Oxygen in our body is circulated with the help of red blood cells. Haemoglobin is a type of protein in the red blood cells that carries oxygen throughout our bodies. Low haemoglobin (also known as anaemia) is a common condition, especially in people with diabetes. To prevent anaemia and allied symptoms, it is essential to ensure the proper haemoglobin concentration in your body.

Diabetes and Haemoglobin

Diabetes is a condition wherein the body finds it difficult to maintain the normal blood sugar range of less than 140 mg/dL. A low haemoglobin level can intensify several clinical aspects of diabetes or its progression. To ensure good health, it is vital to maintain haemoglobin concentration in the range of about 14 to 18 g/dL for men and about 12 to 16 g/dL for women.

If you have diabetes, you must regularly get yourself checked for anaemia, besides trying to be in the normal blood sugar range. Although everyone needs an optimum haemoglobin concentration, it is especially essential for those susceptible to low haemoglobin levels like pregnant women, menstruating women, growing children, and persons with systemic conditions. Now, let’s focus on how to increase haemoglobin.

Low Haemoglobin Symptoms

Low haemoglobin is often referred to as anaemia, which is associated with symptoms like:

• Fatigue
• Weakness
• Shortness of breath
• Fast or irregular heartbeat
• Pale or cold skin
• Dizziness
• Chest pain
• Headaches
• Muscle weakness

How to Increase Haemoglobin Count

As the majority of iron is stored in the body as haemoglobin, an increase in iron intake will help you set right your haemoglobin level. Besides iron, nutrients like vitamin B complex and vitamin C play a significant role in producing haemoglobin. That is why it is essential to have a proper nutritious diet to maintain optimal haemoglobin levels. The best way to increase haemoglobin is to boost the intake of foods that enhance haemoglobin production.

You can improve your haemoglobin concentration naturally by following several home remedies or with the help of iron supplements. Here are some tips to increase your haemoglobin count:

i) Increase your iron intake

Iron-rich foods help boost the production of haemoglobin, forming red blood cells. Although the amount varies with age, gender and physiology, an adult-male needs about 8mg of iron/day, and adult women (between 18 and 50) need about 19 mg of iron/day. The best iron-rich foods include green leafy veggies, meat, seafood, apples (the best source), pomegranate (the best source), watermelon, jaggery and yoghurt.

ii) Maximise iron absorption with the help of vitamin C-rich fruits

Besides maintaining your normal blood sugar range, vitamin C-rich fruits help absorb iron more efficiently and are as crucial as natural iron-rich foods. The line-up of fruits rich in vitamin C includes oranges, lemon, sweet lime, mangoes, gooseberry, strawberries, bell peppers, tomatoes, grapes and berries.

iii) Eat green leafy vegetables and broccoli

Besides being enriched in iron, leafy veggies (spinach, mustard greens, celery) and ​ broccoli are natural sources of vitamin B12, folic acid, and other essential nutrients and help uplift your haemoglobin level. Here, you must note that the raw spinach holds oxalic acid, which can hinder your iron absorption, which is why it is advisable to have cooked spinach.

Moreover, these green leafy veggies are packed with fibre and are low in calories. Thus, they help counter diabetes by maintaining your normal blood sugar range.

iv) Increase your folate intake

One of the types of vitamin B, folate, is used by our body to produce heme, a part of haemoglobin that carries oxygen. Thus, it plays a vital role in haemoglobin production and is found in:

• Beetroot(contains natural iron, copper, phosphorus, magnesium, and vitamins B1, B2, B6, B12, and C)
• Peanuts
• Black-eyed peas
• Kidney beans
• Beef
• Spinach
• Rice
• Avocadoes
• Lettuce

v) Add a daily dose of dried fruits to your diet

Dried fruits like dates and raisins deliver a perfect blend of iron and vitamin C and help elevate your haemoglobin. Figs are loaded with iron, vitamin A, magnesium and folate. However, if you have diabetes, ensure you don’t binge on them.

vi) Try to cook food in iron utensils

Iron utensils help top up your food with iron and help fight low haemoglobin levels.

vii) Avoid products that hinder iron absorption in the body

Cut down on iron blockers like foods containing excess tannins, phytates, polyphenols, and oxalic acids like tea, coffee, cola cocoa, wine, beer and other aerated drinks.

viii) Exercise regularly

A regular workout pushes your body to produce more haemoglobin to meet the increased demand for oxygen in the body.

ix) Go for iron supplements if required

Sometimes, dietary modifications can’t fix a low haemoglobin level. In that case, you may have to consult a doctor and go for oral supplements or other methods to increase your haemoglobin.

 When to See a Doctor

If, while trying home remedies, you notice symptoms like frequent and recurring headaches, severe muscle weakness, irregular or fast heartbeat, or unexplained bruising, it is advisable to see your doctor to prevent any complications.

