By Radhika Ganesan

Diabetes has become a major health threat to the whole world; indeed, the greatest increase will be contributed by India, which has already been declared by the World Health Organization (WHO) as the country with the largest number of diabetics in the world. Diabetes is frequently not diagnosed until complications appear, and approximately one third of all people with diabetes may be undiagnosed, though diagnosed many people are not aware of their condition.

Late detection of diabetes often means that at the time of diagnosis complications have already damaging the eyes, kidneys and nerves. These complications are costly in the physical, financial and psychosocial sense. Early detection and treatment of diabetes may not only improve glycemic control, but also improves blood pressure and lipids.
Who should be screened? In general all adults should be screened at regular intervals
o Family history of diabetes (i.e., parents or siblings with diabetes)
o Overweight (Body Mass Index >25 kg/m2)
o Age >45 years
o Previously identified impaired fasting glucose (IFG) or impaired glucose tolerance (IGT)
o Hypertension (>140/90 mmHg)
o Hyperlipidemia (HDL - 250 mg/dL or both)
o History of gestational diabetes or delivery of a baby over 9 lb (4.1 kg) (ADA -Diabetes Care 2004)

What are the Screening test for Diabetes

Fasting Plasma Glucose: The fasting plasma glucose (FPG) test is the standard test for diabetes. It is a simple blood test taken after eight hours of fasting. The FPG test is not always reliable, so a repeat test is recommended if the initial test suggests the presence of diabetes.

Oral Glucose Tolerance Test: The glucose tolerance test may be more accurate than the FPG in certain groups (e.g., women with a history of gestational diabetes). The test uses the following procedures: I) after an overnight fast Fasting Plasma Glucose test is performed. ii) After this test a person receives 75 g of glucose (100 g for pregnant women) blood samples are taken every half an hour {(fasting-30mts-60mts-90mts-120mts-(five times)} to measure the blood glucose. It not only helps in detecting diabetes but also help to detect the pre-diabetic status, Impaired Fasting Glucose (IFG) & Impaired Glucose
Tolerance (IGT))

Is it important to detect pre-diabetic stage? Yes! Because it is "preventable"
Criteria for the diagnosis of diabetes mellitus

Normal DIABETES

Symptoms of diabetes + Random plasma glucose o Blood pressure check up, regular at every visit for Hypertension (High blood pressure) - should be 40
o An electrocardiogram (ECG), that provides information about the status of heart
o Chest X ray, information about the lungs and shape of the heart and vascular system (aorta and blood vessels)
o Carotid Intima-media Thickness (IMT), marker of early atherosclerosis

Diabetic Nephropathy (Kidney Damage): Person with diabetes are several times more prone to kidney disease than the general population. The earliest manifestation of kidney damage is microalbuminuria, (tiny amounts of protein called albumin are found in the urine). Symptoms include Protein in the urine, High blood pressure, burning during urination, frequent urination, puffiness and swelling around the eyes, hand & feet, excessive itching, nausea, vomiting & weakness.

About 20% of type 2 patients show evidence of microalbuminuria upon diagnosis of diabetes, however, only a small percentage of type-2 diabetics eventually develops kidney disease. Microalbuminuria typically shows up in type 2 diabetics who have high blood pressure. Normal: 15yrs will develop diabetic retinopathy in their lifetime.
Who are more prone to Diabetic retinopathy? : Uncontrolled blood sugar, longstanding diabetes, Hypertension with diabetes & Genetic predisposition.

What are the stages of retinopathy? : Mild non proliferative diabetic retinopathy (NPDR), Moderate-non proliferative diabetic retinopathy, severe retinopathy, Maculopathy and Proliferative diabetic retinopathy. Treatment: Retinopathy can be treated through laser photocoagulation. Screening test: Patients with diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist right from the day of diagnosis of diabetes and every year thereafter. Early detection, timely treatment, appropriate screening and care reduce the risk of vision loss & 90% of diabetes related blindness.

All patients should be regularly screened for risk factors and encouraged at each health care visit to pursue a healthy lifestyle that includes a healthy diet, adequate exercise, weight control and stress reduction. 'Try for good control to be sure, but don't try for perfection. Perfection lasts for a moment, and diabetes lasts a lifetime'. The main theme is to be focus on to 'live a Healthy Life Despite Diabetes'.

The five main diabetic complications!

As with any other disease, you may want as much as possible to learn about diabetes and the complications of diabetes. The more knowledge you have, the easier it will be overcome and manage diabetes.

