Fenugreek (Trigonella foenum-graecum)

Fenugreek (Trigonella foenum-graecum) is an herbal supplement often claimed to be beneficial for the following uses:

Lowering blood sugar in people with diabetes
Helping with a loss of appetite
Lowering cholesterol
Lowering triglycerides
Stimulating milk production in breastfeeding women.



Fenugreek contains sotolon, trigonelline, and 4-hydroxyisoleucine, compounds that are thought to be the active components of it. 4-hydroxyisoleucine may stimulate the secretion of insulin, which is why fenugreek may theoretically lower blood sugar. The seeds also contain fiber and pectin, a complex carbohydrate, both of which may slow down the digestive tract, which can help lower blood sugar. However, it is important to know that there is not enough scientific evidence to show that fenugreek is indeed effective for these uses.

Fenugreek may also contain "blood-thinning" compounds known as coumarins, but it is not known if these compounds are present in high enough quantities to actually make a difference in humans. The herb may also stimulate the uterus, heart, and intestines. However, it is important to know that there is not sufficient scientific evidence to show that fenugreek is effective for these uses.

Side Effects

Fenugreek can cause several side effects

Diarrhea
Indigestion or heartburn
Low blood sugar (hypoglycemia)
Body and urine odors that smell like maple syrup.

Is Fenugreek Safe?

Normal doses are probably safe for most people when taken in normal amounts, such as amounts found in food, although higher doses can cause problems. Some people may be more likely to experience problems than others. Therefore, you should talk with your healthcare provider prior to taking this supplement if you have:

Diabetes
A bleeding disorder
Any allergies, including allergies to foods, dyes, or preservatives.

Also, let your healthcare provider know if you are:

Pregnant or thinking of becoming pregnant
Breastfeeding.

Make sure to tell your healthcare provider about all other medicines you are taking, including prescription and non-prescription medicines, vitamins, and herbal supplements.

It is not known exactly what to expect from a fenugreek overdose, but it is reasonable to assume that taking too much may cause the usual side effects of fenugreek, but they may be more severe. Theoretically, an overdose could cause severe problems, such as internal bleeding or dangerously low blood sugar.

RETINOPATHY IN DIABETES!!

Retina has tiny blood vessels that are easy to damage. Having high blood glucose and high blood pressure for a long time can damage these tiny blood vessels.

Initially these tiny blood vessels swell and weaken. Some blood vessels then become clogged and do not let enough blood through. most patients do not experience any symptoms in this stage

One eye may be damaged more than the other, or both eyes may have the same amount of damage. As diabetic retinopathy becomes worse, new blood vessels grow. These new blood vessels are weak. They break easily and leak blood into the vitreous of eye. The leaking blood keeps light from reaching the retina.

In this stage patients may experience floating spots or almost total darkness. Sometimes, the blood will clear out by itself, in other cases surgery is required to remove it.

Over the years, the swollen and weak blood vessels can form scar tissue and pull the retina away from the back of the eye. If the retina becomes detached, you may see floating spots or flashing lights. You may feel as if a curtain has been pulled over part of what you are looking at. This condition can cause loss of sight or blindness if you don't take care of it right away.

Symptoms

Often, there are no symptoms in the early stages of this diabetic eye disease. Vision may not change until the disease becomes severe, nor is there any pain. Blurred vision may occur when the macula -- the part of the retina that provides sharp, central vision -- swells from the leaking fluid. This condition is called macular edema.

If new blood vessels have grown on the surface of the retina, they can bleed into the eye, blocking vision. Even in more advanced cases, the disease may progress a long way without any noticeable symptoms, so regular eye examinations for people with diabetes are important.

Treatment

There are a number of treatment options for diabetic retinopathy. Your eye doctor may suggest laser treatment, which involves a light beam aimed into the retina of the damaged eye. The beam closes off leaking blood vessels, which may stop blood and fluid from leaking into the vitreous and slow down the loss of sight.

If a lot of blood has leaked into your vitreous and your sight is poor, your eye doctor might suggest you have surgery called a vitrectomy. This procedure removes blood and fluids from the vitreous of your eye. Then, clean fluid is put back into the eye. The surgery often makes your eyesight better.

Diabetic Retinopathy !

Diabetic Gastroparesis!!

Diabetic gastroparesis is the result of damage to the vagus nerve, which controls the movement of food through the digestive system. In a person with this condition, the stomach takes too long to empty its contents. Symptoms include heartburn, nausea, vomiting undigested food, and weight loss. In most cases, treatment does not cure the problem.It often occurs in people with type 1 diabetes or type 2 diabetes. -- it is usually a chronic condition.

