Full name of this physical disorder consists of two words. Diabetes’ and ‘Mellitus’. There is another word ‘Insipidus’ also aligned with the two words. In fact the word (or term) ‘Diabetes’, which owes its origin to Unani language, means ‘That which comes out or that which flows’ and the term ‘Mellitus’ (a word of latin origin) means ‘sugar’ or ‘honey’. Hence, the term ‘Diabetes Mellitus’ means flow of sugar. The Ayurvedic term ‘Madhumeha’ means ‘Rain of honey’ stands for ‘Sugar’. Hence, Diabetes Mellitus and ‘Madhumeha’ are synonyms and they convey the same sense. Diabetes Insipidus is characterized by the persistent excretion of excessive quantities of urine of low specific gravity but this is not a specific kind of ‘True Diabetes’. But when the urine is loaded with excessive content of sugar and the urinary flow, irrespective of the quantity passed in 24 hours, is also on higher side, it may be called of diabetic origin. Diabetes Insipidus can be deduced by excessive thirst and urinary flow in large quantity. When the body fails to utilize the released quantity of sugar, it spills over in to the blood stream and renders the blood laden with sugar. When blood fails to absorb sugar, the excessive quantity passes on to kidneys and loads the urine with sugar.

Do not infer diabetes when there is sugar in urine only but when blood-tests reveal presence of sugar therein (in the blood) then diabetes Mellitus (DM) will be a confirmed diagnosis, calling for a further thorough probe.


Mere presence of sugar in urine is no definite sign or symptom of diabetic status of a person. But, its presence in urine is a forewarning that something is wrong somewhere. And what is wrong and where, will be determined and disclosed by patient’s objective and subjective symptoms, as also by clinical tests. Merely a single test report should never form basis for confirmation of diabetes unless repeated tests, after a gap of 4-5 days, show presence of sugar in urine, then only patient’s blood sugar should be tested and if blood is also shown to have sugar, in that case it becomes a confirmed case for ‘Diabetes Mellitus’ calls immediately which for a doctor’s advice and guidance.

To repeat, mere passing of excessive amount of urine does not confirm diabetes and also large amount of sugar in urine is also not a confirmed symptom of diabetes. But presence of large percentage of sugar in urine and blood is really ‘Diabetes Mellitus’ which should be attended to, after proper investigations and tests.

There is, sometimes, confusion about ‘enuresis’ and diabetes. Enuresis is actually ‘bed wetting’ which often occurs in infants, young people or old persons and usually occurs at night. It is involuntary flow of urine passed while sleeping, especially when the patient is unable to control pressure or urine. In infants and children, it gets automatically cured but if it continues even in or upto old age, then causes may have to the traced to some other disorders.

Diabetes is rightly claimed to be prominent silent killer disease, for the simple reason that it is the only disease which ranks only to cancer. It is a disease which has been baffling the patient and the medical profession alike, for its onset, progress and treatment, and also due to various hypothesis and causes which cause onset of this lingering and baffling disease. The doctor and the patient have to maintain a close contact, in order to avoid further complications. Most of the diabetics lead quite a healthy and fairly long span of life, provided they are motivated, and guided by their physicians, at regular intervals.

Our so- called high profile and modern life-style have further added to diabetic’s dilemma, confusion and lopsided approach. Mass of wanted/unwanted suggestions, myths theories and the so-called ‘effective and curable medicines’ have further complicated this already confused disease. We are today, as confused about diabetes as we were earlier, when diabetes was considered as an incurable and killer disease. Even uptil now there is no definite curative remedy which can rid the patient of this physical upset. Thus the patient becomes a confused entity (lot) due to the reason given above. Let us agree on one point, at least that diabetes is not, at all, curable, and is positively manageable, treatable and controllable, and the only condition is that the patient has to be under guidance, care of his physician. Further, there is no escape from periodical tests also. Any indiscreet deviation could suffice to further complicate the disease.

In order to get so- called ‘Permanent and Finally Curable remedies’ the patient, in his eagerness and anxiety, runs from pillar to post, to seek relief and cure, which (two) factors land him in a state of dismayed uncertainty. He fails to stick to one system of treatment or a single physician, because his anxiety and eagerness do not let him have any respite. In such an awkward situation he prefers to use ‘home remedies’, ‘Magical Cures’, quackeryemanating formulae.’ This way, his wayward and casual approach lands him into such a complicated state, from which he cannot make a retreat.

We can only advise the diabetics, with all the honest sincerity, that there is reason for them to get panicky, disgusted or become a social recluse. Reasonable and regular caution is and should be the watchword for all diabetics and laxity in abiding to lay-down principles and irregular approach should be given a go bye once forever. Do not be ever scared and horrified that you have a dreaded disease, instead assure yourself that you are having a disease which has definite treatment which you can control.

In this book and attempt has been made to educate the patient about causes, effects and complications, cautions, diet, medicines and above all certain myths about diabetes have been removed or, at least an effort has been made to reply to certain apprehensions and myths which often arise in a diabetic’s mind. The information disseminated in this book and the suggestions given, should serve as a guideline to the diabetic. Let us not lose sight of the fact that, unless and until a diabetic’s mind. The information disseminated in this book and the suggestions given, should serve as a guideline to the diabetic has strong mental will, positive approach, a desire to learn and follow prudently and discreetly the suggestion, he may not derive any benefits. Will to learn and determination to follow the advice of his doctor are unquestioned prerequisites not for diabetics alone but all patient s suffering from other ailments.

To add to the patient’s knowledge, charts on height, weight, diet, alternate diets and diet substitutes have also been given, which hopefully will serve as guidelines. Such guidelines are merely suggestions, based on mass usage thereof, but certain modifications and adjustments cannot be ruled out. Medicinal courses and the medicines have been suggested in should be the real guide for a diabetic patient.

