased by a third during the 1990s, and addi onal increases are expected. This rapid increase in the occurrence of diabetes is mostly a ributed to the growing prevalence of obesity in the United States. What can you do to prevent diabetes? Type 2 diabetes is largely preventable. Studies have found that lifestyle changes and small amounts of weight loss in the range of 5-10% can prevent or delay the development of type 2 diabetes among high-risk adults. Lifestyle interven ons including diet and moderate to intense physical ac vity (such as walking for 150 minutes per week) were used in these studies to produce small amounts of weight loss. The development of diabetes was reduced by 40% to 60%

not being physically ac ve. Being obese increases your risk of diabetes, heart disease, stroke, arthri s, and some cancers. If you are obese, losing even 5 to 10 percent of your weight can delay or prevent some of these diseases. For example, that means losing 10 to 20 pounds if you weigh 200 pounds.

during these studies, which lasted three to six years. Preven ng weight gain, increasing ac vity levels and working toward small amounts of weight loss if you are overweight can have a big impact on the likelihood that you will develop diabetes in the future. Thus far, weight management is the best thing you can do to prevent the development of diabetes. Obesity means having too much body fa t . I t i s d i ﬀe re n t f ro m b e i n g overweight, which means weighing

too much. The weight may come from muscle, bone, fat, and/or body water. Both terms mean that a person's weight is g reater t h a n w h at 's considered healthy for his or her height. Obesity occurs over me when you eat more calories than you use. The balance between calories-in and calories-out diﬀers for each person. Factors that might aﬀect your weight i n c l u d e yo u r ge n e c m a ke u p , overea ng, ea ng high-fat foods, and

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Obesity is mostly preventable through a combina on of social changes and personal choices Changes to diet and exercising are the main treatments. Diet quality can be improved by reducing the consump on of energydense foods, such as those high in fat and sugars, and by increasing the intake of dietary ﬁber. Medica ons may be taken, along with a suitable diet, to reduce appe te or decrease fat absorp on. If diet, exercise, and medica on are not eﬀec ve, a gastric balloon or surgery may be performed to reduce stomach volume or bowel length, leading to feeling full earlier or a reduced ability to absorb nutrients from food.

UNITED HUMAN RIGHTS FEDERATION Regd. No.26363D

UNITED HUMAN RIGHTS FEDERATION appeals for your support and cooperation, which goes a long way in its journey to save human & humanity. By joining hands with us by becoming a member of UHRF, and to share our vision of uniting for a common cause and fulfill the dreams of uplifting the international community.

UNITED WORLD DIABETES FEDERATION UNITED WORLD DIABETES FEDERATION

WHY JOIN US United World Against Diabetes is a non-profit organization registered with Government of India, The mission of United World Against Diabetes is to promote diabetes care, awareness and prevention. India is diabetic capital of the world. More than 70 million people are living with diabetes in India and those who never go for any diabetes diagnosis, their number is sky rocketing.

Stop this silent killer and make India

FREE FROM DIABETES

We ar e

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SUPPORT TO DIABETES DIABETESFREE FREEINDIA LIFE CAMPAIGN. CAMPAIGN. Your support is our Motivation

YOGA THE ULTIMATE CURE FOR DIABETES Diabetes – a name that is no longer foreign. These days, this condi on can happen to anybody, irrespec ve of age, place, or gene c history. Yet, there's nothing to fret about because the condi on can be controlled with a li le awareness and care. Good food, regular exercise, and a few minutes of yoga prac ce everyday – the three golden rules to remember if you are a diabe c. But how to ﬁrst ﬁnd out whether you do have diabetes or not? Simple. Just look out for these common symptoms: Are you unusually losing weight?

Do you need to pay frequent visits to the bathroom to urinate? Do you feel hungry or thirsty too o en? If the answer to these is 'yes', it is quite likely that you have high blood sugar, either due to low produc on of insulin in the body, or lack of response from t h e b l o o d c e l l s to t h e i n s u l i n produced. In either case, it's always good to consult a doctor at the earliest. Diabetes can be classiﬁed as Type 1 or type 2 or it can even be gesta onal occurring with pregnancy. Whatever the case, the earlier the condi on is | 36 | DIABETES FREE LIFE JANUARY-2018

treated, the be er it is for the individual. And for this, yoga and medita on, along with good lifestyle prac ces, can be your escorts. How yoga can help ﬁght diabetes - Regular yoga prac ce can help reduce the level of sugar in the blood, along with lowering blood pressure, keeping a weight check, reducing the symptoms and slowing the rate of progression of diabetes, as well as lessening the severity of further complica ons. Let's see how. - Like for most lifestyle diseases, stress is one of the major reasons for diabetes.It increases the secre on of

glucagon hormones in the body, responsible for increasing blood glucose levels. Consistent prac ce of y o ga a s a n a s ( b o d y p o s t u r e s ) , pranayamas (breathing exercises) and a few minutes of daily medita on can help reduce stress in the mind and body. This, in turn, reduces glucagons and can also help improve insulin ac on. - The prac ce of yoga is also proven to reduce weight as well as control increasing weight, which is par cularly important to keep diabetes in check.Sun Saluta on and Kapal Bha pranayama are one of the best ways to weight loss. - Diabetes can also be worsened with the occurrence of high blood pressure, or hypertension. Yoga asanas, such as the Corpse Pose, Bridge Pose, Child Pose, and Yoga Nidra are all helpful in controlling hypertension. - Other yoga postures that are helpful i n d i a b e te s i n c l u d e Va j ra s a n a (kneeling pose), Shoulder Stand, Plow Pose, Lying-Down Body Twist, Bow Posture, Two-Legged Forward Bend, and Si ng Half-Spinal Twist. -Nadi Shodhan Pranayama is also good for diabe cs. It helps release stress and ﬂush out toxins from the body. Another excellent technique to combat diabetes is a unique breathing technique. It has helped several diabe cs across the world reduce blood glucose levels and control their condi on from ge ng worse. You can learn the technique at an Art of Living Part-1 program.

