Manoeuvres for management of diabetes

Type 2 diabetes is the scourge of our times. Globally there are over 425 million diabetics which is projected to rise to 629 million by 2045, suffering devastating consequences resulting in significant morbidity and mortality.1-3Bringing blood sugars down can be challenging. Dietary control, lifestyle modifications and exercise can help but these can be difficult to implement.4 Medically, drugs are the usual method of bringing blood sugar levels under control but they come with their attendant risks and ongoing costs.5 Apart from drugs, the main arsenal against diabetes is exercise but due to one reason or another it is not very popular or practical. In the absence of antidiabetic medications and episodic exercises there seems to be no alternative left. So, when a person is unable to exercise or is not on hypoglycaemic agents, he is rendered defenceless against the deleterious effects of raised blood sugar levels. Regardless, muscles form the frontline defence against diabetes since muscles are the main modifiable factor in utilization of glucose by the body which they can do even in the absence of insulin.6,7 Hence, muscles need to be the first line agents to fight diabetes. However, the muscles need to be activated when the blood sugars are high, that is, within minutes or hours after meals rather than exercising in the morning or evening when the blood sugar may be relatively low. The question is ‘How do we get the muscles to start using up glucose right when it enters the blood stream?’ This is where the manoeuvres described below can help since these can be done almost anytime and anywhere. Following are the proposed manoeuvres:Calf contractions: Alternate contractions of calf muscles of each leg while sitting, giving a good squeeze to the calf muscles. Alternatively, one or both calves can be contracted and held for some time. This manoeuvre can be done even while lying in bed.Pectoral pressure: One or both pectorals can be contracted and held for 30-60 seconds-longer the better. The strength of contractions will depend on one’s motivation and ability. Alternatively, moderate contractions can be maintained for a longer duration.Shoulder squeezes: The back has some of the strongest muscles which can be used to ‘pulverise’ the sugars. In this method the person can sit slightly bent forwards and the shoulders are pulled back and held in that position for 30-60 seconds.These manoeuvres can be done either singly or combined with other manoeuvres described or with dietary modifications, regular exercises or medications for greater efficacy.Of course, like the antidiabetic medications, these manoeuvres need to be titrated, especially when combined with hypoglycaemic agents, otherwise they can lead to hypoglycaemia.8 Even without antidiabetic medication they have the ability to cause hypoglycaemia, if done excessively. Once the muscles get used to these manoeuvres it will be easier for them to use glucose and keep blood sugars down

Screening for retinopathy, risk factors, adherence to treatment and complications among diabetic and hypertensive individuals attending a primary care centre in Puducherry, India

Background: The increasing prevalence and incidence of diabetes and hypertension with increasing age and adult age group are at high risk of developing diabetic and hypertensive retinopathies.Methods: The study was conducted in a rural area of Puducherry, data collection was carried over a period of six months. Self-reported patients of diabetes and hypertension were included in the study and predesigned questionnaire was used to collect the information about socio-demographic details, risk factors, physical activity, history related to DM/HTN and history of fundus examination.Results: Majority of patients screened for diabetes 56% and hypertension 47% was by government hospital. The proportion of diabetics and hypertensives who had undergone fundus examination to rule out diabetic and hypertensive retinopathy was found to be 29.3% (12) and 14.5% (10). Complications such as neuropathy and retinopathy were given by 36.5% (15) and 2.4% (1) of diabetic patients Two third of the patients 64.1% had sedentary life style.Conclusions: Health care providers need to plan for larger coverage of fundus examination among diabetic and hypertensive patients

Effect of regular treatment, follow-up, and lifestyle practices in diabetic patients with ocular manifestations attending a tertiary care hospital in Puducherry, India

Background: The last few decades have witnessed the growth of diabetes mellitus which is affecting all sections of the society. Complications of diabetes and its management present a still further challenge to health care providers. Methods: A hospital-based cross-sectional study was conducted at Pondicherry Institute of Medical Sciences, India, to find out the treatment and follow-up of patients with diabetes mellitus and also to estimate ocular manifestations among the study subjects. Results: Regular treatment was found among 80% while regular follow-up was seen in 55.7% of the diabetic patients. Two-thirds of the patients were on oral hypoglycemic agents only. 18.6% of the patients tested their blood glucose levels once a month. Visit to an ophthalmologist was made in the last 12 months by 32.9% of them. Ocular manifestations were present in both vegetarians 80% and non-vegetarians 76% respectively. Diabetics practicing sedentary lifestyle had more ocular manifestations 87% as compared to 62.5% in those who did not exercise. Ocular manifestation was also higher among those with elevated blood glucose levels 74.4% in comparison to 61.3% among those with normal blood glucose levels. Conclusion: This study highlights the importance of regular treatment and follow-up by patients with diabetes in relation to development of ocular manifestations. Exercise in diabetes is a key factor in delaying complications such as retinopathy