Conclusion

As anaemia is more common in people with diabetes, you must monitor your haemoglobin level and maintain a normal blood sugar range. Iron-rich foods can best help you boost your haemoglobin. Besides, fruits rich in vitamin C help your body absorb iron better and are as essential as iron-rich foods. In this article, we gave you several tips on how to increase haemoglobin. So, make sure to check for your haemoglobin consistently and take appropriate and timely measures to boost the low haemoglobin levels.

Also Read: Anaemia :10 Superfoods for increasing the blood health

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India is known as the Diabetes capital of the world. Of the estimated 77 million diabetics in the country, 25% are expected to develop diabetic foot ulcers during their lifetime. Amongst them, nearly 50% would have an infected diabetic foot ulcer which would require hospitalisation, and a staggering 20% would undergo an amputation.¹

Diabetes lowers the immunity of our body to fight a variety of diseases. These diseases manifest themselves when due care is not given for the management of diabetes. One such issue is a foot ulcer. The foot is a part of the body that generally escapes regular care. When that happens, the skin and tissues of the foot start deteriorating. This deterioration may be exacerbated by an added infection setting in leading to a wound. Such wounds tend to take a long time to heal or resurface after healing, or sometimes just don’t heal at all especially in diabetics and are referred as diabetic foot ulcers.

Diabetic foot is a serious complication of diabetes in the long term and can lead to amputation if left untreated. Hence, diabetic patients should seek guidance from their doctors. Here, early diagnosis and treatment are the keys to manage diabetic foot ulcers effectively. In India, though awareness about diabetes has improved significantly in the past decade, diabetic foot ulcers still lack the required attention.

Improper foot care and poor glycaemic control are amongst the primary reasons for the development of diabetic foot ulcers. These ulcers are often difficult to heal and require long term follow up and treatment. People are unaware and very casual about foot care till it is usually too late which often leads to delay in consultation & treatment.

Also Read: Diabetic Foot Ulcers, Chronic Wounds and Oral Mucositis – Advanced wound healing by GIOSTAR-REMED 

GIOSTAR (Global Institute of Stem Cell Therapy and Research) which is a world leading Stem cells Institute has a dedicated division of wound care under regenerative Medicine.   There is a significant positive outcome of advanced wound care over traditional wound care. It has an innovative and a unique medical treatment system to manage different chronic degenerative conditions non surgically using new frontiers of healthcare like Targeted Nutrition, Therapeutic Lasers, Metabolic Medicine, Preventive health care and cellular therapy. Regenerative Medicine has been called the next evolution of Medical treatments. Because of its unique Healing potential it is expected to revolutionize chronic Healthcare.

For Details: GIOSTAR HOSPITAL

714,Opp to SBI Bank, DR MC Modi hospital road

Rajajinagar, Bengaluru-560086

Ph: 74068 47406/8073237833/63662 09990

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Most people are not aware of the fact that high blood glucose levels is one of the most common reasons for vision loss among adults in the whole world. Diabetic patients have an increased risk of developing eye complications which, if left untreated, can lead to poor eyesight and blindness. However, with frequent monitoring of blood glucose levels and with regular eye examinations and early treatment, it is possible to prevent 98% of serious vision loss due to diabetes.

 How can diabetes affect the eyes?

High blood glucose levels can cause changes in the shape of the lens which can temporarily cause blurring of your vision. This commonly occurs before being diagnosed with diabetes or when diabetes is out of control. When blood glucose levels are reduced through appropriate treatment, the blurriness usually disappears. Therefore getting new glasses should be delayed until blood glucose levels are under better control.

The blood vessels of the retina may swell and leak fluid leading to changes in the retinal layers and causing visual blurriness. This condition is known as diabetic retinopathy and is commonly found among Type I and Type II diabetic patients. Persistently high blood glucose levels can increase the risk of more serious eye problems in people with diabetes, including:

• Retinopathy
• Cataracts
• Macular degeneration
• Glaucoma

 Caring for your Eyes

1. Have a through eye examination by an expert eye care professional when you are first diagnosed with diabetes.

2. Only an expert eye specialist can conduct through examination of your eyes by dilating your eyes, to have a clear picture of your retina.

3. If retinopathy is detected, you will need to have your eyes examined more often.

4. Notify your eye care professional immediately if you notice any changes in your vision.

5. Keep your blood glucose levels, HbA 1 c, blood pressure and cholesterol at recommended levels. High blood glucose, cholesterol and blood pressure increase the risk of eye damage and affect its severity.

6. Have regular health checks including blood pressure readings, cholesterol measurements and kidney function tests as recommended by your health care team.

7. Quit the habit of smoking as soon as possible.

Also read: Smoking cessation at any stage has great health benefits 

8. Maintain a lifestyle that includes regular physical activity and healthy eating to better manage your blood glucose levels.