their confidence levels so that they gain the strength to fight the condi on and live well. - Craving for sweets is a common occurrence in diabetes. Regular prac ce of medita on can help drop such cravings to a large extent. Diabetes happens because the blood cells do not respond to insulin produced. When you follow a regular exercise regimen, your body starts responding to insulin, helping in reducing blood glucose, and also some mes the dosage of medica on required. - Exercise helps improve blood circula on in the system, par cularly in the arms and legs, where diabe c pa ents mostly complain of problems. - It is an excellent way to fight stress, both at the body and mind level, which in turn helps keep glucose levels down. - Regular exercise pa erns can be extremely beneficial to older pa ents with diabetes. In their case, the condi on is partly due to lack of physical ac vity. A few minutes of brisk walking and joint movements,

- A few minutes of regular medita on prac ce also acts as an excellent stress-buster for the mind and body. Interes ngly, while stress is the major cause of diabetes, the condi on in turn results in pa ents ge ng highly stressed about it, which further aggravates the problem. It has also been observed that most diabe cs lose self-conﬁdence and end up brooding over their condi on. This is where medita on can help – restoring | 37 | DIABETES FREE LIFE JANUARY-2018

coupled with some gentle yoga postures – Triangle Pose, Standing Spinal Twist, and Bu erfly Pose – followed by relaxa on in yoga nidra can help. Kapalbha is one of the best op ons for a diabe c. If a diabe c person prac ces this technique regularly, then certainly he can get his disease controlled. This is a very effec ve form of pranayama. Sit down on the floor in a comfortable cross-legged posi on. Take a deep breath and then exhale quickly, making a sound. Always remember while doing Kapalbha , you have to forcefully and quickly exhale a n d s l ow l y a n d d e e p l y i n h a l e . Con nue doing this for 10 mes and then release. This works as a blessing for diabe cs and helps in controlling the disease. Anulom-Vilom is another way of trea ng this disease. Anulom Vilom is a l s o k n ow n a s a l te r n ate n a s a l breathing. Here, you have to close the right nostril and inhale with the le nostril. Then immediately close le nostril and exhale with the right nostril. In this way try breathing slowly and deeply by changing the nostrils.

How to Lose Weight and Keep It Off In our eat-and-run, massive-por onsized culture, maintaining a healthy weight can be tough—and losing weight, even tougher. If you've tried and failed to lose weight before, you may believe that diets don't work for you. You're probably right: some diets don't work at all and none of them work for everyone—our bodies o en respond differently to different foods. But while there's no easy fix to losing weight, there are plenty of steps you can take to develop a healthier rela onship with food, curb emo onal triggers to overea ng, and achieve las ng weight-loss success.

What's the best diet for healthy weight loss? Pick up any diet book and it will claim to hold all the answers to successfully losing all the weight you want—and keeping it off. Some claim the key is to eat less and exercise more, others that low fat is the only way to go, while others prescribe cu ng out carbs. So what should you believe? The truth is there is no “one size fits all” solu on to permanent healthy weight loss. What works for one person may not work for you, since our bodies respond differently to

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different foods, depending on gene cs and other health factors. To find the method of weight loss that's right for you will likely take me and require pa ence, commitment, and some experimenta on with different foods and diets. Some experts believe that successfully managing your weight comes down to a simple equa on: If you eat fewer calories than you burn, you lose weight. Sounds easy, right? Then why is losing weight so hard? Weight loss isn't a linear event over me. When you cut calories, you may

drop weight for the first few weeks, for example, and then something changes. You eat the same number of calories but you lose less weight or no weight at all. That's because when you lose weight you're losing water and lean ssue as well as fat, your metabolism slows, and your body changes in other ways. So, in order to con nue dropping weight each week, you need to con nue cu ng calories. A calorie isn't always a calorie. Ea ng 100 calories of high fructose corn syrup, for example, can have a different effect on your body than ea ng 100 calories of broccoli. The trick for sustained weight loss is to ditch the foods that are packed with calories but don't make you feel full (like candy) and replace them with foods that fill you up without being loaded with calories (like vegetables). Many of us don't always eat simply to sa sfy hunger. We also turn to food for comfort or to relieve stress—which can derail any weight loss efforts before they begin. A different way of viewing weight loss iden fies the problem as not one of consuming too many calories, but rather the way the body accumulates f a t a e r c o n s u m i n g carbohydrates—in par cular the role of the hormone insulin. When you eat