Signs & Symptoms

Heartburn
Nausea
Vomiting of undigested food
An early feeling of fullness when eating
Weight loss
Abdominal bloating
Erratic blood glucose levels
Lack of appetite
Gastroesophageal reflux
Spasms of the stomach wall.

Treatment options

Dietry pattern

Taking small frequent meals
try several liquid meals a day until your blood glucose levels are stable
avoid high-fat and high-fiber foods

Pharmacotherapy

Metoclopramide - Stimulates stomach muscle contractions to help empty food. It also helps reduce nausea and vomiting. Metoclopramide is taken 20 to 30 minutes before meals and at bedtime. Side effects of this drug are fatigue, sleepiness, and sometimes depression, anxiety, and problems with physical movement.

Erythromycin - This antibiotic also improves stomach emptying. It works by increasing the contractions that move food through the stomach. Side effects are nausea, vomiting, and abdominal cramps.

Domperidone - It is a promotility agent like metoclopramide. Domperidone also helps with nausea.

Newer Options - A gastric neurostimulator has been developed to assist people with diabetic gastroparesis. The battery-operated device is surgically implanted and emits mild electrical pulses that help control nausea and vomiting associated with diabetic gastroparesis.

The use of botulinum toxin has been shown to improve stomach emptying and the symptoms of diabetic gastroparesis by decreasing the prolonged contractions of the muscle between the stomach and the small intestine (pyloric sphincter). The toxin is injected into the pyloric sphincter.

Gastroparesis - other causes

Postviral syndromes
Anorexia nervosa
Surgery on the stomach or vagus nerve
Medications, particularly anticholinergics and narcotics (these drugs slow contractions in the intestine)
Gastroesophageal reflux disease (rarely)
Smooth muscle disorders such as amyloidosis and scleroderma
Nervous system diseases, including abdominal migraine and Parkinson's disease
Metabolic disorders, including hypothyroidism.

Gestational / pregnancy induced Diabetes

Gestational diabetes generally resolves once the baby is born. Based on different studies, the chances of developing GDM in a second pregnancy are between 30 and 84%, depending on ethnic background. A second pregnancy within 1 year of the previous pregnancy has a high rate of recurrence.

Women diagnosed with gestational diabetes have an increased risk of developing diabetes mellitus in the future.
The risk is highest in women who needed insulin treatment,
Had antibodies associated with diabetes (such as antibodies against glutamate decarboxylase, islet cell antibodies and/or insulinoma antigen-2),
Women with more than two previous pregnancies,
Women who were obese.

Women requiring insulin to manage gestational diabetes have a 50% risk of developing diabetes within the next five years.
The risk appears to be highest in the first 5 years, reaching a plateau thereafter.

Children of women with GDM have an increased risk for childhood and adult obesity and an increased risk of glucose intolerance and type 2 diabetes later in life.
This risk relates to increased maternal glucose values.It is currently unclear how much genetic susceptibility and environmental factors each contribute to this risk, and if treatment of GDM can influence this outcome.

FOOT PROBLEMS - HEEL FISSURES!!

Heel fissures, also known as cracked heels can be a simple cosmetic problem and a nuisance, but can also lead to serious medical problems. Heel fissures occur when the skin on the bottom, outer edge of the heel becomes hard, dry and flaky, sometimes causing deep fissures that can be painful or bleed.

Heel fissures can affect anyone, but common risk factors are
Living in a dry climate
Obesity
Walking barefoot or wearing sandals or open-backed shoes
Inactive sweat glands

Treatment and Prevention

Moisturizing the feet regularly can prevent heel fissures. Once they occur, you can use a pumice stone daily to gently decrease the thick and flaky layer of skin. Avoid going barefoot or wearing open-backed shoes, sandals or shoes with thin soles. Shoes with strong shock absorption can help to improve the condition.

Moisturizing the feet at least twice a day and wearing socks over moisturizer while sleeping can also help.

INSULIN HOW TO USE??

NOVOLET



VICTOZA

CLIPS!!

DIABETES MELLITUS



DIABETIC NEPHROPATHY




TYPE 1 DIABETES

Common foot problems - Fungal Infection!

Toenail fungus, known as Onychomycosis, Fungal infections occur when microscopic fungi gain entry through a small trauma in the nail, then grow and spread in the warm, moist environment inside the patient's socks and shoes.

