Health Wikipedia

The harmful effects of smoking. Studies show that smokers are five times more likely than that of the nonsmokers to have gum disease. For smokers with diabetes, the risk is even greater. If you are a smoker, diabetic and age 45 or order, you are 20 times more likely than a person without these risk factors to get severe gum disease.

Smoking increases your risk of getting type 2 diabetes
Some recent research shows there is a significant relationship between diabetes and smoking. The more you smoke, the more chance you have of getting diabetes. If you smoke 16 to 25 cigarettes a day, your risk for type 2 diabetes is 3 times greater than a non-smoker. When you quite smoking, your risk decreases during the years that follow.

Smoking affects the way insulin works in your body
In type 2 diabetes, the body does not respond to insulin made by the pancreas. Insulin helps blood glucose enter into the cells for fuel. When you smoke, your body is less able to respond to insulin. When your body resists insulin, your glucose level increase in the blood. Resistance does not start to reverse until you do not smoke for 10 to 12 hours.

Smoking makes it harder to control your diabetes
Studies show that smokers have poorer glucose control than non-smokers do. Smokers who quit have the same blood glucose control as non-smokers. When you have type 1 or type 2 diabetes, glucose control is very important. The HbA1c test checks how well you control your glucose level over 3 months. The goal is to keep your A1c at 7 percent or less. When you have diabetes and you smoke, your A1c level increases. If you quit smoking, your A1c level may decrease to the same level as a non-smokers.

Smoking increases your risk for getting other problems from diabetes
When you have diabetes and smoking habit, your chances are greater for getting other health problems form diabetes — complications. You can get serious eye problems, kidney problems, nerve problems, heart and blood vessel disease and so on.

Even for people who do not have diabetes but smoke, the risk of getting other health problems is greater. The more and the longer you smoke, the more your risk increases. Smoking and diabetes together greatly increase the danger of getting complications. To lower your risk, you must control your glucose levels and quit smoking. Diabetic people will be benefitted in many ways when they quit smoking.

Experts’ views
All smokers need stop smoking in a clear, strong and personalised manner. Ask every tobacco user if s/he is willing to make and attempt to stop smoking at this time (within the next 30 days for example).

Assist all people with smoking cessation. For those unwilling to attempt cessation at this time, stress the 5 R’s.

Relevance: provide individualised information on the hazards of smoking.

Risks: Emphasise the increased risks of heart disease and diabetes complications arising from the combination of smoking and diabetes.

Rewards: Review benefits of smoking cessation.

Roadblocks: Assure people of your willingness to assist in their efforts to stop smoking.

Repetition: Review people’s thoughts about cessation during their following visit.

Key messages
* Review major steps of smoking cessation

* Set a date to stop smoking

* Identify likely relapse triggers and make specific plans for coping with them before stopping smoking

* Assess for nicotine replacement therapy

* Discuss any concerns about weight gain and other concerns related to diabetes

* Make referral for additional smoking cessation support, prescribe nicotine replacement, provide self-help materials, or otherwise assist in a specific plan

* Arrange for ongoing contact

* Schedule follow-up contact either in person or via telephone

* Follow-up contact should occur soon after the date set to stop smoking, preferably within the first week.

Diabetes nutrition focuses on healthy foods. But you can eat sweets once in a while without feeling guilty or interfering with your blood sugar control. The key to diabetes nutrition is moderation.

The scoop on sugar

For years, people with diabetes were warned to avoid sweets. But what researchers understand about diabetes nutrition has changed.

* Total carbohydrate is what counts. It was once assumed that honey, candy and other sweets would raise your blood sugar level faster and higher than would fruits, vegetables or “starchy” foods such as potatoes, pasta or whole-grain bread. But this is not true, as long as the sweets are eaten with a meal and balanced with other foods in your meal plan. Although different types of carbohydrates can affect your blood sugar level differently, it is the total amount of carbohydrate that counts the most.

* But don’t overdo empty calories. Of course, it is still best to consider sweets as only a small part of your overall plan for diabetes nutrition. Candy, cookies and other sweets have few vitamins and minerals and are often high in fat and calories. You will get empty calories — calories without the essential nutrients found in healthier foods.