9. Always take your medications as instructed by your doctor.

Dr. Bhujang Shetty – Chairman 
Narayana Nethralaya
121/C , 1st ‘R’ Block, Chord Road
Rajaji Nagar
Bangalore – 560010
Ph: o8o-6612 1401-1402

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India is known as the Diabetes capital of the world. Of the estimated 77 million diabetics in the country, 25% are expected to develop diabetic foot ulcers during their lifetime. Amongst them, nearly 50% would have an infected diabetic foot ulcer which would require hospitalisation, and a staggering 20% would undergo an amputation.¹

Diabetic foot

Diabetes lowers the immunity of our body to fight a variety of diseases. These diseases manifest themselves when due care is not given for the management of diabetes. One such issue is a foot ulcer. The foot is a part of the body that generally escapes regular care. When that happens, the skin and tissues of the foot start deteriorating. This deterioration may be exacerbated by an added infection setting in leading to a wound. Such wounds tend to take a long time to heal or resurface after healing, or sometimes just don’t heal at all especially in diabetics and are referred as diabetic foot ulcers.

Diabetic foot is a serious complication of diabetes in the long term and can lead to amputation if left untreated. Hence, diabetic patients should seek guidance from their doctors. Here, early diagnosis and treatment are the keys to manage diabetic foot ulcers effectively. In India, though awareness about diabetes has improved significantly in the past decade, diabetic foot ulcers still lack the required attention.

Improper foot care and poor glycaemic control are amongst the primary reasons for the development of diabetic foot ulcers. These ulcers are often difficult to heal and require long term follow up and treatment. People are unaware and very casual about foot care till it is usually too late which often leads to delay in consultation & treatment.

Cadexomer iodine  in wound care management

While there is little data on the choice of appropriate dressings to manage diabetic foot ulcers, research has shown that Cadexomer iodine has superior action compared to many other dressings in chronic infected wounds.² For centuries, iodine-containing products have been utilised as an antiseptic for the treatment of wounds. Historically, iodine was available and used in the form of tincture iodine & alcoholic/aqueous based solutions, which were associated with unpleasant side effects like pain, irritation, and skin staining. The newer iodine preparation in India, Cadexomer iodine, renders additional benefits compared to older iodine formulations with proven safety.

Cadexomer iodine is an antimicrobial dressing ointment with dual benefits. It absorbs all the unwanted fluids from the wounds and in turn, releases iodine slowly which ensures antiseptic action for a prolonged duration. Cadexomer iodine promotes a clean wound healing environment, clears infection effectively, minimizes pain, and accelerates healing. It also has an economic advantage, since it reduces the number of dressing changes required unlike older iodine versions and decreases the overall cost of therapy.

Cadexomer iodine is a newer entrant in wound care management and appears to be a better option in healing ulcers especially in diabetic patients with chronic wounds and biofilms.

Dr. Milind Ruke

Associate Prof. General Surgery

Diabetic Foot & Hyper Baric Division, JJ Hospital

Source

• https://www.valueinhealthjournal.com/article/S1098-3015(17)30823
• https://pubmed.ncbi.nlm.nih.gov/27859922/

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Pancreatic cancer is one of the most prevalent cancer in India and has an unusual mortality rate. According to Conservative reports, not only this cancer is more prevalent among men than women but less than 29% of people are able to outlive this cancer for more than a year without receiving any interventional procedure. The increasing number of fatalities under pancreatic cancer are majorly being caused due to the detection of the disease at a later stage. This makes the early detection, timely treatment and identification of high-risk people extremely important.

Many leading personalities such as Alan Rickman, Steve Jobs and Joan Crawford have suffered from pancreatic cancer and have succumbed to this condition. A recent research conducted by the University of South Carolina in the US found that the onset of diabetes was associated with a 2.3-fold greater increase in the risk of pancreatic cancer than long-standing diabetes. This research further highlights that 80 percent of pancreatic patients have either a new-onset of type 2 diabetes or impaired glucose tolerance at the time of their diagnosis. Hence, according to the study if someone has type 2 diabetes then they are at an increased risk of getting pancreatic cancer also. Based on the evidence from this study, it is extremely important for diabetic patients to take additional care.

How Type 2 diabetes can cause pancreatic cancer 

Type 2 Diabetes requires a higher level of insulin than normal diabetes. This increases the pressure on one’s pancreas to generate more insulin and hence, this is considered as one of the primary reasons for how diabetes can increase the risk of pancreatic cancer among diabetic patients.

Furthermore, pancreatic cancer too can not only lead to insulin resistance by increasing the amount of insulin produced by the pancreas but can also simultaneously lead to a loss in insulin production capacity. In either case, this can increase the risk of type 2 diabetes.

What is the role of duration of diabetes in pancreatic cancer risk?

The duration of diabetes can play a critical role in increasing the pancreatic cancer risk. Many experts have suggested that the longer a person has had diabetes the higher is their risk of pancreatic cancer. People who have had diabetes for more than 5 years are at a much higher risk of pancreatic cancer compared to an average person.

Importance of early diagnosis and treatment 

As both the conditions have a cause and effect relationship, early detection and diagnosis becomes extremely crucial and can enable the clinicians to better manage the conditions.

How can pancreatic cancer be detected? 

Diagnosis for pancreatic cancer usually begins when someone visits a doctor after experiencing symptoms for weeks or months. Symptoms of pancreatic cancer frequently include abdominal pain, weight loss, itching, or jaundice (yellow skin).