Symptoms of toenail fungus, which can be caused by several types of fungi, include swelling, yellowing, thickening or crumbling of the nail, streaks or spots down the side of the nail, and even complete loss of the nail. Toenail color can vary from brown or yellow to white with this condition.

Fungal infections can affect the fingernails as well as the toenails, but toenail fungus is more difficult to treat because toenails grow more slowly. It occurs most often on the big or small toe, but might occur on any toe.

Cause

Toenail fungus can be picked up in damp areas. Athletes and people who wear tight-fitting shoes or tight hosiery that cause trauma to the toes or keep the feet from drying out are at higher risk. The condition can also spread from one toe to another, or to other parts of the body.

Other risk factors include abnormal PH level of the skin, not drying off the feet thoroughly after bathing or exercise, and a compromised immune system in someone who has been exposed to a fungus. Diabetics have an increased risk of contracting a toenail fungus because their immune system is compromised. They should have their nails cut and debrided by a podiatrist.

Treatment and Prevention


Because it is difficult to treat or eradicate toenail fungus, it is a good idea to try to prevent it.

Wash your feet regularly, and dry them thoroughly when they get wet. Wearing nail polish on the toes is not advised because it can seal in fungus and allow it to grow. Keep toenails trimmed, and be sure to disinfect any pedicure tools before using them.

If you do develop toenail fungus, see your foot doctor. The doctor might remove as much of the nail as possible by trimming, filing or dissolving it. Medicated nail polish might be prescribed for a localized infection, but a serious infection will likely be treated with a prescription oral antifungal medication. These medications can have side effects, so be sure to work closely with your doctor on your treatment plan. Only in severe cases will surgical removal of the nail be recommended.

Common foot problems - Heel Pain!!

Heel pain is a common condition in which weight bearing on the heel causes extreme discomfort.

Cause

There are two different categories of heel pain. The first is caused by repetitive stress which refers to a soreness resulting from too much impact on a specific area of the foot. This condition, often referred to as "heel pain syndrome," can be caused by shoes with heels that are too low, a thinned out fat pad in the heel area, or from a sudden increase in activity.

Plantar fasciitis, a very common diagnosis of heel pain, is usually caused from a biomechancial problem, such as flat feet. The plantar fascia is a broad band of fibrous tissue that runs along the bottom surface of the foot, from the heel through the midfoot and into the forefoot. Flat feet can cause the plantar fascia to be excessively stretched and inflamed, resulting in pain in the heel and arch areas of the foot. Often the pain will be most intense first thing in the morning or after a prolonged period of rest. The pain will gradually subside as the day progresses.

Treatment and Prevention

To properly treat heel pain, you must absorb shock, provide cushioning and elevate the heel to transfer pressure. This can be accomplished with a heel cup, visco heel cradle, or an orthotic designed with materials that will absorb shock and shear forces.

When the condition is pronation related (usually plantar fasciitis), an orthotic with medial posting and good arch support will control the pronation and prevent the inflammation of the plantar fascia.

Footwear selection is also an important criteria when treating heel pain. Shoes with a firm heel counter, good arch support, and appropriate heel height are the ideal choice..

Common foot problems - CORNS

Definition

Corns like calluses develop from an accumulation of dead skin cells on the foot, forming thick, hardened areas. They contain a cone-shaped core with a point that can press on a nerve below, causing pain. Corns can become inflamed due to constant friction and pressure from footwear. Corns that form between the toes are sometimes referred to as soft corns.




Cause

Some of the common causes of corn development are
Tight fitting footwear
High heeled footwear
Tight fitting stockings and socks
Deformed toes
Due to foot sliding forward in a shoe that fits too loosely.

Complications that can arise from corns include bursitis and the development of an ulcer.

Treatment and Prevention

There are very simple ways to prevent and treat the corns.
You should wear properly fitted footwear with extra room in the toe box (toe area).
Avoid shoes that are too tight or too loose.
Use an insole that will absorb shock and shear forces.
Also avoid tight socks and stockings to provide a healthier environment for the foot.

Do not use corn removing solutions and medicated pads. These solutions can sometimes increase irritation and discomfort. Diabetics and all other individuals with poor circulation should never use any chemical agents to remove corns.

If the problem persists, consult a Podiatric surgeon

Pedicure in diabetics!