Some of the unavoidable technical words had to be used in this book but, to obviate the said difficulty of readers, a glossary, explaining in simple words the meaning of such terms, has been given at end of the book, which way often be referred to, as and when required. Let us pray for welfare of all and disease for none:

‘Let all the person be happy, without diseases, look to brighter side and let no person have even on iota of pain.’

From now onwards whenever and wherever the word ‘Diabetes’ is used, it will mean ‘Diabetes Mellitus (D.M) and it will also stand equally well for Glycosuria and ‘Diabetes Insipidus’ because symptoms, in the latter two disorders, will also be noticed is Diabetes Mellitus. It would be more correct and precise if we say that Diabetes (or true Diabetes) should mean to convey presence of sugar in blood and urine, along with undermentioned symptoms:-


SYMPTOMS


1. Excessive Thirst: The patient consumes large quantity of water, quite often and in short pauses.

2. Excessive urination: Patient goes to closet again and again, passes large amount of urine. Gets up frequently, at night to vacate bladder, and passes large quantities of water.

3. Excessive Hunger: Patient has a voracious hunger. He becomes a greedy later, if not a glutten, He eats too often and too much but, inspite of excessive eating, he feels hungry and demands food every now the then.


4. Getting Fatigued: He gets tired easily even after exerting a little and also gets out of breath.

5. Loss of Weight: Inspite of consuming large quantity of food and other eatables, he feels like taking food again and again but, despite all this, he continues to lose weight.

6. Pruritus: Pruritus in intense itching of skin. But, in diabetes, there is pruritus on and around genitals and the patient, in his eagerness to gain relief, goes on scratching until there is bleeding from his skin.

7. Eye Problems: His vision becomes opaque and hazy, his retina is adversely affected. The cataract has an earlier onset. His sight is masked, weak and fatigued. Neglect may lead to even total blindness.

8. Neuropathy: It is symptom which is characterized by weak and numb nerve-power. He often says that his calves and legs are weak and senseless, his thinking power has been adversely affected, his organs are not strong enough to carry the weight of his body.

9. Pain in Body: He often complains of pains all over the body, especially in legs.

10. Malaise: Patient remains gloomy, inert and runs away or shuns to do any labour. He is often in a state of run-down of body. Not only his body but his mood also shows a depressed state. And mentally also he remains in a ‘what to do’, ‘what next’ or ‘nothing to do’ mental framework. He becomes a schizophrenic embodiment.

11. Skin Infection: pimples, scratches, rough skin, dry skin, unhealthy skin are the usual symptoms.

12. Late Healing of wounds: This a common complaint on diabetics that their wounds do not heal quickly. In fact, diabetics develop low reactive power which fails to control infections, with the result the even small and ordinary infection-based or other wounds and injuries refuse to show any declining trend. The diabetics are warned to keep their feet well protected from injuries, burns, contusions, and other such maladies. If there is bleeding they must attend to the same, to have the bleeding stopped forthwith.

13. Sexual Apathy or Sexual Excitement: Male patients either lose their urge to perform sex acts or become repugnant to sex matters. Conversely, some of the patients get easily excited and yearn for satiation of their sexual desires.

14. Phimosis: It is common complaint with diabetic males whose prepuces get constricted and thus, can’t be drawn up the glans-penis. When the foreskin cannot be drawn back, after having been once drawn up, it is called ‘Para-Phimosis.’ If Phimosis be a complication of infancy stage, then it is of congenital origin and diabetes will further compound the already existing problem.

15. Diabetic Gangrene and infection of Toes: In diabetes any foot injury can assume highly serious form, if not treated properly and timely. If any injuries fail to heal then decay of the affected part may occur, which may result into cutting or amputation of toe or any other gangrenous or infected part.

16. Diabetic Coma: it may be cause either due to absence or lack of sugar in the body. We will discuss it, in details at some other place in this book.

The above mentioned symptoms are predominant, out of some of the many symptoms. It is not that all the patients may have all the aforesaid symptoms. Many my have all, some most of the said symptoms, while others may be having only a very few of them.

Heredity is said to be a potential factor for communication of diabetes from mother to her off-spring to her off-spring or if the parents, either both or either of them, has had diabetes, their children will also have diabetes. It is true, to some extent, that if an expectant mother is a diabetic, her off-spring will also be a certainly a diabetic. But results to the contrary have also come to light. Exceptions do prove the rules, but exceptions are the rules themselves. Let us not lose sight of the fact that an off-spring has fairly higher chances of imbibing and inheriting diabetes form its mother at the stage from which she has to offer to her off-spring. But, if the mother had diabetes during period of pregnancy, especially when clinical tests had not revealed anything to the contrary or say that there was presence of sugar in urine and blood, then the off spring is liable to inherit the disorder. But drug-induced diabetes is a transitory metabolic reaction only and even if the disorder is passed on to the off-spring, there is every chance that the infant will be a born diabetic, but his symptoms may subside or even disappear, after the time he gives up breast-feeding.

But mothers, who had been confirmed diabetics prior to conception, will definitely pass on such a disease to her off-spring. It is, therefore on detection of profanely, the mother’s sugar level’ must be maintained within normal ranges so that diabetes is not passes on to her foetus. If diabetes is kept under control, in that case, the infact may not have any symptoms of inherited diabetes, but a risk factor cannot, still, be ruled out.

It may be printed out that diabetes is not a communicable and infectious syndrome, like venereal diseases, AIDS, Tuberculosis etc. as it can’t be transmitted from one person to another. If the child was born as a non-diabetic but his parents were or are diabetics, then the child or a grown up young person will not have any diabetes. But it is also true, that children of diabetic parents are more prone to diabetes, because of the ‘risk factor’. It means that such children are in the ‘red’ and there is every risk of their getting diabetes. But, to say that all of them, will become diabetes, is not fair, except to mountain that they should remain on the guard and take all possible and necessary precautions so as to ward off risk of getting diabetes, for the simple reason that they have high ‘risk factor’ looming largely over them and, as such, parents have also a sacred and social obligation to educate, guide and motivate their children to avoid the causes which can cause such a silent killer to invade their body.