Acquiring the Knowledge of diabetes is also useful for those do not suffer from diabetes because this knowledge could be used to prevent the onset of adult diabetes and hopefully avoid this chronic disease altogether.

In addition to knowledge of diabetes such as the diabetes symptoms, diagnosis of diabetes, causes and treatment of diabetes, it is also important to know about all the related diabetic complications. All this knowledge will help you prepare - emotionally and physically - with the possibilities of coping with having not only with your diabetes, but also with other complications that are related to it as well and the lifestyle changes that is necessary to deal with it effectively.

Some factors such as heredity, age and ethnicity can have an influence on people who are prone to diabetes. But regardless of the risk factors associated with diabetes the complications of diabetes will be the same. Below are some of the diabetic complications that people need to be aware susceptible to diabetes are:

DIABETIC NEUROPATHY - If you suffer from diabetes then there is an increased risk of suffering from severe diabetic complications of the nerves. Damage of the nerves in the body will cause poor circulation in the body especially the extremities like the hands and legs, and fingers and toes. Smoking or drinking alcohol only exuberate the problem so limiting these would be a good idea.

HEART DISEASE and STROKE - According to experts, people with diabetes have a much greater risk of developing coronary heart disease, and angina compared to those without diabetes. In fact, these complications are the leading cause of death in diabetics around the world.

Diabetics are prone to heart diseases and stroke because of deposits of fat deposits in the arteries and hardness of the arteries caused by the extra glucose in the blood. This will cause high blood pressure or hypertension to develop.

DIABETIC EYE DISEASE - people who suffer from diabetes have a higher instance of suffering from diabetic eye problems as a result their diabetes. These problems of the diabetic eye may lead to diabetic retinopathy, cataract, glaucoma, and optic nerve damage. If not treated immediately they could lead to irreversible damage of the eyes or even blindness.

DIABETIC KIDNEY DISEASE - Kidney disease is also a very common complication of diabetes, because the parts of the kidneys that filter the blood damage because of high glucose levels. The kidneys will eventually be damaged as a result of being over worked and will be unable get rid of toxic by-product from the blood
This diabetic kidney disease can be avoided by keeping blood sugar levels under control by following your diabetic diets closely and do regular physical activity to keep the blood sugar in check. Other useful things that you could do include: stop smoking and drinking alcohol.

GASTROPARESIS - This is somewhat related to diabetic nerve damage. The nerves in the stomach help the stomach to contract and relax thus allowing the food to pass down into the intestine. When these nerves are damage the food remains in the stomach for long periods causing bacteria to develop. The improper functioning of the stomach also cause the diabetic to struggle in controlling his or her blood glucose level because the organ that convert the food we eat into carbs cannot be predicted. Approximately 20-30 percent of diabetics with type 1 diabetes are vulnerable to suffer gastroparesis because the vagus nerve, which keeps the food moving through the digestive tract are damaged. While people can get type 2 diabetes only suffer from gastroparesis less frequently and only in the advance stages of diabetes.

Diabetes is a disease that affects millions of people in the U.S. alone. A simplified definition of diabetes is when your body does not produce enough insulin to properly use the right kind of sugar into your bloodstream. This can have devastating effects on the body, as the cells do not get all of the fuel they need for energy and growth. While all of the causes of diabetes are not fully understood, eating raw foods helps to reduce some of the currently known risk factors. Therefore, it makes sense to choose a diet of raw foods whether you have been diagnosed or not.

Dietary needs of diabetics
Diabetics still require the same levels of nutrition as everyone else, maybe even more so. Nutrition is one of the most important elements for controlling diabetes properly. As you will see, following a raw food menu will fit in with diabetic nutritional recommendations. Here are some basic tips on eating right.

Choose a wide variety of fruits and vegetables. (Diabetics may need to limit starchy vegetables)

• Avoid processed grains such as white flour, and white rice.
• Opt for whole grains instead.
• Add lentils and beans (like pinto, garbanzo, or kidney beans) to your diet.
• Eat fish a few times a week.
• Consume non-fat dairy products.
• Reduce high-calorie snacks and like cake, cookies, chips, and ice cream.

Raw foods for diabetes
Most of these recommendations fit in well with the raw food lifestyle. The main difference is that the food would not be cooked, as raw foodists eat raw, uncooked, unprocessed and organic food. Fish and dairy products may or may not be a part of your raw foods diet. People that eat raw foods are already reducing their risk for disease, including diabetes.