a meal, carbohydrates from the food enter your bloodstream as glucose. In order to keep your blood sugar levels in check, your body always burns off this glucose before it burns off fat from a meal. If you eat a carbohydrate-rich meal, your body releases insulin to help with the influx of all this glucose into your blood. As well as regula ng blood sugar levels, insulin does two things: It prevents your fat cells from releasing fat for the body to burn as fuel (because its priority is to burn off the glucose) and it creates more fat cells for storing everything that your body can't burn off. The result is that you gain weight and your body now requires more fuel to burn, so you eat more. Since insulin only burns carbohydrates, you crave carbs and so begins a vicious cycle of consuming carbs and gaining weight. To lose weight, the reasoning goes, you need to break this cycle by reducing carbs. Permanent weight loss requires making healthy changes to your lifestyle and food choices. These ps can help you to stay mo vated: Find a cheering sec on. Social support means a lot. Programs like Jenny Craig and Weight Watchers use group support to impact weight loss and lifelong healthy ea ng. Seek out

| 39 | DIABETES FREE LIFE JANUARY-2018

support—whether in the form of family, friends, or a support group—to get the encouragement you need. Slow and steady wins the race. Losing weight too fast can take a toll on your mind and body, making you feel sluggish, drained, and sick. Aim to lose one to two pounds a week so you're losing fat rather than water and muscle. Set goals to keep you mo vated. Shortterm goals, like wan ng to fit into a bikini for the summer, usually don't work as well as wan ng to feel more confident or become healthier for your children's sakes. When tempta on strikes, focus on the benefits you'll reap from being healthier. Use tools to track your progress. Smartphone apps, fitness trackers, or simply keeping a journal can help you keep track of the food you eat, the calories you burn, and the weight you lose. Seeing the results in black and white can help you stay mo vated. Get plenty of sleep. Lack of sleep s mulates your appe te so you want more food than normal; at the same me, it stops you feeling sa sfied, making you want to keep ea ng. Sleep depriva on can also affect your mo va on, so try to get about eight hours of quality sleep a night.

10 TEST AND EXAM EVERYONE WITH DIABETES SHOULD BE GETTING 1. A-1-C blood glucose (blood sugar) test (This lab test should be done every 3 to 6 months. It is diﬀerent from blood tesng you do yourself. The A-1-C tells what your blood glucose has been during the last few months.)

your feet are healthy (a complete exam once a year, a brief foot exam at every oﬃce visit)

The A1C test is like a summary score of what your blood glucose has been over a period of me.

7. Exam of your gums and teeth (every 6 months)

2. Blood pressure

9. Flu shot (at the beginning of ﬂu season every Fall)

If your blood glucose stays too high over a long period of me, it can cause blood vessel damage and lead to serious health problems. O en, there are no symptoms to warn you when your blood glucose has been staying too high. To know for sure whether your blood glucose is staying at a healthy level or not, you need to have an A1C test at least twice a year.

3.Blood test to measure “g o o d ”c h o l e s t e r o l , “ b a d ” cholesterol, and triglycerides in your blood (once a year) 4. “Dilated” eye exam to see if the blood vessels inside your eye are healthy (once a year) 5. Urine test to see if your kidneys are healthy (once a year) 6. Complete foot exam to see if the blood circulaon, nerves, and skin in

8. Weight (at every oﬃce visit)

10. Pneumococcal vaccinaon (ask your doctor if you need it) The A1C is a lab test that tells what your average blood glucose has been during the previous 2 to 3 months. A1C is pronounced “A – one – see.” The A1C test is diﬀerent from blood tes ng you might do yourself. When you test your blood, this tells what your blood glucose is at the moment you do the test. | 40 | DIABETES FREE LIFE JANUARY-2018

For many people with diabetes, the A1C should be less than 7. You and your health care team will decide on an A1C goal that is right for you. When your A1C number is too high, it's a warning that you need to work

on ge ng your blood glucose lower to help protect your health. The closer you can ge ng your blood glucose lower to help protect your health. The closer you can delaying health problems that can happen when you have diabetes. Your doctor, diabetes educator, nutri onist, and others on your health care team can give you informa on and advice on what to do to get your blood glucose under be er control. Your plan might include being more ac ve, working on ea ng the right foods at the right mes in the right amounts, and taking medica ons if prescribed. The purpose of checking your blood pressure is to make sure it is not too high,because high blood pressure can lead to heart problems and stroke. Diseases that damage the heart and blood vessels, including stroke, are the biggest cause of death for people with diabetes. Keeping blood pressure at a healthy level lowers the

risk of heart a ack and stroke. It also lowers the chance of dying from heart disease. If your blood pressure numbers are too high, ask your health care team about what you can do to help get the numbers down. O en, this will mean lifestyle changes, such as healthier ea ng and being more ac ve. Your doctor may prescribe

| 41 | DIABETES FREE LIFE JANUARY-2018

blood pressure medica on as well. If your cholesterol and triglycerides are not at the right levels for good health, you have a greater chance of ge ng heart disease or stroke. The goals for healthy levels of cholesterol and triglycerides can vary from person to person, so it's important to check with your doctor to see what your goals should be.