A doctor will then embark on a search for the cause, using the following lab tests and techniques that may show evidence or other abnormalities –

• Liver Function Test (LFT)
• CT scan of the abdomen and pelvis
• Magnetic resonance cholangiopancreatography (MRCP)
• Endoscopic ultrasound (EUS)
• Biopsy for histology confirmation
• Pet CT scan of the whole body to detect the spread
• Tumour marker test to measure to amounts of certain substances – like CA 19-9 and carcinoembryonic antigen (CEA) – linked to specific types of cancer when found in increased levels in the body

How can diabetes be detected?

The symptoms of type 2 diabetes can often appear suddenly and therefore for people who are above the age of 45 years or more, anyone who has a BMI (Body Mass Index) of more than 25, women who have had gestational diabetes and anyone who has been diagnosed with prediabetes it becomes important for them to check their blood sugar levels.

The following tests are used for the diagnosis of diabetes –

• A fasting plasma glucose test – It measures the blood glucose levels after someone has fasted for at least 8 hours
• An oral glucose tolerance test – It measures the blood sugar after someone has gone for at least eight hours without eating and two hours after drinking a glucose-containing beverage.
• A random plasma glucose test – In this a doctor will check your blood sugar levels randomly without considering when you had your last meal. This test, along with an assessment of symptoms, is used to diagnose diabetes, but not prediabetes.
• Glycated Hemoglobin (HbA1c)- The American Diabetes Association (ADA) recommends to begin A1c testing at age 45 for overweight or obese people; if the result is normal, the testing should be repeated at a minimum of 3-year intervals, with consideration of more frequent testing depending on initial results and risk status, or when classical signs or symptoms of increased blood glucose levels are observed. People who are not diagnosed with diabetes but are determined to be at increased risk for diabetes (prediabetes) should have their A1c level tested at least yearly.

What are the treatment options for pancreatic cancer? 

In the early stages, as the cancer is of small size, it can be removed surgically as it has not spread outside or pancreas to nearby tissues or lymph nodes. However, in the advanced stages, there are various treatment options which are used –

• Chemotherapy
• Immunotherapy
• Radiation Therapy

Why one should also seek a second opinion? 

For effective management of pancreatic cancer, a multidisciplinary team approach is required which can help the patients and their families in understanding the complexity of managing the disease. Therefore, patients and their family members can seek a second opinion to expedite the process of treatment decision as further delay in treatment can put the patient’s health in jeopardy and can rapidly progress cancer to an advanced stage.

As the incidences of pancreatic cancer are growing at an alarming rate it has now become a major health challenge. We need to understand that cancer is curable if timely detection and treatment is provided. Therefore, spreading awareness about this disease has now become imperative and people are now required to be aware about the possible therapeutic solutions.

Dr Aditi Gupta
Lead Consultant –Biochemistry
Aster Labs, Bengaluru

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India has a huge diabetes epidemic. The number of people with Type 2 diabetes is escalating in both the urban and rural areas of the country with almost 60% of Asians reported having diabetes or pre-diabetes by age 60. While we have seen a focused effort to teach people about Type 2 diabetes in the last few years, awareness about Type 2 diabetes or juvenile diabetes is still largely lacking.

In fact, some estimates show that there is an alarming gap between the estimated cases and the actual number of children and adolescents who are diagnosed. This indicates that the condition is most likely not detected in time in most cases. Since early diagnosis is critical for survival, we need a greater effort to detect and educate people on juvenile diabetes.

As a lifelong condition, families of affected children must be taught about daily glucose monitoring, timely insulin injections, and screening for complications. We should also counsel them on the psychological fallout and the need for emotional support. As it cannot be prevented or cured, the responsibility for educating families on the management of juvenile diabetes lies with the healthcare community and the government.

This Diabetes Day we must also thank our nurses, who have been an essential part of our prevention and management strategies. As healthcare professionals who are most connected to our patients, it is their selfless care and devotion which has made an actual difference in our patients’ lives, whether they are adults, adolescents, or children.

Dr. Altamash Shaikh
Consultant Endocrinologist and Diabetologist
Saifee Hospital, Mumbai.

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You heard it right! Green tea can be a medicine for the people who are distress from diabetes, as per National Diabetes and Diabetic Retinopathy Survey report, the prevalence of diabetes in India in 2019 continues to be 11.8%, out of which known diabetes cases was 8.0% and new diabetes cases was 3.8%. The WHO predicted the global occurrence of diabetes among adults above 18 years of age as 8.5% in 2014.

To manage the growing graph of diabetes, our diet and lifestyle play a pivotal role. It is one such dietary supplement that can stimulate the production of insulin if you’re suffering from type 1 diabetes. And, compounds like polyphenols and EGCG Catechins, which do wonders for type 2 diabetic patients.

Before we delve into the benefits for diabetic people,  we first need to know what is diabetes and what are the types of diabetes to understand the role green tea plays in better way.