Father and mothers who are indolent, inactive, obese and drunkards eating too much and too often, avoiding and physical exercise, consuming carbohydrates, fats, least of fibre-based green vegetables and fruits, must exert caution and warn their children to keep away from such factors as are patient causatives of diabetes. You cannot have diabetes of yourself and your children cured but can definitely control it by proper treatment, caution, abstention and dietary control.




OBESITY

, joint affections, asthma and dyspnoea, problems in smooth walking, easy fatigue etc. Obesity means accumulation of extra fat on the entire body, especially on and around neck, waste, abdomen thighs and gluteal muscles. Fatness is caused by too much eating, frequent eating, excessive use of fats, carbohydrates, (including fructose glucose, crystal sugar, lactose, cereals, honey, jaggery confectionery’s sugar based products etc), thyroid’s malfunctioning etc. obesity is a common symptoms of senile and easy going, gluttons, inactive and ‘chair-borna’ persons. Obesity is such a diseases (disorder, symptom) that it gives birth to high blood pressure, heart problems, diabetes, gout

Like the symptoms, causes of diabetes are also not few and the mass of causes to which a patient may be subjected should and do, determine as to what is the cause that has triggered this disorder. Truly speaking discerning the cause/causes, is and arduous and laborious task which can be determined by the doctor only and that also , after careful examinations and clinical tests. In brief following factors may be responsible for causing diabetes:

(1) Inadequate secretion of insulin by an endocrine gland, called ‘Pancreas’ which is known as diabetes of pancreatic origin.

(2) Heredity factor.

(3) Obesity or Overweight.

(4) Dietary indiscretion or too much of eating.

(5) Carbohydrate-protein metabolism. Disturbed/imbalanced.

(6) Malfunctioning of other Endocrine Glands, like Thyroid, Pituitary & Adrenal.

(7) Alcohol

(8) Sugar takes in excess

(9) Drug induced diabetes etc.

Out of the above-mentioned factors, we can further shorten the said list with following major sub-headings.

(1) Heredity

(2) Obesity

(3) Diet & Food

(4) Endocrine Glands’ Malfunctioning

(5) Drug-induced Diabetes.

Now the above factors will be explained in details, under separate individual headings, at later stage.

It is the result of common nutritional disorders and is a trait of the affluent and rich societies since mortality factor is very much aligned to it. It is a breeding ground for most of the killer diseases, as also other ailments which one could avoid easily. Every cause gives rise to an effect and every effect in turn, is capable to causing other effects. The theory of cause and effect fully applies here. An effect must have a cause, similarly, all causes give rise to certain effects in medical parlance. It won’t be out of order to describe the factors which cause obesity which, as is generally and very rightly believed is the mother of many physical disorders (diseases) so, first of all, we will take up those factors.

1. Energy-Intake: Imbalance between energy intake and expenditure thereof causes extra fat in the body, giving rise to many odd clinical signs & causes.

2. Heredity: It has been seen that, in certain, families, there is a tendency to fatness. Eating patterns, genetic factors and activity are closely related t economic, social and cultural factors and such factors are handed down from one generation to another. But, genetic factors do influence body fat and distribution thereof.

3. Endocrine Factors: This factor influences both pathological and physiological states. Hypogondalism, hypothyroidism and hypopituitarism are also contributory factors for causing obesity. Sometimes, Cushing’s syndrome is also accountable for obesity. On the contrary, clinical tests of certain person also do not reveal any endocrine disorder, leaving aside some glaring and rare exceptions. In women, obesity is a common symptom during menstrual periods-at the time of puberty, during menopause and during pregnancy.

4. Social Factors: Our audio-video publicity, in magazines, papers, T.V.radio and other such means have contributed a lot to the changes in our eating patterns, styles and habits. Eating an eatable of a particular brand had become a symbol of social status, problems multiply when we sacrifice out natural instincts to eat, to play second fiddle to fast food, junk food, fried food and canned pouched or bottled food. The bitterest fact is that hunger and satiety are compelled to be relegated to back-seat, instead we are led by external factors, like taste of food, availability and environment. Unluckily, obese persons are more prone to such pranks and temptations. What is required is, either it is not available or what is available is not required. In such case filling the belly seems to be the main object. Obeses persons eat more but have the lowest energy-expenditure. Imbalance between food (more) intake and less expenditure of energy which is main cause for obesity and resultant diseases.
Very often and especially in social gatherings and functions, obeses persons are indiscreet in eating those very food items which are harmful to them. Obese persons are generally avaricious people and they can’t control themselves. They are more led by taste than by necessity.

Expenditure of Energy: simple principle is to eat when you are hungry and never eat stomachful, but these golden principles are given a go-bye by the greedy obese persons. It is also an oft-repeated maxim that ‘After lunch, rests a while, and after dinner ‘walk a mile.’ But ‘rest’ does not and should mean a 2-3 hour sleep after lunch, rather it should be a ‘Nap’ only. Physical activity must commensurate with the amount of food intake. It should not however, construe that exercise will rectify all the dietary over-indulgence.

Obese have been seen to lead an inactive and inert life. When there is no physical activity to expend energy, generated by eating food, there is bound to be extra fat which, inturn, is enough capable to enlarge scope for host of diseases. In whatever form physical activity is resorted to, it must suffice to burn the calories generated by food-intake. It is no use over-loading your system with extra calories, when you do not have an urge to expend energy. It is a also maintained that thermic response to food may be less than normal in the obese persons, thus leading to greater and more conservation of energy.