UNITED WORLD DIABETES FEDERATION UNITED WORLD DIABETES FEDERATION

FACTS AND FIGURES ABOUT DIABETES § Every 10 seconds a person dies due to diabetes. § In the same 10 seconds two more people develop diabetes. § About 366 million people worldwide have diabetes. § India is hub of diabetes with nearly 67 million Indians suffering from it. § Diabetes is predicted to become the seventh leading cause of death in the world by

2030. § Total death from diabetes are projected to rise by more then 50% in the next decade. § The burden of diabetes is increasing globally, particularly in developing countries, due § § § § § §

to rapid increases in overweight, obesity and physical inactivity. Type 2 diabetes is much more common than Type 1diabetes. Type 2 diabetes is around 90% of total count. Cardiovascular disease is responsible for between 50% and 80% deaths among diabetes. 80% of diabetes deaths occur in low- and middle-income countries. Diabetes is a leading cause of blindness, amputation and kidney failure. 183 million people with diabetes are undiagnosed.

§ Diabetes caused 4.6 million deaths in 2011. § 78,000 children develop Type 1diabetes every year. § Total number of people living with diabetes will skyrocket within 20 years if nothing is

done. § Diabetes time bomb is ticking louder. § Type 2 diabetes can be prevented.

(Madhumeha) Diabetes AY U R V E D I C V I E W Diabetes Mellitus is a chronic metabolic disorder in which the body is unable to make proper use of glucose, resul ng in the condi on of hyperglycemia (high blood sugar). Excess glucose in the blood ul mately results in high levels of glucose being present in the urine (glycosuria). This increases the urine output, which leads to dehydra on and increased thirst. Glucose comes from the food we eat and is also made in liver and muscles. The blood carries

glucose to all the cells in our body. Insulin, a chemical (or hormone) produced in the pancreas, is responsible for the uptake of glucose into cells for energy. Decreased levels of insulin aﬀects this mechanism leading to increased glucose in the blood stream. Causes Factors that are o en responsible for causing diabetes are excessive intake of foods which are diﬃcult to digest, such as fried foods, creams, etc. Lack of exercise, mental stress and | 43 | DIABETES FREE LIFE JANUARY-2018

strain, excessive sleep, overea ng a n d c o n s e q u e n t o b e s i t y, excessive intake of sugar and reﬁned carbohydrates, Overloading of proteins and fats ca n a l s o l e a d to d i a b ete s . Hereditary factors also play role in causing diabetes. Symptoms Fa gue Weight loss or weight gain Frequent urinary tract infec ons Blurred vision Excessive swea ng Excessive thirst Excessive hunger Frequent urina on in large

quan ty In Ayurveda, Diabetes Mellitus is known as Madhumeha (Madhu means 'honey' and Meha means 'urine'). Medhumeha is categorized as Vataj Meha (a problem caused by aggrava on of Vata or Air). Vata is an Ayurvedic humor symbolizing wind and dryness. Deteriora on of the body is a characteris c that indicates impairment of Vata. M a x i m u m d e t e r i o ra o n o f dhatus (body ssues) occurs in this type of disease and this is the reason why all vital organs are affected by Diabetes. The other prime cause of Diabetes Mellitus is impaired diges on. Impaired diges on leads to accumula on of specific diges ve impuri es which accumulate in the pancrea c cells and impair the produc on of insulin. Ay u r v e d a d o e s n o t re ga rd Diabetes as a disease that can be treated by mere medicine or by a dietary regimen. Madhumeha is classified as a Maha Rog (Major Disease) because, if not treated in me, it can lead to several co m p lica o n s in t h e b o d y, including eye problems, joint

pains, impotency, kidney failure, sexual and urologic problems, and more. Diabetes is a metabolic disorder and it cannot be merely treated by controlling sugar levels. The treatment recommended in Ayurveda – as against modern medicine – is aimed at rejuvena ng the body to not only balance sugar levels, but also ensuring that no further complica on is caused. The Ayurvedic treatment for this disease is based on an en re change in the lifestyle of the person. Along with medica on and diet, the pa ent is also advised to lead a healthy lifestyle and live an ac ve life. Dietary and lifestyle changes rejuvenate the body's cells and ssues, allowing them to produce insulin properly. Even mental aspects of the disease are stressed upon in Ayurveda. The medicines that are administered are therefore meant to keep the brain in its right manner of func oning. Diet & Lifestyle Advice Include whole grains in the diet, such as wheat bread/pasta and brown rice. Cheese and yogurt prepared

| 44 | DIABETES FREE LIFE JANUARY-2018

with skimmed (nonfat) milk may be taken. Use garlic, onion, bi er gourd, spinach, raw banana, and black plum. Make a ﬂour mixture of 1 part barley, 1 part black chickpeas, and 4 parts whole-wheat ﬂour and use this to form pancakes and bread. Avoid sweet, sour, and salty foods, potatoes, sweet potatoes, colocasia (taro), yams, fresh grains and pulses (legumes), whole yogurt (high in fat), and heavy, oily and spicy foods. Avoid sweet fruits like pineapple, grapes, mangoes, etc. Start doing some light exercise, such as brisk walking. Build up to a brisk walk of 30-40 minutes in the morning and again in the evening. Avoid sleeping in the day me as it increases Kledaka Kapha. Home Remedies Dry the leaves of mango tree and grind to a powder. Mix 1 teaspoon dry powder in a glass of water and drink it daily to reduce high blood sugar levels. Take 2 teaspoons of bi er gourd (karela) juice once a day. One can also increase its use as a cooked vegetable. Ta ke 1 te a s p o o n o f I n d i a n