Diabetes and Its Types

Diabetes occurs because of the high levels of blood sugar (glucose) in the body. The blood sugars in human body are usually controlled by the insulin hormone, which is generated by the pancreas. In a diabetics, pancreas cannot generate insulin hormone in an adequate quantity or there is a problem with how the body cells’ respond to it.

Diabetes are of 2 types:

Diabetes type 1 – Occur when the pancreas stops creating insulin hormone. Daily injection of insulin is the only treatment for this type of diabetes. Type 1 diabetes is generally recognized in children and young adults, even though it can emerge at any time.

Diabetes type 2. This type of diabetes is the universal form of diabetes. This type of diabetes could occur because of insufficient physical activity, poor diet, stress, family history and obesity. If not managed or controlled in its initial stage, this can be fatal.

Reasons why green tea is beneficial

1.Increases insulin production in body

If the individual is suffering from type 1 diabetes, it gets difficult for the body to produce insulin. Some studies evidence that green tea could stimulate your body to produce the insulin, which then will control your sugar levels and transform the nutrients from the food that you just ate into energy. Further, green tea will may also aid in maximizing the functions of the pancreas, which is very significant in the production of insulin. Some studies also suggest that green tea could protect the pancreatic beta cells from any damages.

2. Treats Hyperglycemia

High blood sugar (Hyperglycemia) alongside glucose intolerance is the main reason why diabetes can occur to people. Hyperglycemia, if not addressed, will discharge the oxidative stress which leads to other illness, like diabetic retinopathy.  This diabetic retinopathy will lead to blindness and deafness if you’re not treating it as soon as possible.

3. EGCG catechins reduces excess fat from the body

Green tea contains certain types of flavonoid called epigallocatechin gallate (EGCG catechins), which helps in burning body fat and increases the fat oxidation. Extra fat in human body usually leads to diabetes. EGCG catechins also improve the tolerance against glucose, thereby protecting the individual from developing diabetes type 1. In addition to that, EGCG catechins are also beneficial to protect you from diabetes type 2. Evidence has shown that regularly drinking green tea for 12 weeks (3 months) reduces waist circumference and also has higher levels of adiponectin hormone, which is responsible for lowering the fat accumulation.

4. Stimulates metabolism

Uncontrollable rise of blood sugar levels leads to diabetes. By drinking green tea, the creation of adrenaline hormone that may increase and blood sugar levels will be drop.It is widely known for its ability to stimulate the metabolism, as well as improve immune system which means that there is more energy and blood for use by the brain. This soothing situation will avoid any symptoms related with stress, depression, or anxiety. Lowered levels of stress will be very important for the people who suffer from diabetes.

5. Prevents from obesity

For type 2 diabetes patients, obesity can be fatal. Therefore, drinking a hot beverage like green tea cuts down the extra fat from the body as it helps to burn the calories. It can lower your fatty acids and triglyceride levels which will control obesity and will prevent any complications that may arrive around people with obesity problems.

6. Polyphenols in green tea has anti-diabetic properties

Polyphenols in a green tea is an antioxidant which has anti-diabetic properties. These anti-diabetic properties will inhibit the oxidative stress and increase the glucose tolerance. Consequently, the polyphenols in green tea can aid in diabetes management.

Health experts recommend that people suffering from diabetes need to consume at least four cups of green tea a day. It ought to be taken without adding sugar, milk or cream. The desirable time to drink this beverage is morning. But Consuming this alone will not help in reducing diabetes. You also need to make healthy activities like regular exercising, eating the right food to keep yourself fit and strong and taking your medicines on time.

Mr Sundeip Bhatia
Business Head- India
Shilpa Medicare Ltd, Hyderabad

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[1]. India with an estimated 77 million people living with diabetes is the second most affected country in the world after China¹. According to International Diabetes Federation, one in six people in the world with diabetes is from India. The number is projected to grow to become 134 million by 2045. This statistic clearly shows that diabetes has become a major health issue in the country, and it is extremely important to raise awareness regarding its proper management.

Every year, 14^thof November is commemorated as World Diabetes Day. Based on this year’s theme,‘The Nurse and Diabetes’, it becomes even more important to raise awareness around the crucial role that nurses play in treating people living with diabetes.

Importance of safe insulin injection:

In people with type 1 diabetes insulin is the mainstay of treatment. However, people with type 2 who are not well controlled on oral drug therapy, diet and exercise may also need insulin injections to control their blood glucose levels and prevent long-term complications from cardiovascular disease, stroke, peripheral vascular disease, kidney disease etc. For optimal insulin absorption, insulin needs to be injected into the fat layer under the skin to avoid the muscle. It is also important to use a new site each time for every injection and to change the needle with every use.

“Reuse of needles and incorrect injection technique can lead to complications and medication errors. Needle re-use causes blunting and bending of the needle tip, increasing pain & bleeding, dosage inaccuracy, and Lipohypertrophy. Regular monitoring and  proper management of diabetes can help avoid serious health problems in the long and short term. Hence, it is imperative to adopt right insulin injection technique to manage one’s diabetes and lead a healthy life”, says Dr. Subramanian Kannan, Consultant and Head of Department of Endocrinology, Diabetes and Metabolism, Narayana Health City Bangalore.