Drug-Induced Obesity: Constant and prolonged use of oral contraceptives, insulin, steroids, and phenothiazines stimulate appetite and thus the patient is inclined to eat more. After pregnancy and delivery of child, especially when the confined and nursing mothers are given aforesaid medicines, there is every change of their gaining weight, and thus become obese. Pendulous abdomen and heavy back are the symptoms during postnatal period,

General: Obesity should not be confused with weight gain, because one can have over-weight due to retention of fluid in the body, due to renal, cardiac
or hepatic, and clinical tests hardly reveal such manifestations until there is increase, at least by about 15% of extra-cellular fluid.

Obese people should follow, as a matter of practice and conviction, certain norms and disciplines, such as health charts, weight charts, calorie-based diets, alternate diets, height and weight charts (please refer to relevant chapters and also at the conclusive stage of this book, for further guidance and knowledge) to work a scheduled plan so that they can shed their extra weight.

1. Disorders: Obese are more susceptible and prone to elevation of triglyceride and cholesterol (also known as ‘Hyperlipidaemia’), stones in gall bladder, hyperneusccalmia than general population. The said complications raise part in cases of non-insulin dependent diabetes mellitus (NIDDM) than insulin dependent patients.

2. Psychological Complexes: Because of their shabby-looking and bulging bodies, obese people avoid social gatherings ad functions. Others may like to meet them, even if for the sake of fun, but they would like to have company and the time, which they had to spend with meeting people, is utilized in eating (rather overeating). Young adult females feel ashamed abhor or avoid company, because of their none too-pleasant appearance and disproportionate bodies, they also develop sexual and physiosocial problems.

3. Mechanical Disabilities: These are nit ‘mechanical’ disabilities in literal sense of the term. Here the word ‘mechanical’ means the organic (not mechanical) disturbances of our physical system which emanate from obesity. These may include effort-onset breathlessness (Dyspnoea) enhanced susceptibility to other respiratory infections caused by interference with mechanism of respiration, of adipose tissue around the trunk. Abdominal and diaphragmatic hernia may also ensue, due to the very fact that abdominal muscles, supporting the Viscera and leg muscles (whose contractions promote venous return) are less efficient. Further, asteo-arthritis of knees, hips and lumbar-sacrel spine, apart from that in feet, are more common in the obese than with the non-obese, the latter are by no means immune to such disorders.

4. Disorders of Cardiovascular System (C.V.S.): Obesity puts extra weight and strain on heart, forcing it to work more than its capacity, as a result of which the heart also increases as the obesity and body-weight rise. Blood pressure (high) is a common problem, apart from substantial increase in cardiac output, blood volume and stroke volume. Main monster, which is responsible for causing many heart problems, is the thickening of blood vessels, narrowing of blood vessels, due to higher concentration of cholestoral. Ischalmia of heart is another complication of obesity which owes its origin to physical, inactivity apart from other factors.

5. Life expectancy: But for the side effects of obesity, the obese might have enjoyed longer span of life. 10-15% over-weight may not adversely affect much life span, but 30% increase in weight will reduce life span, and 40% increase will lead to 50% life span. The lower the weight (that weight within 10-15% increase is standard weight) the linger the life span.

6. Digestive complications: This again is a compound set of disorders like flatulence, burning sensation. Nausea or even vomiting, acidity, gastritis, gastralgia, gastrodynia, bilumy etc which are directly also related with over-eating and Physical inactivity. So the trio of overeating, physical inactivity and obesity should be handled judiciously and in a well thought out and planned way. There is, however, no room for laxity, indiscretion in food-intake, and physical activity. The obese should never adhere and resort to any so-called ‘Quick weight reducing’ methods which benefit none but the advertisers. First of all, single out the cause(s) which is /are considered to be responsible for adding to fat and , if the cause is attributed to any disease or other disorder, mere removal of the discerned cause, will pave way towards weight reduction. Further, never take any drug which claims to prove as a ‘wonder weight-reducing’ medicinal device. It has often been noticed that such drugs adversely affect appetite.

Obese people have plenty of time for eating, working, attending to functions and social gatherings, for useless and unproductive entertaining devices but, alas!, they have no time to devote to their health problems much less to shed down their weight or for any physical exertion. Even going to Gyms and so called Health Clubs have become a matter of social status and publicity but only a selected few go to such places to gain actual benefit. There is a mushroom growth of such health centres which are hardly of any benefit.

In order to get rid of many disorders, which often affect the obese and give rise to many other coincidental side-effects, should follow a course of dietary control and physical activity, in consultation with their dietician/doctor and also a person who could guide them, as to what exercise would be of use to them, keeping in view their physical status and health problems.


DIET (including carbohydrate metabolism)

Diet plays an important role in diabetes. It will depend on health status and also what amount of oral, drug(s) or insulin a patient takes. An attempt should be based on to a achieve a flat profile of glycaemia throughout the duration of 24 hours. By and large, dietary pattern is required to be modified quite often, in view of rise and fall of sugar levels in blood and urine. Once a dietary chart has been finalized, based on the condition of the patient, it should be closely and honestly followed by the patient. Any deviation, if desired or needed, should always be done in consultation with the attending physician, but never by the patient himself.