If you have diabetes and are thinking about a raw foods program, you can see how it is an ideal choice. A raw food diet helps those with diabetes by sticking to the current dietary guidelines. The reason raw foodists do eat uncooked food is because all of the naturally occurring enzymes. These enzymes promote optimum health and digestion. Diabetes is a serious disease, so be sure to check with doctor before switching to raw foods. Take some time to explain what the raw foods diet is all about. Be sure to continue monitoring your blood sugar level according to your doctor’s instructions. Some diabetics eating raw foods have seen remarkable improvements in their condition.

Eat to Beat Diabetes
When it comes to maintaining good blood sugar levels, a healthy diet is vital. People with diabetes have to take extra care to ensure their diet is properly balanced with their insulin and oral medications.

The right meal plan will help any diabetic improve blood glucose levels, blood pressure and cholesterol numbers.
All diabetics must control their refined carbohydrate intake. These types of carbohydrates increase blood glucose levels. While some promote health, others when eaten often and in large quantities, may increase the risk for diabetes.

Carbohydrates come from a wide array of foods including fruit, vegetables, beans, milk, popcorn, potatoes, cookies, spaghetti and corn. The most common and abundant ones refined in are sugars, fibers and starches. It is advised diabetics avoid white bread, rice and pasta, along with foods containing unnaturally added sugars.

The body will convert all types of refined carbohydrates into glucose. Eating extra servings of rice, pasta and bread will make blood sugar rise.

Diabetics should consume carbohydrate-rich foods close to their natural form. These items have greater vital nutrient density. Whenever possible, replace highly processed grains, cereals and sugars with natural whole-grain products.

Eating complex carbohydrates rich in fiber significantly lower blood sugar levels. It is capable of slowing down the digestion and absorption of carbohydrates and increasing the sensitivity of tissues to insulin, thereby preventing rises in blood sugar.

It is recommended diabetics eat 13 fiber-rich servings of fruits, veggies, beans and grains daily. Soluble-fiber rich foods include orange and grapefruit segments, prunes, cantaloupes, papayas, raisins, lima beans, zucchini, oatmeal, oat bran and granola. Other foods high in soluble fiber include barley, peas and strawberries.

The glycemic index system, or GI, is a good guideline for diabetics to follow.
Invented in the early 1980s by University of Toronto researchers, the glycemic index ranks carbohydrate foods by their effects on blood sugar levels.

The GI assigns carbohydrate-containing foods a number based on how they affect blood sugars. The longer the body has to break an item down into glucose, the slower the rise in blood-sugar levels, and the lower the GI. Adding a half a teaspoon of cinnamon to any meal can stabilize blood sugar swings.

Many diabetics also supplement with vitamins, herbs and medicinal teas. Incorporating natural ginseng into a diet can produce positive affects. This herb, which is recognized throughout China to have healing properties, has been known to help improve fasting blood glucose levels and increase insulin secretion.

The easiest method to control diabetes is through proper diet. An eating plan high in fiber and low in refined carbohydrates will ensure the best strategy to beat the disease.

Diabetes is a disease that results from too much sugar (glucose) in the blood, which means that your body does not have sufficient insulin available to convert food into energy. Insulin is a hormone that helps sugar enter the body's cells and maintains the level of sugar in the blood.

The main concern while monitoring diabetes is to watch that the sugar level does not cross the normal range. This means that one requires cutting down on many types of food and consuming regularly those foods, which are fine at regulating diabetes.

People with diabetes should try to manage a healthy weight and consume a diabetic food that is:
1) Low in fat quantity
2) Low in sugar quantity
3) Low in salt quantity
4) High in fruit and vegetables
5) High in starchy carbohydrate foods, such as bread, chapatti, rice.

There is no such diabetic food that diabetes patients should never eat. In addition, there is no requirement to cut out all sugar. But, people with diabetes should aim and eat only small amounts of foods that are high in sugar, fat.