Have your cake and eat it, too
Sweets count as carbohydrates in your meal plan. The trick is substituting small portions of sweets for other carbohydrates — such as bread, tortillas, rice, crackers, cereal, fruit, juice, milk, yogurt or potatoes — in your meals. To allow room for sweets as part of a meal, you have two options:

* Replace some of the carbohydrates in your meal with a sweet.

* Swap a high carb-containing food in your meal for something with fewer carbohydrates and eat the remaining carbohydrates as a sweet.

Let’s say your typical dinner is a grilled chicken breast, a medium potato, a slice of whole-grain bread, a vegetable salad and fresh fruit. If you would like a frosted cupcake after your meal, look for ways to keep the total carbohydrate count in the meal the same. Trade your slice of bread and the fresh fruit for the cupcake. Or replace the potato with a low-carbohydrate vegetable such as broccoli. Adding the cupcake after this meal keeps the total carbohydrate count the same.

To make sure you are making even trades, read food labels carefully. Look for the total carbohydrate in each food, which tells you how much carbohydrate is in one serving of the food.

Consider sugar substitutes
As part of diabetes nutrition, artificial sweeteners can offer the sweetness of sugar without the calories. Artificial sweeteners may help you reduce calories and stick to a healthy meal plan — especially when used instead of sugar in coffee and tea, on cereal or in baked goods. In fact, artificial sweeteners are considered free foods because they contain very few calories and don’t count as a carbohydrate, a fat or any other food in your meal plan.

Examples of artificial sweeteners include:

* Acesulfame potassium

* Aspartame

* Saccharin

* Sucralose

Artificial sweeteners don’t necessarily offer a free pass for sweets.

* Keep an eye out for calories and carbs. Many products made with artificial sweeteners, such as baked goods and artificially sweetened yogurt or pudding, still contain calories and carbohydrates that can affect your blood sugar level.

* Sugar alcohols are not calorie-free. Sugar alcohols, another type of reduced-calorie sweetener, are often used in sugar-free candies, chewing gum and desserts. Check product labels for words such as “isomalt,” “maltitol,” “mannitol,” “sorbitol” and “xylitol.” Although sugar alcohols are lower in calories than is sugar, sugar-free foods containing sugar alcohols still have calories. And in some people, sugar alcohols can cause diarrhea.

Reconsider your definition of sweet
Diabetes nutrition does not have to mean no sweets. If you are craving them, ask a registered dietitian to help you include your favorite treats into your meal plan. A dietitian can also help you reduce the amount of sugar and fat in your favorite recipes. And don’t be surprised if your tastes change as you adopt healthier eating habits. Food that you once loved may seem too sweet — and healthy substitutes may become your new idea of delicious.

Do you know when to be concerned about your child’s weight? Of course, all children gain weight as they grow older. But extra pounds — more than what is needed to support their growth and development — can lead to childhood obesity. Childhood obesity is a serious medical condition that affects children and adolescents.

It occurs when a child is well above the normal weight for his or her age and height. Childhood obesity is particularly troubling because the extra pounds often start kids on the path to health problems that were once confined to adults, such as diabetes, high blood pressure and high cholesterol.

Causes
Although there are some genetic and hormonal causes of childhood obesity, most excess weight is caused by kids eating too much and exercising too little.

Children, unlike adults, need extra nutrients and calories to fuel their growth and development. But children who eat more calories than needed gain weight beyond what is required to support their growing bodies.

Risk factors
Many factors — usually working in combination — increase your child’s risk of becoming overweight like diet, inactivity, genetics, psychological factors, family factors, socioeconomic factors and so on.

When to seek medical advice
Not all children carrying extra pounds are overweight or obese. Some children have larger than average body frames. And children normally carry different amounts of body fat at the various stages of development. So you might not know just by looking at your child if his or her weight is a health concern.

If you are worried that your child is putting on too much weight, talk to a physician. S/he will evaluate if your child’s weight is in an unhealthy range.