Soak your feet into your little foot basin containing warm, soapy water or a disinfectant for sore feet.
After 15 minutes, gently brush nails with a nail brush.
Use a pumice stone to rub off dead skin and smoothen heels. A gentle to and from movement helps to scrub off dead cells.
Blot dry excess water from feet and between your toes.
Trim your nails using scissors or nail clipper. Cut it straight across.
Use an emery board or nail file to file nails. Avoid filing the sides of nails as it will lead to ingrown toe nails.
Use a little cuticle cream to ease back cuticles steadily and very gently. Do not cut cuticles as toe nails require them for protection. Just loosen cuticle and push back gently.
A damp cotton wool covered orange stick helps to clean undernails.
Massage in a rich cream or moisturizing lotion.
Give your feet a relaxing massage using long sweeping movements.

Thyroid & Diabetes..

Diabetic patients have a higher prevalence of thyroid disorders compared with the normal population. Because patients with one organ-specific autoimmune disease are at risk of developing other autoimmune disorders, and thyroid disorders are more common in females, it is not surprising that up to 30% of female type 1 diabetic patients have thyroid disease. The rate of postpartum thyroiditis in diabetic patients is three times that in normal women. A number of reports have also indicated a higher than normal prevalence of thyroid disorders in type 2 diabetic patients, with hypothyroidism being the most common disorder.


Thyroid disease in the general
population: 6.6%
Thyroid disease in diabetes:
Overall prevalence: 10.8¬13.4%
Hypothyroidism: 3¬6%
Subclinical hypothyroidism: 5¬13%
Hyperthyroidism: 1¬2%
Postpartum thyroiditis: 11%


The presence of thyroid dysfunction may affect diabetes control. Hyperthyroidism is typically associated with worsening glycemic control and increased insulin requirements. There is underlying increased hepatic gluconeogenesis, rapid gastrointestinal glucose absorption, and probably increased insulin resistance. Indeed, thyrotoxicosis may unmask latent diabetes.

First, in hyperthyroid patients, the diagnosis of glucose intolerance needs to be considered cautiously, since the hyperglycemia may improve with treatment of thyrotoxicosis.

Second, underlying hyperthyroidism should be considered in diabetic patients with unexplained worsening hyperglycemia.

Third, in diabetic patients with hyperthyroidism, physicians need to anticipate possible deterioration in glycemic control and adjust treatment accordingly. Restoration of euthyroidism will lower blood glucose level.

Even subclinical hypothyroidism can exacerbate the coexisting dyslipidemia commonly found in type 2 diabetes and further increase the risk of cardiovascular diseases. Adequate thyroxine replacement will reverse the lipid abnormalities.
In young women with type 1 diabetes, there is a high incidence of autoimmune thyroid disorders. Transient thyroid dysfunction is common in the postpartum period and warrants routine screening with serum thyroid-stimulating hormone (TSH) 6¬8 weeks after delivery. Glucose control may fluctuate during the transient hyperthyroidism followed by hypothyroidism typical of the postpartum thyroiditis. It is important to monitor thyroid function tests in these women since approximately 30% will not recover from the hypothyroid phase and will require thyroxine replacement. Recurrent thyroiditis with subsequent pregnancies is common.

Thanks Dr.deepa

I would like to thank Dr.Deepa (Diabetologist) for her sincere support. Right from the day I started this blog she has spared a bit of her valuble time to go through the posts in my blog and comment about each and every post. I would like to post a small part of her comments which might be useful to the readers of this blog.


Comments about Otelixizumab


This Drug is effective only if there is some beta cell reserve in the body and only if are known to have some autoantibody. Otherwise no use. This has created an excitement in the type 1 children, which actually might not be useful unless they have a significant c peptide level. Pts having a subnormal reserve of insulin can also be tried on this drug as there are other benefits in retaining the existing B-cells.

Comments about Glucometer

Actually the first blood should be wiped off and only the second drop should be taken without squeezing much. Because the first drop contains more of interstitial fluid more than blood. Most of them forget this pt.

Comment about Alcohol & Diabetes

The reason for using calorie free drink mixers is that, by adding soft drinks, the glucose in it can actually trigger insulin release and worsen the anticipated hypoglycemia. Since there is no calorie in alcohol the insulin release cannot be neutralized. The reason why pt develop hypo after taking alcohol is that it suppresses HGO (Hepatic Glucose Output).And most of the pts skip the food after taking alcohol, so the condition is even more worse.

Once again I would like to thank Dr.Deepa for her comments and hope that her support for my blog will continue in future too!!

Can a Diabetic have ALCOHOL??

Beyond all the health and safety concerns about alcohol, if you have diabetes and are on diabetes medications that lower blood glucose, you need to practice caution. Insulin and some diabetes pills can lower blood glucose. So, you should not drink when your blood glucose is low or when your stomach is empty.