What foods to eat in Diabetes?
1) People with Diabetes must take lots of fruits and vegetables in which fiber content is very high. Such type of food lessens the need for insulin, the reason being it releases energy into the body cells slowly. A high fiber diet means more chromium, which is very cooperative in the treatment of diabetes.
2) As for vegetables, onion, garlic, ginger, radish, spinach, kale, cucumber, carrot, tomato, cabbage and cucumber are outstanding in the diabetes treatment. Moony, kidney beans which have been sprouted, and unripe banana which is cooked, are also advisable.
3) Fenugreek seeds which have been soaked in water are almost fine for diabetic patients and should be included in diabetic food plan.
4) In fruits diet, you can take guava, Indian blackberry (also called jaunt), fig, kiwi fruit, apples, citrus fruits and pomegranate juice. As, fruit juice is high in fructose (fruit sugar) and can cause blood sugar levels to rise rapidly, it’s excellent for diabetics to drink fruit juice with a meal and avoid having more than one small glass a day.
5) Substitute white sugar with palm sugar, dates and honey, if you desire to have something sweet.
6) Fats like olive oil and peanut oil should be included in diabetes food plan.
10) Eat non-fat dairy foodstuffs such as skim milk, non-fat yogurt and non-fat cheese, plain yoghurt.
11) Some herbs and vegetables are specially prescribed for diabetes, like Bitter Gourd and bitter melon juice.

What to avoid?
1) Processed foods, white sugar, white flour and junk food, must be completely avoided. Avoid sweets, glucose, fruit sugar, cakes, ice cream, chocolates and soft drinks.
2) Avoid smoking and alcohol as far as achievable.
3) Try to give up from sweets, ice-creams and chocolates, including the so-called sugar-free kinds.
4) Foods made from white flour, rye, corn, polished rice, bread, cakes, biscuits, pies.
5) Cottage cheese
6) Avoid commercially package foods such as fast foods, chips, ready-to-eat foods, snack foods and "health foods."

Some useful tips you should remember while eating out
• You should give preference to water and calorie-free "diet" drinks instead of regular soda, fruit mock tails, sweet tea and sugar-sweetened drinks
• You must avoid creamy toppings like mayonnaise as far as possible.
• Try to eat high-fat topping salads, dressings, cheeses, and croutons.
• Choose a thin-crust pizza with more vegetable toppings but limit yourself to one or two slices. Left the extra cheese, which add calories, fat, and sodium.
• Finish your meal with sugar-free, fat-free frozen simple yogurt or a little cone of fat-free yogurt.

Diabetes Foods and Nutritional Requirements for Diabetics
Diet plays an important role in managing diabetes. This article will help you know about the diabetes foods and nutritional requirements for diabetics.

Diabetes Foods
Foods that can be eaten as much as one wants – Green leafy vegetables, fruits except banana, lemon; clear soups, onion, salads, mint, spices, plain coffee or tea, skimmed and butter milk
Foods that can be eaten in moderation – Fats, meat, egg, cereals and pulses
Foods to be avoided – Simple sugars (glucose, syrup, sweets and honey), dried fruits, cake, fried foods, candy, alcohol and nuts

Nutritional Requirements for Diabetics
Carbohydrates – High carbohydrate and high fiber diet improve insulin binding and increase in monocyte insulin receptor binding. High carbohydrate diet is likely to elevate serum triglyceride levels (endogenous cholesterol). Hence carbohydrate is maintained to about 50% of total calories. Most carbohydrates should be in form of polysaccharides such as bread, cereals, beans, etc. Rapidly absorbed mono and disaccharides such as sweets, chocolates and sweetened drink should be avoided.

Proteins – A diet high in protein is good for the health of diabetics because it supplies the essential amino acids needed for tissue repair. In patients with NIDDM, consumption of protein along with carbohydrate will lower the blood glucose concentration due to amino acid stimulation of insulin secretion; this help to compensate for the defect in glucose mediated insulin secretion seen in so many of these patients. Protein also promotes satiety and helps both types of diabetic patients to adhere to the carbohydrate allowance.

Fats – Low fat diet increases insulin binding and also reduces LDL and VLDL levels and lowers the incidence of atherosclerosis which is more common in diabetics. Fat content in the diet should be 15-25% of total calories and higher in polyunsaturated fatty acids.

Dietary Fiber – Diets high in carbohydrate and fiber improve glucose metabolism without increasing insulin secretion. They lower fasting serum and peripheral insulin concentrations in response to oral glucose administration in both diabetic and non-diabetic individuals. Fenugreek seeds which contain high fiber are useful to diabetics.

Artificial Sweeteners - High content of sugar consumption is undesirable for diabetics and for obese individuals. Non-caloric and high intense sweeteners are available as sugar substitute. Always seek the insights of a qualified health professional before embarking on any health program.