Complications
Obese children can develop serious health problems, such as diabetes and heart disease, often carrying these conditions into an obese adulthood.

Overweight children are at higher risk of developing Type 2 diabetes, Metabolic syndrome, High blood pressure, Asthma and other respiratory problems, Sleep disorders, Liver disease, Early puberty or menarche, Eating disorders, Skin infections

The social and emotional fallout also can hurt your child, especially resulted in low self-esteem and bullying, behavior and learning problems and depression.

Healthy eating
Parents are the ones who buy the food, cook the food and decide where the food is eaten. Even small changes can make a big difference in your child’s health.

* When buying groceries, choose fruits and vegetables over convenience foods high in sugar and fat. Always have healthy snacks available. And never use food as a reward or punishment.

* Limit sweetened beverages, including those containing fruit juice. These drinks provide little nutritional value in exchange for their high calories. They also can make your child feel too full to eat healthier foods.

* Sit down together for family meals. Make it an event — a time to share news and tell stories. Discourage eating in front of a screen, such as a television, computer or video game. This leads to fast eating and lowered awareness of how much you are eating.

* Limit the number of times you eat out, especially at fast-food restaurants. Many of the menu options are high in fat and calories.

Physical activity
A critical component of weight loss, especially for children, is physical activity. It not only burns calories but also builds strong bones and muscles and helps children sleep well at night and stay alert during the day. Such habits established in childhood help adolescents maintain healthy weight despite the hormonal changes, rapid growth and social influences that often lead to overeating. And active children are more likely to become fit adults.

To increase your child’s activity level:

* Limit recreational screen time to fewer than two hours a day.

* Emphasise activity, not exercise.

* Find activities your child likes to do.

* If you want an active child, be active yourself.

* Vary the activities.

Prevention
Whether your child is at risk of becoming overweight or currently at a healthy weight, you can take proactive measures to get or keep things on the right track.

* Schedule yearly well-child visits. Take your child to the doctor for well-child checkups at least once a year.

* Set a good example. Make sure you eat healthy foods and exercise regularly to maintain your weight. Then, invite your child to join you.

* Avoid food-related power struggles with your child.

* Emphasise the positive. Encourage a healthy lifestyle by highlighting the positive — the fun of playing outside or the variety of fresh fruit you can get year-round, for example.

* Be patient. Many overweight children grow into their extra pounds as they get taller. Realise, too, that an intense focus on your child’s eating habits and weight can easily backfire, leading a child to overeat even more, or possibly making him or her more prone to developing an eating disorder.

Coping and support
Parents play a crucial role in helping children who are obese feel loved and in control of their weight. Take advantage of every opportunity to build your child’s self-esteem.

Consider the following advice:

* Find reasons to praise your child’s efforts.

* Talk to your child about his or her feelings. Help your child find ways to deal with his or her emotions that don’t involve eating.

* Help your child focus on positive goals.

Doctors may soon be able to diagnose inherited diseases such as cystic fibrosis, thalassaemia and sickle cell anemia in fetuses by simply testing a blood sample taken from the mother.

Until now, prenatal diagnoses of such disorders have been possible only through invasive procedures like amniocentesis, which carry a risk of fetal miscarriage.

Amniocentesis is the extraction of a small amount of fluid from the sac surrounding a developing fetus.

But scientists in Hong Kong and Thailand may have found a way to diagnose in fetuses such “monogenic” diseases, which are caused by a single error in a single gene in the human DNA.

This is only possible because fetal DNA circulates in maternal blood, a discovery Lo and his colleagues made several years ago.

Many scientists have since been trying to find the best way to differentiate fetal DNA from maternal DNA, before they can even get down to looking for any anomalies in the fetal DNA. But these efforts have not met with much success.

In an article published in the Proceedings of the National Academy of Sciences, Lo and his colleagues said they had devised a counting system that could “bring non-invasive prenatal diagnosis of monogenic diseases closer to reality.”

Using highly precise digital blood testing technology, both mutant and normal DNA sequences are counted in maternal plasma and that is then used to calculate the number of mutant genes inherited by the fetus and to determine the probability of the fetus developing any monogenic disease.