gooseberry (amla) juice mixed with 1 teaspoon of bi er gourd juice twice a day. Daily Rou ne for a Diabe c Wake up Time Wake up by 6 am in the morning, as you also need ample me to exercise. Have a glass of lukewarm water mixed with two teaspoonful of fresh lemon juice every day. Exercise Exercise forms an important part of treatment for diabe c pa ents. A morning walk is the best form of exercise. Yoga and medita on can also be beneficial, especially to relieve stress and bring clarity to the mind. If your health permits, opt for exercises such as jogging, swimming, cycling, etc. Breakfast In the morning, take two slices of whole meal bread with bu er and fresh milk (boiled and taken warm). Seasonal fresh fruits can be taken occasionally, with or without milk. At Work If you are an office-goer, make sure you carry filling snacks with you all the me, as Diabe cs are a d v i s e d n o t t o ke e p t h e i r stomachs empty. Instead of snacking on cheese, chips or crackers, enjoy a handful of nuts or seeds. Go for variety with s u nfl owe r, p u m p k i n s e e d s , almonds, cashews, and walnuts. Lunch For lunch, opt for steamed or lightly cooked green vegetables such as cauliflower, cabbage, tomatoes, spinach, turnip, asparagus and mushrooms.

Ve ge ta b l e s o u p o r b o i l e d vegetables can also be taken. In addi on, two or three whole wheat bread (chapa s), sprouts, salad, boiled rice, len ls (daal) etc. can be taken according to appe te. A glass of bu er milk (salty lassi) is a nice drink to end the lunch. Roasted cumin seeds, black salt, grated ginger and green coriander leaves can be added to the bu er milk. Day me Sleep I f yo u a re a n o n - w o r k i n g Diabe c, always remember not to sleep during the day me, as it increases Kledaka Kapha. A subdosha of Kapha, Kledaka Kapha governs the protec ve mucous lining of the diges ve system, thereby facilita ng proper diges on. In an increased state, it can lead to impairment of diges on, which can cause addi onal problems in Diabetes pa ents. Evening Snacks Have a glass of fresh fruit or vegetable juice. You can also take Ayurvedic tea with roasted chickpeas. Dinner Always remember that your dinner should be light and not have too many items. Boiled vegetables, sprouts, co age cheese (paneer) or a bowl of salad made from fresh raw vegetables of the season. Also, make it a point to eat at least two hours before you go to bed. Bed me Go to sleep before 10 pm. Have a glass of fresh boiled warm milk before going oﬀ to bed. Useful herbs for diabetes | 45 | DIABETES FREE LIFE JANUARY-2018

management 1 Jambhul (Eugenia jambolana)Powder from jamun core is useful. 2 Gurmar(gymnema sylvestre). 3 Bi er Gourd/bi er melon (Momordica charan a) 4 Bel (Aegle marmelos). 5 Fenugreek (Trigonella foenum graecum) 6 Turmeric 7 Neem. 8 Triphala 9 Shilajit Useful drug formula ons â&#x20AC;&#x201C; 1 Chandrabrabha. 2 Arogyavardhini. 3 Asanad tablets 4 Shilajit Va 5 Trivanga bhasma. 6 Vasant Kusumakar Diet in Diabetes Use barly ,Varee, Mung, Kuli ha, Chickpeas, old rice, bi er gourd, Dodaka, dudhee gourd in diet. Roasted rice and wheat are more useful . Include 'Tikta ras' items in diet. In summa on, diabetes is not just a lack of insulin. Its most probable cause is plain poor maintenance of your body. It 's cure will need to include all of these things discussed. By doing all, diet, herbs, exercise and stress management, we will be able to take care of a single problem Diabe s.

SOME FORMS OF DIABETES

he “Diabesity” epidemic (obesity and type 2 diabetes) is likely to be the biggest epidemic in human history. Diabetes has been seriously underrated as a global public health issue and the world can no longer ignore “the rise and rise” of type 2 diabetes. Currently, most of the na onal and global diabetes es mates come from the IDF Atlas. These es mates have signiﬁcant limita ons from a public health perspec ve. It is apparent that the I D F have consistently underes mated the global burden. More reliable es mates of the future burden of diabetes are urgently needed. To prevent type 2 diabetes, a be er understanding of the drivers of the epidemic is needed. While for years, there has been comprehensive a en on to the “tradi onal” risk factors for type 2 diabetes i.e., genes, lifestyle and behavioral change, the spotlight is turning to the impact of the intra-uterine environment and epigene cs on future risk in adult life. It highlights the urgency for

discovering novel approaches to preven on focusing on maternal and child health. Diabetes risk through epigene c changes can be transmi ed inter-genera onally thus crea ng a vicious cycle that will con nue to feed the diabetes epidemic. History provides important lessons and there are lessons to learn from major catastrophic events such as the Dutch Winter Hunger and Chinese famines. The Chinese famine may have been the trigger for what m ay b e v i e we d a s a d i a b e te s “avalanche” many decades later. The drivers of the epidemic are indeed genes and environment but they are now joined by deleterious early life events. Looking to the future there is the poten al scenario of future new “hot spots” for type 2 diabetes in regions e.g., the Horn of Africa, now experiencing droughts and famine. This is likely to occur should improved economic and living condi ons occur over the next few decades. Type 2 diabetes will remain one of the greatest challenges to human health for many years to come. | 47 | DIABETES FREE LIFE JANUARY-2018