It is pertinent to point out that specified diets charts cannot and should not be prescribed for two persons, alike, who may be having, if at all, identical symptom. Following factors must be kept in mind while prescribing a dietary regimen :

1) Age, sex, profession, health status, as also diabetic status of a person must be taken into consideration, while preparing a dietary chart.
2) Diet prescribed should be within financial reach of the patient. If costly food-items are prescribed, the patient may not be able to stick to it.
3) Diet must be related ot the quantum of physical labour put in by a patient. For instance, a laborer would require more and higher calorie, based diet than a person working in an office, similarly in IDDM cases, one must be careful not to keep oneself without food, especially after taking an insulin injection.
4) NIDDM patient’s diet will differ from Insulin dependent patient, because the latter will require more quantity of carbohydrate as compared to the former.
5) Prescribed diet should not be monotonous. In order to avoid such monotony, patient’s diet should often be substituted by alternate food items.
6) Food must be tasty, otherwise the patient may be compelled to violate the dietary restrictions. Diet- menus of breakfast, lunch, supper and dinner must be often changed, without sacrificing the basic requirements in this regard, so that the patient does relish his food, instead of thinking that he has been subjected to and forced into a dietary pattern to which he is averse.
7) Diet of a child, growing child, pregnant woman, workman, labourer and that of an office workers should be designed and tailored to meet his physical and professional requirements
8) Prescribed food should be liked by the person so as to satisfy his taste-buds or else he will be forced to seek deviation of his own choice.
9) Food must also be satiating, that is after taking his food, the patient should feel fully satisfied and also feel that his hunger has been satiated or else he will often eat more and more.
10) Calorie-based diet should be a complete blend of well-balanced carbohydrate, protein, fat, vitamins and minerals, in addition to green and fibre-based vegetables.
11) Constipation is a common and normal complication of diabetic and if the prescribed food does not have enough of roughage, his complication will become still worse. A diabetic’s diet must have plenty of fibre, green vegetables, low-carbohydrate, bran and citrus fruits.
12) A healthy person normally requires about 100 to 300 gms of carbohydrates, 50-80 gm protein, 50-100 gms of fats, in addition to green and fibre rich vegetables and fruits. A diabetic’s diet should have less of carbohydrates, but not less quantity of protein, rather protein-intake should be increased. Fat content will be determined by the level of cholesterol in the blood, as also heart condition, and digestive capacity of the patient.
13) Easy availability of prescribed food items is of almost necessity. If the prescribed item is cheaper and useful also, but is not available easily (or if available, at the exorbitant rates), the patients shall be obliged to bid good-bye to it. The patients with limited resources and the ‘have nots’ are as lucky as the ‘have’ are, hence the former will develop a sort of inferiority complex for his inability to procure. Such diverse situations should always be avoided, if not eliminated once forever.
14) Those addicted to drinking should gradually taper their alcohol intake, as sudden cessation/withdrawal may have some psychological, emotional and physical upsets.
15) Dieting restrictions should never develop a feeling of “going off my diet”, fear of under-eating or over-eating. Dr. Joseph I Goodman says “Nutritional neurosis and food faddism” “should not disturb and cause any fear to the diabetic patient, much so his rest of family members.”
16) Let the other family be started of such foodstuffs which are forbidden to a diabetic who, on certain gatherings may also join others in eating and drinking sessions, but imprudent discretion should not outweigh sense of proportion.
17) Now a word about sweets and alcohol, again quoting Dr.Goodman, “The medical evidence is clear: Neither sweets nor alcohol are, in themselves, harmful to diabetics. Since the forceable removal of these items form the diet can produce severe neurosis in diabetics and their families, this alone is an ample reason to make certain that the age-old stigma against such items is erased. But there is more. The evidence is also clear that the removal of such sources of carbohydrate from the diabetic’s diet can do physical as well psychological harm. It can result in dangerously lowered levels of energy on the one hand and increased levels of cholesterol and triglyceride (cholesterol-related fatty acid) on the other.”

There are no hard and fast rules to govern such a patient’s daily food requirements. It is height of imprudence to hold diet and the patient responsible for any fluctuations in blood sugar level, for the simple reason that diet is but one of the various factors that cause and precipitate onset of diabetes. Japanese, Germans, Negroes consume carbohydrates in much more quantity than the Indians, but incidence of diabetes is far less in the former and far greater in the latter. To hold excessive use of carbohydrates, as the only contributory cause and main culprit, for causing diabetes, is nullified by the aforesaid example.

It is not possible to prescribe a calorie-based diet for such and every diabetes patient. It is neither feasible nor advisable, for the simple reason that every patient’s life style, food-patterns, amount of labour expended during work-period or quantum and duration of rest, habits of a person, apart from age sex etc. differ. So, a uniform dietary pattern cannot be worked out. For instance, if a diabetic person, working in an office, takes to a field job or traveling job, his calorie intake will naturally vary and such a suddenly changed situation. If he sticks to his physician’s dietary directions, he will, in all probability, fall a prey to hyperglycemia. If reverse is the case, he is liable to suffer from hyperglycemia in such a situation, the patient has to be his own master because in a lowered sugar level,. He may even meet his end if he is not fully aware of crisis management of such odd situations.

They are strict conformists to their eating patterns, rather better than the non-diabetics. They are cautious and punctual also. They take their doctor’s advice in right earnest and comply with the same. When a patient is admitted to some hospital, he is kept on closely measured diet but despite this, the blood/urine sugar levels do fluctuate, despite regular monitoring and medical care though his physical activity remains constantly the same. If in such a controlled and monitored situation, a patient can have the said fluctuations in blood and urine sugar levels then who is to blame-the patient or his doctor? It is certain that doctor and his attendants should shoulder the responsibility. Further dilemma is that ignoring the same anticipated supposed amount of physical activity coupled with normal workload of the dietician and the doctor prescribe the same diet when, infact, the situation has dramatically taken a turn about. So, dietary restrictions and prescription thereof to a diabetic patient does not seem to hold the ground, in view of the above quote instance.

Departure form normal food pattern is no crime nor should it be condemned. It is not physically possible for a diabetic or his family members to strictly stick or remain glued to a set pattern of precise measurement of food intake or complex food exchanges and meticulous calorie counting . Whenever there is any fluctuation noticed in sugar levels, the doctor, at once, concludes that the patient has deviated from his counsel. But, it is generally not the case.