Lo, however, noted that the accuracy of this method would depend on the concentration of fetal DNA in maternal blood.

Thalassaemia is a blood related genetic disease that can result in reduced fertility or even infertility. Early treatment can improve the quality of life of patients.

Cystic fibrosis affects the respiratory, digestive and reproductive systems and can lead to fatal lung infections.

Depression may make it harder for people with diabetes to keep their blood sugar levels in check, researchers have found.

In a study of more than 11,000 U.S. veterans with type 2 diabetes, the investigators found that over a decade, those diagnosed with depression consistently had a higher average hemoglobin A1C level — a standard measure of long-term blood sugar control.

The findings are concerning, in part, because studies have found that diabetics have a higher risk of depression than non-diabetics. It is estimated that about 30 percent of people with diabetes also suffer from depression at some point.

“Our study shows that depression is a major and important comorbidity in people with type 2 diabetes,” Dr. Leonard Egede, one of the researchers, said.

He and his colleagues at the Medical University of South Carolina, in Charleston, report their study findings in the journal General Hospital Psychiatry.

Briefly, the researchers analysed records from 11,525 mostly male veterans treated for type 2 diabetes between 1997 and 2006. At the outset, 6 percent also had a diagnosis of depression. On average, the researchers found, this group consistently showed a higher hemoglobin A1C level over the years.

The difference between groups was small — a gap of 0.13 percent overall — but for any one person, even a slightly higher hemoglobin A1C, sustained over time, can raise the risk of diabetes complications, Egede noted.

The reasons for the findings are not clear, but one possibility is that dealing with depression makes it harder for diabetics to manage their blood sugar with lifestyle measures and medication.

Fahim Ahmed was tested as diabetic incidentally after a urine test. That was about ten years ago, and from then on Mr Fahim, like so many other people with diabetes, became fixated on his blood sugar. His doctor warned him to control it or the consequences could be dire — he could end up blind, lose a leg, fail his kidneys and so on.

Mr Fahim, a 45-year-old business executive of a reputed organisation in the city, tried hard. When dieting did not work, he began taking pills to lower his blood sugar and pricking his finger several times a day to measure his sugar levels. They remained high. So he agreed to add insulin to his already complicated regimen.

Blood sugar was always in his mind. But in focusing entirely on blood sugar, he ended up neglecting the most important treatment for saving lives — lowering the cholesterol level. That protects against heart disease, which eventually kills nearly everyone with diabetes. He was also missing a second treatment that protects diabetes patients from heart attacks — controlling blood pressure. He assumed everything would be taken care of if he could just lower his blood sugar level.

Most diabetes patients try hard but are unable to control their diseases in this way and most of the time it progresses as years go by. Like many diabetes patients, he ended up paying the price for his misconceptions about diabetes. Last year, Mr Fahim had a life-threatening heart attack.

Diabetes goes undetected in many heart patients. It is a silent threat for many people who end up with heart disease because these patients do not feel the actual intensity of pain due to nerve damage as a consequence of diabetes. Blood sugar control is important in diabetes, specialists say. It can help prevent dreaded complications like blindness, amputations and kidney failure. So, controlling blood sugar is not enough.

In part it is the fault of proliferating advertisements for diabetes drugs that emphasise blood sugar control, which is difficult and expensive and has not been proven to save lives. And in part it is the fault of public health campaigns that give the impression that diabetes is a matter of an out-of-control diet and sedentary lifestyle and the most important way to deal with it is to lose weight. Again, the fault for the missed opportunities to prevent complications and deaths lies with the medical system. The doctors typically spend just 5 minutes with diabetes patients, far too little for such a complex disease.

Mr Fahim found all that out too late. So, no matter how carefully patients try to control their blood sugar, they can never get it perfect — no drugs can substitute for the body’s normal sugar regulation. So while controlling blood sugar can be important, other measures also are needed to prevent blindness, amputations, kidney failure and stroke.

Dr Md Rajib Hossain