The Interna onal Diabetes Federa on (IDF) has asked a very simple ques on, if you look at the world's most populous countries, where would diabetes ﬁt? Numerically diabetes, if it were a na on, would surpass the United States as the third most populated country in the world. While there are approximately 320 million people in the U.S., there are now 415 million people in the world with diabetes according to the IDF . This is clear evidence to suggest that we have a major global problem with type 2 diabetes. The IDF has a empted to create awareness of the importance of type 2 diabetes. In the year 2000, I D F es mated there were 151 million people with diabetes globally and predicted that by 2030, there would be 324 million people in the world with d i a b e te s . T h e Wo r l d H e a l t h Organiza on (WHO) also es mated the global prevalence of diabetes in 2000 and 2030–171 million people with diabetes in 2000 and 366 million by 2030. They were terribly wrong,

because by 2015 there were already 415 million people with diabetes, far above what was predicted in 2000 for 30 years later. And the situa on may even be worse than that. To perform its global projec ons, the I D F es mates how many people have diabetes in each country. If a country does not have data about diabetes prevalence, the IDF extrapolates from another country using regional data or match geography, World Bank income, et h n i c i t y a n d l a n g u a ge . T h e s e extrapola ons are less reliable. If anything, the current IDF es mates are s ll a quite serious underes mate. This issue is of more than academic interest because young researchers in epidemiology may think the IDF and WHO data are gospel. Unfortunately, they may represent a quick grab of data that go out for public rela ons purposes and not necessarily for public health beneﬁt and planning. In 1978, a Kroc Founda on Interna onal Conference on Epidemiology of Diabetes and Its Macrovascular Complica ons was held in Santa Ynez Valley, California. A endees included Kelly West, Peter Benne , Harry Keen and other legendary ﬁgures in diabetes epidemiology. I was also there, though

as a “budding” epidemiologist! The Santa Ynez Valley mee ng produced a classifica on of diabetes, diagnos c criteria, and proper protocols for diabetes epidemiology studies, so if a study was done in Japan, it would be comparable to one performed in the United States. This heritage of consensus and standardiza on has been lost of late because of the prac ce of the IDF and WHO and indeed the Global Burden of Disease Group and others to publish data which underes mate the burden of diabetes and, if used for public health purposes, probably underes mate the resources required to a ack the epidemic. So we have issued a word of cau on and hopefully the word will get out . So what about this epidemic of diabetes? I started my diabetes epidemiology ac vi es in the Pacific and, later on, the Indian Ocean island of Mauri us. The inspira on for me to get into diabetes research came from the early studies of Ian Prior, a famous cardiovascular epidemiologist who, in the mid-1960s, published informa on about high rates of diabetes in Polynesians living in New Zealand and the Pacific islands. In 1975, I was in London training at Guys

| 48 | DIABETES FREE LIFE JANUARY-2018

Hospital and it was Christmas. It was snowing and cold and no one came to work. I was si ng there by myself and I picked up an old Bri sh Medical Journal and read about Ian Prior's research showing high rates of diabetes in Polynesians. Subsequently Peter Benne showed that Pima Indians living in Arizona had the highest prevalence of diabetes in any community in the world. There was also a study in Australia showing how indigenous people have high rates of diabetes. So when I returned to Australia from London, I decided to inves gate the issue of diabetes in Paciﬁc Island popula ons. A er our group showed very high rates of diabetes in the Paciﬁc, the WHO asked me to go to Mauri us to have a look at the diabetes problem there as there were some indica ons that diabetes was becoming a problem on that beau ful and idyllic Indian Ocean Island. It was important to understand d i a b ete s i n M a u r i u s b e ca u s e although it had a rela vely small popula on of 1.2 million, the popula on represented three major ethnic groups: Asian Indians from India, Creole- South African Black popula on, and Chinese people. Together, these three ethnic groups

represent approximately two-thirds of the world's popula on. Whatever was happening in Mauri us could be extrapolated to other countries where there were Indian, Chinese and Creole or Black popula ons. Epigene cs and risk for diabetes Although I have always been a strong believer in the “CocaColoniza on” story, a term suggested by Arthur Koestler, that changes of lifestyle in rural and tradi onal island popula ons have caused the epidemics of obesity and diabetes, I think there are emerging data that suggest we need to rethink the story and consider the impact of epigene cs. In 1990, David J. P. Barker ﬁrst proposed that in utero metabolic adapta on deﬁnes a trajectory of growth that prepares the fetus for its likely adult environment. What happens in utero to the fetus depends on the mother's and the father's behaviors before concep on and the mother's during pregnancy. The story goes back to the Dutch winter famine . At the end of World War 2, there was a

famine during the Nazi Germany occupa on of Holland. Women who were pregnant were on very poor d i e t s . S o m e 3 0 y e a r s l a t e r, researchers looked to see what happened to the children who were born at that me. They found high r a t e s o f d i a b e t e s , o b e s i t y, hypertension, and indeed some mental disorders like schizophrenia in the oﬀspring of women who were undernourished during early pregnancy. This raised the issue of the famine and what happened many years later when these children became adults. Their risks of chronic diseases were increased. This is just an example of some of the risk factors that can inﬂuence in utero this process and it's been well demonstrated in animal studies that this happens. All of the data so far in humans is retrospec ve, but there is now a prospec ve study in Singapore led by Professor Sir Peter Gluckman, to assess the impact of epigene cs at a h u m a n l eve l . W h at i s a l s o interes ng is that diabetes itself is one of the many factors that can