“Certain dietary pattern, the complexity and confusion of the diets are not the only self-defeating factors. Quite often the diets call for types of foods or preparation so different from the family routine that they become disruptive. The inclusion of expensive diets can become a financial burden. And, most important, too often doctors and dieticians fail to a diet to fit the bodily requirements and life style of the patient.” And continuing his observation Dr. Goodman goes on to add that “Men who require 2500 or even 3500 calories per day, for example, are given diets containing only 1800 calories. Such errors made for thin men as well as for heavy, women as well as (for) children. Why?” Dr. Goodman’s ideas conform to what has been written and stressed upon heretofore.

In view of the above, calorie-based diet is no criterion for control diebates nor is it a fool-proof method. Its basic motive and concept are really laudable, but its prudent applicability has often been abused and distorted.

While prescribing a calorie-based diet, the following considerations must be kept in mind. Some of the points, mentioned hereunder, may look to be a rehash/recapitulation of what has already been said (and more so when opinions differ on this aspect)

1) Duration of diabetes affection and ravages wrought by it on various organs of the body.
2) Age, sex, profession and health status of the patient.
3) His age, life style, dietary pattern, financial position.
4) Diet should be nutritious, devoid not only of monotony but should also be tasty and satiating.
5) It should not disturb family budget and dietary pattern of a family.
6) It should be complete and well-balanced, as for as suitable blend of carbohydrates, protein, fat, vitamins and minerals are concerned.
7) Present diabetic status should form basis for dietary regimen.
8) Only minimal and very essential/reasonable conditions should be put in the patient so that there is no room left for his wrong & voluntary deviations.
9) Patients should be guided to adjust his diet as per his glucose level in blood and urine. This is called self-management technique.
10) Dietary regimen should not force the patient to become a social recluse.
11) Care must he taken to ensure that dietary regimen is not allowed to stretch to a fasting (or still worse to starvation) and clearly advised neither to be too indulgent nor instinctive. A middle path, balancing of both the facts, should be carved out and followed strictly, leaving enough scope for the marginal and emergent situations.
12) Any sudden deviation should always be avoided.
13) The members of the family should also be guided properly about the safeguards and precautions while preparing for and serving food to a diabetic.
14) Gradual withdrawal from certain food items, if prohibited or considered harmful, should be stressed upon and , in this aspect, patient and his family members cooperation is of utmost help.

While prescribing a calorie-based diet for the young ones, following points may be borne in mind:
1) If dietary restrictions are put on a child, it should always be kept in mind that the young one has been subjected to this agonizing malady and should not be made to suffer either mentally or physically. Further his diet should be designed in such a way that his needs for maturation, growth and development must not be hampered.
2) IDDM is a serious problem for the child and his parents, because he has to take injections regularly and after injections have been taken, he must be given a high calorie-based diet otherwise his blood sugar level will fall and hypoglycaemia stage may ensue. Food, prescribed for the child, must meet his physical, sport-related exercise based needs.
3) They should eat before and if needed during period of competition and there is no reason why a diabetic child should not participate in sports, attend to his normal study courses and other daily chores but the only pre-requisite is that his diet must be tackled to meet all his such and all other requirements. No diet should be prescribed which fails to meet a child’s requirements of body, might, intellect and an all-round development.

Note:- How much calorie is required per day for a certain type of diabetics, can be determined and decided by a dietician and physician, keeping in view the factors mentioned heretofore. But, for the convenience of the patients, diet charts, based on calorie-based diets are merely suggestive and do not and cannot have relevance to actual calorie requirement of a person. At best, they are only guiding indictors and should also be deemed to be so. The readers may refer to such charts to get a first-hand and basic knowledge and guidance about diet and calories, given at end of this book.

SUGAR DISORDER DUE TO ENDOCRINE GLAND’S MALFUNCTIONING

Following endocrine glands are said to cause diabetes, if their secretion is not normal.
1. pancreas
2. Thyroid _ This aspect will be dealt with, in details, later on.
3. Pituitary
4. Adrenal.

Our body is, as is well known, cell-based entity. In order to keep alive and in functioning condition cells play an important part and they can function only when they are nourished and compensated by various food constituents, like carbohydrates, protein, fats, vitamins and minerals, for which various chemical processes take place, within out body, thus enabling it to receive energy. Energy is generated by various food constituents, as indicated above. Body uses and utilizes these food-stuffs as fuel which gets exhausted (or burnt) by oxygen and the resultant end product emerges as energy, heat, carbon dioxide and water. Energy is a motivating factor which helps the body to perform its various functions.

Carbohydrate is a major part of out food, which, is derived from potatoes, sugar and sugar-based food items, like sugar-cane juice, crystal sugar, jaggery and unrefined sugar, fruits like grapes, mangoes etc. in fact, even oranges, limes, peaches, lichies, loquats, berries etc. also have enough portion of sugar contents. Among cereals, wheat flour contains maximum amount of carbohydrates, as also its bi-products.

The starch, generated by the food we take, when intermingles with various enzymes, present in out intestines and end-product of this chemical process is glucose. Glucose remains stored in our liver and is released only when our body needs it. Glucose, after being absorbed into intestines, travels to liver and remains stored there in the form of glycogen which remains stored therein until and unless body-cells need it to provide energy to body. When body-cells need it, it gets converted into glucose and its unutilized portion enters the blood stream for onward travel to body-cells. Fats and protein also generate glucose.
Entire quantity of glucose generated by food does not convert into glycogen due to various metabolic factors. Liver has limited storage capacity and entire quantity of glucose, when it fails to convert it into glycogen and the liver also fails to store it, then the excess quantity of glucose (140mg per 100 It.) passes on to urine, and thus there is presence of sugar in the urine. Further, various enzymes and secretions, including insulin, also mix up with the blood stream and try to control absorption of sugar in the blood. But, due to lack or insufficient secretion of insulin, the sugar (glucose) release is passed to blood steam which also causes rise in blood sugar level. Presence of sugar in urine and blood will suffice to confirm diabetic status of a person. Due to metabolic disturbance in sugar absorption, certain functions of the body are affected, giving rise to various symptoms, which have already been pointed out earlier. A gram of carbohydrates generates about 4 calories.