One of the most effective ways to manage diabetes is by investing in training programmes for healthcare professionals. They should be aware of the right techniques and safe practices of handling insulin injection. Deploying effective education and training on safe and correct utilization of insulin injections to the nursing staff can significantly improve patient outcomes.

“We work with a dedicated team of clinicians and diabetes educators who train patients on various aspects of injection technique right from the first visit itself. Our team spends time with the patient making them confident to independently take their injections, follow correct injection site rotation, prevent re-use and the awareness and prevention of Lipohypertrophy. Looking at the larger benefit of optimizing insulin administration for better glycemic control, we must discourage the re-use of insulin needles.” said Dr. Ameya Joshi, Consultant endocrinologist, Endocrinology Department Bhakti Vedanta Hospital and Research Institute, Mumbai and Institute of Diabetes Endocrinology And Nutrition (INDEAN) clinic, Mumbai

Adherence to proper medication is essential to determine treatment outcomes for patients. In India, this is particularly true in the management of NCD’s such as diabetes. Insulin injections are life-saving medical intervention for proper handling of diabetes. An honest commitment and understanding of accurate technique by healthcare professionals and patients will certainly ensure effective diabetes management.

[1]https://www.diabetesatlas.org/en/sections/demographic-and-geographic-outline.html

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• The average HbA1C level – the best indicator of a patient’s long-term blood sugar control, stood at 8.48% , registering a marginal improvement over the last year
• Hyderabad, Kolkata, and Jaipur have shown a dip in HbA1c levels in the last two years
• People with diabetes are at up to 50% higher risk of a fatal outcome and severe health complications due to COVID-19

06 November 2020, New Delhi: In the run-up to World Diabetes Day, the Novo Nordisk Education Foundation today unveiled the second-year report of its Impact India: 1000-Day Challenge’ programme. The program was launched two years ago with an ambition of reducing the HbA1c levels of people with diabetes in India by 1% over the next 1000 days, thereby reducing the risk of complications and the economic burden associated with diabetes. Encouraged by the government’s ground-breaking health care initiatives like Ayushman Bharat and the availability of real-time data from digital platforms, this programme further strengthens Novo Nordisk’s belief that it is now possible to fight the battle against diabetes.

According to the report, the average HbA1c level of the country was recorded at 8.48% from October 2019 to September 2020. Though the average HbA1C level has decreased marginally compared to last year’s figures, the prevailing high HbA1c levels is a matter of deep concern especially in the light of the COVID-19 pandemic which puts people with uncontrolled diabetes at a higher risk of a fatal outcome and serious health complications. The data collection exercise for the iDCI was conducted across 30 Indian cities. The average respondent age was 55 years, of which 57% were males and 43% female.

At present, more than 77 million people are living with diabetes in India and country’s annual spend is approximately INR 64,500 crores on diabetes related healthcare which is further expected to increase if diabetes is not controlled. HbA1c is the best recommended indicator of long-term blood sugar control and gives average blood sugar control for 3 months.

The second-year report was launched in the presence of  Mr Vikrant Shrotriya, Trustee, Novo Nordisk Education Foundation, Prof. Dr A.K. Das, Professor of Medicine, Pondicherry Institute of Medical Sciences, Puducherry and Patron of the Impact India programme, Shri Sachin Kumar Singh, CEO, Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP), Department of Pharmaceuticals, Govt. of India and H.E. Freddy Svane, the Danish Ambassador in India.

Amidst these COVID-19 pandemic times, a few cities have shown a drop in their HbA1c levels from Jan-June 2018 to July-Sep 2020. These include Hyderabad, Kolkata, and Jaipur but the majority of Indian cities have seen an upsurge in HbA1c levels.

• In South India, Hyderabad HbA1c levels have dropped from 8.64% to 8.02 % (down by 0.62%) in 24 months.
• In the East,Kolkata registered a drop from 8.24% to 7.96% (down by 0.28%) in the same period.
• Jaipur in North India has notched a dipfrom 8.30% to 8.01% (down by 0.29%) in the same period.

Speaking about the programme, Dr A.K. Das, Professor of Medicine, Pondicherry Institute of Medical Sciences and Patron of the IMPACT India programme, shared, “For the last two years, Impact India  has striven to create awareness on the ‘Indian Reality’ of diabetes management. We have created a scientific framework as a part of our train-the-trainer approach through which 3311 doctors have been reached via 180 Impact Workshops across 150+ cities so far. We are hopeful that the programme will continue to empower thousands of Indians on successful diabetes management.”

 Mr Vikrant Shrotriya, Trustee, Novo Nordisk Education Foundation, said, “We have worked towards managing diabetes for nearly 100 years at Novo Nordisk. The “Impact India: 1000-Day Challenge” Programme is a unique initiative focused at educating and improving the lives of people with diabetes  We believe that our real competition is with the uncontrolled growth in diabetes, lack of awareness, and restricted access to medicines. So, we will continue partnering with stakeholders including healthcare professionals, professional associations, and government bodies to overcome these obstacles. We are happy that cities like Hyderabad, Jaipur and Kolkata are showing a decline in their HbA1c levels over the last two years, and are hopeful that by next year, many more Indian cities will report similar dips.”