| 49 | DIABETES FREE LIFE JANUARY-2018

cause epigene c changes. We know that mothers with pre-gesta onal diabetes and mothers with gesta onal diabetes are more likely to have offspring who are either obese or have diabetes. And the epigene c effect appears to be intergenera onal. It means you could have a vicious cycle perpetua ng the diabetes epidemic. Gluckman and Hansen have authored a book, Mismatch , sugges ng that a baby born in a famine situa on expects to come out into the famine, but may arrive into an obesogenic environment. I have tried to make this phenomenon a li le clearer by poin ng out that with undernutri on in pregnancy, the adapta on is to expect a scarce resource environment. If the expecta on is not met because the baby arrives to an obesogenic environment, we may see both early changes in the child, and an increased risk of obesity, diabetes, and heart disease in adult life. CYSTIC FIBROSIS AND DIABETES Cys c fibrosis (CF) is a gene c disorder that affects mostly the lungs, but also the pancreas, liver, kidneys, and

intes ne. Long-term issues include difficulty breathing and coughing up mucus as a result of frequent lung infec ons. Other signs and symptoms may include sinus infec ons, poor growth, fa y stool, clubbing of the fingers and toes, and infer lity in males. Different people may have different degrees of symptoms. No cure for cys c fibrosis is known. Lung infec ons are treated with an bio cs which may be given intravenously, inhaled, or by mouth. Some mes, the an bio c azithromycin is used long term. I n h a l e d hy p e r t o n i c s a l i n e a n d salbutamol may also be useful. Lung transplanta on may be an op on if lung func on con nues to worsen. Pancrea c enzyme replacement and fat-soluble vitamin supplementa on are important, especially in the young.Airway clearance techniques such as chest physiotherapy have some short-term benefit, but longterm effects are unclear.The average life expectancy is between 42 and 50 years in the developed world.Lung problems are responsible for death in 80% of people with cys c fibrosis.

People with C F R D may not experience any symptoms. Some diabetes symptoms are similar to other CF symptoms you may already have. Many people with CFRD do not know they have CFRD un l they are tested for diabetes. Some common symptoms, like increased thirst and urina on, are caused by high blood sugar levels, known as hyperglycemia. Other symptoms of CFRD are excessive fa gue, weight loss, and unexplained decline in lung func on. The CF care guidelines for CFRD recommend that people with CF ages 10 and older be tested every year for CFRD with an oral glucose tolerance test (OGTT). The OGTT is the best way to diagnose CFRD and is usually done in the morning a er an eighthour fast. If you are diagnosed with C F R D, you will receive proper treatment in order to feel be er, gain weight and improve your lung func on. CFRD can be well managed with insulin, along with monitoring your blood sugar levels, ea ng your usual

high-calorie diet, and staying ac ve. There are many types of insulin, which are grouped by how fast they work and how long they last in the body. Insulin is injected into the body and helps your body cells absorb the energy (calories) from the food you eat. Calories in food come from carbohydrates, protein, and fat. Insulin helps the body cells absorb these three nutrients so you can achieve and maintain a healthy body weight and good nutri onal status. Unlike people with type 1 or type 2 diabetes, people with CFRD s ll need to eat the same high-calorie, highprotein, high-fat, high-salt diet to help achieve and maintain a healthy body weight. Since foods with carbohydrates turn into blood glucose when eaten, people with CFRD need to count the carbohydrates in the foods they eat so they can give themselves the right amount of insulin. Your diabetes care team will help you determine the amount of insulin you need for your carbohydrates.

UNITED WORLD DIABETES FEDERATION UNITED WORLD DIABETES FEDERATION

WHAT WE ARE DOING § Public awareness of diabetes as a serious disease and awareness of

risk factors § Early detection of diabetes by organizing diabetes camps § Diet and nutrition for diabetes § Free medicine distribution for poor section of our society § Yoga and meditation for diabetes § Herbal, Ayurvedic and Natural remedies to control blood sugar level § New research and development for diabetes § Special events for children living Type 1 diabetes § Advocacy for diabetic living people § Organizes diabetes awareness camps in corporate and societies § Guide to pre-diabetic peoples how to controls diabetes

L P A EA B C

Global Wellness Foundation

GLOBAL WELLNESS FOUNDATION

Diabetes Free Life Mission – Diabetes Awareness Van Appeal for contribu on Diabetes is major health challenge in India, Globally India known as a Diabetes capital in the world, Around 70 million people diagnosed diabe c but as per IDF more than 51% Indian popula on is s ll not unaware about diabetes because they not goes any diagnosis for it, As per latest survey most of Indian women are unaware about diabetes and complica ons, due to lack of awareness and their poor financial condi on, Rural areas GP (General Prac oner) are not equipped proper knowledge and diagnosis of Type1 diabetes, Children’s with type 1 diabetes require inject insulin regularly without insulin even they can`t servive, Children with type 1 are dying due to lack of awareness or insulin unavailability. United World Diabetes Federa on is going to start India`s first Diabetes awareness van under campaign “Diabetes Free Life Mission” This diabetes awareness van will operate ini ally in five states includes Delhi, Haryana, Rajasthan, Maharashtra and U ar Pradesh. We will cover all ci es and rural areas and spread diabetes awareness, conduct diabetes screen test, educate people about preven on and control of diabetes.