Alcohol can cause hypoglycemia shortly after drinking and for 8-12 hours after drinking. So, if you want to drink alcohol, check your blood glucose before you drink and eat either before or while you drink. You should also check your blood glucose before you go to bed to make sure it is at a safe level -- between 100 and 140 mg/dL. If your blood glucose is low, eat something to raise it. The symptoms of too much alcohol and hypoglycemia can be similar -- sleepiness, dizziness, and disorientation.

A Few Guidelines

If you choose to drink alcohol, limit the amount and have it with food. Talk with your health care team about whether alcohol is safe for you.

Women should drink 1 or fewer alcoholic beverages a day (1 alcoholic drink equals a 12 oz beer, 5 oz glass of wine, or 1 ½ oz distilled spirits (vodka, whiskey, gin, etc.)
Men can drink 2 or fewer alcoholic drinks a day.
If you drink alcohol at least several times a week, make sure your doctor knows this before he/she prescribes a diabetes pill.

More Tips to Sip By

Drink only when and if blood glucose is under control.
Do not omit food from your regular meal plan.
Test blood glucose to help you decide if you should drink.
Wear an I.D. that notes you have diabetes.
Sip a drink slowly to make it last.
Have a no calorie beverage by your side to quench your thirst.
Try wine spritzers to decrease the amount of wine in the drink.
Use calorie-free drink mixers -- diet soda, club soda, diet tonic water, or water.
Drink alcohol with a snack or meal. Some good snack ideas are pretzels, popcorn, crackers, fat-free or baked chips, raw vegetables and a low-fat yogurt dip.
Find a registered dietitian to help you fit alcohol into your food plan.
Do not drive or plan to drive for several hours after you drink alcohol.

Landmarks in Insulin's journey!!

1922 Banting, Best, Collip use bovine insulin extract in humans
1923 Eli Lilly produces commercial quantities of much purer bovine insulin than Banting et al. had used
1923 Farbwerke Hoechst, one of the forerunner's of today's Sanofi Aventis, produces commercial quantities of bovine insulin in Germany
1923 Hagedorn founds the Nordisk Insulin laboratorium in Denmark – forerunner of today's Novo Nordisk
1926 Nordisk receives a Danish charter to produce insulin as a non-profit
1936 Canadians D.M. Scott, A.M. Fisher formulate a zinc insulin mixture and license it to Novo
1936 Hagedorn discovers that adding protamine to insulin prolongs the duration of action of insulin
1946 Nordisk formulates Isophane porcine insulin aka Neutral Protamine Hagedorn or NPH insulin
1946 Nordisk crystallizes a protamine and insulin mixture
1950 Nordisk markets NPH insulin
1953 Novo formulates Lente porcine and bovine insulins by adding zinc for longer lasting insulin
1955 Frederick Sanger determines the amino acid sequence of insulin
1969 Dorothy Crowfoot Hodgkin solves the crystal structure of insulin by x-ray crystallography
1973 Purified monocomponent (MC) insulin is introduced
1973 The U.S. officially "standardized" insulin sold for human use in the U.S. to U-100 (100 units per milliliter). Prior to that, insulin was sold in different strengths, including U-80 (80 units per milliliter) and U-40 formulations (40 units per milliliter), so the effort to "standardize" the potency aimed to reduce dosage errors and ease doctors' job of prescribing insulin for patients.
1978 Genentech produces biosynthetic 'human' insulin in Escheria coli bacteria using recombinant DNA techniques, licenses to Eli Lilly
1981 Novo Nordisk chemically and enzymatically converts porcine to 'human' insulin
1982 Genentech synthetic 'human' insulin (above) approved
1983 Eli Lilly and Company produces biosynthetic 'human' insulin with recombinant DNA technology, Humulin
1985 Axel Ullrich sequences a human cell membrane insulin receptor.
1988 Novo Nordisk produces recombinant biosynthetic 'human' insulin
1996 Lilly Humalog "lispro" insulin analogue approved.
2000 Sanofi Aventis Lantus insulin "glargine" analogue approved for clinical use in the US and Europe.
2004 Sanofi Aventis Apidra insulin "glulisine" insulin analogue approved for clinical use in the US.
2005 MedActiv invents the world's smallest fridge, the Medifridge, to safely transport insulin for patients.
2006 Novo Nordisk Levemir "detemir" insulin analogue approved for clinical use in the US.

Colour Coding of Insulin!!