Mr Sachin Kumar Singh, IRS, CEO of BPPI, Department of Pharmaceuticals advised that “The Government of India has made adequate provisions for all known/ diagnosed people with diabetes to receive a regular supply of prescribed medicines. The data generated under the IMPACT India programme will be useful in identifying the trend in HbA1c levels across major cities in India.  We congratulate Novo Nordisk Education Foundation for developing a tool through which policymakers and doctors can analyze the trends and accordingly prepare the right medical approach and policies for people living with diabetes. “

H.E. Freddy Svane, Ambassador of Denmark to India, mentioned, “Novo Nordisk Education Foundation has been doing an admirable work in the field of diabetes awareness in India.  I congratulate everyone who has contributed towards the “Impact India: The 1000-Day Challenge” Programme, second year running. The positive difference that this programme has made in the lives of people living with diabetes in India is commendable.”

Former Indian Cricketer and Brand Ambassador, Novo Nordisk India, Anil Kumble said, “As a sportsperson, I have learned that a healthy exercise routine goes a long way in staying physically and mentally fit. This year, the COVID-19 pandemic has forced us to stay home for prolonged periods of time, barring us from performing outdoor sports or other exercises. However, indoor exercises are as beneficial as their outdoor counterparts. Practices like Yoga, Pilates and brisk walking are useful in keeping blood glucose levels down in people with diabetes. The iDCI findings concretely demonstrate that diabetes can be controlled even under a lockdown if people with diabetes are to follow a balanced exercise regimen.”

Dr. Banshi Saboo, President, Research Society for the Study of Diabetes in India (RSSDI) informed, “The high level of HbA1c in people with diabetes is deeply concerning. The COVID-19 pandemic has had a catastrophic influence on the physical and mental wellbeing of people. Under such a scenario, staying fit through physical exercises becomes critical for effective management of diabetes. In our pursuit to encourage people to stay healthy, we have partnered with Novo Nordisk to bring the second edition of Pedals Changing Diabetes. The 5K Virtual Run & Cyclothon urges people to take up running or cycling as a fun way to keep fit and manage their diabetes. We look forward to participation from people across the country in the Pedals Changing Diabetes programme as this will help in raising awareness around the disease and its management.”

iDCI (Indian Diabetes Care Index) was introduced in the year 2018 as part of the programme to improve diabetes care in the country. Based on big data analytics, iDCI has been providing a real-time view of the average HbA1c in India, a key indicator of the state of diabetes control across select cities.  Under the Impact India programme, digital platforms are also being leveraged to partner with practitioners (doctors and paramedics) to evolve and implement an approach to diabetes care appropriate to India. iDCI is a dynamic tool that not only tracks the status of diabetes care but also helps to increase awareness, motivate, and sensitize healthcare professionals (HCPs) and society towards better diabetes management.

The last two years of the programme has seen significant contributions from healthcare practitioners (HCPs), and people living with diabetes from across the country. There has been an improving trend in the iDCI results since its inception, and this will lead to a reduction in the future burden of diabetes-related complications in India.

 (HbA1C levels recorded Between July-September 2020)

About Novo Nordisk Education Foundation 

The Novo Nordisk Education Foundation (NNEF) was founded in 1997 with a mission to “enhance healthcare through awareness and education” NNEF drives several projects including the Changing Diabetes^® Barometer, Changing Diabetes^® in Children programmes and World Diabetes Day awareness activities in partnership with state governments and other key stakeholders. As a result of these efforts, more than 750,000 people have been reached; nearly 4000 doctors and paramedics have been trained and over 100 community diabetes centres have been established. Under the Changing Diabetes^® in Children programme, more than 4000 children have been receiving free treatment and care since 2011. Taking the commitment to care further, NNEF launched “IMPACT India”, an India specific solution-oriented programme on the eve of World Diabetes Day in 2018 with an ambition to reduce the average HbA1c of the country by 1% over a three-year period.

  For more information visit: nnef.in 

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November 6, 2020: COVID-19 doesn’t seem to spare anyone, and especially to those having comorbid conditions such as diabetes. In India, 73% of the COVID-19 deaths are linked with comorbidities including diabetes, hypertension, cardiovascular and respiratory diseases, reveals the data of the Ministry of Health and Family Welfare, GoI. Undoubtedly, Diabetes has been observed among the most common comorbidities in COVID-19 patients.

In the diabetes awareness month, to know the role of diabetes in aggravating diabetes onslaught, the truth behind COVID induced diabetes and other diabetes-related issues were discussed at length in ‘India COVIDiabetes E-Summit’ organised  by the ‘Healthcare Advocacy Group’ — HEAL Foundation in association with ICCIDD on 5^th Nov’ 2020.