ASSOCIATED WITH GLOBAL WELLNESS FOUNDATION

UNITED WORLD DIABETES FEDERATION UNITED WORLD DIABETES FEDERATION

UNITED WORLD DIABETES FEDERATION

United World Diabetes Federation In Association With National Skill Development Corporation

Diabetes Educator: In rural areas where diabetes specialty doctor and hospital is not available and people are not aware about how to control and prevent diabetes, awareness plays a very important role in the control of diabetes so we require a skilled person who can care, counsel, aware and educate diabetes health in general public. United World Diabetes Federa on is planning to train and cer fy 1, 00,000 diabetes educator in India with Govt. of India`s, unique ini a ve Pradhan Mantri Kaushal Vikas Yojna. Diabetes Educator skill program focuses mainly on:• Lifestyle modiﬁca on • Diet & nutri on for diabetes • Yoga for diabetes • Self Management Educa on • Path physiology of diabetes and its complica ons • Screening diabetes test and diabetes complica on control.

www.diabetesfreelife.in

UNITED WORLD DIABETES FEDERATION UNITED WORLD DIABETES FEDERATION

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United World Diabetes Federation, is a section 8 company registered in India under the provision of Companies Act, 2013.Having its registered office at 52 Babar Road, New Delhi-110001. The company was registered on 27/09/2016 with Registrar of Companies, New Delhi with CIN No. U74999DL2016NPL306481

UNITED WORLD DIABETES FEDERATION

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The information in this publication is for information purposes only. ‘Diabetes Free Life’ Magazine assumes no liability or responsibility for any inaccurate, delayed or incomplete information, nor for any actions taken in relevance thereon. The information contained about each individual, event or organization has been provided by such individual, without verication by us. The opinion expressed in each article is the opinion of its author and does not necessarily reect the opinion of ‘Diabetes Free Life’ Magazine. Therefore, ‘Diabetes Free Life’ Magazine carries no responsibility for the opinion expressed thereon.Comments are welcome, but they should be on-topic and well-expressed. Abusive, antisocial or off-topic comments will be prohibited. Any jurisdiction disputes subject to at Pune only.

Recipes For Diabe c

adai Tofu: The very prefix of "kadai" is a qualifier for a recipe. . . You can be almost sure you are in for a rich, scrump ous feast! this special dish, which is a low cal varia on of the original recipe, is just as tasty as the high calorie original version. Sliced capsicum make the dish look rather "pre y" and colourful! kasuri methi infuses an interes ng flavour to the dish. You can make it at home: just clean, wash and sun-dry the fenugreek leaves for 2-3 days and kasuri methi is ready. If you keep it refrigerated in an air- ght bo le, you can use it for months! since it is dried and the flavour is concentrated, it is to be used only in small quan es. Relish with low cal accompaniments like phulka, missi ro s or occasionally if you are feeling indulgent with soya puris.

Ingredients 2 tsp soya oil 2 tsp ginger-garlic (adrak-lehsun) paste 1/2 cup ﬁnely chopped onions 1/4 tsp turmeric powder (haldi) 1 tsp coriander-cumin seeds (dhaniajeera) powder 1 tsp chilli powder 1 tsp garam masala 1 tsp dried fenugreek leaves (kasuri methi) 1/2 cup fresh tomato purée 1/4 cup sliced capsicum 1 cup tofu , cut into thick strips 1/2 tsp sugar 2 tbsp low fat cream salt to taste 2 tbsp chopped coriander (dhania) for garnishing

Method 1. Heat the soya oil in a non-s ck kadhai, add the ginger-garlic paste and onions and sauté ll the onions turn light brown in colour. 2. Add the turmeric powder, coriander-cumin seeds powder, chilli powder, garam masala and dried fenugreek leaves and cook for 2 to 3 minutes. 3. Add the tomato purée and ¼ cup of water and simmer for 10 minutes. 4. Add the capsicum, tofu, sugar, cream, salt and ¼ cup of water, mix lightly and cook for another 5 minutes. 5.Serve hot garnished with coriander.

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Masala Karela recipe How to make Masala Karela Ingredients

salt to taste

1 cup deseeded and thinly sliced bi er gourd (karela)

Method

2 tsp oil

o Be Mixed Together Into A Mixture

1/2 cup ﬁnely chopped onions

1. Heat the oil in a broad non-s ck pan, add the bi er gourd slices and mix well. Cover with a lid and cook on a medium ﬂame for 10 to 12 minutes or ll they turn brown in colour, while s rring occasionally. 2. Add the prepared mixture, mix well and cook on a medium ﬂame for another 1 to 2 minutes, while s rring occasionally. 3. Serve immediately.

1/4 cup grated cauliflower 1/4 cup finely chopped coriander (dhania) 1 tbsp besan (bengal gram flour) 1/2 tsp chilli powder 1 tsp coriander (dhania) powder

| 59 | DIABETES FREE LIFE JANUARY-2018

Be Nice To Diabetics. We Deal with Enough Pricks Already!