Due to above carbohydrate factor, consumption of much sugar is considered to be the chief cause of diabetes, Excess of sugar is not a true and definite indication of DM, for the simple reason, that if a person consumes abnormal amount of sugar producing foodstuff, the excessive amount (after the body has already utilized its required quantity to meet its purpose) of sugar will pass on to urine but when the person returns to normal intake of carbohydrates, his urine will not show any presence of sugar. But, if the blood also shows higher glucose presence, then only it is a true case of DM, when blood sugar level crosses is normal (optimum) range, then the extra unconsumed sugar appears in urine. As for blood sugar tests and their details, we will take up its details, later on, so as to give one and all a clear pathological picture on clinical tests etc.

It is not that the carbohydrate factor is the only factor in diabetes. As maintained earlier, insufficient amount of insulin release by the pancreas, further complicates and precipitates sugar-absorption process. For instance, if one takes sugar in excess but his pancreas release sufficient amount of insulin to help quick absorption of glucose (sugar), then there won’t be any amount of extra unabsorbed sugar which could ever pass on to blood stream. Conversely, if a patient’s body generates sufficient amount of glucose but his body requirement is not in proportion, to the amount of glucose(or glycogen, stored in the liver) generated and, above all, the secretion of insulin is in larger quantity, then the patient is bound to have hypoglycemia (low sugar content in the body). The following comparison will clarify out view point.
a) More intakes of carbohydrates generate larger quantity of glucose. Liver stores glucose according to its retentive capacity. Excess generation but non-retention of glucose passes on to blood stream and there is lack of insulin to absorb it. Hence sugar passes on to urine and blood, causing a state of hypoglycemia.
b) Even if there is higher quantity of sugar, due to excessive intake of carbohydrates and liver also stores glucose as per its retentive capacity. The excess quantity of glucose is released in the body via blood steam. Now, even if the glucose requirement of body is high along with higher secretion of insulin, the glucose released by liver and also the excessive quantity is absorbed by higher quantity of insulin-release. In such a situation, the body cells do not get sufficient glucose to feed various body-organs and as a result of which sugar/glucose level falls down below normal limits which, in turn, result in hypoglycemia. Both the aforesaid, hyper and hypoglycemia states do not augur well for a person’s health condition. Hence, both extremes should be avoided or at best, an honest effort must be directed towards avoidance of such high and low sugar levels.

It does not mean that energy-generating carbohydrates are not useful for the body because our body does not and cannot function without energy which is provided by food, rich in carbohydrates. Energy, generated by food, is the end-product of glucose. For the diabetics, a tapered quantity of glucose can be can be determined by present state of blood sugar level. Persons with low sugar content in their blood will require higher intake of sugar-rich carbohydrates to compensate for the low sugar levels.

It may be noted that the sugar obtained from fruits is called ‘Fructose’. From the milk it is called lactose and that which is obtained from sugar etc. is called ‘Glucose’. As for the sugar content, glucose, fructose and lactose in descending order should be termed as highest, high and low. Certain fruit sugars, like grapes and mangoes, have high percentage of sugar content.

Generally 60% of the foodstuff eaten should consist of carbohydrates, 40% of protein and 20% of fats, providing also sufficient extra quantity for vitamins and minerals. But above mentioned percentage will require to be tapered according to condition of the patient. Thus, obese and hyperglycemias will require less carbohydrates and hypoglycemia, and weak persons will require higher percentage of carbohydrates. Calories required by a person, during 24 hours, will actually determine ratio of said essential food constituents and nutrients.

Main component of protein is amino acids which are off-shoots of Nitrogen, Sulphur, Carbon, Hydrogen and oxygen, that is , when these elements combine together, they give birth to amino acids which, in turn, are the main stay of protein. Proteins are converted into amino acids by the body’s chemical processes which help to build up, strengthen and sustain tissue in the body. Not only that, amino acids re-build up the worn out and impaired tissues, especially during disease and old age. Extra amount of amino acids are converted into glucose by the liver. Nitrogen is an important constituent of protein, which is excreted via urine in the form of urea. In diabetics, proteins, instead of breaking into amino-acids, break into glucose which helps, the blood sugar level to rise. Excess of protein also damages the kidneys, enhances albumin and creates various disorders of digestion. But all said and done, tissues and muscles do require protein for growth of body tissues and for their repair when damaged.

Protein is abundantly found in soyabean, vegetables, animal sources like milk, butter, other milk products, eggs, fish, meats, pulses, maize, corn, grams etc. For the vegetarians soyabean, pulses and milk are the best sources of protein, and for non-vegetarians fish and eggs are the best sources. In food, protein should form 40% part of a diet. In any case, escape of protein, through urine, should always be guarded against, otherwise protein urea may result in, damaging various vital parts within the kidney, sometimes in conjunction with other-precipitants.

During growth stage, protein is required in higher quantity for proper growth of body, along with other necessary nutrients. In health, the body converts protein into amino-acids which serve to strengthen the tissues but, in diabetes, amino-acids are converted into sugar. Due to limited retentive storage capacity of the liver, the sugar, so produced, finds its way into the blood steam along with sugar generated by carbohydrates, as a result of which excess quantity of sugar gets spilled over to blood stream, causing rise in blood sugar level. The fact is that liver fails to convert excessive amino-acids to glucose. From infancy to old age protein continues to remain an essential nutrient for the body. One gram of protein supplies 4 calories and, in dietary charts, its various sources are utilized to make up for protein supply and supplementation job.