‘India COVIDiabetes e-Summit’ was the 10^th Episode of the HEAL-Thy Samvaad series, wherein public healthcare experts, Diabetologists, Endocrinologists and heads of medical research bodies participated vigorously; deliberated on different topics of the e-Summit and supported to celebrate ‘Blue Diwali’ with a purpose to inculcate awareness around diabetes amongst the masses and its prevention as ‘Blue-colour’ depicts the sky that vaults all national borders: A way of saying diabetes affects us all. Coincidently, first time in 20 years World Diabetes Day (WDD) and the festival Diwali are falling on 14^th November 2020.

During the keynote address of ‘India COVIDiabetes E-Summit’ — the 10^th Episode of HEAL-Thy Samvaad on ‘Best learnings of Diabetes Management in COVID-19 Times and ‘COVID induced diabetes: A reality or a myth’ Dr Shashank R Joshi, Padma Shree Awardee, Chair, International Diabetes Federation, South East Asia, Dean, Indian College of Physicians, Endocrinologist, Joshi Clinic, Lilavati Hospital, Apollo Sugar Clinic & Bhatia Hospital while answering a question put by Dr Swadeep Srivastava, Founder, HEAL Foundation and co-moderator of the E-Summit on the Indian Sugar Mills Association (ISMA’s) campaign of encouraging Indians to eat more sugar endorsed by the govt., said, “I condemn this initiative as this is not something we are proud of. Every 6 second, we are losing people with diabetes on the planet. We are in ‘Diabetes Awareness Month’, it is important to recognise that sugar kills. And sugar is a form of tobacco. I think trying to promote excess consumption of sugar is detrimental to health. And, such type of initiative if it is done by the govt., probably, I think, it hasn’t had the oversight of the health department, and I am certain that health department and experts will take it into cognisance and they will make their course correction. Probably, this has been done without their knowledge. It may have done by the sugar bodies to increase sugar consumption.”

“We have two things — we have severe malnutrition in India and that might need a little bit of sugar, normal healthy people need a little bit of sugar with exercise. Unfortunately, we are sedentary Indians and we keep eating, we love sweets. But caloric access is not recommended. All Non-communicable diseases can be increased by diabetes. Remember why diabetes is a big disruption in COVID because sugar is a cultural medium to grow any virus. As far as COVID-induced diabetes is concerned, so many patients who neither had diabetes nor any family history before they were contracted with COVID-19, but after 3-4 months, they are diabetic. Yes, there is COVID-induced diabetes as a distinct entity,” added Dr Joshi.

Answering the Indian Sugar Mills Association (ISMA’s) campaign of encouraging Indians to eat more sugar endorsed by the govt., while addressing the ‘India COVIDiabetes E-Summit’ — the 10^th Episode of HEAL-Thy Samvaad, Dr Navin Verma, Assistant Director, Centre for Non-Communicable Diseases, NCDC, New Delhi, said, “Malnutrition maybe a component which needs to be addressed but not by promoting sugar in general. And definitely, if health ministry or other ministries have different opinions regarding this, they should sort it out. He further added that government has already issued guidelines in August to screen every diabetic patient. As lifestyle activities are the sheet anchor of all non-communicable diseases and diabetes is also a non-communicable disease, we need to correct our lifestyle to stay healthy.”

Elaborating on the COVID’s role in aggravating diabetes onslaught, Dr AK Jhingan, Chairman, Delhi Diabetes Research Centre, said, “Diabetics are very prone to COVID-19 infection. The normal morbidity in COVID is 2.3% while in diabetics, it is 7.3% — three times more. I have seen during the COVID scourge that elderly people, as well as 60% of males with diabetes, are the most vulnerable lots. As far as the sugar intake is concerned, the American Heart Association recommends for the male to take 36 gm and to women 24-25 gm added sugar daily.”

Addressing the ‘India COVIDiabetes E-Summit’ — the 10^th Episode of HEAL-Thy Samvaad, Ms Shilpa Joshi, RD, Director, Mumbai Diet and Health Centre, Vice President, Indian Dietetic Association, Hon’ble Secretary-All India Association of Advancing Research in Obesity, said, “One of the greatest problems in Indian diet is the high content of carbohydrate. We need to reduce it. Usually, people take 60-65% carbohydrate in their diet while it shouldn’t be more than 50%. Ensure that the fat intake should be from natural sources only. Micronutrients like Zink, Vitamin B-12 must be provided to the COVID-19 patients to prevent infection. We need to hydrate with water and not with Cola. Increase the intake of fruits and vegetables and decrease the carbohydrate contents from the diet.”

While moderating ‘India COVIDiabetes E-Summit’ — the 10^th Episode of HEAL-Thy Samvaad, Dr J Kumar, Group Medical Director, Paras Group of Hospitals, said, “Diabetes is a normal indisposition but during COVID times, people with comorbid conditions such as diabetes has turned vulnerable. Not to speak of COVID, if you are not keeping yourself healthy, any infection can attack you. So, the take-home message is — everyone needs to be careful and diabetics should be extra careful during COVID times to stay healthy and safe.”

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