Like protein, animal food and vegetable foods supply fats to the body. Fat contains maximum of calories (9 calories in a grain). Fat supplies more energy to body, as compared to carbohydrate and protein, and this is why its percentage is the lowest in dietary charts, excepting a very few and rare cases where fat intake is more. Fat, taken into the body by food, is converted into fatty acid ad glycerol which deposits in various body orgains. If there is sufficient amount of carbohydrate stored in the body, then extra carbohydrates are also converted into fat. In a healthy person’s body, fat expenditure (or burning or consumption of fat)produces water, energy and carbon dioxide. But, during diabetes and starvation situations and due to lack of presence of carbohydrates in the body, the fast, instead of converting into the said three bi-products convert into ketone bodies, thus giving rise to symptoms of diabetic ketoacidosis/ketosis.

In addition to production of ketone bodies (1) Acetone (2) Acetoacetic acid and (3) Beta (b) hydroxybutyric acid are produced by lack of carbohydrates. Abnormal amounts of acetoacetic acid also arise in the body due to inadequate amount of carbohydrates and increased amount of fats are used for energy build up. Excessive presence of the said three constituents (factors) results in their expulsion through urine. Such a situation gives rise to a serious disorder, called ‘Acidosis” in which condition, the acetones are expelled by the urine. If such an abnormal condition is allowed to continue, the patient slips into ‘diabetic coma’. Such an extreme situation should never be allowed to develop and if developed, should be treated without any delay.

Fats can be divided into saturated and unsaturated varieties. For a diabetic, heart patient, and patient of blood pressure, arterio-sclerosis, coronary heart disease, with high cholesterol, saturated fat is a poison. In fact, all the aforesaid disorders, in one way or the other, are caused by high consumption of saturated fats which are found, in plenty, in vegetable oils and animals meats. Such patients should always adhere to a low-fat or a totally fat-free diet, and all the necessary fats should be obtained from milk (skimmed), soyabean milk and above all, vegetable oils like from sunflower oil and til oil, groundnut oil which do not saturate in the system. Of all these sun-flower oil (refined) is said to be the best.

I had read somewhere that, in Germany, Germans use sun-flower oil to ward off and cure heart disorders. Take 10 ml (one tablespoonful) sunflower oil, without washing your mouth, in the morning, on rising (nothing should be take before that). Revolve the contents for 10 minutes in the water and rinse your mouth with lukewarm water thereafter. Later on, you may use toothpaste or any other means to cleanse your mouth with lukewarm water. But, it has be continued for a fairly long time. It is said to activate and regenerate blood vessels of the heart. Further, it may also be of use to asthmatic patients.

There cannot be any pattern which should guide and govern dietary pattern for all diabetes, for uniform application, for the simple reason that dietary recommendations for children, growing young persons, obese, pregnant diet may not be suitable for the other. Dietary regimen and intake will depend on the chemical symptoms and findings. Following hints, on diet intake are only general guidelines and may have, often, to be modified in accordance with diabetic status of a patient. In a diabetic patient, proper consideration, as to diet intake, should be based on chemical finding, age, sex general health status of a person, his profession and energy expenditure availability, affordability and financial status etc.

(1) Such patients must take sufficient food after insulin injection because insulin lowers blood sugar level instantly and to offset the effects thereof, food must be taken, with reasonable amount of carbohydrate, to compensate for the ravages caused by insulin. Insulin is given to growing children and also to indoor patients due to be operated (who are diabetic). In such a situation, blood sugar level should be continuously watched and, if necessary, matched by proper and requisite intake of food.
(2) For growing children, it is a knotty problem because if we reduce their diet quantity, they will get weak and be unable to carry out their studies, games and other physical activities. Child’s physical and mental activities and faculties must be preserved.
(3) The parents should educate, guide and mentally prepare the child about his having diabetes and precautions and restrictions he would be required to follow, without creating any fear in his mind (called a Diabetic Niurosis). A child (1-10 years) will require 1000 calories diet, and after he has crossed 10 years, addition of 100 calories per year of age, should be added. And for 11 years onwards a diet having 2000 calories will suffice. From 15th year, add 200 calories for boys and 100 calories for girls (per year of age).
(4) It is not possible to restrict a child from taking sweets or sugar. Strenuous exercises and games, where too much energy is expended, should be compensated by (Before and after physical exercises and games) food items like biscuits, sandwich, matthi, Bara, samosa etc. In any case, hypoglycemia states should not be allowed to surface, because child cannot be expected to self-management of such extreme stages. The child should not suffer from ‘Fear psychosis’. As the sugar level is controlled, insulin intake will be tapered and as a result thereof, the child can return to his near normal diet, but precaution is still a watchword. So, while prescribing diet for an insulin dependant child, factors like his age, health, infection to certain diseases expected and actual amount of labour put in, his study-load etc. should be borne in mind.
(5) periodical guidance is a pre-requisite for the IDDM patients because, as soon their blood sugar changes (whether higher or lower) , his insulin and diet intake would required to be changed as per chemical tests. The child should never feel let down or dismayed. Instead his moral should always be boosted.
(6) As for the elderly IDDM patients, management is not difficult but expert counseling cannot be ruled out. Regular check-ups, chemical tests, constant or periodical contact with the physician and strick regimentation are all the more necessary, Elderly persons can easily follow the instructions of their doctors. They, too, should restrict excessive food which is rich in carbohydrates but not after taking the insulin injections, they must take enough food to offset bad effects of insulin. In any case extreme situations should always be prevented from happening and if any such situation occurs, timely action by reducing or taking excessive intake will meet the emergent crisis.